Mime therapy is a combination of mime and physiotherapy and aims to promote symmetry of the face at

rest and during movement and to control synkinesis (Beurskens et

al 2004b). First, participants were taught to massage their face and neck daily for 1015 min. Massage
consisted of effleurage and kneading both sides of the face. Stretching
exercises of the affected side followed to relieve mimetic muscles involved in synkinesis. Then,
participants were taught to recognise tension and to feel the difference between
tension and relaxation in general and more specifically in the facial musculature, because synkinesis may
increase muscle tone which can be exacerbated by stress. Third,
specific exercises to co-ordinate both halves of the face and to decrease synkinesis were taught. Basic
exercises (forehead wrinkle, eye closure, smile, snarl, lip pucker)
with variations in amplitude and speed, exercises for one side of the face to control separate movements,
relaxation of the lower jaw, exercises of the mouth (smiling, pouting)
and the eye with simultaneous inhibition of synkinesis (slow, small movements and counteraction) were
included. A mirror was used for feedback. Fourth, eye and lip closure exercises were taught. In cases of
lagophthalmus (inability to close the eyelids fully) the upper eyelids were stretched.
Eye exercises were performed with variations in speed and force, whilst keeping the lips still. Lip closure
exercises comprised exercises of the cheek (filling the cheeks with
varying amounts of air) and eating and drinking exercises whilst keeping the affected eye open (small
movements). Fifth, exercises were performed to increase the participants
awareness of lip movements and the position of the mouth
for various sounds. Vowels as a, e, i, and o, and consonants
such as p and b were used for the position of the lips.
Lastly, expression exercises were taught. Mime therapy
aims to develop a conscious connection between the use of
certain muscles and facial emotional expression. Exercises
were performed in two ways: working from the use of
certain muscles towards an expression, or working from an
expression as a starting point for a movement. For example:
the participant was asked to raise the forehead or to perform
an expression depicting amazement. Other expressions
were evoked by asking the participant to: open the eyes
wide (surprise), lift the upper lip (disgust), or tighten the
lips (anger).
Participants al


1. Simple traditional exercise To improve the activation level of various group of facial muscles Suck the cheeks
between the teeth Wrap the lips over the teeth Puckering of the lips Speech sounding sh, P, B, F with
teeth held together or fixed Eye closing exercise; look down, close the eyes, once closed continue to look down .
2. Title Otol Neurotol. 2003 Jul;24(4):67781. Positive effects of mime MIME Method sample Stability of benefits of mime
therapy in sequelae of facial nerve paresis during a 1-year period. Result/ conclusion RCT 50 patients
HouseBrackmann score of Grade IV. Facial Disability Index Facial Disability Index improved substantially Follow up of
the above RCT 48 9 months majority absence of deterioration 50 Sunnybrook Improvement in Facial Grading
symmetry System House facial grading therapy on sequelae of facial paralysis: stiffness, lip mobility, and social and
physical aspects of facial disability. Otol Neurotol. 2006 Oct;27(7):1037-42. Outcome Aust J Physiother.
2006;52(3):177RCT 83. Mime therapy improves facial symmetry in people with long-term facial nerve paresis: a
randomised controlled trial
3. Mime combination of mime and physiotherapy Performing expression Can also be helpful in chronic facial
paralysis
4. Functional exercise Developed as a multi dimensional and patientcentered approach to rehabilitation of individuals
with facial paralysis Prakash V, Hariohm K, Vijayakumar P, Thangjam Bindiya D. Functional training in the
management of chronic facial paralysis. Phys Ther. 2012;92:605613. Encompasses major facial functions The
functional training program consists of patient education, functional training and complementary exercises
5. Functional training Improved ability to express context specific emotions and other physical functions of face
Patient education Positive coping strategies and Improved social interaction skills Functional Training
Program Functional training Complimentary exercise Improved ability to activate various facial muscles
6. Functional training To facilitate context specific spontaneous and voluntary emotions 1. Watch movies,
television programs and funny videos. 2. Narrate them during the treatment session in the clinic. 3. Think
about the funny incidents that had happened in your life or the jokes you heard or read recently and share it
with friends or family members.
7. Functional training To facilitate motor functions of facial muscles around the eyes, lips and mouth. 1. Hum
or sing songs that you like as frequently as possible 2. Play games like peek -a- boo, blowing bubbles with
your kids. 3. Rinse the mouth and spit the water down slowly. 4. Blow a pipe while imagining that you are
cooking in the kitchen and suddenly the fire puts off in the wood stove; you have to blow the pipe to make the
fire again.
8. Functional training Still no clinical trial to prove effectiveness
Grading:

The grading system developed by House and Brackmann categorizes Bell palsy on a scale of I to VI,[3, 4, 5] as follows:
Grade I: normal facial function
Grade II: mild dysfunction
Grade III: moderate dysfunction
Grade IV: moderately severe dysfunction
Grade V: severe dysfunction
Grade VI: total paralysis
Biofeedback, Transcutaneous electrical nerve stimulation (TENS) Thermal methods or massage, alone or
in combination with any other therapy.
simple movement retraining Expression training- mime Functional training PNF? Massage