Myoelectric signals of levator palpebrae superioris as a trigger for FES to restore the paralyzed eyelid

Future treatment options for facial nerve palsy: a review on electrical stimulation devices for the orbicularis oculi muscle

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.

A blink restoration system with contralateral EMG triggered stimulation and real-time artifact blanking

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.

Surface electromyography recording of spontaneous eyeblinks: applications in neuroprosthetics

OBJECTIVE

We are designing an implantable neuroprosthesis for the treatment of unilateral facial paralysis. The envisioned biomimetic device paces artificial blinks in the paretic eyelid when activity in the healthy orbicularis oculi (orbicularis) muscle is detected. The present article focuses on electromyography (EMG)-based eyeblink detection.

STUDY DESIGN

A pilot clinical study was performed in healthy volunteers who were intended to represent individuals with facial paralysis. Spontaneous eyeblinks were detected by a surface EMG recording. Blink detection accuracy was tested at rest and during voluntary smiling and chewing.

SETTING

Fifteen participants were asked to wear surface recording electrodes on the left side of their face, detecting the orbicularis oculi, the masseter, and the zygomatic muscle EMG activity.

SUBJECTS AND METHODS

Participants were asked to look ahead, voluntarily smile, and chew according to an experimental protocol. Custom software was designed with the purpose of selectively filtering the multichannel EMG recordings and triggering a digital output.

RESULTS

The software filter allowed elimination of spurious artificial eyeblinks and thus increased the accuracy of the EMG recording apparatus for the spontaneous blinking.

CONCLUSION

Orbicularis oculi EMG recording worked as a real-time eyeblink-detecting system. Moreover, the multichannel EMG recording coupled to a proper digital signal processing was very effective in specifically detecting the spontaneous blinking during other facial muscle activities. With regard to closed-loop biomimetic devices for the pacing of the eyeblink, the EMG signal represents a valid option for the recording side.