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| | |-+  Hypertonic Muscles, Synkinesis and Neuromuscular Retraining
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Author Topic: Hypertonic Muscles, Synkinesis and Neuromuscular Retraining  (Read 2707 times)
MrsNewMommy
Regular
**
Posts: 83

BP from pregnancy 10/9/09; now 99.9% recovered


« on: 06 February, 2010, 03:33:25 am »

Hello!

I am new to this forum and developed Bell's Palsy on October 9, 2009 (one week before giving birth to my beautiful baby boy!).  I experienced my first movement in my cheek at around 5-6 weeks and things have slowly and steadily progressed since then.  I can now make a decent smile, move my eyebrow somewhat and wrinkle my forehead a little.  My speech has also greatly improved.  February 9 will mark the 4 month point.

I recently saw a neuromuscular retraining therapist as I started developing some unwanted movements at week 12.  For example, when I close my eyes (still not a full close), my cheek tenses up and pulls my mouth into a mild smile.  When I blink (i.e. blink the good eye and the BP eye follows along with a 30% blink), my cheek flutters and you can see it twitch a little when you look really close and focus.  When I raise my eyebrow, my cheek also tenses and pulls the mouth  up a little.  Also, when I flare my nostril, my cheek, lower eyelid and corner of mouth move a little. My cheek was also extremely tight but it has loosened up a little.  My nasio-labial fold is also more pronounced and the cheek is slightly puffier than the good side.  When I wake up in the morning the puffiness is worse and subsides over the day.  Very recently I have also noticed some twitches and fluttering along my lower eyelid, especially when I chew food or say certain words (like "your diaper has a poo poo" - the words "poo poo" seem to bring out the sensations.  I don't normally say this phrase but find myself saying it more now that I have a 3 month old!).  In terms of the eye, I am wondering if all this tugging, fluttering and such is a sign of healing rather than synkinesis...

I have frequented other forums wondering about these symptoms and the general consensus is that I am experiencing  synkinetic movement and hypertonicity in the cheek which may or may not go away with continued healing (but many were in favour of the prospect for resolution of these problems with continued healing).  The therapist I consulted came highly recommended by other BP patients and she has specialized training in NMR.  She told me that synkinesis and hypertonicity absolutely will NOT resolve on their own with continued healing and will only improve by participating in an NMR regimen.  On the other hand, she runs a business and needs paying clients to keep up her livelihood so I wonder if she is being totally forthright...

My question is (and I apologize or the lengthy background but thanks for staying with me!): has anyone ever experienced similar synkinetic movements and hypertonicity while recovering and had it disappear on its own without NMR?  If it doesn't disappear on its own and if NMR isn't effective for me, can Botox in my cheek help?

Any feedaback would be greatly appreciated!  Thank you!!!!
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evadnee
Newbie
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Posts: 30


« Reply #1 on: 06 February, 2010, 03:39:30 pm »

Dear MrsNew Mommy,

Please check out old post by Kframe, think it was titled 5 months into BP (early January). Many people are suffering simular synkenesis/healing? at this point in recovery.
Hope somebody who has recovered can answer this question,

E
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Ruth
Forum God
*****
Posts: 1373



« Reply #2 on: 07 February, 2010, 03:38:26 pm »

Hi Mrsnewmommy,

As  someone who was diagnosed in April 2004 and after almost a year of little or no movement I started a regime of NMR through a referral to a therapist on the BPIS site.

She was fantastic and gave me a set of exercises tailored to my specific needs. Have alook at 'Tips for Physio therapy and Facial Re-training' in the Useful Information section for some more information.

The only thing I can really suggest is that you check out the therapist thoroughly, make sure they have specific BP experience and be wary of any electrical stimulation as it can cause more damage.

The NMR worked very well for me and though my face is not perfect I am A LOT better than I was. It is not a quick fix and takes time and determination but the results I have had are permanent.

Good Luck and let us know how you get on.

Take care,
Ruth Smiley

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Ruth :-)
MrsNewMommy
Regular
**
Posts: 83

BP from pregnancy 10/9/09; now 99.9% recovered


« Reply #3 on: 11 February, 2010, 06:13:46 pm »

Hello!

Thank you Ruth and Evadnee. 

The therapist I have been seeing is vehemently opposed to Estim (thankfully) and I unfortunately did have 3 stupid estim sessions lasting 5 minutes each in the early stages while I was desperately trying to find a quick fix and I didn't know better Sad

My concern with my therapist is that she is so adamantly against the prospect that mild synkinesis (she says I have a mild case) can resolve on its own with continued healing.  For example, as the orbital muscles strengthen, I wonder if my cheek will become less involved in the eye-closure process.  It seems that while my muscles are still rather weak, other stronger muscles are being called upon to assist.  My cheek was the first to regain movement and is the strongest muscle on my face now.  It is so strong in fact that I can now produce a smile at 85% of what it was pre-BP.  The other muscles move but are lagging behind in the strength department.  It seems that this may be playing a role in the perception of synkinesis...  The fact that my therapist is unwilling to recognize this possibility concerns me.  Perhaps on the other hand I am being too pompous and come across as thinking that know everything  Tongue (I really am quite humble and am just throwing ideas out there...)

By the way Ruth - I saw your video and think you have made a great recovery Smiley
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Ruth
Forum God
*****
Posts: 1373



« Reply #4 on: 12 February, 2010, 08:06:23 pm »

Hi Again,

The inappropriate movements you are experiencing do indeed sound like synkinesis and while I have had excellent results with NMR you are only 4 months in and the flutterings and tuggings you are feeling can be associated with recovery as well as synkinesis and hypertonicity.

I think you need to feel confident in your therapist and you wonder whether you are getting all the information as she is running a business and essentially are questioning her motivation at therapy which is a viable concern. However she does sound like she is experienced and her policy against using ESTIM is a good sign that she knows what she is doing.

My opinion and it is just that is, that at 4 months there is still a lot of healing for you to do. If you feel that you need to take more time to see how your face will recover without the therapy then you should take it. Your therapy is meant to heal and relax you and if it is causing you concern then it will not accomplish that.

I don't think it is pompous to have information and to ask questions and your therapist should have the answers for you, it's up to you to take that information and make an informed decision that is right for you based on your own research and your comfort with your therapists recommendations.

I can't imagine accomplishing the level of recovery I have without the help of my therapist but I was much further along and my synkinesis was well established before I started the NMR and had the regime catered to my specific needs.

Wanting to push ahead and find something to do to speed your recovey is perfectly natural and I think every single one of us has wanted  that quick fix but it may just be that you need to give yourself a little more time to feel like you are at a point where the therapy can help. If you feel that you haven't completely healed on your own then taking more time until you feel comfortable with the therapy may be what you need to do.

Talk to your therapist about it and let us know what she says.

Come back and let us know how you're doing.

Take care,
Ruth Smiley
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Ruth :-)
MrsNewMommy
Regular
**
Posts: 83

BP from pregnancy 10/9/09; now 99.9% recovered


« Reply #5 on: 12 February, 2010, 10:42:25 pm »

Hi Ruth,

Thank you so much for your well-reasoned reply.  I truly appreciate your insight and perspective.  I had a visit with my therapist today and we fleshed out all of my concerns.  She explained that the movements I am experiencing could be the result of either aberrant nerve regeneration or co-contraction of muscles (just as I was hypothesizing that other muscles jump in to help out the weaker muscles to perform their function). 

Since I have recovered a great deal thus far, it is likely that my synkinesis is due to co-contraction rather than cross-wiring (which tends to happen in more severe cases of BP where further damage is sustained by the nerves and axons and such, as evidenced by a very delayed start to recovery).  Either way, the same NMR program is necessary to undo the patterns of unwanted movement.  It is possible that the muscles could return to their normal movement pathways on their own once I am fully healed but it's best to start NMR now just in case so that the patterns do not become too entrenched. 

I feel much better after thoroughly discussing things and you certainly helped me get to this point of comfort as well.

Thank you!
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Ruth
Forum God
*****
Posts: 1373



« Reply #6 on: 13 February, 2010, 02:18:51 pm »

Hi Again,

That's great news.  Smiley
It sounds like you asked the questions you needed answered and are satisfied to move forward.

NMR was a great help to me and I'll look forward to hearing your progress over time.

My thereapist started me out very slowly and made sure to reiterate often the importance of taking things slowly, doing my exercises in a controlled manner and not forcing the movements past the point of comfort and if I was tired or my face felt tight I was advised to skip it for that day, use heat to relax the face and try again the next day.

Good Luck and keep us posted.

Ruth Smiley

P.S. Thank you for the comment about my video, I was nervous but glad to do it in the end. As far as my recovery goes I am at a good place and I still feel those tugs, twitches and pulls and whatever they may mean is OK with me.
Have a great weekend  Smiley
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Ruth :-)
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