Facial movement retraining is NOT about:
Making many facial expressions as much as you can.
WHY is facial movement retraining different?
Facial muscles are different to other muscles in our body and cannot be “strengthened” the same way as after an orthopedic muscle injury. Learning about your facial muscles and how they work as well as becoming aware of your own facial habits and patterns will enable one to be more successful in learning to coordinate a meaningful smile and comfort in public settings.
Facial muscles are different to other muscles in our body.
- They have less receptors (muscle spindles) in them that detect muscle length and position sense.
- Facial muscles move skin, not bones and joints.
- Facial movements and subsequent expressions can result from a thought or instruction such as “make a soft smile”, but can also result from an emotional state of being such as “feeling happy” or “hearing a funny joke.”
- Facial muscles have smaller motor units which mean that the facial muscles move in a much more precise and intricate fashion.
Facial muscle paralysis or weakness is resultant from a nerve injury and it’s sequelae, not a direct muscle injury. This is not an orthopedic injury and cannot be treated in the same way. It’s important for retraining to involve the brain and mental / cognitive input.
Regular strength training approaches involving repetitions of many facial expressions and working “as hard as you can” to make a smile, close your eyes, pucker or other expression, often results in too many facial muscles working together at the same time. This does not necessarily get the targeted muscle to work any better. Less movement may actually result as so many muscles are contracting at the same time. Indeed, if someone has synkinesis, regular strength training will just facilitate the synkinesis instead of inhibit it. The face will often just feel tighter and more restricted, resulting in more difficulty making the expression that is intended.
WHAT is facial neuromuscular retraining (movement retraining)?
Facial neuromuscular retraining is a client focused approach to regain controlled, symmetrical facial expressions and inhibit any synkinesis if present. Therapy aims to promote client comfort in private and social settings including eating out, business environs, public speaking and family photos.
Empowering the client in formulating treatment goals, and learning treatment strategies to perform by themselves at home is integral to the success of facial retraining.
The client is educated and guided to become more aware of their facial muscles and function with different expressions, eating, drinking, dental care, talking and all tasks performed during the day. This is significant to promote improvement in facial comfort and expression with whatever task one is doing during their day.
Neuromuscular retraining is based on principles of neuroplasticity and motor control. This is a comprehensive program to retrain the brain, nerves and muscles to control facial movement and expressions. One can learn to reinforce correct movements and inhibit aberrant or unwanted movement patterns. As one becomes more aware of the face and desired movement patterns, the brain relearns how to control these new movements and expressions.
Learning any skill is task specific and practice needs to be guided in this fashion. As we use our faces all day in whether in response to how we are feeling or in communicating in a variety of settings, hence it’s important that principles of neuromuscular retraining are integrated to what one is doing the whole day – at work and home. This can apply to our facial expressions at rest, while listening, talking, working at the computer, eating, drinking, smiling at family, friends or greeting new people, or even getting angry with a snarl, frowning or looking surprised.
Neuromuscular retraining and manual therapy to the face is a non-invasive and non-surgical approach. However, Botox injections given by the treating physician can be very useful in assisting the neuromuscular retraining when there is significant synkinesis.
WHEN can facial neuromuscular retraining be started?
Facial Neuromuscular retraining can be started when there is some return of movement to the affected side of the face. Sometimes, an evaluation is started earlier to assist with eye care strategies to prevent eye dryness.
WHO is neuromuscular retraining suitable for?
People with facial paralysis or facial weakness, with or without synkinesis, can benefit from facial neuromuscular retraining.
Some of the causes of facial paralysis or weakness include:
- Bell’s Palsy
- Ramsay Hunt Syndrome
- Lyme Disease
- Congenital Facial Palsies
- Post Surgical removal of acoustic neuroma’s, facial nerve or parotid tumors
- Trauma – skull fractures, facial lacerations or surgeries resulting in insult to the facial nerve
- After facial reanimation surgery
While the cause of facial paralysis may vary, facial retraining facilitates the relearning of symmetrical facial movements, expressions and vital functions such as eating, drinking, talking, socializing and communication. Control on both the affected and unaffected side of the face needs to be relearned and coordinated.