Life Care Plans specify the medical conditions and ongoing medical requirements of catastrophically and/or chronically ill or injured individuals, and quantify the cost of supplying them with requisite, medically-related goods and services over a specified probable duration of care.
Qualitative and quantitative medical and quality-of-life needs for chronically ill, injured, and disabled individuals to ensure they are able to adequately plan for the future.
While Life Care Plans are highly individualized, they generally include, but aren't limited to:
Thorough Case OverviewChronological Review of Records to DateInterview & Physical ExaminationSummary of DiagnosesGlossary and Description of Pertinent Injuries & IllnessesSpecific Medical Requirements for TreatmentProjection of Future Care CostsThere are two types of Life Care Plans based on an individual's ability to perform activities of daily life (ADL.)
Catastrophic Life Care Plans outline treatment costs and needs of people living with permanent physical or mental impairment or chronic illness who have lost the ability to fully perform ADL.
After an individual suffers an injury or illness that affects the brain, or has a mental disability requiring diagnostic clarification, a thorough neurophysiological evaluation can provide an in-depth assessment of skills and abilities linked to brain function. These include the following tests that measure attention deficits, problem solving, memory recall, language, I.Q./academic skills, visual-spatial skills, and social-emotional functioning, among others.
CognitiveMotorBehavioralLinguisticExecutive FunctioningOnce completed, neuropsychological examinations can help predict a person’s ability to perform activities of daily life (ADL) such as seeking and maintaining employment, attending school, managing finances and safely maneuvering through their environments. A neuropsychological evaluation can be administered in any setting through a variety of non-invasive, standardized tests designed to measure a full spectrum of mental abilities. These can include guided conversation to determine the subject’s emotional state, thinking/reasoning abilities and memory recall, as well as other standardized testing designed to reveal dexterity and fine motor skills, hand/eye coordination and materials manipulation. Testing is often followed by personal interviews with family members, caregivers, or individuals associated with the subject.
Non-Catastrophic Life Care Plans detail treatment costs and needs of people living with permanent, chronic illness or physical impairment who retain the ability to perform some or all ADL, but do so with noted difficulty and loss of quality of life.
An Independent Medical Evaluation involves a physician, psychologist or other healthcare professional who has generally not previously been involved in an individual’s care, who conducts an unbiased examination to assess the cause, extent, and medical treatment of an injury/illness, often when liability is at issue. The IME is important in determining the degree of impairment and adequately plan for future cost of care.
IMEs at MDCLCP (MD Certified Life Care Planner) are performed by physicians who are board certified in Physical Medicine & Rehabilitation, Pain Medicine, Neurology, and Brain Injury Medicine. As board-certified physicians who are also certified Life Care Planners, MDCLCP is uniquely qualified to prepare comprehensive Life Care Plans.
An expert witness is someone, who by virtue of education, training, skill or experience, is believed to possess expertise and specialized knowledge in a particular subject that is materially beyond that of the average person.
Life Care Planning is a tool that, when performed by a physician, requires specialized training and board certification before it can be expertly applied. The certification of Life Care Planning is not mandatory when performing LCPs, but it certainly helps to get that extra training when doing Life Care Plans.
If the life care planner provides opinions outside of the scope of expertise, regardless of whether or not he/she is a physician, his/her testimony runs the risk of being successfully challenged via Daubert or Kumho, precedent-setting cases regarding the admissibility of witness testimony. The trier of fact can disqualify the expert’s testimony based on the lack of the specialized knowledge that the life care planner requires.
It is important to seek a Life Care Planning Professional with the proper certifications. Our expert testimony includes:
Independent Medical Examinations (IMEs)DepositionsCertified Life Care PlansAs Life Care Planners who are also board-certified physicians, we routinely perform systematic medical assessments and consultations to expertly formulate diagnostic conclusions and recommendations for ongoing care requirements. We provide a medically oriented assessment of your existing Life Care Plan to ensure that it includes:
Nature, cause and extent of injury, disability, and/or illnessAccurate medical determinant for future medical needs and costs including possible and probable complications associated with the individual’s conditionLimitations affecting activities of daily living (ADL)And more...Children with birth injuries may face a number of physical and mental health-related issues over the course of their lives, some that may not appear until years later.
Cerebral Palsy, Brachial Plexus Injuries, broken bones, and brain injury from oxygen deprivation, maternal infection or improper medical treatment are a few examples of situations that can result in a lifelong need for therapy, medical equipment and other special accommodations to assist with a child’s living, educational and recreational needs.
The constant care and many challenges faced by families of babies born with birth-related impairment can be a huge emotional and financial strain.
MDCLCP can play a valuable role in increasing quality of life for children born with birth injuries and the families that care for them by creating Life Care Plans outlining the needs and costs associated with future care.
Brachial Plexus Injuries occur when the nerves responsible for sending signals from the spinal cord to the shoulder, arm and hand suffer trauma that results in them being stretched, compressed or torn away from the spinal cord. This can affect both the ability to fully and freely move these limbs, as well as the ability to feel temperature and pain in arms, wrists and hands.
Injury to this vital network of nerves can occur in a variety of ways (contact sports, cancer and radiation, inappropriate autoimmune response) and drastically range in severity depending on the victim’s age and the exact location and circumstances of the injury.
Contact sports, cancer and radiation, as well as an inappropriate autoimmune response can all injure the Brachial Plexus. Newborns can even sustain Brachial Plexus Injury during a difficult labor and delivery.
The most severe injuries of this type generally occur in high speed auto or motorcycle accidents.
While many minor Brachial Plexus Injuries may heal on their own with proper treatment, others can require ongoing medical or surgical intervention such as nerve grafts, and nerve/muscle transfers, accompanied by physical therapy to restore function. The most severe injuries can result in chronic conditions ranging from stiff, painful joints and muscle atrophy to the permanent muscle weakness or paralysis in the arms and hands.
MDCLCP can play a valuable role in increasing quality of life for people living with ongoing healthcare requirements from Brachial Plexus Injury by creating Life Care Plans outlining the needs and costs associated with future care.
Spinal Cord Injury (SCI) is an umbrella term that takes into consideration multiple kinds of injury to the spinal cord. The most accepted way to classify SCI is through the American Spinal Injury Association (ASIA) International Standards for Neurological Classification of Spinal Cord Injury. These standards use the “ASIA impairment scale” to determine the specific kind of SCI the patient suffers from. In this sense, the degree of impairment is assessed as follows:
ASIA A: There is no sensory or motor function in the sacral segments (nor below the level of the lesion).ASIA B: Sensory but no motor function is preserved below the level of injury and includes the sacral segments.ASIA C: Motor function is preserved below the neurological level, and more than half of key muscles below the level of injury have a muscle grade less than 3 (i.e., they can’t lift an extremity against gravity).ASIA D: Motor function is preserved below the neurological level, and at least half of key muscles below the level of injury have a muscle grade greater than or equal to 3 (i.e., they can lift an extremity against gravity).ASIA E: Normal; sensory and motor function are normal on physical examination.Just as there are multiple kinds of injury to the spinal cord, there are multiple manners of causation for resulting conditions. These can include, but are not limited to trauma, radiation myelopathy, transverse myelitis, epidural abscess, and SCI tumors.
Polytrauma occurs when a patient suffers multiple traumatic injuries at one time, often, but not always, from a serious motor vehicle accident or work-related incident.
Injuries in Polytrauma patients are defined by the widely accepted Injury Severity Score (ISS) and tend to be a serious and complex combination of conditions with Traumatic Brain Injury (TBI) being the most common. When combined with one of more additional injuries such as spinal cord injury (SCI), burns, amputation, orthopedic or internal injuries, among others, Polytrauma patients generally face an extended and complex treatment and recovery.
MDCLCP can play a valuable role in increasing quality of life for people living with ongoing healthcare requirements from multiple traumatic injuries by creating Life Care Plans outlining the needs and costs associated with future care.
Many people live out their lives with chronic pain due to injury or disability. In fact, even when original injuries can be “successfully treated,” chronic pain often remains, affecting a person’s ability to perform the simple everyday tasks that others take for granted. Maintaining a job and household, participating in social engagements, even getting dressed, is all made more complicated when in constant pain. Often called the “invisible disability,” chronic pain can cause people to become inactive for fear of worsening pain and isolate themselves from others, which can lead to depression and put a strain on family and social relationships.
MDCLCP can play a valuable role in increasing quality of life for people living with chronic pain that remains after injury or disability by creating Life Care Plans outlining the needs and costs associated with future care.
Although the life of a person who suffered thoracic or lumbar SCI is changed forever, this patient has significantly better outcomes than the cervical SCI population.
Bladder DysfunctionNeurogenic BowelOsteoporosisPulmonary ComplicationsSleep ApneaPancreatitisUrinary Tract Infections (UTIs)HypercalcemiaPressure UlcersSexual DysfunctionInfertilityOrthostatic HypotensionFractureHypercaliuriaHeterootopic CalcificationAutonomic DysreflexiaInsulin ResistanceCholecystitisDepressionOsteoporosisSuperior Mesenteric Artery SyndromeSpasticityJoint ContracturesSyringomyeliaChronic PainDeep Venous Thrombosis (DVT)Pulmonary Embolism (PE)Concussion or mild traumatic brain injury (TBI) accounts for 90% of TBI. It is defined as a clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status and level of consciousness resulting from mechanical force or trauma. It does not require a loss of consciousness. A concussion can affect coordination, balance, memory, and speech. Although a concussion may be mild in nature, it is critical it be identified and addressed in a timely manner since a second concussion shortly after can be life threatening or cause permanent impairment or disability.
This is complicated because mild TBI can be easily missed on physical examination and imaging studies are not helpful in determining the presence or absence of brain damage (with the possible exception of diffusion tensor imaging, which may show diagnostic findings that correlate with reduced performance on cognitive tests.) The diagnosis is determined in the patient’s history. Is the patient confused? For how long has he/she been confused? Is he/she coherent? Is the patient easily distracted? Can the patient follow simple commands? These are the questions that need to be asked to determine if the patient has a concussion. Aside from confusion, there are other symptoms commonly seen in concussions.
Poor memory
Poor concentrationTinnitus (ear ringing)DizzinessBlurred visionFrequent/consistent headachesNausea or vomitingPhotophobia (sensitivity to light)Loss of sense of smell or tasteMood swingsDepressionConcussion severity is graded with three systems: Cantu, Colorado Medical Society Guidelines, and American Academy of Neurology (AAN).
The Glasgow Coma Scale (GCS) is used to determine the severity of TBI: Severe TBI (Coma) – GCS score of 3-8; Moderate TBI – GCS score of 9-12; and Mild TBI – GCS score of 13-15.
After the initial injury the patient may suffer diffuse axonal injury (DAI), in which there is extensive damage in the white matter tracts of the brain. As opposed to mild TBI, when there’s DAI, a brain MRI can show white matter bleeding. Subsequent brain damage occurs due to brain swelling.
Coma. The patient has no wakefulness and his/her eyes remain closed with no evidence of comprehension or purposeful movement.
Vegatative state (VS). Patient experiences a sleep-wake cycle on electroencephalogram (EEG) and can open his/her eyes, but demonstrates no self awareness or purposeful behavior. With persistent VS (less than three months from the time of TBI,) damage can be reversible through rehabilitation. Damage incurred with permanent VS (12 month or longer) is generally considered irreversible.
Minimally conscious state (MCS). Patient demonstrates a partial preservation of conscious awareness and purposeful behavior through inconsistent but reproducible visual fixation, verbalization and the ability to follow simple commands. Because of inconsistent patient responses, it is often difficult to distinguish definitively between VS and MCS.
There’s no proven treatment to promote the emergence of any of the above mentioned disorders of consciousness. Treatment is centered in avoiding complications, like treating spasticity, avoid pressure sores, and prevent muscle atrophy and contractures. The medication regimen should (if possible) not adversely affect neurologic recovery. The use of stimulants such as ritalin and antidepressants, have been successfully used to improve attention and responsiveness.
Post-traumatic seizures (PTS) and epilepsy (PTE)5% of hospitalized TBI patients have late PTS (occurring after the first week), and about the same number have one or more seizures within the first week of hospitalization.Most PTS happen one to three months post-injury.TBI severity correlates with incidence of PTS.The greatest risk of having PTS is within the first two years post injury.Seizures that don’t respond to anti-convulsant medications can often be managed surgically through medial temporal and neocortical resection or vagal nerve stimulation.HypertensionProblems with cognition: attention, executive functioning, and memory recall.TachycardiaSocial IsolationMarital problemsDifficulty drivingFatigueHyperthermiaSpasticityProfuse sweatingHydrocephalusCranial nerve injuriesOlfactory nerveFacial nerveVestibulacochlear nerveOculomotor nervesOptic nervesPoor AppetiteAltered feeding patternDeep Venous Thrombosis (DVT)/Pilmonary Embolus (PE)Neurogenic BladderHyper metabolic stateHypothalamic pituitary dysfunctionDecrease in the release of pituitary hormones: thyroid stimulating hormone, follicle stimulating hormone, leuteinizing hormone, prolactin, growth hormone, ACTHPoor balanceVertigoHeadachesVision problemsTinnitus (ringing in the ears)Post-traumatic agitationAggressionDisinhibitionEmotional lability (exaggerated changes in mood or disproportionate emotional responses)Heterotypic ossification (bone formation outside of skeletal tissue)Hyponatremia (low sodium in blood)Psychogenic polydipsia (when the patient drinks so much water that it causes electrolyte imbalances)Diabetes insipidus
Our MD certified life care planners provide comprehensive assessments for individuals with catastrophic injuries and chronic conditions. Contact us for expert medical evaluations and future care cost analysis.
