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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.
Assessment of your facial nerve using electromyography (EMG). 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 EMG. Don’t worry: your therapist does not need to have this
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equipment; it is still possible to assess facial nerve function by close observation and examination
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of your face. The therapist will look at your face at rest and then assess the muscle tone, normal
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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.
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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.
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