National Rehabilitation Hospital Research Articles

Epidemiology of traumatic spinal cord injury in Ireland, 2017-2022.

Retrospective population based study on traumatic spinal cord injury (SCI) in Ireland. To gather the most recent epidemiological data prior to the implementation of a new national trauma strategy. Also, to consider if the COVID-19 pandemic impacted on SCI epidemiology in Ireland. Republic of Ireland. All patients with TSCI discharged from the National Rehabilitation Hospital (NRH), the national acute SCI unit and two neurosciences centres were included. The International Spinal Cord Injury Core Data Set was collected on all patients at discharge from rehabilitation between 2017 and 2022. Overall crude incidence of TSCI was 14 per million per year, ranging between 11.3 and 18.4. 12.7% of patients did not survive to discharge from hospital. In those completing rehabilitation, the mean age of injury onset was 50.1 years (SD 19.9). Males accounted for 75.7%. The most common impairment was incomplete tetraplegia, 45.3% of all TSCI. Leading aetiology was falls, 53.9% of injuries. Patients with incomplete tetraplegia and those whose cause of injury were falls were older than those with all other impairments and injury aetiologies (p < 0.001). Overall incidence of TSCI is similar to our previous studies. Also similar is the predominant pattern of older people sustaining falls resulting in incomplete tetraplegia.

A protocol for a scoping review of methodologies used to explore patient experience in post-acute rehabilitation settings.

Patient experience is routinely collected in the clinical environment in many different ways throughout various person-provider encounters, but so far limited research focused on understanding the methods of using it to improve the quality of healthcare. This paper presents a protocol for a methodological scoping review examining the methods of obtaining, analysing, reporting, and using patient experience data for quality improvement in rehabilitation settings. The scoping review will be conducted according to the guidelines from the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the methodological framework by Arksey & O'Malley. A comprehensive search of the literature will be performed using a three-step search strategy: an initial limited search of two databases was already performed and helped to identified relevant key words and index terms. The developed search string will be adapted and applied across four databases. This will be followed by search of the reference lists of selected sources and hand-search relevant data-hubs. Studies with a clear focus on patient experience or feedback collected or used for healthcare improvement in rehabilitation context, will be included. A data extraction framework will be developed and piloted to guide the literature screening and data charting. Qualitative content analysis will be employed to address research questions and the results will be presented - beside the descriptive format - as a map of data in chart and tabular formats. This scoping review will show the extent and scope of the literature on the applied methods of collecting, communicating, and using patient experience for quality improvement in post-acute rehabilitation settings and will evaluate and map the evidence on these topics. The findings will inform a research project entitled "An exploration into the use of patient experience to inform improvement in a National Rehabilitation Hospital".

Interdisciplinary Teamworking in Rehabilitation: Key learnings and perceived challenges to change from healthcare professionals at a National Rehabilitation Hospital

In Ireland interdisciplinary healthcare teams have been recognised as a key component of integrated care and research recognises importance of teamwork for patient care and safety (Leonard, 2004; Manser, 2009; Forse et al., 2011; Sacks et al., 2015). Within rehabilitation care, teamwork is essential in addressing complex health challenges such as chronic impairments, co-morbidities and more complex problems (Ouwens et al., 2005; Wade, 2015). Yet research on teamwork in non-acute settings is far behind that of acute settings (Miller et al., 2018). In rehabilitation, healthcare teams naturally include a wide range of professions, from multiple disciplines (Wade, 2016), often in a multidisciplinary approach with different professions focused on different goals (Koroner, 2010). Little is known about how rehabilitation teams can optimise communication, work together to create common goals and effectively function as an interdisciplinary team. The complexity of creating this type of change and shifting to new models of teamwork is captured in this study, which details the efforts of a self-organised “grassroots” group of healthcare professionals who created and implemented an interdisciplinary teams framework within a national rehabilitation hospital. A focus group was utilised to capture the shared lived experience of the participants and thematic analysis with a critical approach (Braun &amp; Clarke, 2006) was selected as an appropriate method for the purposes of constructing latent themes around key challenges and perceived barriers to change. Participants described resistance to shifting to an IDT model of care as stemming from cultural issues of hierarchy, power and control, disciplinary loyalty and identity. Key learnings are drawn from these experiences to form recommendations for organisational efforts to shift to interdisciplinary and transdisciplinary ways of working. This study is part of a larger action research project, and embedded academic researchers worked collaboratively with the participants as co-researchers to design this study and others focused on teamwork. The co-research team deemed this study’s topic a priority due to its potential significance for other healthcare professionals seeking to create change and collaborative working in their organisations.

Upper extremity kinematics: development of a quantitative measure of impairment severity and dissimilarity after stroke.

Strokes are a leading cause of disability worldwide, with many survivors experiencing difficulty in recovering upper extremity movement, particularly hand function and grasping ability. There is currently no objective measure of movement quality, and without it, rehabilitative interventions remain at best informed estimations of the underlying neural structures' response to produce movement. In this article, we utilize a novel modification to Procrustean distance to quantify curve dissimilarity and propose the Reach Severity and Dissimilarity Index (RSDI) as an objective measure of motor deficits. All experiments took place at the Medstar National Rehabilitation Hospital; persons with stroke were recruited from the hospital patient population. Using Fugl-Meyer (FM) scores and reach capacities, stroke survivors were placed in either mild or severe impairment groups. Individuals completed sets of reach-to-target tasks to extrapolate kinematic metrics describing motor performance. The Procrustes method of statistical shape analysis was modified to identify reaching sub-movements that were congruous to able-bodied sub-movements. Movement initiation proceeds comparably to the reference curve in both two- and three-dimensional representations of mild impairment movement. There were significant effects of the location of congruent segments between subject and reference curves, mean velocities, peak roll angle, and target error. These metrics were used to calculate a preliminary RSDI score with severity and dissimilarity sub-scores, and subjects were reclassified in terms of rehabilitation goals as Speed Emphasis, Strength Emphasis, and Combined Emphasis. The modified Procrustes method shows promise in identifying disruptions in movement and monitoring recovery without adding to patient or clinician burden. The proposed RSDI score can be adapted and expanded to other functional movements and used as an objective clinical tool. By reducing the impact of stroke on disability, there is a significant potential to improve quality of life through individualized rehabilitation.

Content, face, and construct validity of the Irritable Bowel Syndrome Quality of Life(IBS-QOL) as a measure of bowel-related quality of life in spinal cord injury.

Neurogenic bowel dysfunction is commonly encountered after a spinal cord injury (SCI),leading to a tremendous impact on quality of life (QOL).The neurogenic bowel dysfunction score (NBDS)is commonly used to measure the severity of bowel dysfunction and predict QOL. However, there is no comprehensive instrument to assess bowel-specific QOL for SCI patients. Instead, the Irritable Bowel Syndrome-Quality of Life (IBS-QOL)questionnaire evaluates the impact of bowel dysfunction on several aspects of QOL, although this questionnaire has not been validated for the SCI population. Motivated by the compelling need of instruments to accurately evaluate the QOL in patients who develope NBD after SCI, we aimed to assess the construct, content, and face validity of IBS-QOLin this population. Adult SCI patients with at least 3 months after their injury were recruited from the outpatient clinic of a national rehabilitation hospital. Patients completed the NBDS and IBS-QOLvia telephone interview or paper survey in the clinic. Content and face validity were assessed via interviews with professionals with expertise in providing chronic care for SCI, as well as a subgroup of patients. Construct validity was assessed using the hypotheses testing method. Internal consistency was assessed using Cronbach's ⍺. Factor analysis was performed to assess the dimensionality of the IBS-QOLin the SCI population. A total of 106 patients with a median age of 45.5 years (interquartile range: 21-79) participated in the study. The majority of the sample were men (n = 82, 77%) and had endured thoracolumbar injuries (n = 74, 71.2%). Twelve patients (sevenEnglish- and fiveSpanish speakers) and six professionals took part in content/face validation interviews. The median IBS-QOL total score was 15.91/100 (interquartile range: 4.55-33.14). IBS-QOLdifferentiated the subgroups of patients with severe bowel symptoms in terms of uneasiness, sweating, or headaches during bowel emptying (p = 0.0003), time spent on bowel emptying (p = 0.0065), flatus incontinence (p = 0.0076), and overall satisfaction with bowel function (p < 0.001), demonstrating its adequate construct validity. Interviews with the patients and professionals supported the comprehensiveness, comprehensibility, and relevance of IBS-QOLfor assessment of bowel-related QOL in the SCI population. Item-level analysis of professional responses showed that 97% of questions were relevant to the construct and population of interest. Internal consistency analysis yielded a Cronbach's ⍺ of 0.9684. Exploratory factor analysis yielded six underlying factors which cumulatively accounted for 72.21% of the total variance, reflecting the dimensionality of bowel-related QOL in SCI population. IBS-QOLquestionnaire is a comprehensive measure of bowel-related QOL which encompasses the concerns of SCI patients. Our findings support the content, face and construct validity of IBS-QOLas a measure of bowel-related QOL in SCI. Further studies are warranted to assess the reliability and responsiveness of IBS-QOL,and to evaluate its performance across different patient populations.

Pilot of a person-centred, interdisciplinary approach to goal setting in Ireland’s National Rehabilitation Hospital: a study protocol

Background: Research has emphasized the value of a person-centered, interdisciplinary approach to structured goal setting in rehabilitation; yet these approaches are not consistently implemented in clinical practice, limiting the effect that goal setting can have on rehabilitation. The introduction of a new interdisciplinary, person-centered goal setting process to Ireland’s national rehabilitation hospital offers an opportunity to gain novel insight into barriers to implementing and normalising IDT goal setting in complex, specialist rehabilitation services. Methods: The goal setting process was collaboratively designed based on iterative rounds of patient and staff feedback. It will be piloted in three different units of the hospital. The outlined study was co-designed by embedded academic researchers and knowledge stakeholders (the quality improvement team responsible for introducing the new process; and two former patients). The aim is to use a mixed methods approach to capture patient and staff experiences and perspectives of the new process. Data will be collected by embedded researchers with a combination of self-report measures and qualitative interviews with both staff and patients. Self-report measures focus on capturing person centeredness of goals, shared decision making, interprofessional socialization and process normalization. Quantitative data will be represented using descriptive and inferential statistics; qualitative data will be analysed using reflexive thematic analysis. Discussion &amp; Conclusion: From this data the researchers aim to present a holistic view of the patient and staff experiences of the goal setting process. This may further illuminate challenges and potential solutions to implementing changes to goal setting within this context. Findings will be used to inform implementation within the hospital and will contribute to knowledge for rehabilitation practice around implementing IDT goal setting. This will add an Irish perspective to existing goal setting rehabilitation literature.

The impact of road safety strategy and policy on admissions to a national rehabilitation hospital; a 5-year retrospective review and reflection on trauma data

BackgroundGlobally, road traffic collisions (RTCs) are a common cause of death and disability. Although many countries, including Ireland, have road safety and trauma strategies, the impact on rehabilitation services is unclear. This study explores how admissions with RTC related injuries to a rehabilitation facility has changed over 5 years and how they contrast to major trauma audit (MTA) serious injury data from the same timeframe.MethodsA retrospective review of healthcare records with data abstraction in accordance with best practice was performed. Fisher’s exact test and binary logistic regression were used to determine associations and statistical process control was used to analyse variation. All patients discharged with an International Classification of Diseases (ICD) 10 coded diagnosis of Transport accidents from 2014 to 2018 were included. In addition, serious injury data was abstracted from MTA reports.Results338 cases were identified. Of these, 173 did not meet the inclusion criteria (readmissions) and were excluded. The total number analyzed was 165. Of these, 121 (73%) were male and 44 (27%) were female and 115 (72%) were under 40 years of age. The majority [128 (78%)] had traumatic brain injuries (TBI), 33 (20%) had traumatic spinal cord injuries and 4 (2.4%) had traumatic amputation The numbers varied over the time period of the study but showed normal variation and not special cause variation which suggests no significant impact of policy in the time frame. There was a large discrepancy between the number of severe TBIs reported in the MTA reports and the numbers admitted with RTC related TBI to the National Rehabilitation University Hospital (NRH). This suggests there may be many people not accessing the specialist rehabilitation services they require.ConclusionData linkage between administrative and health datasets does not currently exist but offers huge potential for understanding the trauma and rehabilitation ecosystem in detail. This is required to better understand the impact of strategy and policy.

A protocol for a scoping review of methodologies used to explore patient experience in post-acute rehabilitation settings

Background: Patient experience is routinely collected in the clinical environment in many different ways throughout various person-provider encounters, but so far limited research focused on understanding the methods of using it to improve the quality of healthcare. This paper presents a protocol for a methodological scoping review examining the methods of obtaining, analysing, reporting, and using patient experience data for quality improvement in rehabilitation settings. Methods: The scoping review will be conducted according to the guidelines from the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the methodological framework by Arksey &amp; O’Malley. A comprehensive search of the literature will be performed using a three-step search strategy: an initial limited search of two databases was already performed and helped to identified relevant key words and index terms. The developed search string will be adapted and applied across four databases. This will be followed by search of the reference lists of selected sources and hand-search relevant data-hubs. Studies with a clear focus on patient experience or feedback collected or used for healthcare improvement in rehabilitation context, will be included. A data extraction framework will be developed and piloted to guide the literature screening and data charting. Qualitative content analysis will be employed to address research questions and the results will be presented – beside the descriptive format - as a map of data in chart and tabular formats. Conclusions: This scoping review will show the extent and scope of the literature on the applied methods of collecting, communicating, and using patient experience for quality improvement in post-acute rehabilitation settings and will evaluate and map the evidence on these topics. The findings will inform a research project entitled “An exploration into the use of patient experience to inform improvement in a National Rehabilitation Hospital”.

Prospektivna opservaciona kohortna studija oralnog zdravlja osoba sa invaliditetom

Introduction: People with disabilities represent a vulnerable category of the population in terms of oral health due to the inability to adequately maintain oral hygiene. The aim of our work is to analyze the status of oral health expressed by an adequate indicator in the population of people with disabilities who come to the national special rehabilitation hospital in Serbia for prosthetic rehabilitation. Material and methods: The study was performed as a prospective observational cohort study that included 51 subjects who had at least one limb amputated and who were hospitalized for prosthetic rehabilitation after limb amputation. After the examination of the oral cavity, the Decayed, Missing and Filled Teeth (DMFT) index was determined, which represents the sum of the total number of carious, filled and extracted teeth. Results: Patients had an average DMFT index of 22 (median) with an interquartile range of 17 to 27. The high value of the DMFT index was most heavily influenced by the number of extracted teeth. The median number of extracted teeth was 16 (interquartile range: 10 - 25). There were significantly less carious teeth, 2 (0 - 3), while there were the least teeth with dental fillings, 0 (0 - 2). Conclusion: High values of the DMFT index in the patients with disabilities indicate the need for the oral health improvements in this vulnerable population.

A Study On The Application Of Mobile Arm Support In Individuals With Cervical Cord Injuries

<h3>Research Objectives</h3> To investigate the change in the active range of motion (AROM) of the shoulder and elbow joints by applying the mobile arm support (MAS) in cervical injury patients with limitations in the proximal part of the upper extremities. Additionally, the user satisfaction with MAS was assessed. <h3>Design</h3> One group before-after trial. <h3>Setting</h3> Inpatients at the National Rehabilitation Center. <h3>Participants</h3> This study included five tetraplegic patients with at least one year since the onset and neurological level of injury at C3–C4 level. <h3>Interventions</h3> Participants were trained by applying the Wilmington Robotic Exoskeleton (WREX). Training was conducted based on the Jebsen–Taylor hand function test. Six sessions of the intervention were conducted for 30 minutes each, thrice a week for 2 weeks. <h3>Main Outcome Measures</h3> The AROM of the shoulder and elbow joints was measured. Additionally, Korean-Quebec User Evaluation of Satisfaction with Assistive Technology (K-QUEST) was used to evaluate the satisfaction. <h3>Results</h3> The AROM of the shoulder joint increased from 38.040±35.710° to 49.960±36.884° for flexion, 26.380±19.367° to 31.800±14.249° for extension, 18.980±12.765° to 21.340±14.570° for adduction, 44.180±24.547° to 53.620±24.253° for internal rotation, and 28.020±17.071° to 34.900±20.793° for external rotation, but without significant differences. The elbow joint showed no AROM change. K-QUEST assessed the satisfaction with the equipment, with a 5-point scoring system from 1 (not satisfied) to 5 (very satisfied). Most items showed a satisfaction level ≥4, confirming positive results with WREX. <h3>Conclusions</h3> MAS training in patients with chronic cervical injury demonstrated an increase in the AROM of the shoulder. Thus, MAS training can improve the upper extremity functions in cervical injury patients. Additionally, the K-QUEST results confirmed positive satisfaction with the WREX equipment in these patients. <h3>Author(s) Disclosures</h3> Jung-Eun Lim(1), Woo Yeung Kim(2), Onyoo Kim(2) (1)National Rehabilitation Research Institute, National Rehabilitation Center and Hospital, Seoul, South Korea (2)Department of Rehabilitation Medicine, National Rehabilitation Center and Hospital, Seoul, South Korea

Traumatic brain injury epidemiology and rehabilitation in Ireland: a protocol paper.

Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. In Ireland, a dearth of research means that we neither know the number of people affected by TBI, nor have the required data to improve neuro-rehabilitation services. This is a study protocol to examine the epidemiology and pathways through rehabilitation for a cohort of TBI survivors in the Republic of Ireland. Aims: 1. To document the epidemiological data of TBIs in Ireland. 2. To explore the pathway of TBI survivors through rehabilitation/health services. 3. To document the experiences of those providing care for TBI survivors in Ireland Methods: This is a quantitative cohort study. Existing routine datasets will be used to report epidemiological data. Participants with moderate or severe TBI will be recruited through two brain injury service providers, two acute hospitals that provide neurosurgical services, and the National Rehabilitation Hospital. Participants with TBI will be surveyed on two separate occasions, to explore their use of health and rehabilitation services. Those providing care or support to TBI survivors will be surveyed, on one occasion. Additionally, data from the medical records of TBI survivors will be extracted to capture key information about their TBI, such as mechanism of injury, severity, hospitalisation and follow-up. TBI survivors' use of health care will be followed prospectively for six months. Expected outcomes: The epidemiological data of TBI in Ireland will be documented. Data on survivors' experiences of how rehabilitation services are accessed, and any barriers encountered with rehabilitation/health services will be reported. The experiences of those providing care or support for TBI survivors will be captured. It is expected that the outcomes of the study will support advocacy efforts toward the redevelopment of neuro-rehabilitation services in the Republic of Ireland.

A retrospective study of needs and interventions among patients with myotonic dystrophy type 1 in Denmark referred to rehabilitation in the period 2000-2019.

Electronic medical records from the period 2000-2019 of a randomized sample of patients with DM1 (N = 193) were reviewed to identify rehabilitation needs and interventions. The sample was classified into four subgroups of disease classifications. The number of identified needs and interventions were presented as medians and range, and differences between subgroups were illustrated by Kruskal-Wallis one-way analysis of variance. The needs were categorized using the International Classification of Functioning, Disability and Health (ICF). A total of 2099 needs and 2103 interventions were registered. The most frequent needs were coordination of healthcare services (480) and employment and income (363), while the most frequent interventions were counselling (835) and follow-up (386). Patients with congenital DM1 had the most needs and interventions per person. In relation to the ICF, the most registered needs were environmental factors (880) and activity and participation (848). All subgroups of patients with DM1 had a substantial number of needs and interventions related to coordinating and navigating within the healthcare system. The subgroup of patients with congenital DM1 had the most needs and interventions compared to the other subgroups.

Traumatic brain injury epidemiology and rehabilitation in Ireland: a protocol paper

Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. In Ireland, a dearth of research on TBI means that we neither know the number of people affected by this injury, nor have the information required to improve neuro-rehabilitation services. Aims: This is the protocol for a study that will examine pathways through rehabilitation for survivors of TBI in the Republic of Ireland. The experiences of family members providing care or support to a person with TBI will also be explored. Additionally, the study will estimate the incidence and prevalence of TBI in Ireland. Epidemiological data and information on how people with TBI access rehabilitation and health services will support advocacy efforts towards the redevelopment of neuro-rehabilitation services. Methods: The research is a mixed method, observational cohort study design. Participants with moderate to severe TBI will be recruited through two brain injury service providers, two acute hospitals that provide neurosurgical services, and the National Rehabilitation Hospital. Questionnaires will be administered to participants with TBI on two separate occasions, six months apart, and to family members providing care or support to an individual with TBI, on one occasion. Data from the medical records of participants will be abstracted to capture key information about their brain injury. TBI survivor participants’ use of health care will be followed prospectively for six months. Expected outcomes: The study will outline participants’ pathways through rehabilitation in Ireland, to understand how rehabilitation services are accessed, and the barriers to accessing these services. The incidence and prevalence of TBI in Ireland will be estimated. Experiences of family members providing care or support to an individual with TBI will be detailed. The outcomes of the study will support ongoing efforts to improve care for TBI survivors in Ireland and to redevelop neuro-rehabilitation services.

The Effects of Group Art Therapy on the Primary Family Caregivers of Hospitalized Patients with Brain Injuries in South Korea.

This study examined the effects of group art therapy on depression, burden, and self-efficacy in primary family caregivers of patients with brain injuries. This was a quasi-experimental, nonequivalent control group and a pre- and post-test design. This study was carried out in one national rehabilitation hospital targeting 41 primary family caregivers of patients with brain injuries. Group art therapy intervention was carried out three days per week comprising 12 sessions over four consecutive weeks. The experimental group (n = 20) received group art therapy, whereas the control group (n = 21) did not. We used a time difference method to minimize the risk of contaminating the control group by sampling sequentially. For depression, although there was a significant difference after the intervention (t = 3.296, p = 0.004), the mean difference score was not statistically significant between the experimental group and the control group (t = 0.861, p = 0.395). The experimental group showed a significantly greater decrease in burden (t = 2.462, p = 0.020) and significantly greater improvement in self-efficacy (t = −6.270, p < 0.001) than the control group. Group art therapy may be an effective nursing intervention for primary family caregivers of patients with brain injuries.

Comprehensive Neuropsychological Assessment of Cognitive Functioning of Adults With Lower Limb Amputation in Rehabilitation

ObjectiveTo establish a comprehensive profile of cognitive functioning in people engaged in lower limb amputation (LLA) rehabilitation. DesignCross-sectional study as part of a longitudinal prospective cohort. SettingA national tertiary rehabilitation hospital. ParticipantsAdult volunteer participants (N=87) referred for comprehensive rehabilitation for major LLA were sampled from 207 consecutive admissions. Participants with both vascular (n=69) and nonvascular (n=18) LLA etiologies were included. InterventionsNot applicable. Main Outcome MeasuresDemographic and health information and a battery of standardized neuropsychological assessments. ResultsCompared to normative data, impairment was evident in overall cognitive functioning (P≤.003). Impairment was also evident in particular areas, including reasoning, psychomotor function, information processing, attention, memory, language/naming, visuospatial functions, and executive functions (all P≤.003 Holm-corrected). There were also higher frequencies of impaired functions across most aspects of functioning in this group compared with expected frequencies in normative data (P≤.003 Holm-corrected). There were no significant differences in cognitive functioning between participants of vascular and nonvascular LLA etiology. ConclusionsFindings support the need for cognitive screening at rehabilitation admission regardless of etiology. Administration of comprehensive neuropsychological assessment with a battery sensitive to vascular cognitive impairment is recommended in some cases to generate an accurate and precise understanding of relative strengths and weaknesses in cognitive functioning. Cognitive functioning is a potential intervention point for improvement of rehabilitation outcomes for those with LLA, and further research is warranted in this area.

Fiabilidad y validez de la Escala de la Calidad del Desempeño Sensoriomotor en bebés de 2 a 15 meses de edad, con retraso motor o parálisis cerebral

IntroductionThe Sensory Motor Performance Scale (ECDSM2-15), recently developed using Delphi methodology, is a scale to assess the sensory and motor development of infants aged 2 to 15 months previously diagnosed with motor delay or cerebral palsy. This scale classifies the strategies used by infants into typical/normal, delayed, and atypical/patology and identifies the influence of the components of alignment, movement, and support base on functional outcome. Given its importance, there is a need to analyse the biometric characteristics of this scale. ObjectiveTo determine the reliability and construct validity of the ECDSM2-15 scale. Patients and methodsA descriptive and prospective study was conducted in 454 boys and girls aged 2 to 15 months who showed delayed motor development or were diagnosed with cerebral palsy at the Teletón-Chile Institutes, Pedro Aguirre Cerda National Rehabilitation Hospital, and Amancay Neurological Rehabilitation Center. Reliability and construct validity analyses were performed. ResultsInternal consistency and intra-observer variability showed a Cronbach's alpha > 0.80. Variability of evaluators versus control group showed a Kappa index> 0.60. Factor analysis showed a significant Kaiser-Meyer-Olkin index > 0.7 with Bartlett's sphericity test (p <.0001). The analysis of principal components with varimax rotation in the six subscales explained between 60 and 87% of the variance. ConclusionThe scale is reliable, consistent and valid in its construct and can be used in assessment, clinical follow-up and research.

Digital Revolution – Implementation of an Electronic Assistive Technology Pilot Project in a Neuro-Rehabilitation Setting

Introduction: Electronic Assistive Technology (EAT) including communication devices, environmental control systems and personal computers have always been seen an important component of patients’ rehabilitation. At the National Rehabilitation Hospital (NRH) this inclusion of EAT had been largely unsystematic and challenging due to limited EAT knowledge and skill. In addition inefficiencies in trialing equipment without technical support had prevented timely access to EAT. This paper describes a developing integrated EAT service. Context: The Electronic Assistive Technology (EAT) Clinic is a joint Occupational Therapy (OT) & Speech and Language Therapy (SLT) service. Referrals are received from speech & language therapists or occupational therapists. The clinic offers assessment, trial, loan and support services for electronic assistive devices for inpatients across all NRH Programs (Brain Injury, Spinal Cord Injury, Prosthetic and Orthotic Rehabilitation and Peadiatrics). Key Objectives of the EAT clinic: To deliver an effective and efficient EAT service to meet the needs of the population of inpatients within the NRH. Develop systems to ensure that clinic staff are continuously up-skilled in the rapidly developing area of EAT in order to ensure highest quality service provision for patients To provide access to technology that can enable independence for patients and create efficiencies in providing the most appropriate EAT solution. Provide EAT recommendations and/or solutions to patients upon discharge. Outcomes of the Project to date: The EAT clinic has progressed through investment in stock, securing a physical clinic space, upskilling key staff, allocation of protected staff time and the approval of a therapy assistant. This pilot has resulted in onsite delivery of individualised EAT solutions for inpatients by Occupational Therapy (OT) and Speech and Language Therapy (SLT) Departments. There have been significant cost savings in terms of staff time as well as a reduction in the number of inappropriate devices being purchased. Service users now have the opportunity to engage in assessment with an EAT team and trial one or more EAT solutions during their rehabilitation. In addition the clinic provides education for less experienced clinicians, patients and their families. Future Plans: Global increasing digital literacy demands that EAT be seamlessly integrated into rehabilitation settings. This EAT Clinic plays an important role in the promotion and adoption of mainstream technology devices and specialised assistive technology devices to improve patient outcomes. The continued aim of the EAT Clinic is to provide service-users with the opportunity to experience electronic assistive technologies during their rehabilitation while being supported by skilled therapists. A business plan has been composed to support contingency planning for the service into the future as well as identifying opportunities for continuing professional development and developing specialisations in the area of EAT.

Improving Access to Patient Education

Introduction and Problem Description: Spinal Cord Injury (SCI) is a difficult, life-changing event with great emotional impact on those who sustain the SCI and their families. Patient education has the potential to provide patients and their families with the knowledge and skills necessary to care for themselves post SCI and help minimise secondary complications over time (Shepherd et al., 2012). At the Spinal Cord System of Care (SCSC) Programme in the National Rehabilitation Hospital (NRH) in Ireland patient education has predominately been delivered through paper-based materials or face to face interactions with members of the interdisciplinary team (IDT). However, an audit of patient education folders in 2013 revealed that only 12% of patients used their folder routinely during their rehabilitation. Patients reported that information in the folders was overwhelming and daunting and that they were consulting the internet for information. One key difficulty in providing patient education is that there is a lot to learn and limited time during a rehabilitation admission to do so. Factors such as a person’s level of education, preferred learning style, their psychological adjustment to the injury (learning readiness) and emotional support can influence their ability to learn and problem solve (Van Wyk et al., 2015). Impairments in hand function as a result of a SCI means that physical access to paper-based educational materials is very challenging (Shepherd, 2012). Another barrier to acquisition of knowledge, skills and behaviours from SCI patient education in Ireland is that once a person is discharged from the neuro-rehabilitation setting there is limited access to credible, quality information sources. Practice Change Implemented: The National Standards for Safer Better Healthcare highlight the importance of using feedback from service users to improve the quality of the services provided (HIQA, 2012). The internet has been identified as a preferred means of accessing information for people with SCI (Letts et al., 2011; Goodman et al., 2008; Matter et al., 2009). In addition, the proliferation of smart devices being used on wards and integrated into therapy has been recognised in the literature (Fager and Burnfield, 2013; Folan et al., 2015). This change project aimed to tap into the virtual context to maximise educational opportunities for people with SCI. Chou et al. (2012) suggest that by bringing information to the patient at the place and time of their choosing, e-learning has the potential to broaden the reach of existing services. The addition of e-learning resources for SCI patient education at the NRH is an additional channel rather than a substitute for verbal or paper-based education materials. Aim: That the addition of e-learning resources reviewed and adapted by staff and patients in a SCI rehabilitation programme will improve access to meaningful and appropriate SCI patient education. Theory of Change: The Health Service Executive (HSE) change model (Figure 2) was chosen to guide the project because it recognises the cyclical nature of change, the key role of leadership and aims to improve patient experiences in healthcare. This model helped staff participate actively in the change process and work collaboratively in teams to improve delivery of patient education (HSE, 2008).

The challenge of integrating care in dual diagnosis; Anti-NMDA-receptor encephalitis; presentation and outcome in 3 cases referred for Complex Specialist Rehabilitation

Introduction: The successful implementation of an integrated care pathway for any given condition is a challenge. Even more challenging is the successful implementation of integrated care for individuals who have multiple co-morbidities which cause activity limitation and participation restriction. This is further compounded when there is dual mental health and physical disabilities that require integrated working across multiple disciplines, specialties, institutions and organisations. Even more complex is the situation where there is a rare diagnosis that results in dual pathology and the management of these is the purpose of this study. Anti-NMDA-Receptor encephalitis is a relatively new diagnostic entity with patients typically presenting with significant psychiatric symptoms followed by progressive neurological deterioration. More than 50% are associated with tumours, especially ovarian teratoma. Methods: Retrospective analysis of the interdisciplinary case notes of 3 cases of females with anti-NMDAR encephalitis with complex mental and physical impairments, activity limitation and participation restrictions who were referred for complex specialist interdisciplinary rehabilitation to a National Rehabilitation Hospital. An analysis of demographics, presenting features, management and outcome was performed. Results: Implementation of a bespoke multimorbidity care pathway that crossed diagnostic, disciplinary, specialty and organisational boundaries resulted in improved activities of daily living and participation for these patients who will continue their rehabilitation in the community with health and social care support. Discussion: Patients with anti-NMDA receptor encephalitis can present to different specialties in different care settings (psychiatry, general practice, acute general settings) which can result in variability in management, delays in treatment and unsatisfactory outcomes for patients. Although typically associated with paraneoplastic syndromes, this disease also occurs in absence of neoplasm which can present a more challenging treatment path. A high index of suspicion is required in these cases and mobilisation of a wide number of care professionals to develop a person centred coordinated care plan. There are currently no clear guidelines on the management of these patients and a variety of treatment regimens may need to be tested before clinical improvement is seen. Response to treatment can be delayed so there is a need for integrated care across a number of specialties, disciplines and settings to deliver improved outcomes for these patients. Without key enablers such as an integrated healthcare record, being in place, this can often be a challenge. However, even In the absence of such enablers, excellent communication and co-ordination is possible. In each of the cases, Rehabilitation services acted as the coordinator of services to ensure implementation of the treatment plan and to ensure successful transitions of care and ultimately transition to the community with appropriate flow up and supports. Physicians need to have a basic understanding of the clinical characteristics, differential diagnosis, treatment regimens and Rehabilitation requirements of these patients and integrated care pathways should be in place to ensure patient centred co-ordination of care to ensure optimum outcomes for patients.

9 Retrospective survey of epilepsy and anticonvulsant usage in patients with acquired brain injury (abi) at a national rehabilitation hospital

Objective There is a lack of data with regard to the epidemiology of epilepsy in patients admitted to the NRH. Developing the knowledge base is likely to help inform prescribing practice, risk discussion, education of patients and staff thereby improve care and clarity of communication both to people with epilepsy and those involved in supporting them. This study aimed to gather data on: 1. Epidemiology of seizures/epilepsy relating to in-patients at the 2. NRH, Anticonvulsant prescribing practice Method A proforma was developed identifying key factors pertaining to epilepsy/seizures. This was piloted on 5 cases and amendments made. Discharge letters of all patients with ABI, discharged between 1/1/14–31/12/14 were analysed retrospectively using this proforma and data extracted. Results A total of 279 discharge letters were examined (181M, 98F). 52 patients had a diagnosis of epilepsy at the time of admission. 42 patients (36M, 16F) had a diagnosis of secondary epilepsy and 10 a diagnosis of primary epilepsy. Of the 42 cases, 23 had had neurosurgical intervention post brain injury. Secondary epilepsy occurred with greater frequency in patients with traumatic brain injury (n=20), haemorrhagic stroke n=7), brain space occupying lesion (n=7) as compared to ischaemic stroke patients (n=3). 43%% (n=120) individuals were on anticonvulsants at admission for diverse reasons, mostly seizures 15.8% (n=44) and neuropathic pain 10% (n=28). In 33 patients out of 120, no clear indication was evident for their anticonvulsant prescription. Most frequently prescribed anticonvulsants were levetiracetam 21% (58), pregabalin 7.52% (21), sodium valproate 4.65% (13), and gabapentin 2.86% (8). Eleven patients had seizures during admission and in three, seizures occurred during weaning of anti-convulsants. Seizure rescue medication i.e. buccal midazolam was prescribed for 7 of 279 on discharge. Conclusion Secondary epilepsy is common in this population examined. It was more prevalent in those who underwent neurosurgical intervention. Seizures and neuropathic pain were main reasons to be on anticonvulsants. Levetiracetam was the most commonly prescribed agent. Weaknesses of the study were the retrospective study design, the poverty of detail on seizure type, reasons for prescription of anticonvulsants and reliance on accuracy of discharge letters. Qualitative work is needed to look at experience of epilepsy in this group with long term follow up to help inform education, discussions and treatment.