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Locked-In syndrome

Locked-In syndrome is a condition in which a patient is aware and awake, but cannot move or communicate due to complete paralysis of the body. It is the result of a brain stem stroke in which the ventral part of the brain stem is damaged. It results in quadriplegia and inability to speak in otherwise cognitively intact individuals. Those with Locked-In syndrome may be able to communicate with others by coding messages by blinking or moving their eyes, which are not affected by the paralysis. more...

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Locked-in syndrome is also known as Cerebromedullospinal Disconnection, De-Efferented State, Pseudocoma, and ventral pontine syndrome. Unlike persistent vegetative state, in which the upper portions of the brain are damaged and the lower portions are spared, locked-in syndrome is caused by damage to specific portions of the lower brain and brainstem with no damage to the upper brain.

Patients who have Locked-In Syndrome are fully aware. They will know exactly where their arms and legs are, and unlike paralyzed patients, they can still feel sensations of pain and touch. Some patients may have the ability to move certain facial muscles. The majority of locked-in syndrome patients do not regain motor control, but several devices are available to help patients communicate.

Patients with locked-in syndrome report feeling mostly tranquil, and some report feeling a little sad. This is contrary to the panic and terror that would be expected in people who cannot move or speak. This finding indicates that emotions are due to interpretations of bodily sensations. Since those who are locked-in have no bodily feeling, the brain fails to receive feedback indicative of alarm.

Parisian journalist Jean-Dominique Bauby had a stroke in 1995, and when he awoke 20 days later he found that his body had all but stopped working: he could only control his left eyelid. By blinking his eye he dictated a word at a time and in this way he wrote The Diving Bell and the Butterfly.

This syndrome was a plot point of the CSI: NY series premiere episode "Blink."

The original version of this article contained text from the NINDS public domain pages on TBI at

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Red rover, red rover
From Pulp & Paper, 2/1/04 by Gates, George

Some of us are old enough to remember the childhood game I've used to title this column. If you're not, here's how it goes: two groups of kids face each other across an open space. Each group faces the other, forming a chain with arms linked or hands held tightly. One group starts chanting, "Red rover, red rover, we dare (so-and-so) over!" If you're the soand-so in the other group whose name is called, you run at full speed across the open space and try to bash your way through the other group's people-chain. If you do, you get to choose one of their people for your side. If you don't, you have to join their chain. Or maybe go home, or eat worms, or some such. I mostly remember the taunting chant, daring somebody to crash through your line. Also, the instant of fear as someone thundered toward me, intent on removing arm from body.

I thought of the game recently after working in three different places where good people are genuinely trying hard to improve things. One is in a continuous processing industry with a company doing reasonably well. The second is in the tumultuous healthcare sector involving a labormanagement partnership effort. The third, which might seem unusual, is with a church leadership group faced with combining two reluctant parish communities. One is facing change they're choosing to make, another is choosing to deal with change they have to make, the last is staring at change nobody wants to make.What they have in common is what I'll call the Red Rover Syndrome.

NO MAN'S LAND. First, there's a wide gap between two opposing sides-a kind of no-man's-land that nobody wants to be the first to cross. In the first instance, it's between company leadership and the shop floor. In the second, it's between union and management.The third is between the pastor with his leadership council and people sitting in two very different sets of pews. Each side attributes motives, schemes, and evil intent to the other. Each side carries enough grudging history from its dealings with the other to justify locking arms in resistance and assuming the worst.

Next, there's the taunting dare. Suspicion and mistrust, rooted in reasons real or imagined (it makes no difference) freeze people in opposition. I'm sure you've heard the questions yourself:

* "Are they really committed to fixing things?"

* "Will they get on board or drag their feet again?"

* "How will we know they won't stick it to us?"

* "Will they respect our history and experience?"

They.Them.The other.To follow Max DePree's quote above, each party decides to deal with change by waiting for the other to start. In Red Rover language, they dare each other over. Each waits for the other to prove its sincerity, honesty, commitment, and trust.They wait for the other to step forward, to run at them, and try, just try, to break their resistance.

And then there's the fear. It usually takes the shape of wondering what's really going to happen as some unbidden change rumbles in our direction. In my cases, it's management afraid the employees won't "get on board," it's employees afraid of another failed promise to improve things, it's union leaders afraid of some trick to eliminate jobs and cut membership, and it's parishioners afraid that the place and traditions they love will disappear. In your own case, well, fill in the blank.

PROCEEDING IN THE ABSENCE OF TRUST. Some elements of Red Rover Syndrome may be unavoidable. When it comes to change, there will always be misunderstanding, resistance, and fear. But the truth of DePree's comment is striking: we can always decide how to deal with the change we create or the change we find staring us in the face.

We can choose to proceed in the absence of trust and by that very choice create the trust we look for. We can choose to set aside the baggage of history and step forward ourselves rather than stand frozen, waiting for the other to begin. And we can choose to open the door to honest and open dialogue, seeking and giving the information we need from one another to address our fears-enough, at least, to begin.The only alternative is to stand locked in opposition and fear, daring somebody else to make a move.

GEORGE GATES is president of Core-R.O.I Inc.

Copyright Paperloop, Inc. Feb 2004
Provided by ProQuest Information and Learning Company. All rights Reserved

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