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Mime therapy is a combination of mime and physiotherapy and aims
to promote symmetry of the face at
rest and during movement and to control synkinesis (Beurskens
et
al 2004b). First, participants were taught to massage their face
and neck daily for 1015 min. Massage
consisted of effleurage and kneading both sides of the face.
Stretching
exercises of the affected side followed to relieve mimetic
muscles involved in synkinesis. Then,participants were taught to
recognise tension and to feel the difference between
tension and relaxation in general and more specifically in the
facial musculature, because synkinesis may
increase muscle tone which can be exacerbated by stress.
Third,
specific exercises to co-ordinate both halves of the face and to
decrease synkinesis were taught. Basic
exercises (forehead wrinkle, eye closure, smile, snarl, lip
pucker)
with variations in amplitude and speed, exercises for one side
of the face to control separate movements,
relaxation of the lower jaw, exercises of the mouth (smiling,
pouting)
and the eye with simultaneous inhibition of synkinesis (slow,
small movements and counteraction) wereincluded. A mirror was used
for feedback. Fourth, eye and lip closure exercises were taught. In
cases of
lagophthalmus (inability to close the eyelids fully) the upper
eyelids were stretched.
Eye exercises were performed with variations in speed and force,
whilst keeping the lips still. Lip closure
exercises comprised exercises of the cheek (filling the cheeks
with
varying amounts of air) and eating and drinking exercises whilst
keeping the affected eye open (small
movements). Fifth, exercises were performed to increase the
participants
awareness of lip movements and the position of the mouth
for various sounds. Vowels as a, e, i, and o, and consonants
such as p and b were used for the position of the lips.
Lastly, expression exercises were taught. Mime therapy
aims to develop a conscious connection between the use of
certain muscles and facial emotional expression. Exercises
were performed in two ways: working from the use of
certain muscles towards an expression, or working from an
expression as a starting point for a movement. For example:
the participant was asked to raise the forehead or to
perform
an expression depicting amazement. Other expressions
were evoked by asking the participant to: open the eyes
wide (surprise), lift the upper lip (disgust), or tighten
the
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Physiotherapy and Aims to Promote Symmetry of the Face at Rest
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lips (anger).
Participants al
1. Simple traditional exercise To improve the activation level
of various group of facial muscles Suck the cheeksbetween the
teethWrap the lips over the teethPuckering of the lipsSpeech
sounding sh, P, B, F withteeth held together or fixedEye closing
exercise; look down, close the eyes, once closed continue to look
down .
2. Title Otol Neurotol. 2003 Jul;24(4):67781. Positive effects
of mime MIME Method sample Stability of benefits of mimetherapy in
sequelae of facial nerve paresis during a 1-year period. Result/
conclusion RCT 50 patientsHouseBrackmann score of Grade IV. Facial
Disability Index Facial Disability Index improved substantially
Follow up ofthe above RCT 48 9 months majority absence of
deterioration 50 Sunnybrook Improvement in Facial Gradingsymmetry
System House facial grading therapy on sequelae of facial
paralysis: stiffness, lip mobility, and social andphysical aspects
of facial disability. Otol Neurotol. 2006 Oct;27(7):1037-42.
Outcome Aust J Physiother.2006;52(3):177RCT 83. Mime therapy
improves facial symmetry in people with long-term facial nerve
paresis: arandomised controlled trial
3. Mime combination of mime and physiotherapy Performing
expression Can also be helpful in chronic facialparalysis
4. Functional exercise Developed as a multi dimensional and
patientcentered approach to rehabilitation of individualswith
facial paralysis Prakash V, Hariohm K, Vijayakumar P, Thangjam
Bindiya D. Functional training in themanagement of chronic facial
paralysis. Phys Ther. 2012;92:605613. Encompasses major facial
functions Thefunctional training program consists of patient
education, functional training and complementary exercises
5. Functional training Improved ability to express context
specific emotions and other physical functions of facePatient
education Positive coping strategies and Improved social
interaction skills Functional TrainingProgram Functional training
Complimentary exercise Improved ability to activate various facial
muscles
6. Functional training To facilitate context specific
spontaneous and voluntary emotions 1. Watch movies,
television programs and funny videos. 2. Narrate them during the
treatment session in the clinic. 3. Thinkabout the funny incidents
that had happened in your life or the jokes you heard or read
recently and share itwith friends or family members.
7. Functional training To facilitate motor functions of facial
muscles around the eyes, lips and mouth. 1. Humor sing songs that
you like as frequently as possible 2. Play games like peek -a- boo,
blowing bubbles withyour kids. 3. Rinse the mouth and spit the
water down slowly. 4. Blow a pipe while imagining that you
arecooking in the kitchen and suddenly the fire puts off in the
wood stove; you have to blow the pipe to make thefire again.
8. Functional training Still no clinical trial to prove
effectiveness
Grading:
The grading system developed by House and Brackmann categorizes
Bell palsy on a scale of I to VI,[3, 4, 5] as follows:Grade I:
normal facial function
Grade II: mild dysfunction
Grade III: moderate dysfunction
Grade IV: moderately severe dysfunction
Grade V: severe dysfunction
Grade VI: total paralysis
