Spinal unit long term inpatient management of patients with severe neurological deficit

Patients with the 'locked-in syndrome' are now being presented to spinal units for long term care. This is becoming a problem in spinal cord injury units, which have developed to accept spinal cord injury in the acute stage, to manage problems resulting from this, and to conduct a rehabilitation programme. A case history is presented of a patient with Guillain-Barré's recurrent syndrome, already 3 years an inpatient in a spinal unit and with minimal recovery. Problems in care are described in a patient with total bulbar palsy, paralysis of the intercostal and of the diaphragm includes inability to swallow due to bulbar paralysis with nutrition delivered by jejunostomy. The presence of a tracheostomy, as well as the bulbar and laryngeal palsy, render vocal communication impossible. Total care has been provided in a spinal unit for the past 3 years, with no complications occurring during his management. Given continuation of expert care, life expectancy may be that of many years. Is a spinal cord injury unit the proper place for long term management of cases of this nature and many similar cases described as having the 'locked-in syndrome'?