Background
Multi-disciplinary facial palsy clinics are considered best practice internationally for the management of peripheral facial palsy. There is increasing evidence that specialised facial physiotherapy improves facial function, quality of life and decreases synkinesis. Synkinesis is abnormal regrowth of the facial nerve leading to unwanted co-contractions of muscles during attempted movement.

Purpose
To establish New Zealand’s first multi-disciplinary clinic for facial palsy patients initially within the greater Wellington area and provide evidence-based facial therapy for patients living with facial palsy.

Methods
A three monthly facial palsy clinic with a Physiotherapist, Plastic and Craniofacial Surgeon and close contact with an Opthalmologist was established in August 2023. Referrals are accepted for patients with a peripheral facial palsy that has not resolved within four months of onset. An initial joint assessment covers eye care, functional problems, psychological impact, previous therapy and patient goals. Photos, video and outcome measures are recorded including the Sunnybrook Facial Grading System (FGS). Appropriate therapeutic management is started depending on the stage of recovery. This may include education, soft tissue mobilisation, taping and facial neuromuscular retraining. The team discusses chemical dennervation for synkinetic muscles or surgical intervention where appropriate.

Results
Seventeen referrals have been received. One patient declined treatment and two patients have only had initial assessments. The remaining 14 patients show an average improvement in FGS between initial assessment and first follow up (approximately one month) of 12 points. Thirteen out of 14 patients showed an improvement with one remaining the same. The mean time since onset of palsy was 21 months.

Conclusion
Early results show a positive impact in symmetry, function and synkinesis from access to specialised multi-disciplinary facial palsy care.

Implications
Facial palsy patients should have access to the benefits of specialist multi-disciplinary care in New Zealand. This could be delivered through tele-health to improve access.

Background: As many as 60-80% of people with Guillain-Barré Syndrome (GBS) report persistent fatigue which significantly limits everyday functioning despite motor recovery. In other neurological conditions, there is evidence regular physical activity can reduce fatigue and it is plausible this may also apply to people with GBS.

Purpose: We evaluated the effectiveness, feasibility and acceptability of an online physiotherapist led activity-focused coaching programme designed to decrease fatigue in people who had prior GBS.

Methods: We recruited eight people diagnosed with GBS more than two years previously with fatigue limiting daily activity. We used mixed methods with a single system design to evaluate the impact on fatigue, activity, wellbeing and confidence to exercise through repeated measures of the outcomes across three phases (baseline, intervention, follow-up). We used qualitative interviews to explore participants’ perspectives of the programme.

Results: The online activity-focused coaching programme was effective in reducing fatigue for most participants. Participants found the programme both feasible and acceptable. They perceived benefit from the online sessions, which were supplemented by reminders and other forms of feedback set up during the sessions. Participants liked the coaching style and found it useful to develop a personalised plan to manage fatigue through setting goals and making an action plan, reflecting on progress and trying out ways to keep themselves on track. Participants felt they learnt a lot about fatigue, themselves and strategies to manage fatigue, which included graduated physical activity.

Conclusions: Graduated physical activity is an important part of managing fatigue after GBS. A coaching approach helped participants develop skills to set goals and make a personalised plan to manage fatigue.

Implications: Physiotherapists are well positioned to guide physical activity to manage fatigue. The incorporation of coaching with physiotherapeutic knowledge can give clients skills and confidence to manage their condition.