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!

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.

Can’t Sleep?

Practice Good Sleep Hygiene 

Learning how to practice good sleep hygiene may help you find a restorative sleep once again.  What is sleep hygiene?

Sleep hygiene is defined by Oxford as, “habits and practices that are conducive to sleeping well on a regular basis.”  Sleep is the foundation that allows us to function in our daily lives.  If we don’t sleep well, we can’t think as well and any pain or mood symptoms can worsen.

A first step in rehabilitation is often to help restore sleep.  Your family doctor may have medical suggestions (medications, sleep study, sleep specialist or other therapies) and occupational therapists often provide tips to help you develop healthy sleep habits.

Here is a handout on sleep hygiene to get you on your way to finding that refreshed morning feeling.

Sleep Hygiene PDF

Tips for Pacing.PDF

Cognitive Strategies after Concussion or Mild TBI:

Some people who have sustained a concussion may experience a change in their thinking (cognitive skills) and may have trouble with:

Sometimes these changes can make everyday tasks more difficult. So, what can you do?

Keep organized 

• Use a daytime calendar, or phone to help you remember appointments and things you need to do.
• Keep important things (like keys, phones, medications) in the same place so you don’t forget where you put them.

Use strategies to help you focus and remember

• Set alarms to help you remember to do things at a certain time.
• Write notes to yourself and place them in areas where they remind you to do important tasks.
• Avoid noisy and distracting environments that make it hard to concentrate instead.
• Try to work in a quiet area when you need to work, read, or study.

Try to reduce stress 

• Take a rest break before you feel tired or overloaded.
• Break up large or complicated activities into smaller more manageable tasks.
• Pace yourself and don’t try to do everything at once.
• Practice deep breathing and relaxation strategies. (See our resource page on diaphragmatic breathing).

If you feel that your thinking doesn’t go back to normal after a few weeks see your doctor or health care provider and discuss the possibility of getting support during your recovery. Our occupational therapists at Turning Point are trained in cognitive rehabilitation and can assist you learn additional strategies to manage your thinking difficulties. Talk to your OT and they can work with you to make a personalized plan.

More information about concussions and mTBI can be found at: www.brainstreams.ca

Chronic Pain

For the first time since 1979, International Association for the Study of Pain (IASP) introduced a revised definition of pain, the result of a two-year process that the association hopes will lead to improved ways of assessing and managing pain.

The definition is: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,” and is expanded upon by the addition of six key Notes and the etymology of the word pain for further valuable context.

 

A multi-national, multidisciplinary Task Force developed the revised definition with input from all potential stakeholders, including persons in pain and their caregivers.

The revised definition was introduced in this article in the journal PAIN and a via a press release. An infographic also illustrates the changes.

IASP Announces Revised Definition of Pain

Standards of care to manage chronic pain includes the development of self management skills, but for many people, professional guidance is helpful to know what questions to ask, where to go for support and little things you can do to reduce your pain intensity and improve daily functioning.

Much of the educational information we provide and reinforce to our clients can be found on the Fraser Health website,  Manage Pain .  I highly recommend reviewing the relevant subheadings which include: medication usage, support groups, exercise, depression, sleep and even financial resources.  There are links to helpful videos and local resources.  I hope you find this website useful in your journey to develop your own self-management toolkit to manage your pain.