Decreased Facial Expression in PD (Hypomimia) - PMD Alliance

I recently had the opportunity to see a great patient I newly diagnosed with Parkinson’s (PD). While most people are coming to my clinic complaining of having tremors, balance problems, or dexterity issues, the reason that brought him was decreased facial expression. As a businessman, customers commented to his colleagues about his “upset and lack of emotion” expression. Long story short, he also had slowness, stiffness, and very mild tremors, and a diagnosis of PD was made. While he experienced improvement of most symptoms with levodopa, he came back with the question: How can I improve my facial expression? I was somewhat astonished as I feel I have heard most questions from people with PD, but I do not remember anyone asking me how to make the facial expression better. His question made me more aware of the impact of decreased facial expression in PD.

We might ask ‘how bad can the facial expression be?’ Let’s think about this for one moment. The facial expression has a significant role in human interactions and plays an essential role in our society. It may even lead to a misdiagnosis of a mental health disorder. At that time, I decided to call a good friend, Dr. Dawn Bowers, an expert in Parkinson’s disease’s cognitive aspects, who has done extensive research in facial expressivity in PD. My question to her was ‘Is there anything people with PD (and other parkinsonian symptoms) can do to improve facial expressivity?’

The answer: Yes, some things may help.

They may seem silly, but they can work. The first recommendation is chewing gum. This keeps the facial muscles moving in a simple way. Number two: Sing loud in the shower (or wherever you may be and feel comfortable). For how long: 15-20 minutes per day. Third: Get a mirror and make exaggerated facial expressions multiple times per day. This is the silliest of all. Make sure you add the upper part of your face. Another possible intervention: Find out if any speech therapist in your area offers respiratory strength muscle training. This is an intervention typically performed using a small device that can help strengthen weakened muscles. It may help improve the mobility in the muscles around the mouth involved in facial expression.

More information about the device can be found at The most important thing is to do something and to keep practicing.

Ramon Rodriquez-Cruz, MD, is an Associate Professor of Neurology at the University of Florida in Gainesville and is also the Director of Movement Disorders Clinic. Besides his interests in surgery for movement disorders, Dr. Rodriguez has special interest in the translation of the latest advances in movement disorders research and the application into clinical practice. He is also experienced in the administration of Botulinum toxin for dystonia and spasticity. The main goal in his practice is to provide the highest level of care and improve the quality of life of his patients. In addition to clinical care, Dr. Rodriguez is investigator in multiple clinical trials attempting to find ways to delay the progression of Parkinson’s disease as well as development of new therapies.

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