Denlinger, R., VanSwearingen, J., Cohn, J., Schmidt, K.L.(2008).
Puckering and blowing facial expressions for patients with facial movement disorders. . Physical Therapy Journalin press.

Abstract
Background and Purpose Individuals with facial movement disorders are instructed to perform various facial movements as part of their physical therapy rehabilitation. A difference in movement of the Orbicularis oris muscle has been demonstrated among people without facial nerve impairments when instructed to “pucker your lips” or “blow, as if blowing out a candle”. The study’s objective was to determine whether the within subjects’ difference between “pucker your lips” or “blow, as if blowing out a candle” found in people without facial nerve impairments is present in people with facial movement disorders. Subjects and method Individuals (N = 67) with unilateral facial movement disorders were observed as they produced puckering and blowing movements. Automated facial image analysis of both puckering and blowing was used to determine the difference between facial actions for the movement variable: maximum speed, amplitude, duration, and each corresponding asymmetry. Results There was a difference between the amplitude of movement for puckering versus blowing. “Blow, as if blowing out a candle” produced greater amplitude of movement. Discussion and Conclusion The findings demonstrate that puckering and blowing movements in patients with facial movement disorders differ in a manner that is consistent to differences found in healthy individuals. This information may be useful in assessment and intervention of facial movement disorders affecting the lower face.