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Rehabilitation For A Patient With Peripheral Facial Palsy

K. Nakamura, N. Takeda
Published 2008 · Medicine

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Synkinesis is the most unpleasant sequelae of peripheral facial palsy. It is an abnormal involuntary associate facial movement such as eye closure during smiling and mouth movement during blinking. Synkinesis strongly reduces the quality of life; however, treatment of synkinesis is difficult. We developed new rehabilitation therapies to prevent and to treat the synkinesis.We developed a mirror biofeedback rehabilitation method to prevent synkinesis involving eye closure during mouth movement. We instructed a patient to move his mouth while keeping their eyes open symmetrically using a mirror (mirror biofeedback). Thirty minutes of daily training was continued for a period of 10 month.To evaluate the degree of synkinesis, we computed the % eye opening, as a percent ratio of the width of the eyelid of the affected side relative to the normal side.The % eye opening was compared between patients with and without the training. The % eye opening was significantly greater in the group with training than in the control group. This outcome indicates that our mirror biofeedback rehabilitation effectively to prevents involuntary eye closure during mouth movements.EMG biofeedback rehabilitation is used to prevent synkinesis of involuntary mouth movement during eye closure.To treat the synkinesis of eye closure during mouth movement, we developed a combination therapy of mirror biofeedback rehabilitation with botulinum A toxin injection. Botulinum A toxin is injected into the orbicularis oculi muscle that shows involuntary associate movement. After botulinum A toxin injection, mirror biofeedback rehabilitation was continued for a period of 10 months.The % eye opening was compared before and after treatment. The % eye opening during mouth movement was significantly improved after treatment. This outcome indicated that combination therapy with mirror biofeedback and rehabilitation with botulinum A toxin injection is an effective treatment for facial synkinesis after facial palsy.
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