Rehabilitation Of Facial Paralysis Research Articles

Effectiveness of Hypoglossal-Facial Anastomosis in the Rehabilitation of Facial Paralysis Following Vestibular Schwannoma Surgery: A Systematic Review.

The facial nerve plays a crucial role in facial expression and sensory functions, with irreversible injuries often demanding rehabilitation therapies, with hypoglossal-facial nerve anastomosis (HFA) being one of the treatment options. This systematic review assessed different HFA techniques for facial paralysis, particularly post vestibular schwannoma resection, focusing on effectiveness and associated morbidities. Fifteen studies, comprising a case series and a retrospective cohort, were analyzed. Techniques included end-to-end, split, side-to-side, end-to-side, and jump interpositional graft hypoglossal-facial anastomosis (JIGHFA). Positive outcomes were observed with end-to-end and side-to-side techniques, while the split technique and JIGHFA showed promise. Comparative analyses favored the 'end-to-side' approach. Shorter intervals between surgery and HFA correlated with improved outcomes. Methodological variations highlight the need for prospective studies with standardized methodologies for robust evidence and informed decision-making on optimal HFA techniques.

Facial expression detection using posterior-auricular muscle surface-electromyographic activity

IntroductionFollowing 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 methodsPAMs 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. ResultsPAMs 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%). ConclusionThis 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.

Research progress of Traditional Chinese Medicine nursing in rehabilitation of peripheral facial paralysis

Research progress of Traditional Chinese Medicine nursing in rehabilitation of peripheral facial paralysis

Review of Drug Therapy for Peripheral Facial Nerve Regeneration That Can Be Used in Actual Clinical Practice.

Although facial nerve palsy is not a life-threatening disease, facial asymmetry affects interpersonal relationships, causes psychological stress, and devastates human life. The treatment and rehabilitation of facial paralysis has many socio-economic costs. Therefore, in cases of facial paralysis, it is necessary to identify the cause and provide the best treatment. However, until now, complete recovery has been difficult regardless of the treatment used in cases of complete paralysis of unknown cause and cutting injury of the facial nerve due to disease or accident. Therefore, this article aims to contribute to the future treatment of facial paralysis by reviewing studies on drugs that aid in nerve regeneration after peripheral nerve damage.

Masseteric nerve position on the "temporomandibular joint-chin tip" artificial axis: an anatomical study.

The use of the masseteric nerve develops in the surgery of facial paralysis rehabilitation. The objective of this study was to determine the topography of the masseteric nerve and to deduce and predict a precise and reproducible anatomical cluster to facilitate its clinical identification during V-VII neurotization surgery. For the purpose of this work, a cadaveric study was performed on 31 hemi-faces. All dissections were performed bilaterally and comparatively, following steps aiming at simulating, as close as possible, the clinical conditions of a facial palsy rehabilitation by V-VII anastomosis. For the identification of the masseteric nerve, bony reference points were used, i.e., the temporomandibular joint (TMJ) and the chin point (CT). A virtual axis was drawn between the TMJ and the CT, and the distance [TMJ-MN] determining the smallest length h was then plotted against the distance [TMJ-CT] determining the largest length H, thus allowing the calculation of an h/H proportion ratio (PR) indicating the proximal part of the masseteric nerve from the TMJ. The average length h between the TMJ and the NM was 3.5cm (± 0.1cm) from the TMJ, i.e., an average ratio h/H [TMJ-MN]/[TMJ-CT] of 28.1% 4.0 and a median ratio of 28.6% of the distance [TMJ-CT]. Our study opens new perspectives for facilitating its identification and use, offering practitioners a tool to make V-VII the neurotization procedure less complex, with the eventual prospect of a minimally invasive procedure combining imaging, surgery, and augmented reality.

Masseteric nerve transference with sling tendon for symmetry in the restoration of facial paralysis: An effective combination of dynamic and static correction

Masseteric nerve transposition has shown to be an effective technique for the treatment of facial paralysis. Due to its low morbidity at the donor site, its consistent anatomy, and one-stage operation, it constitutes a reliable option for both complete and incomplete facial paralysis. Masseteric nerve transference has proven to achieve good commissural excursion and dynamic symmetry. However, some patients with heavy faces and complete facial paralysis recover incompletely after surgery characterized by an asymmetrical smile with asymmetry at rest, affecting the cosmetic appearance. For these patients, we propose a novel combination of masseteric nerve transposition for the dynamic rehabilitation of the smile with a tendon sling suspension to create symmetry at rest. A detailed description of the surgical technique is given and results after using it with eight patients show good functional and aesthetic satisfaction. A combination of both dynamic and static techniques for complete facial paralysis rehabilitation may provide adequate symmetry with the contralateral healthy side both at rest and when smiling.

Therapists’ perceptions and attitudes in facial palsy rehabilitation therapy: A mixed methods study

ABSTRACT Background Facial palsy rehabilitation therapy plays an essential role in treating facial palsy. Purpose This study aimed to gain insight into therapists’ perceptions and attitudes toward facial palsy rehabilitation therapy and to examine whether therapists could be categorized into distinct groups based on these attitudes and perceptions. Methods Thirteen semi-structured, in-depth interviews were conducted in a purposive sample of therapists. Interviews were analyzed using thematic analysis. Next, a questionnaire containing questions about therapists’ characteristics and perceptions and attitudes toward facial palsy rehabilitation therapy was sent to all facial palsy rehabilitation therapists in the Netherlands and Flanders (n = 292). Latent class analysis (LCA) was performed to identify and analyze distinct groups of therapists. Results Seven themes were derived from the interviews: treatment goals, therapy content, indications, measurement instruments, factors influencing success, emotional support, and cooperation with colleagues. The questionnaire was filled out by 127 therapists. A 2-group structure consisting of a positive class and a negative class was found to fit the questionnaire data best. No distinction could be made regarding therapists’ characteristics. Conclusion Considerable variation in stated treatment practices was present among therapists. Therapists could be classified into 2 groups. This study raises several hypotheses that require further study.

Rehabilitation of unilateral peripheral facial paralysis in Guillain-Barré: a case study

ABSTRACT Facial palsies have multiple etiologies, but have in common the negative impact not only on the functions of the stomatognathic system but also on the self-image and emotional expression. This article aimed to describe a case study of unilateral peripheral facial palsy caused by the Guillain-Barré Syndrome. Hence, it shares assessment and intervention experiences related to this type of change and presents its functional results. It also highlights the important role of the interdisciplinary team (which comprised a physiatrist, physical therapist, speech-language-hearing therapist, occupational therapist, and nurses) to catalyze the patient’s evolution and the management of possible complications. Moreover, it is rather important to integrate the patients as members of the rehabilitation team, empowering them and giving them responsibility for the success of the intervention.

Effectiveness of Kinesio taping on peripheral facial paralysis

Peripheral facial paralysis is a rapid unilateral facial paralysis or paralysis of unknown etiology. Nearly 30% of patients leave sequela that have a negative impact on the patient's quality of life, both physically and psychologically. As its safety, convenience and effectiveness, Kinesio taping has been gradually used in the rehabilitation of peripheral facial paralysis. However, whether Kinesio taping is effective for peripheral facial paralysis is still unknown. The purpose of this systematic review (SR) and meta-analysis will summarize the current evidence of Kinesio taping used as an intervention for peripheral facial paralysis.We will search the following electronic databases for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) to evaluate the effectiveness of Kinesio taping in treating peripheral facial paralysis: China National Knowledge Infrastructure (CNKI), Wanfang Date, SinoMed, Technology Periodical Database (VIP), PubMed, Embase, Web of Science, and The Cochrane Library. Each database will be searched from inception to April 2020. Studies that present clear descriptions of Kinesio taping in treating peripheral facial paralysis administration are published in peer-reviewed journals in any languages and are published in full will be taken into consideration. The entire process will include study selection, data extraction, risk of bias assessment and meta-analyses. Assessment of risk of bias and data synthesis will be conducted using Review Manager 5.3 software.The current evidence on the Kinesio taping for managing peripheral facial paralysis will be illustrated using subjective reports and objective measures of performance. The primary outcome is the effective rate. Secondary outcomes include House-Brackmann scale, Portmann score, facial nerve conduction velocity, Facial Disability Index, Facial Disability Index include Facial Function score and social Function score.This protocol will present evidence on the efficacy of Kinesio taping in relieving peripheral facial paralysis.Since all the data used in this SR and meta-analysis have been published, ethical approval is not required for this review. The results of this SR will be published in a peer-reviewed journal or presented at conferences. INPLASY ID:: (INPLASY2020100008).

Use of Elastic Bandage in the Rehabilitation of the Facial Paralysis: Case Report

AbstractThe therapeutic action before the rehabilitation of facial paralysis has used various resources, among them the application of elastic bandage. The use of the same has become increasingly more frequent in speech-language rehabilitation, with findings of positive results, including cases of facial paralysis. The objective of this study was to describe the effects of the application of elastic bandage in an adult patient with facial paralysis after stroke. Type of study: case report. Male patient, 68 years old, was evaluated with facial paralysis in the left hemiface after three years of episode of stroke. At the beginning of the intervention, he presented central facial paralysis on the left, with a reduction in the amplitude of contraction of the risorius and zygomatic muscles. In addition, he presented hyper-reactivity of the right facial muscles, with compensatory movements. The therapy had a duration of 45 minutes and a frequency of twice a week, with a total duration of two months. Massage facilitator of neuromuscular proprioception, functional exercises and application of elastic bandage at the end of each session were carried out. The application occurred in the two facial hemispheres, with the aim of stimulating the movement of the paralyzed side and inhibiting the compensatory movements and the hyperactivity of the healthy side. Improvement of the range of movement of the muscles of the paralyzed side and reduction of compensatory movements of the contralateral side were verified, resulting in greater facial symmetry. It was concluded that the application of elastic bandage, associated with other techniques of speech therapy, promoted the optimization of the facial movements of adult patients with facial paralysis after three years of stroke. Keywords: Athletic Tape. Facial Paralysis. Speech. Resumo A atuacao terapeutica frente a reabilitacao da paralisia facial tem utilizado de diferentes recursos, dentre eles a aplicacao da bandagem elastica. O uso desta tem se tornado cada vez mais frequente na reabilitacao fonoaudiologica, com constatacoes de resultados positivos, incluindo casos de paralisia facial. O objetivo desse estudo foi descrever os efeitos da aplicacao da bandagem elastica em um paciente adulto com paralisia facial apos acidente vascular encefalico. Tipo de estudo: relato de caso. Foi avaliado paciente sexo masculino, 68 anos de idade, com paralisia facial em hemiface esquerda apos tres anos de episodio de acidente vascular encefalico. No inicio da intervencao, apresentava paralisia facial central a esquerda, com reducao da amplitude de contracao dos musculos risorio e zigomatico. Alem disso, apresentava hiper-reatividade da musculatura facial direita, com movimentacoes compensatorias. A terapia apresentava duracao de 45 minutos e frequencia de duas vezes por semana, com duracao total de dois meses. Foram realizados: massagem facilitadora de propriocepcao neuromuscular, exercicios funcionais e aplicacao de bandagem elastica no fim de cada sessao. A aplicacao ocorreu nas duas hemifaces com o objetivo de estimular o movimento do lado paralisado e de inibir os movimentos compensatorios e a hiperatividade do lado saudavel. Foram verificados melhora da amplitude de movimento da musculatura do lado paralisado e reducao dos movimentos compensatorio do lado contralateral, resultando em maior simetria facial. Concluiu-se que a aplicacao da bandagem elastica, associada as demais tecnicas de fonoterapia, promoveu a otimizacao da movimentacao facial de paciente adulto com paralisia facial apos tres anos de acidente vascular encefalico. Palavras-chave: Fita Atletica. Paralisia Facial. Fala.

Motor Imagery in Facial Palsy Rehabilitation

Intentional facial expression of emotion named facial mimic is critical to healthy social interactions. Psychological and functional implications of the facial paralysis present a devastating management problem to patients afflicted because their face have an important challenge of facial muscles that are fundamental also for affective communication

Role for 2D image generated 3D face models in the rehabilitation of facial palsy.

The outcome for patients diagnosed with facial palsy has been shown to be linked to rehabilitation. Dense 3D morphable models have been shown within the computer vision to create accurate representations of human faces even from single 2D images. This has the potential to provide feedback to both the patient and medical expert dealing with the rehabilitation plan. It is proposed that a framework for the creation and measuring of patient facial movement consisting of a hybrid 2D facial landmark fitting technique which shows better accuracy in testing than current methods and 3D model fitting.

Effectiveness of electrical stimulation for rehabilitation of facial nerve paralysis

Background: Despite no significant advantage being demonstrated for its use and no standardization of treatment guidelines, electrical stimulation is still applied by therapists to treat facial paralysis. The aim of this investigation was to determine whether electrical stimulation therapy for patients with acute or chronic facial nerve paralysis improves time to, and rates of full recovery and facial function compared with no intervention. Method: A systematic review of randomized and quasi-randomized controlled trials through Scopus, Medline, PEDro, Embase, CINAHL, Pubmed, and Cochrane Library search engines for studies published up until August 2016. Reference lists were reviewed for further studies. Review Manager was used to extract data and review quality of the studies. Studies were assessed for randomization of participants, allocation concealment, blinding of participants, assessors and physiotherapists, presence and reporting of outcome data. Results: Five studies were included for analysis – four during acute recovery and one in chronic facial nerve paralysis. In acute facial nerve paralysis, two studies found no benefit of electrical stimulation and two studies found improvement. A meta-analysis on changes in the House–Brackmann Score after treatment, rates of full recovery and time to full recovery showed no statistically significant difference between intervention and control groups. In chronic facial nerve paralysis, one study found improvements after extensive electrical stimulation on the Facial Paralysis Recovery Profile. Conclusions: There is no evidence to support the use of electrical stimulation during the acute phase of recovery after Bell’s palsy and there is low-level evidence for patients with chronic symptoms. Furthermore, there is no evidence available on the use of electrical stimulation for other causes of facial nerve paralysis.

Spontaneity of smile after facial paralysis rehabilitation when using a non-facial donor nerve.

The current focus in dynamic reanimation of facial paralysis lies not only in restoring movement but also regaining smile spontaneity. It has been argued that a spontaneous smile can only be achieved using the contralateral facial nerve as donor via cross-face nerve grafting. Techniques based on the motor nerve to the masseter, however, have shown good rates of spontaneity as well. Patients with complete facial paralysis reanimated using free gracilis to masseteric nerve or masseteric-to-facial nerve transfer were included. Patients were grouped according to gender comparing the rates of spontaneous smile. Thirty-six patients (17 women and 19 men) underwent gracilis innervated by the masseteric nerve whereas masseteric-to-facial nerve transfer was performed in 30 cases (14 women and 16 men). For both techniques, women showed significantly higher rates of spontaneity. Additionally, women recovered spontaneity earlier than men. Along with providing a strong and reliable commissural pull, the motor nerve to the masseter is able to restore spontaneity as well. Women seem more prone to achieving it. Brain plasticity and the close relationship between the cortical areas of the masseteric and facial nerves are most likely the mechanisms underlying smile spontaneity.

Temporalis pull-through vs fascia lata augmentation in facial reanimation for facial paralysis

Objectives:Surgical rehabilitation of facial palsy is challenging as each case is unique and success rate is often unpredictable. In one technique, temporalis is elevated from origin preserving vessels, and this elevation increases the length which is tunneled into buccal tissues (pull-through technique, Group A). In the other technique, a harvested fascia lata is attached to temporalis after a coronoidectomy release and the fascia lata is attached to the modiolus (Group B). The aim of this study is to compare the two different surgical techniques.Materials and Methods:Case records of 22 cases, 15 females, and 7 males who were operated between 2008 and 2012 for facial palsy with at least 1-year follow-up, using either of the techniques were assessed for pull of muscle, postoperative pain, recovery time, motor control, and symmetry at rest. Descriptive statistics are presented.Results:The Group A (n = 7) and Group B (n = 15) formed the study group. In the Group A, residual asymmetry (n = 3), poor postoperative muscle pull (n = 2) were noticed while in the modified group it was 2 and 3, respectively. The technique used in Group B had better pull of muscle, symmetry, faster recovery time, and better motor control at 1-year follow-up than the conventional technique.Discussion and Conclusion:The difference between the two groups is due to preservation of original muscular architecture, vascular channel supply. As the muscle is not traumatized, no fibrosis occurs aiding regaining of normal function. In addition, the facial reanimation is more successful in the Group B. The mechanism and success behind the technique used in Group B is discussed elaborately in terms of localregional anatomy and physiology

Functional and anatomical basis for brain plasticity in facial palsy rehabilitation using the masseteric nerve

Several techniques have been described for smile restoration after facial nerve paralysis. When a nerve other than the contralateral facial nerve is used to restore the smile, some controversy appears because of the nonphysiological mechanism of smile recovering. Different authors have reported natural results with the masseter nerve. The physiological pathways which determine whether this is achieved continue to remain unclear. Using functional magnetic resonance imaging, brain activation pattern measuring blood-oxygen-level-dependent (BOLD) signal during smiling and jaw clenching was recorded in a group of 24 healthy subjects (11 females). Effective connectivity of premotor regions was also compared in both tasks. The brain activation pattern was similar for smile and jaw-clenching tasks. Smile activations showed topographic overlap though more extended for smile than clenching. Gender comparisons during facial movements, according to kinematics and BOLD signal, did not reveal significant differences. Effective connectivity results of psychophysiological interaction (PPI) from the same seeds located in bilateral facial premotor regions showed significant task and gender differences (p<0.001). The hypothesis of brain plasticity between the facial nerve and masseter nerve areas is supported by the broad cortical overlap in the representation of facial and masseter muscles.

Modified Technique for Rehabilitation of Facial Paralysis Using Autogenous Fascia Lata Grafts

In this retrospective study we used a modified surgical technique for midface reanimation in patients with facial nerve paralysis. Facial atonicity can cause functional impairment regarding speech articulation, oral competence, breathing, and eyelid closure. Furthermore, esthetic and psychological aspects play an important role in patients' emotional interaction and social integration. The chosen rehabilitative technique should offer support against prolapse of facial structures and remedy of functional disabilities and, thereby, prevention of social stigmatization due to disease-related changes in appearance. Between 2005 and 2013, fascia lata grafts were used as static support in 15 cases of unilateral facial paralysis. Two fascia lata grafts were subcutaneously inserted in the upper and lower lips crossing the midline and sutured at 4 points, including the unaffected part of the orbicularis oris muscle and modiolus. The slings were suspended against the zygomatic arch with an osteosynthesis plate. The patients perceived surgery results as considerably improving their appearance, speech, and alimentation. In 93.3% of cases, no postoperative complications occurred. The follow-up results (8 months to 8 years) remained stable. This retrospective study showed the advantages of static facial reanimation in appropriate cases. The bony fixated support of the fascial slings allows an immediate improvement of facial symmetry. Additional attachment points including the unaffected part of the orbicularis oris muscle and the use of 2 independent fascia lata slings allow a more accurate adjustment of suspension forces and an incomplete dynamic reanimation of the mouth corner. With respect to its simplicity and minimal invasiveness, this surgical procedure is associated with low morbidity and rapid improvement of the patient's esthetic appearance.

Analysis of mimic facial movements based on motion capture

Mimic facial expressions and emotions represent one of the most important human skills of nonverbal communications [1, 2]. In pathological situations which include facial disorders, in facial palsy rehabilitation or in the new field of facial transplantation, it is important to have accurate knowledge and measurement data of this particular movement. Thus, the biomechanical understanding of this skill might help clinicians and physiotherapist in their endeavour. In fact, until now, facial mimic disorders diagnosis and rehabilitations are based on qualitative and subjective observations [3].

Robot Assisted Physiotherapy to Support Rehabilitation of Facial Paralysis

We have been developing the Robot Mask with shape memory alloy based actuators that follows an approach of manipulating the skin through a minimally obtrusive wires, transparent strips and tapes based pulling mechanism to enhance the expressiveness of the face. For achieving natural looking facial expressions by taking the advantage of specific characteristics of the skin, the Robot Mask follows a human anatomy based criteria in selecting these manipulation points and directions. In this paper, we describe a case study of using the Robot Mask to assist physiotherapy of a hemifacial paralyzed patient. The significant differences in shape and size of the human head between different individuals demands proper customizations of the Robot Mask. This paper briefly describes the adjusting and customizing stages employed from the design level to the implementation level of the Robot Mask. We will also introduce a depth image sensor data based analysis, which can remotely evaluate dynamic characteristics of facial expressions in a continuous manner. We then investigate the effectiveness of the Robot Mask by analyzing the range sensor data. From the case study, we found that the Robot Mask could automate the physiotherapy tasks of rehabilitation of facial paralysis. We also verify that, while providing quick responses, the Robot Mask can reduce the asymmetry of a smiling face and manipulate the facial skin to formations similar to natural facial expressions.

Comparison of Hemihypoglossal Nerve versus Masseteric Nerve Transpositions in the Rehabilitation of Short-Term Facial Paralysis Using the Facial Clima Evaluating System

Masseteric and hypoglossal nerve transfers are reliable alternatives for reanimating short-term facial paralysis. To date, few studies exist in the literature comparing these techniques. This work presents a quantitative comparison of masseter-facial transposition versus hemihypoglossal facial transposition with a nerve graft using the Facial Clima system. Forty-six patients with complete unilateral facial paralysis underwent reanimation with either hemihypoglossal transposition with a nerve graft (group I, n = 25) or direct masseteric-facial coaptation (group II, n = 21). Commissural displacement and commissural contraction velocity were measured using the Facial Clima system. Postoperative intragroup commissural displacement and commissural contraction velocity means of the reanimated versus the normal side were first compared using a paired sample t test. Then, mean percentages of recovery of both parameters were compared between the groups using an independent sample t test. Onset of movement was also compared between the groups. Significant differences of mean commissural displacement and commissural contraction velocity between the reanimated side and the normal side were observed in group I but not in group II. Mean percentage of recovery of both parameters did not differ between the groups. Patients in group II showed a significantly faster onset of movement compared with those in group I (62 ± 4.6 days versus 136 ± 7.4 days, p = 0.013). Reanimation of short-term facial paralysis can be satisfactorily addressed by means of either hemihypoglossal transposition with a nerve graft or direct masseteric-facial coaptation. However, with the latter, better symmetry and a faster onset of movement are observed. In addition, masseteric nerve transfer avoids morbidity from nerve graft harvesting. Therapeutic, III.