Emotionale Auswirkungen einer Fazialisparese

Zusammenfassung

Die Fazialisparese ist nicht nur eine mimische Bewegungsstörung, sondern führt bei zahlreichen Patienten unter Umständen bereits im akuten Stadium, sehr häufig aber im chronischen Stadium zu einer emotionalen und kommunikativen Störung. In dieser Übersichtarbeit werden die derzeitigen Kenntnisse der psychologischen und neurobiologischen Grundlagen des Zusammenhangs zwischen Gesichtsmimik und Emotion und den Beziehungen zwischen einer gestörten Gesichtsmimik und emotionalen und kommunikativen Störung darstellt. Derzeit ist über die Folgen einer Fazialisparese auf die Emotionsfähigkeit und emotionale Kommunikationsfähigkeit nur wenig bekannt. Viele Patienten klagen nicht nur darüber, dass der Anblick ihres Gesichts bei anderen Personen negative Gefühle hervorruft, sondern auch darüber, dass andere Personen ihren inneren Gefühlszustand nicht mehr adäquat von ihrem Gesichtsausdruck abgelesen werden kann. Das alles führt bei den Patienten zu Stress, Angst und häufig zur Depression. Die Patienten vermeiden folglich soziale Kontakte, was diese Störungen verstärkt. Mit dem Facial Disability Index steht dem HNO-Arzt ein einfacher Fragebogen zur Verfügung um derartige Störungen zu entdecken. Standardisierte Therapiekonzepte, die auf eine Verbesserung des emotionalen Gesichtsausdrucks abzielen und solche Störungen behandeln, liegen bislang nur in rudimentärer Weise vor. Hier gibt die Arbeit ebenfalls einen Ausblick auf neue Behandlungsverfahren, die wir in unserem Jenaer Fazialis-Nerv-Zentrum zurzeit entwickeln und evaluieren.

Abstract

Emotional Impact of Facial Palsy

Facial palsy is not only a movement disorder but leads also to an emotional and communicative disorder in chronic stage but also in some patients already during the acute phase of the disease. The present review describes the current knowledge of the neurobiological and psychological fundamentals on the relation of facial movement and its emotional context. So far there is not much knowledge on the impact of a facial palsy on the interaction between facial movement, emotional processing and communicative skills of the patient. The emotional contagion seems to be reduced in patients with facial palsy. The ability to express emotions seems also to be reduced. Moreover, the patients feel to be perceived negatively. In fact, most of the expressions of patients with facial palsy are allocated with a negative affect even when the patients are smiling. Patients with facial palsy react with negative stress, anxiety and depression. The patients avoid social contacts. In turn, this reinforces the communicative disorder. The otorhinolaryngologist can use the Facial Disability Index as a simple questionnaire to detect such dysfunctions. Diagnostics that are necessary to develop a therapy program are presented in this review. Standardized therapy concepts that are not only treat the movement disorder but also the emotional context is missing so far. Finally, the review will give an outlook on potential therapy strategies.

Schlüsselwörter

Fazialisparese - Kommunikationsstörung - Depression - Gesichtsausdruck - Mimik - Emotion

Key words

facial palsy - communcative disorder - depression - facial expression - mimic - emotion

• Literatur

• 1 Finkensieper M, Volk GF, Guntinas-Lichius O. Erkrankungen des Nervus facialis. Laryngo-Rhino-Otol 2012; 91: 121-141 quiz 142
• 2 Melvin TA, Limb CJ. Overview of facial paralysis: current concepts. Facial Plast Surg 2008; 24: 155-163
• 3 Sardesai MG, Moe K. Recent progress in facial paralysis: advances and obstacles. Cur Opin Otolaryngol Head Neck Surg 2010; 18: 266-271
• 4 Lindsay RW, Robinson M, Hadlock TA. Comprehensive facial rehabilitation improves function in people with facial paralysis: a 5-year experience at the Massachusetts Eye and Ear Infirmary. Phys Ther 2010; 90: 391-397
• 5 Bruce V, Young A. Understanding face recognition. Br J Psychol 1986; 77 (Pt 3) 305-327
• 6 Haxby JV, Hoffman EA, Gobbini MI. The distributed human neural system for face perception. Trends Cogn Sci 2000; 4: 223-233
• 7 Darwin C. The Expression of the Emotions in Man and Animals. London: John Murray; 1872
• 8 James W. The Principles of Psychology. New York: Dover; 1890
• 9 Cannon WB. The James-Lange theory of emotions: a critical examination and an alternative theory. By Walter B. Cannon, 1927. Am J Psychol 1987; 100: 567-586
• 10 Ekman P. Facial expression and emotion. Am Psychol 1993; 48: 384-392
• 11 Aviezer H, Hassin RR, Ryan J, Grady C, Susskind J, Anderson A, Moscovitch M, Bentin S. Angry, disgusted, or afraid? Studies on the malleability of emotion perception. Psychol Sci 2008; 19: 724-732
• 12 Aviezer H, Bentin S, Dudarev V, Hassin RR. The automaticity of emotional face-context integration. Emotion 2011; 11: 1406-1414
• 13 Oatley K, Keltner D, Jenkins MJ. Understanding Emotion. Oxford: Blackwell Publishing; 2006
• 14 Byrne PJ. Importance of facial expression in facial nerve rehabilitation. Cur Opin Otolaryngol Head Neck Surg 2004; 12: 332-335
• 15 Wild B, Erb M, Bartels M. Are emotions contagious? Evoked emotions while viewing emotionally expressive faces: quality, quantity, time course and gender differences. Psychiatry Res 2001; 102: 109-124
• 16 Falkenberg I, Bartels M, Wild B. Keep smiling! Facial reactions to emotional stimuli and their relationship to emotional contagion in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2008; 258: 245-253
• 17 Schulte-Rüther M, Markowitsch HJ, Fink GR, Piefke M. Mirror neuron and theory of mind mechanisms involved in face-to-face interactions: a functional magnetic resonance imaging approach to empathy. J Cogn Neurosci 2007; 19: 1354-1372
• 18 Cattaneo L, Rizzolatti G. The mirror neuron system. Arch Neurol 2009; 66: 557-560
• 19 Keysers C, Gazzola V. Towards a unifying neural theory of social cognition. Prog Brain Res 2006; 156: 379-401
• 20 Bastiaansen JA, Thioux M, Keysers C. Evidence for mirror systems in emotions. Philosophical transactions of the Royal Society of London Series B. Biol Sci 2009; 364: 2391-2404
• 21 Gallese V. The roots of empathy: the shared manifold hypothesis and the neural basis of intersubjectivity. Psychopathology 2003; 36: 171-180
• 22 Hess U, Kappas A, McHugo GJ, Lanzetta JT, Kleck RE. The facilitative effect of facial expression on the self-generation of emotion. Int J Psychophysiol 1992; 12: 251-265
• 23 Mori K, Mori H. Examination of the passive facial feedback hypothesis using an implicit measure: with a furrowed brow, neutral objects with pleasant primes look less appealing. Percept Mot Skills 2010; 111: 785-789
• 24 Soussignan R. Duchenne smile, emotional experience, and autonomic reactivity: a test of the facial feedback hypothesis. Emotion 2002; 2: 52-74
• 25 Davis JI, Senghas A, Brandt F, Ochsner KN. The effects of BOTOX injections on emotional experience. Emotion 2010; 10: 433-440
• 26 Strack F, Martin LL, Stepper S. Inhibiting and facilitating conditions of the human smile: a nonobtrusive test of the facial feedback hypothesis. J Pers Soc Psychol 1988; 54: 768-777
• 27 Keillor JM, Barrett AM, Crucian GP, Kortenkamp S, Heilman KM. Emotional experience and perception in the absence of facial feedback. J Int Neuropsychol Soc 2002; 8: 130-135
• 28 Ekman P. Psychosocial aspects of facial paralysis. In: May M. Hrsg The Facial Nerve. New York: Thieme; 1986: 781-787
• 29 Twerski AJ, Twerski B. The emotional impact of facial palsy. In: May M. Hrsg The Facial Nerve. New York: Thieme; 1986: 788-794
• 30 Vanswearingen J. Facial rehabilitation: a neuromuscular reeducation, patient-centered approach. Facial Plast Surg 2008; 24: 250-259
• 31 Merkel KE, Schmidt KL, Levenstein RM, VanSwearingen JM, Bentley BC. Positive affect predicts improved lip movement in facial movement disorder. Otolaryngol Head Neck Surg 2007; 137: 100-104
• 32 Schmidt KL, VanSwearingen JM, Levenstein RM. Speed, amplitude, and asymmetry of lip movement in voluntary puckering and blowing expressions: implications for facial assessment. Motor Control 2005; 9: 270-280
• 33 Gilden DH. Clinical practice. Bell’s Palsy. N Engl J Med 2004; 351: 1323-1331
• 34 Kappos L, Mehling M. Images in clinical medicine. Dissociation of voluntary and emotional innervation after stroke. New Engl J Med 2010; 363: e25
• 35 Holstege G. Emotional innervation of facial musculature. Mov Disord 2002; 17 (Suppl. 02) S12-S16
• 36 Michel L, Derkinderen P, Laplaud D, Daumas-Duport B, Auffray-Calvier E, Lebouvier T. Emotional facial palsy following striato-capsular infarction. J Neurol Neurosurg Psychiatr 2008; 79: 193-194
• 37 Rubin LR. The anatomy of a smile: its importance in the treatment of facial paralysis. Plast Reconstr Surg 1974; 53: 384-387
• 38 Schumann NP, Bongers K, Guntinas-Lichius O, Scholle HC. Facial muscle activation patterns in healthy male humans: a multi-channel surface EMG study. J Neurosci Meth 2010; 187: 120-128
• 39 Sedda A, Manfredi V, Bottini G, Cristani M, Murino V. Automatic human interaction understanding: lessons from a multidisciplinary approach. Front Hum Neurosci 2012; 6: 57
• 40 Valente SM. Visual disfigurement and depression. Plast Surg Nurs 2004; 24: 140-146 quiz 147-148
• 41 Coulson SE, O’Dwyer NJ, Adams RD, Croxson GR. Expression of emotion and quality of life after facial nerve paralysis. Otol Neurotol 2004; 25: 1014-1019
• 42 Ishii LE, Godoy A, Encarnacion CO, Byrne PJ, Boahene KD, Ishii M. What faces reveal: impaired affect display in facial paralysis. Laryngoscope 2011; 121: 1138-1143
• 43 Sonnby-Borgstrom M, Jonsson P, Svensson O. Gender differences in facial imitation and verbally reported emotional contagion from spontaneous to emotionally regulated processing levels. Scand J Psychol 2008; 49: 111-122
• 44 Bradbury ET, Simons W, Sanders R. Psychological and social factors in reconstructive surgery for hemi-facial palsy. J Plast Reconstr Aesth Surg 2006; 59: 272-278
• 45 Godoy A, Ishii M, Byrne PJ, Boahene KD, Encarnacion CO, Ishii LE. How facial lesions impact attractiveness and perception: differential effects of size and location. Laryngoscope 2011; 121: 2542-2547
• 46 Ishii L, Godoy A, Encarnacion CO, Byrne PJ, Boahene KD, Ishii M. Not just another face in the crowd: society’s perceptions of facial paralysis. Laryngoscope 2012; 122: 533-538
• 47 MacGregor FC. Facial disfigurement: problems and management of social interaction and implications for mental health. Aesth Plast Surg 1990; 14: 249-257
• 48 VanSwearingen JM, Brach JS. Validation of a treatment-based classification system for individuals with facial neuromotor disorders. Phys Ther 1998; 78: 678-689
• 49 Robinson E, Rumsey N, Partridge J. An evaluation of the impact of social interaction skills training for facially disfigured people. Br J Plast Surg 1996; 49: 281-289
• 50 Brach JS, VanSwearingen J, Delitto A, Johnson PC. Impairment and disability in patients with facial neuromuscular dysfunction. Otolaryngol Head Neck Surg 1997; 117: 315-321
• 51 VanSwearingen JM, Cohn JF, Turnbull J et al. Psychological distress: linking impairment with disability in facial neuromotor disorders. Otolaryngol Head Neck Surg 1998; 118: 790-796
• 52 Fu L, Bundy C, Sadiq SA. Psychological distress in people with disfigurement from facial palsy. Eye (Lond) 2011;
• 53 VanSwearingen JM, Cohn JF, Bajaj-Luthra A. Specific impairment of smiling increases the severity of depressive symptoms in patients with facial neuromuscular disorders. Aesth Plast Surg 1999; 23: 416-423
• 54 VanSwearingen JM, Brach JS. The Facial Disability Index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system. Phys Ther 1996; 76: 1288-1298 Discussion 1298–1300
• 55 Kahn JB, Gliklich RE, Boyev KP, Stewart MG, Metson RB, Mckenna MJ. Validation of a patient-graded instrument for facial nerve paralysis: the FaCE scale. Laryngoscope 2001; 111: 387-398
• 56 Guntinas-Lichius O, Straesser A, Streppel M. Quality of life after facial nerve repair. Laryngoscope 2007; 117: 421-426
• 57 Henstrom DK, Lindsay RW, Cheney ML, Hadlock TA. Surgical treatment of the periocular complex and improvement of quality of life in patients with facial paralysis. Arch Facial Plast Surg 2011; 13: 125-128
• 58 Salles AG, Toledo PN, Ferreira MC. Botulinum toxin injection in long-standing facial paralysis patients: improvement of facial symmetry observed up to 6 months. Aesth Plast Surg 2009; 33: 582-590
• 59 Beurskens CH, Heymans PG. Physiotherapy in patients with facial nerve paresis: description of outcomes. Am J Otolaryngol 2004; 25: 394-400
• 60 Pereira L, Obara K, Dias JM, Menacho MO, Lavado EL, Cardoso JR. Facial exercise therapy for facial palsy: systematic review and meta-analysis. Clin Rehabil 2011; 25: 649-658
• 61 Ekman P, Friesen W. Pictures of facial affect. Palo Alto: Consulting Psychologists Press; 1976
• 62 Diehl-Schmid J, Pohl C, Ruprecht C, Wagenpfeil S, Foerstl H, Kurz A. The Ekman 60 Faces Test as a diagnostic instrument in frontotemporal dementia. Arch Clin Neuropsychol 2007; 22: 459-464
• 63 Kennedy KM, Hope K, Raz N. Life span adult faces: norms for age, familiarity, memorability, mood, and picture quality. Exp Aging Res 2009; 35: 268-275
• 64 Ebner NC, Riediger M, Lindenberger U. FACES – a database of facial expressions in young, middle-aged, and older women and men: development and validation. Behav Res Meth 2010; 42: 351-362
• 65 Kaulard K, Cunningham DW, Bülthoff HH, Wallraven C. The MPI facial expression database – a validated database of emotional and conversational facial expressions. PloS one 2012; 7: e32321
• 66 Lang PJ. Behavioral treatment and biobehavioral assessment: computer applications. In: Sidowski B, Johnson JH, Williams TA. Hrsg Technology in mental health care delivery systems. Norwood: Ablex; 1980
• 67 Kühner C, Bürger C, Keller F, Hautzinger M. Reliability and validity of the Revised Beck Depression Inventory (BDI-II). Results from German samples. Nervenarzt 2007; 78: 651-656
• 68 Beurskens CH, Heymans PG. Mime therapy improves facial symmetry in people with long-term facial nerve paresis: a randomised controlled trial. Aust J Physiother 2006; 52: 177-183
• 69 Salas CE, Radovic D, Turnbull OH. Inside-out: comparing internally generated and externally generated basic emotions. Emotion 2012; 12: 568-578
• 70 Miltner WH, Bauder H, Sommer M, Dettmers C, Taub E. Effects of constraint-induced movement therapy on patients with chronic motor deficits after stroke: a replication. Stroke 1999; 30: 586-592
• 71 Morris DM, Taub E. Constraint-induced movement therapy. In: O’Sullivan SB, Schmitz TJ. Hrsg Improving Functional Outcome in Physical Rehabilitation. Philadelphia: F.A. Davis; 2012
• 72 Brown DM, Nahai F, Wolf S, Basmajian JV. Electromyographic biofeedback in the reeducation of facial palsy. Am J Phys Med 1978; 57: 183-190
• 73 Rodner F, Hegazy D, Denzler J.. Multiple Kernel Gaussian Process Classification for Generic 3D Object Recognition From Time-of-Flight Images. Proc Intl Conf Image Vision Computing 2010;
• 74 Haase D, Denzler J. Anatomical Landmark Tracking for the Analysis of Animal Locomotion in X-ray Videos Using Active Appearance Models. Proc Scand Conf Image Analysis 2011; 604-615
• 75 Skouras E, Popratiloff A, Guntinas-Lichius O, Streppel M, Rehm KE, Neiss WF, Angelov DN. Altered sensory input improves the accuracy of muscle reinnervation. Restor Neurol Neurosci 2002; 20: 1-14
• 76 Angelov DN, Ceynowa M, Guntinas-Lichius O, Streppel M, Grosheva M, Kiryakova SI, Skouras E, Maegele M, Irintchev A, Neiss WF, Sinis N, Alvanou A, Dunlop SA. Mechanical stimulation of paralyzed vibrissal muscles following facial nerve injury in adult rat promotes full recovery of whisking. Neurobiol Dis 2007; 26: 229-242