Effective Rehabilitation

for Patients with

 

 

Facial Nerve Paralysis

 

 

 

Facial Neuromuscular Retraining Program

 

Facial nerve rehabilitation continues to be one of the most under-treated areas of rehabilitation.  Approximately 25% to 30% of patients with Bell’s palsy and many acoustic neuroma patients are left with incomplete facial nerve function. Facial nerve paresis can also occur after tumor excision surgery.  Problems such as synkinesis, mass uncontrollable action of facial muscles create not only cosmetic inconvenience but also functional deficits with eating, drinking and, most importantly, communication.

 

Traditional therapy techniques such as electrical stimulation and gross facial exercises have been widely use in the treatment of facial paralysis even though there is evidence that this is ineffective and even contraindicated. Waxman in 19841 and Cohan in 19862  have suggested that electrical stimulation may interfere with neural regeneration and studies proving its efficacy are also lacking in the literature.  Balliet’s article in 19853 also demonstrated that gross non-specific facial exercises typically given to patients reinforce abnormal movement patterns.

 

 

Treatment Program

 

Facial neuromuscular retraining program is a problem solving approach to treatment using selective motor training to facilitate symmetrical facial movements and control undesired gross motor activity. 

 

Evaluation methods include:

¨      International Facial Grading Scale

¨      Facial Grading System,

¨      Videotape and photographic  assessment

¨      Postural scan

¨      Surface EMG analysis

 

Treatment may include:

¨      Surface EMG biofeedback

¨      Specific mirror exercises

¨      Relaxation Strategies

¨      Postural education

¨      Exteroceptive and proprioceptive techniques

¨      Patient education

¨      Individualized home program

 

 

Clinical Studies

 

In 1982, Balliet et al. described a comprehensive clinical program that combined EMG feedback, mirror exercises and a detailed home exercise program and demonstrated improved function with patients with more than two years post facial nerve injury. 4 

 

In 1991, Ross et al. compared two treatment groups with a third control group that received no treatment. 5  All patients were more than 18 months post Bell’s palsy or acoustic neuroma excision with facial nerve paresis.  One group was treated with EMG feedback and mirror exercises, the second group received mirror exercises alone and the third group had no treatment. Patients in both treatment groups demonstrated improvement in facial motor control, excursion of movement and decreased synkinesis.  The control group showed no change.  A follow-up study one year later showed that the gains were maintained without continued treatment.

 

 

1         Waxman B: Electrotherapy for Treatment of Facial Nerve Paralysis (Bell’s palsy). Health Technology Assessments Reports, National Center for Health Services Research 1984; 3:27

 

2         Cohan CS, Kater SB: Suppression of neurite elongation and growth cone motility by electrical activity. Science 1986; 232:1638-1640

 

3         Balliet R, Lewis L: Hypothesis: Craig’s “face saving exercises” may cause facial dysfunction. Canadian Acoustic Neuroma Association Connection, 1985

 

4         Balliet R, Shinn JB, Bach-y-Rita P: Facial paralysis rehabilitation: Retraining selective muscle control. Int Rehab Med, 1982; 4:67-74.

 

5         Ross B, Nedzelski JM, McLean JA: Efficacy of feedback training in long-standing facial nerve paresis. Laryngoscope 1991; 101(7):744-750.

 

 

 

Indications for Referral

 

 

Bell’s Palsy

Ramsey Hunt Syndrome

Traumatic Facial Nerve Injury

Post-surgical tumor resection

(Acoustic neuroma, meningioma, facial nerve neuroma)

Congenital paralysis

Carcinoma

Post-operative repairs

(Neural anastomosis, facial nerve graft)

 

§      Patients with any of these conditions may benefit from facial retraining techniques, even years after facial nerve involvement.

§      In the early stages, regular follow-up with a facial nerve specialist (physician and/or therapist) will ensure that if facial rehabilitation is appropriate, it will be started at the optimal time.

§      It is necessary that there is some nerve recovery/muscle contractions prior to commencing facial movement retraining.

 

 

 

 

Therapists:

 

Joanne Dorion, a registered physiotherapist received her BSc. PT from McGill University in 1982.  She has extensive clinical experience in facial neuromuscular retraining and is also involved in the education of health care professionals in the area of facial retraining.

 

Sylvia Loong, a facial therapist graduated from Queen’s University in 1989 and has completed specialized training in facial neuromuscular retraining at Sunnybrook Health Science Centre, University of Toronto.

 

 

Treatment Locations:

 

 

East York Physiotherapy Centre

294 Main St Suite 202, Toronto, ON

M4C 4X5

Tel:(416) 768-1852

 

 

 

 

 

Back In Action Physiotherapy

292 Main St N, Markham Ontario

L3P 1Y8

Tel:      (905) 472-8978

Fax:     (905) 472-6638

 

Email:   general@backinactionphysio.com

Web:  http://www.backinactionphysio.com