A Telerehabilitation Approach to Chronic Facial Paralysis in the COVID-19 Pandemic Scenario: What Role for Electromyography Assessment?

Abstract

There is a lack of data on patient and diagnostic factors for prognostication of complete recovery in patients with peripheral facial palsy. Thus, the aim of this study was to evaluate the role of a telerehabilitave enhancement through the description of a case report with the use of short-wave diathermy and neuromuscular electrical stimulation combined to facial proprioceptive neuromuscular facilitation (PNF) rehabilitation in unrecovered facial palsy, in a COVID-19 pandemic scenario describing a paradigmatic telerehabilitation report. A 43-year-old woman underwent a facial rehabilitation plan consisting of a synergistic treatment with facial PNF rehabilitation, short-wave diathermy, and neuromuscular electrical stimulation (12 sessions lasting 45 min, three sessions/week for 4 weeks). Concerning the surface electromyography evaluation of frontal and orbicularis oris muscles, the calculated ratio between amplitude of the palsy side and normal side showed an improvement in terms of movement symmetry. At the end of the outpatient treatment, a daily telerehabilitation protocol with video and teleconsultation was provided, showing a further improvement in the functioning of a woman suffering from unresolved facial paralysis. Therefore, an adequate telerehabilitation follow-up seems to play a fundamental role in the management of patients with facial palsy.

Keywords: digital health; digital transmission of medical care; electromyography; precision medicine; rehabilitation; remote medical diagnosis; shortwave diathermy; telemedicine; telerehabilitation.

Figure 1

Study flow chart. Abbreviation = PNF, proprioceptive neuromuscular facilitation.

Figure 2

Movements executed by the patient during the examination to evaluate facial palsy at the different time-points from the left to the right: T0 (baseline), T1 (after 5 weeks), and T2 (at the end of treatment). (A): kiss with closed lips; (B): wrinkle the forehead; (C): elevate eyebrows; (D): bite the upper lips; (E): bite the lower lips; (F): puff up the cheeks.

Figure 3

The graph shows the sEMG signal of the frontal muscle in the upper portion of the figure and the orbicularis oris in the lower portion of the figure. EMG representations are outlined in green for the side of the palsy and red for the side of the face not affected by the paralysis. At each timepoint of the evaluation of the case report, the raw data are represented on the left, while on the right the envelope of the sEMG signal is filtered and rectified to evaluate the ratio between the two mean amplitudes. So, for both muscles at T0, there is an obvious difference between paralysis and the normal side, while, at T1 and T2, the difference between the left and right-side decreases.