COTA’s Managing Director, Lauren McCluskey, joins Stewarts Soundbites to discuss the benefits of amputee specialist case managers, tailored rehabilitation, and the role of case managers in maximising recovery. Watch the podcast or read the key insights.

Last week our Managing Director, Lauren McCluskey, joined Chris Smith, a Partner in the Stewarts Personal Injury team, for their podcast, ‘Stewarts Soundbites’. During the episode, the pair discussed the benefits of using an amputee specialist case manager.

In addition to this, the episode explored how a case manager advocates for injured individuals, coordinating their rehabilitation and multidisciplinary team to maximise recovery, all while supporting both the client and their family.

The podcast also discusses how, as specialist amputee case managers, COTAs provide tailored rehabilitation by understanding the complexities of limb loss, ensuring appropriate clinical decisions, and collaborating with legal and medical teams to achieve the best long-term outcomes.

The pair also discussed the importance of having our clients have rehabilitation goals to help them aim towards a certain target. They also evaluated the impact geography can have on a client's rehabilitation and whether, as case managers, we’d recommend residential rehabilitation.

During the 15-minute discussion, Lauren shared a wealth of valuable case management insight, creating a captivating podcast episode. If you’d like to watch the podcast, you can do so below. Alternatively, you can read the write-up of the podcast below.

Learn more about COTA’s specialist and nationwide case management services.

The Stewarts Soundbites podcast can be found in writing below. Chris Smith, Stewarts Personal Injury Partner, is asking the questions with Lauren McCluskey, COTA Managing Director, answering them. 

What is a case manager?

“For me, the role of a case manager is to act as an advocate for the injured person, to maximise their recovery. Case managers not only need to be dynamic, but they also need good communication and assessment skills while being responsive and proactive. Clients need to be comfortable as you’re an integral part of their life at a critical time because you are going to be coordinating their multidisciplinary team (MDT), treatment, and supporting their recovery. All while ensuring they are getting the very best quality of life, post-injury.”

I always say to clients it's one of the most important decisions you’ll make.

“It’s important to recognise it’s not just the injured person; it’s their entire family. When instructing a case manager, it’s important to remember this, as families require not only emotional support but also a lot of questions. For example, they might not understand the difference between rehab and the claims process. Having that understanding as a Case Manager is vital.”

What’s the benefit of having an amputee specialist case manager?

“That’s my absolute passion. I set up COTA Case Management a few years ago because I felt really strongly about ensuring people with complex orthopaedic issues, in particular amputees, have an appropriate case manager with the right clinical background and knowledge base on how to deal with amputations.

While there are a lot of transferable skills in case management, amputees in particular have a unique set of complex issues that need specialist input to ensure they get the appropriate rehab at the appropriate time. While the case manager is working for the client and isn’t part of the litigation team, they also need to understand amputations within the context of the client.

Without that clinical background of knowledge, it's really hard to make clinically reasoned judgements to make sure the client gets what they need and also giving that strong clinical rationale and understanding amputations is really important for the longer term; it feeds into both the medical experts and the legal team's opinions."

Theres's specialist spinal and brain injury case managers but not amputee case managers?

“Absolutely, while I appreciate there's a lot of transferable skills, if you don’t appoint someone with the right clinical background and previous experience of working with amputees, you can sometimes run the risk of rehab becoming quite prescriptive and not tailored to that individual.”

When speaking about prescriptive rehab and then tailored rehab, how soon do you need to be instructed?

“The earlier the better. Recently at COTA we’ve seen an increase in clients coming to us while they’re in the hospital, which is just fantastic. It's well documented that earlier rehabilitation produces better outcomes, and it's in the best interest of everyone involved."

There’s no one size fits all approach fits-all approach I think there a bit of a misconception sometimes with amputation injuries as people often have an impression of conventional rehab. 

What are the complexities involved in assembling a rehab team and what does that rehab look like for an amputee?

“You don’t want to be prescriptive. It’s individual and tailored to that person and what their needs are. Again, this is where I believe having that specialist case management input from an amputee specialist isn’t something to be underestimated because you can then tailor it to their needs.

For example, constructing the right MDT is really important. They (the client) are going to have a prosthetics team, prosthetist, physio, orthotists, occupational therapists, and clinical psychologist. There are lots of different things that people will need to access.

One of the big things I look at is adjusting to limb loss and especially all the emotional support around it. This means there are also non-clinical things that I think can be really important; for example, peer support should not be underestimated at all. Getting someone in touch with another amputee can be crucial, as well as ensuring the correct professional team is around them.”

Looking back on your experience as a case manager, what's different and perhaps more difficult about assembling that MDT for an amputee?

"As all case managers will say, you’ve got to get the right team in place, and that goes without saying. However, it is critical to look at the goals of a client, and in terms of complexities, it could be things like understanding the prosthetic components and giving the clear clinical rationale to what different things they (the client) might need. This could be different options for (prosthetic) feet or arms and explaining why certain options are needed.

Sometimes there can be complexities around the rescission itself. This could be surgery that’s required, getting the right plastics consultants or the right orthopaedics. Another big consideration can be pain, and not just clear pain but phantom limb pain, as that can be incredibly complex to help the individual navigate this while ensuring they’ve got the right professionals around them.”

Does geography play a part sometimes? Especially when assembling that team and finding the right type of people that you need to work alongside your client.

“I’d like to say no, but ultimately it does. You want to make access to rehabilitation as easy as possible for the client, as they've been through a massive trauma, and you don't want to make rehabilitation difficult for them. Therefore, getting the right professionals as local as possible is vital.

Although that is a challenge for amputees, and you’ve got to consider some important factors. For example, you've got to consider how far they (the client) are going to have to go in a car, as they may really struggle psychologically being in a car, and they may really struggle from a pain perspective being in a car. You then need to consider the balance of travelling to an appointment versus the benefit that they get out of it. So, I think yes, it does. We'd like it not to, but ultimately it does.”

Do you think that plays a part sometimes in in clients considering residential rehab?

“Yes, I think it does; there’s lots of evidence to support this from the military, for example. Whereas in the case of having early access to intensive residential rehab, it can give a better, longer-term output. However, it's not always the right thing for every client, and that, again, is where you need to think about tailoring it to the individual. For some people, it's really important to maintain a level of normality.

For example, this could be continuing their role within their family, or they may need to be at home for a certain reason. Yes, it's great, and yes, it does give great outcomes, but again, it's got to be right for the person.”

I think it comes back to the fact that there's no one size fits-all approach and residential rehab might be right for one client or patient but it's certainly not right for the next.

“Absolutely.”

You touched on the client-specific goals, looking at what's important to the individual. Have you got some examples of slightly different goals that your clients have had and how they've gone on to achieve them?

“I think for me it's critical to address what their priorities are. Within the context of the (legal) claim, there might be different priorities going on; there may be various things that, as a solicitor, you want. However, ultimately, it's got to be what that person wants and what motivates that person, and that's what you've got to tap into. I think if they're going to achieve a good outcome and have a meaningful life as an amputee going forward, then we've got to find out what motivates them.

A couple of examples I've got in particular: I had one client whose ultimate goal was just to be a mum they didn't really care about walking as such. They obviously did in the longer term, but their number one goal was being a mum and being able to fulfil her roles as a mother.

I've got another amputee client who is a pretty decent-level footballer, and football is the driving factor behind their rehab. They're not really bothered about maybe what their accommodation is, but playing football is the driving factor.

I think if you can tap into what motivates them (the client) and put that at the top of the priority list, then you can address all the other things around it. Because they then buy into the rehab process and they're motivated to partake, and they don't just see it as these things I have to do. They see that as a benefit to them, and it's going to give them the quality of life that they want in the longer term.”

I could talk to you for hours about this, Lauren, and we have in the past! Very briefly there, you mentioned the competing interest sometimes of litigation and rehab.

So how important is it to be able to work with the litigation teams on the claimant and defendant sides with the engagement of the insurer to get those best outcomes?

“It’s absolutely critical; having that early collaboration is in everyone's interests. Number one, you're ensuring the client's needs are met in a timely manner so they can make the best possible recovery. But it is also important, and it's something you have to have in mind commercially, that you've got to manage costs.

You've got to provide clear, strong clinical rationale for why things are being recommended and have the ability to challenge professionals if you don't agree with their recommendation. That is so important, and there are competing interests often, but I think if we can all work together as early as possible and as collaboratively as possible, the outcome will be better for everyone."

In summary, it's early intervention with that specialist approach, and collaboration is key.

Get in touch with our expert team to discover how COTA’s specialist case management services can support amputees on their rehabilitation journey.