Paul M. Deutsch & Associates, P.A. Life Care Plan DOB · burns and amputation. The psychologist can...

Michael Curry Projected Evaluations

Life Care Plan

Item / Service Age Year Purpose Cost Recommended ByCommentFrequency/

Replacement

DOB: Oct 27, 1971Aug 27, 2005Jan 12, 2007Electrical BurnsBilateral UpperExtremities

D/A:

Primary Disability:Date Prepared:

Paul M. Deutsch & Associates, P.A.10 Windsormere Way, Suite 400Oviedo, FL 32765(407) 977-3223 Fax (407) 977-0311

Rehabilitation andLong-Term NeedsAssessment

Assess handicappingconditions $0 - $0

Per Year

Paul M. Deutsch,Ph.D., CRC, CCM,CLCP, FIALCP Lic.Mental Hlth. Couns.(Chptr. 491 Psych.Pract. Act.)

Ending

Beginning Per Unit

A life care plan is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis, and research, which provides an organized,concise plan for current and future needs, with associated costs, for individuals who have experienced catastrophic injury or have chronic health care needs. (IALCP -International Academy of Life Care Planners, 2003. Definition established during the 2000 Life Care Planning Summit)

Through the development of a comprehensive Life Care Plan, a clear, concise, and sensible presentation of the complex requirements of the patient are identified as a means ofdocumenting current and future medical needs for individuals who have experienced catastrophic injury or have chronic health care needs.

The goals of a comprehensive Life Care Plan are to: improve and maintain the clinical state of the patient; prevent secondary complications; provide the clinical and physicalenvironment for optimal recovery; provide support for the family; and to provide a disability management program aimed at preventing unnecessary complications and minimizingthe long-term care needs of the patient.

1 X Only, Alreadyaccomplished.

1

34 8/17/06

34 8/17/06

Growth Trend To Be Determined By Economist. Table 2 Copyright ©1994. page 1


Life Care Plan


Replacement


D/A:



Psychological Assess need foradjustment counselingand formulate treatmentplan.

$270 - $380

Per Year


Ending

Unit cost based on a two hourevaluation.

Beginning Per Unit

Electrical shock patients represent a challenge for the neurorehabilitation specialist. Successful management usually requires a broad-based approach incorporatingpsychologic counseling and education as to the nature of the symptoms as well as medical attention to specific complaints. Patients may benefit from both individual andsupport-group therapy. Family and vocational issues may benefit from a team approach. Therapeutic interventions are usually symptom-focused. The pathophysiology of thecomplaints in the post-lightning, postelectric shock syndrome is poorly understood. The psychologic, psychophysiologic and “organic” components are not well separated.These patients represent a challenging and possibly prolonged management problem. Source: Neurorehabilitation of Lightning and Electrical Injuries, P. Yarnell, MD, D.Lammertse, MD, Seminars in Neurology - Volume 15, No. 4, 12/1995.

Long-term neuropsychiatric complications include depression, anxiety, inability to continue in the same profession, aggressive behavior, and suicide. Source: Cooper, MaryAnn and Price, Timothy G. ELECTRICAL AND LIGHTNING INJURIES. http://www.uic.edu/labs/lightninginjury/Electr&Ltn.pdf

Amputation as a consequence of burn injury presents unique challenges to the rehabilitation team. Early involvement of a psychologist can help address emotional adjustment toburns and amputation. The psychologist can also assess for cognitive impairment given the high incidence of neurologic sequelae. Psychologic adjustment issues are commonin burn patients. Fukunishi found the incidence of post-traumatic stress disorder and major depression was 34% and 7% respectively. These patients will benefit from counseling,psychotherapy and pharmacologic agents. As the patient becomes more proficient with his prosthesis, a vocational rehabilitation assessment would be appropriate for possiblereintegration into the workforce. Source: Huang, Mark E., MD; Nelson, Virginia S., MD, MPH; Flood, Katherine M., MD; Roberts, Toni, L., DO; Bryant, Phillip R., DO; Pasquina,Paul R., MD. Limb Deficiency and Prosthetic Management. 3. Complex Limb Deficiency. Archives of Physical Medicine and Rehabilitation, Volume 87, Supplement 1, March2006, pp. S15 - S20.

1 X Only

2

35 1/2007

35 1/2007



Life Care Plan


Replacement


D/A:



NeuropsychologicalTesting

Evaluate cognitivedeficits associated withelectrical injury

$2800 - $4000

Per Year


Ending

Beginning Per Unit


Amputation as a consequence of burn injury presents unique challenges to the rehabilitation team. Early involvement of a psychologist can help address emotional adjustment toburns and amputation. The psychologist can also assess for cognitive impairment given the high incidence of neurologic sequelae. Source: Huang, Mark E., MD; Nelson,Virginia S., MD, MPH; Flood, Katherine M., MD; Roberts, Toni, L., DO; Bryant, Phillip R., DO; Pasquina, Paul R., MD. Limb Deficiency and Prosthetic Management. 3. ComplexLimb Deficiency. Archives of Physical Medicine and Rehabilitation, Volume 87, Supplement 1, March 2006, pp. S15 - S20.

Neurobehavioral problems after lightning and electrical injuries are diverse. Commonly reported are decreased cognitive function, pain syndromes, depression, post-traumaticstress disorder and significant alterations in social and work roles. Studies of lightning and electrical injuries have identified disabling neuropsychiatric changes for somesurvivors, often persistent and influenced by individual premorbid emotional and coping patterns. Standards of care in the fields of brain injury, behavioral medicine, andpsychotherapy can inform rehabilitation strategies. Proper assessment is important, as well as an individualized approach to treatment. Multidisciplinary intervention focuses onmanaging symptoms, learning compensatory skills, providing psychosocial support and preventing maladaptive behaviors. Source: Primeau, Margaret. Neurorehabilitation ofbehavioral disorders following lightning and electrical trauma. Neurorehabilitation 20 (2005), pp. 25-33.

1 X Only

3

35 1/2007

35 1/2007



Life Care Plan


Replacement


D/A:



Occupational Therapy Reassess need fortherapy and formulatetreatment plan; thereafterperiodic reassessment.

$300 - $400

Per Year

Marco Rodriguez,M.D. and Raj Patel,M.D.

Ending

Beginning Per Unit

The rehabilitation protocol must be modified to the individual patient in question. The clinician should approach each patient individually and progress them with a personalized andtailored approach in close communication with the surgeon and therapist. Functional hand motion and strength are the end results of successful flexor tendon surgery andrehabilitation (Vucekovich, 2005). Source: Bolitho, Glynn, M.D., Ph.D., FACS. Hand, Tendon Lacerations: Flexors. Last Updated; June 8, 2006.www.emedicine.com/Plastic/topic331.htm

The burn therapists' goals are to restore the general condition of the patient, achieve wound healing and full functional recovery, eventually with good cosmetic results. Earlyprevention of contractures is obtained by positioning/splinting and exercises. Later, when wound coverage is nearly complete, the patient is enrolled in the rehabilitation phase.Emphasis is given on the recovery of function and strength, by the use of ROM, composite and functional movements patterns, passively and/or actively performed. In therehabilitation phase, scar management should be discussed and followed-up by the different specialists (requiring eventually medical, surgical and physical-kinesi therapies). Intrauma cases complicated by amputation and/or neurological problems, progress is enhanced by rehabilitation engineering. The goal of rehabilitation is the restoration of anindividual with a disability from lightning or electrical trauma back into society. Successful rehabilitation requires a team effort. The team includes those in the medical andtherapeutic fields, those in the sociological and psychological fields, rehabilitation engineers and technologists, basic and clinical scientists, consumer groups and the individualhim/herself. The key to success in the management of patients with electrical burn injuries is the constant communication and discussion among the various members of theteam. Source: Selvaggi, Gennaro; Monstrey, Stan; Van Landuyt, Koen; Hamdi, Moustapha and Blondeel, Phillip. Rehabilitation of burn injured patients following lightning andelectrical trauma. Neurorehabilitation, 20 (2005), pp. 35-42.

1 X now; then 1 X/ year for 3 years;thereafter 1 Xevery 3-4 years.

4

35 1/2007

Life Exp.



Life Care Plan


Replacement


D/A:



Assistive TechnologyEvaluation

Evaluateequipment/aides forindependent functionwhich will enhance hisindependence.

$250 - $350

Per Year


Ending

Beginning Per Unit

Assistive Technology is any item, piece of equipment, or system, whether acquired commercially, modified, or customized, that is commonly used to increase, maintain, orimprove functional capabilities of individuals with disabilities. Source: Publication of the Office of the CIO/HPCC, National Oceanic & Atmospheric Administration (NOAA), U.S.Department of Commerce. http://www.masc.noaa.gov/masc/amd/section508/attach_a_addem_6-24.html

Occupational Therapy: Assistive Technology assessment and evaluation providers are most often licensed and or certified in related fields such as Physical Therapy,Occupational Therapy, and Speech/Language Pathology. Rehabilitation Engineers, while not certified/licensed, have engineering or technology backgrounds. OccupationalTherapists are professionals who have training and expertise in clinically recognized areas. All practicing therapists must pass standardized tests and be certified or licensed intheir field. Qualified therapists have a working knowledge of assistive technology foundations, devices, and applications, and can complete a formal AT assessment which maybe required by your funding source. Standards for formal AT assessments vary, but a good assessment should verify a need for assistive technology and verify that therecommended AT will meet that need. Source; TechACCESS Home Page. What is an Assistive Technology Assessment? http://www.techaccess-ri.org/assess1.htm

1 X / 3-4 Years

5

35 1/2007

Life Exp.

Nutritional Evaluation Provide nutritionalcounseling make dietaryrecommendations toenhance healing andmaintain weight.

$75 - $125

$150 - $250Per Year

Paul M. Deutsch,Ph.D., CRC, CCM,CLCP, FIALCPbased on medicalinformation andclient interview

Ending

Beginning Per Unit

If a patient with wounds has undetected or untreated nutritional deficiencies, wound care may be even more compromised than usual in achieving a healing status. Wounddehiscence and poor healing after surgery has been correlated with Vitamin C and Zinc deficiency as well as hypoproteinemia. Impaired antibody production, decreased hostresistance to infection, decreased white cell proliferative response and depression of skin reactivity to antigens have been associated with weight loss and decreased serumalbumin in patients. If calorie-protein intake stops for 24 hours, collagen synthesis halts and wound healing is adversely affected. Vitamin C has been noted for years to berequired for stable collagen synthesis that results in well healed wounds. Vitamin C is noted to be deficient after major trauma and requires replacement. It is also noted to bedeficient in the population in some instances. Nutritional assessment can help identify individuals who are compromised and at risk for impeded wound healing. Nutritionalassessment may be broken down into four basic components: 1) anthropometrics; 2) biochemical measures; 3) clinical data and health history; and 4) dietary history includingintake data. An individual's calorie and protein needs may be determined and an appropriate nutrition care plan can be implemented and monitored. Source: Nutrition in WoundHealing. http://woundhealer.com/e_nutrition/nutrition_in_wound_healing.htm

2 X / Year

6

35 1/2007

Life Exp.



Life Care Plan


Replacement


D/A:



Recreational Therapy Evaluate and makerecommendations foradaptive activities.

$350 - $450

Per Year


Ending

Evaluation cost includes the cost ofstart-up equipment and supplies.

Beginning Per Unit

Recreational Therapy Outcomes: In the areas of physical medicine and rehabilitation, studies have documented these Recreational Therapy outcomes: Improvedphysical health; Reduced complications related to secondary disability; Improved long-term health status and reduced health risk factors; Improved cognitive functioning;Improved psychosocial health and well-being; Reduced reliance on the health care system; Increased life satisfaction; High-quality social relationships; Decreased depression;Increased self-efficacy, self-confidence, and adjustment to disability; Improved self-esteem; Increased ability to use activity to cope with stress from hospitalization/illness;Decreased social isolation; Increased perceived quality of life; Improved community functioning and ability to overcome barriers. Source: Sorensen, Beth, MS, TRS/CTRS,CCM; Luken, Karen, MS, TRS/CTRS. Improving Functional Outcomes with Recreational Therapy. The Case Manager, September/October 1999, pages 48 - 52.

1 X / 3-4 Years

7

35 1/2007

70 2041

Vocational Evaluation Assess currentvocational status in orderto make adaptiverecommendations toinsure continuedemployment.

$1500 - $2500

Per Year


Ending

Beginning Per Unit

Amputation as a consequence of burn injury presents unique challenges to the rehabilitation team. Early involvement of a psychologist can help address emotional adjustment toburns and amputation. The psychologist can also assess for cognitive impairment given the high incidence of neurologic sequelae. As the patient becomes more proficient withhis prosthesis, a vocational rehabilitation assessment would be appropriate for possible reintegration into the workforce. Source: Huang, Mark E., MD; Nelson, Virginia S., MD,MPH; Flood, Katherine M., MD; Roberts, Toni, L., DO; Bryant, Phillip R., DO; Pasquina, Paul R., MD. Limb Deficiency and Prosthetic Management. 3. Complex Limb Deficiency.Archives of Physical Medicine and Rehabilitation, Volume 87, Supplement 1, March 2006, pp. S15 - S20.

1 X Only

8

35 1/2007

35 1/2007


Michael Curry Projected Therapeutic Modalities

Life Care Plan


Replacement


D/A:



Individual Counseling Aid in psychosocialadjustment and areduction in depression.

$135 - $170

Per Year


Ending

$6,480 - $8,160 for 48 sessions; then$3,240 - $4,080 for 24 sessions;thereafter $610 - $915 / year.

Beginning Per Unit

Electrical shock patients represent a challenge for the neurorehabilitation specialist. Successful management usually requires a broad-based approachincorporating psychologic counseling and education as to the nature of the symptoms as well as medical attention to specific complaints. Patients may benefitfrom both individual and support-group therapy. Family and vocational issues may benefit from a team approach. Therapeutic interventions are usuallysymptom-focused. The pathophysiology of the complaints in the post-lightning, postelectric shock syndrome is poorly understood. The psychologic,psychophysiologic and “organic” components are not well separated. These patients represent a challenging and possibly prolonged management problem.Source: Neurorehabilitation of Lightning and Electrical Injuries, P. Yarnell, MD, D. Lammertse, MD, Seminars in Neurology - Volume 15, No. 4, 12/1995.

Long-term neuropsychiatric complications include depression, anxiety, inability to continue in the same profession, aggressive behavior, and suicide. Source:Cooper, Mary Ann and Price, Timothy G. ELECTRICAL AND LIGHTNING INJURIES. http://www.uic.edu/labs/lightninginjury/Electr&Ltn.pdf

Amputation as a consequence of burn injury presents unique challenges to the rehabilitation team. Early involvement of a psychologist can help addressemotional adjustment to burns and amputation. The psychologist can also assess for cognitive impairment given the high incidence of neurologic sequelae.Psychologic adjustment issues are common in burn patients. Fukunishi found the incidence of post-traumatic stress disorder and major depression was 34% and7% respectively. These patients will benefit from counseling, psychotherapy and pharmacologic agents. As the patient becomes more proficient with hisprosthesis, a vocational rehabilitation assessment would be appropriate for possible reintegration into the workforce. Source: Huang, Mark E., MD; Nelson,Virginia S., MD, MPH; Flood, Katherine M., MD; Roberts, Toni, L., DO; Bryant, Phillip R., DO; Pasquina, Paul R., MD. Limb Deficiency and ProstheticManagement. 3. Complex Limb Deficiency. Archives of Physical Medicine and Rehabilitation, Volume 87, Supplement 1, March 2006, pp. S15 - S20.

1 X / week for 48weeks; then 2 X /month for 12months;thereafter 4 - 6 X /year for crisisintervention. 9

35 1/2007

Life Exp.

Family Counseling andEducation

Learn about disability andassist with adjustment inchanges in lifestyle.

$135 - $170

Per Year


Ending

$1,620 - $2,040 for 12 sessions.Beginning Per Unit


2 X / month for 6months

10

35 1/2007

35 7/2007


Michael Curry Projected Therapeutic Modalities

Life Care Plan


Replacement


D/A:



Occupational Therapy Provide instruction oncompensatory strategies toassist him in performingactivities of daily living andenhance his independence.Post-surgical rehabilitation andmaintenance therapy is alsoneeded.

$135 - $170

Per Year


Ending

$4,860 to $6,120 for 36 sessions now; then$8,370 to $10,540 for 62 sessions post handsurgery (2007); then $7,020 to $8,840 for 52sessions after toe to finger transfer (2008); then$610 to $915 / year for 3 years; then $610 to$915 / 3-4 years.

Beginning Per Unit

The rehabilitation protocol must be modified to the individual patient in question. The clinician should approach each patient individually and progress them with a personalized andtailored approach in close communication with the surgeon and therapist. Functional hand motion and strength are the end results of successful flexor tendon surgery andrehabilitation (Vucekovich, 2005). Source: Bolitho, Glynn, M.D., Ph.D., FACS. Hand, Tendon Lacerations: Flexors. Last Updated; June 8, 2006.www.emedicine.com/Plastic/topic331.htm

The burn therapists' goals are to restore the general condition of the patient, achieve wound healing and full functional recovery, eventually with good cosmetic results. Earlyprevention of contractures is obtained by positioning/splinting and exercises. Later, when wound coverage is nearly complete, the patient is enrolled in the rehabilitation phase.Emphasis is given on the recovery of function and strength, by the use of ROM, composite and functional movements patterns, passively and/or actively performed. In therehabilitation phase, scar management should be discussed and followed-up by the different specialists (requiring eventually medical, surgical and physical-kinesi therapies). Intrauma cases complicated by amputation and/or neurological problems, progress is enhanced by rehabilitation engineering. The goal of rehabilitation is the restoration of anindividual with a disability from lightning or electrical trauma back into society. Successful rehabilitation requires a team effort. The team includes those in the medical andtherapeutic fields, those in the sociological and psychological fields, rehabilitation engineers and technologists, basic and clinical scientists, consumer groups and the individualhim/herself. The key to success in the management of patients with electrical burn injuries is the constant communication and discussion among the various members of theteam. Source: Selvaggi, Gennaro; Monstrey, Stan; Van Landuyt, Koen; Hamdi, Moustapha and Blondeel, Phillip. Rehabilitation of burn injured patients following lightning andelectrical trauma. Neurorehabilitation, 20 (2005), pp. 35-42.

3 X / week for 12weeks now; then 2 X/ week for 31 weekspost-surgical; then 2X / week for 26weeks after toetransfer; then 4-6 X /year for 3 years; then4-6 X / 3-4 years.

11

35 1/2007

Life Exp.

Assistive TechnologyTraining

Train to use assistivedevices to help withactivities of daily living.

$115 - $125

Per Year

Paul M. Deutsch,Ph.D., CRC, CCM,CLCP, FIALCP,Marco Rodriguez,M.D. and Raj Patel,M.D.

Ending

$920 - $1,000 for 8 sessions; then $460- $500 every 3-4 years thereafter.

Beginning Per Unit

Assistive Technology is any item, piece of equipment, or system, whether acquired commercially, modified, or customized, that is commonly used to increase, maintain, orimprove functional capabilities of individuals with disabilities. Source: Publication of the Office of the CIO/HPCC, National Oceanic & Atmospheric Administration (NOAA), U.S.Department of Commerce http://www.masc.noaa.gov/masc/amd/section508/attach_a_addem_6-24.html

2 X / week for 4weeks initially;then 4 sessionsevery 3-4 yearsthereafter to trainwith newtechnology. 12

35 1/2007

Life Exp.


Michael Curry Orthotics/Prosthetics

Life Care Plan


Replacement


D/A:



Left Hand Prothesis Cosmetic replacement ofamputated fingers. Lefthand ring and littlefingers.

$17000 - $21000

Per Year

Paul M. Deutsch,Ph.D., CRC, CCM,CLCP, FIALCP andRaj Patel, M.D.Ending

Dr. Patel indicates that it is possiblethat Michael could use cosmetic handprosthesis.

Beginning Per Unit

NOTE: According to information provided by Pillet Prosthetics, who specializes in cosmetic prosthesis, Michael will need complex hand prostheses because the area ofamputation of the fingers will not leave enough residual stump to place digit prostheses. Evaluation would be needed to determine exact cost. Unit cost is an estimation providedby Pillet Prosthetics.

1 X / 4-6 Years

13

35 1/2007

Life Exp.

Right Hand Prothesis Cosmetic replacement ofamputated fingers. Righthand 2nd, 3rd, & 4thfingers.

$17000 - $21000

Per Year

Paul M. Deutsch,Ph.D., CRC, CCM,CLCP, FIALCP andRaj Patel, M.D.Ending

Dr. Patel indicates that it is possiblethat Michael could use cosmetic handprosthesis.

Beginning Per Unit

NOTE: According to information provided by Pillet Prosthetics, who specializes in cosmetic prosthesis, Michael will need complex hand prostheses because the area ofamputation of the fingers will not leave enough residual stump to place digit prostheses. Evaluation would be needed to determine exact cost. Unit cost is an estimation providedby Pillet Prosthetics.

1 X / 4-6 Years

14

35 1/2007

Life Exp.


Michael Curry Home Furnishings and Accessories

Life Care Plan


Replacement


D/A:



Toilevator HeightModification Kit

Ease in going from sittingto standing. $279 - $389

Per Year


Ending

Kit for elevating the toilet in lieu of araised toilet seat. Cost of installation isincluded in the unit cost.

Beginning Per Unit1 X / 4-6 Years

15

35 1/2007

Life Exp.

Bidet Seat for Toilet Provides personalhygiene secondary toloss of hand function.

$1228 - $1335

Per Year


Ending

This bidet seat is designed toaccommodate for the fact that Michaelis a large man.


16

35 1/2007

Life Exp.

Heavy Duty TransferBedrail System

Ease in getting out of beddue to limitations in goingfrom prone to sitting.

$119 - $120

Per Year


Ending


17

35 1/2007

Life Exp.

Tub and Toilet SafetyRails

Safety aid$300 - $400

Per Year


Ending

Unit cost includes the cost ofinstallation by qualified medicalretrofitter.

Beginning Per Unit1 X Only

18

35 1/2007

35 1/2007

Heavy Duty Lift Recliner Assist him in going fromsitting to standing andstanding to sitting.

$1895 - $3200

Per Year


Ending


19

35 1/2007

Life Exp.


Michael Curry Home Furnishings and Accessories

Life Care Plan


Replacement


D/A:



Trolley Cart with TwoTrays

Allow him to place itemson trays and push fromone place to another.

$139 - $147

Per Year


Ending


20

35 1/2007

Life Exp.


Michael Curry Aids for Independent Function

Life Care Plan


Replacement


D/A:



Desk Top Computer withcomplete Set-up

Operate Voice controlledsoftware to give himaccess to use ofcomputer.

$1500 - $2000

Per Year

Paul M. Deutsch,Ph.D., CRC, CCM,CLCP, FIALCPbased on evaluationand review ofmedical information

Ending

Computer must be powerful enough torun software such as Dragon NaturallySpeaking.


21

35 1/2007

Life Exp.

Maintenance andUpgrade of Software forComputer

Maintain equipment

$150 - $200Per Year


Ending

Beginning Per Unit1 X / Year

22

36 1/2008

75 2046

Voice Activated Software Allow him to operatecomputer with voicecommands.

$200 - $300

Per Year


Ending

Example Dragon Naturally SpeakingV9.


23

35 1/2007

Life Exp.

USB Microphone,Headset and Pod

Allow more accuratedictation andinterpretation by voicerecognition software.

$120 - $130

Per Year


Ending


24

35 1/2007

Life Exp.

Waterpik Oral Care Enhance oral hygiene dueto loss of hand functionmaking it difficult to floss.

$40 - $60

Per Year


Ending


25

35 1/2007

Life Exp.


Michael Curry Aids for Independent Function

Life Care Plan


Replacement


D/A:



Sonic Toothbrush Enhance oral hygiene dueto loss of hand function. $115 - $160

Per Year


Ending


26

35 1/2007

Life Exp.

Portable Bidet Provide ability toaccomplish personalhygiene task when awayfrom home.

$129 - $149

Per Year


Ending


27

35 1/2007

Life Exp.

Speaker Phone Allow hands free talking.$90 - $180

Per Year


Ending


28

35 1/2007

Life Exp.

Adaptive Equipment Enhance Independence

Per Year


Ending

$600 - $700 for initial purchase ofadaptive equipment; then $300 - $400 /year thereafter for the purchase of newequipment and replacement of brokenitems.

Beginning Per Unit

These are examples of some of the adaptive equipment which may be suited for Michael: Plastic Mugs $8.00, Curved Bath Brush $36.50, Terry Cloth Cover for brush - 3for $8.95, Extended Toilet Aid - $59.95; Spring Action Shoehorn $6.95, Self-closing Reacher $39.95, Steel Doorknob Extension Pair $12.75, Playing Card Holder $21.50, RockingT Knife $16.50, Carrying case for knife $6.50, Knife-Fork Combo $16.50, Rocker Knife with Solid Handle $6.00, Easy-slice Knife $29.00, Zipper Pull $4.95, Button hooks $5.50,Sock / hose donner $25.00, Uni-turner $16.00, Key holder $7.00.

Kitchen tools are as age appropriate: Clamp-on Vegetable Peeler $21.95, Deluxe One-handed Paring Board $49.95, Even Slicer and Knife $23.50, Slicing Guide $30.95, HandyMixer $46.95, Clear Measuring Beaker $7.50, Spill-not Jar & Bottle Opener $22.50, One-handed Cordless Can Opener $31.95, Suction Brush $4.95, Pot Strainer $3.95, BowlHolder with Bowl $52.95, Grater with Suction Feet $10.40, Stay-Put Suction Disc $8.95, Folding Pan Holder $12.95.

1 X / Year

29

35 1/2007

Life Exp.


Michael Curry Home Care / Facility Care

Life Care Plan


Replacement


D/A:



Attendant Care Services Assist him with activitiesof daily living whileparticipating inrehabilitation and surgicalreconstruction.

$16 - $24

Per Year


Ending

$16,840 - $31,440 for 842 - 1,572 hoursfor one year; then $15,720 - $30,320 for786 - 1,516 hours for second year; then$14,600 - $29,200 for 730 - 1,460 hoursfor third year.

Beginning Per Unit2-4 hours per day,with an increase to 4- 6 hours per day for8 weeks periodduring handreconstruction and 4weeks period duringtoe to finger transfersurgery.

30

35 1/2007

38 2009

Case ManagementServices

Assist with coordinationof care and offer support. $85

Per Year


Ending

$4,080 - $6,120 / year for three years;then $2,040 - $4,080 / year thereafter.

Beginning Per Unit4-6 hours / monthfor 3 years; then2-4 hours / monththereafter.

31

35 1/2007

Life Exp.

House Cleaning Heavy housecleaningassistance $65 - $85

$3380 - $4420Per Year


Ending

This is not to be added into the totals ifthe economist is preparing a loss ofhousehold services report.

Beginning Per UnitRegular weeklyservice

32

35 1/2007

Life Exp.

Interior / Exterior HomeMaintenance - AssumesOwn Home

Household Maintenance$45 - $65

$2340 - $3380Per Year


Ending

This is not to be added into the totals ifthe economist is preparing a loss ofhousehold services report.

Beginning Per UnitWeeklyAllowance

33

35 1/2007

Life Exp.


Michael Curry Future Medical Care Routine

Life Care Plan


Replacement


D/A:



Primary Care Physician Monitor for complicationsassociated with electricalinjury, such as hypertension,cardiomyopathy,gastrointestinal problems, etc.

$75 - $115

$150 - $230Per Year

Marco Rodriguez,M.D.

Ending

Beginning Per Unit

GI complications affect 6% to 25% of patients with high-voltage injuries. The most common problem encountered is adynamic ileus. The more ominous complications includepancreatic and hepatic necrosis, necrosis of the gallbladder, and injury to hollow viscera of the alimentary tract. Although these serious complications are rare, they are importantbecause of associated morbidity and mortality. In one cohort study of patients with high-voltage injuries, all those who had serious GI complications died. Source: Hartman,Jeffrey; Cuenca, Peter; Della-Glustina, David. Electrical injuries: an emergency department approach; Cardiac monitoring and an ECG are essential, Journal of Critical Illness,March 2002.

Exposure to a significant current may have lasting effects on membrane permeability. This has been suggested as a mechanism of arrhythmia, ongoing muscular necrosis, anddelayed neurologic effects. Clinical findings, such as extensive skin damage and a vertical orientation of the current pathway (upper extremity to lower extremity), are highlypredictive of cardiac complications. Source: Hartman, Jeffrey; Cuenca, Peter; Della-Glustina, David. Electrical injuries: an emergency department approach; Cardiac monitoringand an ECG are essential, Journal of Critical Illness, March 2002.

The variability of cardiac injury in survivors of electrical trauma limits the appearance of cardiac manifestations such as DCM (dilated cardiomyopathy). The literature is repletewith warnings to provide long-term follow-up of electrically injured patients to monitor for latent cardiac dysfunction and cardiomyopathy. We believe electrical injury may beassociated with myocardial dysfunction and short- and long-term evaluation of left ventricular function may be warranted. Source: Buono, Lee M., M.D., DePace, Nicholas L.,M.D. and Elbaum, David M., D.O. Dilated Cardiomyopathy After Electrical Injury: Report of Two Cases. JAOA, Vol. 103, No. 5, May 2003, pp. 247-249.

2 X / Year, inaddition to the 1-2X / year everyoneshould be seen.

34

35 1/2007

Life Exp.



Life Care Plan


Replacement


D/A:



Plastic Surgeon Monitor injuries tobilateral upper extremities $165

Per Year

Raj Patel, M.D.

Ending

$1,980 for 1st year; then $990 / year for2 years; then $165 every 2 yearsthereafter.

Beginning Per Unit

In high-voltage injuries, muscle necrosis can extend to sites distant from the observed skin injury, and compartment syndromes occur as a result of vascular ischemia and muscleedema. Decompression fasciotomy or amputation is often necessary because of extensive tissue damage. Massive release of myoglobin from the damaged muscle may lead tomyoglobinuric renal failure. Vascular damage from the electrical energy may become evident at any time. Pulses and capillary refill should be assessed and documented in allextremities, and neurovascular checks should be repeated frequently. Because the arteries are a high-flow system, heat may be dissipated fairly well and cause little apparentinitial damage but result in subsequent deterioration. The veins, on the other hand, are a low-flow system, allowing the heat energy to cause more rapid heating of the blood, withresulting thrombosis. Consequently, an extremity may appear edematous initially. With severe injuries, the entire extremity may appear mummified when all tissue elements,including the arteries, suffer coagulation necrosis. Damage to the vessel wall at the time of injury may also result in delayed thrombosis and hemorrhage, especially in the smallarteries to the muscle. This ongoing vascular damage can cause a partial-thickness burn to develop into a full-thickness burn as the vascular supply to the area diminishes.Progressive loss of muscle because of vascular ischemia downstream from damaged vessels may mandate repeated deep debridements. Source: Cooper, Mary Ann and Price,Timothy G. ELECTRICAL AND LIGHTNING INJURIES. http://www.uic.edu/labs/lightninginjury/Electr&Ltn.pdf

1 X / month for 12months; then 6 X/ year for 2 years;thereafter 1 X / 2years

35

35 1/2007

Life Exp.

Physiatrist Evaluate and monitorrehabilitation needs. $50 - $160

Per Year


Ending

$125 - $375 for initial eval; then $105 -$210 / year.

Beginning Per Unit


Initial eval, then1-2 X / yearthereafter.

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35 1/2007

Life Exp.



Life Care Plan


Replacement


D/A:



Psychiatric Evaluation Evaluate and monitorpsychotropic medicationsto treat depression andanxiety.

$80 - $100

Per Year


Ending

$250 - $275 for initial evaluation; then$320 - $400 / year.

Beginning Per Unit



Amputation as a consequence of burn injury presents unique challenges to the rehabilitation team. Early involvement of a psychologist can help address emotional adjustment toburns and amputation. The psychologist can also assess for cognitive impairment given the high incidence of neurologic sequelae. Psychologic adjustment issues are commonin burn patients. Fukunishi found the incidence of post-traumatic stress disorder and major depression was 34% and 7% respectively. These patients will benefit from counseling,psychotherapy and pharmacologic agents. As the patient becomes more proficient with his prosthesis, a vocational rehabilitation assessment would be appropriate for possiblereintegration into the workforce. Source: Huang, Mark E., MD; Nelson, Virginia S., MD, MPH; Flood, Katherine M., MD; Roberts, Toni, L., DO; Bryant, Phillip R., DO; Pasquina,Paul R., MD. Limb Deficiency and Prosthetic Management. 3. Complex Limb Deficiency. Archives of Physical Medicine and Rehabilitation, Volume 87, Supplement 1, March2006, pp. S15 - S20.

1 X now for initialevaluation; then 4X / yearthereafter tomonitormedication.

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35 1/2007

Life Exp.



Life Care Plan


Replacement


D/A:



Pain ManagementSpecialist

Evaluate and treatchronic pain associatedwith injuries.

$60 - $150

Per Year


Ending


Beginning Per Unit

Pain control in patients with electrical burn injuries is difficult and challenging. Burn size has not been found to correlate with pain intensity. Social and demographic factors, suchas age, sex, ethnicity, education, occupations or socioeconomic status, do not predict the pain intensity reported in burn injury. Treatment of burn pain represents a difficultchallenge. It is essential to aggressively treat the pain experienced by patients with burn injuries. Source: Rehabilitation of burn injured patients following lightning and electricaltrauma. G. Selvaggi, S. Monstrey, K. Van Landuyt, M. Hamdi and P. Blondeel. Department of Plastic Surgery, Burn Center, University Hospital, Gent, Belgium.Neurorehabilitation 20 (2005) 35-42.

Neurobehavioral problems after lightning and electrical injuries are diverse. Commonly reported are decreased cognitive function, pain syndromes, depression, post-traumaticstress disorder and significant alterations in social and work roles. Studies of lightning and electrical injuries have identified disabling neuropsychiatric changes for somesurvivors, often persistent and influenced by individual premorbid emotional and coping patterns. Standards of care in the fields of brain injury, behavioral medicine, andpsychotherapy can inform rehabilitation strategies. Proper assessment is important, as well as an individualized approach to treatment. Multidisciplinary intervention focuses onmanaging symptoms, learning compensatory skills, providing psychosocial support and preventing maladaptive behaviors. Source: Primeau, Margaret. Neurorehabilitation ofbehavioral disorders following lightning and electrical trauma. Neurorehabilitation 20 (2005), pp. 25-33.

Initial eval, then 2X / yearthereafter.

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35 1/2007

Life Exp.

Cardiologist Evaluate and monitor forcardiac injury resultingfrom electrical shock.

$50 - $290

Per Year


Ending


Beginning Per Unit

Exposure to a significant current may have lasting effects on membrane permeability. This has been suggested as a mechanism of arrhythmia, ongoing muscular necrosis, anddelayed neurologic effects. Clinical findings, such as extensive skin damage and a vertical orientation of the current pathway (upper extremity to lower extremity), are highlypredictive of cardiac complications. Source: Hartman, Jeffrey; Cuenca, Peter; Della-Glustina, David. Electrical injuries: an emergency department approach; Cardiac monitoringand an ECG are essential, Journal of Critical Illness, March 2002.

The variability of cardiac injury in survivors of electrical trauma limits the appearance of cardiac manifestations such as DCM (dilated cardiomyopathy). The literature is repletewith warnings to provide long-term follow-up of electrically injured patients to monitor for latent cardiac dysfunction and cardiomyopathy. We believe electrical injury may beassociated with myocardial dysfunction and short- and long-term evaluation of left ventricular function may be warranted. Source: Buono, Lee M., M.D., DePace, Nicholas L.,M.D. and Elbaum, David M., D.O. Dilated Cardiomyopathy After Electrical Injury: Report of Two Cases. JAOA, Vol. 103, No. 5, May 2003, pp. 247-249.

Initial evaluation;then 1-2 X / yearthereafter.

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Life Exp.



Life Care Plan


Replacement


D/A:



Cardiac Testing Evaluate and monitor forcardiac complicationsassociated with electricalshock.

$896 - $1235

Per Year


Ending

Electrocardiogram: $50 - $55;Echocardiogram: $336 - $400; Chestx-ray: $60 - $130; Stress test: $450 -$650

Beginning Per Unit

Hemorrhage and aneurysm are possible complications from electrical injuries, and cataracts may develop 6 months to a year after injury. Source: Hartman,Jeffrey; Cuenca, Peter; Della-Glustina, David. Electrical injuries: an emergency department approach; Cardiac monitoring and an ECG are essential, Journal ofCritical Illness, March 2002.

The variability of cardiac injury in survivors of electrical trauma limits the appearance of cardiac manifestations such as DCM (dilated cardiomyopathy). Theliterature is replete with warnings to provide long-term follow-up of electrically injured patients to monitor for latent cardiac dysfunction and cardiomyopathy.We believe electrical injury may be associated with myocardial dysfunction and short- and long-term evaluation of left ventricular function may be warranted.Source: Buono, Lee M., M.D., DePace, Nicholas L., M.D. and Elbaum, David M., D.O. Dilated Cardiomyopathy After Electrical Injury: Report of Two Cases.JAOA, Vol. 103, No. 5, May 2003, pp. 247-249.

1 X / 3-4 Years

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35 1/2007

Life Exp.

Neurologist Evaluate and monitor forcomplications associatedwith electrical shock,such as progressivemotor neuron disease,seizures, etc.

$100 - $135

Per Year


Ending


Beginning Per Unit

Affecting 25% to 67% of patients, neurologic complications are common and may result from either low- or high-voltage electrical. Neurologic complications maybe acute (occurring within 24 hours after injury) or delayed (occurring up to 2 years after injury); the prognosis is good for the patient who has acutecomplications but is poor for the patient who has delayed complications. Delayed sequelae may include headaches, amyotrophic lateral sclerosis, seizures,paralysis, reflex sympathetic dystrophy, spasticity, and spastic paralysis. Source: Hartman, Jeffrey; Cuenca, Peter; Della-Glustina, David. Electrical injuries: anemergency department approach; Cardiac monitoring and an ECG are essential, Journal of Critical Illness, March 2002.

Delayed neurologic damage may present from days to years after the insult. The findings usually fall into three clinical pictures: ascending paralysis, amyotrophiclateral sclerosis, or transverse myelitis. Motor findings predominate. Sensory findings are also common, but they may be patchy and may not match the motorlevels. Although recovery is reported, the prognosis is usually poor. Source: Cooper, Mary Ann and Price, Timothy G. ELECTRICAL AND LIGHTNINGINJURIES. http://www.uic.edu/labs/lightninginjury/Electr&Ltn.pdf

The literature on both lightning and electrical trauma contains case reports of delayed neurologic syndromes. These sequelae are reported to follow the initialelectrical insult by anywhere from days to months to years. The delayed neurologic disorders include motor system disease, basal ganglia disorders andmyelopathy. Less commonly reported delayed sequelae include basilar artery thrombosis, subarachnoid hemorrhage, demyelinating disease and intracerebralglioma. Focal lesions of the cerebral cortex and cerebellum can be followed by resolution. Source: Cherington, Michael, M.D. Central Nervous SystemComplications of Lightening and Electrical Injuries. Seminars In Neurology; Vol 15, No. 3, September 1995, pp. 233-240.

Initial evaluation;then 1 X / yearthereafter.

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Life Exp.



Life Care Plan


Replacement


D/A:



EEG Evaluate for seizureactivity. $856 - $860

Per Year


Ending

Beginning Per Unit

The literature on both lightning and electrical trauma contains case reports of delayed neurologic syndromes. These sequelae are reported to follow the initial electrical insult byanywhere from days to months to years. The delayed neurologic disorders include motor system disease, basal ganglia disorders and myelopathy. Less commonly reporteddelayed sequelae include basilar artery thrombosis, subarachnoid hemorrhage, demyelinating disease and intracerebral glioma. Focal lesions of the cerebral cortex andcerebellum can be followed by resolution. Source: Cherington, Michael, M.D. Central Nervous System Complications of Lightening and Electrical Injuries. Seminars InNeurology; Vol 15, No. 3, September 1995, pp. 233-240.

1 X / 3-4 Years

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35 1/2007

Life Exp.

MRI Brain Evaluate and monitor forneurologicalcomplications.

$1495 - $2195

Per Year


Ending

Beginning Per Unit

Affecting 25% to 67% of patients, neurologic complications are common and may result from either low- or high-voltage electrical. Neurologic complications may be acute(occurring within 24 hours after injury) or delayed (occurring up to 2 years after injury); the prognosis is good for the patient who has acute complications but is poor for the patientwho has delayed complications. Delayed sequelae may include headaches, amyotrophic lateral sclerosis, seizures, paralysis, reflex sympathetic dystrophy, spasticity, andspastic paralysis. Source: Hartman, Jeffrey; Cuenca, Peter; Della-Glustina, David. Electrical injuries: an emergency department approach; Cardiac monitoring and an ECG areessential, Journal of Critical Illness, March 2002.

The literature on both lightning and electrical trauma contains case reports of delayed neurologic syndromes. These sequelae are reported to follow the initial electrical insult byanywhere from days to months to years. The delayed neurologic disorders include motor system disease, basal ganglia disorders and myelopathy. Less commonly reporteddelayed sequelae include basilar artery thrombosis, subarachnoid hemorrhage, demyelinating disease and intracerebral glioma. Focal lesions of the cerebral cortex andcerebellum can be followed by resolution. Source: Cherington, Michael, M.D. Central Nervous System Complications of Lightening and Electrical Injuries. Seminars InNeurology; Vol 15, No. 3, September 1995, pp. 233-240.

Delayed neurologic damage may present from days to years after the insult. The findings usually fall into three clinical pictures: ascending paralysis, amyotrophic lateralsclerosis, or transverse myelitis. Motor findings predominate. Sensory findings are also common, but they may be patchy and may not match the motor levels. Althoughrecovery is reported, the prognosis is usually poor. Source: Cooper, Mary Ann and Price, Timothy G. ELECTRICAL AND LIGHTNING INJURIES.http://www.uic.edu/labs/lightninginjury/Electr&Ltn.pdf

1 X / 3-4 Years

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35 1/2007

Life Exp.



Life Care Plan


Replacement


D/A:



Ophthalmologist Evaluate and monitor forcomplications associatedwith electrical shock,such as cataracts,maculopathy, opticneuropathy.

$95 - $150

Per Year


Ending


Beginning Per Unit

The head is a common point of contact for high-voltage injuries, and the patient may exhibit burns as well as neurologic damage. Cataracts develop in approximately 6% of casesof high-voltage injuries, especially whenever electrical injury occurs in the vicinity of the head. Although cataracts may be present initially or develop shortly after the accident,they more typically appear months after the injury. Visual acuity and funduscopic examination should be performed at presentation. Referral to an ophthalmologist familiar withelectrical cataract formation may be necessary. Source: Cooper, Mary Ann and Price, Timothy G. ELECTRICAL AND LIGHTNING INJURIES.http://www.uic.edu/labs/lightninginjury/Electr&Ltn.pdf

Hemorrhage and aneurysm are possible complications from electrical injuries, and cataracts may develop 6 months to a year after injury. Source: Hartman, Jeffrey; Cuenca,Peter; Della-Glustina, David. Electrical injuries: an emergency department approach; Cardiac monitoring and an ECG are essential, Journal of Critical Illness, March 2002.


44

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Life Exp.

Orthopedist Evaluate and monitor forcomplications associated withelectrical shock, such as bonedemineralization,osteonecrosis, pathologicalfractures, etc.

$80 - $125

Per Year


Ending


Beginning Per Unit

Injuries secondary to electrical injury may be as benign as muscle strain secondary to tetanic contraction, or as serious as destruction of the bony matrix and osteonecrosis.Often, high-voltage injuries result in severe tissue destruction requiring several surgical procedures. In a series of high-voltage injuries, DiVincenti and associates found that 63of 65 patients required at least 1 major operation. Source: Hartman, Jeffrey; Cuenca, Peter; Della-Glustina, David. Electrical injuries: an emergency department approach;Cardiac monitoring and an ECG are essential, Journal of Critical Illness, March 2002.


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Life Exp.



Life Care Plan


Replacement


D/A:



X-rays Monitor injuries and forcomplications associatedwith electrical injury.

$60 - $150

$420 - $1050Per Year


Ending

Bilateral arms and hands; hips; spine.Unit cost is charge per body part.

Beginning Per Unit

Injuries secondary to electrical injury may be as benign as muscle strain secondary to tetanic contraction, or as serious as destruction of the bony matrix and osteonecrosis.Often, high-voltage injuries result in severe tissue destruction requiring several surgical procedures. In a series of high-voltage injuries, DiVincenti and associates found that 63of 65 patients required at least 1 major operation. Source: Hartman, Jeffrey; Cuenca, Peter; Della-Glustina, David. Electrical injuries: an emergency department approach;Cardiac monitoring and an ECG are essential, Journal of Critical Illness, March 2002.

1 X / Year

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35 1/2007

Life Exp.


Michael Curry Future Medical Care Aggressive Treatment

Life Care Plan


Replacement


D/A:



Surgical Reconstructionof Right Upper Extremity

Improve function of armand hand $20000 - $35000

Per Year

Raj Patel, M.D.

Ending

Begin and end date are estimated. Unitcost is estimation for totalreconstruction of right hand providedby Dr. Patel.

Beginning Per Unit

1. Flap Exploration, flap rearrangement $5,000.2. Contracture release right hand $5,000 - $10,000.3. Tendon transfer to wrist for ulnar flexion and Flexor tendon transfer for thumb and little finger. Requires two surgical procedures, at least two to three months apart. A. Insert tendon rods $5,000 - $10,000. B. Harvest Brachialis tendon. Tether tendon grafts to the spaces $5,000 - $10,000.Follow-up therapy will be needed.

Two-stage reconstruction is indicated when the digit is not suitable for a 1-stage graft due to the following: Skeletal instability. Joint requiring capsulectomy. Inadequate skincoverage. Pulleys requiring reconstruction. Scarred graft bed. Scarred graft bed is the most common indication. Some digits may be insensate, have severe flexioncontractures, or occur in an uncooperative patient; in these situations, the patients are not candidates for reconstruction. The decision to proceed with 2-stage reconstructionusually is made after failed tenolysis. Resect the flexor digitorum profundus, leaving the distal 1 cm, back to a point 2 cm distal to the lumbrical origin. Preserve the flexordigitorum superficialis from the proximal end of the chiasm of Camper distally to prevent recurvatum deformity of the PIP joint. The Hunter silicone rod or the Holter-Hauser rodmay be used. The Holter-Hauser rod has a screw fixation device distally. A 4-mm rod usually is selected for adults. The proximal end of the rod is brought out proximal to the wristcrease. Complications include synovitis (15-20%), migration, extrusion, flexion contracture, and buckling of the rod. Hunter found no propensity for longitudinal contracture in theprimate model. The final outcome is better when wounds are left to mature for a longer time. Source: Bolitho, Glynn, M.D., Ph.D., FACS. Hand, Tendon Lacerations: Flexors.Last Updated; June 8, 2006. www.emedicine.com/Plastic/topic331.htm

Multiple surgicalprocedures listedbelow.

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35 3/2007

35 5/2007



Life Care Plan


Replacement


D/A:



Surgical Reconstructionof Left Upper Extremity

Improve function of leftarm and hand. $10000 - $15000

Per Year

Raj Patel, M.D.

Ending

Begin and end date are estimated. Unitcost is estimation for totalreconstruction of left hand provided byDr. Patel.

Beginning Per Unit

1. Exporation of flap and flap rearrangement $5,000.2. Release of web space contracture and reconstruct flap and skin graft of left hand $5,000 - $10,000.SKIN GRAFTS: A wound that is wide and difficult or impossible to close directly may be treated with a skin graft. A skin graft is basically a patch of healthy skin that is taken from one areaof the body, called the "donor site," and used to cover another area where skin is missing or damaged. There are three basic types of skin grafts. A split-thickness skin graft, commonly usedto treat burn wounds, uses only the layers of skin closest to the surface. When possible, your plastic surgeon will choose a less conspicuous donor site. Location will be determined in part bythe size and color of the skin patch needed. The skin will grow back at the donor site, however, it may be a bit lighter in color. A full-thickness skin graft might be used to treat a burn woundthat is deep and large, or to cover jointed areas where maximum skin elasticity and movement are needed. As its name implies, the surgeon lifts a full-thickness (all layers) section of skinfrom the donor site. A thin line scar usually results from a direct wound closure at the donor site. A composite graft is used when the wound to be covered needs more underlying support,as with skin cancer on the nose. A composite graft requires lifting all the layers of skin, fat, and sometimes the underlying cartilage from the donor site. A straight-line scar will remain atthe site where the graft was taken. It will fade with time. ADVANCED WOUND CARE: FLAP SURGERY/MICROSURGERY: Though success will largely depend on the extent of a patient'sinjury, flap surgery and microsurgery have vastly improved a plastic surgeon's ability to help a severely injured or disfigured patient. Using advanced techniques that often take many hoursand may require the use of an operating microscope, plastic surgeons can now replant amputated fingers or transplant large sections of tissue, muscle or bone from one area of the body toanother with the original blood supply in tact. A flap is a section of living tissue that carries its own blood supply and is moved from one area of the body to another. Flap surgery can restoreform and function to areas of the body that have lost skin, fat, muscle movement, and/or skeletal support. A local flap uses a piece of skin and underlying tissue that lie adjacent to the wound.The flap remains attached at one end so that it continues to be nourished by its original blood supply, and is repositioned over the wounded area. A regional flap uses a section of tissue thatis attached by a specific blood vessel. When the flap is lifted, it needs only a very narrow attachment to the original site to receive its nourishing blood supply from the tethered artery andvein. A musculocutaneous flap, also called a muscle and skin flap, is used when the area to be covered needs more bulk and a more robust blood supply. Musculocutaneous flaps are oftenused in breast reconstruction to rebuild a breast after mastectomy. This type of flap remains "tethered" to its original blood supply. In a bone/soft tissue flap, bone, along with the overlyingskin, is transferred to the wounded area, carrying its own blood supply. A microvascular free flap is a section of tissue and skin that is completely detached from its original site andreattached to its new site by hooking up all the tiny blood vessels. Source: American Society of Plastic Surgeons. Procedures At A Glance.www.plasticsurgery.org/public_education/procedures/ReconstructiveSurgery.cfm?RenderForPrint=1

1 X Only. Seeprocedures listedbelow.

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35 8/2007

35 8/2007



Life Care Plan


Replacement


D/A:



Multiple Toe Transfers toRight Hand

Replace lost fingers toimprove hand function. $50000 - $100000

Per Year

Raj Patel, M.D.

Ending

Begin and end date are estimated. Unitcost is estimation provided by Dr.Patel.

Beginning Per Unit

Toe transfer should be considered as an option for reconstruction of traumatic amputations of the digits in children. The technique, properly applied, adds no further risk offailures or complications than in adults. Furthermore, it requires fewer secondary procedures and results in better sensory recovery than in adults. Although there is no proof ofthe adverse effects of taking the first toe in a growing child, all of the previous reports exclusively used the second toe. It is believed that future athletic involvement is more likelyto be successful after second toe rather than after great toe transfer. It is also hoped that the transferred second toe may become more thumb-like. In this study, various toetransfers, singly or in combination, were used, including the trimmed great toe, third toe, combined second and third toes, and combined third and fourth toes without seriouslydisturbing the foot function. Trimming the great toe, although not recommended in children, has not proved to disturb physeal growth or result in degenerative arthritis of theinterphalangeal joint. Source: Wei, Fu-Chan M.D., F.A.C.S.; El-Gammal, Tarek Abdalla M.D.; Chen, Hung-Chi M.D., F.A.C.S.; Chuang, David Chwei-Chin M.D.; Chiang,Yuan-Cheng M.D.; Chen, Samuel H. T. M.D. Toe-to-Hand Transfer for Traumatic Digital Amputations in Children and Adolescents. Plastic & Reconstructive Surgery: Volume100(3) September 1997 pp 605-609.

The success rate for toe-to-finger transfers was 94.6% with traumatic amputation. The greatest range of motion in the transferred toe averaging 103 degrees was found in thegroup with reconstruction of the second and third fingers. The grasp ability of patients in this group was outstanding, as it had the highest percentage for managing activities.Source; Stupka, I; Vesely, J; Hyza, P; Kucerova, L; Dvorak, Z. Long-term results of digital reconstruction using toe-to-finger transfers. Eur J Plast Surg (2004) 27: 271-282.

1 X Only

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37 2008

37 2008


Michael Curry Transportation

Life Care Plan


Replacement


D/A:



Adaptations to Vehicle Enhance Independencein Driving $1500 - $2000

Per Year


Ending

Modifications typically required for driver’swith upper extremity limitations are: automatictransmission, steering device, reduced effortsteering, modified gear shifter and modifiedsecondary controls (turn signals, dimmers).


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35 1/2007

Life Exp.

Adaptations to Vehicle -Maintenance

Maintain AdaptiveEquipment

$150 - $175Per Year


Ending

Maintenance on equipment begins oneyear after each new item is purchased.


51

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Life Exp.

AAA Membership Emergency assistance$56 - $81

Per Year


Ending


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35 1/2007

Life Exp.


Paul M. Deutsch & Associates, P.A. Life Care Plan DOB · burns and amputation. The psychologist can...

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Transcript of Paul M. Deutsch & Associates, P.A. Life Care Plan DOB · burns and amputation. The psychologist can...