Spinal Cord Injury (SCI) – recovery from complete paralysis

The rehab client

The client was an Italian speaking, 51-year-old male, previously healthy and active. He worked in the hospitality industry and he and his wife were expecting their first child.

Accident and resulting injuries

The accident occurred when a tree fell on the client while on his way to work. He was immediately taken to a major trauma centre with injuries including:

  • Vertebral fracture (T9) resulting in T7 spinal cord injury (SCI) classification ASIA-A (complete injury)
  • Right temporal lobe contusion and left parietal haematoma
  • Left tibial plateau fracture
  • Multiple rib fractures

The resulting neurological deficits included complete paralysis and loss of sensation in his lower limbs and trunk. This meant the inability to mobilise or transfer independently, impaired respiratory function, lack of bowel and bladder control, and impaired sexual function.

Referral

The client was referred to HCML on a single instruction basis just over a month after the initial incident. It was reported in the pre-initial needs assessment that the client was extremely unlikely to experience any significant neurological recovery, and that the neurological deficits would be permanent.

As an added complication, there were significant issues around liability, with HCML needing to keep a close eye on costs while providing the right care and interventions to ensure the best outcomes for the client.

Immediate needs assessment

An initial needs assessment (INA) was completed within 5 days of referral. With the assistance of an interpreter, Lauren assessed the client’s current circumstances. In addition to neurological injuries, significant barriers included:

  • Living accommodation was not wheelchair accessible – the client and his wife lived in a rented, furnished, third floor apartment.
  • The client would be unable to carry out his job role from a wheelchair.
  • The client’s wife had given birth to their first child two weeks after the accident.
  • The client and his wife had no family or other support in the UK to help with childcare or other critical activity.

The client’s long-term goal was to achieve independence and to be able to travel with his wife and child. They were also keen to grow their family.

Given the client’s age, level of fitness prior to the accident, positive mindset and motivated approach, Lauren predicted that with a solid rehabilitation programme, the client would achieve functional outcomes that would encompass all of his goals. These included independent personal care, transfers, independent community mobility in a manual wheelchair and to drive an adapted car.

Recommendations

Lauren identified the following areas requiring consideration:

  • Inpatient rehabilitation
  • Long-term bowel and bladder management
  • Adaptive equipment
  • Accessible housing enabling independent activity using a wheelchair
  • Vocational realignment
  • Outpatient therapy
  • Fertility treatment

Interventions

The client was transferred to a specialist inpatient spinal cord injuries unit within two weeks of the INA. Lauren worked with the unit to arrange for accommodation close by and travel assistance for the client’s wife.

Lauren provided case management throughout the client’s stay, attending multi-disciplinary team meetings and keeping in regular contact with the case manager at the unit.

Just over a month into his programme, the client was regularly taking part in gym sessions and classes to maintain and increase upper limb strength for independent transfers. He was also able to stand with an Oswestry frame and learnt how to complete his own programme of independent stretches in lying and supported sitting. He started to gain independence in personal care and dressing and continued to work with an occupational therapist on improving this.

With a recommended stay of approximately two months in inpatient rehabilitation the family’s council application for an accessible ground floor property would not be met before the discharge date. Lauren began to look for private rental accommodation for the client and his family as an interim option. Ultimately, a short-term rental in a wheelchair accessible house in Kent was sourced through the Aspire Charity housing team, while a new build accessible apartment in Camden was being secured through the council.

Upon discharge, the client was referred to the community therapy team and placed on a waiting list for NHS treatment. In order to ensure continued progress in recovery, Lauren arranged for private occupational therapy and physiotherapy treatment. This was initially commenced with one therapy team while the client was living in his temporary accommodation in Kent and handed over to a new treatment team when they moved into their new home in central London.

Outcomes

Just five months after the accident, the client was able to:

  • carry out basic self-care, bed mobility and transfers independently
  • self-manage bowel and bladder programme
  • perform independent stretches and pressure care
  • mobilise in wheelchair indoors and on flat surfaces outdoors independently.

Through 2020 to 2021, Lauren worked with the client, his family and a combination of NHS and private medical and therapy intervention to improve bladder and bowel function, pain management, community access, attending the gym, swimming and assessment for driving. The covid19 pandemic put an abrupt hold on NHS specialist consultant and therapeutic intervention from March 2020 so private treatment was utilised predominantly for the next year. With services opening up in 2021, medical and therapeutic intervention has been provided as a mix of NHS and private services, with HCML facilitating team communications for optimal outcomes.

With HCML providing deferred funding for case management, balancing effective rehabilitation with cost efficiency, the client has made great progress in the three years since the accident, with ongoing goals still being achieved.

Get in touch

If you’d like to find out more about how we support personal injury cases and what we offer by way of deferred funding, please get in touch with our Personal Injury Business Development Managers:

Craig Riley | 07447920074 | craig.riley@hcml.co.uk

Alison Hatchard | 07443774487 | alison.hatchard@hcml.co.uk