Abstract Details

Title Transcranial Direct Current Stimulation as an Adjunct Intervention to Acute Neurorehabilitation in Locked-in Syndrome: A Case Report

Topic Neuro-rehabilitation

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 14-012

Objective

To describe the feasibility, safety, and outcomes of intensive, team-based neurorehabilitation incorporating transcranial direct current stimulation (tDCS) in acute locked-in syndrome (LIS).

Background LIS following pontine infarct results in near-complete paralysis with preserved consciousness. Recovery is rare and treatment options are limited. While tDCS has shown promise in enhancing motor network plasticity after stroke, its use in LIS remains virtually unreported.

Design/Methods A 37-year-old woman with LIS after pontine infarct entered an interdisciplinary neurorehabilitation program. After limited early gains in the first 2 months of her recovery, she began adjunct treatment with tDCS to complement ongoing care. The core protocol targeted the bilateral motor cortex (C3-C4; 2.5 mA, 20 min) administered twice daily for one month, then increased to three times daily, integrated with occupational therapy, physical therapy, and motor imagery exercises. A bifrontal montage (F3-F4; 2.0 mA, 30 min) combined with mindfulness was used intermittently across the treatment period, and anodal stimulation (F7; 2.5 mA, 20 min) was added later to support speech therapy.

Results After 100 sessions over two months, the patient showed progressive, sustained neurologic recovery. The tDCS treatment was well tolerated with no adverse effects. Motor gains included midline head control (up to 7 min), reliable call-bell activation by head movement, purposeful blinking/nodding, volitional facial movement, and emerging bilateral limb extension. Functional mobility improved with initiation of gait trials in LiteGait. Communication gains included improved facial muscle control and consistent head-nodding, with emerging vocalization through sighing. The patient reported better mood and motivation.

Conclusions Within comprehensive inpatient rehabilitation, adjunctive tDCS was feasible, safe, and associated with meaningful motor and behavioral gains, supporting multimodal, team-based neuromodulation for severe brainstem stroke recovery.

Authors/Disclosures
Elizabeth Quilty PRESENTER	Ms. Quilty has nothing to disclose.
Matthew Brecher	Mr. Brecher has nothing to disclose.
Leila Simani, PhD	Dr. Simani has nothing to disclose.
Prin Amorapanth, MD, PhD	Dr. Amorapanth has nothing to disclose.
Lindsey Gurin, MD (Langone Orthopedic Hospital)	Dr. Gurin has received personal compensation in the range of $0-$499 for serving as a physician reviewer with Healthcare Quality Strategies, Inc. Dr. Gurin has received personal compensation in the range of $500-$4,999 for serving as a consultant with Human Services Research Institute.
Benjamin Babaev	Mr. Babaev has nothing to disclose.
Allan George	Mr. George has nothing to disclose.
Holly O'Hearn, PT	Ms. O'Hearn has nothing to disclose.
DIANA MORENO, OTR/L	Ms. MORENO has nothing to disclose.
Shayna Pehel	Ms. Pehel has nothing to disclose.
Giuseppina Pilloni, PhD (NYU Grossman School of Medicine)	Dr. Pilloni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceragem.
Leigh E. Charvet, PhD (NYU Langone)	Dr. Charvet has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Johnson & Johnson. Dr. Charvet has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Springer Healthcare. Dr. Charvet has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for YBrain. Dr. Charvet has stock in Johnson&Johnson.

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