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Reanimation of paralysed facial muscles by electrical stimulation has been studied extensively in animal models, but human studies in this field are largely lacking. Twenty-four subjects with a peripheral facial nerve palsy with a median duration of three years were enrolled. We studied activations of four facial muscles with electrical stimulation using surface electrodes. In subjects whose voluntary movement was severely impaired or completely absent, the electrical stimulation produced a movement that was greater in amplitude compared with the voluntary effort in 10 out of 18 subjects in the frontalis muscle, in 5 out of 14 subjects in the zygomaticus major muscle, and in 3 out of 8 subjects in the orbicularis oris muscle. The electrical stimulation produced a stronger blink in 8 subjects out of 22 compared with their spontaneous blinks. The stimulation could produce a better movement even in cases where the muscles were clinically completely paretic, sometimes also in palsies that were several years old, provided that the muscle was not totally denervated. Restoring the function of paralysed facial muscles by electrical stimulation has potential as a therapeutic option in cases where the muscle is clinically paretic but has reinnervation.

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.

Highlights • Transcutaneous facial muscle stimulations of healthy participants (N=24) were investigated. • Visually observable movement of the forehead and the lower lip was achieved in all participants. Stimulation of a smile was more challenging. • Stimulations evoking small movements were rated as relatively pleasant and tolerable. • Complete eye blink was achieved in 22 participants, and the sensation was rated mainly as tolerable. • The results encourage developing further facial pacing technology, which can offer a new treatment option for patients with facial paralysis. Abstract The present aim was to investigate transcutaneous facial muscle stimulation in order to take further steps in developing facial pacing technology, which can offer a new treatment option for patients with unilateral facial paralysis. This technology ultimately measures muscle activations from one side of the face and simultaneously activates the corresponding muscles of the other side with electrical stimulation. Four facial muscle locations— frontalis , orbicularis oculi , zygomaticus major , and orbicularis oris —of the healthy participants (N = 24) were stimulated to produce an eyebrow raise, eye blink, smile, and lip pucker, respectively. The results showed that a visually observable movement of the forehead and the lower lip was achieved in all participants. On average, the stimulations at the movement threshold were rated as tolerable in terms of pain ratings and neutral in terms of pleasantness ratings. Complete eye blink was achieved in 22 participants, and most did not experience painful sensations. The stimulation of the cheek evoked observable movement in 23 participants, but the stimulation also often resulted in concurrent activation of the eye, mouth, and nose area. The results suggest that transcutaneous stimulation seems to be a promising method for developing further facial pacing technology. [ABSTRACT FROM AUTHOR]

Abstract: The present aim was to investigate the functionality of a new wireless prototype called Face Interface. The prototype combines the use of voluntary gaze direction and facial muscle activations, for pointing and selecting objects on a computer screen, respectively. The subjective and objective functionality of the prototype was evaluated with a series of pointing tasks using either frowning (i.e., frowning technique) or raising the eyebrows (i.e., raising technique) as the selection technique. Pointing task times and accuracies were measured using three target diameters (i.e., 25, 30, 40mm), seven pointing distances (i.e., 60, 120, 180, 240, 260, 450, and 520mm), and eight pointing angles (0°, 45°, 90°, 135°, 180°, 225°, 270°, and 315°). The results showed that the raising technique was faster selection technique than the frowning technique for the objects that were presented in the pointing distances from 60mm to 260mm. For those pointing distances the overall pointing task times were 2.4s for the frowning technique, and 1.6s for the raising technique. Fitts’ law computations showed that the correlations for the Fitts’ law model were r =0.77 for the frowning technique and r =0.51 for the raising technique. Further, the index of performance (IP) value was 1.9 bits/s for the frowning technique and 5.4 bits/s for raising the eyebrows technique. Based on the results, the prototype functioned well and was adjustable so that two different facial activations can be used in combination with gaze direction for pointing and selecting objects on a computer screen. [Copyright &y& Elsevier]

• Frontalis of 12 participants was transcutaneously stimulated using four waveforms. • All the waveforms produced movements equally successfully. • Discomfort ratings did not differ either, but some individual preferences did exist. • There was a linear relation between the stimulation amplitudes and evoked movement. Facial pacing systems aim to reanimate paralyzed facial muscles with electrical stimulation. To aid the development of such systems, the frontalis muscle responsible for eyebrow raising was transcutaneously stimulated in 12 healthy participants using four waveforms: square wave, square wavelet, sine wave, and sinusoidal wavelet. The aim was to investigate the effects of the waveform on muscle activation magnitude, perceived discomfort, and the relationship between the stimulus signal amplitude and the magnitude of evoked movement. The magnitude of movement was measured offline using video recordings and compared to the magnitude of maximum voluntary movement (MVM) of eyebrows. Results showed that stimulations evoked forehead movement at a magnitude comparable to the MVM in 67% of the participants and close to comparable (80% of the MVM) in 92%. All the waveforms were equally successful in evoking movements. Perceived discomfort did not differ between the waveforms in relation to the movement magnitude, but some individual preferences did exist. Further, regression analysis showed a statistically significant linear relation between stimulation amplitudes and the evoked movement in 98% of the cases. As the waveforms performed equally well in evoking muscle activity, the waveform in pacing systems could be selected by emphasizing technical aspects such as the possibility to suppress stimulation artifacts from simultaneous electromyography measurement. [ABSTRACT FROM AUTHOR]