Overview
In this case study, Scott Frame shares how his objective and expert opinion helped to identify how a Claimant could make progress after a traumatic experience.
Instruction requirements
Condition and prognosis to:
- Report on Claimant’s past, present and future orthotic needs, with costings.
- Report on whether Scott Frame considers the orthotic support provided to date has been reasonable, appropriate and adequate.
Background
The Claimant contracted septicaemia after giving birth. Despite treatment with IV antibiotics, her condition deteriorated and she was admitted to ICU. During this, a central venous catheter was inserted into her jugular vein.
Despite improvement in the Claimant’s general medical condition, it became apparent that she had developed a left hemiplegia with cranial imaging demonstrating an extensive infarction of the right cerebral hemisphere.
Formal diagnosis: Significant brain injury resulting in right-sided hemiparesis. The Claimant now requires orthotic management of left upper and left lower limbs.
Scott Frame’s assessment findings
- The Claimant is able to walk unaided, albeit with some instability; she presents with right-sided ‘drop foot’ and hyperextension of left knee.
- Mild involuntary dystonic movements of right upper limb during gait.
- The Claimant has significantly reduced prehension capacity on right side. At rest, the thumb and fingers rest in a fisted position; Claimant can manually extend fingers and thumb using contralateral hand only.
- Parathesia in left upper and lower limbs; left upper arm sensations reported to disturb sleep.
Scott Frame’s recommendations
Based upon a significant degree of impairment, associated with hemiplegia, Scott Frame is of the opinion the goals of treatment should be focused contracture management of the right upper and lower limb, and function of the right lower limb during gait.
- Right custom ankle-foot-orthosis (AFO); manage stability during stance and clearance during gait
- Right knee hyper-extension brace; manage abnormal loading of posterior cruciate ligament and hamstring tendons
- Retail footwear allowance – Claimant will require wider and deeper retail footwear to accommodate the volume of the AFO
- Custom lycra sleeve (dynamic compression orthosis) for right upper limb; to improve position of functional tasks
- Right upper limb resting splint (AFO); to manage range as part of the stretching regime
Costs
As a rough guide, the annualised costings for the recommendations made within this case were:
Initial provision: £2,500–£3,000
Annualised costs: £1,000–£1,200
Estimated life expectancy: Reduced by 10 years (in her early thirties at time of report)
