[Recovery from locked-in syndrome: rule rather than exception]

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Critical Care

Background:

• Acquired brainstem injury can lead to locked-in syndrome (LIS), a condition with a generally poor prognosis.
• Despite the challenges, partial motor function recovery is possible and significantly enhanced by intensive rehabilitation.
• Identifying and addressing treatment bottlenecks in the acute phase of LIS is crucial.

Purpose of the Study:

• To evaluate the potential for motor function recovery in patients with locked-in syndrome.
• To identify critical bottlenecks in the intensive care unit (ICU) treatment of acute LIS.
• To explore the benefits of early, intensive rehabilitation for LIS patients.

Main Methods:

• Case study analysis of two patients with locked-in syndrome.
• Questionnaire survey distributed to medical doctors specializing in rehabilitation.
• Review of treatment protocols and outcomes for acute LIS in the ICU setting.

Main Results:

• Partial motor function recovery is achievable in LIS patients, even years after onset.
• Small neurological improvements can lead to substantial functional benefits for patients.
• Bottlenecks in acute LIS treatment within the ICU were identified.

Conclusions:

• Early initiation of intensive rehabilitation, even while on life-sustaining treatment in the ICU, is recommended.
• This early intervention may significantly improve the long-term recovery trajectory for LIS patients.
• There is a need for validated prognostic instruments to predict recovery in LIS.