Loss of Facial Expression/ Masked Face

Generally, we communicate not only through words but through subtle, fast-moving changes in facial expression. It’s easy for most of us to understand why having an expressionless face could be traumatic. A person who isn’t able to convey these emotions facially would be at a loss since others may discount or misinterpret words when the expressions don’t match up.

Masked face (also known as hypomimia) is the loss of facial expressions commonly associated with Parkinson’s disease. As such, we tend to use the term hypomimia to describe facial masking within the context of Parkinson’s. It suggests the actual loss of motor control rather a physical manifestation of emotional blunting.  Hypomimia can affect both voluntary facial movements (such as a smile) and involuntary ones (such as occurs when a person is startled).

In Parkinson’s, masking can develop as the progressive loss of motor control extends to the facial muscles as it does to other parts of the body. Dopamine is the neurotransmitter (chemical messenger) that transmits the signal from the brain to the muscles to produce movement. When PD damages the nerve cells that produce dopamine, the motor symptoms and ability to control muscles are affected. Certain medications can significantly blunt a person’s emotional response.

Masked face can complicate an already difficult situation, alienating acquaintances who may be put off or disturbed by the apparent lack of emotional response. When PD affects the facial muscles, causing a mask-like expression, many of the nonverbal cues are not present, which may lead to challenges communicating with others and negatively impact relationships. The relationships most often affected are those with family and friends.

Facial expression matters. Research has shown that quality of life is better in people with Parkinson’s who have undergone regular facial exercise and therapy to improve facial control than those who have not. It is not a secret that people with Parkinson’s usually develop reduced facial tone and movements of facial expressions. While not everyone will experience masking with their Parkinson’s, those who do may realise that they are blinking often and their stares are blank. Weakness in facial muscles may also cause motor problems like difficulty in swallowing and drooling of saliva.

There are facial exercises which, when practiced regularly, can help better control these symptoms. It’s best to perform these facial exercises in front of a mirror. Because a person with Parkinson’s can’t always accurately feel how big or exaggerate a movement they are making, using a mirror helps them to see the movement for themselves. 

These simple exercises include:

1. Smiling

By holding a broad smile on your face, this exercise works on your Zygomaticusmuscles at the side of your face, helping you express positive emotions better. Try doing this 20 times a day, holding the smile for 5 seconds each time. You can adjust the number of repetitions to your capabilities; it is important to ensure that you are not overdoing it and over-tiring your face.

2. The closing of eyes

The orbicularis oculi muscle is one of the two major components that form the core of the eyelid, the other being the tarsal plate. The orbicularis oculi muscle is composed of skeletal muscle fibres and receives nerves from the facial nerve. It is an important muscle in facial expression. Make your Orbicularis Oculi muscles work by shutting your eyes as tightly as possible. Do this 20 times a day for 1-2 seconds each time. By practicing and using these muscles in thes eyes, you can help keep masking at bay.

3. Raising of eyebrows

The occipitofrontalis muscle (epicranius muscle) is a muscle which covers parts of the skull. It consists of two parts or bellies: The occipital belly, near the occipital bone, and the frontal belly, near the frontal bone. The occipitofrontalis muscle is innervated by the facial nerve.

Raise your eyebrows and make creases on your forehead to perform this exercise. It works on your Occipitofrontalis Muscles to promote good blood supply from several arteries. Repeat at least 10 times.

4. Flaring of nostrils

Dilate your nose and push it upwards, relax your face in between attempts. Repeat this process 10 times to stretch your Nasalis muscles.  

5. Tongue movements in mouth

Open your mouth and move your tongue within the mouth around the teeth. This exercise can help you manipulate food with the tongue and detect remains that are stuck in the cheeks after swallowing.

6. Lips pouting

This exercise works on the Orbicularis Oris muscles and helps you maintain facial harmony. Protrude your lips and hold the position. Retain the position as you count until 5. Repeat 10 times.

7. Jaw dropping

Jaw dropping strengthens Pterygoids muscles that help in chewing. To perform the exercise, drop your jaw to open your mouth and make a small “O” with your lips. Keep repeating small “O” or big “O” as per your competency. It’s recommended to repeat it for 10 times.

Choir singing or voice amplification have been proven in helping to control specific facial muscle more effectively in Parkinson’s.

The Lee Silverman voice treatment (LSVT) technique is also used by some to help people with Parkinson’s speak louder and clearer. It employs articulation exercises that are similar to stage acting techniques in which a person is taught to projects and enact “speaking behaviour“.

Parkinson’s Care and Support UK provide free speech and sound therapy, which can be very useful for strengthening the various facial muscles.