This has been a busy year for me, as I have been traveling to spending time with other therapists who specialize in treating facial paralysis.  I had the pleasure of spending three days at Radboud University Medical Center in the Netherlands with Carien Beurskens, PT.  She is such an amazing therapist with years of experience and knowledge, and it was a true honor to spend time with her and her patients. I was so excited to apply what I learned with Carien to treating my patients in Sarasota, Florida when I returned home.  Thank you, Carien!  A trip to Sidney, Australia allowed me to meet with Susan Coulson, PT and spend a few hours learning more about the interdisciplinary team that she is a part of in Australia.  She was very encouraging and supportive.  Thank you, Susan!  The most intensive experience I had this year was at the 13th International Facial Nerve Symposium, which was a scientific meeting of doctors, therapists, and scientists from around the world who came together for 3 days of intensive meetings in Hollywood, California.  The rehabilitation section was headed by Jackie Diels, OT, from Wisconsin, whose expertise was seen not only in the rehabilitation section meetings, but also on the various panels she participated in and in her wonderful talk to the general assembly.  Jackie’s knowledge, creativity, and scientific approach in treating and teaching patients how to improve their facial function are unmatched in my opinion.  Thank you, Jackie, for all you have shared teaching therapists from around the globe.  These wonderful women have helped me grow as a therapist, and I’m grateful to be able to work with patients who have facial paralysis at Equinox Physical Therapy in Sarasota, Florida.

Strangled by Growth, by Emily Carr 1931

Acoustic Neuromas are nerve sheath tumors surrounding the vestibular or cochlear nerves. The vestibular nerve is the balance nerve that goes from the inner ear to the brain. The cochlear nerve is the hearing nerve that goes from the cochlea to the brain. When the tumor grows, it can press on the nerves as they travel through a boney canal to reach the brain. This is how the tumor can damage a person’s balance and hearing. Also in this boney canal is the facial nerve. Damage to the facial nerve can result in facial paralysis.

At Equinox Physical Therapy, we specialize in treating people who have balance problems or facial paralysis as a result of acoustic neuromas. The majority of these patients come to see me following surgery, or radiation to the tumor. A few months ago, I had the pleasure of speaking to the members of the Acoustic Neuroma Association in Sarasota, Florida. They had the idea to videotape the talk for the members who were unable to attend the meeting. They were so pleased with the video, that they asked me if they could post it on their national website. The title of the talk was “The Vestibular System and How it is Affected by Acoustic Neuroma”. If you would like to learn more about this topic, you too can watch the video below.

The Vestibular System and How It Is Affected by Acoustic Neuroma from Acoustic Neuroma Association on Vimeo.

Bell Palsy is a condition that causes facial paralysis, and was named after Sir Charles Bell (1774-1842) who described the Facial Nerve and cases of facial paralysis in his writings. 

Who:  20-30 people per 100,000 people develop Bell Palsy per year.  It can occur at any age, but the median age is around 40 years old.

What: by definition, it is defined as idiopathic, acute unilateral peripheral facial palsy.  

Where:  It usually occurs on one side of the face.  Bell Palsy causes weakness or paralysis in all branches of the nerve.  In other words, people show signs of weakness or paralysis in the forehead, midface, and lower face with Bell Palsy.  

When: It comes on suddenly, usually within 48 hours and reaches its peak within a week.   People with Bell Palsy should show some signs of recovery within 6 months of onset.  If a person has complete facial paralysis with no signs of recovery at 6 months, they need further work up, because chances are it is not Bell Palsy, and they may have something serious causing their facial paralysis.  

Why:  When Bell Palsy was defined, it was defined as idiopathic, meaning “we don’t know what causes it”.  However, new research is pointing to the herpes simplex virus type 1 as a major cause of Bell Palsy.  

What to do:  If you have sudden facial paralysis, you need to find out right away what is causing it so that you get the proper treatment.  A physician needs to examine you and determine if it is Bells Palsy, or something more serious such as a stroke or brain tumor.   

How is it treated:  Initially, patients with Bells Palsy may be prescribed an anti viral medication, and/or a steroid medication to help protect the facial nerve and promote healing.  If the facial weakness does not completely recover on its own, the patient may be sent to a speach, ocupational or physical therapist who specializes in treating facial paralysis to retrain the facial muscles how to work again. 

Reference:  The Facial Nerve by Slattery and Azizzadeh, Chapter 9 on Bells Palsy & Ramsey Hunt Syndrome by Shingo Murakami.

Painting: Green Eye Mask by Amadeo de Souza-Cardoso, 1915

Facial paralysis occurs when the facial nerve is damaged and unable to send messages to the muscles of the face that create facial expressions. This problem can occur for several different reasons. Some causes include: tumor, trauma, stroke, or genetic disorders.

The most common cause of facial paralysis is due to Bell Palsy. While most of the time, Bell Palsy patients recover fully, research tell us that about 20-30% have lasting weakness or paralysis.

I first started treating people with facial paralysis because I was a vestibular specialist. The vestibular system or inner ear balance system is innervated by cranial nerve 8 (the Vestibular Nerve). The muscles of the face used for facial expression are innervated by cranial nerve 7 (the Facial Nerve). These 2 nerves run side by side on their way to the brain in a tunnel in the bone called the Internal Auditory Canal (IAC). This is a very narrow space, with only enough room for the nerves to travel. If a tumor is growing in this small place, or an infection travels to this area, both nerves can be damaged. We see this with large acoustic neuroma tumors, or with infections such as Ramsey Hunt Syndrome.

When facial paralysis does occur, it can take a lot of time for the nerve to heal. The first signs of movements of the face can be only just a flicker, but as the nerve heals, the movements can become stronger. Working with a physical therapist who has special training in treating facial paralysis can help improve the outcome for patients with this problem. They can teach a person what to expect while they are recovering, how to do stretches to ease pain and tightness in the face, how to retrain the muscles to move in a symmetrical way with the unaffected side of the face, and how to manage a condition called synkinesis (when facial muscles which should not be working when making a certain expression try to “help” anyway).

*Sculpture by Jun Kaneko 2007, Untitled Head in Glazed Ceramic and Steel