Facial Rehabilitation

The type of therapy you receive will depend on the cause of your facial palsy. It will also depend on how long you have had your facial palsy and the type of damage to your facial nerve. Facial rehabilitation therapy services vary across the country. You may be referred to a physiotherapist or a speech and language therapist for assessment and treatment of your facial palsy.

It is important that you seek help from a therapist who specialises in facial rehabilitation or who has specialist knowledge in the management and treatment of facial palsy. Below are some general guidelines about what to expect from facial rehabilitation.

What can you expect from facial rehabilitation therapy?

The focus of the first session with your therapist will be assessment. The therapist will want to find out all about your symptoms, any recovery you may have noticed, and any other information that you think he/she should know. Assessment may include some of the following:

• Assessment of your facial nerve using surface electromyography (sEMG). Sticky electrodes are placed on your face over various muscles, usually the brows, temples, cheek, chin and neck. This is a painless procedure, and takes just a few minutes. The therapist will measure how much energy your facial muscles are creating when you are still and when you try to move them; for example, when you try to raise your brow, close your eyes, smile and whistle. In order for a muscle to move, the muscle fibres must contract. A muscle can only contract if the nerve to that muscle is intact and working. Your facial nerve can be likened to the flex of a kettle. If the flex from the plug to your electric kettle is damaged, then your kettle will not work properly because the electricity cannot travel through it in the normal way.
• Only a few specialist centres have sEMG. Don’t worry: your therapist does not need to have this equipment; it is still possible to assess facial nerve function by close observation and examination of your face. The therapist will look at your face at rest and then assess the muscle tone, normal movements, and any abnormal movements that may be present.
• The therapist will note whether the facial muscles are weak and floppy, or short and tight.
• The health of your eye will be very important and your therapist will give you advice and information about how to protect your eye from damage.
• The therapist may refer you to other medical specialists such as an ophthalmologist, if you are experiencing problems with your eye and have not been referred for treatment.
• Finally, your therapist may feel you require further investigations and will write to the person who referred you for therapy to discuss further investigative procedures.

What advice can you expect to receive?

The advice you are given will depend on your symptoms. You may receive advice and information about the following:

• Advice on eye care and taping the eye closed.
• Advice on mouth care and dry mouth management.
• Advice on how to make eating and drinking easier.
• Advice on how to make your speech clearer.

What sort of treatment will your therapist recommend?

Once assessment is complete the therapist will ensure that you understand about your particular symptoms, how the facial nerve has been affected, and how the facial nerve recovers. Below is a list of some of the treatment options, but this will depend on your specific symptoms:

• Education about how the facial nerve works and how it recovers plays a very important part in the therapy. This is because you will need to become very familiar with your face, how it moves, looks, rests and functions.
• A home exercise programme that may include the following:
  • Massage to keep the muscles mobile and healthy.
  • Stretches to lengthen muscles which have become short or tight.
  • Exercises to help relearn and develop balanced facial movements.
  • Relaxation of your facial nerve and muscles.
  • Exercises to reduce involuntary, unwanted movements.

At the early stage, it is very unlikely that the therapist will ask you to work on facial movement. It is important that the muscles are fit enough before starting any movement exercises.

• All exercises which focus on movement should be very gentle and carried out very carefully. Force and over effort when trying to work muscles which are too weak can cause additional problems of tightness and involuntary movements called synkinesis.
• Not all exercises are suitable for all people with facial palsy, and you may complicate your recovery if you try to work without the help of a specialist therapist.
• Exercises need to be done on a daily basis in order to make the most of your recovery, so your therapist should guide and support you through the recovery process.
• Therapy may continue for many months but dedication to your home exercise programme and ongoing support from your therapist will help you achieve the best recovery possible in your given situation.

What is facial exercise?

Facial exercise means moving your face using your facial muscles (trying to use the facial nerve). This is different to massage or taping, where you use your hands to move the face (trying to keep the area comfortable).

For further information about facial rehabilitation therapy, please go to facialtherapyspecialists.com.

Therapists working in facial rehabilitation are aware of the social and psychological problems associated with facial palsy. They can direct you to your nearest facial palsy support group or refer you to other organisations that can offer you the help that you need.

View the Facebook Live presentation in March 2021 by Catriona Neville of Facial Therapy Specialists International.