Major trauma news

 

Subarachnoid haemorrhage - a medical emergency

Subarachnoid haemorrhage (SAH) is a medical emergency. Fast admission to hospital for surgery is critical as any delay in surgical treatment can result in severe brain injury or death. Mortality and morbidity rates are high: 30% of people who suffer a SAH die within 24 hours; overall, around half of all cases of SAH result in death; and those who survive can experience long-term disability from brain damage. Getting It Right First Time’s (GIRFT) recent report into cranial neurosurgery highlighted surgery for SAH as one of the most time-critical procedures undertaken by cranial neurosurgeons. It is also one of the areas in which the GIRFT team found that critical delays in admission for surgery are putting patients’ lives at risk.

What is subarachnoid haemorrhage (SAH)?

A subarachnoid haemorrhage (SAH) is a type of stroke caused by bleeding into the subarachnoid space between the membranes on the surface of the brain. It is often, but not always, caused by a cerebral (brain) aneurysm – a bulge in a weakened area of a blood vessel – which ruptures and bleeds into the area surrounding the brain. SAH often occurs without warning but can sometimes follow activity which involves physical effort or straining.

Cerebral aneurysms are often symptomless until they rupture but can sometimes be detected before rupture if the patient starts experiencing symptoms, such as visual problems, pain on one side of the face or around the eye or persistent headaches, from pressure on the brain caused by the (unruptured) bulge in the blood vessel. If an aneurysm is detected before it ruptures, surgery is often recommended to prevent rupture leading to SAH.

Cerebral aneurysms are hard to predict or prevent but the following may increase an individual’s  risk: 

  • smoking
  • high blood pressure
  • excessive alcohol consumption
  • a family history of the condition
  • other rare conditions including autosomal dominant polycystic kidney disease (ADPKD)

Less common causes of SAH include:

  • abnormal development of blood vessels 
  • brain tumour (either cancerous or benign) causing damage to the blood vessels
  • brain infection, e.g. encephalitis
  • rare conditions which narrow or block the brain’s arteries
  • vasculitis – inflammation of the brain’s blood vessels, e.g. from infection

The symptoms of SAH:

  • sudden, agonising headache – often described as a blinding pain unlike anything experienced before, as if hit on the head
  • neck stiffness
  • nausea and vomiting
  • sensitivity to light (photophobia)
  • blurred or double vision
  • stroke-like symptoms – e.g. slurred speech or weakness on one side of the body
  • loss of consciousness or convulsions (fits)

What is the treatment for SAH?

If someone is suspected to have suffered an SAH they need to be admitted to hospital as an emergency. On admission to hospital the diagnosis of SAH will be confirmed by a CT scan. If the CT scan is negative but the patient’s symptoms suggest they have had an SAH, a lumbar puncture might be carried out to check the cerebro-spinal fluid (CSF) for evidence of bleeding into the brain.

If SAH is diagnosed or suspected, the patient will be transferred to a hospital offering cranial neurosurgery. If the haemorrhage has been caused by a brain aneurysm, surgical repair and prevention of further bleeding may take place, either by clipping – a surgical procedure involving craniotomy in which the blood vessel is clipped to prevent further bleeding - or coiling, in which platinum coils are fed into the aneurysm via a catheter inserted into a blood vessel in the patient’s groin or leg. Both procedures take place under general anaesthetic.

Medication may also be given:

  • To prevent secondary cerebral ischaemia – a complication of SAH in which brain damage occurs from reduced blood supply to the brain
  • To prevent seizures
  • To reduce sickness and vomiting

How common is SAH?

Around 6,000 people a year are admitted to hospitals in England with a subarachnoid haemorrhage. SAH is the cause of one in every 20 strokes in the UK. It can happen to people of all ages but is most common between the age of 45 and 70. Slightly more women suffer from SAH than men.

Deficiencies in medical treatment of SAH

Subarachnoid haemorrhage is a medical emergency. The recent GIRFT report into cranial neurosurgery described treatment of SAH as “one of the most time-critical procedures undertaken by cranial neurosurgeons, where bleeding from a ruptured cerebral aneurysm can cause rapid and extensive brain damage”. With SAH mortality rates of 30% within 24 hours and around half of all SAH cases leading to fatality, even a short delay in admission for surgery can be fatal. The longer the delay in treating SAH, the greater the risk of severe brain damage or death.

In 2013, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recommended that the nationally-agreed standard of 48 hours from diagnosis for surgical treatment of all bleeding brain aneurysms should be met consistently and comprehensively by all health care professionals treating these patients. In doing so it recommended a move towards seven day service provision.

In June 2018, the cranial neurosurgery GIRFT team found that 10% of patients do not receive surgery for subarachnoid haemorrhage within the target of 48 hours from diagnosis. Issues raised in the report about delays in throughput and patient pathways across cranial neurosurgery nationwide, such as lack of available theatres and beds, were thought to contribute to the SAH treatment delays, with the day-of-the-week of the patient’s admission disproportionately affecting the timing of their treatment. Despite the NCEPOD’s recommendation for seven-day service provision, SAH patients receiving treatment within the 48 hour target fell to 74% for patients admitted on a Friday and 58% for those admitted on a Saturday, compared with 83% for other days of the week. 

At Boyes Turner we are highly experienced in acting for brain injured and severely disabled clients whose injury arose in whole or in part from negligent delays in their medical treatment. These cases are complex and are often contested. They require specialist handling to disentangle the extent and impact of the negligently caused injury from the patient’s outcome if correct medical treatment had been given. We work hard to secure early admissions of liability, interim payments, and ultimately the best settlements for our clients which will meet their needs for care, therapies, specialist equipment and adapted accommodation. 

Boyes Turner welcome the findings and recommendations of the GIRFT team’s report into cranial neurosurgery in the hope that genuine improvements in healthcare will reduce the number of patients unnecessarily harmed by delays in treatment for SAH. Meanwhile, we will continue to work to protect the interests of those who have already been harmed or bereaved as a result of negligent healthcare. 

If you have suffered disability or bereavement from delayed medical treatment please contact our specialist lawyers - email them at mednegclaims@boyesturner.com.

Is the Boyes Turner personal injury team right for you?

When someone has suffered a personal injury it is essential that they pick the right solicitor to assist them with their claim.

Carefully selecting the correct solicitor will ensure that you have:

  1. Access to up to date legal advice.
  2. Advice from a large network of specialists that we work with, such as medical experts, barristers, financial and welfare benefit advisors, employment and educational experts, housing and conveyancing specialists, and more.
  3. Access to specialist care and rehabilitation providers to assist you in your recovery journey.
  4. A speedy conclusion of your claim.
  5. Peace of mind that you will receive the compensation you need to secure your future.

No two claims are the same, even if the injuries are similar or if they were injured in the same accident. Thankfully Boyes Turner’s team of dedicated personal injury specialists are able to advise on all types of personal injury claims from minor injuries right through to life changing injuries such as brain injuries, spinal injuries and amputations.

Below we give you a quick introduction to the partners in the team and the specialisms they hold.

Kim Smerdon

Kim Smerdon leads Boyes Turner’s highly regarded personal injury team. A specialist in catastrophic injury cases, Kim acts for clients with acquired brain damage, spinal injuries and serious orthopaedic injuries.

Kim has extensive experience of all types of personal injury cases and has acted for clients who have been injured in road traffic accidents, in the workplace, as a result of defective products and criminal injuries.

A keen charity fundraiser, Kim recently completed the 3 Peaks Challenge, climbing Ben Nevis, Scafell Pike and Snowdon in 24 hours to raise over £35,000 for The Debbie Fund, a charity set up to raise funds for research into cervical cancer.

Kim is a member of the Law Society’s Personal Injury Panel and an accredited senior litigator and brain injury specialist with the Association of Personal Injury Lawyers (APIL). She is an associate member of the Child Brain Injury Trust, and a member of the Brain Injury Social Work Group, Headway and Spinal Injuries Panel Solicitors. She is a Headway Life Member, a trustee of Headway Thames Valley and trustee of the Bicycle Helmet Initiative Trust, a charity committed to saving young people’s lives by promoting safer cycling and benefits of using a cycle helmet. 

Claire Roantree

As a partner in Boyes Turner’s highly regarded personal injury team, Claire acts for clients with life-changing injuries, such as mild to very severe brain injury, spinal cord injury, amputation, severe burns, complex orthopaedic and musculoskeletal injury, chronic pain and PTSD. 

Claire works closely with the defendant insurers, using the Rehabilitation Code and securing interim payments to provide her injured clients with the treatment, care, facilities and support that they need to get their rehabilitation underway straight away, without losing valuable recovery time whilst waiting for final settlement at the conclusion of the claim. Working with experts in a variety of medical and therapeutic disciplines, professional case managers and carers, the client’s immediate needs are prioritised – recovery and rehabilitation – whilst the claim is quantified to make maximum provision  for their future needs for ongoing care, support and financial security.

A keen charity supporter and fundraiser she has used her love of running and walking to fundraise for The Children's Trust, Tadworth. She has run events for Headway SW London for whom she was a trustee for six years. She is a trustee for Cycle Smart and supports the charity’s campaign to raise cycling safety awareness and reduce road traffic accidents. 

Claire is a member of the Law Society's Personal Injury Panel, APIL (Brain Injury Specialist Interest Group), Headway and ABIL (Acquired Brain Injury across London).

As you can see there is no type of claim that the team cannot handle and together they are confident that they can assist you in achieving the best recovery possible as well as the justice and compensation you deserve.

If you would like to speak to our specialist personal injury team please do not hesitate to contact us for a free no obligation advice by email piclaims@boyesturner.com.

Scaffolding and workplace accidents falling, says NASC 2018 Safety Report

The 2018 Safety Report of the National Access and Scaffolding Confederation (NASC) has revealed that the number of workplace accidents and serious injuries reported by its members reached an all-time low in 2017.

What were the 2018 Safety Report findings?

NASC members reported no fatalities at all. Out of a total 89 workplace accidents, there were only 17 major injuries – a reduction both in incidents and injuries from the previous year. In particular, falls from heights had reduced by 46% compared to 2016 and no members of the public were injured around NASC members’ scaffolding.

As the trade body for access and scaffolding in the UK, NASC provides HSE approved safety and technical guidance for scaffolding contractors, their workforce and their clients. Established in 1945, NASC’s membership currently extends to over 240 leading contracting firms, scaffolding manufacturers and businesses, representing more than 16,000 scaffolding workers. NASC’s members undergo strict auditing to make sure that they comply with the highest possible standards of safety. In this way, NASC provides the construction industry with an assurance that its members will be trained, behave and work according to its benchmark codes of conduct, practice and safety.

The President of NASC commended the latest report’s findings as a demonstration of what can be achieved in terms of reduction of workplace accidents through strict compliance with NASC’s industry benchmark standards. Since 2012 reported numbers and frequency of accidents amongst NASC members have reduced by over a third. He reiterated, however, that workplace falls on the same level to remain prevalent and can lead to serious injury or death. Health and safety compliance remains the key to the reduction of workplace injuries.

What can Boyes Turner do to help?

Boyes Turner’s serious injury lawyers welcome the positive findings of the NASC’s 2018 Safety Report. As experts in brain injury, spinal injury severe disability, mesothelioma and asbestos-related disease claims, we help clients who have been disabled by accidents in the workplace, in hospitals, and on the roads, or who have lost family members upon whom they were financially dependent to obtain the rehabilitation and financial compensation that they need to rebuild their lives.

If you or a member of your family has been seriously injured after a fall from height at work and would like to discuss a claim please contact a member of our specialist personal injury team by email piclaims@boyesturner.com.

Colour the world Orange 2017 - International Complex Regional Pain Syndrome Awareness Day

To mark today’s International Complex Regional Pain Syndrome awareness day – Colour the World Orange – we have produced an infographic detailing the symptoms of complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy (RSD).

Buildings across the world are set to turn orange to mark the occasion, the UK buildings are:

·       TRAFALGAR SQUARE FOUNTAINS IN LONDON, UNITED KINGDOM – NOVEMBER 6

·       EMIRATES SPINNAKER TOWER IN PORTSMOUTH, UNITED KINGDOM – NOVEMBER 6

·       FRESH DIRECT ARENA IN LEEDS, UNITED KINGDOM – NOVEMBER 6

·       SWINDON CENTRAL LIBRARY IN SWINDON, UNITED KINGDOM – NOVEMBER 6

·       GATESHEAD MILLENNIUM BRIDGE IN GATESHEAD, UNITED KINGDOM – NOVEMBER 6

·       MANCHESTER TOWN HALL IN MANCHESTER, UNITED KINGDOM – NOVEMBER 2

·       BLACKPOOL TOWER IN BLACKPOOL, UNITED KINGDOM – NOVEMBER 8

As personal injury claim specialists we see a number of chronic pain cases, including Complex Regional Pain Syndrome, one of the most painful types of pain. In our experience, clients develop CRPS after fractures, soft tissue injuries or burns which usually involve extensive swelling and lead to an abnormal neurological pain response that magnifies the effect of their original injury.

If you have been involved in an accident and suffer from chronic pain as a result then get in touch with our expert personal injury claim lawyers on 0800 015 4613 or email PIClaims@boyesturner.com.

The use of technology in rehabilitation following an injury

As claimant brain injury specialists, Boyes Turner are keen advocates of the use of rehabilitation to expedite a person’s recovery following an accident.

At the same time defendants in personal injury claims are encouraged to provide suitable rehabilitative treatment to claimants to assist them in their recovery. To read our article on the Rehabilitation Code 2015 click here.

What rehabilitative options are available to injured persons?

Traditionally, rehabilitation involved adopting physical methods to assist in recovery, for example, physiotherapy or hydrotherapy treatment to aid muscle/strength recovery. One-to-one sessions with a counsellor or neuro-rehabilitation specialist were also used to assist with cognitive behavior therapy. Whilst these forms of rehabilitative therapy are still valid and in many cases the most suitable therapy available, they can take time,  be expensive and not always convenient to the injured person.

In the modern era there is a wealth of technology available to assist rehabilitation specialists when providing rehabilitative therapy and also to allow patients to attend therapy at a time which is convenient to them and often in the comfort of their own home.  This article discusses some of the technological aided rehabilitative therapies available to injured people.

Online exercise programmes and training diaries

Physical therapy

Online applications (apps) can now be used for providing patients with exercise programmes to follow at home to assist in their recovery.  These apps provide the following benefits:

·       Physical exercises can be easily demonstrated to the patient using helpful videos.

·       Easy-to-understand information can be provided to teach patients about their posture, body mechanics and how the body repairs itself via physical therapy.

·       The videos and information can be replayed or re-read a number of times by the patient to ensure they fully understand information. This avoids the problem of patients forgetting the instruction that they received during a time-limited in person

·       Some apps have video recording facilities enabling the patient to record their training so that the treatment provider can analyse normal versus abnormal movement patterns in activities such as walking and running.

·       The videos can also be used for research purposes to help evaluate and treat people with movement impairments.

·       Many apps have a therapy diary which can be updated as the patient trains. This helps the patient to keep a track of their training and also allows their therapist to ensure they are complying with training requirements. Additionally, if the patient is making good progress, the therapist can upgrade the treatment program electronically without the need for an in-person appointment.

·       Some apps use video games as part of the physical therapy training. The use of games makes training fun and motivates patients to take part.

·       The use of these apps also provides a time and cost saving benefit to both the treatment provider and the patient, making rehabilitation more accessible, cheaper and less time consuming.

Neurological therapy

Apps can also be used for providing patients with neurological rehabilitation programmes to follow at home to assist in their recovery.  Examples of online neurological rehabilitation therapy include:

·       Apps that are used to provide physical, visual and audible stimulation to patients requiring neural rehabilitation to aid their recovery. Again these apps can be monitored by neuro-therapists to monitor a patient’s progress and, if necessary, treatment programmes can be upgraded remotely.

·       Apps that are designed to assist brain-injured people in living their day-to-day lives, such as apps that allow patients to follow checklists when using public transport or doing chores such as shopping. Family members or friends can also log in to these apps to provide ideas or support to the patient remotely.

·       App users can talk to other patients with similar problems in online chat room sessions. This helps the patient to avoid feeling alone in their rehabilitation journey, reducing depression, anxiety and other mental health conditions.  A patient with a healthier outlook on life will be more receptive to treatment.

·       As with the physical therapy apps, these apps provide time and cost saving benefits to both the treatment provider and the patient.

Technology assisted physical training

There have been developments in technology assisted physical training, for example:

·       Anti-gravity treadmills are now available to assist with physical rehabilitation therapy and ambulation.
The benefit of these types of treadmills is that they greatly reduce the amount of weight placed on the patient’s lower body.  This reduces pain and pressure on bones and joints whilst exercising and working on their gait.

·       Underwater treadmills reduce pressure on bones and joints whilst also providing measured resistance which assists in recovery.
Many of these treadmills are fitted with underwater cameras which can help the treatment provider monitor gait and recovery and can also help to evaluate and treat people with movement impairments.

·       Exoskeleton suits are available now to assist people with walking disabilities.

Boyes Turner work closely with a network of healthcare professionals and specialist rehabilitation organisations, which enables us to ensure our clients receive early support and rehabilitative intervention, to assist them in rebuilding their lives after serious injury.  Our aim is to help our clients have the best chance of maximising their recovery and returning to a life that allows them to bring closure to what has happened to them and move on.

If you or someone you know has suffered a personal injury due to no fault of their own and would like to discuss pursuing a possible claim for compensation and funding for rehabilitative treatment please call us on  0800 015 4613 or email PIClaims@boyesturner.com.

The Rehabilitation Code 2015

When an individual suffers a personal injury one of their key concerns is how long it will take and what assistance they may need to achieve a full recovery. A slow recovery from a personal injury not only prolongs the pain but can also lead to psychological problems.

In many cases the injured person’s GP and hospital will provide advice and treatment to aid their recovery. However, NHS treatment may take a long time to receive, there may be cost restrictions on what assistance can be provided and the available NHS treatment may not fully provide for the injured person’s needs.

Recognising the need for injured persons to receive the correct rehabilitation advice, assistance and treatment, a number of specialist private organisations* formed a working party to find a solution to this problem. As a result of the working party’s efforts a Rehabilitation Code was published in 2007 and was revised in 2015.

The Rehabilitation Code states that its role:

“… is to restore the individual as much as possible to the position they were in before the accident.  The Code provides a framework for the claimant solicitor and compensator to work together to ensure that the claimant’s health, quality of life, independence and ability to work are restored …”

Description: The Rehabilitation Code 2015

The Rehabilitation Code is relied upon by Boyes Turner to ensure that defendants’ insurance companies do all they can to assist the injured claimant with their recovery as early as possible following an accident.

Our solicitors work with national rehabilitation providers, therapists and clinicians whose common goal is to ensure that clients receive the treatment, care and support they need to give them the best chance of regaining their independence and maximising their recovery to its fullest potential.

Rehabilitation can be far reaching and may not just involve medical treatment or therapy.

Many clients find that as a result of their injuries they can no longer do the job they used to do.  With the assistance of a vocational rehabilitation specialist, our clients have been able to identify new avenues of employment to help regain their sense of purpose. This might involve retraining or going back to further education according to the client’s needs.

Rehabilitation can include the provision of care, aids and equipment, mobility aids such as wheelchairs, adaptations to their home and vehicle. With the right help and support, an injured person can also return to the activities or sports they enjoyed before their accident.

Our network of specialist organisations and services enables us to ensure our clients receive the best possible treatment available to them, to increase their prospects of a making full recovery or returning to their pre-accident lifestyle, bringing closure and allowing them to move on.

Claire Roantree, Partner in the personal injury team at Boyes Turner, is dedicated to ensuring that rehabilitation plays a key part in the recovery of all of her clients who suffer serious or life changing injuries and says that,

“The severity of an injury should not necessarily determine an injured person’s long term outcome. With the right rehabilitation and support at the right time, an individual who has suffered a life changing injury has the potential to achieve new goals and live an independent life.”

If you or someone you know has been the victim of a personal injury and would like a free no obligation advice please call us on  0800 015 4613 or email PIClaims@boyesturner.com.

* The working party included representatives from the Association of Personal Injury Lawyers (APIL) and the Motor Accident Solicitors Society (MASS).  Boyes Turner are members of both of these organisations as well as a number of other specialist organisations dedicated to assisting injured persons.

Road safety for cyclists

The number of people cycling today has increased by more than a quarter in the last twenty years. However, whilst there are many cyclists who use our busy roads without a problem, there are still some who are either afraid or hesitant to cycle, particularly in traffic.

We have noticed a worrying rise in news about cyclists getting into serious accidents on the road recently and so we have put together some safety tips to help cyclists become more aware of the dangers around them and what they can do to ensure they are safe on the roads.

 

Top road safety tips

Safety comes first:

  • Know and follow the Highway Code
  • Wear a helmet
  • Keep your bike roadworthy
  • In wet weather watch your speed – slippery surfaces it will take you longer to stop

Be seen

  • Use lights and wear bright or reflective clothing, especially at night and in bad weather
  • Make eye contact with other road users
  • Use your bell to warn others of your presence
  • Look behind you when changing positions on the road. This will attract the attention of other drivers and you will know what is happening around you.

Safety in traffic

  • Always ride away from the kerb and parked cars
  • Ensure you ride in a stream of traffic when matching its speed

Having control

  • Are you able to shift your body weight when making an emergency stop? Ensure you are able to swerve safely and use your gears properly
  • On the road have two fingers on your brake levers, this will ensure you brake quicker when it is needed

Road communication

  • Don’t forget to communicate your intentions with other road users
  • Use hand signals and road positioning
  • Ensure you look behind you before signalling

Approaching junctions

  • When approaching a junction, position yourself in the middle of the lane. This will prevent dangerous overtaking
  • Use this approach when moving through a roundabout

Need training?

  • If you are unsure of cycle safety on the road, consider having some cycle training

The importance of recording evidence after a road traffic accident

Each year there are thousands of Road Traffic Accidents (RTA) in the United Kingdom.

Final figures for 2016 have not yet been published but data for 2015 reported the following:

  • In 2015 there were 186,209 RTAs in the UK.
  • 162,340 of those accidents involved a “slight injury”.
  • 22,137 of those accidents involved a “serious injury”.
  • 1,732 of those accidents resulted in a death.

In most cases where an RTA occurs the parties involved will attempt to pass the blame on to someone or something else. Causes of RTAs can be varied but often involve:

  • Poor road conditions (pot holes etc).
  • Negligence of another driver (speeding or not paying due care and attention etc).
  • Poor weather conditions (icy roads etc).
  • Criminal activity (drink drivers etc).
  • Trespassers on the road (animals on highways etc).
  • People failing to afford cyclists ample room on the road.

Whatever the cause of an RTA it is important that you do your best to record as much evidence as possible following the accident.

Ways you can record evidence could include:

  • Taking handwritten notes of:
    a) The name of the road where the accident occurred.
    b) The time of the accident.
    c) The details of other vehicles and drivers involved in the accident, including names, number          plates and insurance details.
    d) Taking notes of comments made by other people involved in the RTA.
    e) Making a note of lighting conditions.
    f) Making a note of weather conditions.

  • Looking around the accident site for witnesses who may have seen the accident.If the accident has been witnessed by someone ask the witness for their full name, address and phone number and explain to them that you will pass their details on to the police and your insurer.

 

  • Using your mobile phone or a camera to take pictures of the accident.When taking pictures try to take good images of:
    a) The location of vehicles on the road.
    b) Road conditions.
    c) Skid marks on the road.
    d) Local traffic signs to include speed limit signs.
    e) Registration plates of other vehicles involved in the accident.
    f) Any other matter you feel will help establish who was at fault for the accident.

 

  • Dash cams are also a great way of recording vital evidence surrounding an RTA.
    Dash cams are available to buy on the high street and online with prices starting from as little as £20.00. Some insurers even offer a discount in insurance premiums if your vehicle is fitted with a dash cam.

  • Looking for CCTV in the local area that may have recorded footage of the accident.
    CCTV could be on local businesses, on public transport such as buses or CCTV operated by local authorities.
    If you think someone else may have CCTV footage of an accident, approach the CCTV owner advising them of your accident and ask them to keep the footage for the police and your insurer.
    Recording evidence after an RTA is not just important for establishing criminal liability, but can help ensure that you are compensated for any injuries or losses that may arise from the accident.

If you suffer a serious injury in a road accident you may require long time care, assistance and rehabilitation.

If the other driver is proven liable for the accident, you can claim these costs, together with your net loss of earnings and compensation for your injuries, from their insurance company, so it is in your interests to record as much evidence surrounding the accident as possible.

Dorset Orthopaedic Rehabilitation Conference

It was fascinating to hear Dr Norbert Kang, a Consultant Plastic Surgeon at Royal Free Hospital, talk about Targeted Muscle Reinnervation at Dorset Orthopaedics Training Day this spring.

TMR is a surgical procedure used to improve the control of upper limb prostheses. This is a procedure where residual nerves in muscles of an amputated limb which has lost its function, are transferred into another muscle to reinnervate new muscle targets.

Dr Kang described how surgeons take stumps of nerves in muscles then reattach and use the muscles as an interface and amplifier of the amputated nerve motor signals. This allows for better control of prosthetic arms.

Once patients have undergone TMR surgery, they are fitted with advanced pattern-recognition myoelectric prosthesis. The aim of TMR is to improve control and function by more subconscious and flowing movement, in transhumeral (above elbow) and glenohumeral (above shoulder) amputees.

Dr Kang stated that in many of his patients, the surgery has eradicated or reduced pain by removing painful neuromas which can cause phantom limb pain or neuroma pain, usually within 6-12 months of surgery.

TMR is carried out on the NHS under the “reconstructive surgery” tariff in order to achieve pain relief with or without follow up rehabilitation. However, if the aim of surgery is to achieve better control of the upper limb prosthesis, once pain is controlled after surgery, patients must commit to a rehabilitation process which can be time consuming and labour intensive.

It is recommended that patients practice for between 4-5 hours a day using visual and memory to control movement in order to calibrate new muscle movement with that of their normal arm.  Once they are able to calibrate movement with the unaffected limb, the prosthetic limb can be fitted with the use of a harness with a control panel.

It is good to know that TMR surgery could be done under the NHS to relieve pain, particularly if you have a client in pain and a defendant who does not admit of liability and will not agree to adopt the Rehabilitation Code and provide rehab funding.  If or when funding does become available, Dr Kang stated that rehabilitation with the prosthetic limb can be carried out at a later stage in any event.

If the whole procedure is carried out on a private basis, Dr Kang recommended that a multi-disciplinary team approach be adopted to include the surgeon, Prosthetist and Pain specialist.

I am always fascinated to learn of the advances made at the amputation conferences that we attend. Many clients complain about pain after traumatic or elective amputation.  The current surgical procedures that are available will come as welcome news to those who suffer intolerable pain due to neuromas or phantom limb pain.

Boyes Turner's visit to the London Prosthetic Centre

Claire Roantree of the personal injury team and Sita Soni of Boyes Turner’s medical negligence team recently visited the London Prosthetic Centre in Kingston for an update on the work the clinic are undertaking in prosthetic technology.

London Prosthetics Company

It was great to catch up with lead prosthetist, Abdo Haidar on some of his current patients, the types of prosthetics available to them and the fantastic outcomes achieved with Abdo’s help. It was inspiring to hear how these individuals have taken steps to rebuild their lives with their bespoke prosthetic limb/s and the activities they have been able to get back to. We discussed the importance of follow up appointments and therapies to get the most out of the prosthetic limb and help the individual resume their pre-accident lifestyle as far as possible.

Abdo provided an update on current prosthetic technology including the SocketMaster, an innovative project that he is working on with other European organisations. Abdo explained the thinking behind the SocketMaster design being the creation of socket comfort-optimisation by a custom designed mechanical and electronic frame. The aim is for the design and construction of a well-fitted prosthetic socket to be completed within a few hours in the same day. It was fascinating to see the prototype and hear about the initial testing stage. The clinical trials of fifty lower limb amputees within the London Prosthetic Centre are to be completed during 2017.

SocketMaster - London Prosthetic company

Claire Roantree says “It is clear to see that Abdo’s clients significantly benefit from his unwavering enthusiasm and passion as a Prosthetist and his commitment to push the boundaries in prosthetic advancement. We were privileged to observe the work that goes into prosthetics at LPC.  I am excited to see how the trials go for Socket Master as this will be hugely beneficial to prosthetic wearers in the future.”

We look forward to continuing our relationship with the London Prosthetic Centre and keep a look out for future joint events.

For further information about amputation compensation claims talk to us confidentially and without any commitment or cost – call us on our freephone number 0800 015 4538 or email us at PIClaims@boyesturner.com.

If you would like further information about London Prosthetic Centre click here.

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The service was personal, professional and considered. I was treated so kindly and in the end I knew that not only had I found the right organisation but also the right person.

Boyes Turner client

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