Mr. Odhrán Ó hUallacháin:

A severe acquired brain injury is usually defined as being a condition where a person has been in an unconscious state for six hours or more or post-traumatic amnesia of 24 hours or more. These patients are likely to be hospitalised and receive rehabilitation once the acute phase has finished. That definition is taken very much at the time of injury whereas we look at the people when they come to us. We focus more on how they are now. We assess them objectively using outcome measures that measure how dependent they are on other people and how much assistance they need for their daily activities. That is one section of it. We also look at their cognitive status. For example, do they need assistance making decisions under the Assisted Decision-Making (Capacity) Act? We also look at their social setting. Are they living at home? Do they have support at home or are they living in a care home? These are the kinds of people we work with on a day-to-day basis. They are the most vulnerable people we have. As Mr. Schäler said, there are services for them. We take them and we look at what their goals are along with what their needs are. At the same time, we consider the physical activity guidelines set out by the WHO and by the clinical practice guidelines. We try to apply them to the clients. There are physical activity guidelines and we consider the body, mind and soul concept. There are physical activity guidelines for people without disability and the same guidelines exist for people with disabilities. They might have to do it a little bit differently but we still do it. We use a mixed model of robotic gait therapy and we use conventional gym equipment that has been modified to the person's abilities. We manage to get them to do the activities that everybody needs to stay healthy. With the mind and soul element of what we try to do, our clients are brought into a big open clinic with people working on different things at different times of the day. There is a big open space where people get to interact with each other. It is a community where everyone is rowing in the same boat. There is a sense of fun, there are jokes and horses are talked about. It is an opportunity for the clients to share their experiences with each other and it is the same thing for the families. They get to share tips and share stories. They get to live this together as we go forward.

We try to adapt this holistic approach to our setting under the HSE's New Directions framework of 2015. We look at the principles of the patient-centred approach, community inclusion, independence, quality of life and promoting equal rights for people with disabilities. Article 26 speaks about habilitation and rehabilitation and our success can be measured. Yes, certain people are improving and there are people who have gone back to work and gone back to university, and they are back driving, but that will not be the case for everybody, as Mr. Schäler said. Other people might get to go on a trip away with their family. They might get to spend some time with their friends. Other successes are that people are not getting sick, not having to spend time in hospitals or going to the GP, and not having antibiotics. There are different ways of measuring our success and the effectiveness of what we are doing. We are just looking for the support to continue to do that.