Beurskens and Heymans (2006)(1919 Beurskens CHG, Heymans PG. Mime therapy improves facial symmetry in people with long-term facial nerve paresis: a randomised controlled trial. Aust J Physiother. 2006;52(3):177-83. http://dx.doi.org/10.1016/S0004-9514(06)70026-5. PMid:16942452.
http://dx.doi.org/10.1016/S0004-9514(06)...
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Session frequency: Once a week. |
| Duration: 3 months. |
| Procedures: |
| - General instructions for home procedures (they are supposed to be done at home for 30 minutes every day); |
| *The participants were trained to massage their face and neck for 10 to 15 minutes a day and do stretching exercises on the affected side to relieve the symptoms of synkinesis in the muscles involved. |
| *Posteriorly, they were taught to recognize tension and feel the difference between tension and relaxation in general and, more specifically, in facial musculature. |
| - Orofacial massage: a) specific exercises to coordinate the right and left hemifaces and decrease synkinesis; b) exercises (forehead wrinkle, eye closure, smile, growl, wrinkle the lips) with varying amplitudes and speeds; c) exercises for each side of the face to control separate movements, mandible, lip (smile, pouch), and eye relaxation, with simultaneous synkinesis inhibition (slow, small movements and contraction); d) stretching exercises for the eyelids to adjust eye closure, with varied speed and strength, not moving the lips; e) for lip closure, cheek-filling exercises were used with variables amounts of air, as well as eating and drinking exercises while keeping the eyes in open synkinesis. |
| *Note: The exercises were performed with a mirror for feedback. |
Magalhães (2009)(2020 Magalhães HV Jr. Fonoterapia na paralisia facial periférica: uma abordagem miofuncional orofacial. RBPS. 2009;22(4):259-63. http://dx.doi.org/10.5020/18061230.2009.p259.
http://dx.doi.org/10.5020/18061230.2009....
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Session frequency: Not informed. |
| Duration: Not informed. |
| Procedures: |
| - In general terms, with a myotherapy approach associated with proprioceptive and exteroceptive sensitivity to the contraction of the paralyzed muscle, exercises can be used to favor increased tonicity of the relaxed musculature, improving the heat and blood supply in the region. |
| - In the flaccid phase, the patient can use isometric exercises with the contraction of the muscles on both sides of the face, associated with induction massage on the paralyzed side. |
| - Stimulating the motor points of the face can be an alternative, decreasing orofacial muscle contraction and improving blood flow and oxygenation of the tissues. Orofacial musculature stimulation involves active and passive stretching, increasing the sensory perception of each muscle involved, changing the muscle tone, and seeking orofacial myofunctional balance. |
| - Thermotherapy with ice on the paralyzed side aims at the contraction of the paralyzed musculature via proprioception and exteroception reflex arc, as cold is perceived by the general somatic afferent fibers of the trigeminal nerve, which is connected in its sensitive core to the facial motor nucleus, contracting the face muscles by stimulation of the special efferent fibers of the facial nerve. |
| - In the phase of movement recovery, the muscles begin to hint at some movements. At this moment, the speech-language-hearing therapist must require isotonic exercises to work muscle mobility without induction massage. |
| - Using a mirror along with neuromuscular procedures favors visual feedback to control movement in the flaccid and movement recovery phases; it is likewise with electromyographic biofeedback, which has been used as a resource for visual and/or auditory feedback. |
| - In PFP, neuromuscular training, besides instructing the client, improves the function and decreases contraction and synkinesis with isotonic orofacial myofunctional exercises, relaxation and stretching strategies associated with dissociation of the movements, and use of humid-heat thermotherapy for 5 minutes. |
Tessitore et al. (2009)(2121 Tessitore A, Paschoal JR, Pfeilsticker LN. Avaliação de um protocolo da reabilitação orofacial na paralisia facial periférica. Rev CEFAC. 2009;11(3, suppl 3):432-40. http://dx.doi.org/10.1590/S1516-18462009000700019.
http://dx.doi.org/10.1590/S1516-18462009...
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Session frequency: Once a week. |
| Duration: 1 year. |
| Procedures: |
| - General instructions for home procedures for people in the initial phase of PFP, in which the musculature is flaccid. |
| *Cares with the affected eye: reinforcing medical instructions about the use of eye drops and ointment, always sleep with an eye patch while instructed to, make sure the eye is closed, use eye drops whenever you feel the eye dry or burn, wear sunglasses when out in the sun, wear a hat (if necessary) and do not go out in the wind. |
| *Instruction regarding orofacial maneuvers that make movements easier, which should be self-stimulated by the patient twice a day, before meals: slide the fingers up and down the forehead, slide the fingers above the eyebrows (distal to medial), slide the fingers over the cheeks (upward), slide the fingers on the lips and cheek (horizontally, simulating a smile), masticatory functional use on the paralyzed side (rest the fingers on the mandible base, on the affected side, to minimize food stasis in the vestibule). The indicated duration and number of repetitions were not informed. |
| - Orofacial massage: activation of the motor areas and point on the face (frontal, nasal inferior, nostril, eye, labial, chin, and suprahyoid areas), for sensory stimulation: the motor areas (on both sides of the face) and the motor points (only on the paralyzed side) are activated; a suction cup is used on the paralyzed face to encourage muscle tone with its vacuum; intermittent vibration is used on the paralyzed side to increase muscle tone, continuing on the other side to decrease its muscle tone (which is hyperactivated), and functional requirement with inhibition of the healthy side and use of body strength associated with functional requirement (e.g., eye closure and concomitant use of strength with feet plantar support, activating the muscle chains, distal impulse – Vassalva maneuver; all possible facial movements are required in facial level: raising and joining eyebrows, closing the eyes, contracting the nose, inflating the cheeks, tightening the lips, pouching, smiling, and opening the corner of the mouths as wide as possible). The indicated duration and number of repetitions were not informed. |
| - Posteriorly, perform the isotonic and isometric exercises described below: |
| *Isotonic: a) Look at a fixed spot and blink (30 times); b) look down and close your eyes (30 times); c) quickly raise and lower the eyebrows (10 times); d) quickly join and relax the eyebrows (10 times); e) quickly contract and relax the nose (10 times); f) quickly alternate between pouching and smiling with closed lips (10 times); g) quickly alternate between pouching and smiling with open lips (10 times). |
| *Isometric: a) raise the eyebrows and hold for 5 seconds (5 times); b) join the eyebrows and hold for 5 seconds (5 times); c) contract the nose and hold for 5 seconds (5 times); d) pouch and hold for 5 seconds (5 times); e) smile with closed lips and hold for 5 seconds (5 times); f) pouch with open lips and hold for 5 seconds (5 times); g) smile with open lips and hold for 5 seconds (5 times). |
| *Note: In case of synkinesis, muscle contractures or spasms, use heat on the face in combination with intra- and extraoral slide maneuvers on the nasogenian sulcus to release the musculature. |
Romão et al. (2015)(2222 Romão AM, Cabral C, Magni C. Intervenção fonoaudiológica precoce num paciente com paralisia facial após otomastoidite. Rev CEFAC. 2015;17(3):996-1003. http://dx.doi.org/10.1590/1982-021620159114.
http://dx.doi.org/10.1590/1982-021620159...
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Session frequency: Once a week with daily exercises. |
| Duration: 63 uninterrupted days. |
| Procedures: |
| - General instructions to the patient (in all the sessions): a) always do the exercises in front of a mirror; b) you are not supposed to feel pain or discomfort; c) all the exercises must be performed in symmetry and balance, each exercise must be rigorously controlled for the movement to be symmetric and harmonious; d) do the exercises three times every day: morning, afternoon, and evening; e) take breaks in between the periods to rest and not fatigue the musculature; g) cares with the eyes: wear sunglasses, as well as micropore tape at night, to help completely seal the eyes. |
| - Speech therapy performed with isotonic and isometric exercises: |
| *Week 1: smile and massage with the fingers; close the eyes supporting with the fingers, contract and hold closed for 5 seconds; counter-resistance exercise with a spatula, push the spatula with the cheek as far as the teeth; vibrate the lips; suck a thickened liquid with a thick straw; facial massage in the direction of the muscle fiber (done only in the session); pouch and click the lips; click the lips without pouching; mastication exercise with the support of a rubber band. Time: 1 minute and 30 seconds per exercise. |
| *Week 2: counter-resistance exercise with a spatula, preventing it from moving with the cheek; faint smile, supporting with the fingers 3 times and another 3 times without support; counter-resistance exercise with a spatula, push the spatula with the cheek as far as the teeth; close the eyes supporting with the fingers, contract and hold closed for 5 seconds; vibrate the lips; suck a thickened liquid with a thick straw; facial massage in the direction of the muscle fiber (done only in the session); pouch and click the lips; click the lips without pouching; mastication exercise with the support of a rubber band. Time: 1 minute and 30 seconds per exercise. |
| *Week 3: add an exercise to the list: Pouch and hold a straw between the lips and nose. Time: 1 minute and 30 seconds per exercise. |
| *Week 4: counter-resistance exercise with a spatula, preventing it from moving with the cheek; faint smile, supporting with the fingers 3 times and another 3 times without support; counter-resistance exercise with a spatula, push the spatula with the cheek as far as the teeth; close the eyes supporting with the fingers, contract and hold closed for 5 seconds; vibrate the lips; suck a thickened liquid with a thick straw; facial massage in the direction of the muscle fiber (done only in the session); pouch and click the lips; click the lips without pouching; blow out a candle. Time: 1 minute and 30 seconds per exercise. |
| *Week 5: symmetric open smile without the support of the fingers; symmetric open smile with support of the fingers; facial massage in the direction of the muscle fiber (done only in the session, for 5 minutes); vibrate the lips; close the eyes supporting with the fingers, contract and hold closed for 5 seconds; suck a thickened liquid with a thick straw. Time: 2 minutes and 30 seconds per exercise. |
| *Week 6: faint smile without support from the fingers, hold for 5 seconds; open smile without support from the fingers, hold for 3 seconds; mouth rinsing with water; fill a balloon without help; suck a thickened liquid with a thick straw; close the eyes supporting with the fingers, contract and hold closed for 5 seconds; facial massage in the direction of the muscle fiber (done only in the session, for 5 minutes). Time: 2 minutes and 10 seconds per exercise. |
| *Week 7: open smile without support from the fingers and without lowering the lips, hold for 5 seconds; facial massage in the direction of the muscle fiber (done only in the session, for 5 minutes); suck a thickened liquid with a thick straw; close the eyes supporting with the fingers, contract and hold closed for 5 seconds; fill a balloon without help and hold for 10 seconds; join the eyebrows and help with the fingers in the direction of the movement; contract the eyebrows without help. Time: 2 minutes and 10 seconds per exercise. |
| *Week 8: close the eyes without help and hold for 5 seconds, without contracting the corner of the mouth; mouth rinsing with little water; fill a balloon without help; suck a thickened liquid with a thick straw; join the eyebrows and help with the fingers in the direction of the movement; contract the eyebrows without help; make an angry face. Time: 2 minutes and 10 seconds per exercise. |
| *Week 9: given the positive results, the patient was discharged in this session. |
| Kasahara et al. (2017)(2323 Kasahara T, Ikeda S, Sugimoto A, Sugawara S, Koyama Y, Toyokura M, et al. Efficacy of tape feedback therapy on synkinesis following severe peripheral facial nerve palsy. Tokai J Exp Clin Med. 2017;42(3):139-42. PMid:28871583.)
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Session frequency: 3 sessions a day. |
| Duration: 4 weeks. |
| Procedures: |
| - To avoid contraction of the corner of the mouth during slight eye closure movement, the training starts when the muscle contraction symptom is perceived on the affected side. |
| - Tape feedback therapy |
| A therapeutic adhesive tape was placed around the patients’ lips to identify weak contractions, not with finger touch, but with superficial skin sensing around the mouth. The research participants were instructed to avoid moving the corner of the mouth on the affected side symmetrically with the non-affected side during eye closure – i.e., the eyes had to be closed as gently as possible to avoid mouth movements on the affected side, which would be noticed. |
| The patients were prescribed 20 slow eye closures per session. |
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Subtitle: n = number of articles; CAPES = Coordination for the Improvement of Higher Education Personnel