How Expert Witness Physiotherapists Can Maximise Quantum In PI Cases

When it comes to an understanding of the process of rehabilitation of soft tissue injuries, physiotherapists should be the experts of choice. Their hands-on knowledge of diagnosis, recovery rates and treatment costs gives them an advantage when it comes to assessing quantum and outcome. And their charges are generally less than those of GPs and orthopaedic surgeons.

Traditionally, personal injury cases involve a report from an orthopaedic consultant or general practitioner to help establish the nature of the medical condition and its causation and prognosis. An experienced clinical physiotherapist can offer a complete understanding of the whole process from first injury right the way through to recovery. Armed with this knowledge, a more thorough and wide-ranging report can be provided that will accurately reflect the extent and timing of patient recovery – essential when considering issues of quantum and future care costs.

Soft tissue injuries are injuries not involving bony damage such as fractures. They are often incurred as a result of whiplash or repetitive strain and, as the name implies, only involve damage to muscles, tendons, ligaments, fascia and nerves. The damage is usually invisible on x-rays and scans and can be detected only by skilled examination. Torn muscles, ligaments, nerves and cartilages may require a surgeon’s skills. But once this primary care has been administered, the client will invariably be referred to a physiotherapist. A physiotherapist can provide specific and individually tailored treatment aimed at assisting the body’s natural healing and restoring full function.

Examples of relevant soft tissue injuries include:

•Tendonitis
•Tenosynovitis
•Muscle strains
•Lifting injuries
•Lower back pain
•Epicondylitis
•Carpal tunnel syndrome
•Whiplash injuries
•Work-related upper limb disorders.

When examining issues of quantum and future costs, it is essential that a lawyer receives the whole picture: the exact nature of the injury, detail of treatment, likelihood of full recovery, timing of recovery, and an indication of future care costs, if any. An experienced physiotherapist in clinical practice has a wealth of relevant expertise.

A clinical physiotherapist is usually involved with a patient from presentation of the injury through to the end of rehabilitation. Treatment can be broadly divided into four stages:

1: Conducting a detailed specific examination to identify the body structures damaged and any loss of function.
2: Devising a treatment programme.
3 Implementing the treatment programme.
4 Seeing the patient through to the end of rehabilitation – hopefully back to ‘normality’.

The ‘hands-on’ nature of the patient-therapist relationship, plus the inevitably regular patient contact, give physiotherapists an enormous advantage when it comes to diagnosing and treating a complex soft tissue injury. In addition, the wealth of knowledge relating to rates of recovery from the various soft tissue injuries means that when it is applied to cases requiring an evaluation of quantum and likelihood of recovery, the lawyer receives an opinion from an expert with an understanding of the whole rehabilitation process.

Client history:

Any comprehensive account of the background to an injury (particularly where it is work-related) should include information about the claimant’s regular daily activities, whether in a work environment or home situation. A physiotherapist is accustomed to observing and assessing the impact of a client’s environment on his or her injury. This is an essential consideration when seeking to restore full function.

Case Example:

Mr T had been using an improvised workstation and subsequently incurred severe soft tissue injuries. The physiotherapist identified how the postural stresses on the body had resulted in the patient’s symptoms. Excruciating pain along the spine – relieved only by lying flat – and severe pain and tenderness of the forearms were the consequence of sitting for 3 months of intensive work on a laptop.

Client Examination:

Soft tissue injuries are difficult to assess accurately, with x-rays and scans rarely providing useful evidence. Even nerve conduction tests are of little value when assessing damage to nerves subjected to excessive stress. What is required is an evaluation of any adverse mechanical tension within the nervous system which may be restricting movement.

Physiotherapists are used to palpating and testing specific structures within the body to diagnose exactly what has been damaged, i.e. whether it is a tendon, a tendon sheath, muscle, fascia, a nerve or any combination of these. A physiotherapist can help in differentiating between whether the client’s condition is constitutional and has been aggravated by work or trauma, or is caused by work or trauma.

There is a growing acknowledgement of the need for a biopsychosocial assessment when examining people, and this is the approach traditionally taken by a physiotherapist. Social history and status, mental and emotional states, as well as working situation and lifestyle, can all contribute to how the patient reacts to and copes with symptoms.

There are many standard tests that can help with the assessment of the physical condition. One such example is the straight leg raise. The test involves the patient lying comfortably relaxed on his back. The examiner places one hand under the Achilles tendon and the other above the knee. The leg is lifted perpendicular to the bed, with the hand above the knee preventing any knee bend. The leg should be lifted as a solid lever moving at a fixed point in the hip joint.

This is a simple biomechanical test that has been recognised for hundreds of years as a way of identifying lumbar spine (lower back) problems. However, it is of limited value only. When the leg is lifted in the manner described, many structures move – the hamstring muscles, the lumbar spine, the hip and sacro-iliac joints and fascia, as well as the nerves. Pathology of any of these structures may affect the client’s reaction to the test.

An experienced physiotherapist will combine such tests with detailed palpation and observation of functional movements to arrive at the all-important specific diagnosis. In addition, the patient’s posture and manner of movement will be analysed and the results added to the overall assessment.

Case example:

Mrs B was secretly videoed by an insurance company while shopping. A physiotherapist was able to identify how the client had become so used to coping with her injuries that she avoided a lot of the normal, potentially painful, actions employed by other women shopping, e.g. standing upright with arms by her side most of the time, avoiding heavy or bulky items, loading carrier bags lightly, and using both hands to carry each bag.

Expert opinion:

An experienced clinical physiotherapist possesses an unrivalled knowledge and comprehension of how the body works under normal conditions and when coping with a disability or soft tissue injury. With regular and prolonged experience of treating soft tissue injuries, a physiotherapist can offer a valuable and meaningful opinion about all aspects of treatment and recovery.

Prognosis:

An essential component of any medico-legal report is a prediction of future developments on a balance of probabilities basis. A clinical physiotherapist sees large numbers of similar injuries from first contact through to recovery, and can thus give a reasoned prognosis based on experience. This should include the likelihood and anticipated timing of resolution, the need for further treatment and any possible long-term disability.

Conclusion:

When a lawyer is trying to find an expert witness that can help with soft issue PI cases it is worth considering an experienced physiotherapist can bring a unique and valuable perspective in any personal injury case involving a soft tissue injury. Experience of patients from first injury right through to recovery gives such specialists the widest professional knowledge when it comes to assessing future treatment and costs thereof, and arming the lawyer with the necessary detail to fully assess quantum.

Malls Without Walls Make Quantum Leaps

These all new e-malls have a new name with a new face. Their new name is “Multi-Niche, Cooperative, Next-Generation, Super-Mall of e-Stores.” They are not like anything you have seen before. They are multi-niche because they have something for everyone. They are cooperative in that they “partner” with established and trusted businesses for mutual benefits. They are next-generation in that they are just as unique as tomorrow. They are a super-mall of e-stores in that there is an unlimited number of products and services they can present to the public at rock-bottom prices from gourmet cookies to laboratory microscopes to the latest cell phones to fishing or sporting gear through their “partners.” With a flexible format these “malls without walls” are easily enlarged and modified.

Even though they are BIG, they are easy to use. They have a “mall office” where you can find customer support and mall updates. Their office is updated regularly. The whole mall is user-friendly and family safe. There is nothing objectionable about them anywhere. Everything is in a logical, commonsense format which is all controlled from their Home Page. All the latest technologies are used to make shopping easy and enjoyable from the comfort of your home, your office or when you are trout fishing out in the wild.

They have a “window” for each of their e-store so you can “window shop” before you go inside to find the things you want. They are set up in such a way that you can enter the e-store of your choice without doing any “window shopping.” The “departments” allow you to see the big picture for each niche.

They are modeled after a brick and mortar mall but without the walls. When you “drive” with a URL to one of these malls, you will see a beautiful display of “e-stores.” You can do some “window shopping” as you stroll down their “hall” at the center of the Home Page or take a right turn and “walk” into one of their many e-stores. You go to their partner’s “window” by clicking on their partner’s name in the center column.

In summary, this all-new mall:

1. Puts everything in one place;
2. Makes it easy to conveniently shop;
3. Is user-friendly and family safe;
4. Has hundreds of thousands of products and services;
5. Has over 250 specialty stores;
6. Is organized for maximum usefulness;
7. Has the customer’s best interest in mind;
8. Can be enlarged and modified easily;
9. Appeals to all niches;
10. Has well-known and respected “partners;”
11. Does not throw ads in its visitor’s face;
12. Is open 24/7/365 for the customer’s convenience;
13. Can be accessed from any location; and
14. Looks really beautiful, too.

Rune Meanings Rune-LAF Calms Emotions

RUNE-LAF is a rune symbol for THE SEA, it calms the emotions.

Calm your emotions by combining the Ancient Wisdom of the Runes with the power of Quantum Physics. This is the fourteenth rune that will continue you on the road to health, wealth and happiness.

The sea and water are synonyms for our EMOTIONS. Our emotional natures. Besides our physical and mental bodies we also have an emotional body.

I hope by now that you have been practicing the RUNIC BREATHING MEDITATIONS. If you have then the energies that are coming to you from the Quantum Ocean are already starting to change your life for the better.

What is a rune meditation? There are thousands of books written about meditation techniques. But the most important question you must ask yourself is why do you want to meditate? For what reason? What do you want to accomplish?

Life is a series of events that pass upon our consciousness in sequential order. Each event is an energy relationship. When you leave your home in the morning and stop for coffeee … that is an event. What is happening? You have just placed your self (energy unit) in another energy unit, the coffee shop. There will be an energy exchange and a relationship (third energy) set up because of the meeting. During the day many of these energy events will have very little effect upon you. But some will. Some may even change your life.

Meditation is an event. When you are sitting very quietly in your chair and you breathe softly and reach out with your mind and touch something. You cause an energy exchange. So be careful who and what you touch in your meditations. Passive meditation is very dangerous. Because you leave yourself wide open. Your castle is left unguarded, the porticulus is down. Any strange energy can come along and attack you. Runic Meditation is good and safe. Since the runes are untainted Universal Creative Energies — you will be reaching out and touching the Mind of God, so to speak. All the energy exchanges between you and the Runic energies will be very beneficial. You can pick and choose on a daily basis which energies you want to touch. What energies you want to manifest in your life. It will be a runic transfusion.

RUNE-LAF. Runes have been around for a long time. Well before the Viking Age. And even well before man used language on this planet. They are creative energies. Non-verbal energies. The secret to attracting your desires in life is to get these energies inside your aura. They will then attract into your life what you desire. Each individual rune opens a door to the realms of creation. (Quantum Ocean).

RUNE LAF’s primary funciton is to help you CALM YOUR EMOTIONS. Since LAF is the Rune of the Sea, the Vikings used to paint it on the bow of their dragon ships to calm the sea. Other Rune LAF meanings: Rune of the Sea-Rune of Life-Origianl waters-Clams the Etheric Body-Life is a Continuous Process of Initiation

How does RUNE-LAF calm your emotions? Many of life’s illnesses come through emotionally charged thoughts. Negative emotions punch holes in our etheric body. This causes illnesses. Rune-LAF fills you with an energy from the Quantum Ocean that can be called the energy of “Original Waters.” They dissolve those negative emotions and start to heal and add strength to your emotional body. It helps you attract Emotional Self-Control . This increases your powers. To have calm positve emotions does not mean you have to become a sweetness and sunshine goody two shoes. No!. The key to conscious life is for you to control your emotions and not let them control you. Learn to use your anger, fear, self-assertiveness as powerful positive energies in your life.