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Questions and Answers
A client presents with Bell's palsy and reports difficulty closing their left eye. Which muscle is most likely affected, contributing to this specific symptom?
A client presents with Bell's palsy and reports difficulty closing their left eye. Which muscle is most likely affected, contributing to this specific symptom?
- Orbicularis oculi (correct)
- Zygomaticus major
- Frontalis
- Levator palpebrae superioris
A patient with Bell's palsy reports increased sensitivity to low-frequency sounds. Which of the following best explains this phenomenon?
A patient with Bell's palsy reports increased sensitivity to low-frequency sounds. Which of the following best explains this phenomenon?
- Inflammation of the inner ear.
- Damage to the vestibulocochlear nerve (CN VIII).
- Compensatory hearing in the unaffected ear.
- Paralysis of the stapedius muscle due to facial nerve involvement. (correct)
During an assessment of a client with suspected Bell's palsy, which of the following findings would be least likely to be present if the condition is isolated to the facial nerve (CN VII)?
During an assessment of a client with suspected Bell's palsy, which of the following findings would be least likely to be present if the condition is isolated to the facial nerve (CN VII)?
- Impaired function of the trapezius muscle. (correct)
- Loss of taste on the anterior two-thirds of the tongue.
- Unilateral facial drooping.
- Difficulty wrinkling the forehead on the affected side.
A patient's history reveals a gradual onset of Bell's palsy symptoms over a two-week period. Which of the following questions is most important to ask regarding the progression and sensory changes?
A patient's history reveals a gradual onset of Bell's palsy symptoms over a two-week period. Which of the following questions is most important to ask regarding the progression and sensory changes?
A patient with Bell's palsy is experiencing excessive tearing in their affected eye. Which of the following is the most likely underlying cause?
A patient with Bell's palsy is experiencing excessive tearing in their affected eye. Which of the following is the most likely underlying cause?
A patient reports experiencing sudden, intense, electric shock-like pain along their cheek and jaw. Palpation of a specific area on their cheek reliably triggers the pain. Which condition is MOST likely?
A patient reports experiencing sudden, intense, electric shock-like pain along their cheek and jaw. Palpation of a specific area on their cheek reliably triggers the pain. Which condition is MOST likely?
Which of the following characteristics BEST describes the pain associated with neuralgia?
Which of the following characteristics BEST describes the pain associated with neuralgia?
A patient with suspected neuralgia reports that their pain is often clustered, with multiple attacks occurring over a short period, followed by periods of relief. What does this pattern suggest?
A patient with suspected neuralgia reports that their pain is often clustered, with multiple attacks occurring over a short period, followed by periods of relief. What does this pattern suggest?
What is the primary goal of decreasing Sympathetic Nervous System (SNS) activity in the context of provided treatments?
What is the primary goal of decreasing Sympathetic Nervous System (SNS) activity in the context of provided treatments?
A patient presents with intercostal neuralgia following a bout of shingles. Which of the following is the MOST likely underlying mechanism of their nerve pain?
A patient presents with intercostal neuralgia following a bout of shingles. Which of the following is the MOST likely underlying mechanism of their nerve pain?
Why are fascial techniques generally avoided according to the given treatment guidelines?
Why are fascial techniques generally avoided according to the given treatment guidelines?
Which condition involving nerve dysfunction is characterized by pain along the distribution of a nerve in the absence of objective signs or structural damage to the nerve itself?
Which condition involving nerve dysfunction is characterized by pain along the distribution of a nerve in the absence of objective signs or structural damage to the nerve itself?
What is the purpose of using hydrotherapy on compensatory areas?
What is the purpose of using hydrotherapy on compensatory areas?
Why is diaphragmatic breathing emphasized in the treatment approach?
Why is diaphragmatic breathing emphasized in the treatment approach?
What is the rationale behind using inhibitory techniques in this context?
What is the rationale behind using inhibitory techniques in this context?
Why is a towel placed between the therapist and the affected side during the treatment?
Why is a towel placed between the therapist and the affected side during the treatment?
What is the primary purpose of applying cool washes to the affected tissues?
What is the primary purpose of applying cool washes to the affected tissues?
In addition to the affected side of the face, where else should compensatory muscles be treated?
In addition to the affected side of the face, where else should compensatory muscles be treated?
During the acute phase of trigeminal neuralgia, what is the MOST appropriate approach to treatment?
During the acute phase of trigeminal neuralgia, what is the MOST appropriate approach to treatment?
Which of the following is the MOST important question to ask a client with suspected trigeminal neuralgia before considering any treatment near a potential trigger zone?
Which of the following is the MOST important question to ask a client with suspected trigeminal neuralgia before considering any treatment near a potential trigger zone?
A client with trigeminal neuralgia reports pain in the V2 maxillary nerve distribution. Which area is MOST likely affected?
A client with trigeminal neuralgia reports pain in the V2 maxillary nerve distribution. Which area is MOST likely affected?
In the context of trigeminal neuralgia, what is the MOST crucial precaution to observe during assessment and treatment?
In the context of trigeminal neuralgia, what is the MOST crucial precaution to observe during assessment and treatment?
What is the PRIMARY focus of home care advice for a client recovering from a trigeminal neuralgia attack?
What is the PRIMARY focus of home care advice for a client recovering from a trigeminal neuralgia attack?
A patient presents with symptoms mimicking trigeminal neuralgia. What differentiating factor would suggest the pain is MOST likely myofascial in origin?
A patient presents with symptoms mimicking trigeminal neuralgia. What differentiating factor would suggest the pain is MOST likely myofascial in origin?
Following a recent acute attack of trigeminal neuralgia, what treatment approach is MOST appropriate during the acute phase?
Following a recent acute attack of trigeminal neuralgia, what treatment approach is MOST appropriate during the acute phase?
A client presents with a sharp, recurring pain along their cheek and jawline. They also report experiencing muscle spasms in their face. Which condition is MOST likely indicated by these symptoms?
A client presents with a sharp, recurring pain along their cheek and jawline. They also report experiencing muscle spasms in their face. Which condition is MOST likely indicated by these symptoms?
Which of the following cranial nerves is affected in trigeminal neuralgia?
Which of the following cranial nerves is affected in trigeminal neuralgia?
What homecare recommendation would be MOST beneficial for a patient with trigeminal neuralgia to help prevent pain?
What homecare recommendation would be MOST beneficial for a patient with trigeminal neuralgia to help prevent pain?
Which branch of the facial nerve (CN VII) primarily innervates the forehead and orbital area?
Which branch of the facial nerve (CN VII) primarily innervates the forehead and orbital area?
Besides mastication, what other function is associated with the motor branch of the trigeminal nerve?
Besides mastication, what other function is associated with the motor branch of the trigeminal nerve?
If a lesion of the facial nerve occurs after the stylomastoid foramen, what function would be exclusively affected?
If a lesion of the facial nerve occurs after the stylomastoid foramen, what function would be exclusively affected?
A client with trigeminal neuralgia experiences locked jaw. Which of the following is the MOST likely cause of this symptom?
A client with trigeminal neuralgia experiences locked jaw. Which of the following is the MOST likely cause of this symptom?
What is the MOST appropriate initial treatment strategy when working with a client who has a history of trigeminal neuralgia, but is not currently experiencing an acute attack?
What is the MOST appropriate initial treatment strategy when working with a client who has a history of trigeminal neuralgia, but is not currently experiencing an acute attack?
Damage to the stapedius muscle, innervated by the facial nerve, may result in what auditory symptom?
Damage to the stapedius muscle, innervated by the facial nerve, may result in what auditory symptom?
Which sensory function is NOT associated with the mandibular branch (V3) of the trigeminal nerve?
Which sensory function is NOT associated with the mandibular branch (V3) of the trigeminal nerve?
A patient presents with rapid onset unilateral facial paralysis, but reports no facial pain. Which condition is MOST likely?
A patient presents with rapid onset unilateral facial paralysis, but reports no facial pain. Which condition is MOST likely?
Which etiological factor is LEAST likely to be associated with Bell's Palsy?
Which etiological factor is LEAST likely to be associated with Bell's Palsy?
Which population has an increased risk for developing Bell's Palsy?
Which population has an increased risk for developing Bell's Palsy?
A client with Bell's Palsy is receiving facial massage. On the affected side, which massage technique is MOST appropriate?
A client with Bell's Palsy is receiving facial massage. On the affected side, which massage technique is MOST appropriate?
Which of the following instructions is MOST suitable for a Bell's Palsy client to perform at home to improve function?
Which of the following instructions is MOST suitable for a Bell's Palsy client to perform at home to improve function?
Why is diaphragmatic breathing encouraged in the treatment of Bell's Palsy?
Why is diaphragmatic breathing encouraged in the treatment of Bell's Palsy?
What is the MOST common resting deformity observed in infants with Erb's Palsy?
What is the MOST common resting deformity observed in infants with Erb's Palsy?
A patient presents with Erb's palsy following a traumatic injury. Which group of muscles is MOST likely to exhibit motor deficits?
A patient presents with Erb's palsy following a traumatic injury. Which group of muscles is MOST likely to exhibit motor deficits?
In the acute stage of Erb's Palsy, which intervention is MOST appropriate to maintain joint health and prevent contractures?
In the acute stage of Erb's Palsy, which intervention is MOST appropriate to maintain joint health and prevent contractures?
A client presents with Klumpke's paralysis. Which deformity is MOST likely to be observed?
A client presents with Klumpke's paralysis. Which deformity is MOST likely to be observed?
Which of the following muscles would be MOST affected in Klumpke's palsy?
Which of the following muscles would be MOST affected in Klumpke's palsy?
A patient with Klumpke's paralysis exhibits vasomotor dysregulation. What clinical sign would MOST likely be observed?
A patient with Klumpke's paralysis exhibits vasomotor dysregulation. What clinical sign would MOST likely be observed?
Following a brachial plexus injury, what precaution should be taken when applying massage to the affected area?
Following a brachial plexus injury, what precaution should be taken when applying massage to the affected area?
To avoid placing drag on healing tissue during treatment of a brachial plexus injury, what technique is MOST appropriate?
To avoid placing drag on healing tissue during treatment of a brachial plexus injury, what technique is MOST appropriate?
A football player experiences a burner (stinger) after a collision. Which symptom is LEAST likely to be associated with this injury?
A football player experiences a burner (stinger) after a collision. Which symptom is LEAST likely to be associated with this injury?
In Horner's Syndrome associated with Klumpke's paralysis, which combination of symptoms would be expected on the affected side?
In Horner's Syndrome associated with Klumpke's paralysis, which combination of symptoms would be expected on the affected side?
Which of the following factors is MOST important to consider when treating a client with a brachial plexus injury?
Which of the following factors is MOST important to consider when treating a client with a brachial plexus injury?
Which of the following is the MOST likely cause of Horner's syndrome in a patient with Klumpke's paralysis?
Which of the following is the MOST likely cause of Horner's syndrome in a patient with Klumpke's paralysis?
Flashcards
Neuralgia
Neuralgia
Nerve pain resulting from nerve dysfunction, often without structural damage.
Neuralgia Pain
Neuralgia Pain
Sudden, intense pain that feels like electric shocks or throbbing along a nerve.
Common Neuralgia Nerves
Common Neuralgia Nerves
Trigeminal nerve (CN V) and Intercostal nerves
Trigger Zone
Trigger Zone
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Causes of Neuralgia
Causes of Neuralgia
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Trigeminal Neuralgia Treatment (Acute)
Trigeminal Neuralgia Treatment (Acute)
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Relaxation Techniques for Trigeminal Neuralgia
Relaxation Techniques for Trigeminal Neuralgia
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Rib Springing for Thoracic Mobility
Rib Springing for Thoracic Mobility
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When to Treat the Trigger Zone
When to Treat the Trigger Zone
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Trigeminal Nerve Function
Trigeminal Nerve Function
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V1 Supraorbital Branch Innervation
V1 Supraorbital Branch Innervation
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V2 Maxillary Branch Innervation
V2 Maxillary Branch Innervation
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V3 Mandibular Branch Innervation
V3 Mandibular Branch Innervation
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Trigeminal Neuralgia Trigger Zones
Trigeminal Neuralgia Trigger Zones
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Key Sign of Trigeminal Neuralgia
Key Sign of Trigeminal Neuralgia
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Facial Nerve Branches
Facial Nerve Branches
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Bell's Palsy Key Sign
Bell's Palsy Key Sign
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Bell's Palsy Manifestations
Bell's Palsy Manifestations
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Bell’s Palsy Systemic Disorder Risk Factors
Bell’s Palsy Systemic Disorder Risk Factors
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Key History Questions for Bell's Palsy
Key History Questions for Bell's Palsy
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Trigeminal Neuralgia
Trigeminal Neuralgia
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Trigeminal Neuralgia vs. Myofascial Pain
Trigeminal Neuralgia vs. Myofascial Pain
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Trigeminal Neuralgia Precaution
Trigeminal Neuralgia Precaution
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Trigeminal Neuralgia - Acute Treatment
Trigeminal Neuralgia - Acute Treatment
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Trigeminal Neuralgia Treatment
Trigeminal Neuralgia Treatment
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Trigeminal Neuralgia Homecare
Trigeminal Neuralgia Homecare
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Facial Nerve (CN VII) - Motor Function
Facial Nerve (CN VII) - Motor Function
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Facial Nerve (CN VII) - Sensory Function
Facial Nerve (CN VII) - Sensory Function
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Facial Nerve (CN VII) - Autonomic Function
Facial Nerve (CN VII) - Autonomic Function
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Bell's Palsy
Bell's Palsy
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Decrease SNS
Decrease SNS
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Swedish Massage
Swedish Massage
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Treat Compensatory Muscles
Treat Compensatory Muscles
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Hydrotherapy for Affected Area
Hydrotherapy for Affected Area
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Diaphragmatic Breathing
Diaphragmatic Breathing
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Inhibitory Techniques
Inhibitory Techniques
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Towel Placement
Towel Placement
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Avoid Fascial Techniques on affected tissue
Avoid Fascial Techniques on affected tissue
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Erb's Palsy Cause
Erb's Palsy Cause
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Waiter's Tip Deformity
Waiter's Tip Deformity
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Erb's Palsy Nerves
Erb's Palsy Nerves
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Erb's Palsy Myotome Deficits
Erb's Palsy Myotome Deficits
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Erb's Palsy Sensory Deficits
Erb's Palsy Sensory Deficits
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Klumpke's Palsy Cause
Klumpke's Palsy Cause
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Claw Hand Deformity
Claw Hand Deformity
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Klumpke's Palsy Nerves
Klumpke's Palsy Nerves
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Klumpke's Palsy Myotome Deficits
Klumpke's Palsy Myotome Deficits
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Klumpke's Palsy Sensory Deficits
Klumpke's Palsy Sensory Deficits
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Horner's Syndrome Signs
Horner's Syndrome Signs
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Horner's Syndrome Etiology
Horner's Syndrome Etiology
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Burners/Stingers Cause
Burners/Stingers Cause
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Brachial Plexus Injury Treatment
Brachial Plexus Injury Treatment
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Burners/Stingers Symptoms
Burners/Stingers Symptoms
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Study Notes
- Neuralgia is nerve pain that comes from nerve dysfunction.
- Nerve pain presents as pain in a nerve’s distribution, with or without objective signs.
- Trigeminal neuralgia and intercostal neuralgia are the most common types.
Trigeminal Neuralgia (CNV)
- Causes excruciating "lightning-like" or throbbing pain.
- Is often due to damage or injury to affected nerve
- Has a trigger zone that causes attacks when stimulated.
- Causes paroxysmal, intense, unilateral pain along the nerve's distribution that lasts seconds to minutes.
- Originate from a neuroma, previous injury, demyelinating conditions like MS, or bony callus.
- Can be triggered by light touch, temperature extremes, intense light, or movement.
- Avoid stimulating the trigger zone during assessment or treatment.
- The trigeminal nere has three branches: V1 is the supraorbital branch, V2 is the maxillary branch, and V3 is the mandibular branch.
- V1 innervates the eyelid, lacrimal gland, and upper nasal cavity.
- V2 innervates a part of the pharynx, teeth, upper lip, and lower eyelid.
- V3 innervates the anterior 2/3 of the tongue (not taste).
- V2 is the most common area affected.
- Symptoms include painful tics, fascial tics, loss of hearing due to paralysis of tensor tympani.
- Can cause a locked jaw due to paralysis of muscles of mastication.
- Differential diagnosis includes acute migraines and cluster headaches.
- Myofascial pain can make it difficult to differentiate the cases
Intercostal Neuralgia
- Causes unilateral pain in a segment at the intercostal laterally.
- Is not a condition of nerve degeneration but is terrible, lightning-like pain that is often comes on in fits for no reason.
- Post-herpes zoster (shingles) can lead to intercostal neuralgia.
- Address what triggers the pain, what diagnosis or treatment is the patient receiving, and the rate of change.
- Avoid treating the trigger zone during the acute phase but treat the rest of the body.
- Diaphragmatic breathing works around the trigger.
Facial Nerve
- The areas affected by a facial nerve lesion include mastication, audition, deglutition, and the skin of the face.
- Temporal, zygomatic, and mandibular paralysis
- Damage may result in fast transition from tone to flaccidity.
- Bell’s Palsy is Idiopathic
- Increased risk for people with diabetes mellitus and pregnant women in their 3rd trimester
- Can result in flaccid paralysis with autonomic (lacrimation, sweating) and sensory (taste) dysfunctions and impact hearing (hyperacusis).
- Common symptoms: eye closure difficulty, overall drooping, difficulty speaking/eating/drinking, brow droop, disappearing of wrinkles on affected side, and excess lacrimation.
- Unable to close the eye and wrinkle forehead
- Palsy is a condition of nerve degeneration.
- Protect fragile tissue on the affected side, encouragement is helpful
Treatments for facial lesions
- Techniques should feed and stimulate the area from mid-line toward the lesion
- Treatments include diaphragmatic breathing and treating the chest, posterior shoulder, scalp, face.
- Use light brushing/stroking toward lesion and PNF stretching.
- Can do cue and assist with fascial expressions (therapeutic movement)
- Avoid fascial techniques and ensure pressure and stroking on unaffected side is toward lesion site.
Brachial Plexus Traction Injuries
- Typically from birthing process/difficult delivery.
- Can occur from traumatic injury in adults.
- Over-stretch injury or compression injury.
- Erb's Palsy typically affects the upper plexus.
- Erb's Palsy is Typically caused by Deltoid CS-.
- Erb's Palsy leads to extension of the shoulder with traction of c-spine
- Can be caused falling from a height and grabbing catch
- or Manipulation during delivery of breech birth
- Klumpke's Paralysis affects the lower plexus.
- Results in clawed hand, ape hand, path hand resulting in loss of nerve fibres
- Klumpke's Paralysis will result in finger adduction/finger abd and add/MCP flexion, PIP & DIP flexion
- Horner's syndrome is associated with Klumpke's paralysis.
- Horner's Syndrome is probably injury to the superior cervical ganglion/autonomic fibres innervating the eyes and face which leads to Miosis
- Anhidrosis relates to dysregulation/inhibition
Common Symptoms
- Report lancinating pain or pain occurring hours after incident.
- Causes progressive weakness right after injury, or may only take a few minutes or hours.
- Treat proximally to the edge of the edema if present.
- "Blocking " proximal to the lesion prevents placing drag on the healing tissue.
- After regeneration has passed that site (approx 2 weeks post trauma or 3 weeks if slower to heal), treat tissues closer to lesion with light strokes and gentle compression.
Continued Care and Questions to Ask
- Has healing progressed/plateaued and prevented chronic situation?
- Positioning, splinting/immobilizing or range of motion.
- How often does patient perform exercise/movement/stretches?
- Address positioning when changing position on the table.
- Is the affected side shortened or contracted?
- What does myotome, dermatome, and sensory testing indicate? How are they going?
- Splinting, retraining, and re-education.
- Focus on regaining lost function and preventing deformity.
- Help manage edema using unidirectional stroking, manual lymphatic drainage.
- Decrease contractures.
- Promote relaxation with diaphragmatic breathing and gentle contrast hydro therapy.
- Facilitate any regained function through strengthening exercises and sensory re-education.
- Educate on being aware of the desensitized tissues, using different fabrics, etc.
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