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<div class="editorbox"> '''Original Editor '''- [[User:Redisha jakibanjar|Redisha jakibanjar]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
<div class="editorbox"> '''Original Editor '''- [[User:Redisha jakibanjar|Redisha jakibanjar]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
= Introduction=
= Introduction=
Mime is a performance art which is based on non verbal expression. Pantomime is the best-known form of mime.<ref name=":0">Beurskens CH, Devriese PP, Van Heiningen I, Oostendorp RA. The use of mime therapy as a rehabilitation method for patients with facial nerve paresis. International Journal of Therapy and Rehabilitation. 2004 May;11(5):206-10.
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 emphasis 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 mimetic muscles work. Continuing on from this, in 1997,  Jan Bronk and otolaryngologist, Pieter Devriese, began to consider the potential effect of using mime on patients with facial paralysis.<ref name=":0">Beurskens CH, Devriese PP, Van Heiningen I, Oostendorp RA. [https://www.researchgate.net/publication/225026704_The_use_of_mime_therapy_as_a_rehabilitation_method_for_patients_with_facial_nerve_paresis The use of mime therapy as a rehabilitation method for patients with facial nerve paresis]. International Journal of Therapy and Rehabilitation. 2004;11(5):206-10.
avalable from: https://www.researchgate.net/publication/225026704_The_use_of_mime_therapy_as_a_rehabilitation_method_for_patients_with_facial_nerve_paresis
</ref>  
</ref> In 1975, the department of facial research at the Wihelmina Gasthuis in Amsterdam introduced a film entitled peripheral facial palsy and Jan Bronk illustrated the function of the mimetic muscle. Later, in 1997, Jan Bronk and Pieter Devriese explored the possibilities of mime with patients.<ref name=":0" /> In 1981, the mime therapy was published in a booklet and was revised several times and is translated into English.


== '''MIME Corporel''' ==
== '''Mime Corporel''' ==
Mime corporel is the new form of mime and was founded by Etienne decroux (1987)<ref name=":0" />. The body and movement analysis in mime corporel is fundamentally different from that of the medical world. To perform the mime, artist has to learn to isolate and to articulate respectively to move and to emphasize specific movements. The basic principle of mime corporel  are:
Mime is a form of performance art, which uses non-verbal expression to convey a story. Pantomime is the best-known form of mime.<ref name=":0" /> Mime corporel, a specific type of mime, was founded by Etienne Decroux in 1987.<ref name=":0" /> As stated by Beurskens and colleagues, the underlying principles of mime corporel are:<ref name=":0" />
* Movement is rhythm of the body in space and time
* "Movement is rhythm of the body in space and time"
* The essence of movement is made visible by exaggerated movements.
* "The essence of movement is made visible by exaggerated movements"


== '''Development of MIME Therapy''' ==
== '''Development of Mime Therapy''' ==
Jan Bronk was the teacher in mime school and he developed the analytical principles into a teaching model<ref name=":0" />. He developed a way of working using functioning capabilities to help activation in less well functioning area. He also made analysis of the face especially emotional expressions to help patients with facial nerve paresis. The analysis using the principle of mime corporel includes:
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.<ref name=":0" /> Through his analysis of the face and facial expressions, he was able to help individuals with facial nerve paralysis / paresis.
* Breathing: The impairment of facial expression will be reflected by tension elsewhere in the body. Breathing will reduce tension.
 
* Articulation: mime teaches the expressive possibilities of movement normally occurring unconsciously. For example/; the mouth corner can be pulled down extremely fast which gives a completely different expression than that caused by allowing the mouth corner to drop gradually.
The following areas are considered in a mime corporel analysis:<ref name=":0" />
* Alertness and awareness of the direction of movement. The direction can be towards or away from the body, displaying different emotions.
* Breathing
* Expression mime is the art of movement and an art of communication. The purpose of mime is to deepen the individual's capacity for non-verbal communication.
** 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 ==
== Physiotherapy and Mime Therapy ==
In 1980, after being treated by Jan Bronk, physiotherapists began to treat patients and specific items were elaborated, such as stretching of facial muscles<ref name=":0" />, the inhibition of synkineses by counteracting movements and coordination exercises between the affected and normal side of the face.On 11<sup>th</sup> Jan, Jan Brook died at the age of 57 years. After his death, the first two trained physiotherapists continued to give courses.
From 1980, physiotherapists who studied with Jan 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


=== Aim of the Mime Therapy ===
Mime therapy is now used to promote symmetry of the face at rest and while moving, and to control synkinesis.<ref name=":0" />
Mime Therapy is used to promote symmetry of the face at rest and during movement and also to control synkineses<ref name=":0" />


=== Mime Therapy Components ===
=== Mime Therapy Components ===
Components of mime therapy include:<ref name=":0" />
As will be discussed in more detail below, components of mime therapy include:<ref name=":0" />
# Anamnesis, patient information about treatment and prognosis
# Anamnesis (i.e. medical history)
# Self massage of face and neck
# Face and neck self-massage
# Breathing and relaxation exercises
# Breathing and relaxation exercises
# Specific exercises to coordinate both facial halves and to decrease synkineses
# Exercises to enhance coordination between both sides of the face and to reduce synkinesis
# Eye and lip closure exercises
# Exercises to assist with eye and lip closure
# Letter and word exercises
# Letter and word exercises
# Expression exercises
# Facial expression exercises


==== Anamnesis, Patient Information About Treatment and Prognosis<ref name=":0" /> ====
==== Anamnesis, Patient Information About Treatment and Prognosis<ref name=":0" /> ====
* The first treatment session is used to explain the causes, course and prognosis.
* The first treatment session focuses on explaining the causes of dysfunction, the treatment and likely prognosis to the patient
* To objectify the actual situation of the facial paresis, the outcome measures are used.
* The patient is assessed using the [[Facial Grading System|Sunnybrook Facial Grading System]], [[House–Brackmann Scale|House-Brackmann Scale]] and [[Facial Disability Index]]
* Photos and /or videos of the patient at rest and making five facial expressions are made.
* The patient is photographed and / or videoed at rest and while performing five facial expressions
* Patient also receives information regarding mime therapy, the necessity of doing homework and the integration of exercise into daily life.
* The patient is also given information about mime therapy, the importance of participating in a home programme and the need to integrate exercise into daily life


==== Self-Massage<ref name=":0" /> ====
==== Self-Massage<ref name=":0" /> ====
* Patients are taught to massage their face and neck for about 10-15 minutes to relax the facial musculature and to promote the circulation
* Patients are taught self-massage  
* It involves knowing one's own face and discovering which area has reduced and heightened tension.
** The face and neck should be massaged for around 10 to 15 minutes per day to relax the facial musculature and to promote circulation
* It consists of effluerage and massage of both side of the face
** Consists of effleurage and massage on both sides the face
* Stretching of affected side is done in slow manner following the course of muscle and is done for about 15 seconds
* 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<ref name=":0" /> ====
* 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 recognise any tension in the body and compare this to relaxation, both in general and in the facial muscles


==== Breathing and Relaxation Exercises ====
==== Specific Exercises to Coordinate Facial Halves and to Decrease Synkinesis<ref name=":0" /> ====
* From a holistic point of view, mind doesn't function separate from the body, thus relaxing the face also require relaxing the body.
Basic exercise principles are as follows:
* Pa<ref name=":0" />tients are taught to recognize tension and relaxation in the facial musculature in general
* 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


==== Specific Exercises to Coordinate Both Facial Halves and to Decrease Synkineses ====
==== Eye and Lip Closure Exercises<ref name=":0" /> ====
This is done through<ref name=":0" />:
* Basic exercises with variation in amplitude and speed
* Exercises for one side of the face
* Relaxation of the lower jaw
* Exercises of the mouth and of eye with simultaneous inhibition of  synkineses through slow , small movements and counteraction


==== Eye and Lip Closure Exercises ====
* Patient practises eye and lip closure at different speeds / forces
Exercises are performed with variation in speed and force<ref name=":0" />


==== Articulations<ref name=":0" /> ====
==== Articulations<ref name=":0" /> ====
* These exercises are performed to increase the awareness of lip movements and position of mouth for various sounds.
* These exercises aim to increase a patient's awareness of lip movements and mouth position for various sounds
* Vowel sound, consonant sounds and words are used for articulations
* Vowel and consonant sounds and words are used for articulations
* Increased articulation will give more self-esteem during communication
 
==== Expression Exercises<ref name=":0" /> ====


==== Expression Exercises ====
* These exercises aim to develop an awareness of the connection between the use of specific muscles and certain facial expressions
Throughout the therapy, it is vital to try to develop a conscious connection between use of certain muscles and facial emotional expression<ref name=":0" />.  Learning to use the facial muscles more consciously  while expressing emotions can help the patients to cope  with the distressing after effect of paralysis.
* The patient can either work towards a mood using specific muscles, or can start with the mood to generate the movement


=== Treatment Session<ref name=":0" /> ===
=== Treatment Session<ref name=":0" /> ===
* The average no of treatments session is ten each session lasting approximately 45 minutes and the patient attends once weekly or less.
* On average, patients have ten 45 minutes therapy sessions
* Follow up treatment is usually planned after 3 or 6 months.
* Sessions are once a week or less
* Patients have to complete the homework on a daily basis, helped by a  homework book.
* Follow-up treatment is usually at 3 to 6 months
* Nowadays, owing to new insights and experience, mime therapy starts when degeneration is visible (synkineses). This can be after 3 months following paralysis.
* Patients are given a home programme and homework book / diary
* Mirror is used as feedback instrument.
* Mime therapy should be used when degeneration (i.e. sykninesis) is obvious - this may be around 3 months after facial paralysis begins
* Mirrors can be used as a feedback tool


== Evidence ==
== Evidence for Mime Therapy ==
* Mime therapy improves facial symmetry in people with long term facial nerve paresis. There were greater improvements in the Sunnybrook Facial Grading System for all three components of facial symmetry in the group that received mime therapy compared with the group on the waiting list. Similar improvements were present in the House-Brackmann Facial Grading System. After mime therapy, facial asymmetry at rest and synkinesis decreased and facial symmetry of voluntary movement increased<ref name=":1">Beurskens CH, Heymans PG. Mime therapy improves facial symmetry in people with long-term facial nerve paresis: a randomised controlled trial. Australian Journal of Physiotherapy. 2006 Jan 1;52(3):177-83.
* Mime therapy has been found to improve facial symmetry in people who have long-term facial nerve paresis:<ref name=":1">Beurskens CH, Heymans PG. [https://abrafin.org.br/wp-content/uploads/2015/01/PFP.pdf Mime therapy improves facial symmetry in people with long-term facial nerve paresis: a randomised controlled trial]. Australian Journal of Physiotherapy. 2006;52(3):177-83.
available on:https://abrafin.org.br/wp-content/uploads/2015/01/PFP.pdf
</ref>
</ref>
* This therapy can be generalized across sex, age, and duration of the paresis as it has been tested on people with long-term facial nerve paresis who are similar to the patients who have been seen by both outpatient departments for more than ten years<ref name=":1" />
** After mime therapy, both facial asymmetry at rest and synkinesis were reduced and facial symmetry during voluntary movement improved
** The authors found that mime therapy can be generalised across:<ref name=":1" />
*** Sex
*** Age
*** Duration of paresis


== References ==
== References ==

Revision as of 00:16, 22 August 2021

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

Introduction[edit | edit source]

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 emphasis 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 mimetic muscles work. Continuing on from this, in 1997, Jan Bronk and otolaryngologist, Pieter Devriese, began to consider the potential effect of using mime on patients with facial paralysis.[1]

Mime Corporel[edit | edit source]

Mime is a form of performance art, which uses non-verbal expression to convey a story. Pantomime is the best-known form of mime.[1] Mime corporel, a specific type of mime, was founded by Etienne Decroux in 1987.[1] As stated by Beurskens and colleagues, the underlying principles of mime corporel are:[1]

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

Development of Mime Therapy[edit | edit source]

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.[1] 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:[1]

  • 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[edit | edit source]

From 1980, physiotherapists who studied with Jan 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.[1]

Mime Therapy Components[edit | edit source]

As will be discussed in more detail below, components of mime therapy include:[1]

  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[1][edit | edit source]

  • The first treatment session 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 videoed at rest and while performing five facial expressions
  • The patient is also given information about mime therapy, the importance of participating in a home programme and the need to integrate exercise into daily life

Self-Massage[1][edit | edit source]

  • 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 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[1][edit | edit source]

  • 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 recognise 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[1][edit | edit source]

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[1][edit | edit source]

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

Articulations[1][edit | edit source]

  • 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[1][edit | edit source]

  • 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[1][edit | edit source]

  • On average, patients have ten 45 minutes therapy sessions
  • Sessions are once a week or less
  • Follow-up treatment is usually at 3 to 6 months
  • Patients are given a home programme and homework book / diary
  • Mime therapy should be used when degeneration (i.e. sykninesis) is obvious - this may be around 3 months after facial paralysis begins
  • Mirrors can be used as a feedback tool

Evidence for Mime Therapy[edit | edit source]

  • Mime therapy has been found to improve facial symmetry in people who have long-term facial nerve paresis:[2]
    • After mime therapy, both facial asymmetry at rest and synkinesis were reduced and facial symmetry during voluntary movement improved
    • The authors found that mime therapy can be generalised across:[2]
      • Sex
      • Age
      • Duration of paresis

References[edit | edit source]

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 Beurskens CH, Devriese PP, Van Heiningen I, Oostendorp RA. The use of mime therapy as a rehabilitation method for patients with facial nerve paresis. International Journal of Therapy and Rehabilitation. 2004;11(5):206-10.
  2. ↑ 2.0 2.1 Beurskens CH, Heymans PG. Mime therapy improves facial symmetry in people with long-term facial nerve paresis: a randomised controlled trial. Australian Journal of Physiotherapy. 2006;52(3):177-83.
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