Amputee Rehabilitation

Rehabilitation following an amputation can be physically and psychologically complex and may take years before reliable function is restored. The process aims to restore independence to the individual, allowing them to carry out as many normal activities as possible. Successful rehabilitation will be tailored to personal requirements and will usually include mutli-disciplinary input from physiotherapy, occupational therapy, prosthetics, psychology, nursing and medicine. The disruption to work may require involvement from a specialist vocational practitioner in addition.

Initially, neurorehabilitation will focus on the management of pain, reducing the impact of post-traumatic stress disorder, improving transfer techniques (such as from wheelchair to bed or toilet) and exercises to maintain joint mobility and improve muscle strength. For those requiring a lower limb prosthesis, physiotherapy and prosthetics will also focus on learning to walk on the prosthetic limb. For upper limb amputees the focus will be on learning how to control elbow, wrist and hand position using more proximal neuro-muscular drive to create useful function.

The NRC’s amputee rehabilitation medico-legal experts can assess and advise on rehabilitation plans and potential, and adaptations required to an individual’s home environment such as ramps, lifts and other modifications as well as long-term support.

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Brachial Plexus Injury

Brachial plexus injury most commonly occurs as a result of shoulder trauma sustained by a motorcyclist in road traffic accidents. Sensory and motor function of the arm may be completely or partially impaired and often brachial plexus injury is accompanied by severe neuropathic pain.

Treatments include surgery to achieve nerve and muscle transfers, pain relieving medication, physiotherapy, occupational therapy, orthotics and clinical psychology.

The NRC’s brachial plexus experts can provide court reports and expert witness testimony on all aspects of brachial plexus injury.

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Brain Injury Rehabilitation

Brain injury can range in severity from mild to catastrophic and no matter how a person’s brain injury is categorised, it is likely to have caused very significant impairments which reduce activity and participation and so adversely affect quality of life.

The causes of traumatic and acquired brain injury are many and include trauma from accidents, birth trauma leading to cerebral palsy, infections such as meningitis and encephalitis, hypoxia and anoxia from reduced blood flow to the brain during cardiac arrest, and spontaneous subarachnoid haemorrhage and stroke.

Every brain injury is unique and so rehabilitation must be tailored to the individual and their needs. Neurological rehabilitation is often a long and complex process which can help the brain to regain lost function, develop new neural pathways and learn alternative ways of working. This helps to minimise the long term impact of the impairments and increase independence.

A brain injury can affect nearly every aspect of a person’s cognitive, emotional, behavioural and physical function. It can alter the ability to see, speak, swallow, move, understand, express ideas, plan and execute tasks, and can lead to socially inappropriate behaviours and mood and anxiety disorders. Even people who have no physical impairment may be profoundly affected cognitively such that they cannot work, live independently or maintain personal relationships.

Rehabilitation after a brain injury may require the input of speech and language therapy, occupational therapy, physiotherapy, psychiatry, neuro-psychiatry, psychology, neuro-psychology, nursing and medicine. It will almost always require the input of specialist brain injury case manager to co-ordinate the complex rehabilitation process. In many cases where there is potential for return to work, input from a vocational specialist will be required.

The NRC’s brain injury rehabilitation expert witnesses will assess and advise on rehabilitation potential, programme requirements to achieve goals and will specify how and where this can be delivered across a range of inpatient, outpatient and community rehabilitation services.

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Cerebral Palsy

Cerebral palsy is the general term for a number of neurological conditions that affect movement, speech, swallowing, intellect and behaviour to varying degrees. About one in 400 children has cerebral palsy, and the symptoms usually become apparent within about three years of birth as the child fails to meet their developmental milestones. Cerebral palsy can occur if the brain is damaged before, during or shortly after birth, particularly during a difficult or premature birth.

A team of rehabilitation professionals must work together to manage the many impairments arising from cerebral palsy. This may include professionals in physiotherapy, orthotics, speech and language therapy, occupational therapy, psychology, nursing, medicine and orthopaedics.

The NRC’s cerebral palsy experts can advise on all aspects of cerebral palsy in both adults and children.

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Clinical Psychology & Neuropsychology

Clinical psychologists work with individuals with difficulties including anxiety and depression, adjustment disorder and post-traumatic stress disorder (PTSD).

Clinical neuropsychologists work in the branch of psychology which addresses the link between the brain and function. In particular neuropsychologists identify the impairments of thinking (cognition), understanding, planning, attention, memory, intellect and behaviour. Using a diagnostic approach, psychologists assess a clients’ needs through interviews, tests and observations.

Clinical psychologists and clinical neuropsychologists work within the multi-disciplinary team (MDT) to ensure a comprehensive understanding of the psychological problems faced by the injured person.

The NRC’s expert neuropsychologists can provide assessment, court reports and expert witness testimony.

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Complex Neurological Disability

Individuals with complex disabilities associated with chronic neurological conditions such as multiple sclerosis and spina bifida may experience impairments in their physical and cognitive abilities and emotions. Bladder, bowel and sexual function are often impaired in addition to movement in these conditions.

The aim of rehabilitation and disability management in these conditions is to minimise the impairments arising, especially from complications such as infection, and to maximise the ability, participation and quality of life of the individual.

Our medical experts are experienced in assessment, court reports and medico-legal witness testimony in complex neurological disability.

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Guillain–Barré Syndrome

Guillain–Barré syndrome (GBS) is a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. The initial symptoms are typically changes in sensation or pain along with muscle weakness, beginning in the feet and hands. This often spreads to the arms and upper body with both sides being involved. The symptoms develop over hours to a few weeks. During the acute phase, the disorder can be life-threatening with about 15% developing weakness of the breathing muscles requiring mechanical ventilation. Some are affected by changes in the function of the autonomic nervous system, which can lead to dangerous abnormalities in heart rate and blood pressure.

The profound muscular weakness in the acute phase means that many patients are unable to walk, transfer, sit, feed themselves or toilet without assistance for many weeks or even months.

The rate and extent of recovery from GBS is very variable and most sufferers are left with a significant impairment of distal muscular function, which often causes profound long-term disability of hand function, commonly complicated by upper limb flexion contractures.

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Hypoxic Brain Injury

Cerebral hypoxia or anoxia occurs when there is an interruption of the supply of oxygen to the brain is insufficient to maintain normal brain function. The terms hypoxia and anoxia are used interchangeably.

Hypoxic/Anoxic brain injury can be caused by cardiac arrest, irregular heart rhythm, very low blood pressure (such as from blood loss during trauma), suffocation, choking or drowning, smoke inhalation and drug poisoning such as carbon monoxide poisoning or overdose.

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Life Expectancy

An estimate of life expectancy is an essential element of many medico-legal cases. It is an area in which the NRC has a particular expertise.

While a great many factors contribute to a reduction in life expectancy, five are particularly relevant in neurological impairment as follows: mobility, swallowing, epilepsy, continence and cognitive function.

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Musculoskeletal Rehabilitation

Musculoskeletal injuries often accompany neurological injury. Most commonly these give rise to problems with movement and pain.

In an integrated approach our experts consider the effects of musculoskeletal injuries and are able to advise on their management in the context of the neurological injury.

Specifically, injured people often suffer physical deconditioning from prolonged inactivity, and may experience considerable weight gain, pain and fatigue, accompanied by depression. Dealing with these problems is fundamental to comprehensive rehabilitation.

Our medical experts can provide court reports and expert witness testimony in regards to musculoskeletal rehabilitation.

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Neuro-physiotherapy

Neuro-physiotherapy is the sub-specialty of general physiotherapy which deals with problems of movement arising from neurological injury or disease, such as acquired brain injury, spinal cord injury, brachial plexus injury, stroke, Multiple Sclerosis and Guillain-Barre Syndrome.

Neuro-physiotherapists deal with muscle stiffness (commonly called spasticity) or spasm, muscle weakness, tremor and sensation, in order to improve posture, balance, and more natural patterns of movement in the upper limbs, lower limbs and trunk.

These issues are addressed within the context of enabling function such as walking, transferring, and performing activities of daily living like washing, dressing and toileting.

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Neuropsychiatry

Neuropsychiatry is a branch of psychiatry that relates mental or emotional disturbance to disordered brain function.

In brain injury rehabilitation, neuropsychiatrists work as part of the interdisciplinary team to manage particularly complex behavioural problems.

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Paediatric Rehabilitation

Our rehabilitation experts can also assess and report on the rehabilitation of older children and adolescents across a range of neurological conditions and symptoms.

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Speech & Language Therapy

Brain injury and neurological conditions can cause impairments in speech and language function, and swallowing.

Our expert speech and language therapists work with individuals to diagnose and improve communication skills. In neurorehabilitation, speech and language therapists work as part of the interdisciplinary therapy team to increase an individual’s autonomy.

Our speech and language experts can assess and advise, provide court reports and expert witness testimony.

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Spinal Cord Injury Rehabilitation

Following a spinal cord injury, recovery, rehabilitation and reintegration can be a long and difficult process. All interventions by the interdisciplinary therapy team aim to increase functional independence and ability.

Rehabilitation interventions and timescales will depend entirely on the level of the spinal cord injury.

The spinal cord injured person may present with a wide range of impairments of sensation, movement, bladder, bowel and sexual function, and problems with anxiety, depression, PTSD and adjustment disorder.

Vocational rehabilitation is often integrated with clinical rehabilitation in spinal cord injury.

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Stroke Rehabilitation

Following a stroke, many individuals will require long-term support to regain as much independence as possible. Though the therapy required is unique to each individual, it is likely to involve physiotherapists, occupational therapists, speech and language therapists, psychologists, rehabilitation physicians and specialist nurses.

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