Life after spinal cord injury – daily living, benefits, rehab and claims.

A SCI can cause mobility problems, such as loss of movement, diminishing the capacity to perform daily activities like walking, washing oneself and getting dressed. As limited mobility can lead to a more sedentary lifestyle, there is a risk of weight gain, cardiovascular disease and diabetes. Regular physical activity not only helps to avoid health conditions like these, but aids independence, overall wellbeing and self-esteem.

Whilst the stomach and intestines work much the same as before the injury, control of bowel movement is often altered, requiring more time, thought and planning. You may not be able to feel when the stool is ready to come out and may need help expelling it. Establishing an effective bowel management routine is important both physically and socially, and to help you gain confidence in daily life.

Loss of hand and arm function, particularly with cervical injuries, poor trunk control and swallowing difficulties can make eating and drinking a challenge. Good nutrition is key to support healing and recovery, and fewer calories are required because of reduced activity levels. A protein rich diet (chicken, fish, eggs) helps with tissue repair and a high fibre diet (pasta, rice) helps to regulate the bowels. Staying hydrated is also important to avoid problems like constipation, urinary tract infections and pressure ulcers.

SCIs can also lead to psychological difficulties including anxiety, depression and post-traumatic stress disorder, as well as feelings of social isolation. Multi-disciplinary rehabilitation should include access to mental health services from the outset where required; it should not be an afterthought. You (and indeed your family) may benefit from cognitive behavioural therapy, eye-movement desensitisation, acceptance and commitment therapy, and mindfulness.

Pain (both chronic and acute) is a symptom experienced by many people with SCIs, as are exaggerated reflex activities and muscle spasms.

Pain can be musculoskeletal (bones, muscles, joints) or neuropathic (nerves) caused by damage to the nerve fibres in the spinal cord. Pain management differs greatly from person to person, but often includes medication (to reduce hypersensitivity), exercise and stretching (for muscle stiffness), meditation and distraction/focussing on activities that you enjoy. A good sleep pattern and rest are also key.

Many people with SCIs require some adaptations to their home. This can range from installing ramps, adapting bathrooms and widening doors, to a full extension requiring input from an architect or accommodation expert.

A case manager can help you to make these arrangements for adaptations including sourcing workmen, applying for planning permission and arranging local authority grants.

Adaptive equipment and assistive technology can be very useful, helping you improve your physical functioning and better adapt to the routines of daily life.

Equipment can range from walking aids, wheelchairs, profiling beds and hoists, to complex wheelchairs and standing frames, smart devices and assistive robotics.

Case managers and therapists can work to identify and trial equipment to assist with daily tasks so that you can live more independently.

Rehabilitation should be multi-disciplinary, flexible and lifelong.

Your rehabilitation is unique and therefore specific to you. It may involve physiotherapists for your mobility, specialists in bowel management and nutrition, psychiatrists and/or psychologists for your mental health, specialists in pain management, case managers/community liaison nurses, accommodation experts for home adaptations and occupational therapists for your work.

People with a SCI still have every possibility of having a fulfilling career.

Under the Equality Act, you are protected against discrimination. Your employer must make reasonable adjustments for your return to work, including flexibility around working hours, access to the work premises and modified equipment.

If you are unable to return to the same role as before your injury, there will be opportunities in other areas more suited to your skills and physical abilities.

You may be eligible for Personal Independence Payments (PIP) in view of your SCI. Eligibility depends on the severity of your condition and its impact on your daily living. You must be over 16, have difficulty carrying out everyday tasks, and have had your condition for three months and expect to still have it in nine months. It is advisable to consult the government guidance before making an application, since the rules often change.

PIP combines two components: mobility (if you need help getting around) and daily living (if you need help with everyday tasks like washing, dressing, managing medications). Each component can be paid at the standard rate or the enhanced rate. A scoring system is used to assess your eligibility for PIP and your ability to carry out each activity is measured against a list of standard statements describing what you can or can’t do (descriptors).

SCI can be the result of an accident, arising from a road traffic collision, accident at work or from an accident involving an animal. In cases like these, where the accident has been caused by another individual’s negligence, you may have a claim for personal injury compensation. A SCI can arise as the result of:

• a road traffic accident involving another vehicle;
• a cycling accident;
• as a pedestrian hit by another vehicle;
• a fall from a horse;
• a slip or a fall;
• an accident at work; or
• an accident on holiday or overseas including a skiing accident or during a package holiday.

SCIs can also be caused or made worse by negligent medical care. You may be able to make a clinical negligence claim for compensation if:

• you have developed a SCI as a result of substandard surgical treatment;
• there has been a negligent delay in treating the symptoms of your SCI, leading to a worse outcome; or
• the treatment you received for your SCI (e.g. spinal surgery) was carried out in a substandard way, leading to a worse outcome.

In order to prove a personal injury or clinical negligence claim, you will need to show three things. First, that there was a duty of care owed to you. Second, that this duty was breached by failing to meet the required standard of care. Third, that the breach or breaches caused or materially contributed to an outcome that would have otherwise been avoided i.e. your ongoing symptoms. Relevant medical experts will be instructed give their opinion in the form of reports.

If liability is established, the next step is to value the claim. The aim of compensation is to (as far as is possible) put you back in the position you would have been in but for the negligence.

Past losses (e.g. travel, voluntary care, loss of earnings) will be calculated, so it is a good idea to keep hold of receipts and outgoings.

Future losses (e.g. care, loss of earnings, occupational therapy, equipment, accommodation) will be calculated by experts in the relevant fields, such as physiotherapy, rehabilitation medicine, care and occupational therapy and accommodation.

There are a number of organisations like the Spinal Injuries Association (SIA) and Cauda Equina Champions Charity (CECC) which provide useful information, guidance and support.

We at RWK Goodman are Trusted Partners of both SIA and CECC. Regular referrals are made to our specialist spinal teams, giving you the legal support you need to navigate a claim.