Mime Therapy

Original Editor - Redisha Jakibanjar Top Contributors - Redisha Jakibanjar, Shristi Maharjan, Kim Jackson, Jess Bell and Wendy Walker

Introduction

In 1975, the department of facial research at the Wihelmina Gasthuis in Amsterdam produced a film called Peripheral Facial Palsy. The film was created for medical professionals and aimed to emphasize the need for early assessment and effective intervention for individuals with facial paralysis/paresis. In this film, Jan Bronk, the director of the Dutch Mime Centre, demonstrated how the mimetic muscles work. Continuing on from this, in 1997, Bronk and otolaryngologist, Pieter Devriese, began to consider the potential effect of using mime on patients with facial paralysis.

The following page summarises the information largely found in The use of mime therapy as a rehabilitation method for patients with facial nerve paresis - an article by Beurskens and colleagues.

Mime Corporel

A mime is a form of performance art, which uses non-verbal expression to convey a story. Pantomime is the best-known form of mime. Mime corporel, a specific type of mime, was founded by Etienne Decroux in 1987. As stated by Beurskens and colleagues, the underlying principles of mime corporel are:

• "Movement is the rhythm of the body in space and time"
• "The essence of the movement is made visible by exaggerated movements"

Development of Mime Therapy

Jan Bronk developed the principles of mime corporel into a specific teaching model and also adapted mime for use in other areas, including health and rehabilitation. Through his analysis of the face and facial expressions, he was able to help individuals with facial nerve paralysis/paresis.

The following areas are considered in a mime corporel analysis:

• Breathing
  • Facial expression impairments relate to other areas of tension in the body
  • Breathing can help to reduce this tension
• Articulation
  • Mime teaches students about the "expressive possibilities of movement normally occurring unconsciously"
  • Understanding this can help expressions be correctly interpreted
• Alertness and awareness of movement direction
  • Can be used to help to convey different feelings
• Expression
  • Mime can be used to enhance non-verbal communication

Physiotherapy and Mime Therapy

From 1980, physiotherapists who studied with Bronk started to use his method to treat facial patients. Certain parts of the approach were altered, to create a more comprehensive treatment, including:

• Facial muscle stretching
• Counteracting movements and coordination exercises to help to reduce synkinesis

Mime therapy is now used to promote symmetry of the face at rest and while moving, and to control synkinesis.

Mime Therapy Components

As will be discussed in more detail below, components of mime therapy include:

1. Anamnesis (i.e. medical history)
2. Face and neck self-massage
3. Breathing and relaxation exercises
4. Exercises to enhance coordination between both sides of the face and to reduce synkinesis
5. Exercises to assist with eye and lip closure
6. Letter and word exercises
7. Facial expression exercises

Anamnesis, Patient Information About Treatment and Prognosis

• The first treatment session in this program focuses on explaining the causes of dysfunction, the treatment, and likely prognosis to the patient
• The patient is assessed using the Sunnybrook Facial Grading System, House-Brackmann Scale and Facial Disability Index
• The patient is photographed and/or video at rest and while performing five facial expressions
• The patient is also given information about
  • Mime therapy
  • The importance of participating in a home program
  • The need to integrate exercise into daily life

Self-Massage

• Patients are taught self-massage
  • The face and neck should be massaged for around 10 to 15 minutes per day to relax the facial musculature and to promote circulation
  • Consists of effleurage and massage on both sides of the face
• Patients are taught to discover areas of reduced and heightened tension
• Stretching is also encouraged
  • The patient should slowly stretch along the course of the muscles on the affected side of the face
  • Stretches should be held for around 15 seconds

Breathing and Relaxation Exercises

• Because the mind and body function together, it is necessary to relax the body in order to relax the face
• Patients should be taught to recognize any tension in the body and compare this to relaxation, both in general and in the facial muscles

Specific Exercises to Coordinate Facial Halves and to Decrease Synkinesis

Basic exercise principles are as follows:

• Basic exercises should be completed at varying speeds and amplitudes
• Exercises for one side of the face should be given
• The lower jaw should be relaxed
• It is important to perform exercises for both the mouth and the eye, while also inhibiting synkinesis through slow, small movements and counteraction

Eye and Lip Closure Exercises

• Patient practices eye and lip closure at different speeds/forces

Articulations

• These exercises aim to increase a patient's awareness of lip movements and mouth position for various sounds
• Vowel and consonant sounds and words are used for articulations

Expression Exercises

• These exercises aim to develop an awareness of the connection between the use of specific muscles and certain facial expressions
• The patient can either work towards a mood using specific muscles, or can start with the mood to generate the movement

Treatment Session

• On average, patients have ten 45 minutes therapy sessions regularly
• Then sessions are designed for once a week or less based on the severity of symptoms
• Follow-up treatment is usually at 3 to 6 months
• Patients are given a home regimen program and homework book/diary
• Mime therapy should be used when degeneration (i.e. synkinesis) is obvious - this may be around 3 months after facial paralysis begins
• Mirrors can be used as a bio-feedback tool

Evidence for Mime Therapy

• Mime therapy has been found to improve facial symmetry in people who have had long-term facial nerve paresis:
  • After mime therapy, both facial asymmetries at rest and synkinesis were reduced and facial symmetry during voluntary movement improved efficiently.
  • The authors found that mime therapy can be generalized across:
    1. Gender
    2. Age
    3. Duration of paresis
  • Mime Therapy is designed to focus on the treatment of patients with synkinesis. Only patients with some movement of the facial muscles had advantage over patients without any movement from mime therapy, as it focuses on alteration of movement and strengthening of the muscles.
  • Mime therapy is beneficial as it improves circulation and maintains muscle properties. Visual feedback with the use of mirror, helps in performing exercises properly, eliciting proper facial muscles movements. As miming demands a great sense of muscle and body control, it has shown to be effective in the new growth and production of collagen and connective tissues in facial muscles. It, in return helps to restore muscle action and strength. [Sharvani Belle Praveen Kumar (2018)] Hence, a complete and immediate recovery of facial function.
  • "Mime Therapy is very effective in the treatment of facial palsy."
  • Mime Therapy combined with electrical stimulation results in immediate improvement of function and integrity of facial muscles. It also mitigates the synkinesis in Bell's Palsy.
  • Mime Therapy along with Electromyography Biofeedback (EMG BFB), both are beneficial to enhance the facial muscle integrity and movement.

Limitation

Mime Therapy is not helpful in managing patients with chronic flaccid facial paralysis because there is no existing movement to strengthen or alter. As it focuses on treatment of synkinesis.

It is limited to but not only to:

• Ability of the patient to adhere to the treatment regiment.
• Level of intelligence: Mime Therapy was considered as a difficult treatment protocol to perform. Hence, it was thought that only patients with certain level of intelligence could understand and follow the exercises indicated.