Facial Masking in Parkinson's Disease

Treating the Progressive Loss of Facial Motor Control

A person's face
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Masked facies (also known as hypomimia) is the loss of facial expressions most commonly associated with Parkinson's disease. It is so named because the condition gives the affected person a fixed, mask-like expression.

In Parkinson's disease, masking can develop as the progressive loss of motor control extends to the facial muscles as it does to other parts of the body. Masked facies can complicate an already difficult situation, alienating acquaintances who may be put off or disturbed by the apparent lack of emotional response.

Facial masking may also occur with certain psychiatric or psychological disorders, but, in these cases, the cause is not related to the loss of muscle control but rather an emotional blunting (sometimes referred to as reduced affect display or, in the case of schizophrenia, the flat affect). The same may occur with certain medications that can significantly blunt a person's emotional response.

As such, we tend to use the term hypomimia to describe facial masking within the context of Parkinson's disease. It suggests the actual loss of motor control rather a physical manifestation of emotional blunting.

Masked Facies in Parkinson's Disease

It's easy for most of us to understand why having an expressionless face could be traumatic. Humans communicate not only through words but through subtle, fast-moving changes in facial expression. A person who isn't able to convey these emotions facially would be at a loss since others may discount or misinterpret words when the expressions don't match up.

Masked facies is symptomatic of the degenerative nature of Parkinson's disease. The hallmark feature of the disease is the progressive loss of motor control and not only of major limbs but the finer muscle movement of the hands, mouth, tongue, and face.

Hypomimia can affect both voluntary facial movements (such as a smile) and involuntary ones (such as occurs when a person is startled).

There are also degrees of the effect which doctor use to help track the progression of the disorder:

  • 0 - Normal facial expression
  • 1 - Slight hypomimia, poker-faced
  • 2 - Slight but definitely abnormal loss (diminution) of facial movement
  • 3 - Moderate loss that is present most of the time
  • 4 - Marked loss that is present most of the time

Therapy for Masked Facies

Facial expression matters. Research has shown that quality of life is better in persons with Parkinson's who have undergone therapy to improve facial control than those who have not. It typically demands an intensive, therapist-guided program which would initially focus on broader facial movements, such lifting the eyebrows, stretching the mouth, or puckering the face.

One technique called the Lee Silverman voice treatment (LSVT), is used by some to help people with Parkinson's speak louder and clearer. It employs articulation exercises that are similar to stage acting techniques in which a person is taught to projects and enact "speaking behavior" by:

  • Straightening the posture
  • Looking a person directly in the face
  • Keeping the chin up
  • Taking deep breaths before speaking
  • Focusing on big, loud sounds and slow, short phrases

The LSVT technique and similar rehabilitative approaches (such as choir singing or voice amplification) have proven valuable in helping persons with Parkinson's segregate and control specific facial muscle more effectively when communicating in groups or one-on-one.

Sources:

Dumer, A.; Oster, H.; McCabe, D. et al. "Effects of the Lee Silverman Voice Treatment (LSVT® LOUD) on hypomimia in Parkinson's disease." Journal of the International Neuropsychological Society. 2014; 20(3):302-12.

Ricciardi, L.; Baggio, P.; Ricciardi, D. et al. "Rehabilitation of hypomimia in Parkinson's disease: a feasibility study of two different approaches." Neurological Sciences. 2016; 37(3);431-6.

Ricciardi, L.; Bologna, M.; Morgante, E. et al. "Reduced facial expressiveness in Parkinson's disease: A pure motor disorder?" Journal of the Neurological Sciences. 2015; 358(1-2):125-30.

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