JCPSLP Vol 20 No 2 July 2018
Table 3. Individual performance on the three outcome measures showing raw scores pre and post-intervention
Participant
Diagnosis UMN/LMN
Nottingham scale
House Brackman scale
FaCE scale
Pre % Post % Diff
Pre Post
Diff
Pre n = 75 Post n = 75
Diff
#1
Stroke
UMN
86
100
14 ( p < .001)* 75 ( p < .001)* 16.6 ( p = .011)* 26 ( p < .001)* 0 (-17) ( p = .022)* 26 ( p < .001)* 40 ( p < .001)* 55.5 ( p < .001)*
2 1 1
67
73
6 NS
#2
Unknown
LMN
0
75
2 1 1
60
75
15 (p < .001)* 15 (p < .001)*
#3
Stroke
UMN
66.7 83.3
2 1 1
60
75
#4
Stroke
UMN
74
100
2 1 1
68
73
5 NS
#5
Stroke
UMN
67
50
2 2 0
51
54
11 NS
#6
Stroke
UMN
74
100
2 2 0
50
65
15 (p = .006)*
#7
MVA
UMN
17
57
4 3 1
37
37
0 NS
LMN
0
55.5
#8
Guillian Barre Syndrome
4 3 1
31
ID
ID
#9
Stroke
UMN
48
56
8 NS
5 4 1
50
53
3 NS
2.5 2 0.5
72
74
2 NS
#10
Stroke
UMN
85.1 96.4
11.3 ( p = .012)*
#11
Stroke
UMN
0
0
0
5 5 0
49
49
0 NS
#12
Stroke
UMN
72.5
90
17.5 ( p = .003)*
5 3.5 1.5
59
62
3 NS
ID: incomplete data; NS: non-significant (p < 0.05); Fisher Exact (two-tailed)
Discussion This study set out to demonstrate the effectiveness of a 4- to 5-week sub-acute therapy program, utilising mime and neuromuscular re-education with sEMG and mirror biofeedback to improve both facial symmetry at rest and functional movement. Intervention was offered to nine clients within a routine clinical service with a view to evaluating its effectiveness as a model of service delivery. No control was used in the study. A significant effect of treatment was seen across all outcome measures within the group, with the majority of the participants showing improved functional movement with appropriate facial symmetry, without the development of synkinesis. While a significant group effect was seen in quality-of-life-related factors, at an individual level, significant positive changes in quality of life were seen for three clients. The supervised exercises of graded complexity were effective in training of correct movement patterns and, consistent with Dalla Toffola et al.’s (2012) findings, synkinesis was avoided in all participants. The success of the intensively delivered intervention lends support to earlier studies (e.g., Manikadan, 2007) where intensive delivery has been shown to yield positive outcomes, in contrast to lengthier, lower intensity of clinician input programs (e.g., Beurskens & Heymans, 2006; Segal, Hunter et al., 1995). This study also demonstrated a positive treatment effect in the early stages
post onset. Earlier intervention, as reported in the literature by Teixeira et al. (2008) and recommended by Baricich et al. (2012), has implications not only for available neuroplasticity processes but also for improving the quality of life. One possible reason for the improvement in self-esteem may be related to greater active engagement in rehabilitation rather than having to “wait” passively for change. While one participant with LMN damage had missing data, significant improvement was seen in the second client with this diagnosis, suggesting that the treatment was effective One of the reasons considered to underpin the success of the approach was that both the clinicians and participants were motivated by the objective/visible changes which were recorded after each exercise and available for comparison between sessions. For some participants, this was apparent only when using the sEMG in the initial stages, a feature recommended by Dalla Toffola et al. (2012). When the sEMG values increased and the movement became more visible with the mirror (this occurred when the sEMG results were at approximately 9–10 microvolts), then more reliance on the mirror biofeedback was possible. The mirror was always encouraged for home practice routines to assist the participant in focusing on his/her affected side and preventing other unintended movement, e.g., eye irrespective of locus of damage. The role of biofeedback
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JCPSLP Volume 20, Number 2 2018
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