I'm on my neuro placement at the moment, doing outpatients. One of my pts is a 30 yo female who suffered a bilateral pontine stroke a couple of years ago. She presents with "locked in syndrome", where she is fully functionaing and aware cognitively, but she is unable to execute mvts. she communicates via a lightwriter, where she types in words, and it speaks them for her. Last week, we got her on the tilt table to stretch her calves and do some trunk work. While she was on the tilt table she started laughing. I had no idea what could she could be laughing about, so I asker her, and she typed back, "I farted". For the next five minutes she was laughing uncontrollably. I couldn't do anything except wait until she had calmed down.
I can't imagine how hard it must be to be "locked in". She is extremely bright and cheerful, and always motivated. I think that we can learn a lot from our pts, we think that it is hard being a student, but how much harder is it for them? If they can be bright and cheerful, then we should be more than able to be positive, after all, it is only til the end of the year. And, of course, no matter what happens to you, farting will always be amusing.
5 comments:
A nice story to brighten the day with!
Can you explain "locked in syndrome" a little more. I actually heard the term used today and had no idea what it meant.
Wow what a cute story. I know it really is true, I think sometimes its easy too after you see patients that are quite severely debilitated to look at other patients who appear more fortunate and think, come on you need to be more positive its not that bad compared to so and so. I have to stop and think sometimes because I dont think if I was in even a comparibly easy situation I would respond with half the strength that a lot of these people demonstrate!
I had a pt with the same presentation on my neour prac last year. We had the same problems when she laughed-eg extensor tone+++. One thing that I observed was that many health professionals treated her like she was a baby as she was basically a 30 year old trapped in a 2yr old's body. It was quite a valuble experience to see someone with that presentation and constantly reminding yourself how you should treat them according to age, not case presentation.
We learnt best from our patient.
-annonymous physician
Basically, because this pt has had a bilateral pontine stroke, none of the motor commands which her brain generates (which functions perfectly) can get to where it needs to go, so she is unable to move in a purposeful way. This includes speech as well, so she pretty much has a perfectly functioning brain that is locked into a body that can't move.
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