Minimizing synkinesis during rehabilitation of the paralyzed face: preliminary assessment of a new small-movement therapy

Abstract

Neuromuscular rehabilitation can reduce the severity of chronic facial paralysis, but complete recovery is frequently impeded by synkinesis. We evaluated whether or not such synkinesis could be minimized by preventing its possible reinforcement during rehabilitation. We compared "standard" therapy, which uses the appearance of synkinesis to guide rehabilitation, with a new "small-movement" therapy, which uses smaller movements that should minimize possible subthreshold reinforcement of synkinesis. Ten subjects who had had facial paralysis for 0.5 to 27 years were randomly assigned to either therapy group. Blinded assessments were performed before and after ten 1-hour treatments given over a 1-month interval. Facial movements in both groups were significantly more symmetric after treatment. Although synkinesis tended to be reduced in the small-movement group, this reduction was not significant. The new therapy was at least as good as the standard one, and it may be better. Further studies are required to demonstrate this.