A garrote is normally used from the rear for a number of reasons. Surprise being one and secondly it is more effective from that position. In about one minute the person will begin to lose consciousness but the thrashing around will go on for sometime. Two minutes is a ball park frequently used but it will vary a great deal based on how effective the restraint method is and the physical condition of the person. LE folks have a dozen or so people die each year from restraint holds that have similar effects as the garrote but were only intended to incapacitate the person. Most of those are in very poor health in the first place. As for the parents involvement it is true that MOM can be connected to the materials used in the garrote but I do not believe that a parent has ever used a garrote to kill a child before in the history of murder. Certainly not a manufactured one as used in this case. There have been plenty of extension cords and the like used used in a garrote like manner but the sticks indicate some expertise. First of all the list of people that know what a garrote is much less make one is limited. That does not mean that Patsy or John couldn't be the first.
I have always said that the garrote leads conventional thinking away from the family. Now somebody may have read in the Globe that Patsy check out a book from the local library on garrotes for fun and profit but I don't think so. As for looking her in the eye most killers don't like to do that. I read about one fellow who could not identify his victims because he never looked at their face. So that aspect does not point to or away from Patsy. As for emotion by investigators or the grand jury all liklyhood of sucessful resolution is gone if emotion becomes a part of the process.