Ann Rehabil Med.  2012 Apr;36(2):268-272. 10.5535/arm.2012.36.2.268.

Augmentative and Alternative Communication Training Using Eye Blink Switch for Locked-in Syndrome Patient

• Park SW
• Yim YL
• Yi SH
• Kim HY
• Jung SM

• KMID: 2266767
• DOI: http://doi.org/10.5535/arm.2012.36.2.268

Abstract

Locked-in Syndrome is a severe pontine stroke causing quadriplegia, lower cranial nerve paralysis, and mutism with preservation of only vertical gaze and upper eyelid movement in a conscious patient. We present a case of a Locked-in Syndrome patient who received communication training with augmentative and alternative communication equipment by using eye blinks. After 3 weeks of training, the patient was able to make an attempt to interact with other people, and associate a new word by Korean alphabet selection. Augmentative and alternative communication equipment which uses eye blinks might be considered to be beneficial in improving the communication skills of locked-in syndrome patients.

Keyword

Augmentative and alternative communications systems; Communication aids for handicapped; Locked-in syndrom

MeSH Terms

Communication Aids for Disabled
Cranial Nerves
Eye
Eyelids
Humans
Mutism
Paralysis
Quadriplegia
Stroke

Figure

• 

  Fig. 1 Self-Calibrating Auditory Tone Infrared switch.

• 

  Fig. 2 Raw signals from the sensor were amplified and transferred to the control sensor box. Then, the controller sent information to the personal computer by using a phototransistor that converted optical signals into electrical signals. A light emitting diode and a beep sound would occur with one blink (click) of the sensor by the patient. At the same time, electrical signals were output by voice through the Switch Interface.

• 

  Fig. 3 Scanning training program for motor skills, response time and accuracy; (A) when patient clicks, the arrow moves to the target; (B) when patient clicks, bubble grows; (C) when entering into the squared circle, patients are required to click and; (D) when insects enter the circle, patients are required to click.

• 

  Fig. 4 The patient practicing training program using eye blink.

• 

  Fig. 5 The Clicky2.0 automatically scans each item (alphabets, commonly used words and sentences) according to the order and time interval previously set up. When a patient blinks his eye at the intended moment, a Self-Calibrating Auditory Tone Infrared switch is activated.

Reference

1. Smith E, Delargy M. Locked-in syndrome. BMJ. 2005; 330:406–409. PMID: 15718541.

2. Patterson JR, Grabois M. Locked-in syndrome: a review of 139 cases. Stroke. 1986; 17:758–764. PMID: 3738962.

3. Doble JE, Haig AJ, Anderson C, Katz R. Impairment, activity, participation, life satisfaction and survival in persons with locked-in syndrome for over a decade: follow-up on a previously reported cohort. J Head Trauma Rehabil. 2003; 18:435–444. PMID: 12973273.

4. Casanova E, Lazzari RE, Latta S, Mazzucchi A. Locked-in syndrome: improvement in the prognosis after an early intensive multi-disciplinary rehabilitation. Arch Phys Med Rehabil. 2003; 84:862–867. PMID: 12808539.

5. Söderholm S, Meinander M, Alaranta H. Augmentative and alternative communication methods in locked-in syndrome. J Rehabil Med. 2001; 33:235–239. PMID: 11585156.

6. Bauer G, Gerstenbrand F, Rumpl E. Varieties of the locked-in syndrome. J Neurol. 1979; 221:77–91. PMID: 92545.