Brudny J, Hammerschlag P E, Cohen N L, Ransohoff J
Department of Rehabilitation Medicine, New York University School of Medicine, NY 10016.
Laryngoscope. 1988 Apr;98(4):405-10. doi: 10.1288/00005537-198804000-00010.
For reinnervation of facial paralysis, the XII-VII nerve anastomosis provides tone and mass contraction but rarely allows selective muscle control. The efficacy of EMG rehabilitation was evaluated in 30 patients who had no coordinated control of facial muscles. EMG signals from bilateral homologous facial muscle sites were converted into computer-compatible waveform traces and displayed on a video monitor. This facilitated modification of neuromuscular responses using behavioral shaping techniques. A six-point Facial Nerve Grading Scale was introduced for hypoglossal-facial nerve anastomosis to assess the results of EMG rehabilitation. Rehabilitation lasted from 3 to 18 months. Ten patients (33%) achieved the highest possible grading (II) with symmetry and synchrony of function and spontaneity of expression; 17 (57%) reached grade III, which allowed voluntary control of eye and mouth function; 3 (10%) showed minimal gains. It is suggested that neural plasticity allows therapeutic manipulation of central facilitory and inhibitory mechanisms, and possible unmasking of neural connections between the ipsilateral VII and XII nerve motor nuclei which leads to improved facial function.
对于面瘫的神经再支配，舌下神经-面神经吻合术可提供肌张力和整体收缩，但很少能实现选择性肌肉控制。对30例面部肌肉无协调控制的患者评估了肌电图康复的疗效。来自双侧同源面部肌肉部位的肌电信号被转换为计算机兼容的波形轨迹，并显示在视频监视器上。这有助于使用行为塑造技术来改变神经肌肉反应。引入了一个六点面神经分级量表来评估舌下神经-面神经吻合术的结果，以评估肌电图康复的效果。康复持续3至18个月。10例患者（33%）达到了可能的最高分级（II级），功能对称、同步且表情自然；17例（57%）达到III级，可自主控制眼和口的功能；3例（10%）改善甚微。提示神经可塑性允许对中枢促进和抑制机制进行治疗性操作，并可能揭示同侧VII和XII神经运动核之间的神经连接，从而改善面部功能。
