The team's findings, to be presented at the Canadian Stroke Congress, stem from a year study that followed the rehabilitation of 25 LIS patients, people who are aware and awake but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles.
LIS results from a lesion to the brainstem, which can occur when a stroke impacts this specific small area at the junction between the spinal cord and the left and right hemispheres of the brain. The lesion blocks the brain's motor pathways, resulting in almost complete paralysis. The majority of patients in this study received training to use some form of technology that could enhance their independence. Others, who had even more limited movement, require more sophisticated computerized interfaces to activate a scanning system, which permits combined computer-supported communication and safe wheelchair control.
Though these patients are virtually completely immobile, they are sometimes left with the ability to make a one- or two-degree movement of the head, a twitch of a finger or toe, or an eye movement. These minimal functions can open up their world in many ways.
Some patients in this study, for example, learned to operate a motorized wheelchair or control a mouse to access a computer with just the slightest head movement. Even just knowing the mental state of locked-in patients could have huge ramifications for the way we approach care for them.
This is an immense tragedy. Use of the technique among patients and their families could become widespread, if the operations are simplified. Ideally, it will find its way into homes, enabling daily communication between locked-in patients and their loved ones. Nathan Hurst blends a love of storytelling with a passion for science and the outdoors, covering technology, the environment, and much more.
Marsh, however, did something almost unheard of: he recovered. On the third day after his stroke, a doctor peered down at him and uttered the longed-for words: "You know, I think he might still be there. Let's see. The moment that doctor discovered Marsh could communicate through blinking was one of profound relief for Marsh and his family — although his prognosis remained critical.
But once they left, it was lonely — not in the way of missing people but the loneliess of knowing there's no one there who really understands how to communicate with you. The only way for Marsh to sleep, was to be medicated. That, however, only lasted four hours, after which there had to be a three-hour pause before the next dose could be administered. In questions submitted by Guardian readers to Marsh ahead of this interview one asked about his experience of his hospital care while the staff did not think he was conscious.
Marsh said: "The staff who work at night were the newest and least skilled, and I was totally at their mercy. I felt very vulnerable. I did get injured a couple of times with rough handling and that always happened at night.
I knew I wasn't in the best of care and I just counted the minutes until I would get more medicine and just sleep. In response to another question, about the right-to-die debate, Marsh said he has no opinion. Doble, Jennifer E. Haig, Christopher Anderson, and Richard Katz. A spelling device for the paralysed. Brain—computer communication: Unlocking the locked in.
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