Why Life Care Plans Differ — and What to Look For

Life care planning is grounded in established methodology, yet its application can vary. Careful attention to how needs are analyzed and projected over time can help clarify the basis for differing conclusions in catastrophic injury cases.

Why Life Care Plans Differ — and What to Look For

Life care plans are often central to discussions of future need in catastrophic injury cases — yet equally qualified experts can produce very different projections.

When this occurs, the difference is rarely explained by credentials alone.

More often, it reflects differences in methodology.

Understanding how a life care plan is developed — not just what it contains — can assist in evaluating its reliability.

A Structured Approach to Long-Term Need

Life care planning has historically been described as a consistent methodology for analyzing needs arising from disability across the individual’s life expectancy.

At its core, the process is intended to identify:
• The impact of a health condition
• The resulting functional implications
• The services or supports that may be required over time

Recommendations are driven by identified needs rather than funding availability.

Moving Beyond Diagnosis

A diagnosis describes a medical condition. A life care plan addresses how that condition affects daily function and participation.

A commonly used clinical framework considers:
Impairment → Activity Limitation → Participation Restriction

This reflects:
• Changes in body structure or function
• Effects on task performance
• Impact on real-world roles and engagement

Individuals with similar diagnoses may experience very different functional implications.

Individualized vs. Generic Planning

Life care plans are intended to be individualized.

This typically involves consideration of:
• Functional presentation
• Environmental context
• Available supports
• Anticipated interactions between condition and daily life

Rather than applying uniform assumptions, planning may reflect the individual’s circumstances and environment.

Lifespan Considerations

Long-term needs may evolve over time.

Planning often considers:
• Anticipated functional change
• Secondary effects associated with long-term disability
• Environmental transitions
• Shifts in independence

Accordingly, life care plans are generally regarded as dynamic documents that may be updated as circumstances change.

The Role of Environment

Needs may be influenced by:
• Living environment
• Access to services
• Transportation
• Work or educational settings
• Community participation

Incorporating environmental context can help align projections with daily life.

Consistency of Methodology

A consistent methodology involves:
• Comprehensive assessment
• Data analysis
• Use of available clinical and outcome information
• Consideration of long-term needs across life expectancy

Consistency refers to the analytical process — not to uniform recommendations across cases.

Questions That May Assist Review

When reviewing or retaining a life care planning expert, attorneys may consider:
• How are impairments translated into functional impact?
• How are activity limitations considered?
• What assumptions were made regarding independence?
• How are environmental factors incorporated?
• Are potential secondary effects considered?
• How does the plan address change over time?

These questions do not favor a particular outcome, but may help clarify how projections were developed.

Applying Methodology in Litigation

When life care plans differ, the underlying methodology often explains why.

Evaluating how projections were developed — including assumptions, functional translation, and consideration of long-term impact — can assist in understanding the basis for differing conclusions.

In some matters, additional analysis may be helpful to:
• Clarify methodological assumptions
• Evaluate consistency with standards of practice
• Examine functional implications
• Assess alignment between projected services and individualized need

Legal teams on either side may seek this type of review when:
• Evaluating an opposing life care plan
• Responding to differing projections
• Clarifying areas of agreement or disagreement

In some instances, even the retaining party may request an independent review when an existing plan raises questions regarding assumptions, scope, or functional alignment.

Closing Perspective

Whether developing a life care plan or reviewing an existing one, attention to methodology can help ensure projections reflect individualized need rather than generalized assumptions.

Turning Point Life Care Planning provides life care planning and life care plan rebuttal services to assist legal teams in evaluating long-term needs across a range of injury types.

Pediatric Catastrophic Injury Requires Lifespan Planning

Why pediatric catastrophic injury cases require a developmentally grounded, OT-led life care planning approach to ensure accurate and defensible future care projections.

The Lifelong Impact of Pediatric Catastrophic Injuries and the Role of OT-Led Life Care Planning

When catastrophic injuries occur during infancy or childhood, the resulting medical, functional, and financial consequences extend across an entire lifetime. Pediatric catastrophic injury cases require a fundamentally different life care planning approach than adult-onset injuries, as growth, development, environmental transitions, and evolving functional expectations dramatically influence future care needs and costs.

Catastrophic Injuries in Childhood: Lifelong Implications

When catastrophic injuries—such as spinal cord injury, brain injury, brachial plexus birth palsy, or limb loss—occur during the perinatal period or childhood, their consequences are profound and enduring. These injuries affect not only the child but also their family system, resulting in lifelong challenges related to health, independence, participation, and quality of life. Outcomes are not static; they evolve over time in response to physical growth, cognitive and psychosocial development, environmental demands, and changing societal expectations.

Consider, for example, a child with a spinal cord injury. Over the course of development, this child may:

Litigation Considerations in Pediatric Catastrophic Injury Cases

When pediatric catastrophic injuries become the subject of litigation, the implications extend well beyond immediate medical care. These cases involve lifelong disability, secondary medical complications, repeated medical interventions, escalating future medical costs, vocational and avocational limitations, risk of premature aging, and long-term impacts on independence and quality of life.

Pediatric cases benefit from expert involvement that:

The Role of an Occupational Therapist Certified Life Care Planner

From a litigation perspective, pediatric life care planning must move beyond diagnosis-based projections to anticipate how injury interacts with development, function, environment, and evolving adult roles over time.

An occupational therapist certified life care planner translates medical diagnoses—impairments in body functions and structures—into practical implications for function, independence, and lifetime financial impact. Pediatric life care plans are contextualized within a developmental framework and address anticipated changes across the lifespan, including:

Functional Assessment

• Movement, strength, sensation, endurance, and cognition
• Impact on developmentally expected play, school participation, socialization, and daily activities
• Activity analysis addressing energy conservation, adaptive strategies, compensatory techniques, and temporal demands
• Fluctuations in function related to growth and secondary complications

Environmental Assessment

• Home accessibility and safety across changing environments over the lifespan
• Impact on family roles, routines, and habits
• Parental needs, supports, and coping strategies

Equipment and Adaptive Solutions

• Orthoses, prostheses, and static or dynamic splints
• Wheelchair and seating systems, medical strollers, and vehicle seating
• Durable medical equipment such as beds, lifts, bath systems, and ramps
• Adaptive technologies supporting mobility, communication, safety, and daily activities

Future Forecast Into Adulthood

• Driver evaluation and training
• Vocational potential and workplace accommodations
• Health care self-management and consumer skills
• Avocational interests and community participation
• Independent living and adult relationships
• Parenting considerations
• Premature aging and secondary health risks

The result is a life care plan that is clinically accurate, developmentally responsive, and defensible.

Case Example: Pediatric Spinal Cord Injury

The following example illustrates why pediatric life care planning requires specialized expertise and cannot rely on adult-based assumptions or static care models.

A two-year-old child sustained a mid-level cervical spinal cord injury in a pedestrian–motor vehicle collision. At four years of age, she presents with tetraplegia and neurogenic bowel and bladder. Life care planning questions uniquely relevant to this pediatric case include:

Meet Our Expert

Mary Jane Mulcahey, PhD, OTR/L, FASIA, CLCP
Board-Certified Occupational Therapist | Certified Life Care Planner

MJ Mulcahey Turning Point Life Care Planning

Dr. Mulcahey has over 30 years of clinical and research experience with children and adults with catastrophic injuries. She is Program Director and Lead Faculty for the Graduate Certificate in Life Care Planning at Thomas Jefferson University in Philadelphia. Recognized internationally for her expertise in pediatric and adult spinal cord injury and pediatric chronic conditions, Dr. Mulcahey is a past president of the American Spinal Injury Association and former Chair of the Board of Directors of the Shriners Hospitals for Children – Pediatric Spinal Cord Injury Program and the American Occupational Therapy Foundation.

Her extensive clinical experience, scholarly work, and interdisciplinary collaboration inform the development of life care plans that are evidence-based, practical, developmentally grounded, and defensible.

Have a pediatric catastrophic injury case?
Early involvement of a pediatric-trained occupational therapist certified life care planner helps ensure future care projections are clinically accurate and defensible. Contact Turning Point Life Care Planning to discuss expert support.

 

Certified Life Care Planner (CLCP) with direct brain injury experience

Why a Brain-Injury–Experienced Certified Life Care Planner Matters in Traumatic Brain Injury Cases

Traumatic brain injury (TBI), concussion, and mild traumatic brain injury (MTBI) cases frequently present complex and disputed functional issues that extend well beyond what is visible on imaging or reflected in isolated medical records. Individuals may appear outwardly intact while experiencing meaningful limitations in attention, endurance, executive functioning, emotional regulation, sensory tolerance, and daily performance.

In these cases, the accuracy and credibility of a life care plan depends on the evaluator’s ability to translate neurological injury into real-world functional impact and future care needs. A Certified Life Care Planner (CLCP) with direct brain injury experience is uniquely positioned to provide this level of analysis.

Why Brain Injury Cases Require Specialized Life Care Planning Expertise

Brain injury cases differ from purely orthopedic or medical claims in that functional impairment is often variable, cumulative, and influenced by cognitive, sensory, emotional, and endurance-related factors. Concussion and mild traumatic brain injury may involve delayed onset of symptoms, fluctuating presentation, or prolonged recovery despite normal imaging.

A brain-injury–experienced CLCP evaluates not only diagnoses, but how neurological changes affect daily activities, work performance, safety, and long-term independence. This functional perspective is critical when future care needs, household services, vocational capacity, and supportive interventions are being evaluated for litigation purposes.

Specialized life care planning is particularly relevant in cases involving:

Understanding the Functional Impact of Concussion and Traumatic Brain Injury

Brain injury exists along a spectrum, from concussion and MTBI to more complex moderate and severe injuries. While medical classifications are important, life care planning focuses on how the injury affects a person’s functional capacity over time.

Individuals with concussion or MTBI may experience slower cognitive processing, difficulty multitasking, reduced tolerance for sustained activity, visual discomfort, headaches, fatigue, or increased symptom exacerbation with prolonged work or screen use. For some, these symptoms persist and evolve into post-concussion syndrome, impacting reliability, pacing, and daily consistency.

Moderate to severe brain injuries may involve broader changes in memory, executive function, emotional regulation, communication, coordination, and safety awareness. These changes can affect driving, household management, employment, social participation, and independent living, all of which must be addressed in a defensible brain injury life care plan.

How a Brain-Injury–Focused CLCP Strengthens a Life Care Plan

A CLCP with brain injury experience translates neurological findings into functional implications that are meaningful in a legal context. This includes analysis of:

By grounding recommendations in documented medical care and functional presentation, the life care plan provides a clear framework for understanding future needs while remaining consistent with accepted life care planning methodology.

Case Example: Mild Traumatic Brain Injury With Persistent Post-Concussion Symptoms

A 35-year-old professional sustains a concussion in a high-speed rear-end collision and is diagnosed with mild traumatic brain injury (MTBI). Initial imaging is unremarkable. Despite conservative management, she develops persistent post-concussion symptoms affecting attention, cognitive endurance, visual tolerance, and fatigue.

Months later, treating providers document post-concussion syndrome with ongoing functional limitations impacting both work performance and daily activities.

Key legal and functional considerations include:

From a damages perspective, these limitations influence employability, household service needs, future medical management, and long-term support costs—elements that must be accurately reflected in a defensible life care plan.

Common Questions in Brain Injury Life Care Planning

Can significant impairment exist with normal imaging?
Yes. Functional limitations following concussion or MTBI are frequently present despite normal imaging findings and require clinical and functional assessment.

Why are mild TBI cases often disputed?

Because symptoms may be subtle, delayed, or variable, functional impact is sometimes underestimated without specialized evaluation.

How does cognitive fatigue affect long-term functioning?
Reduced endurance and symptom exacerbation over time can significantly limit work capacity, daily productivity, and consistency.

Meet the Expert

Dr. Ashea Neil, OTD, OTR/L, CLCP
Doctor of Occupational Therapy • Certified Life Care Planner • Certified Work Capacity Evaluator
Ashea Neil Turning Point Life Care Planning

Dr. Neil provides clinically grounded evaluation and expert support in orthopaedic, neurological, chronic pain, pediatric, and traumatic injury cases, including extensive experience in brain injury rehabilitation. For more than fifteen years, she has worked with individuals recovering from concussion, mild traumatic brain injury, and more complex brain injury presentations.

Her background includes specialized training in concussion and traumatic brain injury, advanced functional assessment coursework, vestibular rehabilitation experience, and direct involvement in rehabilitation programming for neurological populations. She has published and presented on concussion-related functional assessment and visual-vestibular impairment.

In her medical-legal practice, Dr. Neil provides life care planning, functional capacity evaluation, and vocational assessment services. Her opinions are grounded in functional performance analysis and presented in a clear, defensible manner appropriate for mediation, deposition, and trial.

Evaluating a Brain Injury Case?

If you are assessing a concussion or traumatic brain injury case and would like to discuss appropriate life care planning scope or functional considerations, our team is available to consult and assist in determining the appropriate level of analysis.

CHT life care planner upper extremity hand injury

Why a Certified Hand Therapist Life Care Planner Matters in Upper Extremity Injury Cases

How a CHT-CLCP strengthens damages analysis, care projections, and case value for plaintiff and defense attorneys

When upper extremity injuries are involved in litigation, subtle functional losses in the hand, wrist, or elbow can translate into lifelong limitations, diminished earning capacity, and significant future medical costs. These cases benefit from a specialist who understands fine motor function, long-term surgical outcomes, and real-world task performance.

A Certified Hand Therapist who is also a Certified Life Care Planner (CHT-CLCP) brings that level of specialization.

Why Specialization Matters for Hand & Upper Extremity Cases

A Certified Hand Therapist must complete 4,000+ hours of direct upper extremity rehab practice, a minimum of three years of clinical work, and pass an advanced examination focusing exclusively on upper-limb rehabilitation. When that expertise is combined with life care planning training, attorneys benefit from dual-credentialed expertise that strengthens the credibility and defensibility of future care projections.

This specialization becomes invaluable in claims involving:

 

Upper extremity trauma is rarely isolated. Functional consequences often evolve — and a specialist is best positioned to evaluate long-term implications.

How a CHT-CLCP Strengthens a Life Care Plan

A hand-specialized LCP translates clinical impairment into function, independence, and cost impact over a lifetime, ensuring your plan accounts for:

  1. Future treatment + surgical planning
  1. Functional outcome analysis
  1. Equipment & adaptive solutions
  1. Aging-related complication forecasting

 

The result:
A life care plan that is clinically accurate, defensible, and practical, informed by real-world outcomes — not just literature.

Case Example — High-Velocity Dominant Wrist Trauma

A middle-aged nurse sustains a comminuted wrist fracture from a motorcycle crash requiring ORIF and prolonged therapy. Despite maximum rehabilitation, grip strength remains poor and endurance is limited.

Key attorney-relevant questions become:

 

A CHT-CLCP knows how to anticipate these functional issues, verify needs with treating providers, and justify future treatment, equipment, and cost projections with clarity for mediation or trial.

How a CHT-CLCP Supports Your Legal Strategy

Beyond authorship of the life care plan, our expert can assist counsel by:

 

For hand-intensive occupations — healthcare, mechanics, laborers, artists, musicians, office professions — work capacity and future earning potential may be significantly affected. A specialized planner ensures those losses are captured accurately.

Meet Our Expert

Elisa Marks, OTR/L, CHT-CLCP
Certified Hand Therapist • Certified Life Care Planner • 25+ years upper extremity clinical experience

Elisa Marks Turning Point Life Care Planning

Elisa brings decades of direct treatment experience in hand and upper extremity rehabilitation, has served as an educator in the field, and is a pre-publication reviewer for the Journal of Hand Surgery. Her evaluations and life care plans reflect the lived reality of upper extremity recovery — not just theory — resulting in highly credible, defensible work product for litigation.

Have a Hand or Wrist Case? Consult With Us.

Early involvement from a hand-specialized life care planner strengthens case value, clarifies future care costs, and improves expert strategy.

The Role of Occupational Therapy in Life Care Planning

1. Comprehensive Assessments:

One of the first steps in life care planning is conducting a thorough assessment of an individual’s current abilities. OTs evaluate physical skills, cognitive functioning, daily living activities, and environmental factors. This comprehensive evaluation provides a clear understanding of the individual’s unique needs and challenges.

2. Identifying Goals:

Based on the assessment, OTs work collaboratively with individuals and their families to identify realistic and meaningful goals. These goals can range from regaining mobility and self-care skills to enhancing social participation and emotional well-being. By setting clear objectives, the foundation for a personalized life care plan is established.

3. Creating Customized Interventions:

OTs develop tailored interventions that align with the identified goals. These might include therapeutic exercises, adaptive strategies, and assistive technologies designed to enhance daily functioning. OTs also provide education and training to individuals and their families, empowering them to implement these strategies in their daily lives.

4. Collaboration with the Medical Team:

Life care planning is a team effort that involves collaboration among various healthcare professionals. OTs work closely with physicians, rehabilitation specialists, and case managers to ensure that all aspects of care are coordinated. This collaborative approach helps to accurately determine the needs of those who have been seriously injured and ensures that everyone is on the same page regarding the individual’s care plan.

5. Addressing Social and Environmental Factors:

Occupational Therapists consider the broader context of an individual’s life, including social supports and environmental barriers. They work to create practical solutions that promote accessibility and participation in community activities. This holistic approach not only improves physical health but also enhances emotional and social well-being.

6. Ongoing Evaluation and Adjustment:

Life care planning is not a one-time process; it requires ongoing evaluation and adjustments as an individual’s needs change. OTs play a vital role in regularly assessing progress, modifying goals, and adapting interventions as necessary. This flexibility ensures that the life care plan remains relevant and effective over time.

At TPLCP, we understand the invaluable contributions of Occupational Therapists in the life care planning process. As a firm of certified life care planners who are also OT professionals, we work collaboratively with individuals and their families to ensure that everyone receives the comprehensive support they need to live fulfilling lives.

For more information about the role of Occupational Therapy in life care planning or how TPLCP can assist you, please explore our resources or contact us directly through our website at TPLCP.com!

Preparing for a Life Care Planning Assessment with an Occupational Therapist

A life care planning assessment is a critical step in understanding your long-term needs following an injury or illness. If you’re scheduled for a two-hour session with an occupational therapist, it’s natural to feel a mix of curiosity and apprehension. This assessment is designed to help you, not only to outline your current abilities and limitations but also to pave the way for strategies and resources that can enhance your quality of life. Here’s how you can prepare to make the most out of this comprehensive evaluation.

Understand the Purpose of the Assessment
The primary goal of a life care planning assessment is to develop a clear and evidence-based plan that addresses your ongoing medical, therapeutic, and daily living needs. The occupational therapist will evaluate your functional abilities, identify challenges, and recommend tailored solutions. This plan may include recommendations for assistive devices, modifications to your home or work environment, therapy services, and other resources to support your recovery or management of a chronic condition. This assessment also involved consulting with any treating or other retained experts on your file.

Gather Relevant Documentation (if able)
Before your assessment, try to organize documents that may help the occupational therapist understand your situation. Your attorney will have likely provided medical records, but it is helpful to consider these addition documents:

 

Reflect on Your Daily Activities
Think about how your condition affects your daily life. Be ready to discuss:

 

Keeping a journal for a few days leading up to the assessment can help you recall these details. Note times of day when symptoms are better or worse, as well as any activities you avoid due to discomfort or difficulty.

Dress Comfortably
Wear clothing that allows for ease of movement. The assessment may involve physical tasks or exercises to evaluate your range of motion, strength, and endurance. Comfortable attire will help you participate fully without unnecessary discomfort.

Communicate Openly and Honestly
Your occupational therapist relies on accurate information to provide meaningful recommendations. Be transparent about your symptoms, even if you’re worried they might seem minor or subjective. This is especially important for issues like pain, fatigue, or mental health challenges, which are often invisible but have a significant impact on daily life.
If certain tasks feel embarrassing to discuss, remember that the therapist’s role is to support you without judgment. Sharing openly will ensure your assessment reflects your true needs.

Prepare Questions or Concerns
Use this opportunity to gain clarity about your condition and potential next steps. Some questions you might consider include:

 

Rest and Hydrate
A two-hour assessment requires focus and energy. Try to be well-rested and hydrated before the session. If you use any mobility aids, assistive devices, or braces, have them with you.

Post-Assessment: What to Expect
After the assessment, the occupational therapist will develop a comprehensive life care plan. This document will include recommendations tailored to your unique needs and circumstances. It may take a few weeks for the final report to be prepared, especially if the plan is part of a legal case. Use this time to reflect on the experience and start implementing any immediate strategies or suggestions provided during the session.

Conclusion
Preparing for a life care planning assessment with an occupational therapist can help you maximize the benefits of this invaluable process. By organizing your documents, reflecting on your daily challenges, and communicating openly, you’re taking an important step toward a plan that supports your recovery and long-term well-being. Remember, this assessment is a collaborative effort designed to empower you with tools and resources to enhance your quality of life.

How to Vet a Life Care Planner: A Practical Guide for Attorneys

When a case clearly warrants a life care plan, the name of an “expert” often arrives by way of a colleague’s recommendation. A curriculum vitae (CV) may or may not be attached. The real question is:

Will this life care planner truly help – or quietly weaken – your case?

This guide outlines the key qualifications, credentials, and professional activities to look for when evaluating whether a life care planner will provide defensible, trial-ready work for your client.

Section 1: Certification Matters

Is the expert a Certified Life Care Planner?

Life care planning is a distinct profession with its own:

 

“Life Care Planner” is a trademarked title used by professionals who are certified by:

 

Physicians who are certified as life care planners through ICHCC must also meet defined criteria and training standards.

A certified life care planner receives dedicated training in:

 

Section 2: Experience Counts

Does the life care planner have relevant clinical and forensic experience?

Certified life care planners must have at least three years of relevant rehabilitation experience, but the quality and focus of that experience also matter.

Key questions to consider:

 

Section 3: Professional Engagement in Life Care Planning

Are they actively involved in the life care planning profession?

Understanding the history, standards, and evolving practices of life care planning is fundamental to expert credibility.

Look for evidence that the planner:

 

Section 4: Membership in Disability-Specific Organizations

Do they stay current with diagnosis-specific standards and guidelines?

Beyond professional planning organizations, credible experts also monitor or participate in organizations relevant to the populations they evaluate, such as associations for:

 

Section 5: Contribution to the Profession

Do they contribute to advancing the field?

Professionals who publish, present, or teach within the field typically:

 

Section 6: Specialization and Case Fit

Do they have the right expertise for this specific case?

Many experts build specialized experience, such as in:

 

Matching the expert to the case is essential for credibility and reliable cost projections.

Section 7: Establishing a Proper Medical Foundation

How does the planner establish the medical basis for their opinions?

Life care planners are trained neither to:

 

A defensible plan requires a clear medical foundation supported by:

 

Section 8: How Turning Point Life Care Planning Meets These Standards

Turning Point Life Care Planning maintains a team of highly qualified Certified Life Care Planners who meet all of the criteria identified above.

Our team includes:

 

We work collaboratively to ensure accurate consideration of functional capacity, long-term medical needs, equipment, and community integration over the lifespan.

Section 9: Next Steps – If You’re Evaluating a Case Now

If you have a case that may benefit from a life care plan — or if you are unsure whether the injuries rise to that level — we are available to consult.

Ways to get started:

 

Life Care Planning

Life care planning is a profession with its own standards of practice, certified professionals, with peer-reviewed journals, textbooks, and annual conferences. “Life Care Planner” is a trademarked term to be used by those who are certified by the International Commission on Health Care Certifications or ICHCC. When a life care plan is developed using a methodology consistent with the standards of practice for life care planners the plan should be able to be replicated by another life care planner.

Life Care Planning is a transdisciplinary practice. To be a Certified Life Care Planner is to be an experienced rehabilitation professional licensed to practice within a healthcare profession, e.g. Register Nurse (RN), Occupational Therapist (OT), Physical Therapist (PT), Vocational Counsellor or a Medical Doctor (MD). Certification requires 120 hours of education specific to the practice of life care planning, a certification exam and submission of a life care plan to be approved by the ICHCC board. Continuing education in life care planning is required to maintain certification. The education must include a component on ethics.

A Life Care Plan is defined as “a dynamic document based upon published standards of practice, comprehensive assessment, data analysis, and research, which provides an organized, concise plan for current and future needs with associated costs for individuals who have experienced catastrophic injury or have chronic health care needs.” (International Conference on Life Care Planning and the International Academy of Life Care Planners. Adopted 1998, April.) It is a way to plan for the lifetime needs of an individual with a disability.

Life Care Plans are often used in a forensic setting to help resolve personal injury cases where an individual has sustained an injury at the fault of another person. The subject of the life care plan is referred to as an evaluee. The life care plan is intended to be educational and written so that the plan is understandable by the lay person, using non-technical language which can realistically be implemented.

The standard methodology used to develop a life care plan consists of step-by-step procedures which include: initial case intake, review of medical records and supporting documentation, interview with evaluee and a collateral interview (if appropriate, e.g. TBI), consultation with therapeutic team members, formulation of preliminary opinions, cost research, and confirmation of projections with the evaluee.

Best practice is to conduct the interview at the evaluee’s home; however, due to COVID-19 restrictions and individual preferences, a virtual assessment has become common practice. The home assessment enables the life care planner to consider the social and physical environment that may facilitate or restrict the evaluee’s function. For example, for an evaluee who uses a wheelchair, the need for home or vehicle modifications can be assessed; or for an evaluee with chronic pain, the need for ergonomic equipment or in-home rehabilitation may be considered.

Especially when the evaluee has experienced changes in cognition, collateral interview with a family member, caregiver and/or a close friend will assist with determining the change in function since the subject event and the current level of care being provided. It is standard practice to replace the gratuitous support provided to the evaluee as it is not deemed a reliable source of long-term support.

Given the transdisciplinary nature of life care planning, for areas of the plan that are outside the scope of practice of the life care planner, the life care planner relies on the medical records, consultation with the evaluee’s treating team members (e.g. specialist physicians, chiropractor, physical therapist, psychologist, etc.) or other experts involved with the case (e.g. orthotist, psychiatrist, physiatrist, etc.) to help develop the medical foundation for the life care plan. The life care planner is not intended to be a “secretary” simply providing the cost of the recommendations or others; nor, are they intended to be a “know-it-all,” relying on themselves to provide the foundation for the entire life care plan. In forensic practice, the life care planner applies their knowledge and experience in life care planning to vet care recommendations to ensure each item in the life care plan is likely to be beneficial and appropriate for the evaluee, e.g. a recommendation for pool therapy is not appropriate for someone allergic to chlorine or if an evaluee who would have likely incurred the expense for a gym pass or childcare absent the subject event, they would not be entitled to be compensated for these expenses related to the subject event.

The litigation process is usually the evaluee’s one shot at receiving the funding they require for future care; therefore, it is important that the pricing in a care plan be up-to-date, accurate and enable multiple options of providers within their geographical area. Collateral sources are not relied upon as a reliable source of lifetime funding. There are 18 standard categories of care considered in a life care plan which include: medical services, evaluations, medications, therapies, orthotics and prosthetics, wheelchair equipment, wheelchair maintenance, aides for independent living, home modifications, health maintenance and leisure, vocational/education. Given the potential longevity of the life care plan, e.g. decades, the life care planner provides accurate and geographically specific costing. It is of no help to the evaluee or their caregivers to provide resources that do not provide the intended services, e.g. a case manager who does not work with individuals under the age of 65 with a TBI but specializes in geriatric case management. Providing backup documentation for the resources is best practice and allowed by the majority of subscription fee reference databases given the forensic application.

The goal of each life care plan is to assist the evaluee is to restore function where possible; maintain function and prevent or reduce the risk of secondary complications, e.g. falls, pressure sores, etc. The plan details the services and charges for the services needed by the evaluee over the course of their lifetime. Alternatives for care take into account the developmental stages of the evaluee and the least restrictive environment. The life care planner must be willing and available to communicate the life care plan and objectives to the evaluee and the relevant parties, e.g. attorneys, judge and/or jury.

Traumatic Brain Injury

Have you been told you may have had a concussion or a mild traumatic brain injury (mTBI) that doesn’t feel mild?  You are not alone.  By definition, traumatic brain injury (TBI) arises from external forces or actions that cause the brain to move against the skull or be penetrated.  This can occur in sports, automobile accidents, unintentional falls, gunshot wounds, assaults but the majority of TBI that result in hospitalization are from falls and motor vehicle accidents.

A TBI is classified as mild (mTBI), moderate or severe.  A concussion falls under the mildTBI category but does not mean the symptoms are mild.  A mTBI can result in physical, visual, auditory, cognitive and emotional problems that interfere with someone’s ability to participate in their usual daily activities.

The people at the highest risk of sustaining a TBI requiring hospitalization are people over the age of 75 and males.  These injuries were mostly causes by unintentional falls and car accidents.  TBI is most common amongst people ages 15 to 24 years old.  For additional statistics on brain injury visit Brain Injury Canada (www.braininjurycanada.ca) or Center for Disease Control (CDC) (www.cdc.gov /traumaticbraininjury).

The Centre for Disease Control (CDC), also provides useful information on Brain Injury including monitoring, prevention and links to apps for training and concussion identification.

PROGNOSIS

Once a diagnosis of concussion or TBI is made it is important to follow the recommendations of your treating family doctor or specialist and maintain regular follow-up to monitor symptoms.  The majority of individuals diagnosed with a concussion or mTBI will have a full recovery within six weeks; however, a small percentage may continue to experience disruptive symptoms and require additional medical care and specialized rehabilitation services.  Spontaneous recovery or natural healing of the brain tends to occur within the 18  to 24 months after a moderate to severe TBI, but adaptations will continue to occur that may improve daily functioning.

Many personal factors can speed up or prolong recovery.   Recovery tends to be slower in adults over the age of 40.  Other factors that impact recovery including:  low blood pressure, loss of oxygen to the brain, severity of the injury, prior head injuries, mental illness and other health factors.  At Turning Point, we identify risk factors early in the recovery process and belief in early intervention to help the recovery process.

ASSESSMENT

Occupational therapists (OTs) are trained to identify the physical, cognitive and emotional impairments that are restricting participation in daily activities.  The assessment process typically begins with a referral from a family physician, insurance company, lawyer, other therapists or a self-referral.  Turning Point provides in-home assessments consisting of interview, testing, observations and consultation with other team members to provide a coordinated recovery progress.

TREATMENT

Occupational therapists develop physical activation and cognitive rehabilitation programs while recognizing the psychological impact of the injury.  Education is key and other functional activities are designed within a community-based rehabilitation program to optimize recovery.  OTs are responsible for the assessment and planning of rehabilitation programs, and OT Assistants (COTAs) help reinforce the strategies taught by the OT.  For example, if memory is an issues, the OT will determine a targeted intervention and set up repeated sessions with the client and COTA.  The COTA may review use of memory strategies such as establishing a routine; use of assistive technology such as a smart phone or smart watch to set reminders; remediation activities such as challenging the memory through memory exercises; and functional activities such as creates to-do or other lists to participate in weekly grocery shopping or work tasks.

For those with moderate to severe TBI, treatment is likely to be prolonged and may also include wheelchair and seating assessments, recommendations for home modifications, assistive technology and home support services.

RESOURCES

There are many online and local resources to help support those who have experienced a TBI.  Our OTs often provide clients with support group information, apps available for smart phone, virtual exercises options, etc.  Some clients require OT assistance to apply for disability services such as government benefit programs or school accommodations.  Our OT practitioners love what we do and are available to take your questions and try to help you get the services you need to improve recovery and daily functioning.  We take self-referrals and will attempt to secure funding for services if needed.

Preparing for a FCE

Functional Capacity Evaluations are requested when someone needs to know if you are safely able to do your past or present job.  

 

BEFORE ARRIVAL

Your evaluator will have received and read your medical records and be familiar with your injury, treatment and diagnosis.  They may send instructions beforehand to make the day go well.  For example, usually you will want to wear comfortable, athletic clothing unless instructed otherwise.  And, if scheduled for a full-day, then you need to be prepared with a packed lunch or go nearby for lunch.  Try to get a good night sleep the day before and arrive on-time to your scheduled appointment.  The length of FCEs can vary, but it i typically booked for a 1/2 day or full-day.  It is normal to feel some anxiety, but try to use breathing or other strategies beforehand.

 

FCE DAY

The standard parts of a FCE includes the following: 

  • signing informed consent which includes a description of the FCE, risks and the purpose
  • being informed on how to communicate your symptoms during the evaluation 
  • wearing a heart rate monitor to ensure your safety and monitor your exertion 
  • sharing your current symptoms including location and severity 
  • sharing your current medical and therapy schedule 
  • bring a list of your current medications
  • grip strength testing – your evaluator is looking for you to try your best all-day
  • explaining your social and work history – it is helpful to bring a resume or CV if you have one
  • undergoing a musculoskeletal examination to see how your body moves, observe any swelling, etc.
  • cardiovascular testing by walking, stepping, and/or climbing 
  • other physical tasks that are designed to test your essential job demands
  • work simulation tasks to mimic the actual job
  • some tests are repeated
  • some time cognitive tests are given depending on the injury and job

 

During the FCE, you will be providing feedback frequently while your evaluator is observing your body positions and making sure you are safe throughout the day.  At the end of the day, your evaluator may request you contact them with any change in symptoms over the next one to three days.

 

AFTER THE FCE

If you experience a change in symptoms in the days following the FCE, it is best to contact your evaluator and let them know.  Sometimes, they will reach out to follow-up with you.  Although your job is done, the evaluator will analyze your data, review your medical records again and start writing the report.  The FCE report is typically sent directly to the individual or entity who has requested and funded the FCE.  If you would like a copy of the FCE report, contact your evaluator.

 

FCES AT TURNING POINT

Our facility is located on the 17th floor of a building located in Los Angeles.  We offer free parking and our clinic is accessed via elevator.  Your evaluator will meet you at the reception area and show you around.  You will be shown the clinic where you will be spending your time, the kitchen where you can store your lunch, as well as the washroom for breaks as needed.  The lunch break is usually ~30 minutes.  There are many restaurants within walking distance or you have access to a shared lounge with cable television.  There is guest wifi.

 

You will be given a heart rate monitor that will monitor your heart rate for the day. Our office uses digital measuring devices to ensure your measurements are taken, recorded and stored accurately.  

 

You can see learn more about your evaluator by accessing the Our Team page on this website or give us a call if you have any additional questions.   Remember to communicate with your evaluator for a safe experience.