Development of an Adaptive Serious Game System for Facial Paralysis Rehabilitation: A Facial Movement Recognition Pilot Study.

In recent years, motion-capture technologies have been widely applied in rehabilitation to enhance patient engagement and therapeutic efficacy. Facial paralysis, characterized by impaired facial muscle function due to facial nerve injury, is typically managed through pharmacotherapy and electroacupuncture. However, physical therapy, such as facial muscle exercises, is pivotal in promoting neural remodeling. In this pilot study, we developed an Adaptive Gamified Facial Rehabilitation System based on real-time facial tracking: patients control an avatar by contracting specific facial muscles to fire bullets, and the game automatically adjusts its difficulty according to each user's performance. We recruited ten healthy volunteers and one patient with unilateral facial paralysis. The patient conducted a 21-day intervention combining conventional care with the game-based training system, focusing on activating the zygomaticus major muscle to mitigate drooling and restore facial symmetry. Surface electromyography (EMG) was recorded to quantify muscle activation, and weekly assessments of facial muscle function were conducted. Following the intervention, muscle activation on the affected side increased to 81-90% of the healthy baseline, the House-Brackmann grade improved from IV to II, and Facial Disability Index (FDI) scores rose significantly. Moreover, EMG metrics approached those of the control group. These findings demonstrate that our Adaptive Gamified Facial Rehabilitation System can substantially augment neuromuscular rehabilitation in patients with facial paralysis, offering a feasible approach for personalized neurorehabilitation engineering.