The theme of this podcast episode is the disabling condition of locked-in state. I discuss the typical causes that lead to locked-in state, particularly large strokes in the brainstem, and highlighting cervical dissection is an important mechanism for this. I also review its main clinical manifestations, noting how blinking and eye movements are often the only preserved motor functions, along with the emotional burden it imposes on patients and their families.
I particularly highlight the uncertainty that dominates the early stages when the patient is aware, but family and healthcare personnel assume they are brain dead. Similarly harrowing are the discussions that flavour the management about continuing supportive treatment, and the fearful thoughts that dominate the victims’ experience, from the fear of dying from the condition, or being taken off life support. The podcast also explores the investigations of locked-in, and the acute care which typically requires ventilation and support of all vegetative functions.
Other themes the podcast covers are the devices that enable people in locked-in state to communicate, the rehabilitation which is usually slow and long-term, and outcome which is often poor. I illustrate the issues I cover in the podcast with such memoirs as The Diving Bell and the Butterfly by Jean-Dominique Bauby, Locked-In by Richard Marsh, Blink by Sandra Nett, A Return to Duty by Clodagh Dunlop, In the Blink of an Eye by Mia Austin, and Ghost Boy by Martin Pistorius.
