Compensatory Muscle Activity Inhibition with Kinesiotape Application to the Unaffected Hemiface in a Person with Peripheral Facial Palsy: Two Case Reports ^†

Abstract

Facial palsy (FP) is a nerve disorder causing unilateral facial muscle paralysis, impacting facial symmetry and non-verbal communication. This case study describes two idiopathic FP patients treated with physiotherapy and inhibitory kinesiotape (KT) applied to the unaffected side to reduce muscle hyperactivity. The intervention aimed to improve facial symmetry and psychological well-being. Both patients showed improvements in the Sunnybrook Facial Palsy Scale and the Hospital Anxiety and Depression Scale. Despite these promising outcomes, the small sample size limits our conclusions. Further controlled studies with larger samples are needed to confirm KT’s effectiveness and clarify its role in FP rehabilitation.

1. Introduction

Facial palsy (FP) is a common neurological condition characterized by sudden unilateral facial paralysis due to facial nerve (VII) dysfunction. While FP has multiple potential causes—such as infections, trauma, neoplasms, and autoimmune disorders—the majority of cases are idiopathic, with Bell’s palsy being the most frequent. Although often self-limiting, the sudden onset and uncertain course of FP can be distressing [1].

In addition to motor deficits, FP often leads to facial asymmetry, eye closure difficulties, and impaired oral function, impacting daily life. These limitations can result in significant psychosocial distress [2]. Although most cases recover within 3 to 4 weeks, delayed improvement during this period is associated with a higher risk of long-term impairment, underscoring the importance of early and effective rehabilitation [1,2,3].

Physiotherapy remains the primary approach in FP management, focusing on education, neuromuscular re-education, mirror therapy, proprioceptive training, and biofeedback-based techniques to facilitate neuromuscular control, prevent synkinesis, and promote facial symmetry. Recently, interest has grown in adjunct therapies to enhance these effects [3,4,5,6]. One such modality is kinesiotaping (KT), a non-invasive, elastic therapeutic taping method widely used in musculoskeletal and neurological rehabilitation [7,8].

KT is thought to act by modulating muscle tone, improving circulation, stimulating cutaneous mechanoreceptors, and enhancing the sensory and proprioceptive inputs. In FP, it is typically applied to the affected side to support weak muscles and promote neuromuscular activation [7,8]. However, KT may also be beneficial when applied to the unaffected side to inhibit compensatory overactivity [7]. Such excessive activation may disturb the interhemispheric balance, reinforce maladaptive patterns, and impede recovery by hindering proper activation of the affected side [1]. By modulating the sensory input and proprioceptive feedback, inhibitory KT may help regulate muscle tone and promote more symmetrical neuromuscular control. Despite its potential, the use of inhibitory KT on the unaffected side remains unexplored. Its rationale is grounded in the previously discussed motor control principles, emphasizing bilateral facial muscle interdependence [1].

This case report describes the clinical progression of two idiopathic facial palsy patients who received standard physiotherapy combined with inhibitory KT on the unaffected side, highlighting changes in their facial function, symmetry, and psychosocial outcomes to provide a comprehensive view of rehabilitation.

2. Materials and Methods

2.1. Study Design

This case report followed a prospective observational design and was conducted in alignment with the CARE (CAse REport) guidelines to ensure the completeness and transparency of clinical case reporting [9].

2.2. Clinical Cases

Two adult patients diagnosed with idiopathic facial palsy were evaluated and treated at an outpatient neurorehabilitation clinic. Each patient participated in a structured physiotherapy program over a four-month period, attending sessions three times per week, with each lasting approximately 45 min.

Case 1 involved a 65-year-old retired, active female who presented with sudden-onset right-sided facial paralysis, reporting that she woke up unable to close her right eye and smile properly and experienced facial heaviness and tightness. Case 2 was a 48-year-old male IT engineer with acute right-sided idiopathic facial palsy, who reported difficulty closing his right eye, flattening of the nasolabial fold, and dribbling while drinking.

For both patients, there was no preceding trauma, infection, or identifiable cause. Their medical histories were unremarkable, and neurological examinations confirmed isolated peripheral facial nerve involvement, consistent with a diagnosis of idiopathic facial palsy (Bell’s palsy). Both received corticosteroid therapy and underwent 54 (Case 1) and 52 (Case 2) physiotherapy sessions. MRIs were performed in both cases due to delayed recovery, with no abnormal findings.

2.3. Assessment and Intervention Description

The patients were assessed at two time points, at session 13 (introduction KT) and at the end of the intervention period, as their initial progress was limited. The functional motor outcomes were evaluated using the Sunnybrook Facial Grading System (SFGS), which provides a more nuanced and quantitative evaluation. It assesses three domains: the resting facial symmetry, the symmetry of voluntary movement across five standard facial expressions, and the presence and severity of synkinesis. The scores from each domain are combined to yield a composite score ranging from 0 (complete paralysis) to 100 (normal function), allowing for sensitive tracking of clinical progress over time [10].

To assess the emotional and psychological impact of facial palsy, the Hospital Anxiety and Depression Scale (HADS) was administered at session 13 and post-intervention. The HADS is a validated 14-item self-report questionnaire designed to detect symptoms of anxiety (HADS-A) and depression (HADS-D) in patients with physical health conditions. Each subscale consists of 7 items, scored from 0 to 3, with total scores ranging from 0 to 21 per domain. Scores of 8 or above on either subscale are considered indicative of clinically relevant levels of anxiety or depression. The HADS is widely used in rehabilitation settings due to its sensitivity and its exclusion of somatic symptoms that might overlap with those of physical illness [11].

In addition to these standardized tools, we used qualitative observations documented by the treating therapist throughout the intervention period. These included notes on facial muscle coordination, compensatory patterns, tolerance to kinesiotaping, and subjective impressions of improvement [5].

The rehabilitation protocol included neuromuscular facilitation exercises aimed at enhancing voluntary muscle activation, proprioceptive stimulation using manual and tactile inputs, and verbal biofeedback training to promote neuromuscular control and reduce synkinesis. The patients were also educated on facial muscle awareness, posture correction, and relaxation techniques and were prescribed individualized home exercise programs [4,5].

In addition to standard care, KT was introduced as an adjunct therapy—starting in the fifth week for Case 1 and the third week for Case 2—following clinical reassessment due to delayed recovery. Using a low-tension inhibitory technique, with a stretch of 0 to 10%, administered from the muscle’s insertion to its origin, elastic therapeutic tape was applied to the unaffected hemiface. The KT application was based on the criterion of targeting the hyperactive muscles identified during each session, which varied daily based on the physiotherapist’s clinical assessment. These typically included the frontalis, zygomaticus major and minor, and orbicularis oris muscles. The purpose of KT application was to reduce the contralateral muscle hyperactivity on the unaffected side, aiming to promote functional symmetry by minimizing compensatory movements. Taping was performed every two days and maintained between sessions, with the patients instructed to keep the tape in place continuously unless irritation occurred. Their skin integrity and comfort were monitored.

2.4. Ethical Considerations

This study was conducted in accordance with the principles of the Declaration of Helsinki. Both participants provided written informed consent for participation and publication of anonymized data.

3. Results

Both participants demonstrated notable improvements in their facial muscle strength, dynamic symmetry, and psychosocial well-being over the course of the intervention. Improvements were observed both at rest and during voluntary facial movements, as measured by the SFGS and the HADS, as Figure 1 demonstrates.

Participant 1 showed a significant improvement in their SBFPS score, which increased from 25 to 88, indicating better voluntary movement, resting tone, and reduced synkinesis (see Figure 1a). Their HADS score decreased from 13 to 10, suggesting a mild reduction in anxiety and depression symptoms. Participant 2 exhibited a similar pattern, with their SBFPS score rising from 25 to 96, approaching full functional recovery, and a HADS score reduction from 9 to 3, reflecting a substantial decrease in psychological distress (see Figure 1b). Both participants also reported full functional recovery, with improved facial control, less social self-consciousness, and greater ease in their daily interactions. These reports were consistent with the physiotherapist’s observations of enhanced neuromuscular coordination, reduced compensatory activity, and improved facial symmetry. No adverse effects were observed, and both patients completed the treatment protocol as planned.

4. Discussion

This case study provides preliminary evidence supporting the use of inhibitory KT as a complementary therapy in the rehabilitation of idiopathic FP. Both participants demonstrated improvements in their facial motor function and psychosocial well-being, with enhanced muscle strength, facial symmetry, and a reduction in psychological distress. These findings align with the current literature, which emphasizes the benefits of combining standard physiotherapy with adjunct therapies like KT [7].

The psychosocial outcomes were notably improved, with both participants reporting reduced anxiety and depression as measured by the HADS. This aligns with research suggesting that FP can cause significant psychological distress due to an altered facial appearance and difficulty in social interactions [2]. The reduction in the HADS scores reflects the positive emotional impact of improved facial symmetry and voluntary control, supporting the notion that rehabilitation of facial function contributes to better psychological well-being.

The innovative aspect of this case study was the inclusion of inhibitory KT on the unaffected hemiface to address compensatory hyperactivity—a factor that often complicates rehabilitation and hinders the long-term facial balance, particularly in cases of delayed recovery [1]. While KT is commonly used to facilitate muscle activity on the affected side [7], this approach aimed to modulate excessive activity on the unaffected side to promote more balanced muscle engagement between both hemifaces and prevent complications such as facial asymmetry and synkinesis development. Both participants showed a reduction in compensatory movements, which likely contributed to the overall improvement in their facial symmetry.

While our results are promising, several limitations must be acknowledged. First, this study employed a single-case design with a small sample size of only two participants. The absence of a control group limits our ability to attribute the observed improvements solely to the KT intervention. Future research should include larger sample sizes and randomized controlled trials to further evaluate the efficacy of KT in the rehabilitation of FP. Additionally, while both participants reported subjective improvements in their function and emotional well-being, more comprehensive psychosocial assessments, including qualitative interviews, would provide deeper insights into the emotional impact of facial rehabilitation.

5. Conclusions

These case reports highlight the potential benefits of adding inhibitory KT to standard physiotherapy for the treatment of idiopathic facial palsy, showing improvements in facial symmetry and psychological well-being. This novel approach warrants further investigation through randomized controlled trials to confirm its efficacy, determine the optimal application parameters, and establish clinical guidelines for its use in facial rehabilitation.