Unmoving and unmoved: experiences and consequences of impaired non-verbal expressivity in Parkinson’s patients and their spouses

Abstract

Purpose: Hypomimia, or facial masking, is a decrease in voluntary control and spontaneous movement of the muscles of the face, which may occur in Parkinson’s disease. Little is known about the psychosocial consequences or management of this symptom. The aim of this study was to provide an initial overview of patient & spousal experiences of living with an acquired nonverbal expressive impairment in Parkinson’s disease.

Method: This qualitative study involved a community sample of individuals with Parkinson’s who experienced facial masking, and their close romantic partners. Nine people who had Parkinson’s and nine of their spouses or partners participated in separate (individual) semi-structured interviews.

Results: A descriptive thematic approach was used to analyze the interview data. Key themes relevant to rehabilitation included the misidentification of masking as negative affect, poor symptom recognition, and unmet health resource needs.

Conclusions: The results indicate masking can have an adverse impact on close relationships and psychological well-being. This study presents an initial basis for clinicians working with Parkinson’s populations to recognize of the needs of people who experience masking and better support such individuals and their families to live satisfying social and emotional lives.

Implications for Rehabilitation

• People who have Parkinson’s and their families are often unaware facial masking is a symptom of Parkinson’s disease.

• Masking may be confused with negative affect and become a barrier to satisfying close relationships.

• Masking related health resources and support are perceived to be of poor availability and quality.

• This qualitative study suggests masking be considered as an etiology of interpersonal and psychological difficulties in Parkinson’s disease, and encourages better recognition of this unique population’s health education needs.

Keywords:

• Hypomimia
• facial masking
• facial affect
• emotional expressivity
• psychological wellbeing
• psychosocial management

Acknowledgements

The authors thank the participants for sharing their lives and stories. The assistance of Parkinson’s New Zealand is gratefully acknowledged. This article benefited from the suggestions of three anonymous reviewers.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The first author of this study was generously supported by The Bryant Trust Postgraduate Research Scholarship and a University of Waikato Doctoral Scholarship.