Physical Therapy for Facial Palsy after Stroke: A Case Study

Abstract

Facial palsy subsequent to a stroke interferes with nonverbal communication. Because such facial palsy is of central origin, it is easily influenced by attenuation of balance reactions or by abnormal postural tone from the shoulder girdles and the pelvis. In treatment we thus first work to normalize postural tone throughout the whole body and to foster the emergence of normal balance reactions and postural motor patterns. Only after this initial step do we directly approach the facial palsy itself.
To objectively examine this idea, we decided to closely monitor the progress of a 57-year-old woman admitted to our hospital one year and one week after suffering a stroke resulting in facial palsy. Both the physical therapy and the speech therapy departments worked in close collaboration to improve formulation and symmetry of facial expression, and to work on finely grading movements involved in facial expression. To monitor our progress we recorded changes by photographs in the center of gravity, manual muscle tests of facial muscles, and electromyographic activity. To assess the degree of drooping of the eyelids, we recorded changes in the vertical distance between the upper and lower eyelids.
Treatment continued for five months and three weeks. The improvements we indicated approaching the whole body before trying to treat only the facial region.