HELPING PATIENTS REGAIN THEIR SMILE
By Sarah Zaluski, PT, DPT, Senior Physical Therapist
The Outpatient Physical Therapy Department is offering a new program to
assist patients with facial nerve dysfunction. Severe facial droop can result from
Bell’s palsy, Guillain-Barré, or post-cranial nerve tumor resections, and can last
anywhere from several weeks to years.
In these cases, the body “overcorrects” in the healing process, leading to
symptoms of muscle soreness and tightness. The facial nerves and muscles
can also work in an uncoordinated way, a phenomenon called synkinesis,
leading to unwanted movement in one area of the face when attempting to
move another region. People with synkinesis may involuntarily close an eye or
contract their neck when attempting to smile or pucker their lips. They may
also notice their mouth pulling up and out to the side when closing their eyes
tightly. They may also have tightness in several regions on one side of their
face. Examples include: one eyebrow is higher than the other, one eye appears
smaller, one cheek appears bulky, the mouth can be pulled up and out to the
side, one may notice dimpling in their chin, or tendons contracting in their neck.
The combination of muscle weakness, tightness, and uncoordinated
movement can make everyday things difficult such as chewing food, drinking
from a cup, brushing one’s teeth, forming certain speech sounds, and making
facial expressions. Facial dysfunctions may cause a person to limit their social
interactions, or can create feelings of loss of personal identity.
Patients are amazed when comparing their before and
after photos, often commenting that their smile is no longer
crooked or revealing that they are no longer ashamed
to smile in family photos.
The new facial program in Physical Therapy—developed in collaboration
with NYU Langone’s Department of Otolaryngology (Ear, Nose, and Throat)—
can help decrease facial muscle pain associated with tightness and muscle
INCREASING CONSUMER ADVOCACY FOR
PERSONS WITH TRAUMATIC BRAIN INJURY
Mona Mikael, PsyD, Postdoctoral Psychology Fellow
Anyone who has met a person
who has recently acquired a
traumatic brain injury (TBI) can
see that the experience affects
not only the physical aspects of
a person’s life, but also impacts
areas related to cognition (e.g.,
thinking, memory, judgment)
and behavior (e.g., impulsivity,
fatigue, social interaction). In
the early stages much of the
focus is on the recovery and
rehabilitation of the physical
symptoms. However, as the body heals, other long-term effects of the injury
emerge. It is helpful at this point in the recovery process to receive the
assistance of someone who has also experienced a traumatic brain injury.
Timothy Pruce, an active consumer advocate with the Brain Injury Association
of New York State (BIANYS), began his affiliation with the Rusk through his strong
dynamic working relationship with Dr. Teresa Ashman, associate professor of
rehabilitation medicine, in the psychology service. Together, Mr. Pruce and Dr.
Ashman hope to help individuals with traumatic brain injury to bridge the multiple
stages of the rehabilitation process by providing information about the long-term consequences of TBI that remain after the acute rehabilitation phase. They
initiated a program at Rusk that reaches out to individuals with TBI and their
families to assist them in connecting to community resources, as well as
Rusk Rehabilitation | “The Whole Story” | Spring 2012 | Page Four
spasms, improve resting facial symmetry, and restore symmetry of functional
facial movement. Patients are guided through stretches, relaxation techniques,
and exercises that they can do at home to address their goals.
As a senior physical therapist treating facial dysfunction at Rusk, I ask my
patients what bothers them the most about their condition. Most reply, “I want
to be able to smile again.”
Photo of a patient performing a lip pucker expression,
demonstrating severe synkinesis before therapy
Photo of the same patient performing a lip pucker
expression after facial therapy
During initial evaluations, I take pictures of all of my patients at rest and while
making specific facial expressions, and then photograph them again at follow-up appointments in order to track their progress. Noticeable improvements
often occur immediately, and it is never too late for someone to start therapy.
Patients who have come to therapy 10 years after being diagnosed with Bell’s
palsy have had positive outcomes. Patients are amazed when comparing their
before and after photos, often commenting that their smile is no longer crooked
or revealing that they are no longer ashamed to smile in family photos.
With such rewarding work, it’s no surprise that as my patients improve, it
makes my smile grow right along with theirs.
For more information about the facial rehabilitation program at Rusk, please
contact Sarah Zaluski via email at email@example.com or call the
Outpatient Physical Therapy Department at (212) 263-6075.
providing access to an individual with TBI who understands all the stages
of the rehabilitation process first-hand. The program aims to facilitate the
maintenance of strong ties to both medical and community resources,
from the acute phase of recovery through the later stages of rehabilitation,
especially for harder to reach and often neglected populations.
People like Mr. Pruce and Dr. Ashman aim to help Rusk work proactively
to remove the barriers that exist between those living with brain injury and
their families, and the professionals who serve them. The goal is to eliminate
the gap between patients and community resources, particularly when
dealing with the long and uncertain path of rehabilitation.
The recent trend of reallocating rehabilitation resources from traditional
acute and post-acute inpatient settings to outpatient and home-based
settings clearly indicates the need for community participatory action. As
patients and their caregivers leave Rusk’s inpatient service, there is a great
need for accessible coordination of care. Community advocates like Mr.
Pruce can help these consumers understand and navigate the current
system of services available in New York State and serve as a long-term
liaison for patients and caregivers.
“Through advocacy, education and research, Rusk Institute
of Rehabilitation Medicine and the Brain Injury Association of
New York State bring help, hope and healing to the thousands of
individuals who pass through our halls yearly,” says Dr. Ashman.
Dr. Ashman hopes to implement new dimensions of patient care by
expanding Rusk’s mission to include patient participatory action. Rather than
relying on state facilities, current and former Rusk patients can work together
to form support networks and share their experiences. This effort will give
individuals and their families a better sense of what to expect and how to
maximize access to services. “We aim to increase the voices of our patients
and their family members. Through advocacy, education and research, Rusk
Institute of Rehabilitation Medicine and the Brain Injury Association of New
York State bring help, hope and healing to the thousands of individuals who
pass through our halls yearly,” says Dr. Ashman.