Communicating with the “locked-in” patient
Because you can do it, should you?
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It is a clinical truism that ALS is a degenerative disease of motor neurons. However, other neuronal populations also degenerate. For example, many patients develop abnormal frontal lobe executive function or frank frontotemporal dementia (FTD).1 Another truism is that certain motor nuclei are spared in ALS, namely, those that control the extraocular muscles and the urethral and anal sphincters. Eventually, patients who are maintained on long-term mechanical ventilation develop paralysis of those muscles and become “totally locked in” (TLI).2 Such patients are unable to move and are incapable of communicating with their external environment.
In the total absence of motor function, communication may be possible through manipulation of other physiologic functions. Wilhelm et al. in this issue report on their attempt to communicate with a TLI ALS patient through manipulation of …
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