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Spinal Cord Injury (SCI) and Life Care Planning

Life Care Planning & Lifetime Costs for Spinal Cord Injury Victims

An overview of spinal cord injury:

Spinal Cord Injury (SCI) is damage to the spinal cord that results in a person’s loss of function, feeling, or mobility. The spinal cord is made up of nerve tissue fibers which extend from the brainstem and end down near your lower back.  You have 24 vertebrae in your spine which protects your nerve tissue fibers. Your vertebrae are subdivided into three main sections, cervical, thoracic and lumbar. Your cervical vertebrae are up around your neck.  There are seven cervical vertebrae, with the closest being to your cranium – called C1 (C1 to C7). Your thoracic spine is your mid back. You have 12 thoracic spine vertebrates (T1 to T12). Your lumbar vertebrae are in the lowest part of your back, being one through five (L1 to L5).

The severity of the spinal cord injury is dependent on the level of injury or location of lesion. Injury at the higher levels of the cervical spine are the most severe, which often results in paralysis of all of the extremities.   Injuries can be classified as complete or incomplete spinal cord injury. The complete spinal cord injury means that a person would suffer a complete lack of sensory and motor function is preserved below the level of lesion.  An incomplete spinal cord injury means that the spinal cord is able to convey some messages to and from the brain – also meaning that there is some level of function or feeling below the site of the lesion.

Cervical Injuries often result in full or partial tetraplegia (quadriplegia).  Thoracic and lumbar Injuries often result in paraplegia. Loss of sensation and motor function below the point of injury are not the only severe complications of SCI.  An SCI victim can also face complications such as:

  • Bowel and bladder function is controlled by the sacral region of the spine. Dysfunction includes susceptibility to infections of the bladder and incontinence
  • Sexual function is also associated with the sacral region – there could be a major loss of sexual function
  • Loss of breathing capabilities requiring ventilators or phrenic nerve pacing are attributable to injuries of the C-1 and C-2
  • Inability to regulate heart rate, blood pressure, sweating, and body temperature
  • Spasticity caused by increased reflexes and stiffness of the limbs
  • Neuropathic pain caused by damage or dysfunction of the nervous system
  • Muscle atrophy
  • Gallbladder and renal stones
  • Osteoperosis and bone degeneration
  • Obesity and related illnesses

What is a life care plan?

The life care plan is a complex document, designed to meet the specific long-term needs related to all aspects involved in managing spinal cord injuries over time.  A life care plan is a quantitative document that sets out everything you will need from a care perspective as you age. The plan is put together by a qualified life care planner, based on evidence based standards of care, research, clinical practice guidelines and recommendations from your treatment team to identify long-term rehabilitation needs, medical needs, vocational rehabilitation needs, psychological counselling needs, outlines the cost of durable medical equipment and assistive devices that you will need throughout the span of your lifetime, among other things. The costs of help and equipment set out in the life care plan is normally based on fees charged by service providers and vendors within your local community, and projected over the course of your life expectancy.

The plans are the way to present (then valuate) future medical and other expenses related to the catastrophically injured spinal cord injury victim.  The purpose of a life care plan is to provide the spinal cord injury victim with tools, skills, modalities, therapies, rehabilitative opportunities, and whatever else is available to enhance his or her future life.  The overall goal of any rehabilitation and life care plan is to maximize the client’s abilities and enjoyment of daily living activities while decreasing functional dependency.

The life care plan is usually lengthy and comprehensive.  The various needs of the individual must be explained to a jury so that jurors can visualize why, for example, a spinal cord injury victim should need personal care, rehabilitation and assistive devices.   A formula is used where the cost of each item is multiplied by the number of times the item must be replaced over the remainder of the person’s life.

Life care plans are an absolute necessary in spinal cord injury cases to prove economic damages, since many of the non-economic damages (i.e. pain & suffering) are under assault in Ontario.  Life care planning combines rehabilitation medicine with the economic art of anticipating a victim’s future needs, based upon individual characteristics. Most life care plans are based upon collaboration with other professionals in order to identify relevant indicators of probable future needs throughout the case analysis process and to incorporate necessary medical care, rehabilitation and therapy, vocational guidance, equipment, supplies, and other supports that will be necessary throughout a victim’s life span.

Lastly, the process of life care planning requires a holistic consideration of all aspects of a victim’s current situation so that plan projections accurately reflect the entirety of his or her anticipated needs through life expectancy, such as:

Transportation: Access to professional services and transportation to your primary care providers, physiatrists, neurosurgeons, podiatrists, psychologists etc.

Physical Therapy:  permanent access to physical therapy is vital to help restore and improve function, mobility, reduce pain.

Occupational Therapy: occupational therapy is crucial with relation to issues of work, self care, and recreational activities to increase development and prevent further disability. Occupational Therapy also can assist with the adaptation of your environment to help achieve maximum independence and enhance quality of life.

Psychological therapy: individual and family sessions should be valuated. Many spinal cord injury survivors require ongoing psychological therapy, often for life.

Medication Costs: both over-the-counter and prescription medication cost should be evaluated. Often times spinal cord injury victims require ongoing pain medication, such as Tylenol, Tylenol arthritis, Tylenol PM, ibuprofen etc. Antibiotics, as well as skin creams should also be considered, among others.

Medical & Assistive Supplies: the cost of medical supplies, for life should be costed. Often times spinal cord injury victims will require such items as adult diapers, baby wipes, catheter kits, special stockings, pressure relieving air mattresses, over bed tilt tables, over bed trapeze, manual wheelchairs, cost of manual wheelchair replacement, wheelchair seat cushions, covers, ponchos, backpacks, cupholders, baskets, and wheelchair gloves are important to consider.  In addition items such to consider are transfer benches, reclining rolling shower chairs, a hand-held shower system, shower ramps, grab bars, adaptive dishware, nonslip mats, therapeutic band packs, and reachaers should be considered.

Miscellaneous Costs: other costs such as gym memberships, lifeline medical alert systems, apple watch alert systems should be considered.

Vehicles: transportation cost should be assessed or in the alternative, vehicle modification allowances for hand controls, spinner knobs, parking brake etc.

Home Modification: home modification cost should be valuated in order to remodel the home to be wheelchair accessible, or in the alternative, purchase or build a new home.

Is the life care planner normally qualified?

Life care planning is a specialty area of practice that relies upon a multidisciplinary approach to case analysis and comprehensive plan development.  Approximately 25 years ago, people trained as rehabilitation counselors started developing life care plans that were then used within the health care industry, as well as in litigation.  Since that time, a number of other professionals have become involved in the life care planning process as well.  In fact, certification programs have now been established for individuals who do not have a graduate degree in rehabilitation counseling in order to prepare them for life care planning.  Today, there are literally hundreds of individuals from various professional backgrounds who are involved in the preparation of life care planning, both within the litigation and non-litigation area.

Our firm normally turns to the life care planners who are vocational experts.  They can tell a jury that their regular business is to assist people who are getting back to work, being retrained, or have been determined to be permanently disabled.  Their expert opinion is only part of what they do.  They also have no problem calling a victim’s treatment team and treating physicians who tell them what the future needs are.

Materials needed for a life care plan:

The life care planner will meet, interview, and if possible, vocationally test the client.  Records should be provided ahead of the interview and should include the following types of materials:

  • All medical and specialty records
  • Physical capacities evaluation
  • Medical Expert Opinions
  • Defence Medical Opinions
  • Psychological and psychiatric Expert Opinions
  • Defence Psychological Opinions
  • Hospital Records
  • Ambulance Reports
  • Vocational Opinions
  • Occupational Therapy Records
  • Educational records
  • Tax returns, and all wage-related documentation
  • Fringe benefits
  • List of job duties
  • Past and present employment files
  • Declarations or video clips of friends, family, and coworkers that support vocational and other loss
  • Photos and video of preexisting life and conditions
  • Photos and video of post-injury life and conditions
  • Discovery transcripts

Can my Case Manager Help?

Absolutely. More often than not your case manager can make sure that all of your various medical, occupational, and vocational pieces are identified and managed as best as can be done.  Your case manager can for example:

  • Attend medical appointments to help the plaintiff and doctors better communicate
  • Work with the caregiver to implement suggestions from the doctors and others
  • Assess interpersonal dynamics between the victim and those in his or her household
  • Give voice to how the disabilities were being manifested
  • Provide an opinion regarding future care needs
  • Provide an opinion regarding accessibility-related needs

The Effects of Aging and the Life Care Plan

It is important to ensure that aging is incorporated in projected future life care needs of a spinal cord injury victim.

By definition, aging is a multidimensional process of physical, psychological, and social change. Gaining an understanding of aging is extremely complex.  SCI is not a static condition.  It evolves as the person ages, however life expectancy after spinal cord injury has increased steadily in the past few decades.  Before World War II, life expectancy for those with SCI was poor.  Renal failure and infection were the main causes of early death.  Mortality rates have been decreasing since the introduction of antibiotics, improved emergency transportation, advances in long-term health interventions, and the availability of preventative care at specialized treatment centers.  However, the life expectancy is still diminished compared to the general population

There are five major changes that those with SCI undergo as they age:

1) the effects of living with SCI long-term (e.g., shoulder pain, chronic bladder infections)
2) secondary health conditions of the original lesion or injury
3) pathological processes unrelated to the SCI (e.g., cardiovascular disease)
4) degenerative changes associated with aging (e.g., joint problems); and
5) environmental factors (e.g., societal, cultural) that may potentially complicate the experience of aging with an SCI.

All of these factors have the potential to compromise a person’s ability to sustain independence and participate in his or her communities at later stages in life.   SCI represents a model for premature aging of certain body systems.  This may occur because of additional stresses that extend some physical systems beyond their ability to repair themselves, which then become systematic.

Our Hamilton spinal cord injury lawyers can help protect your future.

The biggest mistake that can be made in catastrophic injury cases is for a non-specialist lawyer or a lawyer that dabbles in personal injury or spinal cord injury to assume that the victim’s injuries speak for themselves.  Each of our clients is unique.  No two people with the same type of injury end up being impacted the same exact way. Nowhere is this seen more clearly than in the case of spinal cord injury (SCI).  Survivors of spinal cord injury have widely different residual effects although injured at the same vertebral level – which is why it is important to have a life care plan prepared in each and every case that is litigated to help juries understand the long-term individual needs of a spinal cord injury victim. They must appreciate the impairment and need to understand how your spinal cord injury.

There is a value in simply being able.  The inability to be able is a devastation that affects one’s life forever – life care planning seeks to establish a quality of life for individuals whose lives would continue to be devastated were it not for support systems that are available.

If you or a loved one has suffered a spinal cord injury as a result of someone else negligence, call us at 905-333-8888 for your free no obligation consultation. Our Hamilton Spinal Cord Injury Lawyers represent spinal cord injury victims province wide.

*This information has been obtained from our experience and knowledge of spinal cord injury law as well as Medical Peer Reviewed Journals and Medical Studies from SCIRE (Spinal Cord Injury Research Evidence) and Pubmed.



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