Locked‐In Syndrome: Practical Rehabilitation Management

Abstract

Locked-in syndrome is a rare and devastating condition that results in tetraplegia, lower cranial nerve paralysis, and anarthria with preserved cognition, vertical gaze, and upper eyelid movements. Although acute management is much like that of any severe stroke, rehabilitation and recovery of these patients have not been previously described. Challenges relevant to this population include blood pressure management and orthostasis, timing and appropriateness of reinstating oral feeding, ventilatory support, decannulation after tracheostomy, bowel and bladder management, vestibular dysfunction, and eye care. Targeted rehabilitation of head, neck, and trunk stability to improve function, and proper fit in an appropriate wheelchair are essential to assist with mobility. Rehabilitation interventions should include a focus on distal motor control and upright tolerance training followed by balance and mobility exercises. In addition, special considerations must be given to developing early methods of communication through use of augmentative systems to call for help and express needs. These systems along with additional technology provide the basis to promote connectivity to family and friends through the use of social media and the internet. Establishment of communication, mobility, and connectivity is essential in promoting independence, autonomy, and improving quality of life. Overall, with specialized rehabilitative care and access to the proper equipment, long-term outcomes and quality of life in these patients can be favorable.

How is family health related to health‐related quality of life among middle‐aged and older adults in rural China? A cross‐sectional study

“…The levels of mobility, self‐care and usual activities may affect individual's ability to remain socially connected and manage their affairs (Farr et al., 2021; Lin et al., 2022). Practical and instrumental family support plays an important role in the rehabilitation of people with impaired function (Babaei & Abolhasani, 2020), and family members are the most potential subjects for providing significant assistance with physical care and existential support (Norinder et al., 2017).…”

Locked-in syndrome revisited

“…158 The currently available recommendations on the rehabilitation of LiS patients suggest that the treatment and management of pain, spasticity, incontinence, nutrition, tracheostomy, vision, vegetative and vestibular functions and communication are highly important. 159 Moreover, the benefit of early interdisciplinary therapy including physical, speech, occupational therapy and the use of assistive devices are critical. 160 Furthermore, based on a case report, multisensory, progressive, multimodal and technology based interven tions are suggested to fill the gap in motor retraining.…”

Demographic, Medical, and Clinical Characteristics of a Population-Based Sample of Patients With Long-lasting Locked-In Syndrome

“…Patients with locked-in syndrome (LIS) have severe paralysis and communication difficulties 1 but function well cognitively 2,3 and can communicate to varying degrees using eye movements. 4,5 The most common cause of LIS is vascular, [6][7][8][9] while more rare etiologies include trauma, infection, severe polyneuropathy, myelinolysis, and inflammatory demyelination. 5,6 LIS can be divided into 3 categories based on clinical presentation.…”

“…4,5 The most common cause of LIS is vascular, [6][7][8][9] while more rare etiologies include trauma, infection, severe polyneuropathy, myelinolysis, and inflammatory demyelination. 5,6 LIS can be divided into 3 categories based on clinical presentation. 10 Classic LIS refers to a condition characterized by intact consciousness, mutism, and quadriplegia, with communication abilities limited to vertical gazing and/or blinking.…”

“…4,5 The most common cause of LIS is vascular, 6-9 while more rare etiologies include trauma, infection, severe polyneuropathy, myelinolysis, and inflammatory demyelination. 5,6…”