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Journal of NeuroEngineering and Rehabilitation
Published in: Journal of NeuroEngineering and Rehabilitation 1/2018

Open Access 01-12-2018 | Research

Recovery of facial expressions using functional electrical stimulation after full-face transplantation

Authors: Çağdaş Topçu, Hilmi Uysal, Ömer Özkan, Özlenen Özkan, Övünç Polat, Merve Bedeloğlu, Arzu Akgül, Ela Naz Döğer, Refik Sever, Ömer Halil Çolak

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2018

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Abstract

Background

We assessed the recovery of 2 face transplantation patients with measures of complexity during neuromuscular rehabilitation. Cognitive rehabilitation methods and functional electrical stimulation were used to improve facial emotional expressions of full-face transplantation patients for 5 months. Rehabilitation and analyses were conducted at approximately 3 years after full facial transplantation in the patient group. We report complexity analysis of surface electromyography signals of these two patients in comparison to the results of 10 healthy individuals.

Methods

Facial surface electromyography data were collected during 6 basic emotional expressions and 4 primary facial movements from 2 full-face transplantation patients and 10 healthy individuals to determine a strategy of functional electrical stimulation and understand the mechanisms of rehabilitation. A new personalized rehabilitation technique was developed using the wavelet packet method. Rehabilitation sessions were applied twice a month for 5 months. Subsequently, motor and functional progress was assessed by comparing the fuzzy entropy of surface electromyography data against the results obtained from patients before rehabilitation and the mean results obtained from 10 healthy subjects.

Results

At the end of personalized rehabilitation, the patient group showed improvements in their facial symmetry and their ability to perform basic facial expressions and primary facial movements. Similarity in the pattern of fuzzy entropy for facial expressions between the patient group and healthy individuals increased. Synkinesis was detected during primary facial movements in the patient group, and one patient showed synkinesis during the happiness expression. Synkinesis in the lower face region of one of the patients was eliminated for the lid tightening movement.

Conclusions

The recovery of emotional expressions after personalized rehabilitation was satisfactory to the patients. The assessment with complexity analysis of sEMG data can be used for developing new neurorehabilitation techniques and detecting synkinesis after full-face transplantation.
Appendix
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Literature
1.
Topçu Ç, Uysal H, Özkan Ö, Özkan Ö, Polat Ö, Bedeloǧlu M, et al. Assessment of Emotional Expressions after Full-Face Transplantation. Neural Plast. 2017;2017:1–7.
2.
Dixon PL, Zhang X, Domalain M, Flores AM, Lin VW-H. Physical Medicine and Rehabilitation after Face Transplantation - The Know-How of Face Transplantation. In: Siemionow MZ, editor. London: Springer London; 2011. p. 151–72.
3.
Fischer S, Kueckelhaus M, Pauzenberger R, Bueno EM, Pomahac B. Functional outcomes of face transplantation. Am J Transplant. 2015;15:220–33.CrossRefPubMed
4.
Mohan R, Borsuk DE, Dorafshar AH, Wang HD, Bojovic B, Christy MR, et al. Aesthetic and Functional Facial Transplantation. Plast Reconstr Surg. 2014;133:386–97.CrossRefPubMed
5.
Siemionow M. The decade of face transplant outcomes. J Mater Sci Mater Med Springer US. 2017;28:1–4.CrossRef
6.
Gülbetekin E, Bayraktar S, Özkan Ö, Özkan Ö. Subjective Recognition of Emotional Expressions in Face Transplant Patients. J Nonverbal Behav. 2017.
7.
Perry B, Richburg BD, Pomahac B, Bueno EM, Green JR. The Effects of Lip Closure Exercise on Lip Strength and Function Following Facial Transplantation: A Case Report. Manuscr Submitt Publ. 2015;26:682–6.
8.
Uysal H, Topçu Ç, Özkan Ö, Özkan Ö, Barçın E, Akgül A, et al. ID 382 – Electrophysiological evaluation of emotional expressions in the facial transplantation patients. Clin Neurophysiol. 2016;127:e127.CrossRef
9.
Devauchelle B, Badet L, Lengelé B, Morelon E, Testelin S, Michallet M, et al. First human face allograft: early report. Lancet. 2006;368:203–9.CrossRefPubMed
10.
Dubernard J-MM, Lengelé B, Morelon E, Testelin S, Badet L, Moure C, et al. Outcomes 18 months after the first human partial face transplantation. N Engl J Med. 2007;357:2451–60.CrossRefPubMed
11.
Lantieri L, Meningaud JP, Grimbert P, Bellivier F, Lefaucheur JP, Ortonne N, et al. Repair of the lower and middle parts of the face by composite tissue allotransplantation in a patient with massive plexiform neurofibroma: a 1-year follow-up study. Lancet. 2008;372:639–45.CrossRefPubMed
12.
Khalifian S, Brazio PS, Mohan R, Shaffer C, Brandacher G, Barth RN, et al. Facial transplantation: The first 9 years. Lancet. 2014;384:2153–63.CrossRefPubMed
13.
Siemionow M, Papay F, Alam D, Bernard S, Djohan R, Gordon C, et al. Near-total human face transplantation for a severely disfigured patient in the USA. Lancet. 2009;374:203–9.CrossRefPubMed
14.
15.
Barret JP, Gavaldà J, Bueno J, Nuvials X, Pont T, Masnou N, et al. Full Face Transplant. Ann Surg. 2011;254:252–6.CrossRefPubMed
16.
Giatsidis G, Sinha I, Pomahac B. Reflections on a Decade of Face Transplantation. Ann Surg. 2017;265:841–6.
17.
Valls-Solé J. Facial palsy, postparalytic facial syndrome, and hemifacial spasm. Mov Disord. 2002;17:49–52.CrossRef
18.
Valls-Solé J. Electrodiagnostic studies of the facial nerve in peripheral facial palsy and hemifacial spasm. Muscle and Nerve. 2007;36:14–20.CrossRefPubMed
19.
Ferrante S, Bejarano NC, Ambrosini E, Nardone A, Turcato AM, Monticone M, et al. A personalized multi-channel FES controller based on muscle synergies to support gait rehabilitation after stroke. Front Neurosci. 2016;10:425.
20.
Ho CH, Triolo RJ, Elias AL, Kilgore KL, DiMarco AF, Bogie K, et al. Functional electrical stimulation and Spinal Cord Injury. Phys Med Rehabil Clin N Am. 2014;25:631–54.CrossRefPubMedPubMedCentral
21.
Hausmann J, Sweeney-Reed CM, Sobieray U, Matzke M, Heinze HJ, Voges J, et al. Functional electrical stimulation through direct 4-channel nerve stimulation to improve gait in multiple sclerosis: a feasibility study. J Neuroeng Rehabil. 2015;12:100. do:96–100CrossRefPubMedPubMedCentral
22.
Chen W, Wang Z, Xie H, Yu W. Characterization of surface EMG signal based on fuzzy entropy. IEEE Trans Neural Syst Rehabil Eng. 2007;15:266–72.CrossRefPubMed
23.
Xie HB, Guo JY, Zheng YP. Fuzzy approximate entropy analysis of chaotic and natural complex systems: Detecting muscle fatigue using electromyography signals. Ann Biomed Eng. 2010;38:1483–96.CrossRefPubMed
24.
Ao D, Sun R, Tong K, yu SR. Characterization of Stroke- and Aging-Related Changes in the Complexity of EMG Signals During Tracking Tasks. Ann Biomed Eng. 2015;43:990–1002.CrossRefPubMed
25.
Sun W, Liang J, Yang Y, Wu Y, Yan T, Song R. Investigating aging-related changes in the coordination of agonist and antagonist muscles using fuzzy entropy and mutual information. Entropy. 2016;18:229.
26.
Jian C, Wei M, Luo J, Lin J, Zeng W, Huang W, et al. Multiparameter electromyography analysis of the masticatory muscle activities in patients with brainstem stroke at different head positions. Front Neurol. 2017;8:1–10.CrossRef
27.
Sun R, Song R, Tong K. Complexity Analysis of EMG Signals for Patients After Stroke During Robot-Aided Rehabilitation Training Using Fuzzy Approximate Entropy. IEEE Trans Neural Syst Rehabil Eng. 2014;22:1013–9.CrossRefPubMed
28.
Popovic-Bijelic A, Bijelic G, Jorgovanovic N, Bojanic D, Popovic MB, Popovic DB, et al. Multi-Field Surface Electrode for Selective Electrical Stimulation. Artif Organs. 2005;29:448–52.CrossRefPubMed
29.
Westerveld AJ, Schouten AC, Veltink PH, Selectivity VDKH. resolution of surface electrical stimulation for grasp and release. IEEE Trans Neural Syst Rehabil Eng. 2012;20:94–101.CrossRefPubMed
30.
Uysal H, Özkan Ö, Barçin E, Şenol U, Tombak K, Özkan Ö. Referred facial sensation on the hand after full face transplantation. Neurology. 2016;86:836–9.CrossRefPubMed
31.
Pincus SM, Gladstone IM, Ehrenkranz RAA. regularity statistic for medical data analysis. J Clin Monit. 1991;7:335–45.CrossRefPubMed
32.
Richman JS, R. MJ, Moorman JR. Physiological time-series analysis using approximate entropy and sample entropy. Am J Physiol Hear Circ Physiol. 2000;278:H2039–49.CrossRef
33.
Topçu Ç. Assessing functional recovery of face and arm transplantation and trauma patients with nonliner methods (Master’s Thesis). Antalya: Akdeniz University; 2016.
34.
Beurskens CHG, Heymans PG. Positive Effects of Mime Therapy on Sequelae of Facial Paralysis : Stiffness. Lip Mobility, and Social and Physical Aspects of Facial Disability. 2003;24:677–81.
35.
Jayatilake D, Isezaki T, Teramoto Y, Eguchi K, Suzuki K. Robot assisted physiotherapy to support rehabilitation of facial paralysis. IEEE Trans Neural Syst Rehabil Eng. 2014;22:644–53.CrossRefPubMed
36.
Aycart MA, Perry B, Alhefzi M, Bueno EM, Kueckelhaus M, Fischer S, et al. Surgical Optimization of Motor Recovery in Face Transplantation. J Craniofac Surg. 2016;27:286–92.CrossRefPubMed
37.
De Letter M, Vanhoutte S, Aerts A, Santens P, Vermeersch H, Roche N, et al. Facial nerve regeneration after facial allotransplantation: A longitudinal clinical and electromyographic follow-up of lip movements during speech. J Plast Reconstr Aesthetic Surg Elsevier Ltd. 2017;70:729–33.CrossRef
38.
Metadata
Title
Recovery of facial expressions using functional electrical stimulation after full-face transplantation
Authors
Çağdaş Topçu
Hilmi Uysal
Ömer Özkan
Özlenen Özkan
Övünç Polat
Merve Bedeloğlu
Arzu Akgül
Ela Naz Döğer
Refik Sever
Ömer Halil Çolak
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Journal of NeuroEngineering and Rehabilitation / Issue 1/2018
Electronic ISSN: 1743-0003
DOI
https://doi.org/10.1186/s12984-018-0356-0

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