Locked in syndrome, from stroke, TBI, ALS, encephalitis, or just intubation with paralysis or limb trauma was always a communication challenge.

Now, after having it myself for a few days from an arbovirus encephalitis, the concern really hit home.

How do you communicate with your patients that are fully aware, fully cognizant but unable to communicate verbally or in writing? I've done it, but it is so time consuming and I always feel like we're missing so much.

What do YOU do?

We had these boards in our ICU at my former job that didn't require the patient to write, but allowed them to point at photos with descriptions to relate what they need/feel/want, etc.

They are great in theory, but honestly, many ICU patients don't even have the strength to point at the board and most attempts from patients who could write led to frustration because they didn't have the stamina to even hold a pen for more than a few seconds and what they did write was usually completely illegible.

I feel for those patients that are unable to effectively communicate....I can't think of much else that would be more frustrating. This is a common problem and I wish I had the answer to help solve the problem. As you mentioned, when the patient isn't able to verbalize their needs and doesn't posess the motor skills that enable them to point or gesture, the options are severely limited. Most of the products I've seen on the market are, again, great in theory, but rarely useful to many critically ill patients. Those that are useful are astronomically expensive, not something most hospitals can afford to routinely supply and therefore, rarely seen used unless it's a device the patient uses at home and the family brings to the hospital with them.

Thank you for your insights, CCRN2BE! I am considering writing an article for a nursing journal and would like to use your comments. Thank you.

Anybody else have issues, concerns, comments about this?

I saw a product at NTI. It was like the device Steven Hawking uses. The patient looks at a phrase selection , or a key board and it speaks it out to the nurse or any caregiver. We tried it and it was great. You just sit in front of it and look at the letter, or the phrase you want and it registers it and speaks it out. They said it is billable too and not expensive when you consider what it does. The nurse at the booth showed us how to ask the patient to look at specific phrases to "train" them, like "I am cold." If the patient looks at the one you tell them to look at and can do it consistently, it is a diagnostic clue as to their LOC and cognitive function. Plus there are some diagnostic screens built in too. Amazing!