Factors affecting the effect of physical rehabilitation therapy for synkinesis as a sequela to facial nerve palsy.

OBJECTIVE: To investigate factors affecting the effect of physical rehabilitation therapy for synkinesis as a sequela to facial nerve palsy. METHODS: A total of 37 patients with peripheral facial nerve palsy in Teine-Keijinkai Hospital were enrolled in this study. All patients showed synkinesis at 6 months after the onset of facial nerve palsy and were instructed in physical rehabilitation by expert staff from their first visit. The degree of synkinesis was evaluated at 6, 9 and 12 months after the onset of facial nerve palsy based on Sunnybrook facial grading system score and asymmetry in eye opening width. The patients were divided into two groups by age, gender, cause of palsy, electroneurography (ENoG) value, onset of synkinesis, initial treatment and timing of the start of physical rehabilitation. RESULTS: Female patients and younger patients did not show any deterioration in synkinesis. Patients in the lower ENoG group and the later onset of synkinesis group showed significant deterioration in synkinesis after the 6th month from onset of facial palsy. CONCLUSION: Physical rehabilitation was shown to prevent significant deterioration in synkinesis in female and younger patients with facial nerve palsy. Careful follow-up with regard to synkinesis is required in cases in which the facial nerve damage is thought to be severe.

Facial Nerve Rehabilitation.

Facial nerve paralysis, although uncommon in the pediatric population, occurs from several causes, including congenital deformities, infection, trauma, and neoplasms. Similar to the adult population, management of facial nerve disorders in children includes treatment for eye exposure, nasal obstruction/deviation, smile asymmetry, drooling, lack of labial function, and synkinesis. Free tissue transfer dynamic restoration is the preferred method for smile restoration in this population, with outcomes exceeding those of similar procedures in adults.

Somatic tinnitus prevalence and treatment with tinnitus retraining therapy.

OBJECTIVES: Somatic tinnitus originates from increased activity of the dorsal cochlear nucleus, a cross-point between the somatic and auditory systems. Its activity can be modified by auditory stimulation or somatic system manipulation. Thus, sound enrichment and white noise stimulation might decrease tinnitus and associated somatic symptoms. The present uncontrolled study sought to determine somatic tinnitus prevalence among tinnitus sufferers, and to investigate whether sound therapy with counselling (tinnitus retraining therapy; TRT) may decrease tinnitus-associated somatic symptoms. METHODS: To determine somatic tinnitus prevalence, 70 patients following the TRT protocol completed the Jastreboff Structured Interview (JSI) with additional questions regarding the presence and type of somatic symptoms. Among 21 somatic tinnitus patients, we further investigated the effects of TRT on tinnitus-associated facial dysesthesia. Before and after three months of TRT, tinnitus severity was evaluated using the Tinnitus Handicap Inventory (THI), and facial dysesthesia was assessed with an extended JSI-based questionnaire. RESULTS: Among the evaluated tinnitus patients, 56% presented somatic tinnitus-including 51% with facial dysesthesia, 36% who could modulate tinnitus by head and neck movements, and 13% with both conditions. Self-evaluation indicated that TRT significantly improved tinnitus and facial dysesthesia in 76% of patients. Three months of TRT led to a 50% decrease in mean THI and JSI scores regarding facial dysesthesia. CONCLUSIONS: Somatic tinnitus is a frequent and underestimated condition. We suggest an extension of the JSI, including specific questions regarding somatic tinnitus. TRT significantly improved tinnitus and accompanying facial dysesthesia, and could be a useful somatic tinnitus treatment.

Brief electrical stimulation after facial nerve transection and neurorrhaphy: a randomized prospective animal study.

BACKGROUND: Recent studies have examined the effects of brief electrical stimulation (BES) on nerve regeneration, with some suggesting that BES accelerates facial nerve recovery. However, the facial nerve outcome measurement in these studies has not been precise or accurate. The objective of this study is to assess the effect of BES on accelerating facial nerve functional recovery from a transection injury in the rat model. METHODS: A prospective randomized animal study using a rat model was performed. Two groups of 9 rats underwent facial nerve surgery. Both group 1 and 2 underwent facial nerve transection and repair at the main trunk of the nerve, with group 2 additionally receiving BES on post-operative day 0 for 1 h using an implantable stimulation device. Primary outcome was measured using a laser curtain model, which measured amplitude of whisking at 2, 4, and 6 weeks post-operatively. RESULTS: At week 2, the average amplitude observed for group 1 was 4.4°. Showing a statistically significant improvement over group 1, the group 2 mean was 14.0° at 2 weeks post-operatively (p = 0.0004). At week 4, group 1 showed improvement having an average of 9.7°, while group 2 remained relatively unchanged with an average of 12.8°. Group 1 had an average amplitude of 13.63° at 6-weeks from surgery. Group 2 had a similar increase in amplitude with an average of 15.8°. There was no statistically significant difference between the two groups at 4 and 6 weeks after facial nerve surgery. CONCLUSIONS: This is the first study to use an implantable stimulator for serial BES following neurorrhaphy in a validated animal model. Results suggest performing BES after facial nerve transection and neurorrhaphy at the main trunk of the facial nerve is associated with accelerated whisker movement in a rat model compared with a control group.

Peripheral facial nerve palsy: how effective is rehabilitation?

OBJECTIVE: To review the current literature to assess the effectiveness of rehabilitation treatment for peripheral facial nerve palsy. DATA SOURCES: A review of the literature was conducted using the following database: PubMed, EMBASE, PEDro, and Scopus. All randomized or quasi randomized controlled trials, case control, cohort studies and case series greater than 6 published between 1990 and 2010 in the English language were included. STUDY SELECTION: All types of peripheral facial nerve palsy were included. We considered all the exercises or rehabilitation programs provided by a physiotherapy in outpatient or home setting and excluded trials in which a drug therapy or surgical intervention was investigated. Three reviewers independently selected the articles. DATA EXTRACTION: To rate the methodological quality of the studies the American Academy of Neurology classification of evidence for therapeutic intervention (Classes I-IV) was applied. CONCLUSION: Peripheral injury of the VIIth cranial nerve can have serious repercussions on the patient's functioning and quality of life. The recovery rate is related to the preservation of the nerve and to the cause of palsy. We obtained a third level of recommendation (level C); mime therapy could be effective to improve functional outcome in these patients. Evidence of specific treatment addressed to specific cause is lacking; likewise, no evidence is available on timing of intervention with respect to time of onset. Well-designed randomized controlled trials are required to evaluate the effect of rehabilitation in patients with facial palsy.

Rehabilitation after cranial base surgery.

Recent advancements in skull base surgery to remove or diminish the size of cranial base tumors allow more to be done than ever before to preserve life for patients who have tumors in anatomic locations once considered unreachable without causing massive functional impairment or death. Nonetheless, the resulting outcome has a direct and serious impact on the quality of life of the patient. In this article on palliation, the authors focus on the rehabilitative techniques used in patients who have undergone extensive cranial base resection. These techniques can also be used to improve the life of patients who have not undergone surgery but suffer from poor quality of life because of the natural growth of the tumor.

Puckering and blowing facial expressions in people with facial movement disorders.

BACKGROUND AND PURPOSE: People with facial movement disorders are instructed to perform various facial movements as part of their physical therapy rehabilitation. A difference in the movement of the orbicularis oris muscle has been demonstrated among people without facial nerve impairments when instructed to "pucker your lips" and to "blow, as if blowing out a candle." The objective of this study was to determine whether the within-subject difference between "pucker your lips" and "blow, as if blowing out a candle" found in people without facial nerve impairments is present in people with facial movement disorders. SUBJECTS AND METHODS: People (N=68) with unilateral facial movement disorders were observed as they produced puckering and blowing movements. Automated facial image analysis of both puckering and blowing was used to determine the difference between facial actions for the following movement variables: maximum speed, amplitude, duration, and corresponding asymmetry. RESULTS: There was a difference between the amplitudes of movement for puckering and blowing. "Blow, as if blowing out a candle" produced a larger amplitude of movement. DISCUSSION AND CONCLUSION: The findings demonstrate that puckering and blowing movements in people with facial movement disorders differ in a manner that is consistent with differences found in people who are healthy. This information may be useful in the assessment of and intervention for facial movement disorders affecting the lower face.

[Rehabilitation options for lesions of the facial nerve]. / Rehabilitationsmöglichkeiten bei Läsionen des N. facialis.

Patients with permanent facial palsies cannot hide their conditions. As a consequence, these patients suffer from massive psychological stress. To achieve satisfactory reconstruction of mimic function, experience with a variety of surgical techniques and adjuvant nonsurgical treatments is necessary. This report provides information on the present repertoire of surgical and conservative options, emphasizing their fields of indications, limitations, and possible combinations.

Electrical stimulation of the paralyzed orbicularis oculi in rabbit.

Dysfunction of the seventh cranial nerve often results in facial paralysis and loss of the ability to blink the eye, which can lead to corneal scarring, diminished vision, and potential loss of the eye. This study investigated the potential of electrical stimulation of the orbicularis oculi muscle as a means of restoring blink function. An animal model of orbicularis paralysis was created by sectioning the seventh cranial nerve in rabbit. Twenty paralyzed and five normal rabbits were acutely implanted with a subcutaneous stimulating electrode near the margin of the upper eyelid. Biphasic current controlled stimulation pulses were delivered between implanted contacts at the medial and lateral edges of the eyelid. Strength-duration curves for lid twitch threshold were generated, and quantitative measurements of lid closure were made for systematically varied parameters including pulse amplitude, pulse width, number of pulses delivered, and duration of paralysis prior to stimulation. Normal rabbits achieved a greater degree of lid closure due to electrical stimulation than rabbits that had been surgically paralyzed. Of rabbits that had been paralyzed, those demonstrating evidence of at least partial reinnervation achieved a greater degree of lid closure than those demonstrating persistent denervation. Trains of 10 ms biphasic pulses delivered at 50 Hz were found to be the most effective means of eliciting lid closure for the range of parameters tested.

[Laser therapy and cryomassage in rehabilitation of patients with facial nerve neuropathy]. / Lazeroterapiia i kriomassazh v vosstanovitel'nom lechenii bol'nykh s nevropatiei litsevogo nerva.

Cryomassage and its combination with low-intensity infra-red laser radiation have been introduced as a novel treatment of facial nerve neuropathy (FNN) in 32 patients. Electrophysiological investigations (facial thermography, classical electrodiagnosis, electromyography of the mimic muscles) and clinical data including those of long-term follow-up show that neither cryomassage nor infra-red laser radiation studied promote transformation of facial tissues in FNN patients. Use of the above factors is effective in a preclinical stage of forming contracture of the mimic muscles. Special techniques of application of local hypothermia and laser radiation can be used in multimodality treatment of both the established contracture and sluggish paresis of the facial muscles.

Early rehabilitation of facial nerve deficit after acoustic neuroma surgery.

OBJECTIVE: To determine whether an early physical rehabilitative program could improve and/or accelerate recovery from a postoperative deficit of facial nerve (FN) function. MATERIAL AND METHODS: A retrospective study of the charts of patients who presented a postoperative FN deficit after surgery for acoustic neuroma (AN) was carried out. Twenty-nine patients were enrolled and divided into 2 groups: 18 who underwent early physical rehabilitation and 11 who did not undergo rehabilitation. All the AN patients underwent translabyrinthine removal and were classified preoperatively according to the House-Brackmann staging system. Physical rehabilitation was performed according to Kabat (i.e. neuromuscular facilitation). FN function was assessed postoperatively and classified according to the House-Brackmann grading system. RESULTS: In Grade IV and V patients, early rehabilitation allowed a faster and better recovery with respect to AN patients for whom rehabilitation was not carried out. CONCLUSION: Early physical rehabilitation has proved to be effective as a helpful tool for recovery from FN deficit and it is therefore advisable to use it soon after surgery, especially for FN deficits worse than Grade IV.

Lower lip-lifting brace for bilateral facial nerve palsy: a case report.

A 55-year-old man suffered from pontine hemorrhage 5 years before he visited our outpatient clinic with complaints of gait disturbance and dysphagia. At the first examination, his inability to close his mouth, eyes, and lower lip led to the diagnosis of facial diplegia. He was instructed to wear a gauze surgical mask and to use artificial saliva for his xerostomia. A videofluorogram of his swallowing excluded aspiration but revealed dysphagia attributable to neck hyperextension arising from efforts to prevent food spilling from his mouth. We prescribed a brace to lift his lower lip as a treatment of his dysphagia. This brace covered his chin to support his lower lip. Our brace resulted in improved function; liquids no longer leaked from his mouth and because the lip elevation eliminated his xerostomia, he no longer required artificial saliva or the gauze mask.

Neuromuscular rehabilitation and electrodiagnosis. 2. Localized peripheral neuropathy.

This self-directed learning module highlights advances in diagnosis and treatment of focal injuries to peripheral and cranial nerves. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Nerve conduction and electromyographic techniques are employed as extensions of the physician's senses in clinical examination and diagnosis. The findings are used to plan treatment, and to predict and measure outcomes. Electrodiagnosis and medical and surgical treatments of nerve injuries are discussed in light of the managed-care utilization review of services.

The facial nerve. Current trends in diagnosis, treatment, and rehabilitation.

Facial paralysis is a potentially devastating disorder with numerous implications. Multiple entities must be considered in its etiology, and recent advances in microbiology, radiographic imaging, electrodiagnostic testing, and microsurgery have provided great insight into the pathophysiology, diagnosis, treatment, and rehabilitation of the facial nerve. Recent DNA PCR testing has shed new insight into the potential cause for Bell's palsy. This article focuses on the evaluation, differential diagnosis, medical treatment, and rehabilitation of facial nerve pathology with primary emphasis on facial paralysis. Surgical management is also discussed, including reanimation of the paralyzed face.

Validation of a treatment-based classification system for individuals with facial neuromotor disorders.

BACKGROUND AND PURPOSE: A method for linking treatments to signs and symptoms of facial neuromotor disorders is needed. We describe the construct validation of a treatment-based classification system for facial neuromotor disorders. SUBJECTS AND METHODS: Based on physical signs and symptoms, 148 patients (mean age = 48.9 years, SD = 16.1, range = 20-93) were assigned to treatment-based categories. The pattern of impairment and disability was compared with clinic expectations. RESULTS: The distribution of impairment and disability scores demonstrated the expected signs and symptoms of the treatment-based categories. Confirmatory principal-components factor analysis indicated 4 factors, corresponding to the treatment-based categories; the factor loadings confirmed the presence of the key sign or symptom characteristic of the categories. CONCLUSION AND DISCUSSION: Classifying facial neuromotor disorders into treatment-based categories appears to be a valid method for categorizing patients with specific impairments or disabilities and may be useful in linking treatments to outcomes.

[The rehabilitation of patients with postneuritic contracture of the mimetic muscles by using locally applied cold action]. / Reabilitatsiia bol'nykh postnevriticheskoi kontrakturoi mimicheskikh myshts s primeneniem lokal'nogo dozirovaniia kholodovogo vozdeistviia.

A method is proposed for combined modality treatment of patients with postneuritic contracture of the muscles of expression of various genesis utilizing local hypothermia as well as hypo- and hyperthermic methods of treatment. Clinical effectiveness of the proposed method of treatment of patients in the acute phase of the facial nerve neuritis, non-existence of important contraindications which are usual with the medicamentous and electrophysiotherapeutic methods of treatment of this condition, and absence of supposed complications enable it to be recommended for clinical application.

Rehabilitation of the lower cranial nerves.

Brain stem lesions frequently cause dysfunction of the lower cranial nerves. Even with successful treatment, dysfunction may remain. Various methods for rehabilitating the patient with persistent lower cranial nerve dysfunction are presented.