Locked-in syndrome: improvement in the prognosis after an early intensive multidisciplinary rehabilitation¹

Abstract 

Casanova E, Lazzari RE, Lotta S, Mazzucchi A. Locked-in syndrome: improvement in the prognosis after an early intensive multidisciplinary rehabilitation.

Objective:

To evaluate prognosis and recovery in patients with locked-in syndrome (LIS) receiving early intensive rehabilitative care.

Design:

Consecutive sample and follow-up for 5 months to 6 years.

Setting:

Three rehabilitation centers in Italy.

Participants:

Fourteen patients with LIS who underwent the same treatment and subsequently recovered.

Interventions:

Intensive nursing care and intensive and early rehabilitative program, including physiotherapy and respiratory, swallowing, and speech training. For 4 patients, occupational therapy was performed; 4 subjects also had oculomotor training. After discharge, rehabilitative maintenance care continued for each patient.

Main Outcome Measures:

Motor recovery according to the Patterson and Grabois classification, functional improvement, and mortality rate.

Results:

A significant motor recovery was found in 21% of subjects, within 3 to 6 months of onset of the morbid event; complete swallow recovery in 42%; verbal communication in 28%; communication through devices in 42%; effective bladder and bowel control in 35%; and good breathing patterns in 50%. At follow-up, the mortality rate was 14% and only 2 complications were reported.

Conclusions:

Intensive and early rehabilitation, begun within about 1 month of the morbid event, improved the functional recovery and reduced the mortality rate, which, as reported in the literature, had been 60% about 10 years ago. Further studies are necessary to confirm these data.

Keywords:  Locked-in syndrome, Prognosis, Recovery of function, Rehabilitation

• 1 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.