Clinical Observations of Hearing, Speech, Language and Swallowing Abilities in Locked-in Syndrome: A Case-based Study

Background: Locked-in Syndrome (LIS) is a rare neurological condition characterized by quadriplegia, mutism, and lower cranial nerve paralysis with intact eye movements and consciousness and communication through eye blink only. The irretrievable LIS condition differs from a coma, persistent vegetative state, and akinetic mutism with preserved volitional vertical eye movements and blinking involving a lack of conscious interaction with the environment. Reports and evidence on assessment and rehabilitation with LIS are scanty. Thus, this case study aims to highlight some of the challenges faced by speech-language pathologists in the assessment and management of LIS in a multidisciplinary rehabilitation center. This study also emphasizes the assessment protocol adapted to diagnose and strategies planned for intervention.  Case Description: A 58 years old male followed by an ischemic brain stroke diagnosed with LIS with a tracheostomy came to the department. Detailed history noted history revealed a brainstem stroke with pons involvement and a tracheostomy with percutaneous endoscopic gastrotomy and immobile vocal folds with limited epiglottic movements with impaired swallowing ability and severe aspiration. The clinical assessment was challenging and difficult to select appropriate assessment strategies for the condition. Detailed Speech, Swallow, and Language evaluations were carried out. The detailed evaluation reported the client with anarthria with tracheostomy secondary to locked-in syndrome. Conclusion: The present case report summarizes the need and findings of various evaluation procedures in the field of communication disorders. The role of an SLP is essential and a proper diagnostic protocol need to be considered along with spectacular observation while assessing LIS.