JMIR Publications

ABSTRACT

Background:

Peripheral facial nerve palsy (FNP) is a debilitating condition that may necessitate surgical intervention. Although motor rehabilitation is considered essential, the most effective approach has not been defined yet.

Objective:

This study aims to evaluate the effectiveness of Emotional Training (ET), a novel telerehabilitation-based treatment, on motor, functional, and psychological outcomes in patients with unilateral facial palsy following triple innervation surgery.

Methods:

A controlled, prospective, assessor-blinded observational trial was conducted at the Rehabilitation Unit, University Hospital San Paolo, Milan, Italy, from January to October 2024. Participants (n = 16) received 1 treatment session every two weeks over 20 weeks, each lasting 45 minutes, according to standard clinical procedures in place at the Rehabilitation Unit. Subjects were assigned to either the PRES group (i.e., in-person approach, n = 8) or the ONLINE group (i.e., telerehabilitation approach, n = 8), based on their ability to attend in-person sessions. The primary outcomes assessed at baseline (T0) and post-treatment (T1) included facial symmetry (Sunnybrook Facial Grading System – SFGS), facial disability (Facial Disability Index – FDI), and anxiety levels (Beck Anxiety Inventory – BAI).

Results:

Statistical analysis revealed significant improvements at T1 for both groups in FDI - Social/Well-being Function subscale, BAI, SFGS - Resting Symmetry Score, SFGS - Symmetry of Voluntary Movement Score, SFGS - Composite Score, SFGS with MassCon - Symmetry of Voluntary Movement score, and SFGS with MassCon - Composite score (for all, p < .001). Only FDI - Physical Function subscale showed a differential improvement at T1 for PRES treatment [ANOVA time*treatment F (1) = 14.356, p = 0.002, Holm-Bonferroni Post Hoc test: p < .001). Lastly, a strong, positive correlation was disclosed between the time elapsing from surgery to rehabilitation and SFGS - Composite Score improvement at T1 (r = 0.94; p = 0.005).

Conclusions:

These results suggest that ONLINE ET protocol is as effective in improving facial motor function, in reducing anxiety, and in enhancing facial expression spontaneity in patients with post-surgery peripheral facial palsy as PRES ET protocol. These findings support the effectiveness of telerehabilitation approaches as a valuable, accessible, and sustainable alternative to conventional in-person therapy for facial nerve recovery.