Abstract
BackgroundWe 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.MethodsFacial 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.ResultsAt 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.ConclusionsThe 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.
Highlights
We assessed the recovery of 2 face transplantation patients with measures of complexity during neuromuscular rehabilitation
A healthy individual performed the same movements with patients concurrently to develop the cognitive aspect of the rehabilitation process; pictures of the emotional expressions and a live video of the patients’ own faces were shown simultaneously to the patients during electrical stimulations and facial Surface electromyography (sEMG) recordings to improve the same aspect of the rehabilitation method
Patient B showed more balance in this expression, and the similarity in the pattern of fuzzy entropy for this emotional motion between patient B and healthy individuals increased after the rehabilitation process
Summary
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. Recovery of facial expressions improves the nonverbal communication and social interactions of patients; it can be considered as an integral part of the rehabilitation of patients after transplantation. Since 2005, 37 partial and full-face transplantations have been performed worldwide [5, 10,11,12,13,14,15]. The ability to perform facial expressions improved in 76% of the reported 24 facial transplantation recipients worldwide [3]. The nature of involuntary eyelid blink restoration is a complicated process, and reinnervation is unpredictable [4]
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