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Neurological Rehabilitation

Near Locked in Syndrome Improvements Following Inpatient Rehab: A Case Report

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 5

    Poster Presenter(s)

  • Giorgina Giampaolo, MD

    Resident
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    Bronx, New York

    • Co-Author(s)

  • VA

    Vishal Anjutgi, MD

    Resident
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    Long Valley, New Jersey

  • AA

    Andrew Abdou, DO

    Attending Physician
    Montefiore, Burke Rehabilitation
    White Plains, New York

Disclosure(s):
Giorgina Giampaolo, MD: No financial relationships to disclose
Case Diagnosis: 53 yo with near locked-in syndrome who improved after inpatient rehabilitation.

Case Description or Program Description: A 53 yo male initially presented to acute care lethargic and covered in vomitus with elevated blood pressure (207/98). Imaging revealed basilar artery occlusion due thrombosed atherosclerotic plaque. He underwent mechanical thrombectomy with TICI3 re-occlusion and stent placement. His course was complicated by acute hypoxic respiratory failure requiring tracheostomy and sepsis. Clinically, the patient displayed fixed eye gaze and left-sided flaccid hemiplegia, with partial antigravity strength in the right upper and lower extremities consistent with a near locked in syndrome, given the partial motor preservation. Patient was discharged to acute inpatient rehabilitation for 5 weeks of intensive physical therapy, occupational therapy, and speech therapy.

Setting: Acute inpatient rehabilitation

Assessment/Results: He had significant improvement throughout acute rehab. He was fitted for a swedish knee cage and aircast and successfully decannulated. He had improvement in bilateral strength and was able to improve communication using gestures and use of a white board. His mobility improved and he was able to ambulate 50 feet with quad cane and moderate assistance. He was discharged to subacute rehab.

Discussion (relevance): This case highlights the potential for recovery in patients with near locked-in syndrome, a condition traditionally associated with poor outcomes. Intensive rehabilitation, including physical, occupational, and speech therapies, played a crucial role in the patient’s recovery. Physiatrists have an important role in managing these complex cases and optimizing functional outcomes.

Conclusions: This patient demonstrated notable recovery, including increased strength, improved communication, and functional mobility, highlighting the potential for functional improvement in patients with near locked-in syndrome with early rehabilitation.