Facial Neuromuscular Retraining for Oral Synkinesis

Abstract

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.

Paralisia facial periférica: atividade muscular em diferentes momentos da doença

“…PFP may result in physical, psychological, social, aesthetic, and functional disorders, once it adversely affects facial expressions (nonverbal communication) and may cause changes in the orofacial functions (7) . Studies indicate that patients with axonal loss may more often present sequelae and functional adaptations (8,9) . The sequelae occur because of the supernumerary recovery of nerve fibers, with flaws in the transmission between axons or nuclear hyperexcitability (8,9) .…”

“…Studies indicate that patients with axonal loss may more often present sequelae and functional adaptations (8,9) . The sequelae occur because of the supernumerary recovery of nerve fibers, with flaws in the transmission between axons or nuclear hyperexcitability (8,9) . The most frequent sequelae are the synkinesis, characterized by an involuntary movement in association with a voluntary movement of distinct and independent muscles groups, for example, the involuntary closing of eyes when attempting to smile, voluntary movement of the forehead or eyes along with movements of the perioral region, or excessive tearing during activities such as chewing (9) .…”

Electromyography and Facial Paralysis

“…In this sense, surface electromyography (sEMG) can give clinicians valuable information because it provides easy access to physiological processes that cause muscle to generate force, produce movement and accomplish the countless functions which allow us to interact with the world around us (De Luca, 1997). Studies have already been successful in reporting the outcome of neuromuscular retraining in combination with sEMG (Daniel & Guitar, 1978;Balliet et al, 1982;May et al, 1989;Ross et al, 1991;Segal et al, 1995;Brach et al, 1997;Cronin & Steenerson, 2003;VanSwearingen & Brach, 2003;Vaiman et al, 2005). Biofeedback sEMG instruments are essentially general purpose physiological monitoring devices that are designed to provide ongoing information about physiological function, such as muscle tension level (Vaiman et al, 2005).…”

Ophthalmic management of facial nerve palsy

“…These exercises may be enhanced using surface EMG biofeedback, 60 and may be particularly useful for disfigurement from facial synkinesis. 61 …”