Acquired Brain Injury and Stroke Specialty Programmes

The Brain Injury and Stroke Teams work together with patients and their families and carers to achieve the best possible outcome from the Rehabilitation Programme, which is tailored to meet each patient’s individual needs.

Patients admitted to the Brain Injury and Stroke Programmes at the NRH have typically sustained a complex, acquired, non-progressive neurological disability following:

• Traumatic brain injury
• Stroke
• Brain haemorrhage
• Other neurological conditions

The service offers Interdisciplinary rehabilitation to patients ranging from:

• Patients who remain in the near coma state, minimally conscious state and locked-in syndrome
• Patients with major physical and cognitive disability
• Patients who sustain a disabling initial head injury or a stroke, but recover the potential to return at least in part to their pre-injury role in society.

The full Scopes of Service for the Brain Injury Programme and Stroke Specialty Programme are detailed in the linked documents.

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Patient care and treatment for the Brain Injury and Stroke Programmes is delivered by interdisciplinary teams, with clinical responsibility led by Prof. Jacinta Morgan (Medical Director for the BI and Stroke Programmes)

In addition, Consultants in Rehabilitation Medicine who provide a service to the Brain Injury and Stroke Programmes include:

• Prof.  Jacinta Morgan
• Dr. Raymond Carson
• Dr. Jacinta McElligott
• Dr. Jacqui Stow
• Dr. Paul Carroll

The Programme Manager for the Brain Injury and Stroke Specialty Programmes is Dr Valerie Twomey.

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This continuum of care includes:

• Brain Injury Comprehensive Integrated Inpatient Rehabilitation Programme
• Brain Injury Outpatient Rehabilitation Programme
• Brain Injury Home and Community Based Rehabilitation Programme
• Brain Injury Vocational Services (the Rehabilitative Training Unit)
• Stroke Specialty Service

This continuum of care ensures that all individuals can receive the most appropriate programme of care based on their injury and their individual rehabilitation needs.

With primary inpatient and outpatient Brain Injury rehabilitation services provided at the National Rehabilitation Hospital, the comprehensive Brain Injury and Stroke Specialty Programmes include a consulting service to:

• Beaumont Hospital
• The Mater Hospital
• St. Vincent’s University Hospital
• Tallaght University Hospital

Additional sessions for continuing rehabilitation for those whose brain injury results in a ‘slow to recover’ process are delivered at:

• Royal Hospital Donnybrook
• Peamount Hospital

The programme aims to discharge all patients after they have achieved their desired rehabilitation goals and have received maximum benefit from the programme.

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Each NRH consultant also receives written referrals from regional hospitals, including Cork University Hospital which, along with Beaumont Hospital, is one of the two major neurosciences centres in Ireland.

While early rehabilitation of patients with acquired complex neuro-disability typically starts in the Neurosciences Unit in Beaumont Hospital and Cork University Hospital, a significant percentage of patients do not require neurosurgical intervention and therefore come directly from the acute hospitals throughout the country.

The NRH attracts referrals involving people who have acquired very severe disability such as vegetative state, and is continuing to enhance its skills in providing services to severe complex disability within a wide-ranging Interdisciplinary team.

General Practitioner referrals appear to be increasing and this may reflect the advances in rehabilitation services in recent years which can provide benefits to patients who sustained their disability many years ago. However, the pattern of increasing General Practitioner referrals may also reflect a cohort of new patients discharged from acute hospitals who wish to access further specialist rehabilitation at the NRH.

Continuous Improvement

Improving the quality of patient treatment and improving access for patients on the waiting list is of the highest priority at NRH. Additional Outreach and Community based rehabilitation services are urgently required in order to achieve this aim.

Strategic Matters

Strategic involvement by NRH Personnel Includes

• Cardiovascular Strategy for Stroke
• National Policy and Strategy for the Provision of Rehabilitation Services

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This section details some information about the Brain Injury Specialty (Inpatient) Programme which relates to how we measure the activity; effectiveness; efficiency of, and access to the Programme. 

In 2019, a total of 129 persons were discharged from the Brain injury inpatient Programme.

Of these, 120 patients were admitted to the Comprehensive Integrated Inpatient Rehabilitation Programme (CIIRP), and 9 patients were admitted for various interventions such as a short period of assessment or review.

Of the 120 patients discharged from the CIIRP Programme;

• 67 patients – (56%) had a diagnosis of Non-traumatic Brain Injury
• 51 patients – (42.5%) had a diagnosis of Traumatic Brain Injury
• 02 patients – (1.5%) had a diagnosis of other Neurological Conditions

The NRH has committed to a programme of continual review of its service delivery.  Following on from reviews, it implements various improvement plans.  During 2019, the areas considered were:

Average Waiting Time for Admission

In 2019, the average waiting time for admission to the Brain Injury Programme was 124 days.

Improvement Patients Made in Their Functional Ability During Their Stay

For patients admitted to the Brain Injury Programme, a measure of independence is taken at both admission and discharge. The measures used in the Brain Injury Programme are the Modified Barthel and the Functional Independence Measure (FIM).

In 2019, the Modified Barthel illustrated that 90% of patients showed improvement and the Functional Independence Measure illustrated that 94% of patients showed improvement.

Average Length of Stay

The Average length of stay for patients in the Brain Injury Programme in 2019 was 84 days.

Discharge to Home*

68% of patients were discharged to home in 2019.

* Rather than back to Acute hospital or residential care

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This section details some information about the Stroke Specialty (Inpatient) Programme which relates to how we measure the activity; effectiveness; efficiency of, and access to the Programme. 

In 2019, a total of 87 persons were discharged from the Stroke Specialty Inpatient Programme.

Of these, 86 patients were admitted to the Comprehensive Integrated Inpatient Rehabilitation Programme (CIIRP), and one patient was admitted for a short period of assessment or review.

Of the 86 patients discharged from the CIIRP Programme;

• 50 patients – (58%) had a diagnosis of Haemorrhagic Stroke
• 29 patients – (34%) had a diagnosis of Ischaemic Stroke
• 07 patients – (8%) had a diagnosis of other Stroke

The NRH has committed to a programme of continual review of its service delivery.  Following on from reviews, it implements various improvement plans.  During 2019, the areas considered were:

Average Waiting Time for Admission

In 2019, the average waiting time for admission to the Stroke Programme was 137 days.

Improvement Patients Made in Their Functional Ability During Their Stay

For patients admitted to the Stroke Programme, a measure of independence is taken at both admission and discharge. The measures used in the Stroke Programme are the Modified Barthel and the Functional Independence Measure (FIM).

In 2019, the Modified Barthel illustrated that 90% of patients showed improvement and the Functional Independence Measure illustrated that 80% of patients showed improvement.

Average Length of Stay

The Average length of stay for patients in the Stroke Programme in 2019 was 84 days.

Discharge to Home*

80% of patients were discharged to home in 2019.

* Rather than back to Acute hospital or residential care

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