Facial motor and non-motor disabilities in patients with central facial paresis: a prospective cohort study

A Systematic Review of Physical Rehabilitation of Facial Palsy

“…As mentioned above, CFP may not resolve spontaneously and the negative impacts of CFP on people who experience this disorder can be wide-ranging. Rehabilitation may maximize functional recovery and improve the quality of life and psychological well-being of people with CFP (6,13,16) however there is currently no comprehensive or systematic review of the literature specific to this disorder to inform therapy planning and provision. This has significant implications for patient management, as it is still not clear to health professionals whether physical rehabilitation techniques work, or which technique is most effective.…”

“…Five studies reported on therapy protocols that combined passive and active methods (e.g., massage/manipulation with active exercise regime). These included three case series' (31,33,34), one non-randomized control trial (32) and one cohort study (6). One case series (33) reported improvements in spasticity of facial muscles; this was demonstrated by reporting the number of participants per scoring level (grade I-V) pre and post treatment on an unnamed grading tool.…”

“…The facial nerve (CNVII) plays a critical role in multiple complex functions of human life including mastication, speech, and successful social communication through expression of mood and emotion (1)(2)(3)(4). Central facial palsy (CFP) results from damage to the central segment of this nerve (facial nucleus in the pons, motor cortex, or connections between the two) (5) and manifests typically as a unilateral impairment of movement opposite to the side of the injury, with predominance in the lower face (6). In contrast, peripheral facial palsy (PFP) results from injury or damage to extratemporal segments of the facial nerve (7), for example in idiopathic "Bell's" palsy, surgery such as mastoidectomy, or inflammation such as herpes zoster (Ramsay Hunt syndrome) (8).…”

“…A study conducted by Cattaneo and Pavesi (9) found that 60% of patients with first-time ischemic cortical stroke (MCA and ACA territories) presented with CFP. Other studies of stroke populations have reported a prevalence of approximately 45% (6). It is evident from multiple searches of libraries and online evidence repositories during clinical management of CFP that most of the available literature relates to rehabilitation of peripheral facial palsy (PFP), and there is very little evidence available to guide therapists working with people suffering from CFP.…”

“…More recently, differing opinions are emerging in the literature regarding rates of spontaneous resolution of CFP (including associated functional and QOL deficits), with some authors noting that in the absence of rehabilitation, symptoms seem unlikely to improve (15). In their study, Volk et al (6) reported that a high percentage of patients continued to present with CFP 3 weeks post-onset, and over 60% of these patients were discharged from sub-acute rehabilitation with deficits persisting for more than 41 days post-stroke. As the available literature suggests that CFP can persist past the initial acute phase of stroke and not resolve spontaneously, people with CFP may benefit from access to a specific rehabilitation program aimed at maximizing recovery of facial movement and function (6,13,16).…”