Movement Therapy for Facial Palsy after Stroke

Abstract

People generally depend on nonverbal means of communication, such as gestures and postures, to socially convey human feelings quite as much as they use verbal means to do so. If the sequelae from a stroke include orofacial paralysis, the patient may be left with a facial asymrnetry that precludes effortless impartation of subtle notions. Orofacial muscles affected by the stroke are susceptible to increased tone due to abnormal postural tone in other parts of the body, particularly in the shoulder girdle or trunk. This means that the therapist must first address the problem of abnormal postural tone throughout the body. Only after this global problem has been brought under adequate control can the therapist pursue treatment directed to improve facial expressiveness. Emphasis is then laid upon eliciting controlled voluntary muscular activity in expressions that require symmetrical movements, as in smiling or frowning. To corroborate this concept, we prospectively studied a 59 year old woman with right hemiplegia who suffered right orofacial palsy as part of her stroke. Our observations and treatment commenced four months and three days after onset of the stroke. Through four months of treatment, this patient experienced improvement in visual field limitation due to right eye closure, and a decrease in asymmetry of facial expression, such as of drooping and rightward deviation of the right side of the mouth.