Mime Therapy

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

Introduction

Mime is a performance art which is based on non verbal expression. Pantomime is the best-known form of mime. 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. In 1981, the mime therapy was published in a booklet and was revised several times and is translated into English.

MIME Corporel

Mime corporel is the new form of mime and was founded by Etienne decroux (1987). 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:

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

Development of MIME Therapy

Jan Bronk was the teacher in mime school and he developed the analytical principles into a teaching model. 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:

• 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.
• Alertness and awareness of the direction of movement. The direction can be towards or away from the body, displaying different emotions.
• 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.

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, the inhibition of synkineses by counteracting movements and coordination exercises between the affected and normal side of the face.On 11^th Jan, Jan Brook died at the age of 57 years. After his death, the first two trained physiotherapists continued to give courses.

Aim of the Mime Therapy

Mime Therapy is used to promote symmetry of the face at rest and during movement and also to control synkineses

Mime Therapy Components

Components of mime therapy include:

1. Anamnesis, patient information about treatment and prognosis
2. Self massage of face and neck
3. Breathing and relaxation exercises
4. Specific exercises to coordinate both facial halves and to decrease synkineses
5. Eye and lip closure exercises
6. Letter and word exercises
7. Expression exercises

Anamnesis, Patient Information About Treatment and Prognosis

• The first treatment session is used to explain the causes, course and prognosis.
• To objectify the actual situation of the facial paresis, the outcome measures are used.
• Photos and /or videos of the patient at rest and making five facial expressions are made.
• Patient also receives information regarding mime therapy, the necessity of doing homework and the integration of exercise into daily life.

Self-Massage

• Patients are taught to massage their face and neck for about 10-15 minutes to relax the facial musculature and to promote the circulation
• It involves knowing one's own face and discovering which area has reduced and heightened tension.
• It consists of effluerage and massage of both side of the face
• Stretching of affected side is done in slow manner following the course of muscle and is done for about 15 seconds

Breathing and Relaxation Exercises

• From a holistic point of view, mind doesn't function separate from the body, thus relaxing the face also require relaxing the body.
• Patients are taught to recognize tension and relaxation in the facial musculature in general

Specific Exercises to Coordinate Both Facial Halves and to Decrease Synkineses

This is done through:

• 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

Exercises are performed with variation in speed and force

Articulations

• These exercises are performed to increase the awareness of lip movements and position of mouth for various sounds.
• Vowel sound, consonant sounds and words are used for articulations
• Increased articulation will give more self-esteem during communication

Expression Exercises

Throughout the therapy, it is vital to try to develop a conscious connection between use of certain muscles and facial emotional expression. Learning to use the facial muscles more consciously  while expressing emotions can help the patients to cope with the distressing after effect of paralysis.

Treatment Session

• The average no of treatments session is ten each session lasting approximately 45 minutes and the patient attends once weekly or less.
• Follow up treatment is usually planned after 3 or 6 months.
• Patients have to complete the homework on a daily basis, helped by a  homework book.
• Nowadays, owing to new insights and experience, mime therapy starts when degeneration is visible (synkineses). This can be after 3 months following paralysis.
• Mirror is used as feedback instrument.

Evidence

• 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
• 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