Comprehensive, Technology- Based, Team Approach for a Patient with Locked-In Syndrome: A Case Report of Improved Function

Abstract

Research Objectives: Can the successful implication of an interdisciplinary, multi-sensory, multi-modal, technology based treatment approach to motor and communication deficits in a stroke survivor with LIS improve function and quality of life? Design: Case Report. Setting(s): Inpatient rehabilitation. Participant(s): 39 y/o with diagnosis of LIS. Intervention(s): Inter-disciplinary, multi- sensory, multi- modal comprehensive technology- based treatments. Main Outcome Measure(s): Functional Independence Measure (FIM) was used to measure level of assistance. Evaluation results by the occupational, physical and speech therapists were summarized from the daily and weekly notes. In addition, the patient's family reported their interpretation of his quality of life on admission due to his inability to independently communicate. By discharge, report was completed by the patient. Result(s): On evaluation, A.R.'s total FIM score was a 17. He had low arousal and inconsistent eye opening on command. He was able to answer yes/no questions via vertical eye gaze inconsistently. He had no active movement in all four limbs, facial musculature, and cervical spine and presented with generalized hypotonicity. After treatment, he was discharged home with home care. His total FIM score was 88, indicating a gain of 71 points from admission. Conclusion(s): 30 ago, the prognosis for LIS was poor. There are popular, commercialized accounts of people in a locked- in state such as the The Diving Bell and the Butterfly, which eluded the medical world to a one- sided view of LIS. Despite classification of classic LIS, A.R. was provided the opportunity to access both motor and communication sources, particularly through the use of various multi-modal technologies. This case report indicates that the combination of early use of these technologies, optimistic goal setting and multi-modal, sensory and frequent treatments helped with recovery, however future studies are needed.