title: Comprehensive facial rehabilitation improves function in people with facial paralysis: a 5-year experience at the Massachusetts Eye and Ear Infirmary.
abstract: BACKGROUND
  The Facial Grading Scale (FGS) is a quantitative instrument used to evaluate facial function after facial nerve injury. However, quantitative improvements in function after facial rehabilitation in people with chronic facial paralysis have not been shown.
  
  
  OBJECTIVE
  The objectives of this study were to use the FGS in a large series of consecutive subjects with facial paralysis to quantitatively evaluate improvements in facial function after facial nerve rehabilitation and to describe the management of chronic facial paralysis.
  
  
  METHODS
  The study was a retrospective review.
  
  
  METHODS
  A total of 303 individuals with facial paralysis were evaluated by 1 physical therapist at a tertiary care facial nerve center during a 5-year period. Facial rehabilitation included education, neuromuscular training, massage, meditation-relaxation, and an individualized home program. After 2 months of home exercises, the participants were re-evaluated, and the home program was tailored as necessary. All participants were evaluated with the FGS before the initiation of facial rehabilitation, and 160 participants were re-evaluated after receiving treatment. All participants underwent the initial evaluation at least 4 months after the onset of facial paralysis; for 49 participants, the evaluation took place more than 3 years after onset.
  
  
  RESULTS
  Statistically significant increases in FGS scores were seen after treatment (P<.001, t test). The average initial score was 56 (SD=21, range=13-98), and the average score after treatment was 70 (SD=18, range=25-100).
  
  
  CONCLUSIONS
  A limitation of this study was that evaluations were performed by only 1 therapist.
  
  
  CONCLUSIONS
  For 160 patients with facial paralysis, statistically significant improvements after facial rehabilitation were shown; the improvements appeared to be long lasting with continued treatment. The improvements in the FGS scores indicated that patients can successfully manage symptoms with rehabilitation and underscored the importance of specialized therapy in the management of facial paralysis.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, National Naval Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889, USA. robin_lindsay@meei.harvard.edu
authors.forename: Robin W
authors.initials: RW
authors.lastname: Lindsay
authors.forename: Mara
authors.initials: M
authors.lastname: Robinson
authors.forename: Tessa A
authors.initials: TA
authors.lastname: Hadlock
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D001905:Botulinum Toxins / Q000627:therapeutic use; D002648:Child; D005081:Exercise Therapy; D005152:Facial Muscles / Q000294:innervation / Q000502:physiology; D005158:Facial Paralysis / Q000209:etiology / Q000534:rehabilitation*; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D008405:Massage; D008875:Middle Aged; D010353:Patient Education as Topic; D012064:Relaxation Therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins