Using Emotional Expression as a Novel Indicator of Functional Outcomes and Facial Rehabilitation Following Face Transplantation via Software-Based Video Analysis
Abstract
This study proposes to use novel imaging software to assess the ability to generate identifiable facial emotional expression as an outcome for face transplantation (FT). We propose to further develop the available software to detect signs of immune rejection objectively, non-invasively, non-intrusively, and in real-time. By using software capable of assessing emotional expression and developing a feature to detect allograft rejection, we will increase evidence about outcomes of FT and improve graft surveillance. It will address the following FY17 RTRP Focus Areas: Development of pre-habilitation or rehabilitation strategies that improve reconstructive transplant functional outcomes; Development of standardized quantitative functional outcome measures for VCA, especially for face transplant; and Development of non-invasive advanced imaging technologies for graft clinical monitoring. Data from Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) show that cranio-maxillofacial battle injuries to the head and neck were found in 42% of patients evacuated out of the theater. The severity of these injuries has increased due to broader utilization of improvised explosive devices (IED), which accounted for over 75% of all combat injuries in OIF/OEF and, in particular, for over 50% of oral and maxillofacial injuries. Explosions to the face result in significant loss of facial tissue, requiring immediate care and extensive surgical procedures. Although initial treatment secures survival, functional and aesthetic outcomes often remain unsatisfying. Severe facial deformities require artificial airways and feeding tubes and, besides the defaced appearance, social re-integration and daily life activities are further diminished by lack of intelligible speech and the ability for facial expression of emotions. With increasing incidence and severity of facial battlefield injuries, it is of utmost importance to provide these Soldiers the best possible treatment and care. FT has proven to be able to restore facial form and function in one single procedure. However, current application is limited to a minority of people, as FT is still a human experiment. It is currently unclear whether obvious but subjective improvements and benefits outweigh the risks of complications, as well as the toxicity of lifelong immunosuppression therapy. The applicability and impact of this research will give objective data support to the subjective life-enhancing value of FT. The indications for the 42 reported cases have ranged from ballistic trauma, neurofibromatosis, animal attacks, and burns. Patients suffering from severe facial disfigurement that desire the benefits of FT could find the ability to regain emotional expression appealing. FT outcomes have traditionally been defined by improvement of motor and sensory function. These are important measures to assess graft recovery, but alone they do not completely define the social function of the face. FT recipients seek to reintegrate into society, where ability to express emotions is integral to success. To the best of our knowledge, there is currently no established method to objectively assess expressed emotion the way human observers do in FT. Additionally, detection of immune rejection still poses challenges in the early stages after FT, especially for visually impaired patients. There exists an unmet need for non-invasive, high-precision assessment of visual changes related to immune rejection of facial allografts. Potential clinical applications include enhanced outcomes monitoring and earlier rejection episode detection, which could improve treatment effectiveness and maintenance of the graft. The aspired software application will validate outcomes objectively, reproducibly, and reliably, and thus demonstrate the benefits of this intervention and advance the field of reconstructive transplant research. Preliminary data already demonstrate the restoration of emotional expre
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810702
Entities
People
- Bohdan Pomahač
Organizations
- United States Army