Electromyography as an Objective Outcome Measure for the Therapeutic Effect of Biofeedback Training to Reduce Post-Paralytic Facial Synkinesis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Ethical Approval, Eligibility Criteria and Study Protocol
2.2. Measurement Times and Recorded Parameters
2.3. Facial Clinemetric Evaluation and Facial Disability Index
2.4. Sunnybrook Facial Grading System
2.5. Statistics
3. Results
3.1. Patients’ Characteristics
3.2. Facial Grading and Facial Palsy-Related Quality of Life
3.3. EMG Amplitudes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Item/Scores | T1 | T2 | T1-T2 | |
---|---|---|---|---|
Mean ± SD | Mean ± SD | p-Value | Effect Size r | |
FaCE facial movement score | 44.2 ± 19.8 | 51.1 ± 19.0 | 0.015 | 0.445 |
FaCE facial comfort score | 49.4 ± 25.0 | 62.8 ± 20.3 | 0.005 | 0.512 |
FaCE oral function score | 74.2 ± 22.5 | 79.58 ± 17.8 | 0.055 | 0.350 |
FaCE eye comfort score | 52.5 ± 27.9 | 60.4 ± 28.8 | 0.034 | 0.388 |
FaCE lacrimal control score | 65.8 ± 24.1 | 71.7 ± 28.4 | 0.071 | 0.330 |
FaCE social function score | 67.9 ± 26.1 | 81.0 ± 19.7 | 0.001 | 0.591 |
FaCE total score | 58.1 ± 16.9 | 67.8 ± 14.6 | 0.001 | 0.634 |
FDI physical function score | 70.8 ± 16.2 | 78.5 ± 14.5 | <0.001 | 0.688 |
FDI social function score | 70.1 ± 19.0 | 82.1 ± 16.8 | <0.001 | 0.682 |
SFGS resting symmetry score | 10.7 ± 4.3 | 6.3 ± 3.9 | <0.001 | 0.775 |
SFGS voluntary movement score | 64.8 ± 13.9 | 74.3 ± 11.7 | <0.001 | 0.846 |
SFGS synkinesis score | 7.4 ± 2.4 | 4.2 ± 1.6 | <0.001 | 0.802 |
SFGS total score | 46.8 ± 14.7 | 63.7 ± 13.8 | <0.001 | 0.874 |
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List of Exercises |
---|
Long eyelid closure |
Closed smile |
Open smile |
Pursed lips/kissing mouth |
Closed smile with transition to kissing mouth |
Pursed lips with transition to showing teeth |
Open smile with transition to “O”/”U” |
Letter exercise O/U |
Letter exercise E/I |
Letter exercise A |
Alternating one-sided smile, then both sides |
Show teeth |
Wrinkle nose |
Raise/lower eyebrows |
Puff out cheeks |
Parameter | Absolute (N) | Relative (%) |
---|---|---|
All | 30 | 100.0 |
Gender | ||
Male | 7 | 23.3 |
Female | 23 | 76.7 |
Handedness | ||
Right | 30 | 100.0 |
Left | 0 | 0 |
Etiology | ||
idiopathic | 12 | 40.0 |
postoperative with benign tumor | 9 | 30.0 |
Ramsay Hunt syndrome | 6 | 20.0 |
traumatic | 3 | 10.0 |
congenital | 0 | 0 |
postoperative with malignant tumor | 0 | 0 |
cerebral insult | 0 | 0 |
Localization of the paresis | ||
right | 15 | 50.0 |
left | 15 | 50.0 |
Presence of oro-ocular synkinesis | ||
yes | 30 | 100.0 |
no | 0 | 0 |
Therapist week 1 | ||
Therapist A | 10 | 33.3 |
Therapist B | 20 | 66.7 |
Therapist week 2 | ||
Therapist A | 19 | 63.3 |
Therapist B | 11 | 36.7 |
Number of training days completed between the first (T1) and second (T2) measurement point | ||
9 training days | 15 | 50.0 |
8 training days | 12 | 40.0 |
7 training days | 3 | 10.0 |
Mean ± SD | Median, range | |
Age at beginning of facial palsy in years | 45.88 ± 13.71 | 47.33; 18.45–70.31 |
Age at start of training in years | 48.62 ± 12.41 | 48.84; 24.05–71.43 |
Height in m | 1.71 ± 0.09 | 1.70; 1.56–1.89 |
Weight in kg | 78.90 ± 17.84 | 72.5; 48.0–150.0 |
BMI in kg/m2 | 26.08 ± 6.43 | 24.95; 16.61–43.36 |
Period between beginning of facial palsy and reinnervation in years (n = 28 *) | 0.33 ± 0.25 | 0.27; 0.04–1.03 |
Time between beginning of facial palsy and first contact with Facial-Nerve-Center in years | 2.11 ± 2.30 | 1.21; 0.44–9.79 |
Time between beginning of facial palsy and first measurement (T1) in years | 2.80 ± 2.41 | 1.84; 1.12–10.99 |
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |
---|---|---|---|---|---|---|---|---|---|
1 | 0.017 (0.2–1.7) | 0.001 (0.6–1.9) | 0.018 (0.2–2.1) | 0.002 (0.6–2.2) | 0.011 (0.3–1.9) | 0.003 (0.6–2.4) | 0.001 (0.7–2.2) | 0.001 (0.7–2.1) | |
2 | 0.017 (0.2–1.7) | 0.202 (−0.8–0.2) | 0.549 (−1.0–0.6) | 0.118 (−1.0–0.1) | 0.570 (−0.8–0.5) | 0.121 (−1.3–0.2) | 0.066 (−1.1–0.0) | 0.097 (−1.0–0.1) | |
3 | 0.001 (0.6–1.9) | 0.202 (−0.2–0.8) | 0.764 (−0.5–0.7) | 0.483 (−0.5–0.2) | 0.536 (−0.3–0.6) | 0.382 (−0.8–0.3) | 0.172 (−0.5–0.1) | 0.564 (−0.7–0.4) | |
4 | 0.018 (0.2–2.1) | 0.549 (−0.6–1.0) | 0.764 (−0.7–0.5) | 0.374 (−0.7–0.3) | 0.879 (−0.7–0.8) | 0.327 (−1.0–0.3) | 0.305 (−0.9–0.3) | 0.516 (−1.0–0.5) | |
5 | 0.002 (0.6–2.2) | 0.118 (−0.1–1.0) | 0.483 (−0.2–0.5) | 0.374 (−0.3–0.7) | 0.340 (−0.3–0.8) | 0.688 (−0.7–0.5) | 0.601 (−0.4–0.3) | 0.938 (−0.6–0.6) | |
— | 0.011 (0.3–1.9) | 0.570 (−0.5–0.8) | 0.536 (−0.6–0.3) | 0.879 (−0.8–0.7) | 0.340 (−0.8–0.3) | 0.052 (−0.7–0.0) | 0.117 (−0.8–0.1) | 0.232 (−0.8–0.2) | |
7 | 0.003 (0.6–2.4) | 0.121 (−0.2–1.3) | 0.382 (−0.3–0.8) | 0.327 (−0.3–1.0) | 0.688 (−0.5–0.7) | 0.052 (0.0–0.7) | 0.900 (−0.4–0.5) | 0.669 (−0.3–0.5) | |
8 | 0.001 (0.7–2.2) | 0.066 (0.0–1.1) | 0.172 (−0.1–0.5) | 0.305 (−0.3–0.9) | 0.601 (−0.3–0.4) | 0.117 (−0.1–0.8) | 0.900 (−0.5–0.4) | 0.795 (−0.4–0.6) | |
9 | 0.001 (0.7–2.1) | 0.097 (−0.1–1.0) | 0.564 (−0.4–0.7) | 0.516 (−0.5–1.0) | 0.938 (−0.6–0.6) | 0.232 (−0.2–0.8) | 0.669 (−0.5–0.3) | 0.795 (−0.6–0.4) |
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | |
---|---|---|---|---|---|---|---|---|---|
1 | 0.075 (−0.1–1.0) | 0.005 (0.2–1.0) | 0.050 (0.0–1.2) | 0.006 (0.3–1.6) | 0.128 (−0.2–1.2) | 0.018 (0.2–1.4) | 0.009 (0.2–1.3) | 0.006 (0.3–1.4) | |
2 | 0.075 (−0.1–1.0) | 0.608 (−0.6–0.4) | 0.652 (−0.8–0.5) | 0.031 (−0.9–0.0) | 0.916 (−0.6–0.5) | 0.198 (−0.9–0.2) | 0.084 (−0.7–0.0) | 0.059 (−0.8–0.0) | |
3 | 0.005 (0.2–1.0) | 0.608 (−0.4–0.6) | 0.935 (−0.4–0.4) | 0.147 (−0.8–0.1) | 0.714 (−0.4–0.6) | 0.409 (−0.7–0.3) | 0.377 (−0.6–0.2) | 0.158 (−0.7–0.1) | |
4 | 0.050 (0.0–1.2) | 0.652 (−0.5–0.8) | 0.935 (−0.4–0.4) | 0.076 (−0.7–0.0) | 0.694 (−0.5–0.7) | 0.460 (−0.7–0.3) | 0.507 (−0.7–0.4) | 0.210 (−0.7–0.2) | |
5 | 0.006 (0.3–1.6) | 0.031 (0.0–0.9) | 0.147 (−0.1–0.8) | 0.076 (0.0–0.7) | 0.039 (0.0–0.8) | 0.467 (−0.2–0.5) | 0.262 (−0.1–0.5) | 0.584 (−0.2–0.3) | |
6 | 0.128 (−0.2–1.2) | 0.916 (−0.5–0.6) | 0.714 (−0.6–0.4) | 0.694 (−0.7–0.5) | 0.039 (−0.8–0.0) | 0.052 (−0.6–0.0) | 0.153 (−0.7–0.1) | 0.033 (−0.7–0.0) | |
7 | 0.018 (0.2–1.4) | 0.198 (−0.2–0.9) | 0.409 (−0.3–0.7) | 0.460 (−0.3–0.7) | 0.467 (−0.5–0.2) | 0.052 (0.0–0.6) | 0.851 (−0.3–0.3) | 0.672 (−0.4–0.3) | |
8 | 0.009 (0.2–1.3) | 0.084 (0.0–0.7) | 0.377 (−0.2–0.6) | 0.507 (−0.4–0.7) | 0.262 (−0.5–0.1) | 0.153 (−0.1–0.7) | 0.851 (−0.3–0.3) | 0.441 (−0.4–0.2) | |
9 | 0.006 (0.3–1.4) | 0.059 (0.0–0.8) | 0.158 (−0.1–0.7) | 0.210 (−0.2–0.7) | 0.584 (−0.3–0.2) | 0.033 (0.0–0.7) | 0.672 (−0.3–0.4) | 0.441 (−0.2–0.4) |
p-Value | Partial η² | |
---|---|---|
Interaction between the change in EMG amplitude of the synkinetic side and therapist A, therapist B and change of therapists | 0.891 | 0.365 |
Interaction between the change in EMG amplitude of the contralateral side and therapist A, therapist B and change of therapists | 0.450 | 0.603 |
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Hahnemann, I.; Fron, J.; Ballmaier, J.; Guntinas-Lichius, O.; Volk, G.F. Electromyography as an Objective Outcome Measure for the Therapeutic Effect of Biofeedback Training to Reduce Post-Paralytic Facial Synkinesis. Healthcare 2025, 13, 550. https://doi.org/10.3390/healthcare13050550
Hahnemann I, Fron J, Ballmaier J, Guntinas-Lichius O, Volk GF. Electromyography as an Objective Outcome Measure for the Therapeutic Effect of Biofeedback Training to Reduce Post-Paralytic Facial Synkinesis. Healthcare. 2025; 13(5):550. https://doi.org/10.3390/healthcare13050550
Chicago/Turabian StyleHahnemann, Isabell, Julia Fron, Jonas Ballmaier, Orlando Guntinas-Lichius, and Gerd Fabian Volk. 2025. "Electromyography as an Objective Outcome Measure for the Therapeutic Effect of Biofeedback Training to Reduce Post-Paralytic Facial Synkinesis" Healthcare 13, no. 5: 550. https://doi.org/10.3390/healthcare13050550
APA StyleHahnemann, I., Fron, J., Ballmaier, J., Guntinas-Lichius, O., & Volk, G. F. (2025). Electromyography as an Objective Outcome Measure for the Therapeutic Effect of Biofeedback Training to Reduce Post-Paralytic Facial Synkinesis. Healthcare, 13(5), 550. https://doi.org/10.3390/healthcare13050550