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Multidisciplinary Care of Patients with Facial Palsy: Treatment of 1220 Patients in a German Facial Nerve Center. J Clin Med 2022; 11:jcm11020427. [PMID: 35054119 PMCID: PMC8778429 DOI: 10.3390/jcm11020427] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/18/2021] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
To determine treatment and outcome in a tertiary multidisciplinary facial nerve center, a retrospective observational study was performed of all patients referred between 2007 and 2018. Facial grading with the Stennert index, the Facial Clinimetric Evaluation (FaCE) scale, and the Facial Disability Index (FDI) were used for outcome evaluation; 1220 patients (58.4% female, median age: 50 years; chronic palsy: 42.8%) were included. Patients with acute and chronic facial palsy were treated in the center for a median of 3.6 months and 10.8 months, respectively. Dominant treatment in the acute phase was glucocorticoids ± acyclovir (47.2%), followed by a significant improvement of all outcome measures (p < 0.001). Facial EMG biofeedback training (21.3%) and botulinum toxin injections (11%) dominated the treatment in the chronic phase, all leading to highly significant improvements according to facial grading, FDI, and FaCE (p < 0.001). Upper eyelid weight (3.8%) and hypoglossal–facial-nerve jump suture (2.5%) were the leading surgical methods, followed by improvement of facial motor function (p < 0.001) and facial-specific quality of life (FDI, FaCE; p < 0.05). A standardized multidisciplinary team approach in a facial nerve center leads to improved facial and emotional function in patients with acute or chronic facial palsy.
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Melo TKMD, Andrade PF, Mateus SRM, Santos-Couto-Paz CCD. Psychometric properties of the Brazilian version of the Sunnybrook Facial Grading System. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: The Sunnybrook Facial Grading System (SFGS) is a scale to evaluate facial function in three domains, namely resting symmetry, voluntary move-ments, and synkinesis. It is commonly used in scientific research and clinical practice to assess and monitor people with facial paralysis. Objective: To translate and cross-culturally adapt the SFGS, develop a version for the Brazilian population (SFGS - Brazil) and analyze its psychometric properties, including validity, interrater reliability and responsiveness. Methods: A multidisciplinary panel translated and adapted the SFGS into Brazilian Portuguese, creating the SFGS-Brazil version. Next, content validation was carried out by a panel of four physical therapists with clinical experience in caring for people with facial paralysis, in addition to interrater reliability and scale responsiveness after physical therapy intervention. Results: For SFGD validation, committee agreement rate and the content validity index were greater than 90%. Agreement (interrater reliability) was excellent for most items and overall (intraclass correlation coefficient = 0.99; p < 0.000) and the scale proved to be responsive, indicating post-intervention improvement (t = 10.66; p = 0.000). Conclusion: The domains and items of the SFGS-Brazil are conceptually equivalent to those of the original version, and the instrument displays adequate psychometric properties, including validity, agreement and responsiveness. The SFGS-Brazil is suitable for the Brazilian population and can be used in scientific studies and clinical practice.
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Negley KJ, Rasool A, Byrne PJ. Motor Relearning After Hypoglossal-Facial Nerve Anastomosis. Am J Phys Med Rehabil 2021; 100:e85-e88. [PMID: 32796157 DOI: 10.1097/phm.0000000000001562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Facial paralysis is a clinical condition associated with significant functional and psychosocial morbidity (Facial Plast Surg FPS. 2011;27(4):346-57). The management paradigm for this condition continues to evolve with the use of both surgical and nonsurgical strategies (Facial Plast Surg FPS. 2011;27(4):346-57). Hypoglossal-facial nerve anastomosis is a surgical technique whereby the hypoglossal nerve acts as a donor motor nerve to restore facial muscle reinnervation via movements of the tongue (Plast Reconstr Surg. 1979;63(1):63-72). This case describes a 33-yr-old woman with unilateral facial paralysis who underwent hypoglossal-facial nerve anastomosis and 14 wks of postoperative rehabilitation. This report highlights the details of her rehabilitation regimen including the specific techniques used to enhance motor relearning of facial expression through movement of the tongue.
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Affiliation(s)
- Kelly J Negley
- From the Department of Physical Therapy, Marymount University, Arlington, Virginia (KJN); Medstar National Rehabilitation Hospital, Washington, DC (KJN); Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Alberta, Canada (AR); and Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Department of Dermatology, Department of Biomedical Engineering, The Johns Hopkins School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland (PJB)
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Volk GF, Hesse S, Geißler K, Kuttenreich AM, Thielker J, Dobel C, Guntinas-Lichius O. Role of Body Dysmorphic Disorder in Patients With Postparalytic Facial Synkinesis. Laryngoscope 2021; 131:E2518-E2524. [PMID: 33729598 DOI: 10.1002/lary.29526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the role of body dysmorphic disorder (BDD) in patients with postparalytic facial nerve syndrome with synkinesis (PFS). STUDY DESIGN A single-center retrospective cohort study. METHODS A total of 221 adults (74% women; median age: 44 years; median duration since onset of facial palsy: 1.6 years) were included. To diagnose BDD, the BDD Munich Module was used. Associations with House-Brackmann grading, Stennert index grading, Facial Clinimetric Evaluation (FaCE) survey, Facial Disability Index (FDI), general quality of life (SF-36), Beck Depression Inventory (BDI), and the Liebowitz Social Anxiety Scale (LSAS) was analyzed. RESULTS A total of 59 patients (27%) were classified as patients with BDD. Significant associations were found between the diagnosis of BDD and female gender and lower FDI, FaCE, and SF-36 scores and higher BDI and LSAS scores. Multivariate analysis revealed BDI, FaCE total score, and FaCE social function subscore as independent factors associated with BDD. CONCLUSION BDD was a relevant diagnosis in patients with PFS. A higher BDD level was associated with general and facial-specific quality of life and more psychosocial disabilities. Optimal treatment of PFS has to include these nonmotor dysfunctions. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2518-E2524, 2021.
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Affiliation(s)
- Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Susanne Hesse
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Katharina Geißler
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Anna-Maria Kuttenreich
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Jovanna Thielker
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Christian Dobel
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
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Volk GF, Geitner M, Geißler K, Thielker J, Raslan A, Mothes O, Dobel C, Guntinas-Lichius O. Functional Outcome and Quality of Life After Hypoglossal-Facial Jump Nerve Suture. Front Surg 2020; 7:11. [PMID: 32266284 PMCID: PMC7096350 DOI: 10.3389/fsurg.2020.00011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/02/2020] [Indexed: 12/22/2022] Open
Abstract
Background: To evaluate the face-specific quality of life after hypoglossal-facial jump nerve suture for patients with long-term facial paralysis. Methods: A single-center retrospective cohort study was performed. Forty-one adults (46% women; median age: 55 years) received a hypoglossal-facial jump nerve suture. Sunnybrook and eFACE grading was performed before surgery and at a median time of 42 months after surgery. The Facial Clinimetric Evaluation (FaCE) survey and the Facial Disability Index (FDI) were used to quantify face-specific quality of life after surgery. Results: Hypoglossal-facial jump nerve suture was successful in all cases without tongue dysfunction. After surgery, the median FaCE Total score was 60 and the median FDI Total score was 76.3. Most Sunnybrook and eFACE grading subscores improved significantly after surgery. Younger age was the only consistent independent predictor for better FaCE outcome. Additional upper eyelid weight loading further improved the FaCE Eye comfort subscore. Sunnybrook grading showed a better correlation to FaCE assessment than the eFACE. Neither Sunnybrook nor eFACE grading correlated to the FDI assessment. Conclusion: The hypoglossal-facial jump nerve suture is a good option for nerve transfer to reanimate the facial muscles to improve facial motor function and face-specific quality of life.
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Affiliation(s)
- Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Maren Geitner
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Katharina Geißler
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Jovanna Thielker
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Ashraf Raslan
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany.,Department of Otorhinolaryngology, Assiut University Hospital, Assiut, Egypt
| | - Oliver Mothes
- Department of Computer Science, Friedrich Schiller University, Jena, Germany
| | - Christian Dobel
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
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Singh P, Singh VP. Mime therapy for Ramsay Hunt syndrome: A case study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.3.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aim: There are limited physiotherapy interventions and lack of significant outcome for Ramsay Hunt syndrome. This case report is the first to our knowledge that uses mime therapy as physiotherapy treatment for Ramsay Hunt syndrome. Method: A 53-year-old male patient received mime therapy along with electrical stimulation at two and half months post-diagnosis. The patient received electrical stimulation at the first week intervention as 30 minutes per session for 5 days a week and was discontinued at the third week intervention because the patient could not continue with facial muscle stimulation at home. Mime therapy was given three times a week for 13 weeks, with a total of 24 visits spread over 3 months. Findings: Facial symmetry was measured using the Sunnybrook Facial Grading System and severity of paresis was measured using the House-Brackmann scale throughout the course of treatment. House-Brackmann grades improved from grade V to grade II. Facial symmetry and synkinesis also improved. The facial disability index also showed improvement in both the physical function and social/wellbeing subscale components (Initial scores: physical subscale = 35/100; social/wellbeing subscale = 55/100. The final scores: physical subscale = 75/100; social/wellbeing subscale = 85/100). Conclusions: Overall, mime therapy was effective and benefits are stable for the short term. Therefore, mime therapy can be a good treatment choice for patients with Ramsay Hunt syndrome. Further research should include randomised controlled trials with a large sample size to prove its long-term effects.
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Affiliation(s)
- Priyanka Singh
- Assistant professor, Physiotherapy Department of Physiotherapy, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Sikkim, India
| | - Vijay Pratap Singh
- Associate professor Department of Physiotherapy, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Sikkim, India
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Kim JH, Kim MY, Lee JU, Lee JA, Yoon NM, Hwang BY, Kim B, Kim J. The Effects of Symmetrical Self-performed Facial Muscle Exercises on the Neuromuscular Facilitation of Patients with Facial Palsy. J Phys Ther Sci 2011. [DOI: 10.1589/jpts.23.543] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ju-Hyun Kim
- Graduate School of Rehabilitation & Health Science, Doctoral Course, Yongin University
| | - Mee-Young Kim
- Graduate School of Rehabilitation & Health Science, Doctoral Course, Yongin University
| | - Jeong-Uk Lee
- Graduate School of Rehabilitation & Health Science, Doctoral Course, Yongin University
| | - Jeong-A Lee
- Graduate School of Rehabilitation & Health Science, Doctoral Course, Yongin University
| | - Na-Mi Yoon
- Graduate School of Rehabilitation & Health Science, Doctoral Course, Yongin University
| | - Byong-Yong Hwang
- Department of Physical Therapy, College of Public Health & Welfare Yongin University
| | - Bokyung Kim
- Department of Physiology, Institute of Functional Genomics, School of Medicine, Konkuk University
| | - Junghwan Kim
- Department of Physical Therapy, College of Public Health & Welfare Yongin University
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Wilson CM, Ronan SL. Rehabilitation Postfacial Reanimation Surgery After Removal of Acoustic Neuroma: A Case Study. J Neurol Phys Ther 2010; 34:41-9. [DOI: 10.1097/npt.0b013e3181cfc324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Comprehensive facial rehabilitation improves function in people with facial paralysis: a 5-year experience at the Massachusetts Eye and Ear Infirmary. Phys Ther 2010; 90:391-7. [PMID: 20093325 DOI: 10.2522/ptj.20090176] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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. DESIGN 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). LIMITATIONS 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.
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Muò R, Schindler A, Vernero I, Schindler O, Ferrario E, Frisoni GB. Alzheimer's disease-associated disability: An ICF approach. Disabil Rehabil 2009; 27:1405-13. [PMID: 16418055 DOI: 10.1080/09638280500052542] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of the study is to provide a description of dementia-associated disability in Alzheimer's disease (AD) patients through the International Classification of Functioning, Disability and Health (ICF). METHOD Twenty-six AD patients at different stages of disease participated in the study. Mini Mental State Examination (MMSE) and Global Deterioration Scale (GDS) were used to stage the degree of cognitive impairment and the stage of disease, respectively. All subjects were classified using the ICF categories in the more detailed four-level version. Correlation between compromised ICF items and both MMSE and GDS scores were calculated through Spearman Rho test. RESULTS Mental functions were impaired in all the subjects examined. Data on activity and participation showed that not only domestic life, self care, and mobility but also communication and interaction and social relationships are compromised in AD patients. Three main areas appeared as the most relevant facilitators: products and technology, support and relationship and services, systems and policies. ICF codes were generally correlated with both MMSE and GDS: subjects who appeared more compromised on MMSE and GDS showed higher impairment of functions, activity limitation, and participation restriction.Conclusion. ICF is a useful tool to describe health status in AD patients in that it underlines important aspects of daily living generally not considered by activity of daily living scales such as communication, social relationships, and recreation and leisure.
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Affiliation(s)
- Rossella Muò
- Associazione Fatebenefratelli per la Ricerca (AFaR), Italy.
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Haltiwanger E, Huber T, Chang JC, Gonzalez-Stuart A, Gonzales-Stuart A. Case study of Bell's palsy applying complementary treatment within an occupational therapy model. Occup Ther Int 2009; 16:71-81. [PMID: 19222052 DOI: 10.1002/oti.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
For 7% of people with Bell's palsy, facial impairment is permanent. The case study patient was a 48-year-old female who had no recovery from paralysis 12 weeks after onset. Goals were to restore facial sensory-motor functions, functional abilities and reduce depression. Facial paralysis was assessed by clinical observations, the Facial Disability Index and Beck Depression Index. Complementary interventions of aromatherapy, reflexology and electro-acupuncture were used with common physical agent modalities in an intensive home activity and exercise programme. The patient had 100% return of function and resolution of depression after 10 days of intervention. The limitation of this study is that it was a retrospective case study and the investigators reconstructed the case from clinical notes. Further research using a prospective approach is recommended to replicate this study.
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Affiliation(s)
- Emily Haltiwanger
- College of Health Sciences, University of Texas at El Paso, El Paso, TX 79902, USA.
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Manikandan N. Effect of facial neuromuscular re-education on facial symmetry in patients with Bell's palsy: a randomized controlled trial. Clin Rehabil 2007; 21:338-43. [PMID: 17613574 DOI: 10.1177/0269215507070790] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the effect of facial neuromuscular re-education over conventional therapeutic measures in improving facial symmetry in patients with Bell's palsy. DESIGN Randomized controlled trial. SETTING Neurorehabilitation unit. SUBJECTS Fifty-nine patients diagnosed with Bell's palsy were included in the study after they met the inclusion criteria. Patients were randomly divided into two groups: control (n = 30) and experimental (n = 29). INTERVENTIONS Control group patients received conventional therapeutic measures while the facial neuromuscular re-education group patients received techniques that were tailored to each patient in three sessions per day for six days per week for a period of two weeks. MAIN MEASURES All the patients were evaluated using a Facial Grading Scale before treatment and after three months. RESULTS The Facial Grading Scale scores showed significant improvement in both control (mean 32 (range 9.7-54) to 54.5 (42.2-71.7)) and the experimental (33 (18-43.5) to 66 (54-76.7)) group. Facial Grading Scale change scores showed that experimental group (27.5 (20-43.77)) improved significantly more than the control group (16.5 (12.2-24.7)). Analysis of Facial Grading Scale subcomponents did not show statistical significance, except in the movement score (12 (8-16) to 24 (12-18)). CONCLUSION Individualized facial neuromuscular re-education is more effective in improving facial symmetry in patients with Bell's palsy than conventional therapeutic measures.
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Affiliation(s)
- N Manikandan
- Department of Physiotherapy, Manipal College of Allied Health Sciences, Manipal, Karnataka, India.
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Leiper C. Invited commentary. Phys Ther 2007; 87:555-8; author reply 558-9. [PMID: 17472954 DOI: 10.2522/ptj.20060085.ic] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Carol Leiper
- Dan Aaron Stay Fit Exercise Program for Individuals With Parkinson Disease or Multiple Sclerosis, Arcadia University, 450 S Easton Rd, Glenside, PA 19038, USA
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VanSwearingen JM, Brach JS. Changes in facial movement and synkinesis with facial neuromuscular reeducation. Plast Reconstr Surg 2003; 111:2370-5. [PMID: 12794483 DOI: 10.1097/01.prs.0000061007.36637.88] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jessie M VanSwearingen
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA 15260, USA.
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