I have updated this article to include a video tutorial that reveals a myriad of muscles in the face, the tensing and relaxing of which are part of the function of Cranial Nerves, and which become rigid in the faces of people with Parkinson’s Disease. I have also included a set of very quick daily exercises based on this which can help to restore facial expressiveness in PD, or at least prevent the degeneration.
INTRODUCTION
I am currently researching the Cranial Nerves and their functions. My interest in this area was piqued because many of the major and common symptoms of Parkinson's Disease are not very well explained by the "death of dopamine producing cells in the Substantia Nigra" scenario. However, atrophy of the Cranial Nerves in people with Parkinson's (PwP) does very straightforwardly explain most of these major secondary symptoms, and, I believe, does so in a very common sense way.
This conclusion is important, because if correct, it means that no chemical "cure", which addresses only the dopamine production issue, will, by itself, fix the causes of the other symptoms too. Indeed, undoing atrophy of any kind in the brain and body takes time and the patient application of suitable stimulation, exercises and therapies. I therefore recommend that we PwP do not just sit and wait for "the lure of cure" to ever materialize, but instead to err on the side of caution: I believe we need to begin the process of bringing our atrophied brains and bodies back from the brink, soonest. Below, I also present a number of suggestions for Cranial Nerve stimulation techniques, which should help us in this regard, if we apply them daily, over the long term.
NOSE
1 Olfactory Nerve
Cranial Nerve 1 - "transmits nerve impulses about odours to the central nervous system, where they are perceived by the sense of smell; the olfactory nerve is somewhat unusual among cranial nerves because it is capable of some regeneration if damaged."
The loss of sense of smell is one of the earliest manifestations and cardinal symptoms of PD.
EYES
2, 3, 4, 6 Optic Nerve, Oculomotor Nerve, Trochlear Nerve , Abducens Nerve
Cranial Nerve 2 - "a paired nerve that transmits visual information from the retina to the brain."
Cranial Nerve 3 - "supplies muscles that enable most movements of the eye and that raise the eyelid and enables the ability to focus on near objects as in reading."
Cranial Nerve 4 - " a motor nerve that supplies the superior oblique muscle" which controls turning of the eye in the socket, in particular the actions of looking down or towards the nose.
Cranial Nerve 6 - "a motor nerve that supplies the lateral rectus muscle of the eye" which controls turning of the eyes outwards, away from the nose."
Eye and vision problems abound in Parkinson's Disease, from dry eyes, involuntary closing of the eye lids, to fixed and unfocused eyes. Visual problems that have been strongly correlated with PD include issues with: visual acuity; contrast sensitivity; color vision; motion perception; visual disturbances and hallucinations. Physical and structural changes to the eye and retina have also been found in people with Parkinson's, as determined by a number of modern eye examination methods. Therapies which involve injecting small amounts of dopamine into the eyeball have proven successful in PD, and strategies based on this are being developed.
FACE
5, 7 Trigeminal Nerve, Facial Nerve
Cranial Nerve 5 - "a nerve responsible for sensation in the face and motor functions such as biting and chewing."
Cranial Nerve 7 - "emerges from the brainstem, controls the muscles of facial expression, and conveys taste sensations from the anterior two-thirds of the tongue and oral cavity."
A blank or expressionless face is one of the classic signs of Parkinson's Disease, used as a principle diagnostic point by neurologists. If this is allowed to progress, the face can take on a "plastic mask" appearance: featureless (puffy), with a "waxy" or shiny appearance. Problems chewing, over-clenching and misalignment of the jaw are common symptoms too. Indeed, temporomandibular joint (TMJ) disorders are strongly correlated with PD.
EARS
8 Vestibulocochlear Nerve
Cranial Nerve 8 - "the auditory vestibular nerve, transmits sound and balance information from the inner ear to the brain."
PwP have very poor balance and may experience dizziness. These symptoms become more pronounced if the disease is allow to progress. PwP are often hyper-sensitive to noise and can become averse to listen to music.
TONGUE
9 Glossopharyngeal Nerve
Cranial Nerve 9 - "connected to tasting, swallowing, salivary secretions and visceral pain, supplying the tonsils, pharynx, middle ear and the posterior third of the tongue."
Loss of sense of taste is strongly associated with PD symptoms, as is dry mouth, thickened saliva and/or dribbling. Visceral pain (dystonia) is also frequently involved.
GUT, ORGANS
10 Vagus Nerve
Due to the far reaching effects of this nerves influence, the Vagus Nerve:
"...it’s a unique cranial nerve in that it innervates the trunk, the torso, the organs, it actually supplies all of the major trunk organs and it’s a bi-directional nerve -we call it a mixed nerve. It’s got fibers going from the brain to the organs, controlling them, and then it’s got fibers going from the organs to the brain, which is a way of letting the brain know what’s happening in the torso, in the body,"
requires very special attention. Therefore, please see my article
THE VAGUS NERVE AND PARKINSON'S DISEASE
for a more information.
NECK, SHOULDERS
11 Accessory Nerve
Cranial Nerve 11 - "supplies specific muscles which tilt and rotate the head, and the trapezius muscle, which works the scapula, including for shoulder elevation and movement of the arm away from the body."
Neck and shoulder problems are extremely common in PD. For example, "frozen shoulder" is a very common initial mis-diagnosis, as was the case for myself. The head and shoulder movements mentioned above are particularly difficult for PwP to access.
TONGUE, MOUTH
12 Hypoglossal Nerve
Cranial Nerve 12 - "controls tongue movements required for speech and swallowing, including sticking out the tongue and moving it from side to side."
Speech problems are another classic, major and degenerative feature of PD, as are issues with swallowing.
A Cranial Nerve Exercise Programme
Here is a set of quick neural exercises and fast workout for maintaining and strengthening the Cranial Nerves, to support our health, growth, and restoration, and assist in long term progressive symptom reduction.
Programme Guide
1. Watch and regularly review the video below,
to ensure a good understanding and improve ability to visualize the specific muscles which we are seeking to innervate with each exercise.
2. Take a few minutes to perform the exercise routine just once or twice a day, do not overdo, especially initially - less is more, consistent practice every day is more important.
3. Hold each expression made for a few seconds, and concentrate (embody) the feelings and sensations created, then relax face before moving on to next.
4. If particular exercises are difficult to perform, use fingers to assist, or close eyes and simply visualize/imagine making the expression and the muscle movement - even micro-twitches will be beneficial.
Additional options
1. Look in the mirror while performing the workout, and consciously notice/observe changes to face.
2. Gently place finger tips on each muscle which is being innervated.
3. Rotate daily between exercising left side only, right side only, and both sides.
4. Find a partner/guide with a healthy Social Engagement/Cranial Nervous System, and follow/mirror/mimic their facial expressions as they go through the routine, exploiting the Mirror Neurons which fire when watching other people move.
FACIAL NERVE EXERCISES
1. Wrinkle forehead.
2. Close eyelids gently and relax face.
3. Close eyes tightly.
4. Draw eyebrows down and inward.
5. Frown and wrinkle top of nose.
6. Flare nostrils out.
7. Draw nose downwards with septum.
8. Close lips tight together.
9. Purse lips as if kissing,
10. Purse lips as if whistling.
11. Puff up cheeks, then slowly blow out breath.
12. Draw corners of the mouth outwards with lips closed.
13. Draw corners of mouth upwards with lips closed.
14. Draw corners of mouth downwards with lips closed.
15. Open lips and show upper teeth by curling/lifting upper lip, opening nostrils.
16. Starting with lips closed, push lower lip out as if pouting.
17. Open lips and show lower teeth, by pulling lower lip down.
18. Smile broadly, showing teeth.
19. Raise ears (for most people this will require manual assistance with fingers).
20. Draw ears back (“).
21. Draw ears up and forwards (“).
There are further videos in the anatomy tutorial system, showing the muscles of mastication and of tongue movement, and similar quick exercise programmes can be constructed based on these.
General Cranial Nerve Stimulation Techniques
Here are some other techniques being used for general health, but which have applications for Parkinson's Disease. While none of these are quick fixes, anecdotal evidence from people with Parkinson's suggests practising these over the medium to long term can help to cumulatively reduce symptoms.
Making Faces
Exercising the facial muscles daily is vital to cranial nerve health. Pulling faces or making exaggerated facial expressions is a simple but effective way to do this. Here is a video by a colleague of mine about facial masking in PD, together with a series of optimal exercises for improvement:
Head and Face Rubbing
I have found that vigorous rubbing of the head and face, using a small amount of coconut oil for lubrication, can be helpful. Indeed, if applied at the right point of my drug cycle, I find this can even help switch my movement back on earlier.
Tapping
A number of stress relieving techniques have been developed around the concepts of tapping key points on the face, head and shoulders with the fingers. These include Emotional Freedom Techniques (EFT) and FASTER EFT. The tapping action stimulates the various Cranial Nerves and hence, as well as quickly providing temporary stress relief, practising these should also help increase the strength or "tone" of the parasympathetic nervous system over time.
Sparking
The concept of sparking uses weak electric shocks via "sparking pens" to boost the stimulating effects of tapping. The benefits of sparking different Cranial Nerve points can be immediately assessed and quantified through "Range of Movement" testing.
Paida
After first publishing this article, a friend pointed me to a Chinese practice of head slapping known as Paida. There are many videos one can find on this on youtube, with many benefits claimed.