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Communications Medicine

Ask Slashdot: Communication With Locked-in Syndrome Patient? 552

Posted by Soulskill
from the our-thoughts-are-with-you dept.
cablepokerface writes "We've had a significant family catastrophe last weekend. My sister-in-law (my wife's sister) is 28 years old and was 30 weeks pregnant till last Saturday. She also had a tumor — it was a benign, slow growing tumor close to her brain-stem. Naturally we were very worried about that condition, but several neurologists assessed the situation earlier and found the tumor to be a problem, but not big enough for her to require immediate surgery, so we decided to give the baby more time. She was symptomatic, but it was primarily pain in her neck area and that was controlled with acceptable levels of morphine.

Then, last Saturday, our lives changed. Probably forever. In the hospital, where she was admitted earlier that week to keep an eye on the baby, the tumor ruptured a small vessel and started leaking blood into the tumor, which swelled up to twice its size. Then she, effectively, had a stroke from the excess blood in the brain stem. In a hurry, the baby was born through C-section (30 weeks and it's a boy — he's doing fine). Saturday night she had complex brain surgery, which lasted nine hours. They removed the blood and tumor that was pressing on the brain.

Last Sunday/Monday they slowly tried to wake her up. The CT scan shows all higher brain functions to work, but a small part of the brain stem shows no activity. She is locked-in, which is a terrible thing to witness since she has virtually no control of any part of her body. She can't breathe on her own, and the only things she can move, ever so slightly, are her lips, eyelids and eyes. And even that's not very steady. Blinking her eyes to answer questions tires her out enormously, as she seems to have to work hard to control those. The crowd on Slashdot is a group of people who have in-depth knowledge of a wide range of topics. I'm certainly not asking for pity here, but maybe you can help me with the following questions: Does anyone have any ideas on how to communicate better with her? Is there technology that could help? Like brain-wave readers or something? Does anyone have any ideas I haven't thought of regarding communication with her, or maybe even experience with it?"
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Ask Slashdot: Communication With Locked-in Syndrome Patient?

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  • Dasher (Score:3, Informative)

    by XPeter (1429763) on Friday May 23, 2014 @11:45AM (#47074661) Homepage

    Dasher is a small software package (akin to notepad) that assists in typing without a keyboard. Maybe you could combine some sort of eye-tracking or morse-code system that can translate her eye movements into numbers and letters on Dasher?

  • Blink Board (Score:5, Informative)

    by Anonymous Coward on Friday May 23, 2014 @11:54AM (#47074755)

    Similar experience here just a month ago. We've had luck with a hastily printed "Blink Board". An 18"x24" laminated print (so it can be written on) with the letters of the alphabet grouped into chunks of 4-letters (ABCD EFGH etc). The family member can point to the groups, and using blinks, allow the patient to (slowly) spell out words.

    On the reverse side, we printed quick "I feel" icons that we can point to (pain, itch, hot/cold, etc).

  • Dasher? (Score:5, Informative)

    by 404 Clue Not Found (763556) * on Friday May 23, 2014 @11:56AM (#47074781)

    The program Dasher [cam.ac.uk] is made to be used by immobilized but conscious patients. It's basically like autocomplete on your cell phone, but instead of typing each letter, you look at it. See their videos, like this YouTube one [youtube.com] or the rest on their website, for a demo.

    It can be used with an eye tracker, following her eye focus instead of eyelids. You might be able to adapt to a brain sensor headset [emotiv.com].

  • Re:Solution (Score:5, Informative)

    by ceoyoyo (59147) on Friday May 23, 2014 @12:03PM (#47074851)

    Slashdot is always remarkably helpful.

    There are a variety of eye trackers on the market, but those might be tiring to use. There are also some EEG devices coming out that might help you, with a bit of hacking.

    Quick google search turns up:

    http://mindflexgames.com/ [mindflexgames.com] - game from Mattel

    http://interaxon.ca/products.h... [interaxon.ca] - input device, doesn't look like it's available yet

    http://emotiv.com/store/headse... [emotiv.com] - this one looks like the most developed. A bit expensive, of course, but nothing like a clinical EEG.

    http://www.transparentcorp.com... [transparentcorp.com] - Some software and another device (NeuroSky).

    http://harteware.blogspot.ca/2... [blogspot.ca] - DIY

  • by Anonymous Coward on Friday May 23, 2014 @12:04PM (#47074867)

    Although the situation in your case sounds much more severe, I had two brain-stem strokes when I was only 39 years old, both in the same day, caused by a ski-helmet that injured my neck in an otherwise perfectly safe fall (obviously I'll never wear a ski helmet again). They were pretty bad strokes, especially the second one, and treatment was not given in time to help because the idiot on the 911 line refused to believe my own diagnosis. I lost all sense of balance and Proprioception, limb coordination, fine motor skills... All were gone and the world did nothing but spin... 2 weeks later I was skiing again at around 75% capacity. Now (8 years later), I am at around 90% in most activities! and probably 95% in those involving gross motor skills rather than fine motor skills. It turns out that brain stem strokes are very common and you should be able to find great support. In most cases the brain rewires itself so quickly and so well to "work around" these types of strokes that recovery is surprisingly quick. I'm not sure that the case you describe is hopeless. And probably the worst thing to do is tell the patient it is hopeless. She needs to have hope that this could repair itself. You need to do some research, lots of it and very fast! Key to my recovery being so quick and so successful was a very strong will-power and my absolute need to get back on those ski slopes ASAP. I continually pushed far beyond the doctors recomendations in terms of physical activity, and that helped force my brain to re-wire and re-learn things quickly. I can still "feel" that the "wrong" parts of my brain or doing the work that used to be done my now-dead parts of my brain stem, but overall I guess I'm lucky. You need to get brain stem stroke specialists involved ASAP. At the time I had my stroke these were practically unknown, usually being misdiagnosed. I had to travel across the state just to find a specialist who had dealt with brain stem strokes. Not all doctors or even specialists will know what they should about this type of injury. Act fast, keep up hope, and maybe you'll find things aren't as bleak as they seem.

  • by tylikcat (1578365) on Friday May 23, 2014 @12:07PM (#47074913)

    I can re-check the research, but IIRC, most folks even, after they've had some months to get used to their new situations prefer to live than to die. (It's easy to project what you think your preferencs would be... but you in the situation is not you watching it from outside. I haven't been through anything nearly this severe, but I dealt with a spine injury which I was told meant I would never live an active life again*... and mostly learned not to try and second guess future me.**)

    * This turned out to be incorrect, but there were some years in there that were chock full of suck.
    ** Which doesn't mean I don't have a living will, but did influence how I wrote it.

  • by sconeu (64226) on Friday May 23, 2014 @12:08PM (#47074937) Homepage Journal

    My late wife had ALS. We used a Tobii [tobiiati.com] assistive communication eyegaze computer. It didn't use blink, it used eye dwell time for "click".

    Since blinking is tiring, perhaps this might be of more assistance.

  • by Bartles (1198017) on Friday May 23, 2014 @12:09PM (#47074939)
    If she has higher brain function, and from the summary it seems she has full higher brain function, pulling the plug without asking her would be murder.
  • Re:Stem cell therapy (Score:5, Informative)

    by umafuckit (2980809) on Friday May 23, 2014 @12:12PM (#47074999)
    I'm a neuroscientist. As far as I know, the science is nowhere near the stage that something like this would stand reasonable odds of working for stroke damage in the brain. It's pretty much a false hope right now.
  • by Jeff Flanagan (2981883) on Friday May 23, 2014 @12:15PM (#47075045)
    >If there is a creator of the universe, why wouldn't he/she/it listen to you?

    Because a creator of universes would be very unlikely to take an interest in some animals on one planet in one universe. It takes a massive ego to expect that a god would give a damn about you.

    I'd expect them to continue to make universes, not be a petty god that monitors the details of tiny lives like the absurd gods of man's imagination.
  • Re:Stem cell therapy (Score:5, Informative)

    by theskipper (461997) on Friday May 23, 2014 @12:35PM (#47075367)

    Worth modding up. For years the term "stem cell therapy" has attracted a bunch of charlatans promising cures way beyond what's currently feasible (or realistically possible). The FDA weighed in again recently: http://www.fda.gov/forconsumer... [fda.gov]

    Having said that, companies like Neuralstem are conducting actual research into regenerative medicine with clinical trials but it remains to be seen how this will work out. And there is serious medical research into cancer stem cells (CD47, etc.) that is an extension of immunotherapy using monoclonal antibodies.

    So it's important to be specific. Traveling to Mexico so you can have some "stem cells" implanted in your spine and expect a magical cure...not a great idea.

  • by tylikcat (1578365) on Friday May 23, 2014 @12:48PM (#47075539)

    I am not a physician. I am a neurobiologist. I work mostly on motor control. (And I teach neuroanatomy, though atm only at an undergraduate level.)

    First things first. It's darned early days in all of this, and recovery from brain injuries is often fairly unpredictable. Even if she doesn't get significantly better - which may be fairly likely, and I don't have enough information to comment - what's hard now will likely become easier via repetition.

    I'll generally agree with the comments that you're probably going to be better off dealing with specialists than trying to get a commerical EEG type device to serve in its place. Though down the road, it might make for an interesting project (and increasingly there are cool things being done with consumer hardware.) The expensive proprietary devices may or may not be optimal... but let everyone catch their breath first.

    Where I think some research could benefit you all a lot is making sure she's seeing the right specialists. Getting in touch with the right people at your local academic hospital - which might, down the road, turn into your not so local academic hospital - is, long term, probably the most useful thing. As other people have mentioned, rest and support can be more useful than trying to fix everything right now. But if you're going nuts looking for options, see if you can start figuring out who, reasonably local, has a serious background in this type of injury, and see if you can get them to look over her MRIs. It can be pretty easy to end up sticking with a suboptimal doctor out of inertia. Asking questions and calling around can really end up being the thing that makes the difference in the long run. (And here I speak from personal experience from my own history of spine injury.)

    If you'd like help navigating the process, drop me a note.

  • by plopez (54068) on Friday May 23, 2014 @12:49PM (#47075567) Journal

    To expand on that, a medicaid lawyer might help. Medicaid has been widened due to ACA, also known as Obamacare. They may be able to help.

  • by sconeu (64226) on Friday May 23, 2014 @01:35PM (#47076183) Homepage Journal

    In case OP is interested in this machine:

    It's an all-in-one form factor, and in my wife's case, they provided mounting hardware for her powerchair. They also provided a rolling rack and mounting hardware for when she was in bed.

    We had the 17 inch screen version, on the theory that bigger was easier to focus on. It also accepts standard USB keyboard and mouse, for configuration purposes, or if the patient has some use of hands. We also had a "big red button" connected by USB that could be used for click, if possible.

    By default, it comes with only the Tobii software communications software enabled. You can purchase (relatively cheaply... $50 or less) unlock for full access to the underlying Windows system, and also the WiFi. It also came with a SIM slot, but the unlock for that was a bit more expensive.

    Just as a side note, I was the guy who asked about text/voice only plans [slashdot.org] a year and a half ago, or so. It was for this computer.

  • Re:Stem cell therapy (Score:4, Informative)

    by umafuckit (2980809) on Friday May 23, 2014 @02:21PM (#47076797)
    This isn't my field, but I'll give an answer a shot. The more peripheral nervous system has a reputation for being better able to re-grow following damage than the more central nervous system. This fact has become contentious, though, and stem cells have more recently been found in the central brain (e.g. the hippocampus). The sensory neurons from the olfactory bulb re-grow constantly. The macular degeneration trials are encouraging. There is a good lay review here [www.nhs.uk]. I don't know to what degree central vision is restored or how well the original circuitry is repaired. The retina, whilst complex, has relatively simple organisation. With the exception of the optic nerve cells that go to the central brain, the connections are fairly short. These facts may contribute to it being a good target for this sort of therapy. If you have an injured spine then you will have damaged cells whose axons could be two feet long. These are the neurons that send motor information down from the brain and sensory information back up. The distance itself may be a big re-wiring challenge. Injecting stem cells into the central brain is currently bleeding edge pure research.

You can do this in a number of ways. IBM chose to do all of them. Why do you find that funny? -- D. Taylor, Computer Science 350

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