This is another in a series of articles which seek to provide a cursory overview of spinal cord injury claims. We have already looked at the anatomy of the spine and types of injury that can arise, and this next article will highlight the importance of early rehabilitation and how access to appropriate therapeutic interventions and OT can have a significant impact on an injured person’s recovery and road to independence.
Purpose of rehabilitation
Whilst this is perhaps a trite observation, everybody is different. And one person’s response to a spinal cord injury will differ to the next. As such there is no one size fits all approach insofar as rehabilitation is concerned, and each individual will require a bespoke rehabilitation regime best suited to meet their needs.
The aims of rehabilitation are numerous in number, but some of the key goals are:
- Facilitating optimal physical recovery;
- Enabling maximal independence in future;
- Supporting the injured person to adapt to a new way of living and managing everyday tasks;
- Assisting the injured person with long term management of bowel and bladder care;
- Psychological support – the adjustment to living with a live-changing injury is significant;
- Vocational coaching and support;
- Education on lifelong risks such as AD and skin integrity.
These goals are very much longer terms aims and aspirations. Inevitably the shorter term aims of rehabilitation may be quite different, and indeed in the acute phase the main goal may be simply to save the injured person’s life. However what is indisputable is that an injured person is only likely to achieve their best possible outcome if they are exposed to early rehabilitative intervention, hence it is key that rehabilitation is a sharp focus from the outset.
Multi-Disciplinary team approach
A rehabilitation regime involves input from a wide range of specialists and experts, which is entirely necessary given the far-reaching and catastrophic impact that a spinal cord injury can have on a person. A typical team will comprise clinicians and specialists in the following disciplines:
- Spinal consultant;
- Neuro-rehabilitation expert;
- Psychiatrist and/or psychologist;
- Urologist;
- Neuro-gastroenterologist;
- Neuro-physiotherapist;
- Occupational therapist;
- Pain expert;
- Tissue viability nurse;
- Assistive technology expert;
- Vocational rehabilitation;
- Accommodation expert.
The above list is far from being exhaustive and it is not unusual for other niche experts to be involved in a person’s rehabilitation journey. That said this extensive repertoire of specialists does serve to demonstrate how complex the management of a spinal cord injured patient can be. The importance of regular MDT meetings to ensure optimal progress is being achieved cannot be over-estimated, and the injured person very much needs to be at the centre of this process. As the injured person starts to make some positive progress, the rehabilitation plan needs to evolve accordingly to meet the person’s changing needs.
These MDT meetings are often attended by the injured person’s case manager, legal teams and the insurers who will be funding the rehabilitation programme. This collaboration between all stakeholders is absolutely key to achieving a successful outcome for the injured person, both in terms of their recovery and return to independent living, and thereafter for any litigation which may flow from the injury.
Role of the case manager
The case manager is the lifeline for the injured person and their family, and will guide them through what is a very traumatic and distressing time. The injured person and their family are more often than not completely overwhelmed by the devastation caused by a spinal cord injury, and the case manager is there to support them at every point of this difficult journey.
One of the main functions of the case manager is to coordinate the rehabilitation programme and to ensure that the injured person’s needs are met and that an optimal outcome is achieved. They are also instrumental in securing longer-term care provision, OT and physical/psychological therapies, accommodation, transport etc. They will also support the injured person to navigate numerous appointments, resume hobbies and work (if possible), and to reintegrate into their community and lead as independent a life as is feasible.
A very important aspect of the case manager’s role is to manage the transition from the acute/inpatient stage of the injured person’s rehabilitation to a discharge home from which point outpatient rehabilitation will have to be accessed. Discharge planning can be enormously challenging and it would be extremely difficult to coordinate the process without the expertise and input of the case manager.
The long-term
With focus and effort, ongoing “maintenance rehabilitation” will help lead to: community reintegration; a fulfilling return to work; adapting to a new way of living with family and in all likelihood carers; maintaining functional skills and physical fitness to ensure maximum independence; re-establishing social life and hobbies; healthy nutrition, and psychological wellbeing.
As already alluded to above, rehabilitation does not stop once a person leaves hospital. In many respects this represents the start of a lifelong journey. Rehabilitation is a lifelong commitment, and is necessary to enable the injured person to integrate their injury into their life.
