Locked in neuro

Neuro placement. We went to a consultant meeting on Friday morning at Shenton Park, where they were presenting a patient who had suffered from 'locked in' syndrome - a pons stroke. This, in case you are like me and couldn't quite remember what this means is - when the cortex remains unchanged however the pons has been compromised so the person cannot move while retaining cognition. Some can only blink to communicate as with the presenting patient. This same patient 8 months later was sitting independently, was able to speak and be understood, uses an electric wheelchair, can type using index finger is able to stand for a few seconds without support and has started facilitated gait training - she is still progressing well.

There are two other cases of locked in syndrome that I have seen (not treated) over the last few weeks. Both went at least a year without physio intervention after their strokes. They now receive weekly physio treatments however it appears to be more for maintenance - one has passive stretches, tilt table and airsplints, is able to sit independently in a wheelchair, is dysarthric however can be understood as with the previous patient.
The second also is in a wheelchair but with greater head and trunk support, is unable to speak and uses a communication board to speak. More stability exercises are used with this patient in attempt to gain independent trunk and head control, passive stretches and tilt table again are used.

The point that was made on Friday to the consultants was that early physio intervention for these patients is imperative to their functional outcome. In return note that 'locked in' syndrome is now a blanket statement, not all will have the same recovery available due to the extent of damage to the pons.