Dr. Claire Donnellan

Summary

Cognitive dysfunction is documented as a common neurological manifestation of antiphospholipid syndrome (APS) with greater reference to secondary APS patient groups, with Systemic lupus erythematosus (SLE) in particular. Evidence regarding neuroimaging biomarkers may contribute further to our understanding of cognitive dysfunction in patients with APS and antiphospholipid antibodies (aPL). The aim of this project was to determine the association between cognitive dysfunction and primary and secondary APS using neuroimaging modalities' evidence.

Project Type

Neuroscience

Summary

Introduction: Some key considerations for a geriatric coordinated care intervention framework should accommodate for life management changes, alterations to self-regulation and acknowledge losses that older adults experience following age-related neurological conditions. One such framework that may be considered for use with a reablement orientation is the Baltes and Baltes Model of Selective Optimization with Compensation (SOC). A proposed intervention called REsources And LIfe Strategy Management (REALISM) was developed based on the SOC Model. The proposed aim is to determine if the REALISM intervention improves outcome in older adults with neurological deficits following stroke and Parkinson's disease. Methods: The research project will include feasibility research work in preparation for the intervention REALISM over 4 phases using the Medical Research Council framework. The aim of this intervention development is to provide older adults, their carers' and healthcare providers with a training programme on managing short- and long-term challenges as a result of neurological conditions (e.g. stroke and Parkinson's disease) using a goal setting and attainment care plan based on the adaptive strategies selection, optimization and compensation. The initial phases (1 and 2) will include protocol development through qualitative action research with stakeholders concerning reablement frameworks for aged care; and feasibility assessment using qualitative and quantitative arms regarding trajectory of conditions and the process of care from acute admission to ongoing care within the community. Phase 3 will involve piloting of the REALISM intervention in terms of training sessions and follow-ups required. The intervention study will be a single-blinded randomised control trial where the control group will receive standard care and the intervention group the REALISM training programme. Outcomes: Primary outcomes will determine improvements in physical, psychological and social functional abilities including health-related quality of life and mood. Secondary outcomes will include metacognition measured by the Meta-cognition Questionnaire 30, self-regulation measured by the Self-regulatory Interview and executive function using the Trial Making Test (A+B). Conclusions: Findings from this intervention study will establish if the use of the REALISM training programme for older adults with chronic neurological conditions and their carers' in using life management strategies will improve self-care, wellbeing and transferability of care, aiding discharge planning from acute to community settings.

Programme

Patient outcome

Project Type

Patient outcome

Summary

Developing an integrated care pathway (ICP) to support the management of neurogenic dysphagia post stroke could enhance quality of care received by improving patient outcomes, promoting patient safety, increasing patient satisfaction, optimising the use of resources and increasing adherence to evidence based standards and guidelines for dysphagia management. An ICP can offer an effective framework for interdisciplinary decision making, thereby acknowledging key aspects of care and variations in the management of neurogenic dysphagia post stroke.

Funding Agency

In progress

Project Type

Health Services Research

Summary

The overall aim of this research project is to determine facilitators and barriers regarding the provision and delivery of recreational services inclusive of respite care for individuals with a physical disability and their informal carers in the Republic of Ireland (ROI). The project will strive to meet a national need in establishing what should constitute and serve the requirements of individuals with a physical disability and their informal caregivers in terms of recreational activity as part of healthcare intervention that is inclusive of leisure breaks. This research investigation will also address an essential requirement in establishing the formal current available recreational activity services and interventions (inclusive of respite breaks and holidays) exclusively for individuals aged between 18 and 65 with a physical disability. This in turn, will inform Irish healthcare policy regarding international best practice for recreational activity intervention for this cohort of the population including their informal caregivers.

Funding Agency

HRB

Programme

Applied Partnership Awards

Project Type

Health Service Research

Person Months

24

Summary

Stroke is one of the leading causes of death worldwide, and while morbidity rates in Ireland have substantially decreased in recent years, rehabilitation of survivors has not improved concurrently. In the proposed research, a state-of-the art therapy to improve upper limb function in stroke survivors will be developed, based upon a novel form of brain-computer interface. Using this approach, magnetic pulses are applied to the scalp over the location on the motor cortex that controls the arm and hand, via Transcranial Magnetic Stimulation (TMS). This evokes a twitch in the stroke-affected muscles (motor evoked potential, MEP), which is recorded using electromyography. The amplitude of this twitch provides a read-out of the excitability of the neural pathways connecting the brain to the muscle. Following stroke, cortico-spinal excitability is dramatically reduced, but recent evidence suggests that its resolution to normal levels may indicate an important neurobiological mechanism of recovery. Using our TMS-neurofeedback approach, the amplitude of MEPs are displayed to the patient in real-time, with rewarding visual and auditory feedback incorporated in a game-like display, to train them over a period of several days to make the amplitudes larger. The aim is to develop the concept of TMS neurofeedback into a suitable rehabilitation intervention for stroke patients, by testing different variants of the protocol and measuring outcomes such as functional improvements, and perceived benefit reported by the users. Additionally, as re- myelination of the corticomotor structural pathways has been proposed as a key recovery mechanism in this process, we will quantify microstructural integrity of the white matter tracts in the brain pre and post neurofeedback training. We hypothesise that patients in an experimental group receiving TMS neurofeedback will demonstrate changes in corticospinal excitability following training, that will be correlated with functional improvements and re-myelination of motor pathways, compared to a control group.

Funding Agency

Health Research Board, Ireland

Programme

Emerging Investigator's Award