03/27/2013 // Concord, CA, USA // LifeCare123 // Greg A. Vigna M.D., J.D. // (press release)
There are very few injuries that are as catastrophic and devastating to the patient and the family unit as a spinal cord injury in a child. Literally within a millisecond all the hopes and dreams of a parent for their child is seemingly irreversibly destroyed. Grief, despair, and anger are common emotions for the parents. This article is written with the hope that it can provide insight for the parents of a child of what is ahead and discuss a very important decision that must be made following a spinal cord injury. That decision is where to go for acute rehabilitation. I will be discussing this from the perspective of a physician trained in the field of physical medicine and rehabilitation with 15 years experience in private practice who had the privilege to train at Texas Institute of Rehabilitation and Research in Houston which is one of the Model Spinal Cord Centers in the country. As a certified life care planner, I will discuss the importance of this to prevent medical complications and improve the functional outcome from a physical, vocational, and psychosocial standpoint. Finally, as a practicing attorney, I will briefly discuss the issues initially that should be taken care of to preserve your family and child’s rights going forward in the future.
Medical Perspective:
A study of adults who suffered spinal cord injuries as children were found ‘to have the greatest opportunity for a satisfying adult life if rehabilitation emphasizes psychosocial factors such as education, employment, and long-term health management. This study, further found that ‘life satisfaction was associated with education, income, satisfaction with employment and life satisfaction was adversely affected by medical complications.’ It is this author’s opinion that the initial inpatient rehabilitation sets the stage for the injured child medically, socially, educationally, and physically. Pediatric spinal cord injuries only represent 3-5% of the approximate 12,000 spinal cord injuries that occur nationally. This is a rare injury and it is imperative that this child and parents obtain the benefit to experience acute rehabilitation at a center with the experience and knowledge of medical professionals with extensive knowledge of pediatric spinal cord injuries.
It is this author’s opinion that the best medical, functional, and psychosocial results can be achieved in the framework of a multidisciplinary rehabilitation approach that can improve the odds that a child will grow up to be independent, self-sufficient, and satisfied with their lives. The parents should insist that the acute rehabilitation team consist of a physiatrist, a pediatrician, physical and occupational therapy, speech therapy, recreational therapy, respiratory therapy, psychologist, family counselors, and case management. This rehabilitation team will work together, have weekly staging to discuss goals of therapy, discuss equipment needs, family needs, future therapy, and future home modifications. The team will have knowledge of the latest assisted technologies for children that can improve the patient’s independence as well as latest equipment that will improve sitting, mobility, and posture to decrease the risk of scoliosis and pressure sore. The team will have access to experts in orthotics to allow for the best braces to be fabricated to facilitate functional ambulation. The team will be accessible to the family by way of family rounds, family meetings, and family education to discuss goals of treatment and to facilitate a working relationship with the family to help remove barriers to recovery. Patient and family training should begin immediately based on the age of the child and the abilities of the parents. It should also stress the importance that the therapy, goals, and expectations for the patient will change as the child ages.
It is this author’s opinion that parents must tour the rehabilitation hospital prior to admission. There are many so called pediatric rehabilitation hospitals, but few that can deliver the care that a child with a spinal cord injury deserves. The rehabilitation hospital must have pediatric nurses, a floor or wing exclusively designated for pediatric patients, consultation services from pediatric surgeons, uroneurologist, pediatric spinal surgeons, and pulmonary specialist. It is imperative that the family ask if the rehabilitation hospital is a center of excellence for spinal cord injury. The family should make an inquiry on the facilities experience with the age of the child and the level of the injury. It is important to interview the physiatrist, who is the leader of the team, and ask about the facility’s experience with children, and the scope of services both for inpatient and outpatient. Every pediatric rehabilitation hospital should be a center of excellence for spasticity management and provide Botox and intrathecal baclofen management. If the facility doesn’t, likely the facility doesn’t have the expertise that your child deserves.
Pediatric rehabilitation is different than adult rehabilitation for many reasons because it is ‘family centered’ as opposed to patient centered because family is essential for the development of a child thru adolescents to adulthood. Further, the tenet of pediatric rehabilitation is that it must take into consideration how an injury will be affected by physical growth, sexual development, and psycosocial growth as the pediatric patient ages regardless of when the injury occurs. There are unique transitions in life from childhood, to adolescence, to early adulthood that must be planned for which will allow a more seamless transition to adulthood. There are unique skills regarding management of bowel and bladder management and a physician must know when the child should assume these skills. There are also unique physical and medical complications in children such as hip dislocation and scoliosis that must be managed by a knowledgeable physician.
Life Care Planner Perspective:
A Life Care Plan is a concise plan for current and future needs with associated cost for individuals who have experienced a catastrophic injury. It is the author’s opinion that it is unfortunate that life care planners are not involved early in the medical course of a patient when critical decisions regarding discharge planning, rehabilitation options, and plans for follow up are being made. A life care planner’s role is both an expert in case management of present and future needs of a patient and an educator of the public to ensure that the injured patient receives the state of the art care ensuring the best possible outcome and the prevention of complications. At this early stage it is necessary to provide the family and a patient with the frame work for future care which will include the best available acute rehabilitation care, psychologic support, future vocational options, equipment needs, future rehabilitation management, and likely options for facility care versus home aid and attendant care. (I will discuss pediatric life care planning in spinal cord patients in the future.)
Lawyer Prospective:
At this early stage medical and family support will take precedent over lawsuit related issues. However, it is necessary for a patient and their family to do the following to preserve their rights going forward: 1) Avoid any potentially damaging admissions, 2) Preserve evidence (such as crash scene evidence) for further evaluation, 3) Verify the accuracy of police reports, and 4) Obtain contract information from witnesses, and 4) Discuss your situation with an attorney who is capable of dealing with the complexity of the medical diagnosis and can provide competent representation in the matter. It is unfortunate that many families of children become indigent because of the cost related to a child that becomes a spinal cord patient. This is another reason to seek early representation by an attorney to investigate the negligent parties funds and resources, and also determine if there is a potential for a defective product that contributed to the cause of the spinal cord injury that would provide a ‘very deep pocket’. A knowledgeable attorney in medical treatments and standard of care may also be helpful to determine if there were any breaches in the standard of care during the care of the child that may of contributed to the severity of the spinal cord injury that may also provide another necessary ‘deep pocket’.
Media Contact:
Life Care Solutions Group, Serious Injury Lawyers
888.990.9410
Media Information:
Address: 1401 Willow Pass Road, Concord, CA 94520
Phone: 888.990.9410
Url: Lifecare Solutions Group
