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. 2018 Mar 6;15(1):15.
doi: 10.1186/s12984-018-0356-0.

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

Çağdaş Topçu  1   2 , Hilmi Uysal  3 , Ömer Özkan  4 , Özlenen Özkan  4 , Övünç Polat  5 , Merve Bedeloğlu  5 , Arzu Akgül  5 , Ela Naz Döğer  5 , Refik Sever  5 , Ömer Halil Çolak  5
Affiliations

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

Çağdaş Topçu et al. J Neuroeng Rehabil. .

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.

Keywords: Full-face transplantation; complexity; emotional expressions; functional electrical stimulation; fuzzy entropy; rehabilitation; surface electromyography.

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Conflict of interest statement

Ethics Approval and Consent to Participate

All experiments were approved by the local Ethics Committees of the University of Akdeniz. Prior to the experiments, all subjects read and signed and informed consent participation form.

Competing Interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Figure 1
Figure 1
Facial muscle activity representations based on the FuzzyEn method for the lid tightening primary movement. a Estimated muscle activities of patient A before rehabilitation. b Estimated muscle activities of patient A after rehabilitation. c, f Mean value of estimated muscle activities of ten healthy individuals. d Estimated muscle activities of patient B before rehabilitation. e Estimated muscle activities of patient B after rehabilitation.
Figure 2
Figure 2
Facial muscle activity representations on a 3D face model based on the FuzzyEn method for the lid tightening primary movement. a Estimated muscle activities of patient A before rehabilitation. b Estimated muscle activities of patient A after rehabilitation. c, f Mean value of estimated muscle activities of ten healthy individuals. d Estimated muscle activities of patient B before rehabilitation. e Estimated muscle activities of patient B after rehabilitation.
Figure 3
Figure 3
Facial muscle activity representations on a 3D face model based on the FuzzyEn method for the happiness facial expression. a Estimated muscle activities of patient A before rehabilitation. b Estimated muscle activities of patient A after rehabilitation. c, f Mean value of estimated muscle activities of ten healthy individuals. d Estimated muscle activities of patient B before rehabilitation. e Estimated muscle activities of patient B after rehabilitation.
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