Comprehensive, technology-based, team approach for a patient with locked-in syndrome: A case report of improved function & quality of life

Abstract

One of the most severe types of stroke is locked-in syndrome (LIS) due to the loss of almost all voluntary motor functions and a high mortality rate. The majority of the literature regarding LIS is based on case reports that utilized multidisciplinary interventions focused on improving functional communication and respiratory care with minimal focus on motor retraining. These reports were neither dynamic nor multi-sensory, and the only technology utilized was in the form of augmentative communication. There are additional types of technology frequently used in the general stroke population that can address similar motor deficits that occur in the LIS population. This case report explains an interdisciplinary approach using motor and communication interventions that are multisensory, progressive, multi-modal, and technology- based. The length of stay was 153 days in acute rehabilitation, after which the patient returned home making significant gains in overall function. In this patient, the FIM changes in motor (+42), cognitive (+29) and total change score of (+71) surpassed what was determined to be a minimal clinically important difference. These results suggest that this treatment program and approach may be a key reason why this patient was able to achieve significant functional gains and report improved quality of life.

Locked-in syndrome revisited

“…160 Furthermore, based on a case report, multisensory, progressive, multimodal and technology based interven tions are suggested to fill the gap in motor retraining. 161 A multidisciplinary approach including nursing interventions is also recommended. 162,163 Although very rare, LiS in children poses special challenges especially in the areas of communication, treatment and end-of-life decisions.…”

Locked-In Syndrome: A Systematic Review of Long-Term Management and Prognosis

“…VitalStim using NMES with a speech therapist not only increases airway clearance but it also advances diet status from NPO to puree solids with ice chips. Eye gaze selection can be used for initial communication that later can progress to the Verbally app for functional communication if hand movement is to return [ 21 ].…”

Therapeutic approaches in locked-in syndrome

“…LIS is characterized by preserved consciousness and cognitive functionality in parallel with lack of speech and complete paralysis, including cranial nerve pairs. 1,2 The so-called locked-in syndrome was described in the medical literature for the first time in 1875, by Darolles. 3 The term LIS was first introduced by Plum and Posner in 1966 as a condition related to ventral pons lesion, disrupting both corticospinal and corticobulbar pathways, excluding the participation of the cortex.…”