by Wanda JK Crook, PT, GCFP
Understanding facial paralysis is appreciating the significant impact that loss of facial expression and function can have on your physical, psychological, and social well-being. Living with a potential risk of impaired vision, difficulties in eating, the inability to smile at your new-born, and your co-workers asking “Why do you always look mad?” can take a devastating toll on your quality of life.
Your facial rehabilitation specialist is aware of the pervasive, life-altering effects of facial paralysis and will empower you with the knowledge and skills necessary to restore maximal facial function. By achieving improved facial symmetry, ocular and oral-motor control, and a return of effective facial expression (an important component of non-verbal communication), you will experience a recovery of your self image and social interactions.
What is Facial Neuromuscular Rehabilitation?
Facial neuromuscular rehabilitation (fNMR) is one component of a multidisciplinary team approach to the treatment of facial nerve palsy and its subsequent effects. Its synonyms include facial neuromuscular re-education, facial retraining, and Mime Therapy. It is typically administered by a physical, occupational, or speech therapist with advanced training in this specialized approach to treating facial paralysis.
Facial NMR is an evidence-based therapeutic practice utilizing specific movement training techniques to optimize facial muscular control.1-6 To affect functional recovery, facial NMR combines the knowledge of: 1) motor learning, 2) neural plasticity (the ability of the brain to reprogram for new movements), and 3) the unique nature of the facial neuromuscular system. fNMR is an educational process utilizing both sensory feedback with focused, coordinated, movement activities to facilitate the return of desired facial movement patterns and to inhibit unwanted or abnormal facial expressions.
How do I get started?
Before beginning facial NMR, a thorough medical assessment of your facial paralysis by a physician specializing in facial nerve dysfunction is strongly recommended. For facial NMR to be effective, disease processes must be stabilized, and the facial nerve must be intact or surgical reanimation completed before initiating therapy.
Facial rehabilitation begins with a comprehensive evaluation which includes:
- A thorough review of all pertinent medical records.
- An assessment of your current facial function and recovery status for:
- Eye closure and eye care,
- Oral-motor skills for eating, drinking, and speech,
- Social & emotional well-being,
- Analyzing the degree of symmetry and muscle function during the formation of basic facial expressions.
- Video and still-shot photography of both spontaneous and voluntary facial movements.
- Surface EMG (if applicable), to augment the evaluation.
- Education in facial anatomy and physiology as it relates to your diagnosis, medical and surgical interventions (if applicable) and the process of recovery.
- A discussion of treatment options.
- Establishment of realistic goals and an individualized treatment plan.
Facial NMR is effective even decades after the onset of injury.
Therapy in the acute stage focuses on education in self-care strategies for both prevention of secondary problems and promotion of maximal functional recovery as the facial nerve heals.
In the post-acute to chronic stages, months to years from the onset of the paralysis, therapy focuses on reducing muscle spasms and abnormal movements, promoting facial symmetry, and achieving selective muscle control for desired facial expression and function.
Clinic sessions are conducted in a relaxed, private, and supportive environment to facilitate a successful learning experience.
Your therapist will work together with your physician(s), helping you to maximize any medical, surgical, and cosmetic interventions / procedures you may choose to include toward reaching your goals.
Therapy is individualized for each client.
Each therapy session is designed to provide you with the education & techniques necessary to confidently follow through with a customized home exercise program. As you begin to regain control over your facial muscles, subsequent clinic visits will include upgrading your home program and making the necessary adjustments to meet your goals.
Facial NMR is both time and cost effective, as most of your therapy will be carried out by you, at home. The duration of each clinic session and the frequency of clinic visits are highly variable given each client’s unique needs. Following your initial evaluation and training sessions, subsequent clinic visits may occur from twice a month to once every six months, depending on the complexity of your case, the progress achieved, and the distance you reside from the clinic. Clients are typically engaged in treatment for one to three or more years. Communication between clinic sessions, via phone or email, is encouraged to both address your questions/concerns, and to provide support in program follow-through.
Commitment leads to success.
Facial NMR will require time, patience, and commitment on your part for the effects to be fully realized. While Facial Neuromuscular Rehabilitation may not be able to restore you to full, pre-injury facial function, the resulting improvements in facial control and self-expression will help you face the world with confidence.
- Beurskens C.H.G. and Heymans P.G.: Mime Therapy Improves Facial Symmetry in People With Long-Term Facial Nerve Paresis: A Randomized Controlled Trial. Australian Journal of Physiotherapy, 52:177-183, 2006.
- Beurskens C.H.G., Heymans P.G., Oostendorp R.A.B.: Stability of Benefits of Mime Therapy in Sequelae of Facial Nerve Paresis During a 1-Year Period. Otology & Neurotology, Inc. 27(7):1037-1042, 2006.
- Coulson S.E., Adams R. D., O’Dwyer N.J., Croxson G.R.: Physiotherapy Rehabilitation of The Smile after Long-Term Facial Nerve Palsy using Video Self-Modeling and Implementation Intentions. American Academy of otolaryngology-Head and Neck Surgery, 134:48-55, 2006.
- Ross B., Nedzelski J.M., McLean J.A.: Efficacy of Feedback Training in Long-Standing Facial Nerve Paresis. Laryngoscope 101:744-750, 1991.
- Shiau J., Segal B., Danys I., Freedman R., Scott S.: Long-Term Effects of Neuromuscular Rehabilitation of Chronic Facial Paralysis. The Journal of Otolaryngology 24(4):217-220, 1995.
- VanSwearingen J.M. and Brach J.S.: Changes in Facial Movement and Synkinesis with Facial Neuromuscular Re-education. American Society of Plastic Surgeons 111(7):2370- 2375, 2003.