Facial palsy can be divided into supranuclear lesion (central facial palsy) and infranuclear
lesion such as Bell's Palsy, an idiopathic disease. The peripheral facial paralysis (PFP) is
a frequent but little-known pathology (20 / 100 000 inhabitants in France a year). Oro-facial
functions and the ability to convey emotional facial information are seriously affected by
facial palsy, thereby reducing patient's quality of life. The PFP can have several
repercussions on the functional, aesthetic, social, occupational and psychological levels.
Evolution and prognosis depend not only on its etiology and gravity, but also on the
precocity and the quality of the medical and paramedical care. It is essential to assess
functional and psychological issues before beginning an adapted global therapeutic care. If
these depressive symptoms can be explained by multiple factors, the inability to smile would
be one of the triggering factors of depression. The facial feedback hypothesis could be one
of many explications because smiling induces a positive emotional state and a feeling of
well-being. In PFP, patients must cope with their difficulties to smile. Their facial
behaviour affected their own emotional experiences.
The main purpose of the present study is to determine if virtual rehabilitation program is
relevant compared to standard therapy. The second aim is to characterize the efficiency by
analysing the time required to obtain a stable score of 4 in the Sunnybrook test. A secondary
objective will be to decrease the functional and social repercussions of the facial paralysis
with an intensive and targeted therapy of the smile. Furthermore, a virtual rehabilitation
program will be implemented in an interactive platform.
To this end, a parallel randomized controlled trial (RCT) of the two groups will be
conducted: standard therapy versus virtual rehabilitation program. RCT involves a treatment
in which active participation of the patient is necessary so only the assessment will be
blinded. Facial motor skills (tongue, mouth and face motricity) are measured using electronic
devices, objective and subjective evaluation with pragmatic fields such as communication,
emotion and quality of life. The severity of patient's facial paralysis is appraised by the
House and Brackmann scale. This global assessment will be conducted before the beginning of
the therapy and every 3 months during 18 months.
The patients will be recruited within the Ear, Nose, and Throat (ENT) service after a
baseline assessment. Simple randomization will be used in order to establish both therapeutic
groups with 45 patients in each group.
Group A: Patients taken care in consultation within the ENT service which provides
oro-myo-functional classical rehabilitation.
Group B: Patients taken care in external consultation who receive oro-myo-functional
rehabilitation through a virtual rehabilitation program targeted at the smile, in their place
of living in virtual conditions.
The patients must have been diagnosed with unilateral peripheral facial palsy, according to
House and Brackmann international classification.
Inclusion time : 18 months
Between-two-groups analysis will be conducted in order to compare a targeted and intensive
implementation-intention rehabilitation such as virtual rehabilitation program to standard
therapy. This virtual therapy will consist in repeating mentally movement desired, so that it
will be more spontaneously executed in the every-day-life situation.