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Mäkelä E, Venesvirta H, Ilves M, Lylykangas J, Rantanen V, Uusitalo H, Verho J, Vehkaoja A, Lekkala J, Surakka V, Rautiainen M. Electrically Induced Blink for the Prevention of Ocular Symptoms and Blurred Vision in Patients With Acute Facial Nerve Palsy. EAR, NOSE & THROAT JOURNAL 2024; 103:NP294-NP300. [PMID: 34714168 DOI: 10.1177/01455613211048576] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Facial nerve palsy causes blurred vision and ocular discomfort due to deficits in blinking and eye closure. The objective of this study was to determine whether eye-blinks could be elicited by electrical stimulation and whether electrically induced blink would have an effect on the visual acuity and ocular symptoms in patients with acute facial nerve palsy. Methods: The zygomatic branch of the facial nerve of fifteen participants with acute facial nerve palsy was electrically stimulated in order to elicit a blink. In successful cases, the participant proceeded with a two-hour TV watching session in which an electrically induced blink was delivered every 5 seconds. The control condition consisted of an otherwise similar TV watching session without electrically induced blinking. Subjective ocular symptoms were evaluated with a Dry Eye Questionnaire and visual acuity was assessed with a Logarithm of the Minimum Angle of Resolution (LogMAR) chart before and after both sessions. Results: The stimulation produced a blink in 8 participants (53%). The visual acuity in the affected eye decreased during the control session, whereas no significant change occurred during the stimulation session. The ocular symptoms were significantly reduced during the stimulation session. Conclusions: Electrically elicited blink is a promising method for reducing the eye symptoms in individuals with acute facial nerve palsy.
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Affiliation(s)
- Eeva Mäkelä
- Department of Clinical Neurophysiology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hanna Venesvirta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mirja Ilves
- Research Group for Emotions, Sociality, and Computing, Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Jani Lylykangas
- Research Group for Emotions, Sociality, and Computing, Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Ville Rantanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hannu Uusitalo
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Ophthalmology, Tampere University Hospital, Tampere, Finland
| | - Jarmo Verho
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Vehkaoja
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jukka Lekkala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Veikko Surakka
- Research Group for Emotions, Sociality, and Computing, Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Markus Rautiainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
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Scherrer E, Chaloupka K. Future treatment options for facial nerve palsy: a review on electrical stimulation devices for the orbicularis oculi muscle. Neurol Sci 2024; 45:1969-1977. [PMID: 38114854 PMCID: PMC11021255 DOI: 10.1007/s10072-023-07226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023]
Abstract
Facial nerve palsy can cause diminished eyelid closure (lagophthalmos). This occurs due to functional deficits of the orbicularis oculi muscle, potentially leading to sight-threatening complications due to corneal exposure. Current management options range from frequent lubrication with eye drops, to the use of moisture chambers and surgery. However, achieving functional restoration may not always be possible. Recent efforts have been directed towards the support of orbicularis oculi muscle function through electrical stimulation. Electrical stimulation of the orbicularis oculi muscle has been demonstrated as feasible in human subjects. This article offers a comprehensive review of electrical stimulation parameters necessary to achieve full functionality and a natural-looking eye blink in human subjects. At present, readily available portable electrical stimulation devices remain unavailable. This review lays the foundation for advancing knowledge from laboratory research to clinical practice, with the ultimate objective of developing a portable electrical stimulation device. Further research is essential to enhance our understanding of electrical stimulation, establish safety standards, determine optimal current settings, and investigate potential side effects.
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Affiliation(s)
- Elena Scherrer
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Karla Chaloupka
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Ilves M, Lylykangas J, Rantanen V, Mäkelä E, Vehkaoja A, Verho J, Lekkala J, Rautiainen M, Surakka V. Facial muscle activations by functional electrical stimulation. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2018.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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De Bonnecaze G, Vergez S, Chaput B, Vairel B, Serrano E, Chantalat E, Chaynes P. Variability in facial‐muscle innervation: A comparative study based on electrostimulation and anatomical dissection. Clin Anat 2018; 32:169-175. [DOI: 10.1002/ca.23081] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/11/2018] [Accepted: 03/20/2018] [Indexed: 11/09/2022]
Affiliation(s)
- G. De Bonnecaze
- Department of Head and Neck SurgeryUniversity of Toulouse CHU Rangueil‐Larrey France
- Department of AnatomyUniversity of Toulouse CHU Rangueil‐Larrey France
| | - S. Vergez
- Department of Head and Neck SurgeryUniversity of Toulouse CHU Rangueil‐Larrey France
| | - B. Chaput
- Department of Plastic and Aesthetic SurgeryUniversity of Toulouse CHU Rangueil‐Larrey France
| | - B. Vairel
- Department of Head and Neck SurgeryUniversity of Toulouse CHU Rangueil‐Larrey France
| | - E. Serrano
- Department of Head and Neck SurgeryUniversity of Toulouse CHU Rangueil‐Larrey France
| | - E. Chantalat
- Department of AnatomyUniversity of Toulouse CHU Rangueil‐Larrey France
| | - P. Chaynes
- Department of AnatomyUniversity of Toulouse CHU Rangueil‐Larrey France
- Department of NeurosurgeryUniversity of Toulouse, Pierre‐Paul Riquet Hospital France
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Pepper JP, Wang TV, Hennes V, Sun SY, Ichida JK. Human Induced Pluripotent Stem Cell-Derived Motor Neuron Transplant for Neuromuscular Atrophy in a Mouse Model of Sciatic Nerve Injury. JAMA FACIAL PLAST SU 2017; 19:197-205. [PMID: 27978547 DOI: 10.1001/jamafacial.2016.1544] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Human motor neurons may be reliably derived from induced pluripotent stem cells (iPSCs). In vivo transplant studies of human iPSCs and their cellular derivatives are essential to gauging their clinical utility. Objective To determine whether human iPSC-derived motor neurons can engraft in an immunodeficient mouse model of sciatic nerve injury. Design, Setting, and Subjects This nonblinded interventional study with negative controls was performed at a biomedical research institute using an immunodeficient, transgenic mouse model. Induced pluripotent stem cell-derived motor neurons were cultured and differentiated. Cells were transplanted into 32 immunodeficient mice with sciatic nerve injury aged 6 to 15 weeks. Tissue analysis was performed at predetermined points after the mice were killed humanely. Animal experiments were performed from February 24, 2015, to May 2, 2016, and data were analyzed from April 7, 2015, to May 27, 2016. Interventions Human iPSCs were used to derive motor neurons in vitro before transplant. Main Outcomes and Measures Evidence of engraftment based on immunohistochemical analysis (primary outcome measure); evidence of neurite outgrowth and neuromuscular junction formation (secondary outcome measure); therapeutic effect based on wet muscle mass preservation and/or electrophysiological evidence of nerve and muscle function (exploratory end point). Results In 13 of the 32 mice undergoing the experiment, human iPSC-derived motor neurons successfully engrafted and extended neurites to target denervated muscle. Human iPSC-derived motor neurons reduced denervation-induced muscular atrophy (mean [SD] muscle mass preservation, 54.2% [4.0%]) compared with negative controls (mean [SD] muscle mass preservation, 33.4% [2.3%]) (P = .04). No electrophysiological evidence of muscle recovery was found. Conclusions and Relevance Human iPSC-derived motor neurons may have future use in the treatment of peripheral motor nerve injury, including facial paralysis. Level of Evidence NA.
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Affiliation(s)
- Jon-Paul Pepper
- USC (University of Southern California) Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, USC, Los Angeles
| | - Tiffany V Wang
- USC (University of Southern California) Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, USC, Los Angeles
| | - Valerie Hennes
- Department of Regenerative Medicine and Stem Cell Biology, Broad CIRM (California Institute for Regenerative Medicine) Center, Keck School of Medicine, USC, Los Angeles
| | - Soo Yeon Sun
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, USC, Los Angeles
| | - Justin K Ichida
- Department of Regenerative Medicine and Stem Cell Biology, Broad CIRM (California Institute for Regenerative Medicine) Center, Keck School of Medicine, USC, Los Angeles
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Attiah MA, de Vries J, Richardson AG, Lucas TH. A Rodent Model of Dynamic Facial Reanimation Using Functional Electrical Stimulation. Front Neurosci 2017; 11:193. [PMID: 28424583 PMCID: PMC5380723 DOI: 10.3389/fnins.2017.00193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/21/2017] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- Mark A Attiah
- Department of Neurosurgery, Center for Neuroengineering and Therapeutics, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA, USA
| | - Julius de Vries
- Department of Neurosurgery, Center for Neuroengineering and Therapeutics, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA, USA
| | - Andrew G Richardson
- Department of Neurosurgery, Center for Neuroengineering and Therapeutics, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA, USA
| | - Timothy H Lucas
- Department of Neurosurgery, Center for Neuroengineering and Therapeutics, Perelman School of Medicine, University of PennsylvaniaPhiladelphia, PA, USA
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Rantanen V, Ilves M, Vehkaoja A, Kontunen A, Lylykangas J, Makela E, Rautiainen M, Surakka V, Lekkala J. A survey on the feasibility of surface EMG in facial pacing. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:1688-1691. [PMID: 28268652 DOI: 10.1109/embc.2016.7591040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A survey on the feasibility of surface electromyography (EMG) measurements in facial pacing is presented. Pacing for unilateral facial paralysis consists of the measurement of activity from the healthy side of the face and functional electrical stimulation to reanimate the paralyzed one. The goal of this study is to evaluate the feasibility of surface EMG as a measurement method to detect muscle activations and to determine their intensities. Prior work is discussed, and results from experiments where 12 participants carried out a set of facial movements are presented. EMG was registered from zygomaticus major (smile), orbicularis oris (lip pucker), orbicularis oculi (eye blink), corrugator supercilii (frown), and masseter (chew). Most important facial functions that are limited due to the paralysis are blinking, smiling, and puckering. With majority of the participants, crosstalk between the measured EMG channels was found to be acceptably small to be able to pace smiling and puckering based on detecting their contraction intensities from the healthy side. However, pacing blinking based on orbicularis oculi EMG measurement does not seem possible due to crosstalk from other muscles, but the electro-oculographic (EOG) signals that couple to the same measurement channel could help to detect eye blinks and trigger stimuli. Futhermore, masseter greatly disturbs EMG measurement of most facial muscles, which needs to be addressed in the pacing system to avoid falsely interpreting its activity as the activity of another muscle.
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Bayrak AF, Olgun Y, Ozbakan A, Aktas S, Kulan CA, Kamaci G, Demir E, Yilmaz O, Olgun L. The Effect of Insulin Like Growth Factor-1 on Recovery of Facial Nerve Crush Injury. Clin Exp Otorhinolaryngol 2017; 10:296-302. [PMID: 28264555 PMCID: PMC5678033 DOI: 10.21053/ceo.2016.00997] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/30/2016] [Accepted: 01/09/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The aim of this study is to investigate the efficacy of locally applied insulin-like growth factor 1 (IGF-1) on the recovery of facial nerve functions after crush injury in a rabbit model. METHODS The rabbits were randomly assigned into three groups. Group 1 consisted of the rabbits with crush injury alone; group 2, the animals applied saline solution onto the crushed facial nerve and group 3, IGF-1 implemented to the nerve in the same manner. Facial nerve injury was first electrophysiologically studied on 10th and 42nd days of the procedure. The damage to the facial nerves was then investigated histopathologically, after sacrification of the animals. RESULTS In the electrophysiological study, compound muscle action potential amplitudes of the crushed nerves in the second group were decreased. In pathological specimens of the first and second groups, the orders of axons were distorted; demyelination and proliferation of Schwann cells were observed. However, in IGF-1 treated group axonal order and myelin were preserved, and Schwann cell proliferation was close to normal (P<0.05). CONCLUSION Local application of IGF-1 in a slow releasing gel was found efficacious in the recovery of the facial nerve crush injury in rabbits. IGF-1 was considered worthy of being tried in clinical studies in facial nerve injury cases.
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Affiliation(s)
- Asuman Feda Bayrak
- Otolaryngology Department, Izmir Ataturk Training and Research Hospital, Izmir, Turkey
| | - Yuksel Olgun
- Otolaryngology Department, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Ayla Ozbakan
- Otorhinolaryngology Department, Kutahya Simav State Hospital, Kutahya, Turkey
| | - Safiye Aktas
- Basic Oncology Department, Dokuz Eylul University, Institue of Oncology, Izmir, Turkey
| | - Can Ahmet Kulan
- Neurology Department, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Gonca Kamaci
- Dokuz Eylul University, Animal Laboratory, Izmir, Turkey
| | - Emine Demir
- Otorhinolaryngology Department, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Osman Yilmaz
- Dokuz Eylul University, Animal Laboratory, Izmir, Turkey
| | - Levent Olgun
- Otorhinolaryngology Department, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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Raslan A, Volk GF, Möller M, Stark V, Eckhardt N, Guntinas-Lichius O. High variability of facial muscle innervation by facial nerve branches: A prospective electrostimulation study. Laryngoscope 2016; 127:1288-1295. [PMID: 27753086 DOI: 10.1002/lary.26349] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/16/2016] [Accepted: 09/12/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To examine by intraoperative electric stimulation which peripheral facial nerve (FN) branches are functionally connected to which facial muscle functions. STUDY DESIGN Single-center prospective clinical study. METHODS Seven patients whose peripheral FN branching was exposed during parotidectomy under FN monitoring received a systematic electrostimulation of each branch starting with 0.1 mA and stepwise increase to 2 mA with a frequency of 3 Hz. The electrostimulation and the facial and neck movements were video recorded simultaneously and evaluated independently by two investigators. RESULTS A uniform functional allocation of specific peripheral FN branches to a specific mimic movement was not possible. Stimulation of the whole spectrum of branches of the temporofacial division could lead to eye closure (orbicularis oculi muscle function). Stimulation of the spectrum of nerve branches of the cervicofacial division could lead to reactions in the midface (nasal and zygomatic muscles) as well as around the mouth (orbicularis oris and depressor anguli oris muscle function). Frontal and eye region were exclusively supplied by the temporofacial division. The region of the mouth and the neck was exclusively supplied by the cervicofacial division. Nose and zygomatic region were mainly supplied by the temporofacial division, but some patients had also nerve branches of the cervicofacial division functionally supplying the nasal and zygomatic region. CONCLUSIONS FN branches distal to temporofacial and cervicofacial division are not necessarily covered by common facial nerve monitoring. Future bionic devices will need a patient-specific evaluation to stimulate the correct peripheral nerve branches to trigger distinct muscle functions. LEVEL OF EVIDENCE 4 Laryngoscope, 127:1288-1295, 2017.
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Affiliation(s)
- Ashraf Raslan
- Department of Otorhinolaryngology and Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology and Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Martin Möller
- Department of Otorhinolaryngology and Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Vincent Stark
- University of Applied Sciences Technikum Wien, Vienna, Austria
| | | | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology and Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
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Current state of stem cell-mediated therapies for facial nerve injury. Curr Opin Otolaryngol Head Neck Surg 2016; 24:285-93. [DOI: 10.1097/moo.0000000000000292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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The effective stimulating pulse for restoration of blink function in unilateral facial nerve paralysis rabbits, verified by a simple FES system. Eur Arch Otorhinolaryngol 2016; 273:2959-64. [PMID: 26742906 DOI: 10.1007/s00405-015-3884-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
The trains of 200 ms biphasic square pulses with the width of 9 ms delivered at 50 Hz were found to be the most suitable and effective mean as stimulation in FES system of restoring the blink function in unilateral facial nerve paralysis rabbit model. FES system is a reliable tool for these patients. Facial paralysis affects thousands of people every year. Many will have long term facial difficulties and the loss of the ability to blink the eye, which can lead to potential loss of the eye. Although many treatments exist, no one approach corrects all the deficits associated with the loss of orbicularis oculi function. FES is a means of providing movement in paralysed muscles to assist with practical activities and one possible way of restoring blink and other functions in these patients. Although some previous researches had investigated the effect of simple FES system on restoration of paralyzed facial muscles, there is still controversy about the appropriate details of the most effective stimulating pulses, such as the frequency, wave pattern and pulse width. Our aim is to find out the parameters of the most appropriate and effective stimulatin verify it by a simple FES system. 24 healthy adult male New Zealand white rabbits were accepted the surgery of right side facial nerve main trunk transaction under general anesthesia as the unilateral facial nerve paralysis models. The platinum tungsten alloy electrodes were implanted in orbicularis oculi muscle. The parameters of stimulus pulses were set to a 200 ms biphasic pulse with different waveforms (square, sine and triangle), different frequencies (25, 50, 100 Hz) and different widths from 1 to 9 ms. Next, we set up a simple FES system to verify the previous results as the stimulus signal. We observed the movement of the both sides of eyelid when eye blink induced by different kinds of pulses. In all animals, the three kinds of waveforms pulse with frequency of 25 Hz could not evoke the smooth blink movement. But the pulses with frequency of 50 and 100 Hz can achieve this effect. The voltage threshold of the square pulse was lower than that of the sine pulse and triangle pulse. With the increase of pulse width from 1 to 9 ms, the voltage threshold decreased gradually. The voltage threshold of the pulse with frequency of 100 Hz was obviously lower than that of 50 Hz. But the amount of total charge of the stimulation pulse of 100 Hz was significantly more than that of 50 Hz. In addition, when the FES system was turned on, the eye blink on the affected side with the stimulation pulses that were set by the previous step results was successfully aroused by the blink movement as a trigger on the contralateral.
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12
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Electrical Stimulation of Eye Blink in Individuals with Acute Facial Palsy. Plast Reconstr Surg 2015; 136:515e-523e. [DOI: 10.1097/prs.0000000000001639] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Frigerio A, Cavallari P, Frigeni M, Pedrocchi A, Sarasola A, Ferrante S. Surface electromyographic mapping of the orbicularis oculi muscle for real-time blink detection. JAMA FACIAL PLAST SU 2015; 16:335-42. [PMID: 25033260 DOI: 10.1001/jamafacial.2014.283] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
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 PARTICIPANTS Blinking 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 MEASURES Real-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. RESULTS The 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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Affiliation(s)
- Alice Frigerio
- Human Physiology Section, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy2Facial Nerve Center, Carolyn and Peter Lynch Center for Laser and Reconstructive Surgery, Division of Facial Plastic and Reconstruc
| | - Paolo Cavallari
- Human Physiology Section, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Marta Frigeni
- Human Physiology Section, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Pedrocchi
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Andrea Sarasola
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
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Yi X, Jia J, Deng S, Shen SG, Xie Q, Wang G. A blink restoration system with contralateral EMG triggered stimulation and real-time artifact blanking. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2013; 7:140-148. [PMID: 23853296 DOI: 10.1109/tbcas.2013.2255051] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Patients suffering from facial paralysis are on the hazard of disfigurement and loss of vision due to loss of blink function. Functional-electrical stimulation (FES) is one possible way of restoring blink and other functions in these patients. A blink restoration system for uni-lateral facial paralyzed patients is described in this paper. The system achieves restoration of synchronized blink through processing the myoelectric signal of orbicularis oculi at the normal side in real-time as the trigger to stimulate the paralyzed eyelid. Design issues are discussed, including EMG processing, stimulating strategies and real-time artifact blanking. Two artifact removal approaches based on sample and hold and digital filtering technique are proposed and implemented. Finally, the whole system has been verified on rabbit models.
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Affiliation(s)
- Xin Yi
- School of Microelectronics, Shanghai Jiao Tong University, Shanghai 200240, China
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A new gyro-based method for quantifying eyelid motion. Int J Artif Organs 2013; 36:195-202. [PMID: 23446763 DOI: 10.5301/ijao.5000178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE We present an innovative method to quantify the eyeblink by using a miniature gyroscopic sensor (gyro), which is applied on the upper eyelid. Electrical Stimulation (ES) of the facial nerve is a promising technology to treat dysfunctional eyelid closure following facial paralysis. We used the new gyro-based method to evaluate the biomechanics of both the spontaneous and the ES-induced eyeblink, and to identify the best ES protocol.
METHODS During blinking, eyelids rotate about the axis passing through the eye canthi, thus we propose to use a gyro for measuring the angular velocity of the upper eyelid (ωe ). The angular displacement of the eyelid (θe ) was calculated by integrating the ωe signal. Two indices were derived from θe: 1) the eyelid angular displacement during eye closure (C), calculated as the peak value of θe ; 2) the eyelid closure duration (D), calculated as the time interval between zero signal and the peak value of θe. In a healthy volunteer we used this method to quantify both the spontaneous eyeblink and the blinks elicited by different ES patterns.
RESULTS For the spontaneous eyeblink, indices C = 14.0 ± 1.8° and D = 94.0 ± 10.8 ms were computed. By comparing C and D indices for spontaneous and ES cases, trains of 10 pulses with a frequency ranging from 200 Hz to 400 Hz proved to induce the most effective and natural-like eyeblinks.
CONCLUSIONS The new gyro-based method proved to be a valuable tool to provide dynamic and real-time quantification of eyelid motions. It could be particularly useful for evaluating the effective and natural-like eyeblink restoration provided by ES.
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Rui YF, Liu JQ, Yang B, Yang CS, Wei DX. Mechanical and electrical stability of parylene-based platinum-black coated wire microelectrode for implantable applications. J APPL ELECTROCHEM 2012. [DOI: 10.1007/s10800-012-0476-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cockerham K, Aro S, Liu W, Pantchenko O, Olmos A, Oehlberg M, Sivaprakasam M, Crow L. Application of MEMS technology and engineering in medicine: a new paradigm for facial muscle reanimation. Expert Rev Med Devices 2008; 5:371-81. [PMID: 18452387 DOI: 10.1586/17434440.5.3.371] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Translational research may lead to development of micro-electromechanical system-based devices to treat muscle and nerve dysfunctions whose current treatments are inadequate and, at best, palliative. This paper discusses the development of engineered microsystems as a treatment option for palsies of the seventh cranial nerve and the potential application of these devices as a platform technology for treatment of other nervous dysfunctions. The engineering techniques for electrical and chemical stimulation of denervated muscle are discussed along with current caveats from clinical and engineering standpoints. As opposed to current treatments, miniaturized implants offer the possibility of the reduced toxicity and increased specificity of direct drug delivery. As with the increased miniaturization of other technologies, engineering of these increasingly small implantable microsystems holds great promise for the future development of yet smaller, even nanoscale, implantable devices.
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Affiliation(s)
- Kimberly Cockerham
- Department of Ophthalmology, Stanford University, Stanford, CA 94305, USA.
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Animal Welfare aspects of the killing and skinning of seals - Scientific Opinion of the Panel on Animal Health and Welfare. EFSA J 2007. [DOI: 10.2903/j.efsa.2007.610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Sachs NA, Chang EL, Weiland JD. Kinematics of electrically elicited eyelid movement. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2006; 2006:2380-2383. [PMID: 17946955 DOI: 10.1109/iembs.2006.260312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Electrical stimulation has demonstrated potential for reanimating eye blink following facial paralysis caused by damage to the seventh cranial nerve. This study investigated the kinematics of lid movement caused by electrical stimulation of the orbicularis oculi muscle in both normal rabbit and rabbit with surgically induced seventh nerve lesion.
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Affiliation(s)
- Nicholas A Sachs
- Doheny Eye Institute and the Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA.
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