Who Is Behind the Facial Mask, Kemosabe?

Behind that facial mask, Kemosabe may be the Lone Ranger of Parkinson’s disease (PD). I am a speech pathologist who has Parkinson's. I have treated many patients in my practice for PD. Yes, facial masking can occur in people with Parkinson’s disease due to the facial muscles becoming stiff and hard to move.

One patient of mine, Irving, was 77 years old and diagnosed with PD. He was referred to me by his physician for speech, voice, and swallowing therapy. Upon entering my office, the first thing I noticed was his facial mask and shuffling gait.

Communication challenges

Facial muscles are used, often unconsciously, to display happiness, sadness, confusion, contentment, and many other moods and emotional cues. Irving had PD for 4 years and had a masked face appearance due to his facial muscles not working as they usually would. This caused a disconnect between what Irving was thinking, saying, or feeling and how his facial cues appeared to others.

I discussed with Irving that his facial muscle control was not working as it usually would. I explained that facial gestures give communicative cues as to what is being said. People learn from watching these cues, and the feeling of the message provide before hearing you speak. When there is a disconnect between the visual cues and spoken words, the other person tends to believe the visual facial cues as the true meaning of the message.

Facial masking appears in about 70 percent of patients with PD. It is caused by a decreased amount of dopamine in the brain.¹

Swallowing problems

I explained to Irving that facial masking affects the ability to chew as well as impeding the transport of the food from the mouth. I further counseled him that his swallow reflex was having difficulty triggering him to safely swallow food or drink.

Irving's tongue movement was slow in propelling the food and liquid through his mouth. In addition, his tongue became stiff with decreased propulsion. Therefore, this inhibited my patient's ability to transport the food and trigger a safe swallow reflex. Irving's tongue movement was stiff with weak propulsion that was inhibiting food and liquid being moved from the front of my mouth to the back of the throat.

The social impact

Facial masking reduced my patient's communicative expression to a blank facial stare. He was embarrassed by the lack of facial cues and was having difficulty trying to move his lips in order to smile and show emotion.

I counseled Irving that masking made it more difficult for others to infer from his expression what was being said. He felt that being devoid of facial expression, people will not be able to determine if he was in pain, happy, sad, or any other expressions without facial and verbal cues telling them how he was feeling.

The stages

His speech was becoming distorted by being slow and belabored. The 3 stages of facial masking are mild, moderate and severe. In the mild stage, there is minimal masking such as less movement in the lower face, and less smiling and mouth movements.

In the moderate stage, the masked look is more pronounced. The lips are parted when at rest. Finally, in the severe stage, masking is increased, and the lips are parted most of the time. Irving was in the second stage of masking. I treated Irving by working with him by doing facial exercises and e-stim.²