Give me a kiss! An integrative rehabilitative training program with motor imagery and mirror therapy for recovery of facial palsy

BACKGROUND: Peripheral facial nerve palsy (FNP) can have various causes, such as Bell's palsy or after surgery for acoustic neuroma. Rehabilitation is often required but there is no evidence that any rehabilitation approach is more efficacious than another. AIM: The purpose of this research was to determine the effects of neurocognitive-rehabilitative approach through mirror-therapy (MT) and motor-imagery (MI), integrated into the traditional rehabilitation with mime-therapy and myofascial-approach. DESIGN: This study was designed as a double-blind, randomized, controlled-trial. SETTING: This study took place from January 2016 to June 2018 at the Unit of Physical Medicine and Rehabilitation, Umberto I Hospital, Rome, Italy. POPULATION: Twenty-two patients were randomized into two groups: mirror-therapy (N=11, MT and MI) and traditional-rehabilitative group (N=11, mime-therapy and a myofascial-approach). METHODS: Outcome assessments were performed before treatment (T0), after one month (T1=10 session, twice/week), after the second and third months (T2=10 twice/week + 5 of MT+MI one/week and T3=10 twice/week + 5 of MT+MI 1/week), and at the 4-week follow-up (T4=2 months follow-up). RESULTS: The analysis of the functional evaluations show that both groups experienced progressive improvement T0 to T3, with stabilization of the results at the follow-up. There was a significant difference in House-Brackmann-Scale scores between T0 and follow-up in favor of the experimental group. In terms of quality of life (FaCE scale), total scores and social function items improved in both groups from T0 to T3. The experimental group obtained better results with regard to quality of life and emotional depression. CONCLUSIONS: The integrated use of MT and MI is efficacious in the rehabilitation of FNP, improving facial physical function. Further studies are needed to determine the predictive factors of the recovery of facial mimic. CLINICAL REHABILITATION IMPACT: The ability of patients with unilateral facial paralysis to recognize and appropriately judge facial expressions and perceive the judgments of others remains underexplored. The likelihood of recovering near-normal facial-function after grade VI facial paralysis is low. Procedures, such as the immediate repair of the facial nerve with an interposed donor graft, might improve facial function in patients with partially injured facial nerves.