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Kim JH, Fisher LM, Reder L, Hapner ER, Pepper J. Speech and Communicative Participation in Patients With Facial Paralysis. JAMA Otolaryngol Head Neck Surg. 2018;144(8):686–693. doi:https://doi.org/10.1001/jamaoto.2018.0649
What is the influence of facial paresis or paralysis on speech and communicative participation?
In this nationwide online survey of patients with unilateral facial paresis or paralysis, respondents reported restrictions in communicative participation that were comparable with restrictions experienced by patients with known causes of communication disorders, such as laryngectomy and head and neck cancers.
Impaired communicative participation may represent a unique domain of dysfunction in facial paralysis; measurement of communicative participation can help quantify the influence of facial paralysis on daily living as well as provide an additional frame of reference when setting goals of care and assessing outcomes of treatment.
Problems with speech in patients with facial paralysis are frequently noted by both clinicians and the patients themselves, but limited research exists describing how facial paralysis affects verbal communication.
To assess the influence of facial paralysis on communicative participation.
Design, Setting, and Participants
A nationwide online survey of 160 adults with unilateral facial paralysis was conducted from March 1 to June 1, 2017. To assess communicative participation, respondents completed the Communicative Participation Item Bank (CPIB) Short Form questionnaire and the Facial Clinimetric Evaluation (FaCE) Scale.
Main Outcomes and Measures
The CPIB Short Form and the correlation between the CPIB Short Form and FaCE Scale. In the CPIB, the level of interference in communication is rated on a 4-point Likert scale (where not at all = 3, a little = 2, quite a bit = 1, and very much = 0). Total scores for the 10 items range from 0 (worst) to 30 (best). The FaCE Scale is a 15-item instrument that produces an overall score ranging from 0 (worst) to 100 (best), with higher scores representing better function and higher quality of life.
Of the 160 respondents, 145 (90.6%) were women and 15 were men (mean [SD] age, 45.1 [12.6] years). Most respondents reported having facial paralysis for more than 3 years. Causes of facial paralysis included Bell palsy (86 [53.8%]), tumor (41 [25.6%]), and other causes (33 [20.6%]), including infection, trauma, congenital defects, and surgical complications. The mean (SD) score on the CPIB Short Form was 0.16 (0.88) logits (range, –2.58 to 2.10 logits). The mean (SD) score of the FaCE Scale was 40.92 (16.05) (range, 0-83.3). Significant correlations were observed between the CPIB Short Form and overall FaCE Scale scores, as well as the Social Function, Oral Function, Facial Comfort, and Eye Comfort subdomains of the FaCE Scale, but not with the Facial Movement subdomain.
Conclusions and Relevance
Patients with facial paralysis in this study sample reported restrictions in communicative participation that were comparable with restrictions experienced by patients with other known communicative disorders, such as laryngectomy and head and neck cancer. We believe that communicative participation represents a unique domain of dysfunction and can help quantify the outcome of facial paralysis and provide an additional frame of reference when assessing treatment outcomes.
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