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The Negative Effect of Unsupervised Exercises on Patients with Facial Paresis

Objectives: Compare facial function at onset of skilled facial rehabilitation of patients with facial paresis performing unsupervised facial exercise routine and patients with no previous intervention. Methods: Retrospective chart review at a tertiary referral center including all patients from our institution who had >1/6 House Brackman score and were referred to physical therapy for facial retraining from 2012 to 2013. Patients were excluded from the study if they had a facial reanimation procedure or electrical stimulation prior to onset of physical therapy. The study used House Brackman (HB) and Facial Grading System (FGS) with 3 subscales: resting symmetry (rFGS), voluntary movement (mFGS), and synkinesis (sFGS). Results: Fourteen patients were referred to facial retraining therapy and met the specified inclusion and exclusion criteria. The medical diagnoses included postoperative acoustic neuroma resection, Bell’s palsy, and Ramsay Hunt Syndrome. Eight patients did not participate in exercise prior to physical therapy evaluation and 6 patients were issued unsupervised facial exercise prior to therapy. Patients who participated in an unsupervised facial exercise program had a significantly higher sFGS score of 6.83 ± 2.23 at initial physical therapy evaluation than those who did not participate in exercises, with a score of 3.75 ± 2.61 (P = .038). There were no significant differences between HB, FGS, rFGS, or mFGS. Conclusions: Patients who participated in unsupervised facial exercises had more synkinesis than those patients who did not. Generic facial exercises prior to formal individualized facial retraining therapy may be counterproductive. Further investigation is necessary to determine if initial synkinesis score impacts overall patient outcomes following intervention.