Locked in Syndrome (LIS)

PT role:

- ROM - education - positioning - monitor for improvement (establish level of LIS) - communicate

what are the 3 categories of LIS

1. complete or total LIS (no eye movement) 2. classic LIS (preserved vertical eye movement and blinking) 3. Incomplete LIS (some recovery of voluntary movements) (this is kaylan)

LIS is defined by what 5 criteria?

1. sustained eyes opening and preserved vertical eye movement 2. preserved higher cortical functions 3. aphonia or severe hypophonia 4. quadriplegia/paresis 5. primary mode of communication that uses vertical eye movements or blinking (technology is changing this)

prognosis of LIS

85% are alive after 10 years younger patients have better prognosis

LIS will go to a _______ more than a home

SNF but if they go home they are probably younger

blood flow to the pons of brainstem?

basilar might be more?

what is the most important priority of the care of LIS in acute care?

develop a means of communication!!!

LIS going home

high degree of financial burden excessive home modifications large amounts of equipment (wheelchair, hoyer lift, ventilation, mattress) therapy is not really indicated at home (maybe once a year for new equipment scripts)

LIS etiology

most often an ischemic stroke basilar artery thrombus with occlusion of perforating arteries it can be: a hemorrhage, head trauma, tumor, infection

acute care management of LIS

most severe neurological condition admitted to the hospital due to respiratory and cardiovascular support needed high risk of DVT, thrombosis, dehydration, pressure sores they often require ventilation and nutrition support

Pathophysiology of LIS

occurs as a result of bilateral lesions in the ventral pons CN 1 - 4 are there STT tract is there Sensation, blinking, some eye movements, cognition, sleep and wake cycles

definition of LIS

preserved awareness relatively intact cognitive functions inability to communicate while being paralyzed and voiceless

Big take away points

recovery/prognosis is poor potential for recovery with incomplete and hemorrhage higher burden basilar artery syndrome of ventral pons sparing CN 1-4 first thing to do: establish form of communication

death from LIS is usually from?

respiratory pneumonia stroke

what 2 Dx can have LIS characteristrics

severe GB or ALS

inpatient rehab for LIS

sometimes they end up in rehab for a trial assume minimal to no functional recovery establish communication (speech therapy) respiratory support (therapy and medicine) --> coughing, position positioning and mobility (PT) --> progressive upright tolerance (they will have hypotension), bed positioning, mattress appropriate wheelchair psychological support

LIS clinical presentation

they are 100% equally aroused and aware this is unlike brain death, coma, vegetative states

recovery in LIS?

they might get horizontal eye movements in 4 weeks incomplete: oral-motor could take years distal recovery can take years they can get their feeding tube out in 1st year maybe

what is locked in syndrome?

ventral pontine infarct complete paralysis preserved consciousness and eye movement