RESEARCH REPORT POSTER DISPLAY

IMPROVING THE SMILE FOLLOWING FACIAL NERVE PARESIS DURING PHYSIOTHERAPY REHABILITATION WITH THE USE OF VIDEO SELF-MODELING AND IMPLEMENTATION INTENTIONS. Coulson S¹, Adams R¹, O’Dwyer N², Croxson G³; ¹School of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Australia. ²School of Exercise & Sport Science, Faculty of Health Sciences, The University of Sydney, Australia. ³Department of otolaryngology, Royal Prince Alfred Hospital, Sydney, Australia

PURPOSE: The inability to smile effectively has been a primary motivator for getting physical therapy and surgical management of the face after facial nerve paresis. However, spontaneous, automatic implementation of an effective smile at the appropriate moment in social situations often remains a problem in the long term. To address this problem, as well as to examine ways to increase transference of smile improvements following physical therapy and surgical treatments, this study used a protocol of Video Self-Modeling followed by structured Implementation Intentions in an attempt to rehabilitate a well-controlled, effective smile after long-term facial nerve paresis. RELEVANCE: Although there may be measurable, visible improvements evident during a physical therapy session or achieved following reanimation surgery, such gains seldom translate into a well-controlled smile which can be used in the brief windows of opportunity that arise in social situations. This may be due to differences between a posed smile and a spontaneous smile in terms of availability for implementation. Techniques which improve the accessibility and performance of a motor skill thus have relevance to physical therapy practice. PARTICIPANTS: Ten subjects with a lower motor neurone facial nerve paresis which was greater than 1 year post-onset participated in this study. METHODS: Video Self-Modeling (video replay of only best Adapted smiles) and Implementation Intentions (planning and visualising implementation of Adapted smiles in pre-determined, specific situations) were used in physiotherapy rehabilitation of an Adapted (more symmetrical) smile in subjects with facial nerve paresis. The study design was a prospective, blinded clinical trial. Ability to produce the Adapted smile on cue was measured using a reaction time test. ANALYSIS: Analyses of variance (ANOVA) with planned contrasts were used to examine the effects of smile type (Adapted or Everyday) on RT and MT data, VAS ratings, and Facial Disability Index. The averaged scores of data 1 and data 2 (pre-intervention) measurement sessions were compared with the averaged scores of data 3 and data 4 (post-intervention) measurement sessions. A 6 month follow-up was also undertaken. STATISTICA 7.0 for Windows was used to perform statistical analysis. RESULTS: After exposure to Video Self-Modeling: (i) reaction time (RT) to initiation of Adapted smiles became 202 msec faster whereas RT for Everyday (asymmetrical) smiles became 150 msec slower (ii) Adapted smiles were completed 521 msec faster (iii) Adapted smiles had higher Movement Control and Overall Quality ratings (iv) Self-report on Facial Disability Index social/wellbeing subscale improved. CONCLUSIONS: Following intervention there were significant changes in availability, execution speed and quality of the smile. Implementation Intentions after Video Self-Modeling ensured transfer of the Adapted smile to pre-determined everyday situations. IMPLICATIONS: This study supports these rehabilitation techniques as being methods that can maximise quality of smiling following facial nerve paresis. KEYWORDS: facial paresis, edited videotape, self-modeling,. FUNDING ACKNOWLEDGEMENTS: Australian Government Postgraduate Award for Doctoral Studies. CONTACT: s.coulson@fhs.usyd.edu.au

ETHICS COMMITTEE: Human Research Ethics Committee. The University of Sydney