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?