Locked-in syndrome: improvement in the prognosis after an early intensive multidisciplinary rehabilitation11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

Casanova, Emanuela; Lazzari, Rosa E; Lotta, S; Mazzucchi, A

doi:10.1016/s0003-9993(03)00008-x

Cited by 84 publications

(32 citation statements)

References 6 publications

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“…The severity of motor impairment was assessed using the Patterson & Grabois scale [3], [65]. This is a 5 points scale ranging from 0 (no recovery- no return of motor function and total dependence in all activities of daily living) to 5 (no neurologic deficit).…”

Section: Methodsmentioning

confidence: 99%

A Comparison of Two Spelling Brain-Computer Interfaces Based on Visual P3 and SSVEP in Locked-In Syndrome

et al. 2013

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ObjectivesWe study the applicability of a visual P3-based and a Steady State Visually Evoked Potentials (SSVEP)-based Brain-Computer Interfaces (BCIs) for mental text spelling on a cohort of patients with incomplete Locked-In Syndrome (LIS).MethodsSeven patients performed repeated sessions with each BCI. We assessed BCI performance, mental workload and overall satisfaction for both systems. We also investigated the effect of the quality of life and level of motor impairment on the performance.ResultsAll seven patients were able to achieve an accuracy of 70% or more with the SSVEP-based BCI, compared to 3 patients with the P3-based BCI, showing a better performance with the SSVEP BCI than with the P3 BCI in the studied cohort. Moreover, the better performance of the SSVEP-based BCI was accompanied by a lower mental workload and a higher overall satisfaction. No relationship was found between BCI performance and level of motor impairment or quality of life.ConclusionOur results show a better usability of the SSVEP-based BCI than the P3-based one for the sessions performed by the tested population of locked-in patients with respect to all the criteria considered. The study shows the advantage of developing alternative BCIs with respect to the traditional matrix-based P3 speller using different designs and signal modalities such as SSVEPs to build a faster, more accurate, less mentally demanding and more satisfying BCI by testing both types of BCIs on a convenience sample of LIS patients.

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Section: Methodsmentioning

confidence: 99%

A Comparison of Two Spelling Brain-Computer Interfaces Based on Visual P3 and SSVEP in Locked-In Syndrome

et al. 2013

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“…The youngest patients have a better prognosis for survival, with more than 85% of individuals still living ten years after onset. 5, 6 With advances in medical technology, life expectancy will likely increase.…”

Section: Introductionmentioning

confidence: 99%

Brain–Computer Interface With Language Model–Electroencephalography Fusion for Locked-In Syndrome

Oken

Orhan

Roark

et al. 2013

Neurorehabil Neural Repair

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Background Some non-invasive brain computer interface (BCI) systems are currently available for locked-in syndrome (LIS) but none have incorporated a statistical language model during text generation. Objective To begin to address the communication needs of individuals with LIS using a non-invasive BCI that involves Rapid Serial Visual Presentation (RSVP) of symbols and a unique classifier with EEG and language model fusion. Methods The RSVP Keyboard™ was developed with several unique features. Individual letters are presented at 2.5 per sec. Computer classification of letters as targets or non-targets based on EEG is performed using machine learning that incorporates a language model for letter prediction via Bayesian fusion enabling targets to be presented only 1–4 times. Nine participants with LIS and nine healthy controls were enrolled. After screening, subjects first calibrated the system, and then completed a series of balanced word generation mastery tasks that were designed with five incremental levels of difficulty, that increased by selecting phrases for which the utility of the language model decreased naturally. Results Six participants with LIS and nine controls completed the experiment. All LIS participants successfully mastered spelling at level one and one subject achieved level five. Six of nine control participants achieved level five. Conclusions Individuals who have incomplete LIS may benefit from an EEG-based BCI system, which relies on EEG classification and a statistical language model. Steps to further improve the system are discussed.

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“…The FIM has floor effects in highly dependent individuals, which was particularly evident in this case warranting the need for more sensitive measures [13]. Research supports that an early and intensive multidisciplinary treatment plan for patients with LIS, begun within one month of onset, improved health status and decreased the chances for mortality [24] Even still, access to an inpatient rehabilitation team is limited and when provided the opportunity, pressure exists for early discharge leading to higher chances of institutionalization [13, 26]. Literature continues to support that lifelong costs are lowest following TBI with supervised home placement after rehabilitation [1].…”

Section: Discussionmentioning

confidence: 96%

“…The patient was further able to make decisions and direct her care, increasing her current and future autonomy. This is of great significance as these patients are often placed in long-term care facilities and at the same time are living longer [24]. Considering lifelong costs has become more important due to the reported longer life expectancy in those with LIS, understanding that up to 83% will live ten years after onset [11, 25].…”

Section: Discussionmentioning

confidence: 99%

Differential Diagnosis and Management of Incomplete Locked-In Syndrome after Traumatic Brain Injury

Surdyke

Fernandez

Foster

et al. 2017

Case Reports in Neurological Medicine

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Locked-in syndrome (LIS) is a rare diagnosis in which patients present with quadriplegia, lower cranial nerve paralysis, and mutism. It is clinically difficult to differentiate from other similarly presenting diagnoses with no standard approach for assessing such poorly responsive patients. The purpose of this case is to highlight the clinical differential diagnosis process and outcomes of a patient with LIS during acute inpatient rehabilitation. A 32-year-old female was admitted following traumatic brain injury. She presented with quadriplegia and mutism but was awake and aroused based on eye gaze communication. The rehabilitation team was able to diagnose incomplete LIS based on knowledge of neuroanatomy and clinical reasoning. Establishing this diagnosis allowed for an individualized treatment plan that focused on communication, coping, family training, and discharge planning. The patient was ultimately able to discharge home with a single caregiver, improving her quality of life. Continued evidence highlights the benefits of intensive comprehensive therapy for those with acquired brain injury such as LIS, but access is still limited for those with a seemingly poor prognosis. Access to a multidisciplinary, specialized team provides opportunity for continued assessment and individualized treatment as the patient attains more medical stability, improving long-term management.

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Cited by 84 publications

References 6 publications

A Comparison of Two Spelling Brain-Computer Interfaces Based on Visual P3 and SSVEP in Locked-In Syndrome

A Comparison of Two Spelling Brain-Computer Interfaces Based on Visual P3 and SSVEP in Locked-In Syndrome

Brain–Computer Interface With Language Model–Electroencephalography Fusion for Locked-In Syndrome

Differential Diagnosis and Management of Incomplete Locked-In Syndrome after Traumatic Brain Injury

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