A Guide to Spinal Injury from day one - Nicola

A PRACTICAL GUIDE TOSPINALINJURY From Day One

Our client Mark

TABLEOFCONTENTS

TITLE

PAGE

The Spinal Column

Understanding Spinal Cord Injury

Types of Spinal Cord Injury

Immediate Actions After a Spinal Cord Injury

Immediate Medical Procedures and Interventions

Diagnostic tests for SCI

Prognosis and Factors Affecting Recovery

Emerging medical treatments and technologies

Questions to ask the medical team

Managing emotional shock and stress

Legal Support following an SCI

Financial Assistance and Benefits (UK)

Legal and Financial Checklist

Practical Tips for Families and Caregivers

Finding Support Groups and Community Resources

Rehabilitation Terms

Medical Glossary of terms

THE SPINAL COLUMN

C1 - C7

Cervical Spine

T1 - T12

Thoracic Spine

T12

L1 - L5

Lumbar Spine

UNDERSTANDING SPINAL CORD INJURY

When a spinal cord injury (SCI) occurs in a child or adult, it can feel overwhelming. This guide explains the medical facts and offers practical advice for those affected by a spinal injuries, their families and other loved ones. We cover what an SCI is, the terms doctors use, what to expect in the hospital, and how to plan for long-term care – all in clear language. We also outline financial and legal support in the UK.

In an incomplete injury, some signals still get through, so there is some preserved sensation or movement below the level of injury. Incomplete injuries vary widely – one person might have slight sensation, while another can move one limb. The extent of function depends on how much the cord is damaged but not fully severed.

What is a spinal cord injury (SCI)? The spinal cord is a bundle of nerves running down your back that carries messages between your brain and body. A spinal cord injury happens when these nerves are damaged. This can disrupt signals for movement, sensation, and body functions. This damage can occur even if the spinal bones (vertebrae) aren’t broken. An SCI affects more than just the ability to walk – it can impact bladder, bowel, skin, and other body systems below the injury. In short, an SCI may cause paralysis (loss of movement) and loss of feeling below the level of the injury. Complete vs. Incomplete injury Doctors often describe SCIs as complete or incomplete. In a complete injury, no signals travel past the injured area – there is no movement or feeling below the injury level.

Levels of injury and effects The spinal cord is organised into levels

corresponding to the vertebrae: cervical (neck), thoracic (upper back), lumbar (lower back), and sacral regions. The higher the injury, the more of the body is affected. Damage in the cervical (neck) region can affect arms, trunk, and legs (tetraplegia/quadriplegia). Thoracic injuries affect the trunk and legs (paraplegia). Lumbar and sacral injuries impact the legs, bowel/bladder, and sexual function, while arms and upper body remain okay.

TYPES OF SPINAL CORD INJURY

Can cause tetraplegia (also called quadriplegia), meaning paralysis of all four limbs. The person may have weakness or paralysis in the arms and legs. Higher cervical injuries (like C1–C4) are the most severe. They can affect breathing (requiring a ventilator)and even heart rate and blood pressure control. For example, a C3 injury will result in paralysis from the neck down and often inability to breathe on one’s own. A C7 injury might leave arm function partly intact but paralyse the legs and trunk. Thoracic (upper/mid-back) injuries: Can cause paraplegia – paralysis of the legs and lower body. The arms and hands still work normally. Thoracic injuries (T1–T12) affect the chest/abdominal muscles and legs. The person may have trouble with balance or coughing and will have bowel, bladder, and sexual function affected. For example, a T6 injury paralyses the legs and lower trunk, but the person can use their arms and hands. Lumbar (lower back) injuries: Also result in paraplegia (legs and possibly part of the lower trunk are paralysed), but the upper body is fine. Lumbar nerves control signals to the hips, knees, ankles, and toes, as well as some bladder and bowel functions. A person with an L1 or L2 injury may need a wheelchair but also use leg braces or other aids if some leg muscle function remains. The sacral nerves (S1–S5, at the lower end of the spine) primarily affect bowel, bladder, and sexual function. Sacral injuries can cause weakness or loss of hip and leg function. Many sacral injuries result in less obvious mobility impairment. For instance, it might cause difficulty with foot movement but could also manifest as loss of bladder/bowel control and changes in sexual function.

CERVICAL (NECK) INJURIES:

THORACIC (UPPER/MID-BACK) INJURIES:

LUMBAR (LOWER BACK) INJURIES:

SACRAL INJURIES:

UNDERSTANDING SPINAL CORD INJURY

Common causes of SCI Most spinal cord injuries happen suddenly due to trauma. Causes include road traffic accidents, falls, violent attacks, sports injuries, and domestic accidents. For example, a car crash or a bad fall can fracture the spine and damage the cord. Sports like diving into shallow water or rugby can also lead to SCI. Violence (such as gunshot or stab wounds) is another cause in some cases. In some cases, it can occur in a healthcare setting after surgery. There are also non-traumatic causes. Diseases or conditions like tumours, infections, or lack of blood supply to the spinal cord can damage it. About 500–600 people sustain a traumatic SCI each year in the UK, and many more have spinal fractures without cord damage. Symptoms and Effects of SCI SCI symptoms vary based on the level and severity of the injury. Possible effects include: Paralysis: Loss of movement in the legs

Treatment and Recovery Doctors use a combination of the following to diagnose a spinal injury: Neurological exams to assess movement and sensation. Imaging scans such as MRI, CT scans, and X- rays. ASIA (American Spinal Injury Association) Scale to determine the severity of the injury. Treatment focuses on stabilisation, preventing complications, and rehabilitation. Key treatments include: Surgery: To stabilise the spine and relieve pressure on the spinal cord. Rehabilitation therapy: Physical, occupational, and speech therapy to maximise independence. Medication: To manage pain, spasticity, and nerve function. Assistive devices: Wheelchairs, braces, and robotic exoskeletons.

(paraplegia) or all four limbs (tetraplegia/quadriplegia).

Bladder and bowel dysfunction: Many individuals with SCI need assistance with bladder and bowel management. Chronic pain: Nerve pain, muscle spasms, or discomfort from pressure sores. Autonomic Dysreflexia: A potentially dangerous rise in blood pressure in individuals with high-level injuries. Breathing difficulties: Injuries in the cervical spine can affect breathing and require ventilator support. Sexual function and fertility changes: SCI can affect erectile function, arousal, and fertility in men and women.

UNDERSTANDING SPINAL CORD INJURY

IMMEDIATE ACTIONS AFTER A SPINAL CORD INJURY

The period right after an SCI – from the incident through the hospital acute care, is emotionally exhausting for families. Knowing what to expect can help. This section covers what decisions you might face, questions to ask, and coping with the initial shock.

At the scene Paramedics will immobilise the spine. Often, the person is taken to a major trauma centre if the injury is suspected to be serious. Once in the emergency department, a trauma team will evaluate all injuries (because spinal injuries often accompany other trauma). They will likely do X-rays or CT scans, start IV lines, and possibly intubate the patient if there are breathing issues. The family might be asked what happened, any medical history, etc. If life- saving measures or surgery are needed, you may not see the patient immediately. Intensive Care Unit (ICU) Many spinal cord injury patients, especially with cervical injuries, go to the ICU initially. In the ICU, they closely monitor heart rate, blood pressure, oxygen, etc. Don’t be alarmed by the number of machines and tubes – these help the team care for your loved one.

C ommon things you might see in the ICU: A ventilator (breathing machine) if they can’t breathe fully independently. IV lines delivering fluids, pain medication, blood pressure support, etc. Possibly an arterial line (a thin tube in an artery) to monitor blood pressure continuously. A urinary catheter to drain the bladder (standard for virtually all SCI patients initially, since they likely can’t control the bladder). Perhaps a nasogastric (NG) tube can be used through the nose to the stomach if the person can’t eat yet. They may be in a neck collar or on a special bed that rotates to prevent pressure sores. The ICU staff will work to stabilise vital signs and prevent complications. One potential complication in high SCI is neurogenic shock (as discussed, causing low blood pressure), so they’ll be managing that with fluids and meds. Another is difficulty breathing or pneumonia, so they keep the lungs clear with suctioning and respiratory therapy.

Surgery or not If the scans show spinal cord compression (like a bone pressing on the cord), or the spine is unstable, surgery is usually done within hours if possible. The surgeon will likely discuss this with the family (or it may happen emergently). In some cases of cervical injury, they may operate through the front of the neck to fuse vertebrae; in other cases, from the back or both. If multiple vertebrae are broken, there may be several levels of fusion. After surgery, the patient might be kept sedated for a day or so or awakened sooner – it depends on their condition. If surgery isn’t needed (say, the spine is stable, and the cord injury came from a bruise that surgery can’t fix), the patient might be managed in a brace. The care team will explain whichever approach is taken. Communication in ICU The patient might be sedated or on a ventilator and unable to speak initially. They may be awake but groggy. Always assume they can hear you – speak reassuringly. ICU staff often allow family to be present in limited numbers once the patient is stable. Ask the nurses about visiting rules. Assign one family member as the point of contact to get updates by phone if you can’t be there constantly. Decision-making Early on, the family may need to help with decisions, especially if the patient is a child or is unconscious. These decisions could include consenting to surgery or procedures. The medical team will explain the risks and benefits. In life- threatening scenarios, they might proceed under emergency protocols, but usually, they will involve the next of kin for consent. If you’re asked to sign consent for surgery, it’s standard procedure – make sure you understand what the surgery entails. Questions to ask might be: What is the goal of the surgery? What are the risks? What happens if we don’t do it?

What families should expect in the hospital In the first days, expect a lot of ups and downs. SCI patients can have unstable blood pressure, fever, or other issues like spinal cord swelling that might cause the level of paralysis to worsen temporarily. They will be on medications to manage pain and prevent blood clots (often, blood thinners are started to reduce the risk of deep vein thrombosis since the patient can’t move legs). The healthcare team is interdisciplinary: you’ll interact with trauma surgeons, neurosurgeons or orthopaedic surgeons, critical care doctors, nurses, respiratory therapists, physiotherapists (even in ICU, they help with lung care and gentle movement), and perhaps a social worker or case manager fairly soon. Managing emotional shock and stress The moment you hear that you or a loved one has a spinal cord injury is often devastating. It is normal for the injured person, if conscious, or family member to experience shock, denial, fear, anger, and profound sadness. You are essentially grieving the sudden loss of the life you knew before. Recognise that this is a healthy grieving process – allow yourself to feel the emotions. You might find yourself on an emotional rollercoaster: hopeful one minute, despairing the next. This is common.

IMMEDIATE ACTIONS AFTER A SPINAL CORD INJURY

IMMEDIATE MEDICAL PROCEDURES AND INTERVENTIONS

Spinal Immobilisation/Stabilisation : Right after the injury (at the scene or in the ambulance), the spine is immobilised to prevent any movement that could worsen the damage. The patient’s neck and back are kept straight, often using a cervical collar (neck brace) and a spine board. In the hospital, they may use devices like a rigid neck collar or traction tongs (e.g., Gardner-Wells tongs) to hold the neck in place if the cervical vertebrae are dislocated. You might see your loved one on a special bed or with their head secured to keep the spine aligned. High-dose Steroids : In some cases, doctors might administer high-dose methylprednisolone (a steroid) within the first 8 hours after injury. This was a common protocol intended to reduce inflammation and secondary damage. However, its use is controversial and not standard in all hospitals now because of mixed evidence and side effects. Don’t be surprised if you hear a discussion of steroid treatment – the medical team will weigh benefits vs. risks. Ventilation support: If the injury is high in the neck (typically C1–C5), the patient may have difficulty breathing due to paralysis of the diaphragm and other breathing muscles. In such cases, they will be placed on a ventilator(breathing machine). A tube will be put into their windpipe (intubation) to help them breathe. Family should be prepared to see this in critical injuries – it can be temporary or, in very high injuries, sometimes long-term. Lower-level injuries usually don’t need a ventilator, but they might need supplemental oxygen initially if the chest muscles are weak. Surgery (Spinal Decompression and Fixation) : Emergency or urgent surgery is often performed to stabilise the spine and relieve pressure on the spinal cord. In this surgery, an orthopaedic or neurosurgeon will remove any bone fragments or slipped discs pressing on the cord (decompression). They will also fixate the spine with hardware (screws, rods, or plates) to hold the vertebrae in proper alignment. For example, if a vertebra is shattered, they may fuse the vertebrae above and below and insert metal rods to stabilise the spine. Early surgery (within 24 hours) is quite common if there’s cord compression; it can potentially improve outcomes or prevent any worsening. After surgery, the patient might wear a brace (like a rigid collar or TLSO brace for the trunk) for weeks while the spine heals. Traction: In some cervical injuries, especially dislocations, doctors might use traction to realign the spine. This could involve weights attached to a harness or tongs in the skull, gently pulling to reposition vertebrae. It’s an older treatment but is still used in some cases before surgery or if surgery must be delayed. In the early hours and days after an SCI, the medical team focuses on preventing further damage and stabilising the patient. Here are key interventions you should know:

DIAGNOSTIC TESTS FOR SCI

Doctors use several tests to evaluate a spinal cord injury, the following are some of those tests and what they hope to achieve:

X-rays Spinal X-rays can show fractures or dislocations of the vertebrae. In an

emergency, if a spinal injury is suspected, X- rays of the spine may be done to look for broken bones. However, X-rays don’t show the spinal cord itself. CT scan (Computerised Tomography) A CT scan is like a powerful X-ray that gives a detailed cross-sectional view of the spine. It’s often done in trauma cases to quickly see bone fragments pressing on the spinal cord or to pinpoint broken vertebrae. CTs are very good at showing bone injuries. MRI (Magnetic Resonance Imaging) An MRI uses strong magnets and radio waves to create detailed images of the spinal cord and nerves. It’s the best test to see the spinal cord tissue and any swelling, bleeding, or compression on the cord. MRI can show if a disc or bone fragment is pushing on the cord, and it helps guide whether surgery is needed. It can also assess any ligament injuries. MRIs take longer and are done once the patient is stable (since the machine is a tunnel you must lie in, sometimes sedated).

The injured person may get a CT scan in the emergency department and an MRI scan, shown above, a little later to assess the spinal cord injury fully. These tests help determine the level of injury and whether it’s complete or incomplete, although the neurological exam is also crucial.

PROGNOSIS AND FACTORS AFFECTING RECOVERY

One of the first questions those injured and their families ask is, “How much recovery is possible?” The honest answer is that it varies greatly from person to person. In this chapter we will look at the factors that determine the extent of recovery.

The severity and level of the injury are the biggest factors. If the injury is complete (no sensation or movement) below the injury, the chances of significant motor recovery are lower than if it’s incomplete. In contrast, incomplete injuries often have better prospects – many people regain at least some function over time, depending on what pathways are intact. The level of injury matters too: injuries lower in the spinal cord mean more of the body is unaffected (e.g., a lumbar injury leaves arms intact, which helps independence). Higher injuries (cervical) involve more critical functions like breathing and arm/hand movements, which are harder to recover fully. Additionally, recovery depends on individual factors such as age, overall health, and any other injuries. Younger people might have more neuroplasticity potential, whereas older individuals may recover slower. Prompt treatment is critical as well – getting pressure off the cord quickly (via surgery) and preventing low blood pressure or further trauma can reduce the extent of permanent damage.

In the early stages, a lot of damage to the spinal cord comes from swelling and secondary injury processes (inflammation, etc.). That’s why intensive care management (like maintaining blood flow to the cord and stabilising the spine) can influence outcomes. One useful measure the doctors use is whether any sensation or movement is present in the first 72 hours after injury. Generally, if a person has some pinprick sensation or toe movement early on, they’re more likely to improve over time than someone with none. But there are always exceptions and please do ask your consultant any questions around your prognosis, this is just a guide to help you have a general understanding of a spinal injury.

In short, the sooner the person can begin appropriate therapy (even if it’s just passive range of motion exercises in the ICU), the better the chances of regaining the highest level of function. Another reason early rehab matters is psychological: it engages the patient in their recovery and gives a sense of progress during a difficult time. Lying in bed for too long can lead to depression and more complications. So, expect that as soon as you or your loved one is out of immediate danger, therapists will start coming by – even in the ICU – to move limbs, sit them up gradually, and work with them. On the following page we look at emerging therapies which are not yet standard care. They offer hope that future improvements are possible. Your healthcare team can inform you if any clinical trials are available for which you or your loved one might qualify. In the meantime,

E arly improvement vs. long-term Most neurological recovery tends to happen in the first 6 months post-injury. The fastest gains are often within 3 months as swelling subsides and the spinal cord heals to whatever extent it can. However, that doesn’t mean recovery stops at 6 months. People can make smaller improvements up to 1-2 years after the injury. For example, someone might regain some additional sensation or muscle flicker in the second year that wasn’t there initially. Generally, incomplete injuries continue to improve longer and more than complete injuries. With a complete SCI, if no improvement is seen after 6 months to 1 year, the functional level is likely to be permanent, though the patient will still get stronger and more skilful in using their abilities and equipment. Keep in mind that recovery can mean different things. It could be neurological recovery (the return of movement/sensation) or functional recovery (learning to do more despite paralysis, using equipment or new techniques). Rehabilitation focuses a lot on the latter – maximising independence even if the nerves don’t recover fully. Importance of early intervention and rehabilitation Early rehabilitation – starting as soon as medically stable – is crucial for the best outcomes. Studies show that starting rehab early can improve functional results. Early physical therapy helps prevent muscle wasting and joint stiffness, keeping circulation and skin health in better shape. Early occupational therapy can ensure the patient can participate in self-care to whatever degree possible, which improves morale and prevents learned non-use. In the UK, specialised Spinal Cord Injury Centres aim to admit patients for intensive rehab as soon as possible after injury. Early rehab also means educating the patient and family early about preventing complications (like chest infections and pressure sores), which can set back recovery.

the focus will be on proven rehabilitation strategies to maximise current abilities.

Remember, every injury is unique. The healthcare team might not be able to give a clear prognosis immediately. Often, they will say, “We need to wait and see.” This isn’t to be evasive – it’s simply that the extent of recovery can’t be known right away. Generally, complete injuries have a low likelihood of significant motor recovery, but incomplete injuries have a wide range of possible outcomes. No matter what, with prompt treatment, rehab, and support, people with SCI can lead fulfilling lives. Many return to work or school, engage in sports (like wheelchair basketball or hand cycling), and have families. The road is challenging, but there is a community of SCI survivors out there living a full life. Focus on potential and not just limits but also prepare and plan for living with the injury as it is.

PROGNOSIS AND FACTORS AFFECTING RECOVERY

EMERGING MEDICAL TREATMENTS AND TECHNOLOGIES

Researchers are exploring whether stem cells or other interventions can repair the damaged spinal cord. Trials have been done injecting stem cells or progenitor cells to see if they can reconnect nerve pathways. As of now, there is no proven cure, but there have been a few cases of modest improvements in sensation or movement in clinical trials. Stem cell therapy is still under investigation – not a standard treatment yet. Families should be cautious of any clinics abroad promising miracle cures for large sums of money; always discuss with your medical team before considering experimental treatments. One promising area is epidural electrical stimulation. This involves implanting a device that delivers electrical currents to the spinal cord below the injury. Coupled with intensive training, some patients with complete injuries have been able to move their legs or even stand with support when the stimulator is on. It’s experimental but has shown exciting results in research settings. Functional Electrical Stimulation (FES) bikes are already used in rehab – these devices stimulate leg muscles to pedal a stationary bike, keeping muscles toned and potentially aiding circulation and bone health. Robotic exoskeletons are wearable battery-powered frames that can move a person’s legs in a walking motion. They allow some people with paraplegia to practice standing and walking in therapy. This can have health benefits (improved circulation, muscle and bone strength, bowel regularity) and psychological benefits, even if it’s not practical for full- time use yet. Robotic arms or assistive devices are also in development for those with limited hand function. Technology is making life easier. There are now lighter, more agile wheelchairs (even some that can climb stairs or elevate the user to reach high objects). Power wheelchairs can be controlled by very subtle movements, head controls, or even mind-controlled interfaces in experimental cases. Computer adaptations like voice recognition or eye- tracking allow those with high injuries to use phones, computers, and smart home devices (lights, thermostats, etc.) independently Scientists are studying drugs that might promote nerve growth or reduce scar formation in the cord. Some trials with medications that block certain chemicals (like those that form the scar tissue) are ongoing. No breakthrough drug is available yet, but it’s a field of intense research.

STEM CELL AND REGENERATIVE THERAPIES:

NEUROSTIMULATORS AND ELECTRICAL STIMULATION

EXOSKELETONS AND ROBOTICS

SACRAL INJURIES:

MEDICATION RESEARCH

Guide V1 February 2025

QUESTIONS TO ASK THE MEDICAL TEAM It’s often hard to know what to ask in the heat of the moment. Here are some important questions for the doctors (you might spread these out over the first week as things stabilise). Write down the answers if you can, or have another family member take notes. In stressful moments, it’s easy to forget what was said. Don’t hesitate to ask the same question again later – doctors understand this is a lot to process.

What exactly is the level of the spinal cord injury, and is it complete or incomplete? (Understanding this gives you a general idea of what functions might be affected.might be affected.

What immediate treatments are being done right now? (Surgery, medicines, etc., in simple terms.)

What complications are you watching for? (For example, ask about breathing, blood pressure, and any signs of additional injuries.)

What is the plan for the next 24–48 hours? (In ICU, plans are often day by day.)

Will I/ my loved one recover movement or feeling? (Be prepared: doctors may say it’s too early to tell. But it’s okay to ask their initial impressions.)

What will the short-term and long-term outlook be? (ask the team about short-term expectations and long-term recovery.

What kind of rehabilitation will I/ he/she need, and when might that start? (Knowing the next phase helps you mentally prepare.)

Are there ways I can assist or things I should do while in the hospital? (Sometimes, the family can help by talking to the patient, playing their favourite music etc

IMMEDIATE ACTIONS AFTER A SPINAL CORD INJURY

MANAGING EMOTIONAL SHOCK AND STRESS

Some practical tips for coping in the immediate aftermath of an injury:

Take it one day at a time: Try not to dwell on distant futures (“Will I/they ever walk? Will they ever have kids?”) in the first week. Focus on each day’s hurdles – ICU survival, successful surgery, etc. Get support for yourself: If the hospital has a counsellor or social worker, talk to them about how you feel. They often can connect you with resources, or even just listen. Sharing your fears and sadness with a professional or a trusted friend can be a relief. Take breaks and look after your basics: It’s easy to want to stay at the hospital 24/7. But remember to eat, stay hydrated, and sleep when you can. You won’t be any help if you collapse from exhaustion. Trade off with other family members to ensure someone rests at any given time. Use your support network: Let family and friends help – whether it’s bringing you meals, taking care of your kids at home, or just lending an ear. People generally want to help; it’s not a burden to accept it. Avoid information overload at first: The internet has tons of info, some scary, some outdated. It might help to assign one person to do research and filter it. Stick to reliable sources (major hospital websites, SCI associations) and remember each case is unique. Hope and realism: It’s okay to hope for the best, but also prepare for the possibility that life is going to be different. The doctors might not give you a firm “will he walk again” answer immediately. Over time, you’ll get a clearer picture. Try to balance hope with realistic expectations so that you’re not crushed by every bit of bad news. For many families, hope comes from seeing small improvements or simply from knowing their loved one survived such a catastrophic injury. It’s very important to realise you are not alone. Hospitals might be able to connect you with a peer mentor – perhaps a person with a spinal injury or a family member who can talk to you and share how they got through the early days. Talking with someone who truly understands can be incredibly comforting. Also, if you find yourself or your loved one dealing with intense anxiety, panic, or depression, ask for a psychologist or counsellor – emotional care is part of the overall treatment after SCI. In summary, the immediate stage after SCI is about medical and emotional stabilisation. Don’t rush yourself to “be strong” or “be okay”—this is a traumatic event for everyone involved. Take care of immediate needs, gather information gradually, and lean on professionals and friends for support. The road ahead is long, but you will not travel it alone.

“Once you choose hope, anything’s possible.” Christopher Reeve

IMMEDIATE ACTIONS AFTER A SPINAL CORD INJURY

LEGAL SUPPORT FOLLOWING AN SCI

A spinal cord injury can have life-changing consequences, and accessing the right legal support from day one is crucial for financial stability and rehabilitation. If the injury resulted from someone’s actions or negligence, seeking legal advice early can help secure compensation for medical costs, lost earnings, and ongoing care.

This guide is provided by Thompsons Solicitors , a UK-wide law firm specialising in serious injuries. We firmly believe that securing specialist legal support from day one is crucial for anyone affected by a spinal injury. Many people are unaware of the immediate support a lawyer can provide from day one following an injury. This chapter explains in more detail why seeking expert legal advice as soon as possible can make a significant difference following a spinal injury. A legal claim can provide long-term security and financial stability, helping families focus on rehabilitation and recovery rather than financial stress. Speaking with a legal expert can clarify your options even if you are unsure whether you have a case. Compensation Pursuing compensation is not just about damages for suffering – it’s about ensuring financial security and access to the best care. The funds can cover lost income, private rehabilitation, psychological therapy, travel expenses to appointments, special equipment (wheelchairs, communication devices), and even things like home renovations (if wheelchair ramps, stairlifts, or a downstairs bathroom are needed). In severe cases, compensation may account for lifelong care costs and even the purchase of a suitably adapted home.

Preserving Evidence A solicitor can help gather evidence while it’s fresh – witness statements, accident reports, CCTV footage – which will strengthen any future claim. Understanding Your Rights A Thompsons lawyer will inform you about the compensation you or your loved one might be entitled to (for pain and suffering, lost earnings, cost of care, etc.) and any time limits for making a claim. In the UK, generally, there’s a 3-year limit from the accident date to file a personal injury claim (exceptions for those who lack mental capacity), however, importantly they will immediately start looking at whether any rehabilitation can be paid for through interim payments. Interim Payments for Rehabilitation If there’s a good case that someone else was at fault, a lawyer can help you obtain interim payments – this means getting a portion of the compensation paid before the final case is settled. Interim payments can be a godsend: they can cover immediate expenses like specialist rehabilitation, home modifications, nursing care, or mobility equipment. In serious injury claims, courts (or insurance companies) often agree to interim payouts once liability is clear, so the injured person doesn’t have to wait years for the case to finish to get financial help.

In summary, getting legal advice from day one, or as early as possible, is important if someone else might be responsible for the injury; in doing this, you are looking out for your or your loved one’s long-term needs. Compensation can fund care, therapy, and support that make a huge difference in quality of life. Early legal involvement can also relieve you of handling insurance calls or paperwork, as the solicitor will take on those communications. While your focus remains on medical recovery, the lawyer works in parallel to protect future interests.

Interim payments for recovery continued: For example, with interim funds, your solicitor could hire a case manager to coordinate rehab and care needs or pay for private therapy sessions that the NHS waiting list might delay. These interventions can markedly improve recovery outcomes. No-Win No-Fee and Advice Thompsons Solicitors work on a “conditional fee” (no-win-no-fee) basis, meaning you don’t pay unless the case wins, so don’t let cost deter you from seeking advice. They offer a free initial consultation and will come and visit you, whether at home or at a hospital anywhere in the country.

Rehabilitation Code In the UK, there is something called the

Types of Compensation Depending on the cause of the spinal injury, different routes for compensation exist:

Rehabilitation Code in personal injury cases. It encourages the at-fault party’s insurer to fund the injured person's reasonable rehabilitation needs even before liability is fully resolved. Thompsons Solicitors specialist spinal injury lawyers can invoke this to get things like a private neurorehabilitation program funded early by insurance.

If it was a road traffic collision , your claim would typically be against the at-fault driver’s insurance. If it was a workplace injury , the employer’s liability insurance may cover it. If it was an assault or criminal act , you might claim through the government’s Criminal Injuries Compensation Authority (CICA) scheme. If you or a loved one was injured in a public place , and liability (blame) can be established, a claim could be against the property owner’s public liability insurance.

Our client Patrick in his converted home and specialist wheelchair, provided for from his compensation.

LEGAL SUPPORT FOLLOWING AN SCI

FINANCIAL ASSISTANCE AND BENEFITS (ENGLAND & WALES)

Regardless of fault or claims, if a spinal injury leaves your loved one with health needs or inability to work, there are various state benefits and supports you should explore. These can provide income or services while you focus on recovery. This chapter looks at the key benefits available to people in England & Wales with a SCI injury.

Some employers have more generous sick pay schemes – check the employment contract. Make sure to inform the employer as soon as feasible about the situation (you can do this on their behalf or provide a note from hospital) to claim SSP. Carer’s Allowance If a family member (spouse, parent, etc.) has to spend a lot of time caring for the injured person (at least 35 hours a week) and the injured person is receiving a disability benefit like PIP daily living, the carer might claim Carer’s Allowance . It’s about £76 per week. Note the carer’s own earnings have to be below a certain threshold to receive this. Carer’s Allowance is a recognition and slight financial relief for those who give up work or reduce hours to care for someone. Universal Credit (UC) This is a means-tested benefit for working-age people and those on low incomes. If the injury has affected your family finances (for example, the injured person and maybe their spouse have lost income), you might apply for UC, which can include a standard allowance plus additional for limited capability to work and perhaps a housing element if you rent. If the injured person is single, they may apply; if they have a partner, it’s a joint claim. Within UC, after health assessment, they can be placed in a no work requirement category due to illness.

Personal Independence Payment (PIP) This is a benefit for people under pension age with a long-term health condition or disability. It is not means-tested (doesn’t depend on income/savings). PIP has two components: daily living and mobility. A spinal injury survivor who needs help with personal tasks or has cognitive difficulties could qualify for the daily living component, and if they have mobility or orientation issues, for the mobility component. It’s meant to help with the extra costs of disability. PIP can be a few hundred pounds a month depending on the assessment. Employment and Support Allowance (ESA) If your loved one cannot work due to their health, ESA (or Universal Credit with limited capability for work component in the newer system) provides income replacement . Initially, if they were employed, they’ll get Statutory Sick Pay from their employer (see below), but after SSP is exhausted or if self-employed/unemployed, ESA/Universal Credit kicks in to provide a basic income while sick.

Statutory Sick Pay (SSP) If the injured person was working as an

employee, they are entitled to SSP from their employer for up to 28 weeks while they are off sick . It’s a fixed weekly amount (around £109 per week currently).

Also inform creditors – many will offer breathing space if they know someone had a major medical emergency. Costs of Rehabilitation The NHS will cover emergency treatment and in- hospital rehabilitation, but sometimes specialist neurorehabilitation units (especially longer-term residential rehab) have limited availability. Compensation or fundraising can come in if your loved one would benefit from a specific rehabilitation program or equipment not readily provided by NHS. Talk to the hospital’s discharge planner about what rehab is being arranged. You have the right to ask for a referral to a specialist centre if you feel your loved one needs it. There are also private rehabilitation facilities in the UK – as mentioned in the previous chapter, interim compensation payments can fund those if needed, or sometimes a personal health budget via the NHS can be arranged. Work and Employment If the injured person was working, keeping their employer in the loop (with appropriate notes from doctors) is important. The employer might hold the job open, or the person might eventually need to be medically retired if they can’t return. If you, as a family member, must stop working or cut hours to provide care, see if your employer offers compassionate leave or flexible working arrangements. You have a right to request flexible working and to take emergency dependants leave (short-term) in England & Wales. After the acute phase, if the survivor can attempt work, Access to Work grants can fund workplace adjustments or support. Some charities help with vocational rehabilitation.

Attendance Allowance: If your loved one is over the State Pension age and has disabilities from a spinal injury, Attendance Allowance is the equivalent benefit to PIP (for seniors). It helps with daily care costs. Industrial Injuries Disablement Benefit: If the SCI happened at work or was caused by work (e.g., falling from a height on a construction site), the injured person might qualify for this benefit, which compensates for disability from work injuries. NHS Continuing Healthcare (CHC) This is not a cash benefit, but if your loved one has very high care needs, they might be eligible for NHS Continuing Healthcare. The NHS funds the cost of care (at home or in a care facility) in full. This is usually for severe cases and involves an assessment. Council Services Local authorities can provide support after a spinal cord injury. For example, you can request a Care Needs Assessment for the injured person and a Carer’s Assessment for the family caregiver. These assessments determine if the council can provide services like in-home carers, respite care, equipment (special beds, wheelchairs), or adaptations to the home (through Disabled Facilities Grants). Many spinal cord injury survivors get helpful equipment or home modifications via the council. The NHS and social services also have rehabilitation support – some areas have community spinal cord injury teams that follow up after hospital. Interim financial help If your family’s income suddenly drops (say the injured person was the main earner), don’t wait to seek help. Aside from benefits, speak to your mortgage lender or landlord – some have policies for serious injury (like mortgage payment holidays).

Thompsons Solicitors have a team of employment lawyers ready to help you on employment matters.

FINANCIAL ASSISTANCE AND BENEFITS (UK)

All these legal and financial considerations can be overwhelming but tackling them one step at a time is empowering. While doctors heal the brain, benefits and claims heal the wallet and ensure you can afford the best care. Don’t shy away from getting professional advice from day one – a spinal injury is often a catastrophic event with ripple effects on income and costs, and there are systems in place to help. The key is knowing about them. LEGAL AND FINANCIAL CHECKLIST

Keep copies of all medical reports and discharge summaries – they will be useful evidence for benefits and claims.

Start a file for receipts of any injury-related expenses (travel to hospital, parking, meds you buy, etc.). These may be claimable later.

If police were involved (e.g., road accident or assault), note the officers’ names and crime reference number. This will help in insurance or CICA claims.

Contact your insurance (car insurance if RTA, or health insurance if you have any that covers rehab) promptly to notify them of the situation – they can’t help until they’re informed.

Check if your loved one had any insurance through work or personal (like critical illness or income protection) – now is the time to claim those if applicable.

Speak to Nicola Saunders a specialist in spinal injuries at Thompsons Solicitors as soon as possible on 07970 787213 to arrange a meeting or have a confidential, no obligation discussion.

PRACTICAL TIPS FOR FAMILIES AND CAREGIVERS

Caring for someone with a spinal cord injury can be challenging, especially at first. In this section, we share practical tips to help families navigate healthcare conversations, find support, and take care of themselves as caregivers. These suggestions come from healthcare experts and experienced SCI families.

Communicating with Healthcare Professionals

Be present at care meetings if possible. Hospitals often have team meetings or family conferences where the whole team discusses progress and plans. Attend these when you can. It’s a chance to hear everyone’s perspective and ask multidisciplinary questions (like how does the therapy plan align with the medical plan, etc.). Designate a primary communicator. If there are multiple family members, decide who will be the main point of contact with the medical team to avoid confusion. That person can then update others. You can, of course, all be involved emotionally, but having one voice for decision- making discussions can streamline communication.

Effective communication with doctors, nurses, and therapists ensures better care for your loved one. Here are some strategies: Ask questions – and don’t be shy about it. If you don’t understand something, ask the doctor or nurse to explain in plain language. Medical staff may use jargon unintentionally; it’s okay to say, “Can you clarify what that means for me?” Keep a running list of questions on your phone or a notebook so you remember them during rounds or appointments. Keep notes or a journal of medical information. Especially in the hospital, you’ll receive a lot of information. Write down key points from conversations with the medical team – for example, the plan for the day, medications and dosages, or precautions to follow. This not only helps you remember, but also provides a record you can refer to later. Some families find it useful to maintain a binder with sections (for therapy notes, doctor’s notes, contacts, etc.).

Build rapport with the staff. Learn the names of the nurses and

therapists; a friendly working relationship can go a long way. Don’t hesitate to share a bit about your loved one’s personality and preferences – it helps staff see them as a person, not just a patient. For example, telling the nurses “He loves football and would appreciate catching the match on Sunday if possible” humanises the care.

Bring someone with you to appointments (once in outpatient stage) Having an extra set of ears is invaluable. They might catch details you miss, or think of additional questions. This is especially useful for big consultations (e.g., with a spinal surgeon or rehab doctor). A companion can also help remember instructions or take notes. Be honest and accurate when reporting info. Whether it’s describing the patient’s pain, mood, or any issue, try to be specific. Instead of “He’s in pain,” say “He rates his pain around 8/10 in his legs especially in the evenings.” This helps the team address it properly. Learn the routine and whom to ask for what. In hospital or rehab, certain questions are best for certain professionals (medication issues – ask the nurse or doctor; therapy schedule – ask the therapist; equipment problem – maybe the rehab engineer or OT). Understanding roles saves time. If you’re not sure, ask any staff and they’ll direct you. Confirm your understanding. At the end of a discussion, you can summarise: “So the plan is, we’ll try the new bladder medication and follow up in two weeks, correct?” This ensures everyone is on the same page. Keep communication respectful and constructive. Emotions can run high, but approach issues calmly. If you disagree with something, voice it as a concern (“I’m worried this plan might not be working because…”) rather than confrontation. Most providers truly want what’s best, and collaborative communication yields better outcomes.

PRACTICAL TIPS FOR FAMILIES AND CAREGIVERS

FINDING SUPPORT GROUPS AND COMMUNITY RESOURCES

You and your loved ones are joining a larger community of people affected by spinal injuries. Whilst it is not a club anyone wants to join, tapping into that community can provide emotional support, practical tips, and a sense of not being alone.

Spinal Injuries Association (SIA) The SIA is a UK charity that supports SCI people and families. They have many resources, including a telephone helpline, peer support services, and local groups. Their website’s “Knowledge Hub” covers everything from bowel care to mental health to legal rights. SIA can connect you with a peer mentor – someone living with an SCI who can mentor your injured loved one (and sometimes a separate one for family members). They also have regular forums and events to meet others in similar situations. Back Up Trust Back Up is another UK charity focusing on practical skills and support, including for family members. They run wheelchair skills training, residential rehab courses, and even adventures like skiing trips for people with SCI. Importantly, they have dedicated services for the family, such as a family mentoring servicewhere you, as a parent/partner/sibling, can be matched with another family member who’s been through it. They also host “relatives’ days” – group sessions (often online nowadays) where families of newly injured individuals can learn and share. These services are often free. Back-Up emphasises that family members often feel guilt, helplessness, and isolation, and they provide a safe space to talk about those feelings. ·

Online communities SCI has many online forums and social media groups (Facebook, etc.). For example, the CareCure forums or Reddit’s r/spinalcordinjuries can connect you with a global community. People ask questions like “How do you manage to sleep with a catheter?” or “Any tips for travelling on a plane in a wheelchair?” and get answers from those who’ve done it. Be mindful that experiences vary, but discussing with peers is comforting. Local support groups Some regions have local SCI support groups, possibly organised by your regional spinal centre or a charity. These might meet monthly. Ask your social worker or SIA about any near you. Meeting in person (or over Zoom) with others in your area can lead to friendships and sharing of resources (like “which local GP is good with SCI patients” or “which pub in town is wheelchair accessible”). Condition-specific organisations If you or your loved one’s injury has specific aspects, like being injured in military service, Blesma (for limbless vets, though they also help SCI) or Help for Heroes might have programs. If the cause was something like Transverse Myelitis, there are groups for that, too.

Counselling and therapy Both you and your loved one might benefit from professional counselling at different stages. Don’t hesitate to seek therapy – it’s not a sign of weakness but a tool for coping. Some charities offer free counselling for a limited number of sessions for SCI folks or families. Respite care services Local councils or charities may offer respite (someone to take over care for a short period) to give family caregivers a break. Even a few hours a week can help, or the option of a week’s respite stay in a care facility if the caregiver is ill or needs rest. Explore this through your council’s adult social care department or ask a SCI support org for leads. Community healthcare resources Remember to use community nurses, OTs, and other services offered by the NHS or social services. They are there to support you at home – for instance, a continence nurse can help adjust bladder programs if you’re struggling, or a tissue viability nurse can advise on wound care for pressure sores. Educational resources Knowledge is power. Consider attending any educational program offered. Some spinal centres offer follow-up educational days or refresher programs for those injured. There are also good reading materials: for example, the MSKTC (Model Systems Knowledge Translation Centre) in the US has free consumer fact sheets on many SCI topics (like “Depression after SCI,” “Bowel management options,” etc.) which are quite applicable to UK readers too. The more you know, the more confident you’ll be.

We wish you the very best on your journey. If you do require legal advice, we recommend seeking support from our specialist spinal injury solicitors at the earliest opportunity, we are here to help from day one .

Disclaimer:

This guide has been produced by Thompsons Solicitors and is intended purely as an informational resource for those affected by spinal injuries and their loved ones. While we aim to provide helpful insights, this guide does not replace the specialist advice and recommendations of medical professionals. Every spinal injury is unique, and prognosis, treatment, and rehabilitation will vary from person to person. It is essential to consult your consultant and medical team and follow their guidance as a priority.

FINDING SUPPORT GROUPS AND COMMUNITY RESOURCES

Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28

www.thompsons.law

Made with FlippingBook Digital Publishing Software