# Retrospective cohort study evaluating patient-reported outcomes following intensive electromyography and video-biofeedback training in chronic non-flaccid facial palsy

## TL;DR

A two-week EMG and video-biofeedback program significantly improved facial function and quality of life in patients with chronic facial palsy.

## Contribution

This study provides evidence for the effectiveness of an intensive EMG and video-biofeedback rehabilitation program in chronic non-flaccid facial palsy.

## Key findings

- Significant improvements in facial function and quality of life were observed after the two-week program.
- Improvements were sustained at six-month follow-up, with outcomes remaining above baseline.
- Age and gender were associated with differences in outcomes, emphasizing the need for individualized approaches.

## Abstract

Chronic non-flaccid peripheral facial palsy is frequently associated with synkinesis, residual motor deficits, and reduced quality of life. Evidence-based, standardized rehabilitation protocols remain limited. This study examined the effect of an intensive two-week electromyography (EMG) and video-based biofeedback program on changes in physical and psychosocial patient-reported outcomes in patients with chronic facial palsy.

This retrospective cohort study included patients with chronic non-flaccid facial palsy, either with synkinesis or residual hypotonia, who completed a two-week EMG and video-biofeedback program between 2020 and 2023. The intervention targeted synkinetic co-activation and improved voluntary motor control in hypotonia. Data consisted of routine documentation and patient-reported outcome measures (PROMs) collected at baseline 6 months before therapy (T1), therapy initiation (T2), therapy conclusion (T3), and six-month follow-up (T4). PROMs included the Facial Disability Index (FDI), Facial Clinimetric Evaluation Scale (FaCE), Short Form-36 Health Survey (SF-36), and Beck Depression Inventory (BDI). Analyses used repeated-measures ANOVA and segmented regression.

A total of 175 patients were included. Significant improvements were observed across all PROMs. From T2 to T3, FDI total score increased by 5.24 points (95% CI 3.90 to 6.60) and FaCE total score by 9.86 points (95% CI 7.80 to 11.92). SF-36 showed improvements in social functioning (+4.67 points, 95% CI 2.19 to 7.15) and emotional well-being (+4.32 points, 95% CI 2.60 to 6.00). BDI decreased by 3.29 points (95% CI –4.63 to −1.96). Segmented regression indicated small but significant pre-therapy improvements from T1 to T2. At follow-up, outcomes remained above baseline, with FDI total score rising from 65.64 ± 14.88 at T1 to 75.31 ± 13.83 at T4 and FaCE total score from 53.89 ± 16.54 to 63.72 ± 17.10 (all p < 0.001). Older age was associated with lower FDI values; male gender was associated with higher FDI and FaCE and lower BDI scores.

Participation in an intensive EMG- and video-based biofeedback program was associated with clinically relevant and sustained improvements in facial function, quality of life, and psychosocial well-being in patients with chronic non-flaccid facial palsy. Age- and gender-related differences highlight the importance of individualized rehabilitation approaches.