"Like Barbells for the Face"

Probably the most striking thing about face transplant patients is their improved visual appearance. But a lesser-understood part of their recovery is helping them regain communicating and eating. That’s where an exercise program designed by Dr. Jordan Green, a speech-language pathology researcher at MGH Institute of Health Professions, comes in.

“It is like using barbells or calisthenics for the face,” says Green, an expert on speech and swallowing who is director of the Speech and Feeding Disorders Lab and associate provost for research at the Boston graduate school. “Patients need to work on improving their facial muscle strength, muscle speed, muscle coordination, and muscle power. We believe our program can translate into better speech production, clearer speech, and improved swallowing.”

Fewer than 40 facial transplants have been performed, so there’s still a great deal unknown about the course of recovery for patients and how to maximize their recovery. The largest number of procedures has occurred at Brigham and Women’s Hospital where Green is collaborating with Dr. Bohdan Pomahac, who leads the hospital’s plastic surgery team, and Dr. Bridget Perry, a 2018 graduate of the MGH Institute’s PhD in Rehabilitation Sciences who is currently a postdoctoral fellow at Tufts Medical Center.

Green's research, funded by a two-year grant from the National Institutes of Health, is focused on two goals. The first is to document the rate and extent of facial motor recovery using computer-based 3D motion tracking similar to those Hollywood filmmakers use to turn live-action movements into animation to track facial motor recovery following transplantation. The use of motion capture placing reflective dots on different parts of the face, lip, and jaw to record a patient’s movement, an approach that promises to be far more accurate than the traditional way of clinicians making sight observations based on their own experience. “Speech is produced too fast and the movements are too small to be tracked fully by the eye,” he says. “This technology significantly enhances the clinical evaluation of facial motor function because it is very sensitive, reliable, and objective.”

Secondly, patients will use a custom computer program to help them perform facial exercises correctly, allowing Green and his team to determine baseline rates of face-motor recovery while testing how well the in-home program works. “There’s still much we don’t know about how these patients recover their facial function after the transplant, and many patients still have trouble speaking, eating, and regaining a full range of facial expression,” Green notes. “Using the computer will allow them to see what they are doing and learn how to improve it.” If successful, this research will provide the evidence needed to promote facial exercise as a critical component of post-surgical rehabilitation.

Green is encouraged by his research’s preliminary findings. Two of the transplant patients who have completed the protocol have experienced significant gains in their speech and motor functions in their face. “The advantage of our computer-based tracking methods is that they can be very precise and reliable because ultimately we want to be able to tell our patients, ‘This is how long it will take you to recover and this is how much function you will regain’,” he says.  “Our hope is that this research will improve the standard of care for patients undergoing this life-changing procedure by advancing clinical assessment and improving speech and swallowing outcomes."

- John Shaw

Video: Assessing and Restoring Lip Motor Function Following Facial Transplantation