The Paretic stage

The Paretic stage refers to the point in time when a person will notice the following:

  • Improved facial symmetry at rest (people may comment that you are looking better)
  • Facial muscles will start to feel firmer and gradually become more defined
  • Small flickers of movement appear, for example, the corner of the mouth may begin to lift when you smile, or your blink may start to feel better
  • You may find that eating, drinking and speech are a little easier as the muscles change from being floppy and loose to regaining their tension

It is really good news when these signs appear and very encouraging.  Try not to get over-enthusiastic by trying to make muscles move that are just recovering.  Muscles which are regaining their tone/tension in the paretic stage will be:

  • Weak
  • Easily fatigued
  • Unable to move normally as the nerve is unable to power or fuel normal movement

The unaffected side of the face may become:

  • Dominant.  This means it starts doing all the work.  In response, the brain will start to neglect the recovering side and pander to the unaffected side.  This will make it harder for normal movement patterns to develop on the affected side of the face because the brain has begun to ignore it.

The most important things to remember at this stage:

  • Allow recovery to develop without feeling that you have to start forcing your face to move
  • Using too much effort to make muscles move will encourage abnormal movement patterns to develop.
  • Everything you do must be very gentle and low in effort.  If squeezing your eyes tightly shut is equivalent to a very high effort level, for example, 10/10.  Try and make all effort levels around 2 – 3/10.
  • The nerve will recover if it can and your job is to make sure that you just allow nature to take its course and be very gentle with any practice.
  • All movement exercises should be slow, gentle, symmetrical using very low effort.

Signs during slower recovery

  • Small involuntary movements may develop. These are a sign that the nerve is recovering and it is normal and unavoidable, but it is vitally important to minimise its development.
  • If you notice any small synkinetic movements lots of care and gentle practice at this point is vitally important to minimise the amount of synkinetic movement you develop.
  • If you do not take care at this early synkinetic stage, you may find that you do not progress but the synkinesis actually gets worse and can have a negative impact on your muscle health.

Read more

The stages of facial palsy

Week 2-3

Week 4-6