A Spark Of Emotion: The Impact of Electrical Facial Muscle Activation on Emotional State and Affective Processing

Facial feedback, which involves the brain receiving information about the activation of facial muscles, has the potential to influence our emotional states and judgments. The extent to which this applies is still a matter of debate, particularly considering a failed replication of a seminal study. One factor contributing to the lack of replication in facial feedback effects may be the imprecise manipulation of facial muscle activity in terms of both degree and timing. To overcome these limitations, this thesis proposes a non-invasive method for inducing precise facial muscle contractions, called facial neuromuscular electrical stimulation (fNMES). I begin by presenting a systematic literature review that lays the groundwork for standardising the use of fNMES in psychological research, by evaluating its application in existing studies. This review highlights two issues, the lack of use of fNMES in psychology research and the lack of parameter reporting. I provide practical recommendations for researchers interested in implementing fNMES. Subsequently, I conducted an online experiment to investigate participants' willingness to participate in fNMES research. This experiment revealed that concerns over potential burns and involuntary muscle movements are significant deterrents to participation. Understanding these anxieties is critical for participant management and expectation setting. Subsequently, two laboratory studies are presented that investigated the facial FFH using fNMES. The first study showed that feelings of happiness and sadness, and changes in peripheral physiology, can be induced by stimulating corresponding facial muscles with 5–seconds of fNMES. The second experiment showed that fNMES-induced smiling alters the perception of ambiguous facial emotions, creating a bias towards happiness, and alters neural correlates of face processing, as measured with event-related potentials (ERPs). In summary, the thesis presents promising results for testing the facial feedback hypothesis with fNMES and provides practical guidelines and recommendations for researchers interested in using fNMES for psychological research

Application of facial neuromuscular electrical stimulation (fNMES) in psychophysiological research: Practical recommendations based on a systematic review of the literature.

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

A Pilot Study of the Rehabilitation Services Provided for Patients with Dysphagia in Medical Settings in Jordan

Services provided for dysphaiga conditions are poorly investigated in Jordan. The aim of this study was to explore the rehabilitation services provided to patients with dysphagia in medical settings in Jordan. Data were collected from public and private hospitals, hearing and speech centres, and rehabilitation centres located in Amman province. Thirty-eight participants (16 patients and 22 professionals from various disciplines) were interviewed. There was limited knowledge about dysphagia among healthcare professionals. The provision of rehabilitation services was minimal and secondary to the provision of medical services. Clinical pathways and guidelines need to be devised to organize the work of professionals involved in the management of dysphagia

Cerebral palsy: Physical therapy and medical treatment issues

A discussion of the various terms associated with CP as well as the different classifications will precede a review of several randomized controlled trials, case studies, cohort studies and other related articles regarding treatment methods. Specifically, the use of Intrathecal Baclofen Therapy (1TB), Botulinum toxin injections (Botox), Selective Dorsal Rhizotomy, Threshold Electrical Stimulation (TES), and Pediatric Constraint-Induced Movement Therapy will be examined

Bionic Lid Implant for Natural Closure (BLINC)

Facial nerve palsy (FNP) leads to an inability to blink. The exposed eye is at risk of developing corneal keratopathy and currently there is a lack of solution to active eye closure that is immediate and reliable. Bionic Lid Implant for Natural Closure (BLINC) proposes the use of an implantable actuator combined with the effects of an eyelid sling for dynamic eye closure. The aims of this thesis are to 1) explore the clinical need for BLINC, 2) describe the BLINC technology, and 3) present the results of its application in cadaveric and live models. Methods The aims of this project are addressed in three parts. In part one, the current therapies addressing key clinical end points in FNP from an ocular perspective and the setting where BLINC may first be used are explored. In part two the science behind BLINC is outlined. Finally in part three application of BLINC in cadaveric and live models are studied followed by a discussion on future steps preceding a pilot study in humans. Results Patients with FNP consistently identify issues related to the eye a primary concern. Current reanimation strategies offer the possibility of dynamic eye closure but the results are delayed and often unpredictable. BLINC reliably achieves active eye closure in cadaveric models by means of a wireless-powered, implantable electromagnetic actuator in conjunction with an eyelid sling. BLINC closes the eye in a similar fashion to natural closure for a symmetrical blink in FNP. Successful application of an inactive device in its complete form is achieved in a live animal without significant morbidity. Conclusion BLINC offers the possibility of restoring active eye closure with use of an implantable actuator. The concept has been successfully demonstrated in cadaveric models with successful device implantation in a live model. Future live trials are needed to address the remaining biocompatibility issues in preparation for human application

Neuromodulation in the treatment of upper limb spasticity

In this thesis I investigated neurophysiological changes following transcutaneous electrical nerve stimulation (TENS) at 100 Hz, and TENS and transcutaneous spinal cord stimulation (tSCS) applied with high-frequency (10 kHz) trains (HF-TENS and HF-tSCS, respectively). I also assessed literature studying neuromodulation for spasticity in SCI and developed a mobile application (app) which aimed to improve spasticity self-management through education of triggers. Paired-pulses of cervical tSCS caused post-activation depression in posterior-root reflexes (PRRs) in wrist flexors and extensors at interstimulus intervals of < 2 s; showing a similar pattern of modulation observed in previous studies with H-reflex activity (8 healthy, able-bodied participants). Another study compared TENS, HF-TENS and HF-tSCS to sham stimulation. Changes in PRRs and motor-evoked potentials (MEPs) in the wrist flexor and extensor were assessed. HF-tSCS was most efficient at modulating corticospinal excitability immediately after intervention, causing a decrease in flexor MEPs lasting 30 minutes (p = 0.015), as well as a trend towards an increase in extensor MEPs. Late spinal inhibition of wrist flexors occurred following 60 minutes of HF-tSCS (p = 0.018). An app was designed to support users in identifying factors which trigger their spasticity by logging and rating events (Penn spasm frequency scale). The design of the app was assessed using questionnaires sent to clinicians and people with spasticity. Results showed that all responders felt that the design of the app could have potential in benefitting symptoms of spasticity. Bringing together neurophysiological and clinical measures of spasticity, a systematic review and meta-analysis of 27 studies assessed the effects of neuromodulation on spasticity in SCI. This revealed a lack of randomised control trials (RCTs). In 3 RCTs and 17 studies without a control group, there was a reduction in spasticity immediately following electrical stimulation according to clinical measures. Four studies included the H-reflex as an outcome measure, with 3/4 reporting no change, or varied results between participants

CIR-Myo News: Abstracts of the 2015 Spring Padua Muscle Days

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A BIONIC EYEBLINK: MANAGEMENT OF FACIAL PALSY

This thesis highlights the current gold-standard surgical procedures for the rehabilitation of mimicry in individuals with facial paralysis and explores the potential application of functional electrical stimulation (FES) as a novel treatment restoring the face mimicry. Closed-loop facial pacing represents an innovative solution for prosthetically assisted movements. In particular, blinking is typically symmetrical, enabling healthy eye blink on one side of the face to serve as a trigger to pace assisted blinks on the contralateral side, in case of unilateral peripheral facial palsy. The goals of this research are developing an eyeblink detection system and advancing the understanding of performing surface FES of the facial nerve in order to elicit artificial eyeblinks. The application of a biomimetic device to individuals with acute reversible facial palsy would provide immediate restoration of the periocular function and could be used until either the patient recovers sufficient function to no longer require assistance for eye closure, or the decision is made to proceed with further surgery

Evidence Synthesis of Shoulder Pain Among Canadian Firefighters

Injury or degeneration of rotator cuff tendon leads to rotator cuff disease (subacromial impingement syndrome and rotator cuff tears). Shoulder pain – pain in the upper arm close to the deltoid muscle insertion has been reported as the most common symptom for subacromial impingement syndrome and rotator cuff tears. However, the current state of evidence on treatment effectiveness of rotator cuff disease is indeterminate. The shoulder function is essential for many of the physically demanding tasks that firefighters perform on the fire ground. For fire services and firefighters, the preservation of active duty is critical for their continued service to their communities. However, the prevalence of shoulder pain among Canadian firefighters has not been synthesized. Further, high quality randomized clinical trials (RCTs) provide the highest level of evidence and assist in clinical decision making. The International Committee of Medical Journal Editors (ICMJE) recommendation of RCT trial registration in public trials registry has been made to improve the reporting, transparency, rigor and reproducibility in RCTs. However, there is a paucity of evidence on the proportion of RCTs with proper trial registrations in the field of rehabilitation therapy. Therefore, the purposes of this thesis were 1) to assess the effects of arthroscopic versus mini-open rotator cuff repair surgery on function, pain and range of motion at in patients with rotator cuff tears; 2) to quantify the effects of surgical vs conservative interventions on clinical outcomes of pain and function in patients with subacromial impingement syndrome; 3) to assess the prevalence of musculoskeletal disorders (MSDs) among Canadian firefighters, 4) to examine the proportion of RCTs that were reported to have been prospectively, retrospectively registered or not registered in the field of rehabilitation therapy, and 5) to use the synthesized evidence to inform the design of a single center (fire-station), investigator-blinded, randomized, 12-month, parallel-group, superiority trial for the evaluation of the efficacy of a shoulder exercises on clinical outcomes in firefighters with shoulder pain. From the existing literature, we found evidence that both arthroscopic and mini-open techniques to rotator cuff repairs with post-operative rehabilitation exercises were effective in improving clinical outcomes of function, pain and shoulder range of motion in patients with rotator cuff tears. However, the between-group differences in outcomes were too small to be clinically important. The effects of surgery plus physiotherapy (exercises) vs physiotherapy (exercises) alone on pain and function were too small to be clinically important at 3-, 6-months, 1-, 2-, 5- and ≥ 10-years follow up. This further highlighted that rehabilitation exercises be considered as the first treatment approach in patients with shoulder pain. We also identified high point-prevalence estimates (1 in 4 firefighters) of shoulder-, back-, and knee-related MSDs among Canadian firefighters (shoulder pain was 23%). Our review study indicated that fifteen years after the introduction of standards for RCT registration by ICMJE, only one-third of the RCTs in the field of rehabilitation therapy were prospectively registered. Subsequently, the emergence of further evidence (observational studies in firefighters and RCTs in active-duty military personnel) indicating the clinical effectiveness of occupation-specific rehabilitation exercises along with our evidence syntheses provided the rationale for the design and conduct of an RCT to assess the effectiveness of firefighter-specific rehabilitation exercises among Canadian firefighter with shoulder pain

Mechanically assisted cough in motor neurone disease

Motor Neurone Disease (MND) is a disabling and inevitably fatal disease, usually with a life expectancy of 2-3 years from symptom onset. It is characterised by progressive wasting and weakness in bulbar, limb and respiratory muscles. There is no cure and treatment is mainly symptomatic. Neuromuscular respiratory failure, with or without a chest infection, is the commonest cause of death in MND patients. It has been shown that supporting respiratory function with non-invasive ventilation, improves survival and quality of life despite progression of the disease. The patients with respiratory muscle weakness may also have a weak cough and significant difficulty in clearing their airways of respiratory secretions. This causes much discomfort, predisposes to chest infections and adversely affects quality of life. Due to lack of evidence in this area, there is no clear consensus or guideline about how best to help such patients. This work aimed to establish the role of cough augmentation techniques in MND. A total of 40 eligible patients with MND were randomised to the breath-stacking technique (n=21) or Mechanical Insufflator-Exsufflator MI-E (n=19) and followed-up at 3 monthly intervals for at least 12 months or until death. All patients were diagnosed with respiratory failure and offered non-invasive ventilation (NIV). The primary outcome measure was the number of days with symptoms of chest infection, treated with antibiotics, in the community or in hospital. Survival and quality of life benefit, assessed by short form 36 mental component summary (MCS) and sleep apnoea quality of life index symptoms domain (sym), were the secondary outcome measures. There were 13 episodes of chest infection in the breath-stacking group and 19 episodes in MI-E group (p=0.87), requiring 90 and 95 days of antibiotics respectively (p=0.85). There were 6 episodes of hospitalisation in each group (p=0.87). The mean duration of symptoms per chest infection was 6.9 days in the breath-stacking group and 3.9 days in MI-E group (p=0.16). The chance of hospitalization, in the event of a chest infection was 0.46 in the breath-stacking group and 0.31 in MI-E group (p=0.47). Median survival in the breath-stacking group was 535 days and 266 days in the MI-E group. The MCS score was maintained above 75% of baseline for a median of 329 days in the breath-stacking group and 205 days in MI-E group (p=0.41). A non-significant improvement in quality of life, compared to baseline was observed in both interventional groups. In MND patients with respiratory failure, cough augmentation is likely to help maintain quality of life in the presence of the distressing symptom of weakened ability to cough. This study was not powered to assess the potential impact on life expectancy. There was no significant difference in terms of pulmonary morbidity between the two groups. A trend towards fewer chest infections was observed in the breath-stacking group, and a trend for reduced duration of antibiotic use and decreased chance of hospitalization in the event of a chest infection was observed in the MI-E group, though these changes did not reach statistical significance. These results are insufficient to draw firm conclusions, but support routine domiciliary use of a suitable cough augmentation technique in patients with ALS requiring respiratory support. The breath-stacking technique may be prescribed for domiciliary use with the onset of respiratory failure. MI-E may be useful in the event of a chest infection when it has the potential to reduce the duration of antibiotic use and chance of hospitalisation or when breath-stacking is no longer sufficient to maintain patient comfort. The results of this trial provide data useful for the power calculations required for a larger-scale multi-centre randomised trial