• 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)
    • Assessing the impact of previous experience, and attitudes towards technology, on levels of engagement in a virtual reality based occupational therapy intervention for spinal cord injury rehabilitation

      McCaughey, Manus Dr.; O’Raw, Paul (2007)
      The aim of the current research project was to determine if there were significant differences between patients with higher or lower levels of experience with technology in terms of their level of engagement with virtual reality (VR) in occupational therapy, their future uptake of VR technology in therapy, and their attitudes towards technology. Patients’ experience of technology was also examined in relation to demographic characteristics such as age and education level. Participants were 10 acute SCI patients with complete and incomplete SCI (C5 – L2), and ages ranging from 21 – 73 years (mean = 38.8 years; SD = 21.04). Time post-injury was 6 – 23 weeks (mean = 13.7 weeks; SD = 5.85). On recruitment patients were asked to rate their level of experience with technology, and were assigned to either a higher or lower experience group based on the median level of experience. There were 5 participants in each group, and they took part in five occupational therapy sessions using the Sony Playstation II EyeToy while their level of participation was recorded by the attending therapist. On completion of the research trials participants were asked to complete a feedback questionnaire aimed at assessing their overall opinion of the experience. The attending therapist was also asked to provide a qualitative assessment of patients’ performance. Results show that participants with higher levels of experience with technology engaged at higher levels with the EyeToy during therapy. This finding was supported by the qualitative assessment from the attending therapist, who judged those from the higher experience group to be more proactive in their approach to therapy. All participants reported that they would use the EyeToy again if it was introduced as a regular part of therapy, although only 7 out of the 10 patients reported they would use the EyeToy for gentle exercise after discharge from hospital. Participants in the higher experience group were also found to hold a more positive attitude towards technology, and used a wider range of more complex technologies in everyday life than those in the lower experience group, who held a neutral attitude to technology. Analysis of participant demographic information revealed that those in the higher experience group were from a significantly younger age group, and had higher levels of formal education than those in the lower experience group. These findings indicate that prior experience of technology is a significant influence on patient participation in VR-based occupational therapy, and suggests that not all patients will equally engage with, nor derive the same benefits from, this novel approach to rehabilitation. Rather, the EyeToy should be regarded as one option among many available to therapists to facilitate SCI patients’ rehabilitation, and can be applied with best therapeutic effect only after each patient’s needs and preferences are taken into account. Final Report presented to the NRH Ethics Committee - October 2007
    • Assessment of Financial Competency in Patients with Acquired Brain Injury

      Delargy, Mark Dr.; Carton, Simone Dr.; Kidd, Nick (2005)
    • Awareness of deficits in traumatic brain injury: a multidimensional approach to assessing metacognitive knowledge and online-awareness.

      O'Keeffe, Fiadhnait; Dockree, Paul; Moloney, Pauline; Carton, Simone; Robertson, Ian H; Trinity College Institute of Neuroscience and Department of Psychology, Trinity College, Dublin, Ireland. (Journal of the International Neuropsychological Society, 2007-01)
      Recent models of impaired awareness in brain injury draw a distinction between metacognitive knowledge of difficulties and online awareness of errors (emergent and anticipatory). We examined performance of 31 Traumatic Brain Injury (TBI) participants and 31 healthy controls using a three-strand approach to assessing awareness. Metacognitive knowledge was assessed with an awareness interview and discrepancy scores on three questionnaires--Patient Competency Rating Scale, Frontal Systems Behavioral Scale and the Cognitive Failures Questionnaire. Online Emergent Awareness was assessed using an online error-monitoring task while participants performed tasks of sustained attention. Online anticipatory awareness was examined using prediction performance on two cognitive tasks. Results indicated that the TBI Low Self-Awareness (SA) group and High SA group did not differ in terms of severity, chronicity or standard neuropsychological tasks but those with Low SA were more likely to exhibit disinhibition, interpersonal problems and more difficulties in total competency. Sustained attention abilities were associated with both types of online awareness (emergent and anticipatory). There was a strong relationship between online emergent and online anticipatory awareness. Metacognitive knowledge did not correlate with the other two measures. This study highlights the necessity in adopting a multidimensional approach to assessing the multifaceted phenomenon of awareness of deficits.
    • 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.
    • 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.
    • 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.
    • 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.
    • An evaluation of virtual reality technology as an occupational therapy treatment tool in spinal cord injury rehabilitation

      McNamara, Angela Dr.; O’Raw, Paul (2006)
      The introduction of virtual reality (VR) games as an occupational therapy (OT) treatment tool is an attempt to use technology as purposeful activity that is more relevant to a modern patient population than traditional art and craft based activities. It is unclear however if VR games are suitable for clinical applications and the current project examines the usability of video-capture VR games in spinal cord injury (SCI) rehabilitation. Participants were 10 male acute SCI patients with complete and incomplete SCI (C5 – L2), and ages ranging from 23 – 56 years (mean = 40.5 years; SD = 14.07). Time post injury was 3 – 6 months (mean = 4 months; SD = 1.25). The first study examined console-based VR games. Participants engaged with three different VR game types: a purely physical game, a physical and cognitive game, and a purely cognitive game. Patients were interviewed about their experience using a 45 point usability questionnaire, and the attending therapists completed a similar survey. Both patients and therapists agreed that VR games increase motivation to attend therapy, and motivate patients to perform past their perceived limits of movement and endurance. The VR games used did not overexert patients and did not cause any extra pain or discomfort. Results suggest that patients with limited experience of computer technology, and over a wide range of ages and social backgrounds, could use the VR games successfully and independently. The second study looked at an equivalent PC-based VR game to determine if there are advantages in using this platform. Participants engaged in a purely physical VR game and were interviewed using a questionnaire as before. The attending therapists completed a similar feedback form. Results showed the PC based VR game was equivalent to the console game in functionality and ease of use, but had the advantage of being more portable and easier to set up and operate. These findings support the idea that VR games are an appropriate and useful compliment to conventional OT. In addition, patients found that having their image and real-time movements displayed onscreen was useful feedback to correct posture and direct upper limb movements.
    • An exploration of child and adolescent sibling’s experience of paediatric traumatic brain injury

      Monaghan, Dr Hugh; O’Doherty, Dr Sarah; Cronin, Heather (2009)
      This study explored the experiences of the sibling relationships of ten young people with a brother or sister with Acquired Brain Injury (ABI). Whilst research has examined outcomes following ABI in young people, and adjustment and family functioning from the perspective of the parents, little is known about the experiences of siblings. A qualitative methodology using Interpretative Phenomenological Analysis (IPA) was used. Participants were interviewed using a semi-structured interview schedule designed to capture participant’s subjective experiences of their relationships within the family and specifically their perceptions of their sibling post-ABI. Four master themes emerged from the analysis. ‘Living with trauma’ illustrated participants’ exposure to their sibling’s mortality subsequent to the initial trauma. ‘Living with loss’ reflected shifts in family relationships and loss of ways-of-being. ‘Life through the lens of ABI’ incorporated participants’ assumption of a hybrid parent-sibling role. ‘Managing loss and finding meaning’ drew on participants’ approaches towards resilience and coping. These themes are discussed in the context of previous literature, in particular in relation to family systems theory and ambiguous loss. It is suggested that these findings may be useful in considering the salient issues for young people with a sibling with ABI. The consequences of these findings for clinical psychology practice, theory and future research are noted.
    • 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
    • An investigation into the functional outcomes of individuals with paraplegia, resulting from spinal cord injury, following discharge from a rehabilitation setting

      McNamara, Angela Dr.; Held, Lisa (2005)
      The purpose of this study was to investigate if changes occurred in the functional independence of spinal cord injured (SCI) patients, following discharge from a rehabilitation setting. The research was carried out on patients with a paraplegic injury, who underwent rehabilitation in the spinal injury unit of a Dublin based rehabilitation hospital. Eight male subjects residing in the Republic of Ireland were recruited to the study between October 2004 and May 2005. Two measures of functional independence, a mood outcome measure and semi-structured interviews were carried out at two separate stages. The first, in the hospital one to five days prior to discharge. The second in the home of the subject six to eight weeks following discharge. Studies investigating the experience of spinal injured patients soon after discharge are very limited. Research to date indicates that the functional independence of those with spinal cord injury improves after a period of one year and longer at home. Results in this study showed that functional independence as measured using the Functional Independence Measure (FIM), decreased following discharge and the change was statistically significant (p=0.041). A decrease was also noted on the Spinal Cord Independence Measure (SCIM), but this was not shown to be statistically significant (p=0.075). Mood was measured using the Centre for Epidemiological Studies Depression Scale (CES-D) and an overall improvement in mood following discharge was observed. The qualitative data obtained through the semi-structured interviews, yielded rich information on the subjects views of the pre and post discharge phase. Six factors which could be associated with changes in functional independence were identified; environmental, lack of appropriate equipment, social support, lack of services, pre-discharge preparation and pain. Exploring the experiences and functional changes of individuals with spinal cord injury following discharge has implications for pre discharge rehabilitation and follow-up. Changes in line with other models of rehabilitation in Australia and America may provide a more transitional period to allow persons with SCI to be well prepared for the physical and emotional challenges presented to them in the community.