Amputee rehab case management requires a lot of specialist expertise and significant relevant experience. In this blog Rebecca Clemence, Amputee Clinical Lead at Breakthrough Case Management, explores the role of Amputee Case Managers in supporting individuals and families who have experienced limb loss.
Rebecca shares her insights from over 20 years’ experience in amputee case management. As well as her recent experiences while leading the Breakthrough team of Specialist Amputee Case Managers who offer support to those who have lost a limb following a traumatic injury.
My role as an Amputee Rehab Specialist Case Manager is to reflect the needs of my client. There are often lots of people involved in the cases we work with – solicitors, insurance companies, multiple health and social care professionals. They don’t always have the same priorities, so I can get pulled in different directions. I need to stay strong and stand up on my client’s behalf. I work hard to make sure the voice of my clients and their families is always heard.
A major aim of an Amputee Rehab Case Manager is to move a client towards being an active prosthetic user. In cases of lower limb amputation, this involves moving them away from being a long-term wheelchair user. While it might sound simple, it is usually a highly collaborative and often lengthy process. Being honest and realistic about this is an important part of our job.
At the same time, for rehabilitation to go well there needs to be a bespoke team of people in place who fully understand the needs of the amputee. A good Amputee Rehab Case Manager will put together the best possible team for each individual client, involving Consultants in rehab medicine, prosthetists, physiotherapists, occupational therapists, psychologists – whatever they need to achieve their goals and live their life beyond limb loss.
The knowledge and expertise needed to build a team also extends to different types of prostheses and assistive technologies. Alongside rehabilitation and care, these tools are fundamental. This might be from the NHS or from a private provider, depending on where someone is in their litigation journey. We need to understand what is available and put the rationale forward to get what’s best for the individual at that time.
In many ways being an Amputee Rehab Specialist Case Manager has some similarities to other types of complex case management. The support we put in place can transform someone’s function almost overnight. I’ve seen individuals go into residential rehabilitation for a short stay, for instance, and come out a completely different person.
Our Specialist Case Managers work with multiple different types of limb loss. Upper and lower limb, double and quadruple amputations, for example. Every case is different, and who the person was before their injury will also have a significant impact on what they need following an amputation. Do they have a young family? Did they play sports or have other hobbies? Do they want / need to drive? Where do they live and what type of house do they have?
Work is another important factor. The amputees we support as Case Managers are mostly working age. Their limb loss has happened as a result of a traumatic injury, clinical negligence, or following a period of limb salvage attempts. Unlike the majority of NHS patients, amputation tends not to be the result of a long-term condition. As a result, the trauma they experience is like a tidal wave through their family, work and social life. As Case Managers we need to understand this and be there to support them.
While supporting clients to live the most independent life possible, we are also guiding them through the complex litigation process. It needs specialist experience to understand this and navigate through what is usually an evolving situation.
The fact that the litigation process is often lengthy can have an enormous psychological impact. It can delay returning to work, which is an important step for many people. And pushing for the most advanced and expensive technology, for example, isn’t always aligned with the individual’s goals. We understand that and work hard to achieve the most appropriate outcomes, while minimising delays and managing the impact they can have.
Making sure that everything happens when it should and providing all the information needed to move things forward is central to the role of an Amputee Rehab Case Manager. Early intervention in cases of limb loss, with the right team who are willing to work collaboratively, is vital to manage the physical, social, environmental, psychological, and socio-economic impacts.
Ongoing mental health support is important, whether a client is suffering from depression or PTSD – or they need some help to stay motivated and optimistic. Timely physiotherapy will help to maintain the strength and conditioning needed to maximise long-term outcomes from prosthetic rehabilitation and to help find at an early stage, an exercise that can be enjoyed and undertaken regularly. Expert occupational and vocational therapy assistance will be needed to optimise independence.
Consistent and frequent rehabilitation also has an enormous impact over the longer term. Rehab dosing is vital in implementing a programme at the required frequency and intensity – with measurable goals and a detailed plan to underpin success. This is where Breakthrough Care comes in with rehabilitation focused care that takes place every day. This usually takes place in the home rather than a a clinic environment, which enables faster progress with the relevant activities that are important for maximising an individual’s quality of life.
Good amputee case management is proactive, accessible and robust. To get the best outcomes for our clients, we need to provide solid evidence for their needs. With clinical justifications and clear rationale that means the recommendations we put forward are accepted.
A good Case Manager will draw on their experience to detail what’s needed and the costs involved. This requires knowledge of many different aspects – statutory services, local authority and the NHS, NICE guidelines, a sound understanding of the NHS frameworks, private provision.
Good amputee rehab case management is also responsive and flexible. There are times when setbacks occur, for example wound issues or issues with the knees or hips that are only discovered once an individual is mobile and using a prosthesis. The Case Manager needs to respond accordingly. For example, navigating NHS delays while leaning towards the private sector to access expertise where required. Whatever is needed to move the client forward. We also need to be creative when solving problems. Because there are sometimes problems that need the input of the diverse team at Breakthrough to solve!
A big part of our role as Amputee Rehab Case Manager is liaising with solicitors – both the client’s and the opposing party. Either instructing party needs you to be up to date on your case. A disorganised Case Manager can add to the waiting game quite easily by not having information to hand when it is requested.
An ability to not just provide important information when needed but also drive a case forward is beneficial to the solicitors we work with. It is also for the ultimate benefit of our clients. Reaching a settlement is important to allow individuals and families to move on with their lives and make plans for the future.
It’s important to note that we are still there for our clients post-settlement. Supporting them for as long as they need us.
Amidst all of our work with solicitors, insurers, the NHS, private providers and health professionals, the client is still the most important person. There’s a lot of detail involved in amputee rehab in litigation, but we also take a holistic approach. Looking at every aspect of a person’s life and supporting them wherever needed, while never judging or interfering.
Putting families in touch with charities such as the as the Amputation Foundation and The Limbless Association for psychological and peer support can add a lot of value. There is nothing quite like the support of a fellow amputee. This could be the first time someone starts to see what life as an amputee really looks like.
On reflection there is a lot involved with being an Amputee Rehab Specialist Case Manager. In summary, successful amputee rehabilitation requires an experienced and responsive team with access to the highest levels of expertise who collectively fully understand the needs of a person who has sustained an amputation as a result of trauma. As Case Managers, we are here to make sure that happens.
Get in touch to discuss how we can support your specialist case management, rehabilitation and care needs.