Confused

[Cheryl R]

I am now confused with how long one is to wait to see a facial therapist.           Jackie has  previously said to wait till a year and this weekend  it was 10 months to a year.        When there is movement.      How did others take this?              Early therapy isn't going to make the nerve heal any faster.      That just takes the slow time on its own.        This can change how I have posted in the past.         I hope to hear more as know there were several in the Fri eve session and the afternoon one.   
                                                                Cheryl R

[saralynn143]

My facial nerve specialist dude at Wash U said nothing until after a year. That included self exercises and physical therapy. He was adamant.

Sara

[ToddH]

Hi, since synkinesis usually begins between 3-9 months post-onset of facial palsy (fp), if you wait a year before beginning facial NMR or exercise you are 1) missing the opportunity to minimize it before it gets worse and 2) allowing the synkinesis patterns to become well-worn cortical pathways in the brain that are harder then to "untrain".  In the chapter I wrote on facial NMR for Mark May & Barry Schaitkin's book, The Facial Nerve, May's 2nd Edition, there is a table (16-1) about criteria for when to begin NMR. Under the condition where there is evidence of synkinesis development,  it states "Begin". Why? "Synkinesis indicates aberrant facial nerve regeneration which can be improved with facial NMR." The time-frame for this is irrelevant.
Now if you are one who never gets synkinesis, then this doesn't apply. That also means that you are likely full recovered within 4-6 months (in mild cases), OR you have remained flaccid due to no facial nerve regeneration, in which case facial NMR and exercise wouldn't help anyway.  There were excellent presentations by facial plastic surgeons at the Conference about how to address the latter problem.
Let me know if any of this doesn't make sense.  

[Cheryl R]

Hi Todd,  I saw you at the symposium but was wondering more since DHM told Darlene she can see a therapist but she is only around 6 weeks post op.             I was thinking more that DHM understood something I had missed.            Actually I sat at the same table with you for supper Fri eve but never talked much as the roar of the crowd didn't help.               So this doesn't pertain to me but the new ones who feel they need to see a therapist right away and also some drs views on it.                Many newbies do do understand the synkinesis and what it is as compared to just paralysis.                    So good way of putting it.
                                                       Cheryl R

[mimoore]

Sorry for the highjack LOVE the new photo Sara!

[Kaybo]

Doesn't she look great?  You can't even tell she has ANY facial problems...

K

PS - I was the photographer - have to get my claim to fame in!  I am keeping track of how many people use photos I took as profile pics - my SIL's have used a number on FB...

[Jim Scott]

Folks ~

Please try to keep your posts here on topic.  We have lots of 'photo' threads going in the AN Community forum.  Feel free to post all photo-related messages there.  Thanks.

Jim

[Debbi]

Hi Cheryl-

I always understood that you could start NMR when you started to get some movement back.  The caveat (according to my doctors) is that you have to be careful not to over-work the muscles.  There seems to be a lot of disagreement about this within the medical community, which causes a lot of confusion for all of us with facial palsy. 

(BTW, it was great meeting you at the symposium!)

Debbi

[ToddH]

Hi Cheryl, I do remember you as well (the photo helps!). It was pretty loud in that room, and since I wear hearing aids in both ears due to hearing loss, had a hard time following conversations, too.
I agree with what Debbi said. It is very natural, when you do start trying to exercise your face, to push strongly. After all, the harder I push the stronger I'll get, right? Wrong. The face is a very finely coordinated machine, and doing small movements, as Jackie D. said, is the way to go. I always tell patient to go for symmetry. For example, winking one eye, or trying to, is always bad because it usaully causes a lot of facial muscles on the winking side to contract together and cause distortion. The best way to relearn eye close is to look down and close with both eyes.
Take care,
Todd

[4cm in Pacific Northwest]

Hi Todd,  I saw you at the symposium but was wondering more since DHM told Darlene she can see a therapist but she is only around 6 weeks post op.             I was thinking more that DHM understood something I had missed.         

HUH?

I am not sure I know who Darlene is. 


I would not tell a 6 week post op patient to go for therapy. The rule is you wait for movement to return however if you are seeing obvious signs of sykenisis it is my understanding that you want to get onto this ASAP. As soon as I noticed my eye closing, when I pursed my lips, I was in to see my oculo-plastics dr to see if we could locate a therapist (Finding my therapist is a whole different off-topic story)

Is it possible you misheard me- or I misheard this Darlene. (Who is Darlene?)

Mis- hearing is so possible with us SSD folks... get more than one if us in a room and yup we can get our information confused.

DHM

[sgerrard]

DHM, I think Cheryl was referring to this post:

http://anausa.org/forum/index.php?topic=10300.msg118545#msg118545

Steve

[4cm in Pacific Northwest]

Ok – thanks Steve.

Darlene (now I remember who this is) says her surgery was 12/6/08 on her signature.

Her post was Aug 17, 2009

That would have her at 7 months. 

She mentions 6 week re-check… but I did not read this as post op.

I was worried that she would go to any physio therapy with a placid face and have damage done- thus I suggested she contact Jackie.

Yup I think the misunderstanding was that Cheryl- you read this a 6 weeks post op.

Easy to see the confusion there… I did not think I sent a 6 week post op patient to seek help …

Keep moving forward and asking questions. That is why we  are here.

DHM

[Cheryl R]

I just looked at Darlenes profile and she was dx in Dec 08 and she says in a post that her surgery was July 1.     I read her last posts so anyway I am not trying to make a big deal of this but do want know what we should be saying to a new facial paraylsis when it is just that someone thinks they can bring back the face on their own and don't understand how the nerve needs to heal first.
                                                             Cheryl R

[4cm in Pacific Northwest]

"...  know what we should be saying to a new facial paraylsis when it is just that someone thinks they can bring back the face on their own and don't understand how the nerve needs to heal first."
                                                           

Yup there was definitely confusion there... and you make an excellent point.

DHM

[salamander]

Here's my addition to the confusion.  I am at nine months and my face started to move at 7 months.  My eyebrow started moving this week which really surprised me.  I do see what I think is synkinesis because whenever I do any movement, the muscles under my eye move upward.

At the conference, I asked Jackie when I should start and she said now would be good.  So I think therapy timing is defitely based on movement and synkinesis, not a time frame. 

I have been doing exercises daily since movement started.  But I need to remember the point about small movements instead of large.  I have a tendancy to try to push it a bit farther than it wants to be.  I will try to be more careful. Something DHM said on another post really struck me - to think of your facial nerves as butterfly wings - treat with gentleness.

Samantha