JCPSLP Vol 20 No 2 July 2018

Methods Participants

needed, clinicians should develop the full potential of the sEMG in rehabilitation for speech and swallowing musculature. Current study This study was undertaken as a quality improvement project within the Rehabilitation in the Home (RITH) program of a metropolitan health service in Western Australia. RITH is a hospital sub-acute program designed to allow for the early discharge of clients home but where discharged clients continue to receive intensive rehabilitation from a team of clinicians for a short period of 4 to 5 weeks. An integrated intervention protocol involving exercise and biofeedback was introduced with FNP as best practice, but with limited evidence reported in the literature, a service evaluation was critical to evaluate early data and underpin future service delivery. Aims The aim of this study was to evaluate the intervention protocol for clients with FNP referred to RITH over a 12-month period. During the period of evaluation, both sEMG and mirror biofeedback were provided intensively, combined with specific, graded, tailored facial exercises, for neuromuscular re-education for the facial muscles. It was hypothesised that clients would achieve improved symmetry at rest and improved functional movement, with limited synkinesis, along with associated changes in perceived quality of life related to improved facial expression. Based on limited previous evidence (e.g., Segal, Hunter et al., 1995), positive results were expected within the 4- to 5-week period and would support the continued routine use of this approach for people with FNP within the local context of service delivery. No control group was used to compare findings against other intervention approaches or protocols (e.g., dose, intensity). Ethical procedures As data collection and evaluation were undertaken as routine care, a written waiver was provided by the chair of the HREC and local quality improvement processes followed. As per QI guidelines, all ethical processes were in place prior to and during the study, including clients providing consent to participate in the evaluation of the service being provided by the speech-language pathology services. This included consent to have photographs taken and for de-identified photographs and outcomes of the study to be disseminated to professional groups and to be used for teaching purposes. All participants were informed of dissemination at the time of the study and provided written consent.

Twelve participants (8 males, 4 females) consented to participate in the treatment program for FNP during a 12-month period. Aetiology of FNP was mixed within the group and included 10 participants with UMN FNP (9 following stroke and one due to a motor vehicle accident) and 2 participants with LMN FNP (one with Guillian Barre Syndrome and one with an undiagnosed palsy, described as “other neurological” in medical records). Mean age was 55.25 years (SD: 13.97, range: 25–76 years) (see Table 1). Mean number of days post onset was 49.9 days (SD: 72.79; range: 1–272), although reduced to 29 days (SD: 16.01) when two outliers were removed (1 day and 272 days) (See Table 1). Assessment and outcome measures Pre- and post-intervention measures were collected during a period of routine clinical care. As the data collection and evaluation were undertaken as routine care, ethical approval was not required (as deemed by the HREC chair) and local quality improvement processes were followed. Assessment measures were taken pre and immediately post treatment and included: 1. Nottingham System (Murty, Diver, Kelly, O’Donoghue, & Bradley, 1994), an objective assessment of facial nerve function involving the measurement of facial movement compared to the rest position and expressed as a ratio and percentage of right versus left, facial measurements to measure symmetry at rest and on movement of the affected side. 2. House Brackman Facial Nerve Grading System (House & Brackmann, 1985), a widely used system grading facial nerve weakness severity. Six grades of descending severity are rated, ranging from 1 = normal to 6 = no movement. 3. Facial Clinimetric Evaluation Scale (FaCE Scale) (Kahn et al., 2001), a self-report instrument, rating across a 5-point scale where 5 = normal , involving 15 questions on the ability to move the face, feeling/sensation in the face on movement, eye comfort, how people react, social participation, and drooling, with a view to determining quality of life. 4. Pre and post photos were taken where consent was given. Intervention protocol Intensive therapy was offered at three to five sessions/week for 45–60 minutes over a 4- to 5-week period (week days

Table 1. Demographic information of participants in the study

Stroke ( n = 9)

MVA ( n = 1)

GBS ( n = 1)

Other ( n = 1)

Total ( n = 12)

Male:female ratio

7:2

1:0

1:0

0:1

12

Mean age (SD, range)

59.70 (10.81, 37–76) 57.33 (82.37, 1–272)

25

56

62

55.25 (13.97, 25–76) 49.90 (72.79, 1–272)

Mean number of days post FNP (SD*, range)

24

11

12

Mean number of days post FNP without outliers (1 and 272 days) (SD)

34.71 (15.49)

24

11

12

29 (16.01)

*NB 2 outliers of time post for stroke group (1 day post and 272 days post)

65

JCPSLP Volume 20, Number 2 2018

www.speechpathologyaustralia.org.au