Ask most people what an occupational therapist is and they will probably answer, ‘someone who helps people with their occupation’. Yet they usually do not know what this means. I work with occupational therapists (OTs) who assist people who have suffered injury or illness and need support to lead independent, productive and satisfying lives. They help them back into work or daily routines through the use of purposeful activity.

What assistance can an OT have when an individual suffers a brain injury?
Clients may have just been discharged from hospital or be referred at a later date suffering mental, emotional and physical problems as a result of their injury. An OT can help them re-learn the skills necessary to manage everyday tasks and work-related activities so they can adapt to their new condition. In order to achieve this, occupational therapy (OT) must take account of all aspects of a person’s life.

When does an occupational therapist become involved in litigation?
Clients struggle to live the life they did before their accident. They experience problems at work or may already have lost their job. Their relationships at home are often under pressure or have completely broken down. They find they cannot manage money anymore and begin falling into debt. They have lost their sense of identity and role in their everyday life. The head injury patient or their families investigate litigation knowing the difficulties they are experiencing were caused by their accident. Once a client receives the first interim payment the rehabilitations process can progress. In some cases they will have received NHS therapy services at the acute stage or are coming to the end of their inpatient treatment and there is no further NHS rehabilitation provision. An OT is usually instructed at this stage. OT fees range between £80-£120 per hour, depending on the amount of travel required or whether a meeting or session is face-to-face or over the phone. The fees are agreed at the start of a period of rehabilitation and added to the value of the claim, or funded by an interim payment.

The effect of brain injury
After being discharged from hospital, the main aim of clients is to get back to normal as quickly as possible. But small activities like getting out of bed in the morning, having a shower, getting dressed, eating breakfast and brushing teeth leave them exhausted and ready for bed again. They find they can no longer process information or put tasks into a correct sequence. Their thinking is not clear and their short-term memory is impaired they may not remember if they have brushed their teeth so they do it again. Repeating tasks means everything takes twice as long as well as contributing to fatigue. One of the most disabling conditions for people with a brain injury is fatigue. When a bone breaks it can be put in plaster and healed but the brain cannot be allowed to rest in this way. We use it for everything – breathing, talking, seeing, feeling, hearing and walking, it is why people can be put into an enforced coma if their brain needs time to heal ie from swelling on the brain to give the organ time to rest and recover. Most of the patients I treat leave hospital while their brain continues to repair itself. The effect of not allowing the brain to rest hinders recovery.

The impact of occupational therapy in achieving positive outcomes
In neuro-rehabilitation it is definitely not the case that one size fits all. I tailor a programme for each client is appropriate. With each client a standard OT Assessment is carried out.

A client in denial
Even though a client may initiate litigation, many people I begin treating with brain injury are effectively in denial. They may know something is wrong but do not want to acknowledge it or do not recognise it. They are grieving for their old life. Their friends and family are also grieving for their old life. Their friends and family are also grieving the person they knew and loved. In cases where the brain’s frontal lobe has been damaged the person may have lost some of their awareness as well as their executive thinking skills. This common symptom of brain injury leads to poor insight, impulsiveness, disinhibition and poor verbal management ie abusive or obscene language. This comes as a big shock to family members. It is as if their loved one has been replaced by a stranger.

Working with medical experts
During a litigation case medical experts are brought in to predict loss of earnings and what support, care and equipment will be required in the long term. They meet the client for a few hours and in that time are expected to establish what is needed to sustain a quality of life they previously experienced. A good medical expert will liaise with the treating therapists – those who see the client sometimes weekly and work closely with them, their families and employers. They realise there are day-to-day nuances that can often get overlooked in reports. They will phone me and ask questions. Why has it taken so long for that person to get back to work? What else is going on that is not allowing them to stay in a job? Do they feel unable to support their partner who is suffering their own medical issues? Is their depression over losing their job affecting their child who has stopped attending school in the middle of exams? The medical expert’s report should take account of everything including those details that at first glance may not appear to be the result of the brain injury, but on closer inspection are revealed to be just that.

Going it alone
The consequences for the person suffering brain injury who chooses to handle the litigation claim directly with their solicitor can be significant. If rehabilitation is delayed this can have a devastating effect upon a client’s ability to return to work, relationships and recovery?

Brain injury: the invisible disease
Without interim insurance payments this level of neuro-rehabilitation involving different therapy specialists is often not available. The National Health Service generally offers twelve weeks community rehabilitation for people with brain-injury after they are discharged from hospital. This is not always through a specialist community neurological service. There are often long waiting lists. It is only after a significant passage of time that they realised they are struggling but by then it is usually too late for NHS treatment. The litigation process is crucial in providing some individuals with the support, treatment and advice they require to achieve a quality of life and manage their lifelong condition as effectively as possible.

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