Desired effect Presentation of muscle group observed Strength grade** Interventions of taping and exercise  Repetitions Frequency per day Initiate Asymmetric at rest; very little palpable  to no movement against gravity Zero to trace PROM to AAROM – gravity assisted position Tape*: activate - origin to insertion. Manual stretching increase circulation, decrease pain <10 reps 3-4 Facilitate Slight asymmetry at rest, minimal range of motion with gravity, moderate  to full with gravity assisted or eliminated Poor to fair AAROM to AROM – gravity assisted to eliminated increasing to against gravity with success Tape: activate -  origin to insertion Manual stretching increase circulation, decrease pain 10-20 1-2 Movement control*** Facial symmetry minimally decreased to  equal, moderate to full range of motion, synkinesis present Good AROM against gravity isolated movement patterns, initiating with effected side and matching. Tape: inhibit -synkinesis insertion to origin and activate as needed Manual stretching of platysma, constant pressure areas of high tone Quality in reps to fatigue 3-4 Relaxation*** Able to perform full range inconsistently , slight synkinesis Good to normal AROM-Visually relax non-effected side attempting to match full range of motion, without synkinesis. Tape: as needed for minor facilitate and or inhibit in combination to desired movement pattern. Manual stretching of non-effected or effected side for pain/soreness management. <10 1 Intervention algorithm modified from Brach et al table of “Treatment based categories and matched treatment”.11 *Kinesio Tex® kinesthetic elastic taping. **Adapted and modified from Kendall in describing facial strength grades - “zero” - No contraction observed or palpated; “trace” - Muscle contraction can be palpated to tighten, no observable movement produced; “poor” - Muscle movement with gravity eliminated; unable to activate muscle against gravity; “fair” - Able to contract muscle partially against gravity; “good” - Full range of motion against gravity (we defined as equal to non effected side with cued expression; not found to be consistent with expression in communicating, or synkinesis present); “normal” - Consistently equal to non effected side with full ROM (for our documentation - without synkinesis). 6 *** Functional neuromuscular re-education was emphasized -for example, cues such as talking on the phone in front of mirror with attention to symmetrical expression and muscle activation.

Table 1: Intervention Description – taping with exercise progression.