SYMMETRY AND SYNKINESIS DURING REHABILITATION OF UNILATERAL FACIAL PARALYSIS

We evaluated biofeedback rehabilitation in patients with severe chroni c unilateral facial paralysis, who had intact facial-motor innervation (House grades 3 to 5). Recovery of facial function was characterized (1) by grading facial movement symmetry, and (2) by counting the numbe r of muscles exhibiting synkinesis during maximal execution of selecte d facial movements (e.g., smiling). Facial function in 21 patients typ ically improved by one House grade. Facial symmetry recovered rapidly during the first 5 months of treatment, and then improved more slowly. However, during this latter period, examination of the relationship b etween symmetry and synkinesis (visualized by a graph plotting symmetr y grades on the x-axis, against the number of synkinetic muscles on th e y-axis) indicated that overall facial control was improving even whe n House grading suggested that it was not. Such information should aid facial retraining and may clarify understanding of underlying rehabil itation mechanisms.