Physical therapy for facial paralysis using the biofeedback

Abstract

Facial nerve paralysis (FNP) is characterized by the lesion of the facial nerve that affects the facial muscle functions and it is caused either by trauma, infection, or it is idiopathic. In some cases it becomes chronic and among the most common complications are corneal drying and synkinesis which may lead to physical, psychosocial and social impairments. Several physical therapy interventions have been proposed for this disorder, but most of them failed to consider the specificity of the facial neuromotor system and none of them has been shown to be effective. The aim of this paper was to provide a systematic review about the use of biofeedback for facial paralysis, including the application techniques and efficacy. Biofeedback is a technique that uses visual or auditive references by electromyography, a mirror or others to provide individual information about motor performance. This technique associated with specific exercises has been shown to be useful in the treatment of FNP. The main effects are based on motor learning processes to improve control and to reduce assymmetry and synkinesis. Factors such as timing and duration of the intervention, follow-up, and adherence to treatment appeared to influence the outcome. Despite the advantages reported in the literature about the application of biofeedback on FNP, the reviewed studies did not consider individual variability and nor determined which characteristics may influence recovery. Moreover, the longterm effects of biofeedback have not been established, as well as whether it is necessary to maintain a home-oriented exercise program.