Serious injuries caused by road traffic accidents are devastating for any person to come to terms with. But when that accident happens to a child, dedicated and holistic support is required for both the child and their family to ensure optimum development and quality of life.

The following outstanding case outlines this support and highlights the dedication of Corporé’s Rehabilitation Case Managers.

Corporé provides expert rehabilitation case management services to the personal injury, risk and absence management markets.

With over 25 years of experience, providing support for many different injuries and conditions, we always strive to achieve the best possible outcomes in a case. This is made possible by our highly capable team of Rehabilitation Case Managers.

Our team have developed extensive clinical experience throughout their careers and have a profound understanding of complex conditions, combined with a determination to support injured parties.

For the particular case outlined below, our Clinical Lead for Catastrophic Services and Rehabilitation Case Manager, Nicola Simpson, was chosen due to her extensive experience in managing catastrophic injuries.

As a Senior Brain Injury Case Manager, Nicola is adept at providing the right care for the most complex of cases, understanding the challenges faced by individuals and their families following life-changing incidents.

In 2015, at the age of just two years old, *Millie (*name changed for confidentiality) was involved in a major road traffic accident where she sustained multiple orthopaedic injuries and a severe head injury.

Due to this devastating accident, Millie needed an emergency craniectomy due to the severe swelling and bleeding in her brain which caused left hemisphere damage, including frontal and temporal lobe damage, plus diffuse damage to the whole brain.

In addition, she wore a Minerva cast for several months. Once this was removed, she underwent cranioplasty to replace the missing part of her skull with a titanium plate.

Once Nicola was instructed to support this case in 2018, Millie required several further operations and specialist reviews, including another cranioplasty, pressure monitoring, fitting of a shunt and pain management.

Nicola liaised with her Paediatric Neurological Rehabilitation Consultant and Neurosurgeon regarding ongoing health difficulties and supported Millie and her family with appointments and hospital admissions.

Further symptoms established from Millie’s accident included a right sided hemiparesis, with a deterioration of muscle mass and strength in her right side, impacting mobility.

Millie’s complex and multiple injuries had significantly affected her development and she required extensive support from clinical teams, psychological experts and help in the community, at home and at school.

This was made possible through Nicola’s careful choice and organisation of a multi-disciplinary team of experts who focused on an area of critical importance to Millie’s development, supporting her to achieve optimum outcomes.

Multi-Disciplinary Expertise

Occupational Therapy and Physiotherapy Support

Nicola arranged for an Occupational Therapist and Physiotherapist to work in tandem. Their focus was to develop Millie’s activities of daily living, sourcing extra-curricular physical activities such as horse riding, gymnastics and rock climbing to encourage her muscle strength and balance.

Millie also required specialist aids with the pair sourcing desk equipment and chair supports for both her home and school, whilst also providing a second skin hand splint to assist her right hand.

This specialist equipment has supported Millie’s posture and tone, encouraging the use of her less dominant and weaker right side whilst helping her engage in tasks to make them less demanding.This is supported by specialist weekly sessions in school, provided by the Physiotherapist, to improve Millie’s fine and gross motor skills. Following regular assessments, a sensory profile has been developed with a program and strategies put in place at home and school to help Millie with sensory overload, sensory seeking and pain management. Millie has responded well to the sensory strategies, finding it easier to concentrate with her learning and becoming more determined to contribute to group classwork rather than just individual sessions.

Following Nicola’s advice, Millie continues to have Physiotherapy and Occupational Therapy support and guidance is also given to her family and school to continue to maintain and develop her posture, mobility and bilateral integration.

Psychological Support

Due to the extent of Millie’s injuries and the severity of the accident, Nicola arranged weekly therapy sessions with a Child Clinical Psychologist. The aim of her sessions is to help Millie understand her acquired brain injury and identify and express her emotions.

Within these sessions, Millie demonstrates a significant amount of emotional intelligence which leads her to feel anger and frustration about the accident. PTSD symptoms were also identified, established in night terrors that were disturbing Millie’s sleep.

Using case management best practice, Nicola arranged for a sleep actigraphy assessment that identified that Millie had a disturbed sleep most nights, sometimes stirring over 10 times a night. This would make her feel irritable and frustrated with her own limitations, feeding the anger towards herself.

To help Millie get a better night’s sleep and therefore minimise the impact of fatigue on her daily activity, a stepped-care approach of a fatigue management plan was created, with the psychologist, family and school to optimise her energy throughout the day.

The Clinical Psychologist also works closely with Millie’s mother, her main caregiver, providing essential support for her PTSD symptoms resulting from the trauma she had experienced from Millie’s accident and the subsequent operations she underwent.

External education and guidance is also provided to family, the other specialists supporting Millie and her teachers to help them understand the impact of her injuries and best support her needs and development.

Educational Support

Millie’s education has remained the highest priority throughout her rehabilitation.

Even amidst the global pandemic, Corporé created policies and risk assessments to ensure Millie continued to receive an education.

Nicola completed these risk assessments and arranged for Millie to receive support at home with two Rehabilitation Assistants before enlisting in individual lessons within her bubble at school, consisting of the two Rehabilitation Assistants, a Speech and Language Therapy team and Specialist Education Consultants who created lesson plans at an adapted level for Millie.

An EHCP application was made with input from the professionals to ensure she received further support in her education and she was awarded full time one-to one support.

For the Speech and language Therapists, there has been a huge focus on helping Millie word find, with her literacy skills, reading and remembering words, in particular for more complex vocabulary. Both the Speech and Language Therapists and Millie have worked incredibly hard on her literacy and language, using a symbol approach and visual cues in her specialised lessons.

Progress was observed following two years of perseverance from Millie who now works at a year two level at the age of 10 years old, demonstrating the impact of this bespoke approach.

Consistent communication between Nicola and Millie’s school has been crucial in developing her education. All multi-disciplinary meetings have been held at the school with involvement from teachers, the headteacher and SENCO. Nicola has arranged for Millie to take part in these meetings to ensure her voice is heard.

During Millie’s rehabilitation, her family moved home to a place that was more suitable to her needs. This meant that a new school needed to be found in a better location.

Since Corporé’s rehabilitation case management approach includes seeking support in the community, Nicola was able to work closely with estate agents and other external professionals to seek the most appropriate property for the family.

Once the family had moved, it was imperative that regular communication and relationship building was established with Millie’s new school. This enabled a smooth transition and a better understanding of her needs by the new school team.

Due to her cognitive ability, it was agreed that Millie would benefit from starting in the year below her age grade where she would be supervised by teaching assistants.

Nicola coordinated training sessions for Millie’s new teacher and teaching assistants on her brain injury, behaviour and how best to support her needs.

Through dedicated support, and even through times of adversity, Millie has been able to remain in mainstream education and enjoy life, having a fantastic range of social and leisure activities and spend time with her family.

She has been keen to raise money for charitable causes and to date, has raised close to an incredible £5,000 for her local air ambulance charity by completing a sponsored walk and from creating and selling bookmarks.

From an incredibly complex case has emerged an efficient rehabilitation case management journey. Without this, Millie may not have had the childhood and independent future she deserves.

The dedicated input and immersive support of Corporé’s case management approach and the extensive expertise of Nicola and the team of professionals, with an outstanding level of communication only established with our process, has meant we continue to be able to achieve significant progress for the incredibly brave Millie and her family, promoting independence and highlighting that together we really are better.

To discover more, please visit corpore.co.uk