1,720,965 research outputs found
Emotional training after facial nerve palsy: From theory to practice
Full text linkBackground: Facial expressions can be either voluntary or emotionally controlled. According to the Component Theory of facial expressions, the upper and lower face motor control is behaviorally independent in adults.
In addition, the right and the left face may also exhibit partially independent motor control. Spontaneous facial expressions are organized predominantly across the horizontal facial axis and secondarily across the
vertical axis. Two neural networks for laughter have been recently described in a tractography study. One network is involved in producing emotional laughter (the pregenual anterior cingulate, ventral temporal pole and ventral striatum/nucleus accumbens), while the second one in non-emotional and conversational laughter (frontal operculum and primary motor cortex M1). Smile production and recognition of others’ smiles are encoded in the pregenual anterior cingulate cortex. Unlike hand mirror neurons (MNs), mouthMNs do not receive their visual input from parietal regions. Facial visual input could reach mouth MNs through the ventrolateral prefrontal cortex. Other strong connections derive from limbic structures involved in encoding emotional facial expressions and motivational processing. The mirror mechanism linked to the face motor control is connected with limbic structures, involved in communication and emotions.
Discussion: Peripheral paralysis of the facial nerve compromises facial motility, resulting in alterations in facial expressions, particularly in representing emotionality and non-verbal communication. The primary therapeutic goal of rehabilitation treatment should be to recover expressive gestures, characterized by a biological function and facial expressions for non-verbal communication. A rehabilitation protocol could be
based on neurocognitive exercises with an emotional component (Emotional training) to recover spontaneous and emotional expressive movements. The patient is asked to reproduce the movements to express different emotions by showing drawings or photos of faces, by reproducing the examiner’s expression or by imaging a situation that evoked a specific emotion. The different sensory channels can be used: visual (viewing photos or videos that arouse a particular emotion), auditory (listening to emotionally significantmusic), tactile (touching surfaces that evoke a pleasant feeling) and gustatory (tasting some favorite foods). Even functional exercises, such as producing movements with the mouth (e.g. blowing) or the other parts of the face, can be proposed in contexts with emotional connotations (e.g. imagine blowing candles at a birthday party).
Conclusion: After a facial paralysis, once voluntary contraction appeared, neuromotor treatment should be integrated with emotional training which is a promising rehabilitation proposal that radically changes rehabilitation intervention
Emotional training of facial nerve palsy : a preliminary report
Full text linkIntroduction: Differently from limb muscles, facial muscles motoneurons can be recruited by two descending motor pathways, one arising from the primary motor cortex and the second arising from the midcingulate area (1). Lesions involving the former pathway are associated to voluntary facial paresis, while lesions involving the latter are associated to emotional paresis (2). Patients suffering a voluntary facial paresis cannot voluntary smile, but for example they smile normally in response to jokes. On the contrary, patients suffering an emotional paresis can voluntarily mimic facial expressions, but are unable to produce spontaneous emotional expressions. During rehabilitation after facial nerve lesion, patients are commonly trained to produce symmetric and isolated voluntary movements [e.g. neuromuscular retraining (3)]. In this work we used emotional activation to train facial muscles after peripheral facial nerve palsy, according to the hypothesis that midcingulate area in addition to the primary motor cortex can participate to the motor recovery after facial nerve lesion.
Materials: Tue House-Brackmann scale (HBS) was used to evaluate facial symmetry and synkinesis, both before and after the rehabilitation program.
Methods: Ten patients (36-76 years) suffering a facial nerve lesion (6 Bell's palsy, 2 Ramsay Hunt syndrome, 2 post-surgery palsy) underwent up to 20 physiotherapy sessions. Each session ( 45 minutes long) was led by a physiotherapist. Consecutive sessions were kept at least 3 days apart. The emotional activation of the paretic facial muscles was obtained by asking patients to recall pleasant memories. Patients were guided by the therapist in increasing their awareness of the emotion-evoked movement by concentrating on kinesthesis.
Results: On average, patients started the rehabilitation 80 days after the nerve lesion. At the beginning of the rehabilitation program, patients suffered a moderate facial asymmetry according to the HBS (median HBS score: 3.5; IQR: 3). At the end of the rehabilitation program, HBS score median was reduced to 1 (IQR: 1), indicating a more symmetric face and less severe synkinesis (Wilcoxon test, p = 0.002). Ali patients improved their HBS score.
Discussion: Emotional training, a form of repetitive task-specific training, seems beneficial for people receiving rehabilitation following facial nerve lesion. Tue neural network mediating the emotional training effects could include structures of the limbic system such as the amygdala which are known to project to the facial muscle motoneurons via the midcingulate area (1).
Conclusion: Emotional training of facial muscles led by a physiotherapist is a promising tool for rehabilitation after facial nerve lesions.
References:
1. Morecraft RJ, Louie JL, Herrick JL, Stilwell-Morecraft KS. Cortical
innervation of the facial nucleus in the non-human primate: a new interpretation of the effects of stroke and related subtotal brain trauma on the muscles of facial expression. Brain (2001);124:176-208
2. Gothard KM. Tue amygdalo-motor pathways and the control of facial expressions. Front Neurosci. (2014); 19(8):43
3. Nicastri M, Mancini P, De Seta D, Bertoli G, Prosperini L, Toni D, lnghilleri M, Filipo R. Efficacy of early physical therapy in severe Bell's palsy: a randomized controlled trial. Neurorehabil Neural Repair. (2013);27(6):542-5
Comprehensive rehabilitation training after iatrogenic facial nerve palsy
No full textIntroduction. Iatrogenic facial nerve injury may occur after surgical procedures and leads to facial disfigurement and functional limitations. After a facial nerve injury, clinical prediction rules define three phases: complete denervation, first manifestation of reinnervation and functional recovery. Patients with facial nerve palsy experience physical, psychological and social disabilities. Many studies support significant benefit from rehabilitation for the idiopathic facial paralysis; contrariwise the efficacy of rehabilitation is uncertain for iatrogenic facial palsy.
Aim. This study sets out to determine whether a comprehensive rehabilitation training, adapted to the stages of recovery after facial iatrogenic nerve injurie, influences the functional outcome of patients. This training has the aim to facilitate the return of intended facial movement patterns and to eliminate unwanted patterns of facial movement (synkinesias).
Materials and method. The Sunnybrook Facial Grading System (SFGS)1 was used to assess the severity of facial palsy. This scale provides a clinical score from 0 to 100 which combines a static and dynamic assessment of facial muscles with the degree of synkinesias.
The Facial Disability Index (FDI)2 is a disease-specific, self-report instrument for the assessment of disabilities of patients with facial nerve disorders. It’s divided in two subscales: the physical function and the social/well-being function. Each subscale provides a score from 0 to 100.
Ten patients (19-67 years; 4 females) suffering an iatrogenic nerve palsy (i.e. after parotidectomy, acoustic neuroma surgery, vascular surgery) occurred 18-24 months before, underwent 20 physiotherapy sessions. Each session (45 minutes long), was led by a physiotherapist. Each patient was evaluated at the beginning, in the middle and at the end of the rehabilitation program.
Results
After the rehabilitation program most symmetry of face at rest (SFGS, Friedman test, p=0.0003) and during voluntary movements (SFGS, Friedman test, p=0.0001) was observed. Presence and severity of synkinesias did not improve significantly (SFGS, Friedman test, p=0.5585). After rehabilitation program patients feel an improvement of social/well-being function (FDI, Wilcoxon test, p=0.0006) but not an improvement of physical function (FDI, Wilcoxon test, p=0.058).
Discussion. Comprehensive rehabilitation training seems beneficial for people following iatrogenic facial nerve injury. People regain facial symmetry at rest and during voluntary movement and feel a reduced degree of subjective distress. The synkinesias do not improve significantly, but the positive trend indicates that the training may have a prevention role in the developing of such phenomena.
Conclusion. Comprehensive training is a promising tool for the recovery of an iatrogenic facial nerve lesion.
Bibliography
1 - Pavese C, Tinelli C, Furini F, Abbamonte M, Giromini E, Sala V, et al. Validation of the Italian version of the Sunnybrook Facial Grading System. Neurological Sciences: official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2013;34(4):457-63.
2 - VanSwearingen JM, Brach JS. The Facial Disability Index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system. Physical therapy. 1996;76(12):1288-98
L'emotional training nelle paralisi periferiche del nervo facciale
No full textIntroduzione. La paralisi periferica del nervo facciale è un esempio paradigmatico di quanto una menomazione di apparente modesta entità possa determinare una severa disabilità. I deficit del VII nervo cranico (nervo facciale) compromettono la motilità del volto, determinando significative alterazioni della mimica facciale, in particolare nella rappresentazione dell'emotività e del costrutto non verbale della comunicazione (1). La muscolatura mimica del volto è controllata da due vie neurali distinte: una volontaria corticale e una involontaria, che bypassa la corteccia cerebrale fornendo risposte rapide e spontanee. L'obiettivo dello studio è proporre un trattamento riabilitativo basato su un programma di esercizi neurocognitivi per il recupero dei movimenti espressivi spontanei ed emozionali nei pazienti con deficit mimici da paralisi del nervo facciale (2).
Materiali e Metodi. Lo studio si è svolto presso l‘Ospedale San Paolo, A.S.S.T. Santi Paolo e Carlo di Milano, dal marzo 2011 al marzo 2017. Per la limitata casistica e per motivazioni etiche è stato predisposto un quasi-experimental study di tipo before-after. È stato eseguito un campionamento di convenienza di tipo non probabilistico, reclutando tutti i pazienti con deficit periferici del nervo facciale presi in carico o in trattamento presso l’U.O. di Riabilitazione Specialistica nel periodo di studio. Tutti i pazienti (n=41) sono stati sottoposti a una valutazione iniziale con la scala di House e Brackmann. I pazienti con paralisi post-chirurgica in trattamento dopo il luglio 2015 (n=9) sono stati valutati anche con Sunnybrook Facial Grading System e Facial Disability Index. Dei pazienti arruolati, 39 sono stati sottoposti a un trattamento riabilitativo con Emotional training (3). Alla conclusione del programma riabilitativo sono state ripetute le scale di valutazione. L’analisi dei dati è stata eseguita con la statistica non parametrica (test di Wilcoxon per le valutazioni before-after e test di Friedman per le misure ripetute). Per tutti i test statistici è stato preventivamente imposto il livello di significatività per un valore di p<0,05 (5%).
Risultati. Sono stati arruolati 41 pazienti (20 ♀; 21 ♂; età media 50±16 anni) di cui 25 con paralisi post-chirurgica, 13 con paralisi idiopatica e 3 con sindrome di Ramsay-Hunt. Due pazienti non hanno iniziato il trattamento mentre due lo hanno sospeso per la patologia di base. I punteggi alla scala di House e Brackmann documentano un miglioramento significativo (p=3,8119·10-7 test di Wilcoxon) dell'intero campione (n=37). Suddividendo il campione in base a un criterio eziologico si osserva un miglioramento significativo nei pazienti con paralisi post-chirurgica (p=3,8147·10-6) e idiopatica (p=0,00098). Il miglioramento dei pazienti con Ramsay-Hunt non ha raggiunto la significatività statistica (p=0,25).
La valutazione dei pazienti con paralisi post-chirurgica utilizzando il Sunnybrook Facial Grading System (FGS) ha documentato un miglioramento significativo del punteggio globale (p=6,00·10-7 test di Friedman), della valutazione della simmetria durante il movimento volontario (p=9,108·10-6) e a riposo (p=0,0001076). Non si sono registrati miglioramenti significativi delle sincinesie (p=0,59408).
Al questionario Facial Disability Index è risultato significativo il miglioramento della funzione sociale e del benessere soggettivo (p=0,0078125 test di Wilcoxon), ma non quello della funzione fisica (p=0,09375).
Conclusioni
L’Emotional training è efficace per il trattamento dei pazienti affetti da paralisi periferiche del nervo facciale idiopatiche (come la paralisi di Bell) o post-chirurgiche (i.e. conseguenti a interventi al volto, alla base cranica, al capo e al collo), con un miglioramento significativo dei punteggi ottenuti alla scala di House e Brackmann.
Per quanto riguarda i pazienti con paralisi post-chirurgica si sono registrati miglioramenti significativi nella simmetria del volto a riposo e nei cinque movimenti testati nel Sunnybrook Facial Grading System.
Nelle paralisi post-chirurgiche è stato documentato un significativo miglioramento della funzione sociale e del benessere soggettivamente percepito, rilevati alla compilazione del Facial Disability Index.
L'analisi dei dati non ha consentito di documentare miglioramenti delle sincinesie, dovute alla rigenerazione aberrante del nervo lesionato.
Ulteriori studi saranno necessari per la prevenzione e il trattamento delle sincinesie e per una valutazione accurata del sorriso spontaneo.
Bibliografia
1. Wild B, Erb M, Eyb M, Bartels M, Grodd W. Why are smiles contagious? An fMRI study of the interaction between perception of facial affect and facial movements. Psychiatry Res - Neuroimaging. 2003;123(03):17–36.
2. Lotter M, Quinci A. La riabilitazione delle paralisi del VII nervo cranico. Piccin. Padova; 2012.
3. Pagani R, Caronni A, Cupello S, Gervasoni F, Previtera AM. Emotional training of facial muscles after facial nerve palsy: a preliminary report. Neurol Sci Off J Ital Neurol Soc Springer. 2014;35(Supplement):S381
The recovery of the spontaneous smile after facial reanimation
No full textBackground: The social smile is quite distinct from the genuine smile. The two types smile are controlled by entirely separated brain circuits: the spontaneous smile emerges from the unconscious limbic system, while the social smile comes from the conscious motor cortex. Moreover, the two types of smile are brought about by a different set of facial muscles, because some facial muscles are outside cortical control The mixed facial reanimation technique after a facial paresis goes good symmetry ot the face at rest, while smiling movement is achievable, but not guaranteed. During rehabilitation treatment alter facial reanimation, patients are commonly trained to “feel” the movement, to perform symmetrical movement with the contralateral side of the face and to reduce synkinesias as much as possible. This study sets out to determine whether, after facial reanimation, a comprehensive rehabilitation, including emotional training, may influence the functional outcome of patients. Patients and methods: This is a quasi-experimental study (before and after). Six patients (19-66 years; 2 females), after facial reanimation for facial paresis, underwent to comprehensive rehabilitation including emotional training sessions once a week tor 6 months. Emotional training was obtained by asking patients to recall different emotions, Each patient was evaluated at the beginning, in the middle and at the end of the rehabilitation program. The House-Brackmann scale (HSB) was used to evaluate global degree ot facial palsy and provides a score from 1 (normal) to 6 (paralysis). The Sunnybrook Facial Grading System (SFGS) was used to combine a static and a dynamic assessment of facial muscles with the degree ot the severity ot facial Palsy and provide a clinical score from 0 (paralysis) to 100 (normal). Results; After the rehabilitation program a global improvement o to paresis was observed (HSB, Friedman test, p=0.00054). A better simmetry of face at rest (SFGS, Friedman test, p=0.0162) and during voluntary movement (SFGS, Friedman test, p=0.0002) was observe. Discussion and conclusions: The neural network that mediates the emotional training effects could include structures of the limbic system which are known to project to the motor neurons of the facial muscles, via the midcingulate area. At the end ot the rehabilitation program the patients had a quite good symmetry ot the face at rest and were able to smile automatically in appropriate situations. Emotional training is a promising tool for the recovery of spontaneous emotional, especially for automatic smile
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
- …
