Ramsay Hunt Syndrome (RHS) is a late complication of chickenpox often associated with facial paralysis and synkinesis. Treatments for acute-onset facial paralysis or synkinesis from any cause may include physical therapy (PT) that focuses on electromyography (EMG) biofeedback, stretching, and heat. Less research has focused on treating synkinesis resulting from RHS.
The purpose of this case report was to assess the effectiveness of adding neuromuscular electrical stimulation (NMES) to more well-studied PT treatments, such as mirror therapy and massage, for decreasing synkinesis in chronic RHS.
The patient was a 62-year-old female with RHS. One year after diagnosis, she began PT to decrease synkinesis with the use of NMES, exercise, and massage. The synkinesis protocol was performed during twice-weekly clinic appointments lasting four weeks, and the patient performed the protocol at home twice daily.
Assessment of facial appearance and function utilized the Sunnybrook Facial Grading System (SFGS) and Synkinesis Assessment Questionnaire (SAQ). SFGS score improved from 64/100 to 89/100. SAQ score improved from 25/45 to 11/45. Both demonstrated decreased synkinesis during smiling and lip puckering.
After four weeks the patient showed improved symmetry and decreased unintended right eye movements during mouth movements, assessed by objective and subjective measures. Long-term studies would add to the body of knowledge for treating facial abnormalities.