Posted by: dlip | August 17, 2011

Massage & Exercise for the face

Who’d have thought that what works for a luxurious facial also works for the muscles on a stroke victim’s face!  However, when you think about it, it seems obvious. And it wasn’t until I actually saw the way the muscles on the face are laid out, that I made the connection.

Study the attached diagram, and you’ll see that it’s almost as if Nature had laid out the blueprint for the flow direction of the massage.

To get started, first sit comfortably at the patient’s head with the top of the head resting on a towel facing your chest and the body away from you. If that sort of a massage bed is not available then sit on the bed and pillow the patient’s head in your lap, placing an absorbent towel on your lap. Make sure you’re comfortable and your back rests against a headboard. Keep a jar or bottle of the stroke patient’s favourite moisturiser handy. Dab a little of the moisturiser on your fingers each time you start to massage a certain area of the face.

Starting at the cleft of the chin massage upwards in a soft firm motion towards the eyes. Next massage around the mouth and upper lip, for this it is better to just use your middle finger. Follow a figure of eight or infinity-sign motion when massaging around the eyes. To massage the nose, use the middle fingers of both hands and gently pull the skin up towards the bridge of the nose and up between the eyes  – see the red musculature in the diagram. End the massage around the nose with a downward stroke towards the cheekbone. Lastly massage the forehead, again following the blue and black muscle structure. But as a final stroke massage the forehead laterally meaning towards the temples. Make a few circular massaging strokes on the temple area. And, before you end the facial massage put a small quantity of the moisturiser and massage the neck starting at the base of the neck and massaging upwards; scoop you hands in behind the neck to give the back of the neck a massage too. You may find doing this  easier than turning the patient around completely.

Once you have massaged the face the muscles will or should be relaxed and loose. Now get the patient to do as many of the following Facial Stretching Exercises – adapted from the Strokehelp blog. Each stretch should be done 3 times working up to at least 5 repetitions.

Facial stretches:

  • Raise eyebrows as high as possible, then relax.
  • Frown as hard as possible, wrinkle nose, and bring eyebrows together.
  • Open his/her mouth wide and stretch it as much as possible.
  • Smile widely while keeping the lips closed.
  • Puff out your cheeks and stretch them as much as possible.
  • Pucker lips as if giving a kiss.
  • Make exaggerated vowel sounds (A, E, I, O, U) stretching as much as possible.
  • Sticking the tongue out as far as possible.  Then, move tongue to the right, to the left, up towards the nose, and down towards the chin.

Jaw stretches:

  • Move the jaw to the right side as far as possible until it pulls but does not hurt, Hold 5 seconds.
  • Move jaw to the left side as far as possible, hold 5 seconds.
  • Alternate right to left jaw movement 5 times.
  • Move the jaw around in a circle making it move as far in each direction until a stretch is felt, but no pain.  Repeat 5 times.

Lip Exercises

  • Lip Retraction : Spread lips into a smile . Hold for 5 seconds. Relax and Repeat 5 times.
  • Lip Protrusion: Pucker lips as if about to kiss someone and hold for 5 seconds. Relax and repeat 5 times.
  • Lip Retraction and Protrusion: Alternately smile and then pucker your lips. Relax and repeat 5 times.
  • Lip Press: Open mouth as wide as possible and hold for 5 seconds.  Then close mouth, Press lips tightly together for 5 seconds. Relax and Repeat 5 times.
  • Pucker lips and make a kissing sound.  Practice slowly 10 times.
  •   Suck  lips into the mouth, then release in a loud smacking noise.  Practice slowly 10 times.
  • Keeping teeth together, say these sounds: “ba, bi, bu,” exaggerating the lip movements. Practice slowly 10 times.

Tongue Exercises

  • With the mouth open protrude the tongue. Be sure it is straight out, not resting on  lips or pointing to one side.  Maintain this position for two seconds.  Practice slowly 10 times.
  • Protrude the tongue and move it slowly from corner to corner over your lips.
  •  Protrude tongue and point it upward toward nose; hold for two seconds,  then relax.  Practice slowly 10 times.
  •  Protrude tongue and point downward toward the chin; hold for two seconds, then relax. Practice 10 times.
  • Move tongue around the lips in a circle, touching all of upper lip, corners and lower lip; relax.  Practice slowly 10 times.
  • Raise the tip of the tongue and touch the upper lip, the upper teeth and the ridge behind the teeth and the hard palate.  Practice slowly 10 times.

Inhale and Exhale Exercises

  •  Puff out the cheeks and press the fingers against one cheek without allowing the air to escape through the mouth or nose.  Practice slowly 10 times.
  • Blow on straw keeping a finger on one end and maintain the air in the straw for 5 to 10 seconds.  Practice 5 times.
  •  Say the (s) sound “ssss” without allowing the air to come through the nose.  Practice slowly 10 times.
  •  Repeat “ka” 20 times, “ga” 20 times, and “sss” 20 times.

Note: I have removed some of the prescribed exercises as I think those are better handled by a professional speech and/ or physiotherapist. For a more detailed list of exercises visit: http://strokehelp.wordpress.com/speech-exercises-2/

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