Kate Gibbons is a Case Manager with Emma Way Associates. She is a qualified physiotherapist and has worked at several London teaching hospitals. Kate has been a Case Manager since 2007 and specialises in helping people with complete and incomplete spinal injuries, and those suffering with amputation. Kate is highly knowledgeable and uses her positive approach to help clients adjust to the challenges they face as a result of their life changing injuries supporting their physical and emotional needs. Julie Marsh, Partner in the Boyes Turner Medical Negligence Team, who works with Kate on a case involving a young bilateral mid foot amputee, spoke to Kate about her work, and why a specific approach is required to case management for an amputee client. Read the case study Julie and Kate worked on here. Questions Can you briefly describe what a Case Manager is? A Case Manager is a nurse, health professional or social worker who works with a person post injury to oversee the rehabilitation process and advocate for them. The case manager will initially complete an assessment looking at all aspects of the injured person’s life, then compare it with their life pre injury and work out how they can re-establish that lifestyle as far as possible through various kinds of care, therapy and support. A case manager is essentially a central person who organises complex care across providers. What is one of the first things that you do when you start working with a new amputee client? After the initial assessment and once funds are approved, I think it’s important to meet with the client and look at their goals. They need to be on board with the process for it to be wholly successful. A case manager will draw on their knowledge to support this process and try to identify some areas that are best tackled initially. What are the most common concerns raised by a new amputee client? What are their priorities? Does that change depending on how long ago the amputation occurred? Most are keen to walk again. That’s usually a big focus for new amputees, but, of course, everyone is different. Being able to wash and use the toilet independently is often pretty high on a new client’s list of concerns too. I definitely think the time since injury makes a difference. I have found that those who have experienced a delay between injury and active rehabilitation/ case management have become accustomed or used to their situation and I’ve found they might accept that lower level of mobility than they can actually achieve. What are the key issues you look to address early on with an amputee? It’s really important to get a full prosthetic and physiotherapy assessment completed, be that in the NHS or privately. It’s good to establish what each service can offer and note from the outset how we’re going to proceed, so that all those concerned are clear on the process and the client’s goals. Giving an individual a timeline is important too, what’s going to happen and when, and by whom. In your role you liaise with many other disciplines including occupational therapists, physiotherapists and accommodation specialists. What are the challenges of working with so many different people? I think ensuring that everyone knows who everyone else is as they are often form different organisations. Some may even be NHS and some private. Covid has actually helped this in a way with everyone working efficiently and swiftly via email and the use of video conferencing to aid communication. I think that we have more multidisciplinary teams now that we’ve ever had! What are the biggest psychological factors amputee clients face in your experience? How important do you feel it is to consider the psychological impact of an amputation when working with a client? It's a really important aspect of case management work, though I should add that some people manage well and have no formal psychological support at all. A good psychologist who can guide the team on management techniques is a huge bonus. You only have to look at the military model to see how important a role they play and how rehabilitation can be massively impacted when the psychological issues are not dealt with. How can prosthetics make a difference to amputees? Our NHS system is brilliant but the funds for the best and most suitable prosthetics are just not available to all. People can also fall through the net so to speak. A client that Julie Marsh and I are working with didn’t have any orthotic or prosthetic input for 3 years post amputation. Some of the best prosthetics on the market, the Genium X3 for example, are only available privately and, without these, clients can’t progress to be the best they can be and achieve all they can. For some, what the NHS offers is suitable, although not always timely and appointments are not always freely available. I have another young female amputee who is finishing her GCSE’s currently and if she were to have to attend appointments on the NHS she would miss a huge amount of school time. Private provision has enabled us to build her rehabilitation around her school work. Can you tell me the most unusual request for help that you have had from an amputee client? It would probably be a horse simulator for a client that wanted to return to horse riding. Who even knew such things existed! It was helpful as our client required some lessons in a very managed and safe situation. Another client needed support to do a road trip through Vietnam. Our work really centres around ensuring as far as possible that our client’s life and ambitions are not limited by their amputation. Can you please tell me what you love most about your job and what are the hardest parts of it? I love working with people, helping them to achieve what they want to achieve and be the best they can be. One of my favourite parts is when clients start to say “I can do that”, be that a physical thing, but often an administrative thing. They have learnt who their support network is and they know how to contact them and when to ask for assistance. The hardest thing – we’re all human after all – would be the sadness I see in some families when an injury has impacted so many people, beyond that of the amputee, in so many different ways. For a period, clients and their family members can be ‘lost’. The rewarding part of my job is seeing people find themselves again or discover a new version of themselves.