Therapist-Guided Facial Proprioceptive Training for Early-Stage Peripheral Facial Palsy: A Protocol With Retrospective Observations

Summary

This manuscript presents a therapist-guided facial proprioceptive training protocol informed by principles of proprioceptive and sensory facilitation. It is designed to support motor initiation and movement control during recovery in patients with early-stage peripheral facial palsy.

Abstract

This article describes a therapist-guided facial proprioceptive training protocol for early-stage peripheral facial palsy. The method uses therapist-applied tactile tapping, a brief facilitative quick stretch, and assisted voluntary contraction to train seven representative facial expressions involving the upper, middle, and lower face. These cues are intended to enhance the patient’s perception of movement direction and to support selective activation of the affected-side facial muscles when voluntary output is weak. To illustrate routine clinical use of the method, we reviewed a retrospective cohort of 40 patients treated in the Department of Rehabilitation Medicine at The First Affiliated Hospital of Soochow University from January 2023 to June 2024. According to the rehabilitation approach documented in the medical records, 20 patients received the proprioceptive training protocol and 20 received conventional facial exercise training. Facial function was evaluated at baseline (T0) and at 4, 8, and 12 weeks (T1–T3) using the Sunnybrook Facial Grading System and the House-Brackmann (HB) scale. Both groups improved over time. In unadjusted exploratory comparisons, both groups showed improvement in Sunnybrook scores and a shift toward less severe HB grades over the 12-week follow-up period. Because group allocation was not randomized and the cohort was retrospective, these observations should be interpreted as descriptive rather than confirmatory. The protocol is presented with emphasis on cueing sequence, pacing, and task-specific assistance to facilitate standardized implementation and video-based demonstration.

Introduction

Peripheral facial palsy is caused by dysfunction of the facial nerve and results in weakness or paralysis of the facial muscles on the affected side. Common manifestations include facial asymmetry, incomplete eye closure, and deviation of the oral commissure^1,2. Although spontaneous recovery can occur within weeks to months, a substantial proportion of patients have persistent deficits in motor control, reduced facial symmetry, or synkinesis, which may lead to long-term functional limitations and impaired quality of life^1,3,

Protocol

The training described in this manuscript was delivered as part of routine outpatient rehabilitation care, and informed consent was obtained from all participants. The retrospective analysis was approved by the Ethics Committee of The First Affiliated Hospital of Soochow University (Approval No. 1179), which waived the requirement for informed consent for the use of retrospective data.

NOTE: Instrument details are available in the Table of Materials. Initiate this protocol during the early to mid-recovery phase (1–12 weeks post-onset) when clinical evaluation reveals reduced facial muscle tone or impaired movement initiatio....

Results

Study cohort and design
This retrospective cohort study included 40 patients with unilateral peripheral facial palsy treated at the Department of Rehabilitation Medicine, The First Affiliated Hospital of Soochow University (January 2023–June 2024). Patients were grouped according to the rehabilitation approach documented in their medical records rather than by random allocation: the facial proprioceptive training group (n = 20) and the conventional training group (n = 20). As this assignment reflecte.......

Discussion

The representative results showed progressive improvement over time in both groups. In these exploratory observations, the proprioceptive training group tended to show higher Sunnybrook scores and a greater shift toward lower HB grades at later follow-up points. Given the retrospective, non-randomized design, these findings should be viewed as hypothesis-generating observations rather than evidence of comparative efficacy. One possible explanation is that patients may require several weeks of repeated therapist-guided cu.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Latex Examination  Gloves	PT.UNIVERSAL GLOVES	TLFVMD44100	Used for hygiene during facial tactile tapping and stretching URL: https://universal-gloves.com/products
GraphPad Prism v10.0	GraphPad Software	N/A	Software used for data visualization and generating figures. URL: https://www.graphpad.com/features
Mirror	Changzhou Kangda Medical Rehabilitation Equipment Co., Ltd.	N/A	Height 170 cm, width 60 cm; used for visual feedback during training URL: http://www.kdkfyl.com/
SPSS Statistics v26.0	IBM Corp.	N/A	Software used for statistical management and exploratory analysis of clinical scores. URL: https://www.ibm.com/products/spss-statistics
Timer	Shenzhen ENO Musical Instruments Co., Ltd.	EM988S	Used to monitor total session duration and pace the 2–3 Hz tactile tapping rhythm. URL: http://www.eno-music.com/cpxl