Facial Masking Can Make It Hard To Gauge The Mood Of A Person With Parkinson’s
Without facial movement, your expression may come across as emotionless, causing you to seem upset or annoyed when you’re not, says physician Chris Airey, MD, medical director at Optimale. He notes that Parkinson’s can affect both voluntary and involuntary facial movements.ae0fcc31ae342fd3a1346ebb1f342fcb
According to the Parkinson’s Foundation, trying to understand a person with Parkinson’s mood can be further complicated byother symptoms on top of facial masking. Facial expressions are an essential part of how we communicate. When you have a straight face along with speech changes, such as a low voice, which is common among Parkinson’s patients, it can be challenging for people to understand your mood, the experts at the foundation explain.
The Parkinson’s Patient Can Reportedly Be Identified If He Has Unconsiderable Facial Expressions Like Frowning Or Smiling And May Even Appear Depressed Or Angry
IMAGE: UNSPLASH
Parkinsons disease has checked the list of diseases that are being taken seriously by the medical fraternity. It is an illness that affects the brain parts, making them impaired eventually and also attacks the nervous system resulting in tremors. Among many symptoms that are considered signs of the illness, a new symptom called masked face is also being considered as a tracker of Parkinsons in people.
Face Masks And Unfinished Tasks
The clouds hover overhead this afternoon. It echoes my emotional state of mind as of late.
I wake up to sunshine and clear blue skies. By noon there is a scattered mantle of white. By dinner time the sunshine toys with me. There will be no oohing and aahing over a breathtaking sunset tonight.
I have been fighting apathy. I start projects that I strive to finish but lose my motivation and inspiration. I never used to be like that. I could have several projects going and would work on each one a little at a time. And I could leave a project and pick it up later in the day or in the week and remember what step I was on. Getting back to projects nowadays? I dont care if I do.
Or do I?
Yes! I do care. However, I am sluggish. I often dont have the energy to start or finish a task I would like to accomplish. And nowadays, due to our friend Corona, its not difficult for me to feel friendless.
I had a phenomenal idea last night while feeling alone and somewhat depressed: I could call a friend. If it hadnt been so late, I would have.
I have been doing well, stranded sheltering here at home. But, I admit it is starting to get to me. I miss hugs and smiles. This coronavirus has stolen smiles from all over the world. You cant see people smile under a mask. Its kind of like having Parkinsons disease a permanent masked face.
The other day I was checking out at the grocery store and the clerk said, Could you back up a few feet?
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Nowadays I Always Wear 2 Masks
I received an email yesterday from my mother-in-law. It had been forwarded to her from a friend of hers. It was missing the attachment, so I dont know what the email said apart from the five words found in the subject line. They read: Why I wear two masks.
It intrigued me and made me think about those of us with Parkinsons disease who already wear two masks every day.
Learn The Symptoms And Treatments For Facial Masking
Facial masking, also called masked facies or hypomimia, is the loss of facial expression most commonly associated with Parkinson’s disease. The condition gives the affected person a fixed, mask-like expression.
There may be several causes of facial masking, including a psychiatric disorder like schizophrenia that may limit affect and expression, or medication that may lead to a similar response. With Parkinson’s disease, the facial masking is typically caused by a progressive loss of motor control.
This article explains why Parkinson’s disease may lead to facial masking and how it is treated. It will help you to learn more about symptoms that sometimes make it harder to interact with loved ones with the condition.
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Taking Off My Parkinsons Mask
Parkinsons can impact the use of facial muscles. Mark shares his experience of having a Parkinsons mask, and what helps him manage his symptoms.
I was diagnosed with Parkinsons in 2017. Most people are well aware of the motor symptoms of tremor, rigidity and the effect on gait, says Mark. But I find non-motor symptoms are the most difficult thing to explain and they affect me just as much.
Ive always loved music, for example. I sang in the Guernsey Choral Society, and have always loved playing and listening to music. But I just wasnt getting the same pleasure from it anymore.
I Wont Lie There Are Many Down Times But I Have A Choice Do Nothing And Achieve Nothing Or Battle On I Chose The Battle
Does it hinder your creativity?
It makes all the other things that I did, apart from photography, a chore and no longer a means of relaxation. I love drawing but it is so slow and I need to concentrate so hard that the sheer joy of flowing strokes becomes a battle.
How has it affected you outlook on life?
I wont lie, there are many down times but I have a choice do nothing and achieve nothing, or battle on I chose the battle.
Control
Explain the concept behind your Concrete project. Why did you decide to do it?
Since I picked up the camera again, I would occasionally ask my subject if they wouldnt mind placing their face in water and looking at the camera. I just liked the effect. Then early last year it dawned on me, I was making people cry because I wouldnt, couldnt, real men dont cry! So then I thought why not do something with the images to raise awareness of Parkinsons disease. I call it Concrete after a little poem that I wrote.
The photos are incredibly stark representations how did you get the reactions out of your subjects for each emotion?
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The Aim Was To Give The Normal Person I Was Photographing The Small Feeling Of What The Loss Of Control Was Like Even For A Couple Of Seconds And For Me To Capture It
How did you get the idea to capture Parkinsons in this way?
Parkinsons makes us stare and show less emotion on our faces than we would normally. None of the subjects had Parkinsons. The aim was to give the normal person I was photographing the small feeling of what the loss of control was like, even for a couple of seconds, and for me to capture it.
Longing
What is the effect gained by using the water technique?
The water acts as a distraction. Try opening your eyes with a face full of water and express an emotion like happiness, for example it is very hard. Without the distraction of the water they would have greater control of their faces and I wanted to take that away. With Parkinsons we sometimes show what we are feeling and at other times we give our faces no clues at all.
What did your subjects think after seeing the photos of themselves?
They were amazed at what they looked like. The most common answer was that they never thought trying to express a specific emotion with a face full of water would be so hard.
Would you say the photography has been a way of coping with Parkinsons?
Yes, totally, all other artistic avenues that I found joy in are a struggle now. Light and dark are my colours and the camera is my brush. I still can create.
Despair
What have you got planned for the future?
What is the treatment and care of Parkinsons like in Australia?
How important is it to have an international community for Parkinsons?
You can get in touch with Chris via
Masked Faces In Parkinson Disease: Mechanism And Treatment
Inclusion Criteria: – A clinical diagnosis of idiopathic Parkinson disease – Hoeh-Yahr Stage 1-3 when off medication – Stable and optimal medical regimen for at least 3 months – No previous surgical interventions for Parkinson’s disease – Participants will include men and women between the ages of 45 and 80 years Exclusion Criteria: – Evidence of dementia based on neurocognitive testing – Current or past history of major psychiatric disturbance . Participants who are taking anti-depressants will not be excluded as long as they are not currently depressed – Other neurologic disturbance or severe chronic medical illness – Presence of oro-facial dyskinesias – Previous surgeries to the larynx that result in poor vocal fold closure and/or positive history of head and neck cancer – History of smoking in the past 5 years – Untreated hypertension – Failing a baseline test of pulmonary function during baseline respiratory evaluation – Known respiratory complications such as chronic obstructive pulmonary disease , asthma – Previous surgical interventions for Parkinson’s disease
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Adjusting My Medication Regime Really Helped
I was having problems physically expressing my emotions, but my mental health issues continued to affect me too. So not only could I not move my facial muscles easily, but the feelings of motivation, enjoyment and enthusiasm all seemed to have waned and diminished within me.
After I was prescribed the right medication, friends and family said I looked much happier, and that I was smiling and laughing more. Adjusting my medication regime really helped.
He says: I went to the Parkinsons UK Members Day. It was truly inspiring. It made me feel more positive, and I realised just how much help is available. Im learning to cope with my condition and Im grateful to have excellent support from my wife, family and friends. I now realise that most things in life are never as bad as they first appear.
Masked Face And Parkinson’s
Facial masking is symptomatic of the degenerative nature of Parkinson’s disease. The hallmark feature of the disease is the progressive loss of motor control.
This loss of control affects major limbs, but it also affects the finer muscle movement of the hands, mouth, tongue, and face. Facial masking affects some 70% of people living with a Parkinson’s diagnosis.
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What Does Masked Face Mean
Hypomimia is a common symptom of Parkinsons disease. Its included in the Unified Parkinsons Disease Rating Scale as a characteristic that can range from slight to severe.
The face contains 42 individual muscles. These muscles are used, often unconsciously, to display happiness, sadness, confusion, contentment, and many other emotional states.
If you have Parkinsons masked face, your facial motor control isnt working as they usually would. This causes a disconnect between what youre thinking, saying, or feeling with how your face appears to others.
A person with Parkinsons masked face may seem uninterested or uncaring, even when the opposite is true. They may also look angry, sad, or completely free of emotion.
Parkinsons disease can also affect the movements that control your voice, giving you a flat, low monotone. This together with masked face can make it hard to communicate what youre feeling and thinking.
Parkinsons disease affects the brain cells that make dopamine. Dopamine helps control muscle movements, and without enough dopamine, the regulation of movement is impaired. This affects the face as well as other movements throughout the body.
Parkinsons disease can affect the facial movements in several important ways by causing:
The Ability Of Patients With Parkinsons Disease To Recognize Masked Faces During Covid
S. Tezcan Aydemir, M. Kuzu Kumcu, N. Durmaz çelik, B. Bakirarar, S. özkan, M. Akbostanc
Category:Parkinson’s Disease: Cognitive functions
Objective: This study aims to evaluate the effect of using masks on face recognition ability in Patients with Parkinsons disease .
Background: Patients with Parkinsons disease suffer from a range of non-motor symptoms such as affective and cognitive disorders, and in the visual perception domain, as well. Among these visual perception difficulties, face recognition problems were reported frequently. Widespread use of masks during COVID-19 pandemic gives a novel opportunity to investigate face recognition disturbances in PwP.
Method: Three groups were included 64 PwP > 24), 58 age and education-matched older healthy controls , and 61 younger healthy controls , aged 30-35. Benton Face Recognition Test-short form , and our close-ended Face recognition difficulties due to using masks during pandemic survey were applied to all groups.
To cite this abstract in AMA style:
Mov Disord.
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How Does Pd Affect Facial Appearance
PD is a chronic, progressive disease of the nervous system. The most common PD symptoms include:2
- Tremors or shaking at rest
- Rigidity of the limbs and trunk
- Difficulty balancing
- Slowness of movement
However, PD might also cause a slew of emotional and communication problems, severely affecting social interaction. One of these problems is a mask-like expression, also known as hypomimia. This can include:2
- Issues producing animated or emotional facial expressions
- Trouble producing emotional speech
- Problems recognizing the emotional, verbal, and nonverbal cues of others
A mask-like facial expression is when the person’s eyebrows, lower lip, and face do not move. This happens because the person has lost the ability to properly control the movement of these muscles. With facial masking, you can appear like you are staring, not interested, angry or upset, or disengaged.1
When you are trying to express yourself one way and your face is telling a different story, this frustration can easily lead to anger and isolation.1,3,4
The Effects Of Facial Masking
My dads face, like many people with Parkinsons who experience facial masking, is less expressive and more neutral than one would expect, given the content of his conversation.
Facial masking causes a loss of facial expressivity. The muscles of the face lose muscle tone, leading to a seemingly blank expression.
For people who dont know facial masking, the blank expression can be misconstrued as a lack of interest, displeasure, low sociability or low cognition. Were accustomed to a persons face shifting and changing regularly with the conversation. With a masked face, there is often slowness and stillness in the muscles of the face.
The primary thing I notice is less blinking and less reaction, positive or negative. However, when someone with a masked face is passionate about a story or topic, you can often see the most genuine and beautiful smile!
Even though I know what facial masking looks like, having a conversation with a person with facial masking can feel confusing. We expect facial responses in conversation. A simple smile, nod, eyebrow raise or crinkle of the eyes makes the person who is talking feel heard. With facial masking, these small movements are not so simple.
From my dads point of view, I imagine it is incredibly frustrating to not be able to effortlessly express himself.
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Loss Of Facial Expression/ Masked Face
Generally, we communicate not only through words but through subtle, fast-moving changes in facial expression.Its easy for most of us to understand why having an expressionless face could be traumatic.A person who isnt able to convey these emotions facially would be at a loss since others may discount or misinterpret words when the expressions dont match up.
Masked face is the loss of facial expressions commonly associated with Parkinsons disease.As such, we tend to use the term hypomimia to describe facial masking within the context of Parkinsons. It suggests the actual loss of motor control rather a physical manifestation of emotional blunting. Hypomimia can affect both voluntary facial movements and involuntary ones .
In Parkinsons, masking can develop as the progressive loss of motor control extends to the facial muscles as it does to other parts of the body. Dopamine is the neurotransmitter that transmits the signal from the brain to the muscles to produce movement. When PD damages the nerve cells that produce dopamine, the motor symptoms and ability to control muscles are affected.Certain medications can significantly blunt a persons emotional response.
Less Animated By Things
Its these feelings of apathy and a lack of motivation which characterise Marks Parkinsons. In fact, his wife Chrissie noticed these symptoms before he was diagnosed, commenting that Mark seemed less animated by things.
At the same time that Mark was experiencing issues, he was also having trouble with his facial muscles.
I remember going with Chrissie to her appointment when she was diagnosed with breast cancer. Afterwards, she said I appeared unmoved by it all. I couldnt understand it.
Friends and family also commented that Mark looked flat and sad. Eventually, he realised his reduced facial muscles were causing him to experience a Parkinsons mask, which meant he was less able to express himself.
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Understanding Facial Masking And Its Communication Hurdles
Professor Linda Tickle-Degnen and her graduate student researchers are exploring the communication hurdles faced by those with Parkinsons disease and how they can be overcome.
The man in the video sits alone at the Tufts Health Quality of Life Lab speaking to an off-camera voice about, of all things, a wedding he recently attended. On the surface, theres nothing unusual about the conversation, but as the tape goes on, a curious atness in his voice and manner become apparent. Linda Tickle-Degnen, lab director and professor and chair of the School of Arts and Sciences occupational therapy department, lets the video run for a few minutes before she begins pointing things out. She starts with the mans lower body, noting that he hasnt moved or otherwise repositioned himself since the interview began. Next, she calls attention to his left hand, which has been trembling slightly. She ends with his face, but no explanation is necessary: hes remained almost expressionless. To the untrained eye, the man appears disinterested, even bored.
Tickle-Degnen notes that practitioners sometimes fail to talk to the person about their feelings because facial masking consistently causes a perception of depression, deception, hostility, and apathy in practitionerseven when they are experts.