Currently submitted to: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Feb 27, 2026
Open Peer Review Period: Mar 23, 2026 - May 18, 2026
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Emotional training in peripheral facial nerve palsy: a prospective, exploratory pilot study comparing surgical and non-surgical patients
ABSTRACT
Background:
Peripheral facial nerve palsy (FNP) leads to motor impairment and psychosocial distress, often requiring prolonged rehabilitation. Emotional Training (ET) is a physiotherapy-based approach intrinsically compatible with technology-assisted and remote rehabilitation models. However, its clinical effects across different FNP etiologies and management pathways remain underexplored.
Objective:
To investigate the motorfunctional and psychological effects of ET in patients with peripheral FNP, comparing individuals who had iatrogenic, neoplastic or traumatic damage and underwent triple innervation surgery with patients affected by idiopathic FNP treated conservatively, while exploring implications for digitally supported rehabilitation.
Methods:
In this prospective, exploratory, observational pilot study, 14 patients with unilateral peripheral FNP were allocated into two cohorts based on etiology and prior clinical management, i.e., SURGICAL (n = 7; iatrogenic, neoplastic or traumatic FNP, triple innervation surgery) and NON-SURGICAL (n = 7; Bell’s palsy, conservative therapy). All participants underwent a standardized ET protocol over 20 weeks. Motor performance was assessed using the Sunnybrook Facial Grading System (SFGS), functional disability with the Facial Disability Index (FDI), and anxiety with the Beck Anxiety Inventory (BAI), at baseline (T0) and post-treatment (T1). Non-parametric and Bayesian analyses were conducted to evaluate between/within-group differences.
Results:
Fourteen patients [SURGICAL: n = 7, age (mean ± SD) = 50.57 ± 18.17, 3F; NON-SURGICAL: n = 7; age (mean ± SD) = 51 ± 11.61, 3F)] completed the intervention with no dropouts. In between-group comparison, NON-SURGICAL group significantly increased the Synkinesis Score in SFGS (p = 0.019, BF₁₀ = 1.903), whereas SURGICAL group increased the FDI – Physical Function subscale (p = 0.002, BF₁₀ = 5.033) and in the FDI – Social/Well-being Function subscale (p = 0.004, BF₁₀ = 3.743) score. In within-group comparison SURGICAL group significantly improved the Resting Symmetry Score in SFGS (p = 0.032, BF₁₀ = 9.262), BAI (p = 0.022, BF₁₀ = 66.338), Symmetry of Voluntary Movement Score in SFGS (p = 0.022, BF₁₀ = 23.300), Composite SFGS Score (p = 0.016, BF₁₀ = 24.859), FDI – Physical Function subscale (p = 0.021, BF₁₀ = 24.550) and FDI – Social/Well-being Function subscale (p = 0.034, BF₁₀ = 10.664); similarly, NON-SURGICAL group improved the Symmetry of Voluntary Movement Score in SFGS (p = 0.034, BF₁₀ = 6.261) and Composite SFGS Score (p = 0.034, BF₁₀ = 6.288). However, for NON-SURGICAL group, a significant increase in the Synkinesis Score in SFGS (p = 0.034, BF₁₀ = 4.964) was also disclosed.
Conclusions:
ET appears to be a clinically relevant PT approach for peripheral FNP, with etiology-specific response patterns that likely reflect differences in underlying neuroplastic mechanisms. ET is suited for hybrid and telerehabilitation models, supporting its integration into digitally enabled rehabilitation pathways. However, these preliminary findings require confirmation in larger, controlled studies. Clinical Trial: not applicable.
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