The Neuro-Proprioceptive facial Rehabilitation (NPR) method addresses aesthetic issues that arise from complications of long-standing Bell’s palsy. It was created by Crystal Touch Clinic’s co-founder, Elena Pashova. The NPR method was presented in 2014 at the World Congress for NeuroRehabilitation in Istanbul. It is based on 25 years of experience and 8 years of scientific research, and can successfully reduce, and in certain cases even reverse, most of the complications of long-standing Bell’s palsy. We address synkinesis, contractures of facial muscles, related facial pains, excessive tearing and dynamic facial asymmetry.
Application of the Neuro-Proprioceptive facial Rehabilitation method for the treatment of patients with long-standing Bell’s palsy produces a measurable and lasting reduction of Bell’s palsy sequelae and improves the quality of life, irrespective of patient’s age, sex or time that had passed since the onset.
About the NPR method
What the Neuro-Proprioceptive Rehabilitation method achieves
The NPR method improves the quality and symmetry of facial movements, general facial appearance and optimizes the functioning of facial muscles. Besides working on physical improvements, the method also addresses psychological recovery from experiencing life changes that long-term recovery and residuals may cause. The systematic application of this method substantially improves the quality of life of our patients.
The entire Neuro-Proprioceptive Rehabilitation method for Bell’s palsy is aimed at:
- Neuronal regeneration of the facial nerve
- Restoration of the symmetry of brain signals to both sides of the face
- Developing skills of conscious relaxation of the facial muscles
- Training of a finely differentiated control of facial muscles, which is essential for overcoming synkinesis
- Forming the correct coordination patterns of facial muscles in order to restore the symmetry of the facial movements
- Restoration of normal symmetrical tone of facial muscles
How does it work?
The Neuro-Proprioceptive Rehabilitation consists of regular working sessions in the clinic every 4-5 weeks and the patient’s own daily work at home in between. For our overseas patients, we compose specially structured programs that allow increasing the interval between regular visits to the clinic to 10-12 weeks. Special NPR techniques that the patients use at home, they learn gradually during the working sessions. Each NPR working session takes 1,5 hours and includes several modules, one of which is the treatment using a working apparatus. The treatment is painless and feels comfortable. Other modules of the working session are carried out without the use of special equipment.
Crystal Touch NPR treatment stimulates several aspects:
- regeneration of facial nerve fibres
- normalization of facial muscles’ tonus on the affected side
- symmetrization of the tonic signals from the brain to both sides of the face
- a proper balance between relaxation and contraction of muscle fibres on the affected side of the face
- blood and lymph circulation in the face tissues
- improves the sense of facial proprioception
Based on our experience, some improvements the patient can already feel and observe after the first working session. As we move through the program and learn new rehabilitation techniques for self-application, the improvements become more visible and lasting.
Does NPR method help to reduce synkinesis?
Crystal Touch NPR method approaches pathological synkinesis as manifestations of pathological facial movement patterns that the patient gradually develops during the first 4-9 months after the onset. We have written an extensive article on what is synkinesis, as well as presented our point of view of synkinesis at several NeuroRehabiliation congresses around the world.
In short, we see synkinesis as a conditioned reflex, that develops during the long Bell’s palsy recovery. As a conditioned reflex, it can be reversed using negative feedback. During our working sessions and at home, our patients learn and apply the techniques of negative feedback to reduce the manifestations of their synkinesis.
Does NPR method reduce facial contractures?
The method addresses the root causes of contractures. Its application helps to normalize the brain signal levels for facial muscles’ tone, “teaches” the contractured facial muscles to relax, and facilitates neuronal regeneration of the facial nerve. As a result, the contractures and pains are gradually reduced, eventually eliminated, and the face becomes more symmetrical.
Do you use Botox or other injections in NPR method?
- We do not use any injections of botulinum toxin (botox), hyaluronic acid nor any other fillers or neurotoxins.
- We do not use any tools from the arsenal of plastic surgery. Face-lifting, thread, implants, etc. are not used in NPR method.
- We do not use electromyostimulation that includes electric shocks, currents of high intensity and painful treatments.
Is the positive result guaranteed after the completion of the program? Does one need any "support" sessions?
All our Bell’s palsy and congenital facial palsy patients who followed the Crystal Touch NPR program have achieved significant improvements. By the end of the rehabilitation program, they had learned how to maintain the achieved results on their own.
Basically, after the completion of the program, there is no need for repeated courses. Some of our patients, however, prefer to follow the “maintenance” sessions once or twice per year.
What can and cannot be expected from the application of the NNPR method?
100% recovery “as it used to be” can hardly be expected. In theory, this is possible, but to achieve these results, the duration of the rehabilitation program will be excessively long (up to a year, sometimes more).
One can expect the following improvements from the application of the NPR method:
- decreased or resolved contractures on the affected side
- symmetrization of the facial movements to the aesthetically acceptable level
- reduction in manifestation degree of synkinesis to the aesthetically acceptable level
- significant reduction or elimination of pains on the affected side of the face (if applicable)
- overall improvements in the appearance, skin color, face contour and facial expression
You can contact us if you have any questions about the method and if it can help you in your specific case.
Please note: The Neuro-Proprioceptive Rehabilitation method is only used to work with complications and residuals. It does not address the acute stage of Bell’s palsy. If you are in the acute stage, watch our video with recommended steps to follow. You can also register for a video consultation with our specialists if you need more guidance and answers to your questions.
Measuring the efficiency of NPR
At Crystal Touch Clinic we measure objectively the progress of facial nerve recovery and the level of synkinesis. We do these measurements before we start any rehabilitation program with each of our patients. We use these measurements to set up the rehabilitation program, tailored specifically to the patient’s recovery needs, as well as to measure the progress between the working sessions or at the end of the recovery.
Measuring the progress of facial nerve recovery
We measure the level of facial nerve recovery with the Nerve Conduction Study. It measures the ability of its various branches to conduct the signals from the brain to the facial muscles. By analyzing the response of the facial muscles to electrical stimuli, we can objectively measure to what extent each branch of the facial nerve has regenerated. This enables us to “see” the functionality level of the facial nerve. In turn, these results let us understand what we need to do during the rehabilitation to help improve the patient’s condition.
Measuring the level of synkinesis
Synkinetic Correlation Test helps us to measure the difference in mimetic patterns of the facial muscles that are involved in synkinetic movements on the affected side
versus the normal movements of a healthy side. While some subjective methods of measuring synkinesis exist, at Crystal Touch we have developed an objective quantitative instrumental measurement protocol to evaluate the intensity of synkinesis.
You can learn more about these two measurement techniques in our article “What we can measure, we can manage!”.