1. Facial Exercises

• Purpose: Promote muscle re-education and improve voluntary facial movements.

• Examples:

  • Raising eyebrows

  • Wrinkling the forehead

  • Closing the eyes tightly

  • Smiling, puckering lips, blowing cheeks

  • Flaring nostrils

Therapists guide these based on muscle involvement and progression.

2. Neuromuscular Re-education

• Technique: Helps retrain the brain-to-muscle connection using mirror feedback and cueing.

• Tools Used: Mirror therapy, biofeedback (e.g., EMG), or verbal and tactile cues.

3. Massage and Soft Tissue Mobilization

• Purpose: Reduce muscle tightness, prevent contractures, and improve circulation.

• Includes: Gentle stroking, kneading of affected muscles, and lymphatic drainage if swelling is present.

4. Electrical Stimulation (with caution)

• Purpose: Stimulate muscle contraction when voluntary movement is minimal.

• Caution: Not always recommended; improper use can lead to synkinesis (miswiring of nerves). Should be done only under professional supervision.

5. Mirror Therapy

• Encourages correct movement patterns and muscle symmetry using visual feedback.

6. Education and Home Program

• Patients are taught to avoid:

  • Overuse or forced movements

  • Massaging too vigorously

• Given personalized daily exercises and relaxation techniques.

7. Treatment of Synkinesis

If abnormal movements develop:

• Stretching and relaxation techniques to inhibit unwanted movements

• Coordination training to separate facial expressions

8. Adjunct Therapies

• Taping: To support facial muscles or eyelid closure

• Heat therapy: To relax tight muscles (if appropriate)

• Speech therapy: If speech or swallowing are affected