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To promote symmetry of the face at rest and during movement
To control synkinesis
10-15 minutes of massage of face and neck daily. Massage includes effleurage and kneading both sides of the face.Stretching exercises of the affected side was also performed to relieve mimetic muscles involved in synkinesis.
Patients are taught to recognise tension and to feel the difference between tension and relaxation in general and more specifically in the facial musculature, because synkinesis may increase muscle tone which can be exacerbated by stress.
Specific exercises to co-ordinate both halves of the face and to decrease synkinesis were taught. Basic exercises (forehead wrinkle, eye closure, smile, snarl, lip pucker) with variations in amplitude and speed, exercises for one side of the face to control separate movements, relaxation of the lower jaw, exercises of the mouth (smiling, pouting) and the eye with simultaneous inhibition of synkinesis (slow, small movements and counteraction) were included. A mirror was used for feedback.
Fourth, eye and lip closure exercises were taught. In cases of lagophthalmus (inability to close the eyelids fully) the upper eyelids were stretched. Eye exercises were performed with variations in speed and force, whilst keeping the lips still. Lip closure exercises comprised exercises of the cheek (filling the cheeks with varying amounts of air) and eating and drinking exercises whilst keeping the affected eye open (small movements).
Fifth, exercises were performed to increase the participant’s awareness of lip movements and the position of the mouth for various sounds. Vowels as a, e, i, and o, and consonants such as p and b were used for the position of the lips.
Lastly, expression exercises were taught. Mime therapy aims to develop a conscious connection between the use of certain muscles and facial emotional expression. Exercises were performed in two ways: working from the use of certain muscles towards an expression, or working from an expression as a starting point for a movement. For example: patients are asked to raise the forehead or to perform an expression depicting amazement. Other expressions were evoked by asking the participant to: open the eyes wide (surprise), lift the upper lip (disgust), or tighten the lips (anger).
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