Frequently Asked Questions
What is Facial Retraining?
Facial retraining is a non-invasive, exercise-based form of rehabilitation for the treatment of facial paralysis, weakness, and reanimation and facial transplant procedures. It compliments other medical, surgical, and supportive forms of treatment in the recovery from facial paralysis. It is administered by specially trained (post-graduate study) physical therapists, occupational therapists, or speech language pathologists. It may be referred to as: facial retraining, facial rehabilitation, facial neuromuscular retraining or rehabilitation, f-NMR, or Mime therapy. Read more for a detailed explanation.
Why should I come to Movement Learning Center for my facial retraining?
Whether you have just experienced your first attack of Bell’s palsy, or have undergone a reanimation procedure for facial paralysis, Movement Learning Center (MLC) can help you achieve the maximum return of facial function and expression. MLC is not a typical physical therapy clinic. Read more
What should I expect on my first visit?
You should arrive at your appointment 5-10 minutes in advance, with your pre-admission paperwork completed. You can download the necessary forms under the Client Portal.
Make certain to print out the “Welcome to MLC” letter for a list of items to bring to your appointment.
During your initial visit, we will review your history pertaining to your facial palsy, discuss how this has affected your life and clarify your goals for seeking treatment. You will then undergo an extensive evaluation including both a visual and hands-on assessment of your facial musculature and related functions. Dynamic and still shot videography will also be performed. A neurological screening, as well as special tests may be done to evaluate for any additional problems such as imbalance, jaw pain or clicking, or visual/ocular control. We will then review the our findings and discuss treatment options. Together, we will come up with a treatment plan with realistic and achievable goals.
Also during this initial session, you will receive extensive education in facial anatomy & physiology pertaining to your diagnosis and symptoms, so that you will understand the process of facial nerve recovery and rehabilitation.
How long will my first visit last?
Expect your visit to last from 2-4 hours, closer to 4 hours if you are from out of town.
How often will I need to come?
Since each person’s facial palsy and goals are unique; there is no pre-determined protocol. Each client’s treatment program is guided by his or her specific needs and desires. In most cases, following a concentrated series of visits to complete your evaluation, education, and training in a home activity program, clients need only be seen on a monthly to quarterly basis, eventually extending to semi-annual to annual basis.
How long will I be in treatment?
It is MLC’s goal to teach you everything you need to know to be your own therapist, so that after a certain period of time you will be able to advance your own program, continuing to make progress toward your goals. Depending on the cause of your facial nerve injury, your potential for improvement, and your personal goals, you may be in treatment for only one visit, or for intermittent sessions up to 3+ years. Every case is unique.
Who will see me?
You will be both evaluated and treated by Wanda JK Crook, Facial Rehabilitation Specialist. Unlike some clinics, where you see someone different at each visit, we feel it is vital to your recovery to keep your sessions with the same specialist who knows you and your history well.
I had therapy for my facial palsy before and it did not help; how is MLC different?
Excellent question. f-NMR is a highly specialized form of therapy that is performed by only a handful of physical, occupational, and speech therapists, worldwide. Post-graduate study and training is required to understand the unique nature of the facial nerve and musculature in order to provide appropriate treatment. Standard therapeutic approaches used by therapists, who have not undergone this additional training, are not effective in the rehabilitation of the face and may even be detrimental to your recovery. MLC recommends you contact us to discuss the specifics of your prior treatment to determine if MLC can offer you a more effective approach.
I’ve read conflicting views regarding use of electrical stimulation for facial palsy. What is your philosophy?
At this time, MLC does not support the use of electrical stimulation to denervated (paralyzed) facial muscles as found in cases of Bell’s palsy, injury to the facial nerve from trauma/surgeries, or following certain facial re-animation procedures. Only in cases of centrally mediated facial paralysis (i.e. stroke) will MLC consider the use of neuromuscular electrical stimulation.
Currently, there is no literature demonstrating safe and effective use of electrical stimulation in acute facial nerve palsy. Furthermore, there is non-human animal research evidence showing a detrimental effect to facial recovery when electrical stimulation is applied to denervated facial muscles, especially in the early stages where the nerve is actively healing.
Many studies attributing the recovery from Bell’s palsy to the use of electrical stimulation do not take into account the fact that approximately 86% of individuals who contract Bell’s palsy will fully recover without any intervention. Thus, the apparent success of their intervention could simply be due to the natural course of recovery and not the electrical stimulation.
It is important to understand that the term “electrical stimulation” is extremely broad and ill-defined. The term itself does not delineate the specific type of electrical current, the time parameters, nor the site of application, to name a few variables. Much more research needs to be done in this area before any definitive recommendations can be made.
Use of electrical stimulation to treat facial paralysis is a hotly debated issue in the facial community, and MLC is active in staying abreast of the latest research regarding the effects of electrical current on the healing of facial paralysis.
My physician referred me to a different clinic; can I still come to MLC?
Yes. State and Federal laws prohibit restriction of referral to any specific therapy program or office. By law, you have the freedom to choose where you receive treatment.
Do I need a physician’s referral?
Many states allow you to see a physical therapist without a physician’s referral; this is called “direct access”. For the states of California and Oregon, direct access is in transition.
The State of California currently has limited direct access to physical therapy and requires a physician’s diagnosis before you can receive PT services. Furthermore, most insurance companies require a physician’s prescription for reimbursement for PT services. MLC/San Diego recommends you contact your insurance company directly to determine if a physician’s prescription is required.
The State of Oregon allows direct access to physical therapy without physician’s referral, and allows for treatment up to 60 days before requiring a physician’s order to continue treatment beyond the initial 60 days. However, many insurance companies still require that you have a physician’s prescription, even for the evaluation, in order to receive reimbursement for the PT services. MLC recommends you contact your insurance company directly to determine if a physician’s prescription is required.
I haven’t seen my doctor for my facial palsy for several years; is this a problem?
Rarely. If you have seen your primary physician within the last year, chances are he or she is familiar with your facial palsy and will gladly write a prescription.
I’d like to come for facial retraining, but my doctor doesn’t think it will help and won’t refer. What can I do?
Doctors often have misconceptions about facial retraining. Usually, they simply have very limited knowledge about this type of service due to f-NMR being a highly specialized area of rehabilitation services. Your physician is wise to not send you to a service they know little about – so do not be upset with them about this. MLC is highly interested in educating our physician community and we encourage you to refer your physician to this website (see section under “For Practitioners”), or to contact us directly, to learn how this service can benefit their patients. If your physician refuses to do this, email us your physician’s name and phone number and we will attempt to contact him/her.
Do you have flexible hours?
Yes, absolutely. MLC is pleased to accommodate the scheduling requirements of out-of-town clients and those unable to take off from work. Weekend and late afternoon hours are available by prior arrangement. Skype video-conferencing is also available for selected follow-up visits for those unable to come to the clinic.
I live out-of-state; how do you work with clients like me?
A significant portion of our clientele is from out of the area. MLC will design an evaluation and treatment regime that fits your schedule. The evaluation and initial training will need to be done in-person, in our clinic, and can be arranged to occur over a 2-3 day period. Subsequent sessions can be done remotely over video-conferencing (Skype) with in-clinic visits reduced to once every 3-6 months. Weekend appointments are available, especially for out-of-town clients. MLC has a list of lodging establishments that are near our office sites. Go to our Out of Town Clients link for more information.
Will my insurance cover the costs of treatment?
Typically, yes. It has been MLC’s experience that all major insurance companies recognize facial retraining as a reimbursable service. The amount of coverage is highly dependent upon your specific insurance plan’s coverage for physical therapy and if we are considered an in-network or out-of-network provider. MLC has an Insurance Verification form to assist you in discussing your specific coverage with your insurance company.
Issues with payment can arise if you are limited by the contract with your HMO or PPO as to where you can receive reimbursable treatment (Kaiser Permanente being one example). Medicare also will only cover services by therapists directly contracted with Medicare.
Since f-NMR is a highly specialized form of therapy, which is not readily available in the United States, or worldwide, clients have successfully appealed to their insurance company for special consideration to receive coverage for these services under the in-network provider rate, even with HMOs. It may be well worth your time to have an in-depth conversation with your insurance company explaining both your needs and the lack of a specially trained therapist either within your area or within the insurance plan’s list of in-network providers. This may maximize your reimbursement.
Do you accept insurance?
MLC is contracted with a select number of insurance companies. Go to the Fees and Insurance link for full details.
Do you accept Medicare?
No. MLC (San Diego and Portland) is not contracted with Medicare. Unfortunately, due to federal laws, you, the Medicare beneficiary, are unable to receive services thru MLC. Even if you wished to private pay, it is illegal for physical therapists to accept fee-for-service from Medicare recipients.
What if I want to receive Botox® injections, do you do this?
No. Physical Therapists are not licensed to provide Botox®. MLC strongly recommends clients who wish to receive Botox® injections receive this service only from highly skilled physicians specializing in the treatment of facial palsy. The physician should have extensive practice in the use of Botox® and other chemo-denervating substances to the face. MLC collaborates with several physicians in both the Southern California and the Portland, Oregon area for administering Botox in coordination with your f-NMR treatments. If you have a physician you are currently using or desire someone closer to home, MLC will gladly work together with your physician-of-choice.
Can Facial Retraining help me if I have had a stroke?
Yes. While the source of the facial paralysis or weakness from a stroke originates from different neural centers than found in Bell’s palsy, many of the same rehabilitation techniques can be applied and be of benefit to the client.
For further information, you may contact us directly via phone or email.