Personalized and movement specific fes oriented rehabilitation process design for face transplant and arm replantation patients

The history of organ transplantation dates back to 17th century. In 1942, British zoologist Sir Peter Brian Medawar indicated for the first time that organ rejection occurred due to immune system. Later in 1954, Joseph Murray performed the first kidney transplant in Chicago. Both scientists were deemed worthy of the Nobel Prize in Medicine in 1960 and 1990 respectively. The number of organ transplants gradually increases around the world. Recent improvements in microsurgical techniques and considerable reduction in the side effects of immunosuppressive drugs have paved the way for composite tissue transplantation. Composite tissues involve structures containing multiple tissues such as face, hands, feet, larynx, anterior abdominal wall, small intestines and etc. Composite tissue transplantation is an operation performed on patients with tissue loss impairing physical integrity and causing loss of function with the aim of improving the form and function of that tissue and increasing patients' quality of life. This study involves face and arm transplant cases among other composite tissue transplantations. Patients who previously had an arm replantation due to sudden traumas were also included in our study. Successful transplants and replantations highlight that such operations are important for the recovery period of patients and that correct, automated movement functions must be created. The biggest challenge in recovery process is the extended period of time needed to restore movement capability of patients due to nerve reinnervation. Although neural regeneration takes place, it takes a very long time for the patient to move like a normal, healthy individual. Contribution of electrical stimulations used in physical therapy to this process is based on a general stimulation mechanism. It is thus very hard to describe some specific movements and to observe the improvement in motor capabilities of patients. This challenge constitutes the motive behind our study, involving muscle dynamics and brain plasticity-oriented rehabilitation process design and analysis. The aim was to create the most effective rehabilitation system to accelerate the post-operative recovery period of full-face, double arm transplant and scapular arm replantation cases. Considering the aims of the study, multiple algorithms were created and analyses were performed in computer environment based on biomedical electrophysiological data obtained from these patients. Valuable data were obtained as these cases with a history of successful transplant operation are limited in number around the world and they provide a considerable contribution in the understanding and interpretation of brain dynamics, muscular and neural transmission mechanism. A personalized rehabilitation system focusing on muscular dynamics and brain plasticity was created as a result of the analysis of obtained data. Personalized and movement specific FES oriented rehabilitation system was used by designing rehabilitation practices to make sure patients go through frequently repetitive, intensified movement treatment, imitative learning (visual imitation), mental practice, target/task-oriented training, correct movement training, assisted movement training and to regulate the organization of muscle and brain dynamics as a result of these tasks. Registry system created in line with transplant characteristics of patients was updated with repeated records. According to the records obtained after the rehabilitation, it was found that organization in movement specific muscles had improved. Similarly, rehabilitation was paused during the rehabilitation break and patients had some rest. When the records kept before and after this resting period were analyzed, it was found that patients had weakening in their capability to perform movements and there was disorganization in movement specific muscle use. This shows us that the system we designed and updated in line with analyses has been more successful thanks to movement learning and functional electrical stimulation of muscles compared to conventional methods.