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Neurological Rehabilitation

From Silence to Strength: Recovering Function in Locked-In Syndrome Through Intensive Rehabilitation

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

    Poster Presenter(s)

  • Sarah Abraham, MD

    PGY-2 Resident Physician
    New York University Grossman School of Medicine PM&R Program
    New York, New York

    • Co-Author(s)

  • Gabrielle N. Avancena, MD (she/her/hers)

    PGY-2 Resident Physician
    New York University Grossman School of Medicine PM&R Program
    New York, New York

  • Mark Ragucci, DO

    Attending physician
    Institute of Rehabilitation Med NYU Med Center
    Brooklyn, New York

Disclosure(s):
Sarah Abraham, MD: No financial relationships to disclose
Gabrielle N. Avancena, MD: No financial relationships to disclose
Mark Ragucci, DO: No financial relationships to disclose
Case Diagnosis: 52 year-old female with history of left basal ganglia infarct, now with Locked-In Syndrome (LIS).

Case Description or Program Description: The patient presented unresponsive and in decorticate positioning. Computed tomography angiography of her head showed proximal basilar artery occlusion, resulting in bilateral ventral lower pons and cerebellar infarcts. She underwent mechanical thrombectomy, and her neurological exam showed complete paralysis of all voluntary muscles except eye movement, intact cognition, and right upper extremity spasticity. Her hospital course was complicated by respiratory failure requiring tracheostomy placement and dysphagia necessitating a percutaneous endoscopic gastrostomy tube. Transfer to subacute rehabilitation was recommended. However, admission was denied due to Candida auris colonization. After initiation of baclofen and early therapy, she demonstrated improved strength and mobility. She was subsequently admitted to inpatient rehabilitation, where she continued to make further functional gains.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: Since admission to acute rehabilitation, the patient was successfully decannulated, is recovering speech function, is undergoing modified barium swallow studies, and started a modified consistency oral diet. She regained partial strength and mobility to perform some activities of daily living with set-up assistance. She still requires partial to total assistance for the majority of activities of daily living. She tolerates standing for 6 minutes and can maintain static sitting balance with partial assistance. The current discharge plan is home with home health services.

Discussion (relevance): Functional recovery in LIS is often limited, but emerging evidence suggests that intensive inpatient rehabilitation can lead to meaningful functional improvements. Integration of task-specific therapies, neuromuscular re-education, and assistive technologies have been used for motor recovery. Speech recovery can be influenced by repetitive speech therapy, respiratory training, and augmentative communication strategies.

Conclusions: This case highlights the impact of early, intensive, multidisciplinary rehabilitation for meaningful functional recovery in LIS, challenging traditional prognostic assumptions and emphasizing the need for continued research into rehabilitation strategies for LIS.