Who has got the key? Locked-in syndrome.

As a physical therapy student on clinical rotations, my schedule (and to some extent, life) revolves around my Clinical Instructor. Here is the thing: hospitals don’t shut down on holidays (or the weekends) so somebody has to be working….when we do we often get to move around to different parts of the hospital and see interesting new things. For instance:

I met a very fascinating patient, “Mr. S” in the Neuro ICU, he had ‘locked-in’ syndrome. 



 LIS is a condition in which a patient is aware and awake but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for the eyes. This happens when there is damage to specific portions of the lower brain and brainstem, with no damage to the upper brain. (This is different than someone being in a ‘persistent vegetative state’ where the upper brain is damage). LIS can be caused by:

  • Traumatic brain injury
  • Diseases of the circulatory system
  • Medication overdose
  • A stroke or brain hemorrhage (usually of the basilar artery)
  • Multiple Sclerosis
  • Amyotrophic lateral sclerosis (Lou Gehrig’s disease)

Interesting aside, LIS was first described by Alexandre Dumas in 1844 in his novel “The Count of Monte-Cristo.” Noirtier de Villefort, victim of a stroke, survived and learned to communicate by closing and opening his eyelids and by vertical movements of his eyes.  This is precisely how my patient communicated with us.  My CI and I worked on positioning and some chest PT with this patient. 

I can hardly imagine what it feels like to be locked inside a body that won’t move. As a therapist I am grateful to be able to help improve the quality of life of someone like “Mr. S” and I hope we can continue to work with him.

Here is an account from a survivor if you are interested in reading more about it:




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