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Jurors at the Central Criminal Court have heard that a little girl who was stabbed in the heart will “never live independently” and can’t swallow safely following a knife attack outside a school on Dublin’s Parnell Square in November 2023.
Dr Aoife Mahony told the three women and nine men that the little girl, who cannot be identified, suffered a “hypoxic brain injury” and now has a “severe neurological disorder,” has “spasticity and tightness in her muscles” and clonus, a neurological condition characterised by a series of involuntary, rhythmic muscle contractions and relaxations.
Dr Mahony said that the child also suffers from “dystonia” and that her brain “cannot communicate sufficiently with her body” regarding how to move.
“Her head control has gradually improved, but she still needs a full-time wheelchair and a hoist”, as well as a “highly supportive walker”, as “she cannot stand or bear weight independently.”
She is “completely reliant on her carers”, is”non-verbal” and has learned to “blink yes and no”; however, a formal assessment of her cognitive ability is “difficult” as a full report requires a detailed assessment, which she has been unable to engage with.
“We don’t have a full report of exactly where [name’s] cognition lies,” Dr Mahony said.
“There’s a mismatch between what she understands and her ability to express that.”
The little girl is fed with a PEG directly into her stomach as it is “hard” for her to “coordinate the movement of her mouth” and it is “hard to protect her own airway”, which means she is “prone to chest infections”.
She is “fed directly into her stomach” but “gets some tastes for pleasure”, Dr Mahony said.
The girl, who is now almost eight years old, is on nine regular medications, including for constipation, pain, sleep and gastrointestinal issues.
“She’ll never live independently,” the jurors heard. Dr O’Mahony said that because the first year post-trauma is significant for brain plasticity, the little girl’s condition is not likely to improve over time.
“As she grows, growth is also a challenge”, and she is “very likely to have scoliosis as she has no central tone.”
“Her chest health is very vulnerable” due to her “difficulty swallowing”.
Dr Louise Baker, a consultant in Neurodisability at Temple Street Hospital, told the court that she has had contact with the girl since her first arrival at the hospital.
“She was a previously healthy five-year-old girl” who sustained an “out-of-hospital cardiac arrest due to a “traumatic stabbing injury” which caused a “severe acquired brain injury”.
Dr Baker said that from the child’s schoolwork it was clear that “she was reaching all her milestones”.
She said that the child’s brain injury was caused by a lack of blood supply and cardiac arrest, describing how, when the little girl was brought to the hospital, the chest cavity had to be fully opened up (a clamshell incision) to allow a heart massage to take place to get her heart to beat again. At the same time, the medical team tried to stop the bleeding from her heart and close the wound.
“She developed seizures in the first 24 hours”, she said.
Dr Baker said that the child’s “whole brain” had been affected and had “suffered dramatically”.
She described how the medical team could see “colour changes” on her brain from CT scans, which confirmed their suspicion regarding the nature of the injuries.
“The worst part of the brain affected was her deep brain matter,” she said.
The jurors heard that the child suffers from “really distressing, painful dystonic movements” and has had “subcutaneous pump infusions” of medications.
As [name] woke up, it was really obvious that she had severe dysonia, and she went into a dystonic crisis,” which was “extremely painful”.
“We needed to try and stop the abnormal movements,” she said, adding that the child’s condition was “so severe and so difficult to manage” that the team “had to put her on a pump [of medication] continuously”.
Telling the jurors that the “gut is a muscle”, she described how the child has “difficulty with their gut as the muscles are reacting in the same way,” that she “had to go to the ICU on two occasions”, and that medics “had to stop her feeding into her stomach” as the food would casue “writhing” in her guts which is a “life long risk for her”.
To “get control of the severe pain we had to feed her through venous access in the ICU twice,” she said.
Dr Baker said that the child will require “full care in all of her daily activities” and “can’t control her hands, her arms, or her legs” as her “brain is sending the messages wrong.”
When Carl Finnegan SC, prosecuting, asked Dr Baker if this situation had remained unimproved, she said, “She’s not able to swallow her spit safely.”
The court heard that the child’s family moved to be closer to where their daughter received treatment and that the medical team were “always we were thinking of home” for the little girl who spent nine months in Temple Street Hospital.
The child requires “24-hour care” and “needs multiple mobility aids,” and has acquired a “lifelong life-limiting disability.”
The accused, Riad Bouchaker of no fixed abode, denies all charges.
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