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Ask Slashdot: Communication With Locked-in Syndrome Patient?
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?"
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?"
Yikes, that sounds like a terrible experience. My sympathies to your sister in law and the whole family.
There are several methods available, most prominently implanting arrays of electrode over pre-motor cortex, which can then be decoded online and used to control a computer pointer.
See for example:
http://www.youtube.com/watch?v...
You might want to contact Frank Guenther at BU. Who has worked on this for several years, and has started the Unlock Project particularly for people in your sister in law's situation.
I'm not a medical expert, but work in computer forensics. I think it's wise to begin recording her facial movements immediately to establish a baseline of activity and determine when improvements or declines occur. This seems like something easily accomplished with today's off-the-shelf technology, such as GoPro style digital cameras.
You probably know this already. For the moment you should concentrate on telling her that everyone is ok and she needs to rest. Talk to her, tell her not to try to respond and not to be frustrated. Don't ask questions as that will make her more frustrated. Keep her in the conversation without expecting her to answer.
Consider unplugging the machines. That's no way to live. Not for her, not for anybody around her. I know it's a terrible prospect, but euthanasia is often the dignified way out.
While I would agree with you in the long term if there were absolutely no further room for recovery. However It is very likely that she will still gain back some of the motor controls she has lost. (though likely not all of it.) Brains have an amazing capacity for rewiring around damage, but it takes time and enormous effort on the part of the patient.
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).
Comment removed based on user account deletion
Wow. Just wow.
Life is suffering. We can all certainly avoid a great deal of suffering by killing ourselves painlessly now, whether we are locked in or perfectly healthy. But life is sweet as well. Dying forecloses on the possibility of further sweetness. This person clearly hasn't given up on further sweetness. This is not a good time to get into an argument about your favorite political hobby horse. I won't say that you suck as a human being, because I'm sure you have some legitimate and possibly heartbreaking reason for having said what you said. But context is everything, and this isn't the place.
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/ - game from Mattel
http://interaxon.ca/products.h... - input device, doesn't look like it's available yet
http://emotiv.com/store/headse... - this one looks like the most developed. A bit expensive, of course, but nothing like a clinical EEG.
http://www.transparentcorp.com... - Some software and another device (NeuroSky).
http://harteware.blogspot.ca/2... - DIY
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.
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.
The question was about methods of communication, not "should she be allowed to live?"
Guitarist Jason Becker communicates very effectively using his eyes. Look up information about him.
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.
We've had similar predicaments in the family, and my dads uncle is in jail (life time sentence) for making the 'human choice' - which was illegal.
It's easy to say someone sucks as a human being, but are you really willing to sacrifice your own life, to euthanize someone elses? (effectively ending two lives at once)
I'm truly sorry for what has happened.
Many people are addressing how to communicate, but few are addressing what to communicate. At this time, your sister-in-law is tired, afraid, and a new mom. Her mental stamina is low and she is trying to heal. Making it harder, her potential to heal won't be apparent immediately, and can take several weeks or months to show.
Let her spend time with the baby. If things go badly this may be her crowning achievement, and if things go well, this may be her greatest mental uplift giving her the energy to heal.
Spend time listening as well as talking with her. Always give her comments to you priority over your comments to her. If her time is limited, there's much she will want to say - you have to let her get it out.
Just take things day by day. There will be good days and bad days. Bad days can actually be good news - healing is tiring, and while her brain swelling goes down and she recovers she will be extra tired. As parts of her brain switch back on and fumble to find their mental feet, she will sometimes seem off-balance.
Finally, given the affected area, modify your expectations of touch. Contact is important, but it should be somewhere she is connected to. If she can't move or feel her hands (which are two quite separate things) but she can move her eyelids, contact with her face might work better. Give her a say in that - she will guide you. Touch and intimacy are vital to her wellbeing.
I hope she makes a full recovery. She may well not. Take what you can get, listen to her, and do the best you can as a family to work with what you now have.
Congratulations on the new baby. I hope they will grow to know and enjoy their mother.
I'd agree with this. This is very early days, and while the road ahead is difficult, she could recover far more than is immediately obvious.
The world's burning. Moped Jesus spotted on I50. Details at 11.
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.
soylentnews.org
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...
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.
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.
Were I in her hospital gown, I know what my answer would be.
Really? Because I don't know what mine would be. And I have thought about it. Some days I feel like I could live without sight as long as I had my limbs. Other times I think I'd be OK in a wheelchair. Then there are days when my inner cheap bastard comes out and says "do whatever's cheapest!" I'm not about to judge somebody who decides either way. This is one of those "unless you've walked a mile in their shoes" sort of situations.
Hell, I don't even know what I will want for dinner tomorrow night.
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.
So ask. Hook her up with one of those Stephen Hawking eye-tracker things, and ask her what she wants.
Frankly, I would not do that until she has learned to cope with her condition. I have a close relative who went through a debilitating stroke and honestly I was about ready to drag her in to a psych ward I was so concerned about suicide risk. Today she gets incredibly frustrated with things, but for the most part is living happily and reasonably productively for somebody who is disabled. She needs a lot of help, but I think that a decision to commit suicide would have been a rash one.
It is simply unwise to make any life decision just after going through a traumatic event. If in a year nothing has changed somebody in this condition would be in a much better place to make a thoughtful evaluation. Maybe less time is required. However, it is foolish to contemplate something like assisted suicide a short time after something like this.
There seems to be a lot of people here who, by their comments, seem like a massive electrical 'stimulation' to their head might be an improvement.
He said "last Saturday", it hasn't even been a week since she had major brain surgery, and from the sounds of it she does have some minor facial control (eyes, lips), and can answer yes/no questions, it's just hard/tiring, "she" is still "in there", just not with a body that is under her control very much. I wouldn't be rushing to "pull the plug" just because she can't breathe on her own - first off it should be *her* decision as long as she is conscious and able to answer yes/no questions at least, and secondly after brain surgery she's likely to have a lot of brain swelling that could take quite some time to decrease and might lead to improvement.
Then perhaps I might elaborate on my trolling. Yes, I'm an asshole. Sometimes that is what is needed.
Prayer is not just some harmless little habbit. It's woo. One of a large number of similar superstitions. While many may have conviction in the power of prayer, every scientific investigation and even just basic common sense says it does squat. Nor is is simply a harmless little ritual that brings some people comfort: It offers a false solution. People *die* because they trust in the power of prayer rather than medicine, just as they die because they get suckered into homeopathy or crystal healing or a hundred other piece of nonsense. Worse, children die because their parents are convinced of the power of prayer.
This scientifically-nonsensical rubbish needs to be pointed out. It's followers need to be challenged into providing verifiable, repeatable, non-cherry-picked evidence in support of their superstition - and, if no such evidence can be provided, then the followers need to be convinced of their error. And if they remain convicted in spite of all evidence to the contary then it is the duty of all right-thinking people to make a mockery of them, so that others may see the error before they too fall prey.
Prayer is something of an odd case, in that even those who claim to believe in the power usually act as if they do not. They will pray for their loved one's to be healed, but take them to the hospital regardless. There are a few exceptions who die for their superstition, but these are the exception. That does not excuse prayer: It only makes the error more apparent.