Evaluation of the Effectiveness of Virtual Reality Self-rehabilitation in the Treatment of Facial Paralysis and Synkinesis

Study Overview
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Brief Summary
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Peripheral facial palsy affects 15 to 40 people per 100,000 inhabitants and induces important functional and social repercussions. Synkinesis is a frequent after-effect of facial palsy recovery, consisting of involuntary facial spasms that disturb the gestural harmony and can go as far as a painful hypertonic spasm. More than 55% of patients recovering from facial palsy will develop transient or permanent synkinesis. These facial hypertonias have two main causes: imperfect axonal regeneration, which is all the more important as the damage is proximal, and hyperexcitability of the facial nerve nucleus due to a lack of central control. Management is therefore essential for the functional restoration of the face, especially since synkinesis do not evolve spontaneously. The main treatments are currently botulinum toxin injection, acting on the motor plate, and functional rehabilitation, consisting on local muscle relaxation and central motor control work. In recent years, therapies based on biofeedback and acting on central motor control have shown interesting results, and technological advances in virtual reality have made it possible to deepen this treatment in patients suffering from stroke, limb trauma or Parkinson's disease. In this project, the investigators evaluate the contribution of virtual reality to the management of facial palsy, and hypothesize that self-rehabilitation using this technology will improve motor control of the skin muscles and reduce complications related to their hypertonia such as synkinesis.

Official Title
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Evaluation of the Effectiveness of Virtual Reality Self-rehabilitation in the Treatment of Facial Paralysis and Synkinesis

Conditions
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Peripheral Facial Palsy, Rehabilitation, Virtual Reality

Intervention / Treatment
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* Other: massages
* Other: motor stimulation and stretching
* Other: virtual reality


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient with recent onset peripheral facial palsy (≤ 12 months). Patient with peripheral facial palsy of grade ≥ III on the House & Brackmann score Patient of legal age (≥ 18 years) Patient with appropriate information and informed consent Exclusion Criteria: Patient with central facial palsy Patient with peripheral facial palsy of > 12 months onset Patient with peripheral facial palsy of grade < III House & Brackmann score Patient who has previously undergone palliative surgery Patient undergoing a botulinum toxin injection protocol Patients benefiting from enhanced protection, i.e. minors, persons deprived of their liberty by a judicial or administrative decision, persons staying in a health or social institution, adults under legal protection, pregnant or breast-feeding women and patients in emergency situations Patients who have not provided informed consent Patients with cognitive disorders that do not allow them to follow the proposed self-education protocol Blind or visually impaired patients (visual acuity of the better eye after correction ≤ 4/10)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental arm<br>patients benefiting from rehabilitation associated with virtual reality | Other: massages<br>* The experimental rehabilitation protocol includes massages<br>Other: motor stimulation and stretching<br>* motor stimulation and stretching<br>Other: virtual reality<br>* Patient watches an avatar of his face performing different movements on a screen, and will have to imagine performing these movements without actually doing them.<br>|
| Active Comparator: Control arm<br>patients benefiting from rehabilitation without virtual reality | Other: massages<br>* The experimental rehabilitation protocol includes massages<br>Other: motor stimulation and stretching<br>* motor stimulation and stretching<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| variation of number of involuntary facial spasm between both groups of patients | variation of synkinesis in patients with recent onset (≤ 12 months) peripheral facial palsy compared with the conventional rehabilitation protocol | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Peripheral Facial Palsy, rehabilitation, virtual reality