Chiara Pavese

Functional and Social Limitations After Facial Palsy: Expanded and Independent Validation of the Italian Version of the Facial Disability Index

Background The Facial Disability Index (FDI) is widely used for self-assessment of functional impairment and quality of life in patients with facial palsy. Objective The study aim was to complete the validation of the FDI by generating an Italian version (IT-FDI) and evaluating its clinimetric properties. Design This was a longitudinal, observational measurement study. Methods The questionnaire was translated, cross-culturally adapted, and administered to 100 consecutive participants (outpatients) with facial palsy. The clinical severity of facial palsy, impairments in physical and social function, and quality of life were evaluated with the Sunnybrook Facial Grading System, IT-FDI, and 12-Item Short-Form Health Survey. Results The IT-FDI showed excellent test-retest reliability for every item and for total scores (intraclass correlation coefficients of .93 and .84 for physical function subscale and social/well-being function subscale, respectively). The IT-FDI confirmed the high internal consistency of the original version, with theta coefficients of .82 for the physical function subscale and .78 for the social/well-being function subscale. The physical function subscale correlated with the Sunnybrook Facial Grading System composite score (r=.44), and the social/well-being function subscale correlated with the 12-Item Short-Form Health Survey mental component (r=.55). The IT-FDI confirmed the good responsiveness of the original version, as expressed by effect size, standardized response mean, and responsiveness ratio of, respectively, 1, 1.03, and 1.21 for the physical function subscale and 0.75, 0.83, and 1.15 for the social/well-being function subscale. Limitations Responsiveness was evaluated with a limited number of participants. Conclusions The results demonstrated the test-retest reliability for all items of the FDI and confirmed its internal consistency, construct validity, and responsiveness with an independent and larger clinical subset. This study completes the validation of the FDI and provides the first validated questionnaire in Italian for assessment of disability and quality of life specifically in patients with facial palsy.

Platysma synkinesis in facial palsy and botulinum toxin type A.

Facial synkinesis is a well‐known disabling occurrence following severe facial palsy. Platysma muscle, innervated by the facial nerve, can be involved in synkinesis as well, but thus far has been little investigated. The aim of our study is to evaluate the presence of platysma synkinesis and its clinical evolution after onabotulinumtoxinA (BoNT‐A) (Botox®; Allergan Pharmaceuticals, Irvine, CA) injections.

Validation of the Italian version of the Sunnybrook Facial Grading System

The Sunnybrook Facial Grading System (SFGS) is one of the most employed scales to assess the severity of facial palsy. The aim of our study was to produce an Italian version of the SFGS and of its explanatory criteria, and to test their measurement properties when employed by Italian physicians. A multidisciplinary committee translated and adapted the scale and its criteria into Italian. Six native Italian physicians, four of whom experienced in facial palsy and two novices, rated independently 29 videos of facial palsy patients twice. Internal consistency, agreement and repeatability were evaluated. The Italian version of the SFGS showed a high degree of internal consistency with a Cronbach’s α of 0.91. The test–retest reliability was high for both inter-rater and intra-rater measures with an ICC of 0.96 and 0.98, respectively. The scores given by the novice physicians were comparable with the scores given by the expert physicians. Our study suggests that the Italian version of the SFGS has excellent internal consistency and reproducibility, comparable to the original scale. Our study confirms in an independent case record the high measurement properties of SFGS and provides the first validated Italian scale for the assessment of facial palsy.

Personality Traits and Perception of Disability after Facial Palsy

Objective: The aim of this study was to determine and quantify how personality traits modulate the well-known relation between neuromuscular impairment and perception of physical and social disability in patients with facial palsy. Methods: Sixty-one patients with facial palsy were evaluated through the Sunnybrook Facial Grading System (SFGS), the Facial Disability Index (FDI), the Beck depression Inventory (BDI) and the Temperament and Character Inventory (TCI). To estimate the effect of the personality traits on physical and social disability as regards neuromuscular impairment, two polynomial models were fitted and validated using specific personality variants and the SFGS composite score as explanatory variables. Results: A role of personality traits in modulating perception of both functional and social/well-being disability was enlightened. A linear effect of the Self-Directedness and the Cooperativeness traits on the perception of functional disability as regards facial impairment was estimated, equal respectively to -0.21 points [CI 95 (-0.35; -0.07)] and +0.23 points [CI 95 (0.06; 0.39)] in FDI score for any level of deviation from the average of each personality trait. As regards social/well-being disability, a linear effect of Novelty Seeking and Persistence traits was estimated, equal respectively to +3.88 points [CI 95 (1.25; 6.49)] and +6.58 points [CI 95 (0.21; 13.17)] for any level of deviation from the average. Conclusion: Personality traits differently influence the relation between disability perception and neuromuscular impairment in facial palsy. This issue might be useful to improve the relationship between physician and patient and to allow personalized therapeutic interventions.

Electrophysiological multimodal assessments improve outcome prediction in traumatic cervical spinal cord injury

Outcome prediction after spinal cord injury (SCI) is essential for early counseling and orientation of the rehabilitative intervention. Moreover, prognostication of outcome is crucial to achieving meaningful stratification when conceiving clinical trials. Neurophysiological examinations are commonly employed for prognostication after SCI, but whether neurophysiology could improve the functional prognosis based on clinical predictors remains an open question. Data of 224 patients included in the European Multicenter Study about Spinal Cord Injury were analyzed with bootstrapping analysis and multivariate logistical regression to derive prediction models of complete functional recovery in the chronic stage after traumatic cervical SCI. Within 40 days after SCI, we evaluated age, gender, the motor and sensory cumulative scores of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), and neurophysiological variables (motor evoked potentials, sensory evoked potentials, nerve conduction study) as possible predictors. Positive outcome was defined by a Spinal Cord Independence Measure total score of 100. Analyzing clinical variables, we derived a prediction model based on the ISNCSCI total motor score and age: the area under the receiver operating curve (AUC) was 0.936 (95% confidence interval [CI]: 0.904-0.968). Adding neurophysiological variables to the model, the AUC increased significantly: 0.956 (95% CI: 0.930-0.982; p = 0.019). More patients could be correctly classified by adding the electrophysiological data. Our study demonstrates that neurophysiological assessment improves the prediction of functional prognosis after traumatic cervical SCI, and suggests the use of neurophysiology to optimize patient information, rehabilitation, and discharge planning and the design of future clinical trials.

Trattamento con tossina botulinica delle sincinesie dopo paralisi del VII nervo cranico

Scopo dello studio e valutare l’evoluzione clinica di pazienti con sincinesie in esiti di paralisi di faciale trattati con infiltrazione di tossina botulinica. Complessivamente sono state effettuate 143 sedute di infiltrazione in 44 pazienti, con una dose di tossina compresa tra 2.5 e 3.5 U.I. per ogni punto di inoculazione. I muscoli infiltrati sono stati: orbicolare delle palpebre, platisma, mentoniero, frontale e zigomatico. La valutazione del quadro clinico e stata effettuata prima del trattamento e dopo 15 giorni utilizzando la versione italiana della Scala di Valutazione Facciale Sunnybrook. Dopo il trattamento con tossina si riducono le sincinesie e migliorano la simmetria a riposo e del movimento volontario, con un significativo incremento del punteggio globale Sunnybrook (test Wilcoxon, p<0.001). Il nostro studio conferma la riduzione delle sincinesie postparalitiche e il miglioramento della simmetria del volto dopo infiltrazione di tossina botulinica.

Trattamento riabilitativo delle paralisi del faciale dopo rianimazione con nervo masseterino

Facial palsy entails functional and aesthetic impairments resulting in severe disability. In the absence of spontaneous recovery, there is an indication for surgical interventions, including facial reanimation with the masseter nerve. For patients undergoing the latter procedure, a rehabilitation approach aims at controlling the newly formed brain circuit: the facial musculature is under the control of the masseter nerve and can be activated through mastication. Our study demonstrates an improvement of both static and dynamic facial symmetry upon activation of masticatory muscles in 12 out of 13 patients. The Sunnybrook mean global score ranged from 15.1 at the first clinical assessment without mastication to a score of 41.5 at the last observation with the patient activating masticatory muscles. Furthermore, the combination of surgical and rehabilitation interventions results in amelioration of functional aspects and social well-being, with an overall reduction of disability. Indeed the facial disability index ranged from a mean score of 43.5 to 68.5 for physical functions, and from 61.6 to 70.8 for the social well-being functions. Thus, facial reanimation with the masseter nerve followed by a rehabilitation programme represents a valid therapeutic option for patients with stable complete facial palsy. Facial palsy entails functional and aesthetic impairments resulting in severe disability. In the absence of spontaneous recovery, there is an indication for surgical interventions, including facial reanimation with the masseter nerve. For patients undergoing the latter procedure, a rehabilitation approach aims at controlling the newly formed brain circuit: the facial musculature is under the control of the masseter nerve and can be activated through mastication. Our study demonstrates an improvement of both static and dynamic facial symmetry upon activation of masticatory muscles in 12 out of 13 patients. The Sunnybrook mean global score ranged from 15.1 at the first clinical assessment without mastication to a score of 41.5 at the last observation with the patient activating masticatory muscles. Furthermore, the combination of surgical and rehabilitation interventions results in amelioration of functional aspects and social well-being, with an overall reduction of disability. Indeed the facial disability index ranged from a mean score of 43.5 to 68.5 for physical functions, and from 61.6 to 70.8 for the social well-being functions. Thus, facial reanimation with the masseter nerve followed by a rehabilitation programme represents a valid therapeutic option for patients with stable complete facial palsy.