The Role of Rehabilitation in Peripheral Paralysis of the Facial Nerve: A Case Report of a Patient Treated with a Neuro-Cognitive Approach

Abstract

Peripheral paralysis of the facial nerve is a pathology that, although not involves any risks for the patient's life, significantly affects not only motor, but also communicative, psychological, and social aspects, having an important impact on the quality of life. The most widely used therapeutic proposals do not always respond to the need to intervene on all the functional components related to the facial nerve, but to prevent and treat complications. The neuro-cognitive proposal, although not found in the literature or in the biomedical databases, takes into account the motor, communicative, verbal and non-verbal functions related to facial mimic, as well as the cognitive-exploratory function of some districts of the face and intervenes following the phases of nervous recovery limiting an abnormal reinnervation. The case reported concerns a patient with a paralysis caused by surgical removal of acoustic neuroma (vestibular schwannoma), with grade III on the House-Brackmann scale, seems to be an example of how an approach of this type is constructed in such a way as to follow the various phases of recovery of the peripheral nerve injury, promoting the recovery of the various functions related to the facial. The patient evaluated with the Sunnybrook Facial Grading System (SFGS) went from 21/100 to 92/100 and did not develop synkinesias after about 5 months of treatment. The neuro-cognitive approach would seem to progressively improve the quality of movement. Moreover, being selective with respect to muscle recruitment and inserted in a functional perspective that respects recovery times, it would seem to limit the appearance of pathological sequelae such as synkinesias and spasms.