Treatment at the Raphael Hospital
Barbara A. Wilson, Allen Paul, Rose Anita, Kubickova Veronika in Locked-In Syndrome after Brain Damage, 2018
On ITU a lumbar puncture was performed, which came back as NAD except for a slightly raised protein. Overnight he was kept sedated and ventilated. The following morning the team attempted to wake him with a view to extubate as his examination and bloods were pristine. Unfortunately, he did not seem to be able to move, although he was alert and moving his eyes. His cough reflex, which had been previously present, was lost. His neurology at this time was of widespread flaccid paralysis, reduced reflexes (especially on the right), equivocal plantars and no gag reflex. A second CT angiogram was completed after consultation with the neurologists, which showed an occluded basilar artery as far as its termination, with otherwise unremarkable vasculature. There was also low attenuation in the cerebellar hemispheres. A diagnosis of Locked-In Syndrome was made.
Introduction to the challenge of pain and communication in disorders of consciousness
Camille Chatelle, Steven Laureys in Assessing Pain and Communication in Disorders of Consciousness, 2015
Some patients can remain in a coma, neither aroused nor aware, for several weeks. Their eyes are constantly closed and they do not manifest voluntary behavioral responses. Generally, patients emerge from their comatose state within two to four weeks (Posner et al., 2007). The prognosis is influenced by different factors such as etiology, the patient’s general medical condition, and age. Outcome is most likely to be bad if, after three days of observation, there are still no pupillary or corneal reflexes, there is stereotyped or no motor responses to noxious stimulation, and an isoelectrical or burst-suppression electrophysiological (EEG) pattern is observed. Prognosis in traumatic coma survivors is better than in anoxic cases (Whyte et al., 2009). Recovery from coma may lead to a vegetative state, a minimally conscious state or, more rarely, to a locked-in syndrome (Bruno, Vanhaudenhuyse, Thibaut, Moonen, & Laureys, 2011; Posner et al., 2007). Coma is generally associated with a global decrease in brain metabolism of 50–70% of the normal range.
Surviving death
Fredrik Svenaeus in Phenomenological Bioethics, 2017
In addition to brain death, coma, and vegetative state, two related conditions should be mentioned in which consciousness is not totally lost: minimally conscious state and locked-in syndrome. A person in a minimally conscious state may look much like a patient in a vegetative state except that awareness can be proved beyond reflexes and automated behaviours like swallowing or blinking when she is exposed to external stimuli. A person in a minimally conscious state is able to understand and respond to simple questions, expressing feelings by means of body language or moving a limb when asked to do so, for instance. A person in a locked-in syndrome is fully aware and conscious despite suffering from total, or nearly total, bodily paralysis. Cognitive functions of the higher brain are intact, while damage to the lower parts of the brain prevents the person from voluntarily moving any part of her body with the exception, in most cases, of vertical movement of the eyes and blinking. A person in a minimally conscious state may easily be mistaken for a patient in a vegetative state, or vice versa, because of the difficulties in establishing whether bodily responses are conscious or automated. And locked-in conscious states may easily go undetected, especially if the paralysis also affects eye movements and blinking. Recalling our phenomenological analysis of what it means to suffer on the three levels of lived body, being-in-the-world, and life narrative, locked-in syndrome appears to be not only a truly nightmarish condition but also a case of at least minimal, if severely restricted, embodiment. A locked-in person is, indeed, never totally locked in because she is able to see and hear what is going on around her and is also able to express herself by way of her eyes. Proprioception and bodily perception are also often present to some degree despite the paralysis (Bauby 1998).
The role of the interdisciplinary team in subacute rehabilitation for central pontine myelinolysis
Published in Disability and Rehabilitation, 2020
Katelyn Fuller, Camilla Guerrero, Maybel Kyin, Cathelyn Timple, Marie Yeseta
Typically, patients show other neurological manifestations, such as encephalopathy and seizures, caused by the metabolic disturbances that later originate CPM, presenting in the form of a brainstem dysfunction and evolving bilateral hemiparesis [1,3,4]. The most severe cases may present with locked-in syndrome, a condition coined by Plum and Poser in 1966 which is defined as a state of wakefulness with detectable awareness within a non-functional body [5]. Although the exact pathogenesis is still unknown, conditions predisposing patients to CPM include alcoholism, liver disease, and malnutrition [2,4]. CPM has been closely correlated with rapid correction of chronic hyponatremia and current theories suggest that there are long-term alterations in the metabolic balance within the body that may trigger a cellular cascade resulting in CPM with acute adjustments in sodium levels [1,4,6–9].
Management of communication disability in the first 90 days after stroke: a scoping review
Published in Disability and Rehabilitation, 2022
Caroline Baker, Abby M. Foster, Sarah D’Souza, Erin Godecke, Ciara Shiggins, Edwina Lamborn, Lucette Lanyon, Ian Kneebone, Miranda L. Rose
This review aimed to include evidence that addressed all types of neurogenic communication disabilities as a consequence of stroke. However, the vast majority of eligible studies addressed either assessment, treatment, or management approaches of one specific communication disability after stroke: aphasia (103/129). Far fewer studies were identified that focused on the management of other neurogenic communication disabilities, such as dysarthria (3/129), cognitive-communication disability (8/129), and sensory loss post-stroke (4/129). Only one study focused on the management of the locked-in syndrome. Two studies focused on apraxia of speech. The variation of diagnostic criteria in apraxia of speech, and common co-morbidity with aphasia, is likely to contribute to the challenges of research and clinical practice management after stroke [167].
Neurobehavioural assessment and diagnosis in disorders of consciousness: a preliminary study of the Sensory Tool to Assess Responsiveness (STAR)
Published in Neuropsychological Rehabilitation, 2018
Verity Stokes, Sarah Gunn, Katie Schouwenaars, Derar Badwan
Extensive diagnostic assessment is essential in order to identify signs of awareness or responsiveness; for example, León-Carrión, Eeckhout, Domínguez-Morales, and Pérez-Santamaría (2002) found that diagnosis of locked-in syndrome (often mistaken for VS) takes 78.8 days on average. Failure to allow sufficient assessment time may contribute to the high misdiagnosis rate. Behavioural assessment in PDoC is considered to represent the current gold standard (Gosseries et al., 2011). Several well-regarded neurobehavioural measures of PDoC exist, but are noted to have drawbacks in some form. The aim of this article is to validate a new scale, intended to draw on the beneficial aspects of prior assessments while eliminating the drawbacks. The existing measures are discussed below, followed by discussion of the new assessment.
Related Knowledge Centers
- Brainstem
- Electroencephalography
- Poisoning
- Proprioception
- Sleep Paralysis
- Tetraplegia
- Vocal Cords
- Manner of Articulation
- Extraocular Muscles
- Vegetative State