Therapy must show measurable benefit to support a case for its continuance

[ MY THERAPY RECOMMENDATIONS are based on a long career in traumatic brain injury (TBI) developed around an accepted approach for this client group. Unfortunately, I am seeing more and more cases where the approach employed by the treating clinician does not follow the proven model.

That model is not cast in stone, and it is justifiable for the treating therapist to steer the intervention in any direction they feel will achieve results; but it is essential that, if the treating therapist breaks from the model, they can still achieve with the claimant an appropriate and measurable level of progress for the amount of time invested. The intervention must deliver value for money.

It is understood that therapy does not come with a guarantee. If the accepted model is followed and a reassessment then shows that the anticipated results haven’t been achieved – in the absence of some other attributable cause – then it is acceptable to reach the conclusion that the claimant has plateaued sooner than expected. The problem arises when the therapist appears not to have targeted the fundamental areas examined in formal assessment and no quantifiable gains appear to have been made. That situation is gold for the defence expert, but a nightmare for the claimant’s expert.

It is essential that SMART (Specific, Measurable, Achievable, Relevant and Time-Bound) goals are used and delivered upon, for the expert to be able to make a case for continued impairmentbased therapy and not be left trying to justify a continuance with no solid evidence.

Assuming joint discussions are not imminent, the claimant’s expert might continue to support the therapy rather than advocating a move to maintenance levels. If this doesn’t then produce a measurable improvement the claimant’s expert will enter the joint discussion at a serious disadvantage, potentially forced to defend why intervention hadn’t already moved to maintenance and undermine any argument for further therapy.

Sadly, the claimant may still have been capable of making measurable progress had the therapist targeted the right areas and employed an approach that is acknowledged as capable of getting results. That leaves the claimant at serious risk of losing out on the therapy they deserve.

The treating therapist has a duty to the claimant to work with the expert to gather the evidence to justify the provision. Moreover, the treating therapist can make or dismantle the case for future intervention. q

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