Restoration of blink in facial paralysis patients using FES

McDonnall, Daniel; Guillory, K. Shane; Gossman, M. Douglas

doi:10.1109/ner.2009.5109238

Cited by 17 publications

(23 citation statements)

References 6 publications

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“…A prior study observed that rabbits initially flinched in response to orbicularis oculi stimulation, but signs of pain diminished over time (Otto, 1997). There is evidence that FES paradigms including interferential stimulation (McDonnall et al, 2009) and low-intensity multichannel stimulation (Somia et al, 2001) render facial muscle stimulation functional but not painful. Finally, facial FES has been achieved in humans reporting only mild pain (McDonnall et al, 2009; Frigerio et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…Previous research on contralaterally-triggered facial FES has been done in larger animal models and humans over the course of several decades (Zealear and Dedo, 1977; Tobey and Sutton, 1978; Broniatowski et al, 1987, 1989, 1991; Cao et al, 2009; McDonnall et al, 2009; Kurita et al, 2010; Frigerio and Cavallari, 2012). However, the therapy has not advanced beyond proof of concept.…”

Section: Discussionmentioning

confidence: 99%

“…A similar, bilateral, closed-loop approach has been used to rehabilitate hand movements after stroke (Knutson et al, 2012, 2016). In the context of facial paralysis, this closed-loop strategy has been demonstrated in rabbits, dogs, and humans (Zealear and Dedo, 1977; Tobey and Sutton, 1978; Broniatowski et al, 1987, 1989, 1991; Cao et al, 2009; McDonnall et al, 2009; Kurita et al, 2010; Frigerio and Cavallari, 2012; Yi et al, 2013). Most of these studies focused on restoration of eye blink and utilized largely qualitative measures of FES performance.…”

Section: Introductionmentioning

confidence: 99%

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A Rodent Model of Dynamic Facial Reanimation Using Functional Electrical Stimulation

et al. 2017

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Facial paralysis can be a devastating condition, causing disfiguring facial droop, slurred speech, eye dryness, scarring and blindness. This study investigated the utility of closed-loop functional electric stimulation (FES) for reanimating paralyzed facial muscles in a quantitative rodent model. The right buccal and marginal mandibular branches of the rat facial nerve were transected for selective, unilateral paralysis of whisker muscles. Microwire electrodes were implanted bilaterally into the facial musculature for FES and electromyographic (EMG) recording. With the rats awake and head-fixed, whisker trajectories were tracked bilaterally with optical micrometers. First, the relationship between EMG and volitional whisker movement was quantified on the intact side of the face. Second, the effect of FES on whisker trajectories was quantified on the paralyzed side. Third, closed-loop experiments were performed in which the EMG signal on the intact side triggered FES on the paralyzed side to restore symmetric whisking. The results demonstrate a novel in vivo platform for developing control strategies for neuromuscular facial prostheses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Rodent Model of Dynamic Facial Reanimation Using Functional Electrical Stimulation

et al. 2017

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“…A team based at Ripple, llc (Salt Lake City, UT) is developing a fully implantable system for restoration of eye-blink in hemiparalysis patients [52]. The overall concept of the device is to record electromyographic (EMG) signals from a small electrode implanted in the orbicularis oculi muscle on the healthy side of the face [53].…”

Section: Emerging Technologiesmentioning

confidence: 99%

Update in facial nerve paralysis

Langhals

Urbanchek

Ray

et al. 2014

Current Opinion in Otolaryngology & Head and Neck Surgery

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Purpose of review To present recent advances in treatment of facial paralysis, emphasizing emerging technologies. This review will summarize the current state of the art in the management of facial paralysis and discuss advances in nerve regeneration, facial reanimation, and use of novel biomaterials. The review includes surgical innovations in re-innervation and reanimation as well as progress with bioelectrical interfaces. Recent Findings The past decade has witnessed major advances in understanding of nerve injury and approaches for management. Key innovations include strategies to accelerate nerve regeneration, provide tissue-engineered constructs that may replace nonfunctional nerves, approaches to influence axonal guidance, limiting of donor-site morbidity, and optimization of functional outcomes. Approaches to muscle transfer continue to evolve, and new technologies allow for electrical nerve stimulation and use of artificial tissues. Summary The fields of biomedical engineering and facial reanimation increasingly intersect, with innovative surgical approaches complementing a growing array of tissue engineering tools. The goal of treatment remains the predictable restoration of natural facial movement, with acceptable morbidity and long-term stability. Advances in bioelectrical interfaces and nanotechnology hold promise for widening the window for successful treatment intervention and for restoring both lost neural inputs and muscle function.

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“…Previous studies have shown the feasibility of facial pacing in animal models 1,[4][5][6][7][8][9][10] and in humans. 2,3,11 This work focuses on the recording arm of the loop (ie, detecting blinks). Tracking an infrared light beam passing across the eye surface has been shown to provide a simple, noninvasive indication of eyelid closure in humans.…”

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confidence: 99%

Surface Electromyographic Mapping of the Orbicularis Oculi Muscle for Real-Time Blink Detection

Frigerio

Cavallari

Frigeni

et al. 2014

JAMA Facial Plast Surg

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IMPORTANCE Facial paralysis is a life-altering condition that significantly impairs function, appearance, and communication. Facial rehabilitation via closed-loop pacing represents a potential but as yet theoretical approach to reanimation. A first critical step toward closed-loop facial pacing in cases of unilateral paralysis is the detection of healthy movements to use as a trigger to prosthetically elicit automatic artificial movements on the contralateral side of the face.OBJECTIVES To test and to maximize the performance of an electromyography (EMG)-based blink detection system for applications in closed-loop facial pacing. DESIGN, SETTING, AND PARTICIPANTSBlinking was detected across the periocular region by means of multichannel surface EMG at an academic neuroengineering and medical robotics laboratory among 15 healthy volunteers. MAIN OUTCOMES AND MEASURESReal-time blink detection was accomplished by mapping the surface of the orbicularis oculi muscle on one side of the face with a multichannel surface EMG. The biosignal from each channel was independently processed; custom software registered a blink when an amplitude-based or slope-based suprathreshold activity was detected. The experiments were performed when participants were relaxed and during the production of particular orofacial movements. An F1 score metric was used to analyze software performance in detecting blinks. RESULTSThe maximal software performance was achieved when a blink was recorded from the superomedial orbit quadrant. At this recording location, the median F1 scores were 0.89 during spontaneous blinking, 0.82 when chewing gum, 0.80 when raising the eyebrows, and 0.70 when smiling. The overall performance of blink detection was significantly better at the superomedial quadrant (F1 score, 0.75) than at the traditionally used inferolateral quadrant (F1 score, 0.40) (P < .05).CONCLUSIONS AND RELEVANCE Electromyographic recording represents an accurate tool to detect spontaneous blinks as part of closed-loop facial pacing systems. The early detection of blink activity may allow real-time pacing via rapid triggering of contralateral muscles. Moreover, an EMG detection system can be integrated in external devices and in implanted neuroprostheses. A potential downside to this approach involves cross talk from adjacent muscles, which can be notably reduced by recording from the superomedial quadrant of the orbicularis oculi muscle and by applying proper signal processing.LEVEL OF EVIDENCE NA.

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Restoration of blink in facial paralysis patients using FES

Cited by 17 publications

References 6 publications

A Rodent Model of Dynamic Facial Reanimation Using Functional Electrical Stimulation

A Rodent Model of Dynamic Facial Reanimation Using Functional Electrical Stimulation

Update in facial nerve paralysis

Surface Electromyographic Mapping of the Orbicularis Oculi Muscle for Real-Time Blink Detection

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