Evaluation of the Effects of an Electromyography-Based Bio-Feedback Training of Patients with Post-Paralytic Facial Synkinesis Using Electromyography Amplitudes as Objective Outcome Measure

Biofeedback rehabilitation programs for facial palsy are not yet commonly accepted nor routinely available for patients suffering under various forms of facial palsy. To improve the scientific evidence, the effect of an intensified 2-weeks facial training combining electromyography (EMG) and visual biofeedback training was objectively evaluated: 30 patients (76.7% female; median age: 48.6 years) with post-paralytic facial synkinesis were included in longitudinal prospective study. At the beginning of each training day, EMG amplitudes of both halves of the face were recorded during relaxation using the EMG system that was synchronously used for the EMG bio-feedback training. A single-factor analysis of variance was done for the change over time and a t-test was used to evaluate the side differences. After the training there was a significant decrease of the EMG amplitudes of both halves of the face (synkinetic side: p < 0.001; contralateral side p = 0.003), indicating an improved voluntary muscle relaxation. There was also a significant im-provement in Sunnybrook Facial Grading System, Facial Disability Index and Facial Clinimetric Evaluation assessed before start of training and at the end (p < 0.001). Electrophysiological im-provements of the facial muscles during combined biofeedback training can be objectively meas-ured using surface EMG recording.