Facial Paralysis and Communicative Participation: The Importance of Facial Symmetry at Rest

Abstract

<jats:sec><jats:title>Objective:</jats:title><jats:p> There is a paucity of research devoted to understanding the communication restrictions encountered by facial paralysis patients. We aim to explore the relationship between patient-reported restrictions in communicative participation and objective facial paralysis severity using validated scales of facial movement. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> We performed a pilot retrospective study using a consecutive series of adult patients with a diagnosis of unilateral facial paralysis. In addition to baseline demographics, subjects were evaluated using the Communicative Item Participation Bank Short Form (CPIB), Electronic Facial Assessment by Computer Evaluation (eFACE), and Sunnybrook Facial Grading System (SFGS). </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Twenty patients were included, 10 (50%) of whom were female with a mean age of 61 ± 13 years and mean duration of facial paralysis of 53 ± 82 months. The mean CPIB score was 14.6 ± 10.0 (range 0-29) and was comparable to scores of patients with conditions known to cause significant communicative disability. The mean eFACE scores were 67.4 ± 29.2, 44.2 ± 30.1, and 73.8 ± 30.0 for the static, dynamic, and synkinesis domains, respectively, with a composite smile score of 58.5 ± 16.9. After adjusting for age, gender, and duration of facial paralysis, significant moderate correlations were observed between the CPIB and the static eFACE domain ( r = –0.51, P = .03) and smile composite score ( r = 0.48, P = 0.0049), in addition to between the CPIB and SFGS synkinesis domain ( r = 0.48, P = 0.04). </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Patients with unilateral facial paralysis experience significant limitations in communicative participation. These restrictions demonstrate moderate to strong correlations with objective assessments of facial paralysis and quality of life measures. Communicative participation may be a helpful means of tracking response to treatment. </jats:p></jats:sec><jats:sec><jats:title>Level of Evidence:</jats:title><jats:p> IV </jats:p></jats:sec>

The Communicative Participation Item Bank: Evaluating, and Reevaluating, Its Use across Communication Disorders in Adults

“…Restrictions in communicative participation were captured by the CPIB for people with spinal cord injury (SCI), 86 facioscapulohumeral muscular dystrophy (FSHD), 87 and facial paralysis. 88,89 These studies revealed a range of communicative participation restrictions with, in some cases, the extent of the restrictions being commensurate with those resulting from more traditionally identified speech or language impairments. One finding of interest is that across these groups, conversational situations that require some element of speed or endurance such as having long conversations, getting your turn in fast-moving conversations, and having to say something quickly are situations that these participants found particularly challenging.…”

Evidence-Based Medicine: Facial Reanimation

“…Together, these deficits lead to significant functional and psychological impairment in emotional expressivity and communication, the sequelae of which significantly decreases the quality of patients' lives. [1][2][3] While most patients will ultimately see some degree of recovery over time, many experience persistent symptoms such as facial weakness, spasm, synkinesis, or aberrant tearing which can also negatively affect their daily living. 4 In an effort to quantify the patient experience, categorize severity, evaluate treatment outcomes, and monitor disease progression, a number of disease-specific outcome measures have been developed.…”

Electroacupuncture combined with Qianzhengsan decoction for the treatment of peripheral facial paralysis: A retrospective study

“…[1][2][3][4] It manifests as facial asymmetry persisting for weeks to months, disappearance of forehead lines, inability to close eye clefts and frown, difficulties in drooping mouth, drooling, brushing teeth, gargling obstacles, eating, and chewing. [5][6][7] Some patients also experience ear pain and facial numbness. PFP is very common in clinical practice and predominately affects individuals aged 20 to 40 years with more males than females.…”