• A Prospective Audit of Inappropriately Occupied Hospital Beds in Patients with Newly Acquired Traumatic Spinal Cord Injury

      Smith, E.; Synnott, K. (Irish Medical Journal, 2019-07)
      Aim To quantify the inappropriate bed occupancy amongst patients with traumatic spinal cord injury (TSCI) awaiting transfer of care from the acute to community. Methods A prospective audit was carried out, of all newly acquired cases of TSCI in 2017, who progressed through acute care and specialist rehabilitation. Results Forty-four patients who were audited spent a total of 3915 days occupying a hospital bed, inappropriate for their phase of care, 78 awaiting admission to specialist acute care, 3126 awaiting admission to rehabilitation and 711 awaiting discharge from rehabilitation. Conclusion Valuable health-care resources are being wasted because TSCI patients cannot move seamlessly from one phase of care to the next. This impacts negatively on the quality of care being delivered to this patient cohort.
    • The Challenge of Integrating Care in Dual Diagnosis; Anti-NMDA-Receptor Encephalitis; Presentation And Outcome In 3 Cases Referred For Complex Specialist Rehabilitation Services

      Carroll, A; Delargy, M (Irish Medical Journal, 2018-03)
      The successful implementation of an integrated care pathway (ICP) for any given condition is a challenge. Even more challenging is successful ICP implementation for individuals who have multiple co-morbidities. This is further compounded when there are dual mental health and physical disabilities that require integrated working across multiple disciplines, specialties, institutions and organisations. Anti-NMDA-Receptor encephalitis (aNMDARe) is a relatively new diagnostic entity with patients typically presenting with significant psychiatric symptoms followed by progressive neurological deterioration. In this case series, we describe 3 cases of females with aNMDARe who were referred for complex specialist rehabilitation (CSR) to The National Rehabilitation Hospital. CSR is the total active care of patients with a disabling condition, and their families, by a multi-professional team who have undergone recognised specialist training in rehabilitation, led /supported by a consultant trained and accredited in rehabilitation medicine (RM). These services provide for patients with highly complex rehabilitation needs that are beyond the scope of local services. In these cases, referral to CSR resulted in the construction of a bespoke integrated care pathway (ICP) that transcended the barriers between primary, secondary and tertiary care and across the boundaries of physical and mental health. A care pathway is a complex intervention for the mutual decision-making and organisation of care processes Rehabilitation services acted as the coordinator of services in these cases to ensure implementation of the care plan and to ensure successful transitions of care and supported local specialist and general teams in the management of these complex cases.
    • Post Stroke Fatigue; Point Prevalence, Characterization, Associations and Radiological Correlation in a Rehabilitation Hospital

      Khan, A; Delargy, M (Irish Medical Journal, 2017-11)
      Post stroke fatigue (PSF) is a frequently reported symptom by stroke survivors undergoing rehabilitation. This cross sectional observational study was undertaken in a rehabilitation facility to look at its prevalence and relationship with various variables like personal factors, type of stroke, social context, hemispheric involvement on CT scan and mobility status. The results showed that PSF was present in 83% (25 out of 30) of the patients included in the study. No clear association could be established between PSF, social, radiological and functional characteristics.
    • Botulinum toxin in the management of sialorrhoea in acquired brain injury

      Carroll, A; McGlone, B (Irish Medical Journal, 2016-06)
      Sialorrhoea as a consequence of severe acquired brain injury can significantly negatively impact on quality of life. Medications used in its management have many side effects which can cause problems in the severely disabled. Botulinum toxin is an effective treatment of sialorrhoea in a number of neurological conditions but may also have a role to play in the management of sialorrhoea following severe ABI. We report on 4 cases of sialorrhoea following acquired brain injury causing a variety of problems, whose parotid glands were injected with Botulinum toxin type A (Dysport) 50mu each, under ultrasound guidance. All cases had a clinically and statistically significant reduction in drooling as measured by the teacher drooling scale (p=0.005) and carers Visual Analogue Scale (p=0.012). There were no side effects reported. Botulinum toxin is an effective treatment for sialorrhoea associated with acquired brain injury.
    • Improving Access to Specialist Rehabilitation Services in Ireland

      Twomey, Valerie; O’Driscoll, Edina (2014-03)
    • Intrathecal baclofen therapy

      Khan, A (Irish Medical Journal, 2014)
      Intrathecal baclofen therapy has been used in the treatment of severe, intractable spasticity resistant to oral agents in brain and spinal cord injury since 1992. A successful trial of intrathecal baclofen infusion administered with a test dose of baclofen injection via a lumbar puncture precedes the therapy and those who respond favorably in the standard screening test go on to receive intrathecal baclofen pump therapy long-term. 1,2
    • Road collisions as a cause of traumatic spinal cord injury in ireland, 2001-2010.

      Smith, Eimear; Brosnan, Michael; Comiskey, Catherine; Synnott, Keith (Thomas Land Publishers, Inc., 2014)
      Road collisions remain the leading cause of traumatic spinal cord injury (TSCI) in the world. Half of all TSCIs in Ireland in 2000 were caused by road collisions. Since then, there has been a downward trend in road fatalities coincident with implemented road safety strategies.
    • The accuracy of noninvasive hemoglobin assessment in an obstetric population

      Cooley, S; Bourke, M; McMorrow, R; McAuliffe, F (American Journal of Obstetrics and Gynaecology, 2012-10)
    • Transanal irrigation in the management of neurogenic bowel dysfunction

      Loftus, C; Wallace, E; McCaughey, M; Smith, E (Irish Medical Journal (IMJ), 2012-07)
    • NRH National Rehabiliation Hospital 31st Annual Report

      National Rehabiliation Hospital (NRH) (National Rehabiliation Hospital (NRH), 2012-05)
    • Rehabilitation psychology: Meeting the needs of individuals with acquired disabilities in Ireland

      Johnstone, Brick; Walsh, Jane; Carton, Simone; Fish, Rosemary (2012-04-30)
    • Irish occupational therapists' views of electronic assistive technology

      Verdonck, Michele; McCormack, Cathy; Chard, Gill (2012-04-30)
    • Lower segment cesarean scar rupture: does it always occur in the next labour

      Corrigan, L; O' Herlihy, C; McGoldrick, A (American Journal of Obstetrics and Gynaecology, 2012-01)
      32nd Annual Meeting - Society for Maternal-Fetal Medicine. The Pregnancy Meeting 6-11 February 2012 Dallas, Texas USA
    • Traumatic brain injury and subsequent rehabilitation focussing on the future

      Delargy, Mark Dr.; Phillips, J.P. Prof.; Geoghegan, Lourda Dr. (2011-05-12)
    • Electronic aids to daily living: be able to do what you want.

      Verdonck, Michèle Claire; Chard, Gill; Nolan, Maeve; Occupational Therapy, National Rehabilitation Hospital, Rochestown Ave, Dun Laoghaire, Co Dublin, Ireland. great.sci@gmail.com (2011)
      This study explores the experiences of Irish people with high cervical spinal cord injuries living with electronic aids to daily living (EADL) and the meaning attributed to such systems in the context of participation in everyday life.
    • Optimising the prescription of prosthetic technologies (opptec): Outcome measures for evidence based prosthetic practice and use

      Ryall, Dr Nicola; Gallagher, Dr Pamela; Ni Mhurchadha, Sinead (2010)
      This study provided a forum for patients and service providers to voice their opinions in what they believe to be the important predictors and outcomes involved in successful rehabilitation following limb loss. To develop a consensus on the most important outcomes and factors to address for both the lower limb and upper limb prosthetic prescription process, the above data relating to lower limb and upper prosthetics were subsequently used in the next phase of the research involving two Delphi surveys of 23 and 53 experts within the lower limb and upper limb amputation and prosthetic field respectively, including users, service providers and researchers. This is the first time consensus has been sought on the most important outcomes, predictors and factors which optimise prosthetic prescription and use. By identifying the important outcomes of prosthetic prescription to both prosthetic users and service providers, we are not only better served to inform outcome measurement, to compare and evaluate research in the field, different interventions or prosthetic components, but also to understand why and when prosthetic technology should be provided. This research is also helpful in pinpointing factors that could potentially be used as predictors of prosthetic use to optimise use after prescription.
    • Rehabilitation of awareness of deficits in patients with traumatic brain injury applying a user-friendly computerised intervention approach

      Morgan, Dr Jacinta; Carton, Dr Simone; Fitzgerald, Mary (2010)
      Objective : Awareness of errors is an important prerequisite in rehabilitation. Few studies have investigated rehabilitation of error awareness following acquired brain injury. Pilot research has shown that receiving feedback about errors during a computerised task of sustained attention improves performance in patients who have sustained a traumatic brain injury. In this study, a computer-based intervention training programme aimed at improving error awareness was developed. Participants and Methods: 20 patients who sustained a Traumatic or Acquired Brain Injury and had low error awareness level were enrolled in the study. Matched random groups design was used to test the effects of audio-visual feedback on error awareness. One group (n=10) received audio-visual feedback on errors and a second group (n=10) did not receive feedback on error. The task involved responding or withholding a response to specific images on a computer screen. Training was undertaken in 8 sessions over 4 weeks. Results: Analysis of pre and post intervention measures indicated that error awareness improved for all participants, and that the improvement was greater for the feedback group. An unexpected finding was that during recruitment more than 80 candidates with serious and recently diagnosed ABI were excluded because they had high levels of error awareness. Conclusions : This intervention provides an engaging task suitable for use amongst a broad age span that can be delivered in the home, community or clinical setting. Its potential use for assessing as well as rehabilitating error awareness shall be explored further. Acknowledgements: The authors would like to thank the patients of the National Rehabilitation Hospital. This work was supported by grants from the Health Research Board, National Rehabilitation Hospital Trust, UCD Seed Fund, and National Disability Authority
    • 29th annual report of the National Rehabilitation Hospital 2009

      National Rehabilitation Hospital (National Rehabilitation Hospital, 2010)
    • Differences in Marital Satisfaction, Coping and Social Support following a Traumatic Brain Injury

      Carroll, Aine Dr.; Byrne, Patricia; Casey, Anne Marie (2009)
      Objective: Adverse cognitive, emotional and behavioural sequelae of Traumatic Brain Injury (TBI) are commonly noted by family members. These sequelae can adversely impact on marital and family relationships. The aim of this study is to examine marital and relationship satisfaction following a TBI amongst patients and partners. Design: A questionnaire based postal survey was used to investigate relationship and marital satisfaction. Participants: Thirty four participants (14 male; 20 female), ranging in age from 25-68 years ( = 44 years, SD 11 years), took part in this study. Sixteen had sustained a TBI and eighteen were partners of patients with TBI. Participants with TBI who were inpatients at the National Rehabilitation Hospital (NRH) and their partners were invited to participate in the study. Outcome Measures: The Marital Satisfaction Questionnaire (MSI-R) was used to examine marital and relationship satisfaction. Results: Both patients and partners reported relationship difficulties following brain injury (z = -3.078, p < .05 patients; z = 2.699, p < .05 partners). Conclusion: This study highlights the significant impact of TBI on relationships for both the TBI survivor and their partners. Implications for interventions in neuropsychological rehabilitation are discussed.
    • Music therapists’ strategies in implementing new posts within health care settings

      Monaghan, Dr Hugh; Edwards, Professor Jane (2009)
      The National Rehabilitation Hospital was one of a number of sites that contributed to a research study in the area of music therapy service development. This research aimed to examine the experiences of expert music therapists in developing new work and to identify strategies for introducing a new role to an existing healthcare team. Service development strategies that were identified included: Providing education about music therapy Conjoint working with other staff Remaining flexible Generating evidence Investing time and energy Results from the research will be disseminated to music therapy students, qualified music therapists and health care managers, to assist in the creation of further music therapy posts nationally and internationally. Final Report presented to the NRH Ethics Committee - October 2009