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The effectiveness of neuromuscular facial retraining combined with electromyography in facial paralysis rehabilitation
Abstract
OBJECTIVE: The study goal was to present the effectiveness of neuromuscular facial retraining techniques used in combination with electromyography for improving facial function even in cases of longstanding paralysis. STUDY DESIGN AND SETTING: We conducted a retrospective case review in a tertiary neurotology clinic. PATIENTS: Twenty-four patients with facial paralysis received neuromuscular facial retraining between April 1999 and April 2001. The patient sample included 6 males and 18 females, with an average age of 44 years. A control group consisted of 6 patients (4 females and 2 males). RESULTS: All patient groups made significant improvements in function with improved symmetry in dual-channel electromyographic readings and increased facial movement percentages. Some of the percentages of posttreatment facial function were as follows: acoustic neuromas, 93%; Bell's palsy/Ramsay Hunt syndrome, 80%; and facial nerve anastomosis, 71%. Synkinesis was reduced by at least 2 levels in patients who initially demonstrated synkinesis. CONCLUSIONS: Neuromuscular facial retraining exorcises and electromyography are effective for improving facial movements. SIGNIFICANCE: Facial retraining is an excellent example of the plasticity of the central nervous system to reorganize, even in cases of longstanding paralysis.
... It does make peripheral facial palsy the most common cranial mononeuropathy; however, in some cases, when it is not possible to determine or define the cause of origin and only when it is the case, it is designated as Bell's palsy. Although, the origin is attributed as a result of the swelling or facial nerve entrapment in its bony canal within the temporal bone [2,[5][6][7][8][9][10][11][12][13][14]; usually, only one side of the face is affected. It might reduce the functionality of both sides. ...
... The seventh cranial nerve, also known as facial nerve shown in Figure 1, originates from the brainstem and travels through the internal auditory and fallopian canals as well as the large parotid. It innervates the orbicularis oris, salivary glands, lacrimal glands, and 23 paired facial muscles via the posterior auricular, temporal, zygomatic, buccal, marginal mandibular, and cervical branches [12]. ...
... Undetermined etiologies and autoimmune processes. Table 1 lists the peripheral facial palsy, and Table 2 lists bilateral facial palsy causes found in the literature [2,11,12,16]. Moreover, viral infections, ischemia, or autoimmune diseases have been postulated as possible pathomechanisms for Bell's palsy [2,4,14,17]. ...
Facial palsy is one of the most frequent mononeuropathies expressed in muscular weakness. The condition is produced by lesions in the seventh cranial nerve that causes esthetic, functional, and psychosocial alterations. The disorder has a qualitative diagnosis, and as a consequence, it does hinder the disease timely monitoring. As time is a key factor for the patient’s recovery, we developed a system capable to quantify the condition and/or damage in the seventh cranial nerve. It allows us to provide the best treatment available that offers the best response to each patient. To know the seventh cranial nerve state is possible due to the connections between whole muscular system and neurons. The system quantifies the muscles activity and displays the differential information of both hemifaces. Our proposal features a mask in which an array of sensors is placed across the frontal, zygomatic minor, risorio, zygomatic major muscles of each hemiface. The data collected are analyzed and displayed in a user-friendly interface.
... At the final analysis nine articles were included (Brach et al. 1997;Cronin and Steenerson 2003;Dalla Toffola et al. 2005;Dalla Toffola et al. 2012;Hasenbring et al. 1999;Pourmomeny et al. 2014Pourmomeny et al. , 2015Ross et al. 1991;Thomas et al. 1993), four of them were RCTs (Hasenbring et al. 1999;Pourmomeny et al. 2014Pourmomeny et al. , 2015Ross et al. 1991). The included studies involved a total of 374 subjects with PNI and of these, 173 underwent intervention with EMG-BF. ...
... The majority of studies found in this review included FP subjects, four of them included participants with diverse etiologies of the disease (Brach et al. 1997;Cronin and Steenerson 2003;Pourmomeny et al. 2014;Ross et al. 1991 One study used routine physiotherapy in the control group, but did not clearly state the interventions (Pourmomeny et al. 2014). Only one article did not involve a controlled design (Brach et al. 1997). ...
... If synkinesis was present, another electrode was positioned over hyperactive muscles to guide its voluntary inhibition. Cronin and Steenerson (2003) also placed electrodes in the healthy side of the face and asked patients to make similar muscle contractions in both sides based on EMG activity, a kind of strategy named motor copy (Criswell 2011). Other studies (Dalla Toffola et al. 2005 added functional movements and words pronunciation to EMG-BF, while avoiding synkinesis. ...
Electromyographic biofeedback (EMG-BF) has been applied to treat different types of peripheral nerve injuries (PNI). However, despite the clinical practice widespread use its evidence is controversial. With the objective of summarize the available evidence on the electromyographic biofeedback effectiveness and efficacy to help motor function recovery after PNI an integrative review was performed. A secondary objective was to identify the conceptual framework and strategies of EMG-BF intervention, and the quality of technical description of EMG-BF procedures. To conduct this integrative review a systematic search of the literature was performed between October 2013 and July 2018, in PUBMED, ISI and COCHRANE databases for EMG-BF original studies in PNI patients of any etiology, in English, Portuguese, Spanish or French, published after 1990. Exclusion criteria were poor description of EMG-BF treatment, associated treatment that could impair EMG-BF effect, inclusion of non-PNI individuals and case studies design. The PEDro scale was used to evaluate study quality of randomized clinical trials (RCTs) included. This resulted in 71 potential articles enrolled to full reading, although only nine matched the inclusion criteria. PNI included facial paralysis, acute sciatic inflammation and carpal tunnel syndrome. The average quality score of the included RCTs was five, corresponding to low methodological quality. Due to the small number of included articles, low quality studies and heterogeneity of interventions, outcomes and population we concluded that there is limited evidence of EMG-BF effectiveness and efficacy for motor function recovery in PNI patients.
... Half of all cases of peripheral facial palsy cases are idiopathic (Bell´s palsy) and the remainder are due to tumor, trauma, injury during surgery, otitis and Ramsay Hunt syndrome (2)(3)(4). Patients exhibiting incomplete recovery of facial palsy suffer from facial muscle weakness, contracture, hyper-kinesis, hyperlacrimation, atrophy and synkinesis (1,(5)(6)(7). The most debilitating sequelae of peripheral facial palsy and incomplete recovery are synkinesis and asymmetry of the face. ...
... Synkinesis is an abnormal involuntary facial movement that occurs with a voluntary movement of a different facial muscle group (4,(7)(8)(9)(10)(11). Synkinesis begins 3 to 4 months after regeneration of facial nerve palsy and continues for up to 2 years (6)(7)(8). The incidence of synkinesis depends on the location of facial nerve injury and is higher in intratemporal injuries than extratemporal injuries (10). ...
... Then each facial expressions should be analyzed, weakened muscles identified and compared with the unaffected side, and finally a tailored method selected for patient management. Neuromuscular re-education based on brain neuroplasticity could be an appropriate method (6). However, this method should be proportional according to the limitations of proprioception in the facial muscles (25).Therefore EMG biofeedback, requiring considerable skill compared with exercise therapy, could be a suitable method and an effective instrument in controlling synkinesis and creating coordination between the two sides of the face (14,28,29). ...
Introduction:
Synkinesis and facial asymmetry due to facial nerve palsy are distressing conditions that affect quality of life. Unfortunately, these sequelae of facial nerve palsy are unresolved. The aim of this study was to investigate the efficacy of a combination of biofeedback therapy and botulinum toxin A (BTX-A) injection for the management of synkinesis and asymmetry of facial muscles.
Materials and methods:
Among referrals from three university hospitals, 34 patients with facial synkinesis were divided randomly into two groups. All participants were evaluated using Photoshop software, videotape, and facial grading system (FGS). The first group received a single dose of BTX-A at the start of treatment, while the second group received normal saline as a control. Both groups received electromyography (EMG) biofeedback three times a week for 4 months.
Results:
The mean FGS values for the BTX group before and after treatment were 55.17 and 74.17, respectively, and those for the biofeedback group were 66.31 and 81.37, respectively. Moreover, it was shown that in both groups oral-ocular and oculo-oral synkinesis decreased significantly after treatment compared with before treatment (P<0.01).When these measurements were performed using Photoshop and videotape, these differences were even greater. Despite the decrease in synkinesis in both groups after treatment, there were no significant differences between the two treatment groups (P>0.05).
Conclusion:
Biofeedback therapy is as effective as the combination of biofeedback and BTX in reducing synkinesis and recovery of facial symmetry in Bell's palsy.
... This recovery takes some weeks or some months [11]. Thirty percent with incomplete recovery suffer from facial muscles weakness, contracture, hyperkinesis, hyperlacrimation, asymmetry, atrophy, and synkinesis [13][14][15][16]. Among these sequelae, asymmetry and synkinesis, related to patients' expression are the most important sequelae. ...
... According to above notes, researchers paid significant attention to exercise therapy as neuromuscular reeducation in different ways and emphasized on its effect [6,7,13,24,34,35,39,57,[59][60][61][62][63], but the used methods and instruments are different [23,63]. These methods comprised EMG biofeedback, mirror biofeedback, mime therapy (combination of thermotherapy, massage, and neuromuscular reeducation) [61], active, active-assistive, and resistive exercise [63]. ...
... The sensitivity of EMG biofeedback instrument, is set according to power of facial muscle in order to strengthen or eradicate muscle activity and in cases that the aim of treatment is to produce symmetry of both sides of face (for reducing and prevention of synkinesis), several canals of EMG biofeedback areused simultaneously. In fact, biofeedback therapy for facial nerve injuries is a neuroplasticity way for patients with facial nerve palsy or patients that cannot coordinate sound and injured side [13]. The function of mirror biofeedback is like EMG biofeedback, it does not need instrument but it has low delicacy. ...
Facial Rehabilitation Facial nerve palsy (FNP) changes facial expression and leads to functional problems in facial movement and negative psychological effect on patients. Fortunately, some of FNP problems recover completely, but some others remain with some sequelae like asymmetry, muscle contracture, synkinesis, and hyperkinesias that need rehabilitation. This article aimed to investigate physiotherapy modalities on these sequelae. Generally, exercise therapy in the form of neuromuscular reeducation was effective when the sequelae of FNP are analyzed. Then, we could select the type of exercise therapy according to that signs and sequelae (symptom). No acceptable researches about physiotherapy modalities like electrical nerve stimulation have been reported. Therefore, using electrical stimulation is not advised. Biofeedback therapy has been approved to be suitable.
... The results demonstrate the mean score =4.560 in partial involvement compared to mean value =6.000 in total involvement while the results show that the mean score=1.190 highly respondents in partial recovery compared to mean value=0.380 in the total recovery this findings show that these patients with partial recovery end up with significant cosmetic or functional sequel such as oral dysfunction, muscle contracture, synkinesis and hemi-facial spasm, these results are in agreement with Gronin study (2003), who conducted that from his study, approximately one third of the patients treated with neuro-muscular facial retraining ends up with significant cosmetic or functional squeals (16) . ...
... In our study we find that Table (10) represents the age groups after ANOVA by (LSD), that total improvement recorded at P<0.01 at age groups from (10)(11)(12)(13)(14)(15)(16)(17)(18)(19) and (20-29) age group., This finding is similar to Elliott study (2006), who observed that there was a predominance of the total improvement (14) case (60.9% ), there average age was of (22.2) years old (SD=16.5) ...
Objectives: The study aims to investigate the efficiency of physiotherapy methods to improve thedegree of the clinical recovery of the peripheral facial palsy.Methodology: This study is carried out at the Rehabilitation Center-Baghdad from November 2009 tillMarch 2010. This study includes (40) patient, their ages are from (13) to (55) years old; (24) male and(16) female with unilateral facial palsy of undetermined cause. House-Brackmann facial recoveryscores have been used before and after the physiotherapy treatment.Results: The results show that the physiotherapy sessions obtained the best effect of the electricalstimulation, exercises and massage in the treatment of facial palsy. Highly respondents in femalescompared to males in the total improvement, highly respondents in partial recovery compared to totalrecovery.Recommendations: The study recommends that the physiotherapists and patients should use thephysiotherapy sessions with follow-up that include stimulation, massage and exercises and completeall sessions of treatment.
... A limited number of studies have investigated the application of NMES within the facial palsy population (Cronin and Steenerson, 2003;Hyvarinen et al., 2008;Alakram and Puckree, 2011), although controversial. In a retrospective case review of patients with facial paralysis who received NMES, the investigators concluded that all patient groups made significant improvements in function with improved symmetry on the basis of dualchannel electromyographic readings as well as increased facial movement on the basis of percentages of movement measured in the study (Cronin and Steenerson, 2003). ...
... A limited number of studies have investigated the application of NMES within the facial palsy population (Cronin and Steenerson, 2003;Hyvarinen et al., 2008;Alakram and Puckree, 2011), although controversial. In a retrospective case review of patients with facial paralysis who received NMES, the investigators concluded that all patient groups made significant improvements in function with improved symmetry on the basis of dualchannel electromyographic readings as well as increased facial movement on the basis of percentages of movement measured in the study (Cronin and Steenerson, 2003). In another study that targeted participants with chronic facial nerve paralysis with sensory-level NMES, a significant improvement was observed in the upper branch of the facial nerve motor action potential distal latencyimprovement of one grade on the House-Brackmann scaleon the affected side in all patients and some patients also reported a subjective improvement (Hyvarinen et al., 2008). ...
Results:
On comparing the total change in labial and lingual strength between the two groups, an increase in total labial strength was found in the treatment group compared with the control group. However, the control group showed an increase in total lingual strength compared with the treatment group. Results for all measurements were not statistically significant. This study concluded that NMES may be a promising modality to combine with labial and buccal exercises for improvement of muscle strength.
... A limited number of studies have investigated the application of NMES within the facial palsy population (Cronin & Steenerson, 2003;Hyvärinen et al., 2008;Alakram & Puckree, 2011). In a retrospective case review of 24 patients with facial paralysis who received neuromuscular facial retraining, Cronin & Steenerson (2003) concluded that all patient groups made significant improvements in function with improved symmetry in dualchannel electromyographic readings. ...
... A limited number of studies have investigated the application of NMES within the facial palsy population (Cronin & Steenerson, 2003;Hyvärinen et al., 2008;Alakram & Puckree, 2011). In a retrospective case review of 24 patients with facial paralysis who received neuromuscular facial retraining, Cronin & Steenerson (2003) concluded that all patient groups made significant improvements in function with improved symmetry in dualchannel electromyographic readings. The subjects also were found to have increased facial movement based on percentages of movement measured in the study. ...
Background:
Lingual, labial and buccal weakness (LLBW) is a widespread consequence of several neurological insults. LLBW impact on oral motor functions such as speech production and swallowing is well documented in the literature. Therefore, it is important for the speech-language pathologists to have access to evidence-based approaches for treatment. Thus, it is imperative that the speech-language pathology field search for effective treatment approaches and explore new treatment modalities that can improve therapy outcomes. One relatively new modality in this field is neuromuscular electrical stimulation (NMES).
Aims:
The purpose of this paper is fivefold: (a) to provide an overview of the general effects of NMES on skeletal muscles; (b) to review the effect of NMES on orofacial musculature evaluating the potential appropriateness of NMES for use in strengthening lingual, labial and buccal muscles; (c) to identify future directions for research with consideration of its potential role in improving speech intelligibility and the oral preparatory phase of swallowing in patients with oral motor weakness; (d) to provide a brief anatomic and physiologic bases of LLBW; (e) to provide background information for orofacial myologists who may encounter individuals with LLBW.
Main contribution:
NMES is a modality that is commonly used in physical therapy and occupational therapy fields that assists in treating several motor and sensory muscular disorders including muscular weakness. The literature reviewed demonstrate that very limited data related to the use of NMES on orofacial muscles exist despite the fact that these muscles can be easily accessed by electrical stimulation from the surface.
Conclusions:
This review of the research using electrical stimulation of muscles highlights the need for experimental treatment studies that investigate the effect of NMES on orofacial weakness.
... Em um evento internacional realizado há duas décadas, já era apontada a importância do acompanhamento dos pacientes com paralisia facial periférica com exercícios, massagens, eletroterapia e biofeedback 7,8,12,17,18 . Cronin & Steenerson 14 propõem o biofeedback por eletromiografia de superfície. Os resultados demonstraram uma melhora da simetria facial e das sincinesias em 24 pacientes. ...
... Entretanto, a eletroterapia pode ser responsável por um aumento de tetanias e hipertonias que, por sua vez, desencadeiam sincinesias. Esta modalidade tem sido abandonada em substituição ao trabalho muscular analítico e técnicas de alongamento muscular [9][10][11][12][13][14] . ...
Peripheral facial paralysis requires specialized treatment. Physical therapy aims at reestablishing facial movements. The aim of this study was to describe and to analyze physical therapy results for individuals with peripheral facial paralysis. Study design: Retrospective study. Method: A retrospective study was carried out at the University Hospital, authorized by the Statistics and Medical File Services, from 1999 to 2003. Data are presented in descriptive form with mean and median values for numeric variables and frequency for categorical variables. Results: Twenty-three files were analyzed during four years. Females predominated and the average age was of 32.3 years (SD±16.5); 14 idiopathic and five trauma cases; 12 with total motor deficit and 11 with partial motor deficit; in the 12 cases that underwent final evaluation, seven had partial and five had total recovery. The physical therapy program used was kinesiotherapy and patient education. Conclusion: In this study, individuals were similar to individuals in other populations. They were treated with kinesiotherapy, as suggested by the scientific literature and recovered.
... This can be attributed to the targeted approach of the novel intervention, which aimed to address both overactive and weakened facial muscles through unique stretching and specific exercise regimen. Evidence from a previous study suggests that targeted exercises can enhance neuromuscular coordination and muscle strength, leading to improved facial symmetry 28 . ...
The purpose of the study was to assess the effects of a novel technique involving facial stretching of the unaffected side along with a structured exercise for the affected side on facial symmetry and facial functions as compared to conventional exercise. A hospital-based parallel-group randomized trial was completed among patients with acute Bell’s palsy in Mangalore, India. Participants were randomized to receive facial stretching and a structured exercise program (experimental group) or the conventional exercise regimen (conventional group). Primary outcomes were facial symmetry and voluntary movement; assessed by the Sunnybrook Facial Grading System (SFGS). Both regimens were given for 3 weeks, with baseline, 10th day, and 20th day assessments. Out of 31 participants screened, 24 were eligible and 12 participants each were assigned to experimental and conventional groups. Change scores revealed greater improvement in the SFGS score (p = 0.002) for the experimental group participants. Facial stretching and structured exercise program exhibited promising results in enhancing facial symmetry and function in acute Bell’s palsy when compared to conventional exercise regimen.
... There have been a number of approaches described in the literature implemented for conservative facial nerve rehabilitation to treat synkinesis. Commonly utilised techniques include biofeedback electromyography [7,8], functional neuromuscular re-education [9,10], video self-modelling [11] and mime therapy [12], all of which have been shown to be beneficial in facial rehabilitation. In particular, the role of surface electromyography (sEMG) biofeedback in improving muscular coordination has been demonstrated [13,14]. ...
Introduction: Following Bell's palsy, 25% of sufferers are left with chronic, difficult to treat involuntary muscle movements (synkinesis). Surface-electromyography (sEMG) biofeedback has an established role in improving muscular coordination. The vestigial posterior auricular muscle (PAM) is the first muscle re-innervated by the facial nerve. This study measured the sEMG signal from PAM in facial animation in healthy subjects and explored the possibility of using PAM in a wearable rehabilitative device. Material and methods: PAMs activity was recorded using sEMG in 41 healthy volunteers during the performance of a set range of facial expressions. To compare results between participants and expressions, the percentage increase from baseline were used. Results: PAMs activity increased significantly from baseline in response to smiling (110.98%) compared with other facial expressions: closing eyes (7.85%); blowing out cheeks (39.35%); whistling (11.84%), and showing lower teeth (38.24%). PAMs activity increased in proportion to smile intensity: lips together smile (55.18%); open smile (111.98%); full denture smile (130.07%); and, laughing (269.42%). Conclusion: This study demonstrates that measurement of smile intensity is possible via the sEMG signal from the PAM. Further studies investigating the applicability of measuring PAM activity during smiling to enhance and guide facial palsy rehabilitation are ongoing.
... There are only a few controlled trials present on the real effectiveness of physical therapy for facial palsies. In a randomized trial on 50 patients with Bell's palsy and a mean HBS of IV, mime therapy, including auto massage, relaxation exercises, inhibition of synkinesis, coordination exercises, or emotional expression exercises, resulted in improvement of facial stiffness [35][36][37][38]. In our study, physical rehabilitation programs were provided to all patients. ...
Background
Sudden onset of unilateral weakness of the upper and lower muscles of one side of the face is defined as peripheral facial nerve palsy. Peripheral facial nerve palsy is often idiopathic and sometimes it could be due to infectious, traumatic, neoplastic, and immune causes. This study aimed to report the clinical manifestation, evaluation, and prognosis in children with peripheral facial nerve palsy.
Methods
57 children under 18 years of age diagnosed with peripheral facial nerve palsy at Çukurova University, Balcalı Hospital, between January 2018 and September 2021, were included in the study.
Results
The mean age of the children at the time of diagnosis was 9.6 ± 7, 4 years. Thirty-two (56.1%) of the patients were female and 25 (43.9%) were male. A total of 57 patients were diagnosed with peripheral facial nerve palsy and categorized into many groups by etiology: idiopathic Bell’s palsy in 27 (47.5%), infectious in 11 (19.2%), traumatic in 6 (10.5%), and others (due to congenital, immune, neoplastic, Melkersson–Rosenthal syndrome, drug toxicity, and iatrogenic causes) in 13 (22.8%). Forty-six of the children achieved full recovery under oral steroids within 1–7 months. Four patients with acute leukemia, myelodysplastic syndrome, Mobius syndrome and trauma did not recover and two patients (schwannoma, trauma) showed partial improvement. Five patients could not come to follow-up control.
Conclusion
Peripheral facial nerve palsy is a rare condition in children with different causes. It could be idiopathic, congenital, or due to infectious, traumatic, neoplastic, and immune reasons. So, when a child presents with facial palsy, a complete clinical history and a detailed clinical examination are recommended. Giving attention to the red flag is very important. Peripheral facial nerve palsy in children is considered to have a good prognosis.
... analysis and no significant difference was found when compared intergroup improvements as explained in Table 4. 11 In accordance with a study of Cronin and Steenerson (2003) conducted a study on surface electromyography results revealed improvement in facial symmetry. 12 Referred to as EMG biofeedback, its purpose is to bring the normally unconscious control of muscles under conscious control. Decreased activity in hyperactive muscles and increased activity in weak muscles as well as improve coordination of muscle groups.EMG is an important part of the program because it provides immediate feedback to the patient, providing an objective means of measuring movements and outcomes. ...
... In cases where the recovery of facial muscle mobility is aggravated, there might be a possibility to assist the production of expressions with a brain-computer interface. Currently, the neuromuscular retraining uses EMG feedback to assist the recovery of facial movements (Cronin & Steenerson, 2003). The motor rehabilitation of limbs already successfully employs BCI feedback of brain signals by focusing on changing the brain activity in the damaged area while imagining the movement, or using this activity to control an assistive device. ...
Facial expressions are the primary mean of the non-verbal social interaction and are therefore highly significant for human communication. In the case of facial paralysis, due to e.g., a stroke or a head trauma, the production of facial expressions might be impaired fully or to a certain degree. Among several treatment possibilities, neuromuscular retraining offers solid chances for the recovery. Inspired by the role of brain-computer interfaces in the motor rehabilitation of limbs, this project aims to pave the way to combining BCI feedback from EEG with facial neuromuscular retraining. The first step to this was to explore whether motor imagery-based paradigms can be used to classify the facial expressions of happiness and anger from the brain response in their motor preparation. Methods employed to answer this question used regularized linear discriminant analysis and common spatial patterns computed for several frequency bands. The classifiers’ under chance level performance indicated that it is not possible to classify the motor preparation of the respective expressions in this setup. Most likely, this is due to the experimental paradigm used to collect the data not being optimal for the development of the ERD/S phenomena, which are crucial for the successful performance of the CSP approach. An alternative experimental paradigm, which aims at collecting data with quantifiable sensorimotor ERD/S and enforcing better control over the muscle movement during the experiment is proposed. The paradigm aims to first parametrize the sensorimotor rhythms underlying the imagery of these expressions. Thereafter, and depending on the results, it can be upgraded to a BCI paradigm with feedback.
... Synkinesis, muscle tension, muscle contracture, and atrophy are the most common consequences of chronic facial nerve palsy (FNP) (1). Muscle tension refers to the condition in which the muscles of the face remain semicontracted for an extended period. ...
Introduction:
Chronic facial nerve palsy has long been known to negatively affect the quality of life in patients. The present study aimed to investigate the efficacy of Botulinum Toxin A (BTX-A) and neuromuscular retraining therapy (NMRT) in the symmetry of chronic facial palsy.
Materials and methods:
Two groups, namely experimental and control, were considered each consisting of 13 patients. The study population included a total of 15 female subjects. The BTX-A was injected into the synkinetic muscle in the experimental group; nevertheless, the patients in the second group participated in special neuromuscular retraining. The rate of reducing synkinesis and symmetrical improvement was evaluated using the Facial Grading System (FGS) after 4 months of treatment. The independent t-test was performed to compare the two groups.
Results:
According to the Sunnybrook FGS, the mean changes in Sunnybrook scores in the experimental and neuromuscular retraining groups were 3% and 24%, respectively. The comparison of the mean scores of the two groups was statistically significant after the interventions (P=0.033). A variable ratio of statistically significant improvement was observed in synkinesis in both groups following the treatment (P=0.041). In addition, by comparing the synkinesis scores between the two groups, the reduction of synkinesis was observed to be greater in the neuromuscular retraining group (P=0.041) after the treatment.
Conclusions:
The findings of the current study indicated that special neuromuscular retraining leads to significant improvement in the FGS score, compared to botulinum toxin therapy alone. Moreover, it was observed that facial symmetry can be treated with special neuromuscular retraining and the patient can overcome synkinesis.
... The efficacy of electrical stimulation (ES) for facial palsy remains debatable, although the use of electric current applications in peripheral nerve regeneration has been widely investigated (Anonsen et al., 1986;Cronin and Steenerson, 2003). Overall, ES is considered inefficient (Coulson, 2005;Diels, 2005) although positive effects have been reported in a few clinical studies (Cole et al., 1991;Targan et al., 2000). ...
Insufficient recovery after injury of a peripheral motor nerve is due to (1) inappropriate pathfinding as a result of axonal regrowth to inappropriate targets, (2) excessive collateral axonal branching at the lesion site, and (3) polyinnervation of the neuromuscular junctions (NMJs). The rat facial nerve model is often used because of its simple and reliable readout to measure recovery of function (vibrissal whisking). Over the last decades scientists have concentrated their efforts to combat mostly NMJ polyinnervation, because it turned out to be very difficult to reduce collateral axonal branching and impossible to navigate thousands of axons toward the original fascicles. In the past, several groups of scientists concentrated their efforts to reduce the activity‐dependent polyinnervation of NMJs by electrical stimulation of the muscles (square 0.1 msec pulses at 5 Hz). The results showed no recovery of functions and a severe reduction in the number of innervated NMJs to approximately one fifth of those observed in intact animals. More recent experiments, however, have shown that motor recovery improved significantly following mechanical stimulation of the denervated facial muscles (vibrissal and orbicularis oculi) and that restored functions could invariably be linked to reduced polyinnervation at the NMJ while the number of innervated NMJ remained the same. These results suggest that clinically feasible and effective therapies could be developed and tested in the near future. Anat Rec, 302:1287–1303, 2019. © 2019 Wiley Periodicals, Inc.
... The effectiveness of neuromuscular facial retraining techniques in combination with electromyography for improving facial function is well documented. 40 Grade I is defined as full recovery, while a return to grade III or higher grade is indicated as poorer recovery. 41,42 All the cases who were followed-up subsequently had improvement of facial function by at least one grade. ...
Introduction The facial nerve is the most commonly paralyzed nerve in the human body, resulting in far-reaching functional, aesthetic and emotional concerns to the patient.
Objective Evaluation of the clinical outcome of 47 patients with traumatic facial nerve paralyses, with respect to clinical recovery and audiological sequelae.
Methods A descriptive longitudinal study was conducted over 24 months between January 2017 and December 2018 at a tertiary center with detailed clinical, topodiagnostic, audiometric and radiological evaluation and regular follow-up after discharge.
Results Road traffic accidents constituted 82.98% of the trauma cases, out of which 76.60% were found to be under the influence of alcohol.
Delayed facial paralysis was observed in 76.60% cases. Temporal bone fracture was reported in 89.36%, with otic capsule (OC) sparing fractures forming 91.49% of the cases. Topologically, the injury was mostly at the suprachordal region around the second genu. The majority of the patients (65%) attained full recovery of facial nerve function with conservative medical management. Audiometrically, 77.27% of the patients had hearing loss at the time of presentation, of which 64.71% were conductive in nature; 51.22% attained normal hearing at follow-up visits.
Conclusion Early initiation of steroid therapy, concurrent eye care and physiotherapy are the cornerstones in the management of traumatic facial nerve paralysis.
... In contrast, the physiotherapeutic treatments like electro-stimulation (ES), despite of their actual common use are still controversial, and in many cases not recommended or show no positive results. In addition, there are a few random and controlled studies that test the efficacy or not of ES [5]. Those uncontrolled reports, aside from their lack of scientific strictness show low or no therapeutic capacity at all; one of them even shows the worsening of facial functioning when electrotherapy is applied. ...
ARTICLE INFO ABSTRACT Bell's Palsy is Upward and outward movement of the eye when an attempt is made to close the eyes. Bells phenomenon is also known as the palpebral oculogyric reflex. Kinesio Taping is a relatively new technique, it is proposed to normalise muscular tone, increased range of motion, increases endurance and improve functional movement. It also provides a constant pull or shear force to the skin. House-Brackmann Grading System is used to measure facial weakness, eyebrow Lift, eyeclouser, asymmetry, synkinesis, movement of mouth, spasm and contracture. Purpose of study is to compare the impact of kinesio taping versus conventional therapy in Bell's palsy patients.
... PFP may be accompanied by disturbances in taste, salivation, and tearing; hyperacusis and hypoesthesia in the external auditory canal; and functional deficits in oral functions such as speech, chewing, sucking, swallowing, and lip hold. The degree of motor impairment is assessed via the House-Brackmann scale to quantify the degree of paresis at diagnosis [11][12][13][14][15][16][17][18] . ...
Patients with peripheral facial paralysis (PFP) have some degree of recovery. The aim of this study was to evaluate prognostic factors and physical therapy modalities associated with functional recovery in patients with PFP. This is a cohort study with 33 patients. We collected the following variables of patients who underwent treatment at the rehabilitation center: age, sex, risk factors, affected side, degree of facial paralysis (House-Brackmann scale), start of rehabilitation, and therapy modality (kinesiotherapy only; kinesiotherapy with excitomotor electrotherapy; and kinesiotherapy with excitomotor electrotherapy and photobiomodulation therapy). The outcomes were: degree of facial movement (House-Brackmann) and face scale applied 90 days after treatment. Degree of PFP was associated with functional recovery (RR=0.51, 95% CI: 0.51-0.98; p=0.036). The facial movement was associated with the time to start rehabilitation (r=−0.37; p=0.033). Lower facial comfort was observed among women, worse ocular comfort was associated with diabetes mellitus, worse tear control with prior PFP, and worse social function with the degree of PFP. Our results indicate that the all modalities present in this study showed the same result in PFP. Recovery of PFP was associated with degree of nerve dysfunction, the length of time to onset of rehabilitation, female sex, hypertension, diabetes mellitus, and previous PFP, all of which were associated with worse outcomes on the face scale.
... Extracranial causes are a malignant tumour of parotid gland [11]. Most recommended treatments include medicine, [12]massage, exercise therapy, [13] electric stimulation, [14], neuromuscular retraining, [15] manual therapy, [2,16], steroid or injection [17], surgery [18] massage, inhibition of Synkinesis, relaxation exercises, emotional expression exercises, and coordination exercises showed early recovery in symptoms of Bell's nerve damage [19]. Transpore tape is widely used as supportive therapy in different brain injuries [20] and supportive therapy to support eyelid/ eyelashes [21]. ...
Bell's palsy is a common, occurring cranial nerve disease that led to the compromise of facial function and appearance. The objective of the study was to observe the immediate effect of Transpore tape on mouth deviation and symptoms in patients with Bell's palsy. The study was conducted in VIP Niazi Hospital of Sargodha, Pakistan. 25 Bell's palsy patients were selected based on inclusion criteria. The angle of mouth was measured by the three-finger index method before and after treatment. The facial function was recorded by a modified Synkinesis assessment questionnaire. The angle of mouth improved from 37.6° ±1.7° to 47.8° ±2.3° (p<0.05) and almost all patients showed an immediate trend in improvement in chewing, drinking and puffing of mouth. Transpore tape is a valid supportive therapy in correction mouth deviation and associated symptoms.
...  íàøåì Èíñòèòóòå íåéðîõèðóðãèè ÷àùå âñåãî âûïîëíÿþò îïåðàöèþ íà íèaeíåì âåêå ïî ìåòîäó Êóíò-Øèìàíîâñêîãî, îêàçàâøóþñÿ î÷åíü ýôôåêòèâíîé, îñîáåííî â ñî÷åòàíèè ñ áëåôàðîððàôèåé. Ó áîëüíûõ ñ íàðóøåíèåì àíàòîìè÷åñêîé öåëîñòíîñòè ËÍ, à òàêaeå ó ïàöèåíòîâ ñ îòñóòñòâèåì êëèíè÷åñêîé è ýëåêòðîíåéðîìèîãðàôè÷åñêîé äèíàìèêè âîññòàíîâëåíèÿ ôóíêöèè íåðâà (ñîãëàñíî øêàëå House-Brackmann -ïÿòàÿ ñòåïåíü íàðóøåíèÿ) ïðîâîäèòñÿ îïåðàöèÿ íåâðîòèçàöèè [15,20,35]. Ïðè íåâðîòèçàöèè ËÍ ñøèâàåòñÿ ñ ïîäúÿçû÷íûì (XII) èëè ñ äîïîëíèòåëüíûì (XI) ×Í. ...
... Facial retraining is an amazing case of the plasticity of the central nervous system to reorganize, even in cases of long-standing paralysis. In individuals with long standing facial palsy, Neuromuscular facial retraining exercises are effective to improve facial movements (6) . Mime therapy is a novel therapy combining mime and physiotherapy. ...
... A positive effect through pallaestethic BFB can also be recognized for children with innate cerebral parases ( [1]). BFB is also used for patients with strokes and facial pareses ( [3]; [8]; [2]). ...
In this paper we describe the ongoing research on the development of a body movement sonification system. High precision, high resolution wireless sensors are used to track the body movement and record muscle excitation. We are currently using 6 sensors. In the final version of the system full body tracking can be achieved. The recording system provides a web server including a simple REST API, which streams the recorded data in JSON format. An intermediate proxy server pre-processes the data and transmits it to the final sonification system. The sonification system is implemented using the web audio api. We are experimenting with a set of different soni-fication strategies and algorithms. Currently we are testing the system as part of an interactive, guided therapy, establishing additional acoustic feedback channels for the patient. In a second stage of the research we are going to use the system in a more musical and artistic way. More specifically we plan to use the system in cooperation with a violist, where the acoustic feedback channel will be integrated into the performance.
... Oral commissure raised by the zygomaticus muscle can be a goal for facial training [14]. This exercise takes the form of "forced laughter" by connecting simple smile patterns on the normal side to the smile caused by temporal muscle contraction on the affected side, so that learning the smile of the temporalis muscle is required after operation [15,16]. ...
Temporalis tendon transfer is a technique for dynamic facial reanimation. Since its inception, nearly 80 years ago, it has undergone a wealth of innovation to produce the modern operation. Temporalis tendon transfer is a relatively minimally invasive technique for the dynamic reanimation of the paralyzed face. This technique can produce significant and appropriate movement of the lateral oral commissure, more closely mimicking the normal side. The aim of this article is to review the technique of temporalis tendon transfer involving transferring of the coronoid process of the mandible with the insertion of the temporalis tendon via intra-oral and transcutaneous approach.
... Bell's palsy accounts for more than half of all cases of idiopathic facial palsy. It is considered to be a diagnosis of exclusion after ruling out all other possible causes [1]. For many patients, the questions about whether their facial function will return to normal or not and how long it would take are what they are mostly concerned about. ...
Objective The aim of this study was to assess the value of facial nerve temporal recording in the diagnosis and prognosis of facial nerve palsy.
Patients and methods The study was conducted on 42 patients with acute unilateral Bell’s palsy (patients’ group) and 43 healthy volunteers who served as a control group. All patients and controls were subjected to clinical examination in the form of history taking and full general and neurological examinations, clinical scoring system using House–Brackmann facial nerve grading system (performed for the patients’ group only), electrophysiological assessment, which included electroneuronography (ENoG) and facial nerve temporal recording.
Results The amplitude of the facial nerve temporal recording was significantly lower in the patients’ group compared with that in the control group, and there was statistically significant increase of the amplitude of facial nerve temporal recording, regaining its normal triphasic waves; as regards correlation study between the percent of degeneration of ENoG and the amplitude of the diseased facial temporal recording, there was positive correlation between them, and it was not reaching the level of statistical significance.
Conclusion Facial nerve temporal recording detects the degenerative changes that occur in the intratemporal segment of the facial nerve; hence, it should be considered as a complementary tool for the ENoG test for early diagnosis and follow-up of Bell’s palsy.
... Eye closure Lips 13 2.43 AE 0 ,. 6 7 4 1 0. 8 9AE 0.40 < 0.001 Puckering lips Eyes 15 2.73 AE 0.84 39 0.91 AE 0.41 < 0.001 Steenerson, 2003). 24 At this stage, the EMG results showed that the IEMG activity varied from 0.60 to 2.59. ...
Introduction Surface electromyographic activity may not be symmetric, even in subjects with no facial paralysis history.
Objective To evaluate the contribution of the index of electromyographic (IEMG) activity in the identification of the two extremes of the facial paralysis course.
Methods Thirty-four subjects with unilateral peripheral facial paralysis were selected. A control group was composed of volunteers without a history of facial paralysis. The electromyographic assessment of the facial muscle was performed by placing surface electrodes during movements of the forehead, eyes and lips using MIOTEC equipment, such as the MIOTOOL (Miotec, Porto Alegre, Brazil) software. The electromyographic activity was also recorded in other channels during the primary activity to identify the presence of synkinesis. The statistical analysis was performed using the Statistical Package for Social Sciences for Macintosh (SPSS Inc, Chicago, IL, USA). The IEMG activity was obtained from the division of the electromyographic activity root mean square (RMS) values on both sides.
Results There was a statistically significant difference among the groups in all the analyzed indexes. The ocular-oral synkinesis in all patients must be correctly identified (with 100% sensitivity and specificity) using an IEMG activity of 1.62 as a cutoff point. The oral-ocular synkinesis must be correctly identified (93.3% sensitivity and 95.9% specificity) using the IEMG activity of 1.79 as a cutoff point.
Conclusion The IEMG activity is below the normal scores in patients in the flaccid stage, whereas patients in the sequelae stage can either show normal values or values above or below the normal scores. The IEMG activity was shown to have high sensitivity and specificity in the identification of synkinesis.
... Patients with remaining symptoms from Bell's palsy appear to experience positive effects from physiotherapy [11] and biofeedback training [12]. In a controlled study on 24 patients with Bell's palsy, neuromuscular retraining exercises were effective in improving facial movements [13,14]. In our medical system is usual to apply electrotherapy modalities for treatment of facial nerve paralysis. ...
Unilateral peripheral facial nerve palsy may have a detectable cause (secondary facial nerve palsy) or may be idiopathic (primary) without an obvious cause (Bell's palsy). Peripheral facial nerve palsy is diagnosed upon the clinical presentation with weakness of all facial nerve branches, drooping of the brow, incomplete lid closure, drooping of the corner of the mouth, impaired closure of the mouth, dry eye, hyperacusis, impaired taste, or pain around the ear. The aim of our research was to assess the effect of physical therapy treatment and sequelae after palsy. We have made retrospective analyze of 10 patients for sequels, after 1-3 years of palsy and physical therapy treatment with House Brackmann facial nerve grading system. Results: the scale is showing III grade of deficit after palsy. Therapy, particularly of Bell's palsy, is controversial due to the lack of large, prospective, randomized, and controlled trials. In our medical system patients are treated with physical therapy. House Brackmann facial nerve grading system can be used like a protocol system for evaluation of treatment in patients with facial palsy.
... The orofacial muscles of expression function together to create repeatedly identifiable facial expressions across cultures (Ekman 1973(Ekman , 1993, and these expressions are generated reflexively, consciously and subconsciously, under reflexive, conscious and emotional control (Coulson et al. 2004;Cronin and Steenerson 2003). Results from the current study imply that the lips have high proprioceptive sensitivity; specifically the mean error at the lips was found to be 0.1 mm lower than that of the jaw. ...
In the human face, the muscles and joints that generate movement have different properties. Whereas the jaw is a conventional condyle joint, the facial musculature has neither distinct origin nor insertion points, and the muscles do not contain muscle spindle proprioceptors. This current study aims to compare the proprioceptive ability at the orofacial muscles with that of the temporomandibular joint (TMJ) in 21 neuro-typical people aged between 18 and 65 years. A novel psychophysical task was devised for use with both structures that involved a fixed 30.5 mm start separation followed by closure onto stimuli of 5, 6, 7, 8 mm diameter. The mean proprioceptive score when using the lips was 0.84 compared to 0.79 at the jaw (p < 0.001), and response error was lower by 0.1 mm. The greater accuracy in discrimination of lip movement is significant because, unlike the muscles controlling the TMJ, the orbicularis oris muscle controlling the lips inserts on to connective tissue and other muscle, and contains no muscle spindles, implying a different more effective, proprioceptive mechanism. Additionally, unlike the lack of correlation previously observed between joints in the upper and lower limbs, at the face the scores from performing the task with the two different structures were significantly correlated (r = 0.5, p = 0.018). These data extend the understanding of proprioception being correlated for the same left and right joints and correlated within the same structure (e.g. ankle dorsiflexion and inversion), to include use-dependant proprioception, with performance in different structures being correlated through extended coordinated use. At the lips and jaw, it is likely that this arises from extensive coordinated use. This informs clinical assessment and suggests a potential for coordinated post-injury training of the lips and jaw, as well as having the potential to predict premorbid function via measurement of the uninjured structure, when monitoring progress and setting clinical rehabilitation goals.
... Terapie " zpětnou vazbou" (EMG feedback, Videofeedback) se používá k nácviku zpřesnění pohybu, k nácviku volního ovládání postižených svalů pomocí převedení elektromyografického nebo video záznamu na obrazovku, event. do reproduktoru v režimu "on-line" a následně aktivní snahou pacienta o aktivní korigovaný cílený pohyb (5). ...
Functional disorders incentral paresis of facial nerve may be influenced by pointed rehabilitation logopedic-nursing procedures which favorably influence facial expression as well as speech or to adjustment of dysphagia and general psychosomatic social state of the patient. The purpose of the paper was to present a survey of orofacial rehabilitation procedures, which can be used in therapy of consequences of central pareses of facial nerve.
... Enrolled subjects suffered from postoperative facial paralysis so these study findings may not apply to patients with facial paralysis of other etiologies. Satisfactory results reported for rehabilitation therapy in patients with facial paralysis 16,19,21 focus on multiple etiologies such as idiopathic Bell's palsy, acoustic neuroma, traumatic and iatrogenic causes, and otitis, among others. [22][23][24] Although these studies may help to compare our findings with other rehabilitation techniques, the lack of studies with similar characteristics hardly can lead to definitive conclusions. ...
Objectives:
To compare the effectiveness of a daily home-based facial exercise therapy with a supervised rehabilitation technique for the treatment of postoperative facial dysfunction in patients undergoing conventional superficial parotidectomy.
Design:
Prospective, randomized trial, controlled.
Setting:
Surgery and Rehabilitation Units, university hospital.
Subjects:
Consecutive patients (n=79, mean age 48 years) who underwent superficial parotidectomy with facial nerve dissection were randomly divided into two groups.
Intervention:
Control group (CG) were given a daily homework manual to perform ordinary postoperative facial mimic exercises autonomously in front of the mirror at home. Experimental group (EG) patients with moderate-severe paresis received supervised rehabilitation therapy that consisted in weekly sessions with facial exercises and massages and performed daily facial exercises at home. EG patients with slight paresis were instructed to undertake self-massage and mirror exercises.
Main outcome measures:
Postoperative dysfunction of facial nerve and branches was quantified measuring the prevalence, magnitude and duration of paresis by the House-Brackmann Facial Nerve Grading System up to 12(th) months.
Results:
Facial paresis incidence at 1(st) week was 77.2%, being the marginal-mandibular nerve the most affected (64.5%). No statistically significant differences were found at any time of the study when comparing the frequency, magnitude and duration of paresis between EG and CG and among patients who had presented moderate-severe paresis. In the absence of intraoperative nerve injury, complete recovery of facial mobility was observed within 12 months, regardless of treatment group.
Conclusion:
Rehabilitation therapy and mirror facial exercises performed autonomously at home were equally effective for postoperative functional recovery.
... These repetitive movements based on irradiation principles and additional bilateral co-contraction initiate early recovery which make PNF more effective at improving facial symmetry and reducing facial disability in subjects post Bell's palsy [32,35]. Whereas in NMR each patient's program differs, and it needs categorization of patients and is used to treat long term sequel as synkinesis so need long settings of treatment session and it does not produce bilateral co-contraction [34,36,37]. ...
Purpose: To evaluate the comparative effectiveness of neuromuscular re-education technique and proprioceptive neuromuscular facilitation technique on improving facial disability and synkinesis in rehabilitation of bell's palsy. Methodology: It was a randomized clinical trial consisting 40 participants (males and females) 20 in each group, with Bell's palsy of non-traumatic origin. Group A received proprioceptive neuromuscular technique (PNF) with conventional PT treatment and Group B received facial neuromuscular re-education technique (NMR) combined with conventional PT treatment for 6 days a week for 4 weeks. Results: The result suggest that Group A had significant higher score at Sunny brook facial grading scale (SFGS) whereas in Facial Disability Index (FDI) Group A had significant difference at total score but there was no significant difference over individual component (social and physical function). Group B had significant better improvement over Synkinesis Assessment Questionnaire (SAQ). Conclusions: Both PNF group and NMR showed significant results and displayed efficient improvement in facial symmetry after 4 weeks of treatment. PNF with conventional PT is more effective in improving facial function and reducing facial disability whereas NMR with conventional PT is better in reducing synkinesis in Bell's palsy rehabilitation.
... These results of neuromuscular reeducation can be explained through the peripheral and central mechanism based on nervous system plasticity. 31 Manikandan 22 demonstrated the inefficiency of the electric stimulation compared to the neuromuscular reeducation with mirror feedback in the acute phase, after a period of 3 months. The results of Manikandan 22 showed that electric stimulation worsened symmetry facial movement. ...
Background: Idiopathic facial palsy (IFP) or Bell's palsy is a unilateral mononeuropathy of the lower motorneuron of the facial nerve, excluding tumor, infectious or traumatic causes. Objectives: To evaluate the efficacy of physical therapy on the outcome of IFP. Search strategy: The electronic databases MEDLINE, Cochrane Database of Systematic Reviews, PEDro and SPORTDiscus, were searched up to December 2009. Selection criteria: Studies included in this review were selected according to the following set of criteria: (1) the design was randomized controlled trial; (2) all participants had an IFP or paresis; (3) the intervention was any modality of physiotherapy (a combination of modalities was possible) except interventions such as acupuncture and osteopathic; (4) the studies were published between January 2000 and December 2009; (5) English language. Methods: The review authors extracted and analyzed the data independently, using the PEDro scale to assess the methodological quality of each eligibly study. Results: Only two eligible studies were identified and included in the review. Both studies were scored 5 out of 10 on the PEDro scale. Both studies found benefits from facial neuromuscular reeducation with mirror feedback in the acute or chronic phase of IFP. The results of these studies could not be pooled for meta-analysis, as the study interventions and assessment were heterogeneous. Conclusions: The experimental studies demonstrated moderate efficacy in the treatment of facial neuromuscular reeducation with mirror feedback in different phases of the paralysis.
... Experiments have shown that electrical stimulation for unilateral facial paralysis improves patients with ongoing facial paralysis by stimulating the nerve on the paretic side. This stimulation restores facial control and lessens synkineisis [12,13]. Due to the use of high voltage and current (to overcome skin resistance) skin irritation may occur [14]. ...
... Approximately 70% of cases of Bell's palsy exhibit complete recovery within 3 months (4). Unfortunately, patients with incomplete recovery of facial nerve palsy (FNP) suffer from facial muscle weakness, contracture, hyperkinesis, atrophy, and synkinesis (1,(5)(6)(7). Among these sequelae, facial synkinesis and asymmetry are the most common and the most serious both psychologically and socially (8), affecting the quality of life of the individual. ...
Introduction:
The important sequelae of facial nerve palsy are synkinesis, asymmetry, hypertension and contracture; all of which have psychosocial effects on patients. Synkinesis due to mal regeneration causes involuntary movements during a voluntary movement. Previous studies have advocated treatment using physiotherapy modalities alone or with exercise therapy, but no consensus exists on the optimal approach. Thus, this review summarizes clinical controlled studies in the management of synkinesis and asymmetry in facial nerve palsy.
Materials and Methods:
Case-controlled clinical studies of patients at the acute stage of injury were selected for this review article. Data were obtained from English-language databases from 1980 until mid-2013.
Results:
Among 124 articles initially captured, six randomized controlled trials involving 269 patients were identified with appropriate inclusion criteria. The results of all these studies emphasized the benefit of exercise therapy. Four studies considered electromyogram (EMG) biofeedback to be effective through neuromuscular re-education.
Conclusion:
Synkinesis and inconsistency of facial muscles could be treated with educational exercise therapy. EMG biofeedback is a suitable tool for this exercise therapy.
... Furthermore, depending on the strength of the bioelectric signals, signals of the ipsilateral face itself can be used for rehabilitation. The effectiveness of neuromuscular facial retraining with EMG in facial paralysis rehabilitation has already been confirmed by Cronin and Steenerson (2003). Their study, involving 24 patients with an average onset of symptoms before the initiation of facial retraining of 32 months showed marked improvements in facial function, symmetry, and decreased synkinesis. ...
This paper introduces a robotic technology-based supporting device, the robot mask, to enhance facial expressiveness and support physiotherapy for facial paralysed persons. The wearable device, which consists of shape memory alloy (SMA)-based linear actuators, functions by pulling the facial skin towards anatomically selected directions. Since facial expressions are silent, SMA was selected over electrical motors. This paper introduces a compact and fully controllable actuation unit with position feedback and a novel controlling scenario that uses the selected hybrid actuation of bidirectional multi segment SMA wires in series to pull the wires. When designing the actuators, a biomechanical analysis was conducted to find anatomical parameters of natural smiles, and the robot mask was evaluated for its suitability as a facial expression supporter.
The true frequency of blepharoptosis and its particular subtypes is not known. The vast majority of upper eyelid ptosis is due to benign etiologies, including involutional and congenital. A recent review of 251 patients across all ages in a tertiary care center reported aponeurotic ptosis as the most frequent subtype (60%), followed by a relatively similar distribution of traumatic, congenital, and mechanical (9–11%). Neurogenic etiologies made up a minority of cases (6%), with 38% due to oculomotor palsy, 29% from myasthenia gravis, and 7% from Horner syndrome. However, this small subset of ptosis cannot be missed - neurologic ptosis may be the sole manifestation of significant systemic and neurologic disease.
Committee It will be a meeting where experts in Physical Medicine and Rehabilitation will share their knowledge and experience, as well as discuss current concepts of disability and future directions for the field. Our goal is to provide multiple opportunities for participants to interact through discussion of presentations, "get togethers" with experts and lunch sessions to review the current status of mechanism-based treatment. Interactions will hopefully generate ideas for future studies and research collaboration among participants. Hands-on demonstration of new approaches for treating patients with the most common rehabilitation conditions will also be available. Visit our site: www.isprm.org/brazil Get prepared for our social programs, which are extensive to the Congress participants' companions, as well as tour opportunities in a country famous for its great natural beauty. Hospitality is a tradition in Brazil, and our event will be characterized by great social events. Do not miss this unique opportunity; you will not only participate in an excellent scientific meeting, but you will be in contact with colleagues from all over the world in a joyful, brotherly environment, with plenty of music, fine cuisine and nice entertainment. We will have very special social events, such as: 1-Welcome party with a music and dancing show 2-Talent show, where participants will display their "other gifts" (further information and registration at the Congress website), followed by a samba school performance. 3-Gala Dinner-Mask Ball 4-Korean Festival 5-Closing cocktail We have selected excellent hotels with lowest rates and high accessibility. Also, we have prepared great pre-and post-Congress sightseeing programs. Visit our website, register, and bring your family along! Make the most of this opportunity and enjoy those well-deserved vacations in a beautiful country. We have also prepared an excellent program for your companions, such as: 1. Guided tour visits 2. Brazilian food cooking course 3. Visit to jewelry manufacturer Amsterdam Sauer, followed by a Brazil-designed jewelry show Join us for strengthening our specialty! Sao Paulo awaits you with wide-open arms!
Among the causes of facial nerve lesions, iatrogenic injuries have currently the highest incidence in extensive surgical interventions of the tumor removal. It should be noted that the majority of patients with tumors in the anatomical location of the facial nerve undergo operation at the stage of pronounced clinical manifestations, when the tumor is of a considerable size and the preservation of the facial nerve is a difficult and sometimes impossible task. In our practice, we conducted 1 clinical observation of a 59-year-old patient hospitalized with a diagnosis of the long-term effects of left facial nerve traumatic injury. Transposition of the temporal muscle on the round muscles of the eyes and mouth on the right half of the face, as a consequence of microsurgical removal of the right cochlear nerve neurinoma under the neuro-monitor, performed under 2.5 x magnification. The postoperative period was uneventful, a good aesthetic result was obtained. To evaluate the results, May and Drucker classification was used: 1-bad (drooing corner of the mouth on the paralyzed side); 2-unsatisfactory (the corners of the mouth were not symmetrical); 3-satisfactory (discreet smile, pulling up the corner of the mouth); and 4-good (patient smiles voluntarily with exposure of the teeth). Three independent observers evaluated the photographs , and then the authors averaged their score. All of the participants had the same preoperative score of 1 because the corner of the mouth on the paralyzed side drooped in all of the patients before surgery. The average postoperative score of all 4 cases was 2,9.
The physical therapy (PT) associated with standard drug treatment (SDT) in Bell palsy has never been investigated. Randomized controlled trials or quasirandomized controlled trials have compared facial PT (except treatments such as acupuncture and osteopathic) combined with SDT against a control group with SDT alone. Participants included those older than 15 yrs with a clinical diagnosis of Bell palsy, and the primary outcome measure was motor function recovery by the House-Brackmann scale. The methodologic quality of each study was also independently assessed by two reviewers using the PEDro scale. Four studies met the inclusion criteria. Three trials indicate that PT in association with SDT supports higher motor function recovery than SDT alone between 15 days and 1 yr of follow-up. On the other hand, one trial showed that electrical stimulation added to conventional PT with SDT did not influence treatment outcomes. The present review suggests that the current practice of Bell palsy treatment by PT associated with SDT seems to have a positive effect on grade and time recovery compared with SDT alone. However, there is very little quality evidence from randomized controlled trials, and such evidence is insufficient to decide whether combined treatment is beneficial in the management of Bell palsy.
Objective: Patients with posttraumatic facial palsy are not homogenous when neuromuscular dysfunction is analyzed and nonselective therapy causes unequal improvement after physical therapy. Study design: Prospective review of patient's records. Setting: Tertiary referral center. Materials and Methods: In order to verify the effects of physical therapy of posttraumatic facial palsy according to the degree of dysfunction, a prospective study on 24 patients was performed by dividing them into four groups: altered initiation of movement, difficulty with facilitation, difficulty with movement control and difficulty with relaxation. Seven patients were previously operated, and the others were treated medicamentously. Interventions: Selective therapy of facial palsy included application of physical procedures and training of facial musculature. Main Outcome Measures: Facial Grading System (FGS) and Facial disability index (FDI) were used for evaluation of treatment. Results: Selective therapy of posttraumatic facial palsy resulted in improvement of all the parameters. The rate of improvement was comparable in FGS and FDI scale. Spontaneous facial nerve recovery showed lower values of improvement for both scales. Significant improvement of selective therapy appeared mostly after 30 days of treatment. Previously operated patients had lower improvement rate. Early selective physical therapy for posttraumatic facial palsy produced significantly better final outcome. Conclusion: Selective and individual approach to physical therapy of posttraumatic facial palsy can have important therapeutical influence on the final outcome. The type and degree of neuromuscular dysfunction must be used for selection of physical therapy.
[Purpose] The present study was designed to evaluate the effect of symmetric self-performed facial muscle exercises on the facial muscle function of patients with facial palsy. [Subjects] The subjects were 26 persons (men=12, women=14) who suffered from facial palsy and were treated by western-oriental medical treatment. [Methods] We educated patients to conduct symmetric self-performed facial muscle exercises three times per day for four weeks by themselves to facilitate neuromuscular function. We evaluated them before and after the exercise period using Yanagihara's Unweighted Grading System and the House-Brackmann Grading System. [Results] After 4 weeks' symmetric self-performed facial muscle exercises, patients showed a significant improvement in facial palsy. The control group also showed a significant improvement. According to both Yanagihara's Unweighted Grading System and the House-Brackmann Grading System, the intervention group showed a greater improvement of scores than the control group. [Conclusion] These results suggest that adding symmetric self-performed facial muscle exercises to the western-oriental medical treatment is a more effective treatment than western-oriental medical treatment alone for recovery from facial palsy.
Background: Ramsay Hunt syndrome (herpes zoster oticus) is characterized by vesicles on the pinna, otalgia, facial nerve palsy and sensorineural hearing loss. It is not such a common dermatological disease like herpes zoster. However, reactivation of the latent varicella zoster virus causes facial palsy and therapeutic onset is one of the prognostic factors in Ramsay Hunt syndrome. Objective: The aim of this study was to elucidate the epidemiology, the clinical characteristics of Ramsay Hunt syndrome and prognosis according to therapeutic ways. Methods: The 84 cases diagnosed as Ramsay Hunt syndrome from January 2000 to July 2007 were assessed in regard to age, sex, clinical characteristics, electromyography (EMG) results, onset of neurological recovery according to medication and onset of rehabilitation therapy by review of medical records. Results: Ramsay Hunt syndrome consisted 4.7% (84 cases of 1787) of total herpes zoster patients. The ratio of male to female patients was 37 : 47, Frequency was slightly higher in female patients. The mean age was 62±14.7 and the age distribution was in the range of 26-87 years. The most common clinical appearance was vesicular eruptions and facical nerve palsy including change in nasolabial fold and location of the lip (73.8%), followed by vesicular eruptions and vestibulocochlear symptoms like tinnitus and vertigo (16.7%), facial nerve palsy and vestibulocochlear symptoms appearing together (9.5%). EMG showed abnormal results in 67.9%, More than one kind of abnormality was commonly observed. The most common abnormal EMG result was fibrillation potential (42.2%), followed by positive sharp wave (31.3%), polyphasia (10.8%), high frequency discharge (8.4%), increased insertional activity (4.8%) and fasciculation (2.5%). There was no significant difference in onset of neurological recovery between acyclovir injections and oral famciclovir or valaciclovir treatment. The patients who had received physical therapy a week after the symptoms had developed, had a faster onset of recovery (2.8 week Vs 4.1 week, p<0.05). Conclusion: This study suggests that antiviral agents of a different kind may not affect recovery onset and earlier rehabilitation therapy seems to be effective in neurological recovery in Ramsay Hunt syndrome.
Rehabilitation takes an important part in the treatment of facial paralysis, especially when these are severe. It aims to lead the recovery of motor activity and prevent or reduce sequelae like synkinesis or spasms. It is preferable that it be proposed early in order to set up a treatment plan based on the results of the assessment, sometimes coupled with an electromyography. In case of surgery, preoperative work is recommended, especially in case of hypoglossofacial anastomosis or lengthening temporalis myoplasty (LTM). Our proposal is to present an original technique to enhance the sensorimotor loop and the cortical control of movement, especially when using botulinum toxin and after surgery.
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Facial nerve palsy is one of the most common diseases in head and neck lesions, and affected patients suffer from facial disfigurement and dysfunction. Since 1980, we have been applying low reactive level laser therapy (LLLT) for patients with facial paralysis. We report herein on the results of a retrospective study concerning those patients in whom LLLT has been applied for peripheral facial paralysis. Seventy-four patients (42 male and 32 female) received LLLT for various entities of facial paralysis over the past 28 years, and included 50 cases with idiopathic facial paralysis, 9 cases with Ramsay-Hunt syndrome, 8 cases of facial and neck tumor, and 7 cases of facial trauma.The overall total improvement rate was 71.4%. No adverse effects were reported in the patients received LLLT for facial paralysis. Among the 4 diagnostic groups, there was no difference in the mean improvement rate. In all patients whose treatment was given within one month of onset was obtained a complete recovery within 4 months. The longer was the period between onset to starting the treatment, the longer was the required therapeutic period. LLLT was effective for facial paralysis in both the acute and chronic phase. LLLT was particularly effective for the acute phase patients whose onset before treatment was 1 month or less. During the period of between 2 months and 6 months from onset, when the injured nerve had the possibility of recovery, LLLT should be performed. In the chronic phase, during the period of over 6 months from onset, LLLT can improve the synkinesis and contracture of the facial muscle. This study is the first report about LLLT for a wide variety of facial paresis. It is not a randomized control study, however, and further study is warranted in order to assess both the efficacy and possible LLLT mechanisms in detail.
Facial paralysis is defined as severe or complete loss of facial muscle motor function.
The study was undertaken to explore a bibliometric approach to quantitatively assess the research on clinical treatment of facial paralysis using rehabilitation, physiotherapy and acupuncture using Web of Science from 1992 to 2011.
Bibliometric approach.
A bibliometric analysis based on the publications on Web of Science was performed using key words such as "facial paralysis", "rehabilitation", "physiotherapy" and "acupuncture".
(1) Research articles on the clinical treatment of facial paralysis using acupuncture or physiotherapy (e.g. exercise, electro-stimulation) and other rehabilitation methods; (2) researches on human and animal fundamentals, clinical trials and case reports; (3) Article types: article, review, proceedings paper, note, letter, editorial material, discussion, book chapter. (4) Publication year: 1992-2011 inclusive. Exclusion criteria: (1) Articles on the causes and diagnosis on facial paralysis; (2) Type of articles: correction; (3) Articles from following databases: all databases related to social science and chemical databases in Web of Science.
(1) Overall number of publications; (2) number of publications annually; (3) number of citations received annually; (4) top cited paper; (5) subject categories of publication; (6) the number of countries in which the article is published; (7) distribution of output in journals.
Overall population stands at 3 543 research articles addressing the clinical treatment of facial paralysis in Web of Science during the study period. There is also a markedly increase in the number of publications on the subject "facial paralysis treatments using rehabilitation" during the first decade of the 21(st) century, except in 2004 and 2006 when there are perceptible drops in the number of articles published. The only other year during the study period saw such a drop is 1993. Specifically, there are 192 published articles on facial paralysis treated by rehabilitation in the past two decades, far more than the output of physiotherapy treatment. Physiotherapy treatment scored only 25 articles including acupuncture treatment, with over 80% of these written by Chinese researchers and clinicians. Ranked by regions, USA is by far the most productive country in terms of the number of publications on facial paralysis rehabilitation and physiotherapy research. Seeing from another angle, the journals that focus on otolaryngology published the most number of articles in rehabilitation and physiotherapy studies, whereas most acupuncture studies on facial paralysis were published in the alternative and complementary medicine journals.
Study of facial paralysis remains an area of active investigation and innovation. Further clinical studies in humans addressing the use of growth factors or stem cells continue to successful facial nerve regeneration.
OBJECTIVES:
This study evaluated the effects of facial stimulation over the superficial muscles of the face in individuals with facial lipoatrophy associated with human immunodeficiency virus (HIV) and with no indication for treatment with polymethyl methacrylate.
METHOD:
The study sample comprised four adolescents of both genders ranging from 13 to 17 years in age. To participate in the study, the participants had to score six or less points on the Facial Lipoatrophy Index. The facial stimulation program used in our study consisted of 12 weekly 30-minute sessions during which individuals received therapy. The therapy consisted of intra- and extra-oral muscle contraction and stretching maneuvers of the zygomaticus major and minor and the masseter muscles. Pre- and post-treatment results were obtained using anthropometric static measurements of the face and the Facial Lipoatrophy Index.
RESULTS:
The results suggest that the therapeutic program effectively improved the volume of the buccinators. No significant differences were observed for the measurements of the medial portion of the face, the lateral portion of the face, the volume of the masseter muscle, or Facial Lipoatrophy Index scores.
CONCLUSION:
The results of our study suggest that facial maneuvers applied to the superficial muscles of the face of adolescents with facial lipoatrophy associated with HIV improved the facial area volume related to the buccinators muscles. We believe that our results will encourage future research with HIV patients, especially for patients who do not have the possibility of receiving an alternative aesthetic treatment.
INTRODUÇÃO: Apesar de o movimento facial e de a atividade muscular poderem ser quantificados por meio de diversas técnicas e de a inabilidade facial poder ser quantificada por meio de questionários de autoavaliação, a relação entre essas medidas objetivas e subjetivas ainda não foi investigada. O objetivo do presente trabalho foi correlacionar dados eletromiográficos dos músculos elevadores do ângulo da boca com o índice de inabilidade facial em pacientes com paralisia facial de longa duração. A hipótese do estudo foi de que indivíduos com maior assimetria facial apresentariam escores menores no índice de inabilidade facial. MÉTODO: A avaliação consistiu na aplicação de uma escala clínica para avaliação da mímica facial, de duas subescalas do Índice de Inabilidade Facial e da realização do exame de eletromiografia de superfície (EMGs). Foram analisados 17 pacientes com paralisia facial de longa duração e os resultados foram comparados ao grupo controle, composto por 17 indivíduos saudáveis pareados por gênero e idade. RESULTADOS: Os participantes do grupo pesquisa apresentaram diferenças significantes entre as hemifaces nas tarefas de repouso e sorriso. O mesmo não foi observado para os participantes do grupo controle. A análise estatística indicou correlação fraca entre os dados da EMGs (assimetria facial) e o Índice de Inabilidade Facial. CONCLUSÕES: O uso de técnicas científicas modernas de análise de dados, como a EMGs, combinadas a medidas de autoavaliação oferece grandes possibilidades para clínicos e seus pacientes. A combinação de diferentes medidas em estudos randomizados que verifiquem o tipo de tratamento que oferece melhor resultado aos pacientes com paralisia facial deverá ser abordada em estudo futuro.
The purpose of this paper is to describe the outcome of facial neuromuscular retraining for brow to oral and ocular to oral synkinesis in individuals with facial nerve disorders. Fourteen patients with unilateral facial nerve disorders and oral synkinesis who were enrolled in physical therapy for retraining were studied. Synkinesis was measured with quantitative video facial position analysis prior to the initiation of physical therapy and at regular intervals during retraining. Retraining included surface electromyographic biofeedback-assisted specific strategies for facial muscle reeducation and a home exercise program of specific facial movements. Twelve of 13 patients with brow to oral synkinesis and 12 of 14 patients with ocular to oral synkinesis reduced their synkinesis with retraining. Patients with a 1-year on greater duration of a facial neuromuscular disorder (excluding patients with unusually marked changes) demonstrated a significant decrease in brow to oral synkinesis and in ocular to oral synkinesis; there was a mean percentage decline in abnormal movement of 60.5 percent (SD = 26.48) and 30.1 percent (SD = 62.57), respectively. We conclude that brow to oral and ocular to oral synkineses associated with partial recovery from facial paralysis were reduced with facial neuromuscular retraining for individuals with facial nerve disorders.
This study investigated the efficacy of a pulsatile electrical current to shorten neuromuscular conduction latencies and minimize clinical residuals in patients with chronic facial nerve damage caused by Bell's palsy or acoustic neuroma excision.
The study group included 12 patients (mean age 50.4 +/- 12. 3 years) with idiopathic Bell's palsy and 5 patients (mean age 45.6 +/- 10.7 years) whose facial nerves were surgically sacrificed. The mean time since the onset of paresis/paralysis was 3.7 years (range 1-7 years) and 7.2 years (range 6-9 years) for the Bell's and neuroma excision groups, respectively. Method And Procedures: Motor nerve conduction latencies, House-Brackmann facial recovery scores, and a 12-item clinical assessment of residuals were obtained 3 months before the onset of treatment, at the beginning of treatment, and after 6 months of stimulation. Patients were treated at home for periods of up to 6 hours daily for 6 months with a battery-powered stimulator. Stimulation intensity was kept at a submotor level throughout the study. Surface electrodes were secured over the most affected muscles. Groups and time factors were used in the analyses of the 3 outcome measures.
No statistical differences were found between the two diagnostic groups with respect to any of the 3 outcome measures. Mean motor nerve latencies decreased by 1.13 ms (analysis of variance test, significant P = 0.0001). House-Brackmann scores were also significantly lower (Wilcoxon signed rank test, P = 0.0003) after treatment. Collective scores on the 12 clinical impairment measures decreased 28.7 +/- 8.1 points after 6 months [analysis of variance test, significant P = 0.0005). Eight patients showed more than 40% improvement, 4 better than 30%, and 5 less than 10% improvement in residuals score.
These data are consistent with the notion that long-term electrical stimulation may facilitate partial reinnervation in patients with chronic facial paresis/paralysis. Additionally, residual clinical impairments are likely to improve even if motor recovery is not evident.
The results of neuromuscular reconstructions of the paralyzed face are difficult to assess. Very sophisticated methods are necessary to measure the motor deficits of facial paralysis or the functional recovery in the face. The aim of this development was a relatively simple system for data acquisition, which is easy to handle and which makes it relatively cheap to delegate data acquisition to centers all over the world, which will not be able to derive a data analysis on their own, but will send their data to a center with specialized equipment. A complex mirror system was developed to get three different views of the face at the same time on the video screen. At each investigation, a digital video is taken from a calibration grid and from standardized facial movements of the patient. Secondary analysis of the digital videofilm is made possible at any time later on by the support of a computer program, which calculates distances and movements three-dimensionally from the frontal image and the right and left mirror images. Pathologies of the mimic movements can be identified as well as improvements after surgical procedures by this system. The significant advantage is the possibility to watch the same movement on the video which is under study and to apply any kind of study later on. Taking the video needs only a few minutes, and fatigue of the patient's mimic system is prevented. Measurements usually at the endpoints of the movements give excellent information on the quantity of the movement or the degree of the facial palsy, whereas the video itself is very informative regarding the quality of the smile. Specific computer software was developed for standardized three-dimensional analysis of the video-documented facial movements and for data presentation. There are options like two-dimensional graphs of single moving points in the face or three-dimensional graphs of the movements of all measured points at the same time during a standardized facial movement. By a comparison of the right- and left-sided alterations of specific distances between two points during the facial movements, the degree of normal symmetry or pathologic asymmetry is quantified. This system is more suitable for detailed scientific multicenter studies than any other system previously established. A very sensitive instrument for exact evaluation of mimic function is now available.