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Nature Aug 2023Speech neuroprostheses have the potential to restore communication to people living with paralysis, but naturalistic speed and expressivity are elusive. Here we use...
Speech neuroprostheses have the potential to restore communication to people living with paralysis, but naturalistic speed and expressivity are elusive. Here we use high-density surface recordings of the speech cortex in a clinical-trial participant with severe limb and vocal paralysis to achieve high-performance real-time decoding across three complementary speech-related output modalities: text, speech audio and facial-avatar animation. We trained and evaluated deep-learning models using neural data collected as the participant attempted to silently speak sentences. For text, we demonstrate accurate and rapid large-vocabulary decoding with a median rate of 78 words per minute and median word error rate of 25%. For speech audio, we demonstrate intelligible and rapid speech synthesis and personalization to the participant's pre-injury voice. For facial-avatar animation, we demonstrate the control of virtual orofacial movements for speech and non-speech communicative gestures. The decoders reached high performance with less than two weeks of training. Our findings introduce a multimodal speech-neuroprosthetic approach that has substantial promise to restore full, embodied communication to people living with severe paralysis.
Topics: Humans; Cerebral Cortex; Clinical Trials as Topic; Communication; Deep Learning; Face; Gestures; Movement; Neural Prostheses; Paralysis; Speech; Vocabulary; Voice
PubMed: 37612505
DOI: 10.1038/s41586-023-06443-4 -
European Journal of Physical and... Feb 2020Peripheral facial nerve palsy (FNP) can have various causes, such as Bell's palsy or after surgery for acoustic neuroma. Rehabilitation is often required but there is no... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Peripheral facial nerve palsy (FNP) can have various causes, such as Bell's palsy or after surgery for acoustic neuroma. Rehabilitation is often required but there is no evidence that any rehabilitation approach is more efficacious than another.
AIM
The purpose of this research was to determine the effects of neurocognitive-rehabilitative approach through mirror-therapy (MT) and motor-imagery (MI), integrated into the traditional rehabilitation with mime-therapy and myofascial-approach.
DESIGN
This study was designed as a double-blind, randomized, controlled trial.
SETTING
This study took place from January 2016 to June 2018 at the Unit of Physical Medicine and Rehabilitation of Umberto I Polyclinic Hospital, Rome, Italy.
POPULATION
Twenty-two patients were randomized into two groups: the mirror therapy group (N.=11, MT and MI) and the traditional rehabilitation group (N.=11, mime-therapy and a myofascial-approach).
METHODS
Outcome assessments were performed before treatment (T0), after one month (T1=10 session, twice/week), after the second and third months (T2=10 twice/week + 5 of MT+MI one/week and T3=10 twice/week + 5 of MT+MI 1/week), and at the 4-week follow-up (T4=2 months follow-up).
RESULTS
The analysis of the functional evaluations show that both groups experienced progressive improvement T0 to T3, with stabilization of the results at the follow-up. There was a significant difference in House-Brackmann-Scale scores between T0 and follow-up in favor of the experimental group. In terms of quality of life (FaCE scale), total scores and social function items improved in both groups from T0 to T3. The experimental group obtained better results with regard to quality of life and emotional depression.
CONCLUSIONS
The integrated use of MT and MI is efficacious in the rehabilitation of FNP, improving facial physical function. Further studies are needed to determine the predictive factors of the recovery of facial mimic.
CLINICAL REHABILITATION IMPACT
The ability of patients with unilateral facial paralysis to recognize and appropriately judge facial expressions and perceive the judgments of others remains underexplored. The likelihood of recovering near-normal facial-function after grade VI facial paralysis is low. Procedures, such as the immediate repair of the facial nerve with an interposed donor graft, might improve facial function in patients with partially injured facial nerves.
Topics: Adult; Aged; Disability Evaluation; Double-Blind Method; Facial Nerve; Facial Paralysis; Female; Humans; Imagery, Psychotherapy; Male; Middle Aged; Neuropsychological Tests; Physical Therapy Modalities
PubMed: 30916916
DOI: 10.23736/S1973-9087.19.05757-5 -
Toxins Feb 2021Unilateral peripheral facial nerve palsy jeopardizes quality of life, rendering psychological consequences such as low self-esteem, social isolation, anxiety, and... (Review)
Review
Unilateral peripheral facial nerve palsy jeopardizes quality of life, rendering psychological consequences such as low self-esteem, social isolation, anxiety, and depression. Among therapeutical approaches, use of Botulinum toxin type A (BoNT-A) on the nonparalyzed side has shown promising results and improvement of quality of life. Nevertheless, the correct technique is paramount, since over-injection of the muscles can result in lack of function, leading to a "paralyzed" appearance, and even worse, functional incompetence, which may cause greater distress to patients. Therefore, the objective of this article is to provide a practical guideline for botulinum toxin use in facial palsy. To this aim, adequate patient assessment, BoNT-A choice, injection plan and dosage, and injection techniques are covered.
Topics: Acetylcholine Release Inhibitors; Adult; Bell Palsy; Botulinum Toxins, Type A; Facial Muscles; Facial Paralysis; Female; Humans; Injections, Intramuscular; Quality of Life; Treatment Outcome
PubMed: 33670477
DOI: 10.3390/toxins13020159 -
Indian Journal of Ophthalmology Jun 2022Marin-Amat syndrome is a rare acquired oculofacial synkinesis first reported in 1918. It manifests as involuntary eyelid closure on jaw opening or on lateral movement of...
BACKGROUND
Marin-Amat syndrome is a rare acquired oculofacial synkinesis first reported in 1918. It manifests as involuntary eyelid closure on jaw opening or on lateral movement of the jaw following a peripheral facial nerve palsy. The increased orbicularis tone due to aberrant connections between the cranial nerve (CN) V and CN VII results in an undesirable wink with major psychosocial impact.
PURPOSE
Most cases in literature were either observed or administered botulinum toxin injection to the orbicularis muscle. There are few sporadic reports of surgical interventions with successful outcomes.Hence there was a need to generate awareness regarding various modes of management of this rare entity.
SYNOPSIS
We present a video on the clinical presentation and management of six such patients, of whom one was bilateral. Five patients were females. Traumatic facial nerve paralysis and Bell's palsy was previously diagnosed in one and five patients respectively. The mean age was 52 ± 9.48 years. The mean MRD (margin reflex distance) 1 and MRD 2 was 3.17 ± 0.60 and 5.33± 0.65 mm respectively. On smiling or on movement of the jaw the MRD 1 and 2 was reduced by 2. 50±0.40 and 1.50+/-0.40 mm respectively. Of the six patients four patients opted for nil intervention.
HIGHLIGHTS
Botulinum toxin injection and preseptal orbicularis resection in the upper and lower eyelid along with blepharoplasty was performed in 1 patient each. Satisfactory reduction in the synkinetic movement was achieved in both. Marin-Amat syndrome is a rare often underdiagnosed synkinetic disorder following peripheral facial nerve palsy. Botulinum toxin injection and preseptal orbicularis resection are viable management options.
VIDEO LINK
https://youtu.be/YQbRecp449w.
Topics: Adult; Blinking; Botulinum Toxins; Facial Nerve; Facial Paralysis; Female; Humans; Male; Middle Aged; Syndrome; Synkinesis
PubMed: 35648031
DOI: 10.4103/ijo.IJO_1262_22 -
Neurology India 2021
Topics: Humans; Paralysis; Water Sports
PubMed: 34979728
DOI: 10.4103/0028-3886.333512 -
Clinical Rehabilitation Oct 2022To study the effects of the "Mirror Effect Plus Protocol" (MEPP) on global facial function in acute and severe Bell's Palsy. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To study the effects of the "Mirror Effect Plus Protocol" (MEPP) on global facial function in acute and severe Bell's Palsy.
DESIGN
Single blind and randomized controlled trial to compare the effects of basic counseling (control group) versus MEPP (experimental group) over one year.
SETTING
Outpatient clinic following referrals from Emergency or Otorhinolaryngology Departments.
SUBJECTS
40 patients ( = 20 per group) with moderately severe to total palsy who received standard medication were recruited within 14 days of onset. Baseline characteristics were comparable between the groups.
INTERVENTIONS
The experimental group received the MEPP program (motor imagery + manipulations + facial mirror therapy) while the control group received basic counseling. Both groups met the clinician monthly until 6 months and at one-year post-onset for assessments.
OUTCOME MEASURES
Facial symmetry, synkinesis, and quality of life were measured using standardized scales. Perceived speech intelligibility was rated before and after therapy by naïve judges.
RESULTS
Descriptive statistics demonstrated improvements in favor of the MEPP for each measured variable. Significant differences were found for one facial symmetry score (House-Brackmann 2.0 mean (SD) = 7.40 (3.15) for controls versus 5.1 (1.44) for MEPP), for synkinesis measures ( = 0.008) and for quality-of-life ratings (mean (SD) score = 83.17% (17.383) for controls versus 98.36% (3.608) for MEPP ( = 0.002)). No group difference was found for perceived speech intelligibility.
CONCLUSION
The MEPP demonstrates promising long-term results when started during the acute phase of moderately severe to total Bell's Palsy.
Topics: Bell Palsy; Facial Paralysis; Follow-Up Studies; Humans; Quality of Life; Single-Blind Method; Synkinesis
PubMed: 35722671
DOI: 10.1177/02692155221107090 -
Ugeskrift For Laeger Apr 2021Todd's paralysis is a clinical entity consisting of acute focal neurological deficits following an epileptic seizure. It occurs after 6-13% of seizures, and the symptoms... (Review)
Review
Todd's paralysis is a clinical entity consisting of acute focal neurological deficits following an epileptic seizure. It occurs after 6-13% of seizures, and the symptoms may last from minutes to 36 hours. Stroke with seizure at symptom onset is difficult to differentiate clinically from Todd's paralysis. The use of advanced imaging such as cerebral CT and MRI with angiography is recommended. This is a review of the current knowledge on pathogenesis, clinical presentation and differential diagnoses, and we propose an investigation plan for patients presenting with symptoms of Todd's paralysis.
Topics: Epilepsy; Humans; Magnetic Resonance Imaging; Paralysis; Seizures; Stroke
PubMed: 33913429
DOI: No ID Found -
Journal of Neuro-ophthalmology : the... Mar 2022This study identifies the diagnostic errors leading to misdiagnosis of 3rd nerve palsy and to aid clinicians in making this diagnosis. The objective of this article is...
BACKGROUND
This study identifies the diagnostic errors leading to misdiagnosis of 3rd nerve palsy and to aid clinicians in making this diagnosis. The objective of this article is to determine the incidence of misdiagnosis of 3rd cranial nerve palsy (3rd nerve palsy) among providers referring to a tertiary care neuro-ophthalmology clinic and to characterize diagnostic errors that led to an incorrect diagnosis.
METHODS
This was a retrospective clinic-based multicenter cross-sectional study of office encounters at 2 institutions from January 1, 2014, to January 1, 2017. All encounters with scheduling comments containing variations of "3rd nerve palsy" were reviewed. Patients with a documented referral diagnosis of new 3rd nerve palsy were included in the study. Examination findings, including extraocular movement examination, external lid examination, and pupil examination, were collected. The final diagnosis was determined by a neuro-ophthalmologist. The Diagnosis Error Evaluation and Research (DEER) taxonomy tool was used to categorize the causes of misdiagnosis. Seventy-eight patients referred were for a new diagnosis of 3rd nerve palsy. The main outcome measure was the type of diagnostic error that led to incorrect diagnoses using the DEER criteria as determined by 2 independent reviewers. Secondary outcomes were rates of misdiagnosis, misdiagnosis rate by referring specialty, and examination findings associated with incorrect diagnoses.
RESULTS
Of 78 patients referred with a suspected diagnosis of 3rd nerve palsy, 21.8% were determined to have an alternate diagnosis. The most common error in misdiagnosed cases was failure to correctly interpret the physical examination. Ophthalmologists were the most common referring provider for 3rd nerve palsy, and optometrists had the highest overdiagnosis rate of 3rd nerve palsy.
CONCLUSIONS
Misdiagnosis of 3rd nerve palsy was common. Performance and interpretation of the physical examination were the most common factors leading to misdiagnosis of 3rd nerve palsy.
Topics: Cross-Sectional Studies; Diagnostic Errors; Electron Spin Resonance Spectroscopy; Humans; Oculomotor Nerve Diseases; Paralysis; Retrospective Studies
PubMed: 32991390
DOI: 10.1097/WNO.0000000000001010 -
Indian Journal of Ophthalmology Aug 2022The Parks 3-step test is an important test in the diagnosis of a single cyclovertical muscle palsy.
BACKGROUND
The Parks 3-step test is an important test in the diagnosis of a single cyclovertical muscle palsy.
PURPOSE
This video is presented to provide a simplified and easy understanding of the Parks 3-step test for post-graduate residents.
SYNOPSIS
The video contains a description of the steps to perform a 3-step test, the results of the test in a case of superior oblique palsy, the conditions that mimic a positive 3-step test, and how to identify these mimicking conditions.
HIGHLIGHTS
This is a simple demonstration of a classic clinical diagnostic procedure.
ONLINE VIDEO LINK
https://youtu.be/1wpjwe19c0E.
Topics: Exercise Test; Humans; Oculomotor Muscles; Paralysis; Strabismus; Trochlear Nerve Diseases
PubMed: 35919015
DOI: 10.4103/ijo.IJO_714_22 -
Circulation. Arrhythmia and... Jul 2023The cryoballoon (CB) represents the gold standard single-shot device for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Single-shot pulsed...
BACKGROUND
The cryoballoon (CB) represents the gold standard single-shot device for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Single-shot pulsed field PVI ablation (nonthermal, cardiac tissue selective) has recently entered the arena. We sought to compare procedural data and long-term outcome of both techniques.
METHODS
Consecutive AF patients who underwent pulsed field ablation (PFA) and CB-based PVI were enrolled. CB PVI was performed using the second-generation 28-mm CB; PFA was performed using a 31/35-mm pentaspline catheter. Success was defined as freedom from atrial tachyarrhythmia after a 3-month blanking period.
RESULTS
Four hundred patients were included (56.5% men; 60.8% paroxysmal AF; age 70 [interquartile range, 59-77] years), 200 in each group (CB and PFA), and baseline characteristics did not differ. Acute PVI was achieved in 100% of PFA and in 98% (196/200) of CB patients (=0.123; 4 touch-up ablations). Median procedure time was significantly shorter in PFA (34.5 [29-40] minutes) versus CB (50 [45-60] minutes; <0.001), fluoroscopy time was similar. Overall procedural complications were 6.5% in CB and 3.0% in PFA (=0.1), driven by a higher rate of phrenic nerve palsies using CB. The 1-year success rates in paroxysmal AF (CB, 83.1%; PFA, 80.3%; =0.724) and persistent AF (CB, 71%; PFA, 66.8%; =0.629) were similar for both techniques.
CONCLUSIONS
PFA compared with CB PVI shows a similar procedural efficacy but is associated with shorter procedure time and no phrenic nerve palsies. Importantly, 12-month clinical success rates are favorable but not different between both groups.
Topics: Male; Humans; Aged; Female; Atrial Fibrillation; Follow-Up Studies; Treatment Outcome; Pulmonary Veins; Cryosurgery; Paralysis; Catheter Ablation; Recurrence
PubMed: 37254781
DOI: 10.1161/CIRCEP.123.011920