1
|
Schuhmann L, Büchner T, Heinrich M, Volk GF, Denzler J, Guntinas-Lichius O. Automated analysis of spontaneous eye blinking in patients with acute facial palsy or facial synkinesis. Sci Rep 2024; 14:17726. [PMID: 39085410 PMCID: PMC11292012 DOI: 10.1038/s41598-024-68707-x] [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: 02/14/2024] [Accepted: 07/26/2024] [Indexed: 08/02/2024] Open
Abstract
Although patients with facial palsy often complain of disturbed eye blinking which may lead to visual impairment, a blinking analysis is not part of routine grading of facial palsy. Twenty minutes of spontaneous eye blinking at rest of 30 patients with facial palsy (6 with acute palsy; 24 patients with facial synkinesis; median age: 58 years, 67% female), and 30 matched healthy probands (median age: 57 years; 67% female) was smart phone video recorded. A custom computer program automatically extracted eye measures and determined the eye closure rate (eye aspect ratio [EAR]), blink frequency, and blink duration. Facial Clinimetric Evaluation (FaCE), Facial Disability Index (FDI) were assessed as patient-reported outcome measures. The minimal EAR, i.e., minimal visible eye surface during blinking, was significantly higher on the paretic side in patients with acute facial palsy than in patients with synkinesis or in healthy controls. The blinking frequency on the affected side was significantly lower in both patient groups compared to healthy controls. Vice versa, blink duration was longer in both patient groups. There was no clear correlation between the blinking values and FaCE and FDI. Blinking parameters are easy to estimate automatically and add a functionally important parameter to facial grading.
Collapse
Affiliation(s)
- Lukas Schuhmann
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Tim Büchner
- Computer Vision Group, Friedrich Schiller University Jena, Jena, Germany
| | - Martin Heinrich
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Joachim Denzler
- Computer Vision Group, Friedrich Schiller University Jena, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany.
- Center for Rare Diseases, Jena University Hospital, Jena, Germany.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Efthimiou TN, Hernandez MP, Elsenaar A, Mehu M, Korb S. Application of facial neuromuscular electrical stimulation (fNMES) in psychophysiological research: Practical recommendations based on a systematic review of the literature. Behav Res Methods 2024; 56:2941-2976. [PMID: 37864116 PMCID: PMC11133044 DOI: 10.3758/s13428-023-02262-7] [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] [Accepted: 09/29/2023] [Indexed: 10/22/2023]
Abstract
Facial neuromuscular electrical stimulation (fNMES), which allows for the non-invasive and physiologically sound activation of facial muscles, has great potential for investigating fundamental questions in psychology and neuroscience, such as the role of proprioceptive facial feedback in emotion induction and emotion recognition, and may serve for clinical applications, such as alleviating symptoms of depression. However, despite illustrious origins in the 19th-century work of Duchenne de Boulogne, the practical application of fNMES remains largely unknown to today's researchers in psychology. In addition, published studies vary dramatically in the stimulation parameters used, such as stimulation frequency, amplitude, duration, and electrode size, and in the way they reported them. Because fNMES parameters impact the comfort and safety of volunteers, as well as its physiological (and psychological) effects, it is of paramount importance to establish recommendations of good practice and to ensure studies can be better compared and integrated. Here, we provide an introduction to fNMES, systematically review the existing literature focusing on the stimulation parameters used, and offer recommendations on how to safely and reliably deliver fNMES and on how to report the fNMES parameters to allow better cross-study comparison. In addition, we provide a free webpage, to easily visualise fNMES parameters and verify their safety based on current density. As an example of a potential application, we focus on the use of fNMES for the investigation of the facial feedback hypothesis.
Collapse
Affiliation(s)
| | | | - Arthur Elsenaar
- ArtScience Interfaculty, Royal Academy of Art, Royal Conservatory, The Hague, Netherlands
| | - Marc Mehu
- Department of Psychology, Webster Vienna Private University, Vienna, Austria
| | - Sebastian Korb
- Department of Psychology, University of Essex, Colchester, UK.
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria.
| |
Collapse
|
4
|
Hosseini SS, Yamini B, Ichkitidze L, Asadi M, Fernandez J, Gholampour S. Enhanced Ionic Polymer-Metal Composites with Nanocomposite Electrodes for Restoring Eyelid Movement of Patients with Ptosis. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 13:473. [PMID: 36770434 PMCID: PMC9920823 DOI: 10.3390/nano13030473] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
The present study aims to use enhanced ionic polymer-metal composites (IPMC) as an artificial muscle (a soft-active actuator) to restore eyelid movement of patients with ptosis. The previous eyelid movement mechanisms contained drawbacks, specifically in the lower eyelid. We used finite element analysis (FEA) to find the optimal mechanism among two different models (A and B). In addition to common electrodes of IPMC (gold and platinum), the bovine serum albumin (BSA) and microcrystalline cellulose (MCC) polymers, with optimal weight percentages of carbon nanotube (CNT) nanofiller, were also utilized as non-metallic electrodes to improve the efficiency of the IPMC actuator. In both models, IPMC with nanocomposite electrodes had higher efficiency as compared to the metallic electrodes. In model A, which moved eyelids indirectly, IPMC with MCC-CNT electrode generated a higher force (25.4%) and less stress (5.9 times) as compared to IPMC with BSA-CNT electrode. However, the use of model A (even with IPMCs) with nanocomposite electrodes can have limitations such as possible malposition issues in the eyelids (especially lower). IPMC with MCC-CNT nanocomposite electrode under model B, which moved eyelids directly, was the most efficient option to restore eyelid movement. It led to higher displacements and lower mechanical stress damage as compared to the BSA-CNT. This finding may provide surgeons with valuable data to open a window in the treatment of patients with ptosis.
Collapse
Affiliation(s)
- Sara Sadat Hosseini
- Department of Neurological Surgery, University of Chicago, Chicago, IL 60637, USA
| | - Bakhtiar Yamini
- Department of Neurological Surgery, University of Chicago, Chicago, IL 60637, USA
| | - Levan Ichkitidze
- Institute of Biomedical Systems of National Research University of Electronic Technology (MIET), 124498 Moscow, Russia
- Institute of Bionic Technologies and Engineering of I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Majid Asadi
- Northern Michigan University, Marquette, MI 49855, USA
| | - Julie Fernandez
- Department of Neurological Surgery, University of Chicago, Chicago, IL 60637, USA
| | - Seifollah Gholampour
- Department of Neurological Surgery, University of Chicago, Chicago, IL 60637, USA
| |
Collapse
|
5
|
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]
|
6
|
Frigerio A, Hadlock TA, Murray EH, Heaton JT. Infrared-based blink-detecting glasses for facial pacing: toward a bionic blink. JAMA FACIAL PLAST SU 2015; 16:211-8. [PMID: 24699708 DOI: 10.1001/jamafacial.2014.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Facial paralysis remains one of the most challenging conditions to effectively manage, often causing life-altering deficits in both function and appearance. Facial rehabilitation via pacing and robotic technology has great yet unmet potential. A critical first step toward reanimating symmetrical facial movement in cases of unilateral paralysis is the detection of healthy movement to use as a trigger for stimulated movement. OBJECTIVE To test a blink detection system that can be attached to standard eyeglasses and used as part of a closed-loop facial pacing system. DESIGN, SETTING, AND PARTICIPANTS Standard safety glasses were equipped with an infrared (IR) emitter-detector unit, oriented horizontally across the palpebral fissure, creating a monitored IR beam that became interrupted when the eyelids closed, and were tested in 24 healthy volunteers from a tertiary care facial nerve center community. MAIN OUTCOMES AND MEASURES Video-quantified blinking was compared with both IR sensor signal magnitude and rate of change in healthy participants with their gaze in repose, while they shifted their gaze from central to far-peripheral positions, and during the production of particular facial expressions. RESULTS Blink detection based on signal magnitude achieved 100% sensitivity in forward gaze but generated false detections on downward gaze. Calculations of peak rate of signal change (first derivative) typically distinguished blinks from gaze-related eyelid movements. During forward gaze, 87% of detected blink events were true positives, 11% were false positives, and 2% were false negatives. Of the 11% false positives, 6% were associated with partial eyelid closures. During gaze changes, false blink detection occurred 6% of the time during lateral eye movements, 10% of the time during upward movements, 47% of the time during downward movements, and 6% of the time for movements from an upward or downward gaze back to the primary gaze. Facial expressions disrupted sensor output if they caused substantial squinting or shifted the glasses. CONCLUSIONS AND RELEVANCE Our blink detection system provides a reliable, noninvasive indication of eyelid closure using an invisible light beam passing in front of the eye. Future versions will aim to mitigate detection errors by using multiple IR emitter-detector units mounted on glasses, and alternative frame designs may reduce shifting of the sensors relative to the eye during facial movements.
Collapse
Affiliation(s)
- Alice Frigerio
- Human Physiology Section, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; Facial Nerve Center, Carolyn and Peter Lynch Center for Laser and Reconstructive Surgery, Division of Facial Plastic and Reconstructive Surgery, Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Tessa A Hadlock
- Facial Nerve Center, Carolyn and Peter Lynch Center for Laser and Reconstructive Surgery, Division of Facial Plastic and Reconstructive Surgery, Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Elizabeth H Murray
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts
| | - James T Heaton
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, Massachusetts;Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston
| |
Collapse
|