In <32B8779D.30A6 at cybrtyme.com> norednex at cybrtyme.com writes:
>>Can anyone help me with some information about the "Locked In" state
>after a TBI??
>A short synopsis of what it entails?
>Please respond, my precious "adopted" son dAniel has emerged from his
>coma, but may be Locked In.
>karen suzanne
>norednex at cybrtyme.comI first saw a locked-in patient nearly 20 years ago, my firs hospital
job as a neuropsychologist. His wife had posted signs saying he was
awake and aware, and I thought "poor, deluded woman!"--but indeed, he
was (much of the time) awake and aware.
He had a brainstem infarct which meant that (or should have meant that)
he was totally paralysed, but still conscious. I say "should have"
because he was not a classic case. In the classic case, paralysis of
everything except eyes is complete, but eye movement can be used to
signal--e.g. by Morse code.
My patient did NOT have good voluntary control of eye movement. He
did, however, have (sometimes) ability to pinch a switch I contrived.
He did better grabbing a $5 bill his wife would pull between thumb and
fingers. Perhaps reflexively, he could soometimes catch or hit objects
thrown at him.
Night nurses claimed he could talk. I never believed it, but when
trying to demonstrate a communication device I hoped he could use, he
suddenly said (very low, but clear) "I saw that."
EACH PATIENT IS DIFFERENT ! However, if he is basically locked-in, and
not in a "persistent vegettive state", then he may very well be aware
of what you say to him, and with some ingenuity you may be able to
devise a way for him to reply. At a minimum, if there is something,
ANYTHING he can do with ANY part of his body, use that so he can reply
"yes" or "no" to your questions. If you play 20 questions well, you
could get a lot out of him that way.
All this assumes he did not have sufficient damage in other brain
structures to impair basic language abilities, etc.
Pleae bear in mind my earlier qualification, "MUCH of the time". My
patient's awareness waxed and waned. It takes some patience and
perceptiveness to sort it out, but sometimes such a patient may be
briefly sleeping, OR may be blocked in even the limited response he has
been using; just wait and tryy again.
Frank LeFever
New York Neuropsychology Group