A Study on the Correlation between Surface Electromyography and Assessment Scale for Facial Palsy

Article information

J Korean Acupunct Moxib Soc. 2013;30(5):107-116
Publication date (electronic) : 2013 December 20
doi : https://doi.org/10.13045/acupunct.2013050
1Department of Acupuncture & Moxibustion Medicine, Korean Medicine Hospital of Woosuk University
2Department of Neuropsychiatry, Korean Medicine Hospital of Woosuk University

This study was supported by academic research grant of Woosuk University in 2013

*Corresponding author : Department of Neuropsychiatry, Korean Medicine Hospital of Woosuk University, 46, Eoeun-ro, Wansan-gu, Jeonju-si, Jeollabuk-do, 560-833, Republic of Korea, Tel : +82-63-220-8617 E-mail : kimlak@hanmail.net
Received 2013 November 02; Revised 2013 November 29; Accepted 2013 December 02.

Abstract

Objectives:

The purpose of this study is to investigate the correlation between surface electromyography(SEMG) and assessment scales for facial palsy.

Methods:

The subjects for this study were 21 patients who had peripheral facial nerve palsy. We analyzed about the correlation between the results of SEMG and facial nerve assessment scales that were carried out at the same time. The assessment scales used in this study were House-Brackmann scale, Yanagihara grading system, Sunnybrook facial grading system.

Results:

There are considerable correlation between the results of SEMG and the results of three kinds of assessment scales for facial nerve palsy.

Conclusions:

SEMG may be an objective examination for facial nerve palsy. Some research aimed at development of SEMG examination guideline for facial nerve palsy will be needed after this. And we expect that many researches for development of diagnostic equipments or treatment equipments that utilize SEMG will proceed.

Fig. 1.

The picture shows position of the surface EMG electrode

Fig. 2.

Correlations between SEMG assessment and clinical scales in facial palsy patients

There is very high correlations between Yanagihara grading system, Sunnybrook facial grading system and SEMG assessment index(Yanagihara scale: r=.795 p<.001, Sunnybrook facial grading system: r=.904 p<.001), SEMG is the percentage(RMS of paralyzed side / RMS normal side).

House-Brackmann Scale

Yanagihara Grading System

Sunnybrook Facial Grading System

General Characteristics and SEMG Assessment and Clinical Assessment Scores

Correlations between SEMG Assessment Score of Frontalis, Zygomaticus and Oris

Correlations between Clinical Assessment Scales

Correlations between SEMG Assessment and Clinical Assessment Scales

References

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Article information Continued

Fig. 1.

The picture shows position of the surface EMG electrode

Fig. 2.

Correlations between SEMG assessment and clinical scales in facial palsy patients

There is very high correlations between Yanagihara grading system, Sunnybrook facial grading system and SEMG assessment index(Yanagihara scale: r=.795 p<.001, Sunnybrook facial grading system: r=.904 p<.001), SEMG is the percentage(RMS of paralyzed side / RMS normal side).

Table 1.

House-Brackmann Scale

Grade Description Characteristics
I Normal Normal facial function in all areas
II Mild dysfunction Slight weakness noticeable on close inspection; may have very slight synkinesis
III Moderate dysfunction Obvious, but not disfiguring, difference between 2 sides; noticeable, but not severe, synkinesis, contracture, or hemifacial spasm; complete eye closure with effort
IV Moderately severe dysfunction Obvious weakness or disfiguring asymmetry; normal symmetry and tone at rest; incomplete eye closure
V Severe dysfunction Only barely perceptible motion; asymmetry at rest
VI Total paralysis No movement

Table 2.

Yanagihara Grading System

Scale of 5 rating no motility - moderate - normal
Y 1 At rest 0 - 1 - 2 - 3 - 4
Y 2 Wrinkle forehead 0 - 1 - 2 - 3 - 4
Y 3 Blink 0 - 1 - 2 - 3 - 4
Y 4 Closure of eye lightly 0 - 1 - 2 - 3 - 4
Y 5 Closure of eye tightly 0 - 1 - 2 - 3 - 4
Y 6 Closure of eye on involved side only 0 - 1 - 2 - 3 - 4
Y 7 Wrinkle nose 0 - 1 - 2 - 3 - 4
Y 8 Whistle 0 - 1 - 2 - 3 - 4
Y 9 Grin 0 - 1 - 2 - 3 - 4
Y 10 Depress lower lip 0 - 1 - 2 - 3 - 4

5 point system : 4-normal, 3-slight paralysis, 2-moderate, 1-severe, 0-total

Table 3.

Sunnybrook Facial Grading System

Resting symmetry (compared to normal side) Symmetry of voluntary movement (degree of muscle excursion compared to normal side) Synkinesis (rate the degree of involuntary muscle contraction associated with each expression)

No movement Slight movement Mild excursion Movement almost complete Movement complete None Mild Moderate Severe


1. Eye Normal 0 Gross asymmetry Severe asymmetry Moderate asymmetry Mild asymmetry Normal asymmetry No synkinesis Slight synkinesis Obvious synkinesis Disfiguring synkinesis

Narrow 1

Wide 1 Brow lift 1 2 3 4 5 0 1 2 3

Eyelid surgery 1

2. Cheek (Naso-la bial fold) Normal 0 Gentle eye closure 1 2 3 4 5 0 1 2 3

Absent 2

Less pronounced 1 Open mouth smile 1 2 3 4 5 0 1 2 3

More pronounced 1

3. Mouth Normal 0 Snarl 1 2 3 4 5 0 1 2 3

Corner drooped 1 Lip pucker 1 2 3 4 5 0 1 2 3

Corner pulled up/out 1

Resting symmetry score : Voluntary movement score : Synkinesis score :

(voluntary movement score×4) - (resting symmetry score×5) - (synkinesis score) = composite score

Table 4.

General Characteristics and SEMG Assessment and Clinical Assessment Scores

Min Max Mean SD
Sex Male 11(52.38%)
Female 10(47.62%)
Age 20 62 42.24 11.278
Elapsed time 2 80 19.00 19.583
SEMG Frontalis (p<0.001) Paralyzed side* 5 127 41.95 36.841
Normal side* 29 266 122.57 70.135
Paralyzed side / normal side(%) 5.35 81.48 34.87 20.61
Zygomaticus (p=0.001) Paralyzed side* 4 90 30.19 23.06
Normal side* 21 473 119.71 110.49
Paralyzed side / normal side(%) 4.86 138.10 36.15 30.38
Oris (p<0.001) Paralyzed side* 14 135 57.95 29.37
Normal side* 36 348 164.62 72.36
Paralyzed side / normal side(%) 17.27 84.55 37.00 15.44
Total Paralyzed side / normal side(%) 16.23 84.11 33.50 16.98
House-Brackmann scale 2 5 3.67 .856
Yanagihara grading system Y1 1 4 2.14 .793
Y2 0 3 1.62 1.024
Y3 1 4 1.95 .805
Y4 1 4 2.05 .973
Y5 1 4 1.86 .793
Y6 0 4 1.52 .873
Y7 0 3 1.33 .796
Y8 0 3 .57 .746
Y9 0 4 1.67 .856
Y10 1 3 1.57 .676
Total 7 36 16.29 6.230
Sunnybrook facial grading system 13 83 40.00 16.230

Elapsed time : days between onset and SEMG assessment.

* :

RMS score.

RMS of paralyzed side / RMS normal side(%).

Y1 ∼ Y10 and Total : Yanagihara grading system score.

‡ :

paired t-test between paralyzed side RMS and normal side RMS.

Table 5.

Correlations between SEMG Assessment Score of Frontalis, Zygomaticus and Oris

Frontal(%)* Zygomaticus(%)* Oris(%)* Total(%)*
Elapsed time r .131 .128 .298 .238
p .570 .581 .190 .300
Frontal(%)* r .569 .468 .758
p .007 .032 .000
Zygomaticus(%)* r .654 .856
p .001 .000
Oris(%)* r .837
p .000

Elapsed time : days between onset and SEMG assessment.

*: RMS of paralyzed side / RMS normal side(%).

r : Pearson correlation coefficient. p : p-value.

Table 6.

Correlations between Clinical Assessment Scales

H-G Yanagihara scale SFGS
Y 1 Y 2 Y 3 Y 4 Y 5 Y 6 Y 7 Y 8 Y 9 Y 10 Total
Elapsed time r .110 .225 .117 .146 −.052 .055 .047 .132 .380 .030 .291 .170 .208
p .634 .326 .613 .528 .821 .814 .840 .570 .090 .898 .201 .461 .365
H-G r −.736 −.666 −.532 −.580 −.663 −.557 −.562 −.391 −.705 −.518 −.797 −.727
p .000 .001 .013 .006 .001 .009 .008 .080 .000 .016 .000 .000
Y 1 r .563 .403 .379 .591 .392 .475 .362 .589 .493 .700 .727
p .008 .070 .090 .005 .079 .029 .107 .005 .023 .000 .000
Y 2 r .523 .621 .607 .514 .593 .234 .532 .330 .763 .644
p .015 .003 .003 .017 .005 .308 .013 .144 .000 .002
Y 3 r .705 .694 .749 .651 .464 .556 .236 .811 .459
p .000 .000 .000 .001 .034 .009 .302 .000 .036
Y 4 r .592 .616 .559 .305 .560 .184 .764 .475
p .005 .003 .008 .179 .008 .423 .000 .030
Y 5 r .764 .555 .398 .736 .440 .859 .595
p .000 .009 .074 .000 .046 .000 .004
Y 6 r .528 .439 .513 .230 .780 .519
p .014 .047 .017 .316 .000 .016
Y 7 r .337 .758 .558 .807 .794
p .136 .000 .009 .000 .000
Y 8 r .313 .410 .554 .487
p .167 .065 .009 .025
Y 9 r .518 .815 .799
p .016 .000 .000
Y 10 r .565 .597
p .008 .004
Total r .814
p .000

Elapsed time : days between onset and SEMG assessment. H-G : House-Brackmann scale.

Y1 ∼ Y10 and total : Yanagihara grading system. SFGS : Sunnybrook facial grading system.

r : Pearson correlation coefficient. p : p-value.

Dark gray background block : p<0.05.

Table 7.

Correlations between SEMG Assessment and Clinical Assessment Scales

H-G Yanagihara scale SFGS
Y 1 Y 2 Y 3 Y 4 Y 5 Y 6 Y 7 Y 8 Y 9 Y 10 Total
Elapsed time r .110 .225 .117 .146 −.052 .055 .047 .132 .380 .030 .291 .170 .208
p .634 .326 .613 .528 .821 .814 .840 .570 .090 .898 .201 .461 .365
Frontalis(%)* r −.592 .708 .562 .328 .150 .448 .302 .469 .322 .507 .313 .550 .614
p .005 .000 .008 .147 .517 .042 .183 .032 .155 .019 .167 .010 .003
Zygomaticus(%)* r −.693 .671 .645 .618 .606 .683 .636 .787 .477 .845 .592 .880 .820
p .001 .001 .002 .003 .004 .001 .002 .000 .029 .000 .005 .000 .000
Oris(%)* r −.384 .535 .321 .245 .144 .512 .408 .329 .485 .578 .508 .532 .692
p .085 .013 .156 .285 .534 .018 .066 .146 .026 .006 .019 .013 .001
Total(%)* r −.688 .796 .633 .485 .401 .644 .497 .672 .502 .763 .569 .795 .904
p .001 .000 .002 .026 .072 .002 .022 .001 .020 .000 .007 .000 .000

Elapsed time : days between onset and SEMG assessment.

*

RMS of paralyzed side / RMS normal side(%).

H-G : House-Brackmann scale. Y 1 ∼ Y 10 and total : Yanagihara grading system score.

SFGS : Sunnybrook facial grading system. r : Pearson correlation coefficient. p : p-value.

Dark gray background block : p<0.05.