Psychological content and social effects involved in the sequelae stage of peripheral facial paralysis

AUTHORS: Mabile Francine Ferreira Silva, Paulo Roberto Lazarini, Marina Lang Fouquet, Maria Claudia Cunha

BACKGROUND: The peripheral facial paralysis (PFP) is due to a decrease or interruption of the axonal transportation of the seventh cranial nerve pair resulting into a

loss of facial movements (VALENÇA e cols., 1999; ADAMS, 1998). When the facial nerve regeneration is not complete, sequelae are identified, such as, post-paralytic hemifacial spasms, muscle contraction, reduced movement amplitude and/or synkinesis (FREITAS e GOFFI-GÓMEZ, 2008; VALENÇA e cols., 2001).

The PFP affects not only the esthetics and functioning of the face musculature, but also the interpersonal communication. Such condition reduce the individual expressiveness, causing a variety of psychological and social problems, such as depression, anxiety, rejection and isolation (FOUQUET, 2000; DIELS e COMBS, 1997).

PURPOSE: to describe the psychological contents and social effects associated with the PFP in adults experiencing the sequelae stage of the facial paralysis.

PROCEDURES: Open interviews with six female adults with age ranging from 43 to 72 years, with a time of PFP from 10 months to 312 months, the trigger question

was: “What have been the consequences of the peripheral facial paralysis in your social and emotional life?” The speech samples were recorded and literally transcribed. The transcription material was systematized according to the Bardin Content Analysis (2002) and was submitted to statistical analysis of psychological content and social effects occurrence. All individuals answered more than one category. This research was approved by the institution’s Ethical Committee.

RESULTS:

Results suggest that the Speech-language pathologist should not only perform esthetic and functioning rehabilitation of individuals with PFP sequelae, but also to pay attention to the psychological contents and social effects involved in these cases, in order to identify and help reducing psychological suffering and promoting social adaptation of these patients.

CONCLUSION The biopsychosocial approach of patients with PFP showed an ample and significant range of subjective contents that justify further studies that can contribute with the speech-language pathology intervention of such condition.

REFERENCES ADAMS, R. D. Neurologia. Rio de Janeiro: McGraw-Hill, 1998. BARDIN, L. Análise de conteúdo. São Paulo: Escuta, 2002. DIELS, H. J.; COMBS, D. Neuromuscular retraining for facial paralysis. Otolaryngol Clin North

Am, 1997; 30(5): 727-43. [Rewiew]. FOUQUET, M. L. Atuação fonoaudiológica nas paralisias faciais. In: Fonoaudiologia em

Cancerologia. BARROS, A. P. B.; ARAKAWA, L.; TONINI, M. D.; CARVALHO, V. A. – Fundação Oncocentro de São Paulo – Comitê de Fonoaudiologia em Cancerologia, 2000.

Pontifícia Universidade Católica de São Paulo Irmandade Santa Casa de Misericórdia de São Paulo São Paulo, SP – Brasil Cases Study

Table 1 – Descriptive Statistics for Age (years)

Minimum Average Maximum

43,11 56,9 72,11

Table 3 – Distribution of frequencies and percentages of the State Civil State Civil N %

Married 4 66,6 Widow 1 16,7

Divorced 1 16,7

Table 2 – Descriptive Stastiistcs for duration (months)

Minimum Average Maximum

10 77,3 312

Table 4 – Frequencies and percentages of psychological contents Occasion Contents N %

Prio

r to

the

PFP

ons

et Stress 5 83,3

Sadness due to factual reason 4 66,6 Resentment due to factual reason 2 33,3

At t

he

mom

ent o

f P

FP

man

ifest

atio

n Shock 6 100 Confused PFP with CVA 3 50

Despair 2 33,3

Afte

r the

PFP

ons

et

Sadness 6 100 Discouragement 5 83,3 Embarrassment 4 66,6

Repulsion to the facial condition 3 50 Ansiety 2 33,3

Irritability 1 16,7

Table 5 – Frequencies and percentages of social effects Subject/ environments established N %

Isol

atio

n Avoided leaving home 4 66,6 Tries to leave but can not 3 50 Avoided meeting people 5 83,3 Avoided talking to people 5 83,3

Ref

usal

s Refused to be taken pictures 3 50 Avoided taking part of meals 4 66,6 Refused to be going to parties 3 50

Had professional problems 1 16,7 Has difficulty with marital relationship 3 50

FREITAS, K. C. S. e GOFFI-GÓMEZ, M. V. Grau de percepção e incômodo quanto à condição facial em indivíduos com paralisia facial periférica na fase de sequelas. Revista da SBFa, v. 13; nº 2; p 113-8, 2008.

VALENÇA, M. M.; VALENÇA, L. P. A. A.; LIMA, M. C. M. Paralisia facial periférica idiopática de Bell: a propósito de 180 pacientes. Arq. Neuro-Psiquiatr.; v. 59; nº 3; 2001.

VALENÇA, M. M.; VALENÇA, L. P. A. A.; LIMA, M. C. M. Nervo facial: aspectos anatômicos e semiológicos. Neurobiol. 62: 77-84, 1999.