The Lindens Clinic Center for Trophic Electrical Stimulation. Conditions treated include, Chronic Facial Paralysis, Synkinesis, Ramsey Hunt Syndrome, Bells Palsy, Lymes Disease, Strokes, Moebius Syndrome, Congenital Palsies & Acoustic Neuroma. The practice is operated by a dedicated team of specialist physiotherapists currently dealing with a wide range of conditions, tailoring treatment to meet individual needs.

October 2006 marked a big personal milestone for Diana Farragher. It was 25 years since she started treating faces. I remember when she chose to look at faces for her Masters degree in muscle physiology reasoning that they had the right balance of red/white muscle for the practical application of TES and they were more interesting than hands. I think now 25 years on she is still realising what an under resourced, under considered and under appreciated group of patients she was about to champion.
Diana treats people who loose the ability to use ½ of their face it can be through trauma, surgery or probably most frightening a virus that can affect any of us.

So what happens when you can’t talk, laugh, cry or even close your eye on one side? Some examples of Diana’s patients problems over the years:-

• A little girl who blew her birthday candles out for the first time at the age of 8

• The gentleman who was a master of ceremonies and couldn’t return to work until he • could clearly say “Ladies and Gentlemen please SIT down”

• The young woman who thought her face ruined her sisters wedding photographs •
• and the lady who wouldn’t attend her sons so it wouldn’t.

• The new mother who sat in a rocking chair every night feeding her baby whilst
• unable to keep food properly in her own drooping mouth.

• The actress who could only do radio shows because of the severe synkinesis ie •
• muscle twitches

• The teacher who couldn’t teach because of the risk of chalk dust to an unblinking,
• dry eye.

• The self employed roofer who couldn’t tolerate heights because of the disturbed
• vision caused by the eyedrops in his unblinking eye.

• The vicar who waits for the congregation to close their eyes first after he has said
• “lets pray” in case they saw the effort it took for him to close his.

• The gentleman who was asked to leave a Manchester restaurant because
• Synkinesis symptoms made his eye close when chewing and 2 ladies complained he
• was making lewd gestures towards them. He left too ashamed to explain.

• The grandma who wanted to go in a supermarket without seeing fear on children’s
• faces and the granddad who wouldn’t see his own grandchildren scared of seeing
• fear on theirs.

• The 11 year old boy whose parents were told he would never smile again so get
• used to it- see his story and his smile on our website

These are the people whose lives make up my working day and the reason why I
have a box of tissues by my desk says Diana.

What is Facial Rehabilitation?

Facial rehabilitation is all about muscle balance techniques in miniature and microscopic. The tiny facial muscles work together to produce the lines and dimples of facial expression and the muscles themselves need to be the correct balance of slow oxidative and fast glycolytic units. Rehabilitation is the process of restoring that balance. The principals of treatment are the same as for any other area of the body by achieving muscle balance it is possible to restore the feel of normal movement. The muscle needs to be restored to prime physiological condition the patient must be motivated to use the trophic stimulator at home but basically they are the ones doing the hard work and the rewards are massive. With the face there is also the aspects of body image and self esteem to consider and
even the task of convincing the person that they are restored in order to leave the past behind.

Diana is well known for her functional approach for rehabilitation. It not so much how it looks but if it feels OK and does what you need then that is an acceptable measure of outcome. One gentleman I remember came complaining that because of his dropping mouth he couldn’t drink from a pint glass when in the pub with his mates. Off Diana went and returned with various glasses and found that he could drink from a half pint glass without dribbling. Satisfied customer off he went and we never saw him again, although Diana had only meant this as a short term measure whilst we treated him!

Proof reading the first issue of a Loss of Face was a daunting task but after years of lecturing to fellow professionals Diana found she had many things to tell the patients directly. Originally the book was intended to be a reliable source of information for all the patients she cannot meet. No one foresaw the bible like role it has taken on. One lady told me recently she knows she is recovering because she can now go out of the house without taking her copy of the book with her.

Highpoints

1987 Diana received The Robert Jones International award which allowed her to present a paper on the treatment of Chronic Bells Palsy to the World Confederation for Physical Therapy in Sydney,

1990 – Diana was awarded a fellowship of the CSP for her work in the development of Trophic Electrical Stimulation and lecturing to further the Knowledge of the profession. “I was a teacher anyway and there was no way I was going to keep quiet about my findings. After I presented my work to the American Physical Therapy association Chicago 1986 they produced a paper authenticating the results”.

2001 –Diana received an OBE for her work with chronic facial paralysis. The nomination had been made by patients and their relatives.

Rewards

The face is so much a part of who we are that all the treatments have an holistic base. The impact on the patients is not just physical but also psychological and emotional. It is not uncommon to hear of new jobs or see new hairstyles or more makeup as the treatment progresses and confidence returns.

“When I first saw the results of trophic stimulation I became hooked. I have enduring memories of the little girl who blew her birthday candles out for the first time at the age of 8 or the lady who once again could sing in the choir with her mouth in a perfect “O”. The gentleman who was a master of ceremonies and couldn’t return to work until he could clearly say “Ladies and Gentlemen please SIT down” or the actress who could only do radio shows because of the severe synkinesis or the teacher who couldn’t teach because of the risk of chalk dust to an unblinking, dry eye.

It was only this week I experienced the feeling of helplessness whilst listening to a lady with bilateral facial paralysis and spasms describe her problems. When she had finished she felt better. “You are the only one who know how I feel” It’s a humbling experience and I am still learning. Over the years many patients have asked when I had my facial palsy then I know I have reached the point of empathy where healing starts. The rewards come in each new smile and each new wink.”

Diana can talk for hours about her patients and what they have taught her. She can talk about their needs and understand them in a way that has led some to be surprised to learn that she has never had a facial palsy herself. Although her left sided synkinesis impression is frighteningly realistic!

She sees each new smile as a tremendous achievement that she is privileged to share.


Diana is currently the head of The Lindens Clinic in Manchester which is a centre of excellence for the treatment of facial paralysis. She has built around her an enthusiastic and highly qualified team of physiotherapists who all share her love of facial rehabilitation. She can’t resist showing off now and then though and try to guess the facial grade of someone as they walk across the car park. An 1 ½ hour assessment later she is usually proved right!

The clinic welcomes patients from around the world and in a recent move is pleased to announce growing links with the NHS as more patients are now PCT funded. The clinic hosts regular training days as Diana still has a love of teaching and she enjoys regular contact with colleagues from throughout the world, seeking her opinions and advice, thanks to the joy of the internet.

In November we hosted an open day for local physiotherapists, doctors, consultants, speech therapists and patients. It was a wonderful chance for us to look back through the archives for pictures of patients over the last 25 years including some lovely babies that will be adults now! We were thrilled when Maureen one of Diana’s patients from her original research trial in 1981 was able to join us – see the photograph as Wendy gave her a practical demonstration of the new biofeedback system in operation – things have certainly progressed over the last quarter of a century.

If you were one of our patients then please send us an email and let us know how you are. Meanwhile we have enjoyed our trip down memory lane and hope that you have too.

Jenny Farragher MSc BSc (Hons)
Lindens Clinic Manager