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Forensic rehabilitation? That sounds suspiciously like an oxymoron. However, in personal injury litigation, a physiatrist, an M.D. or D.O. specializing in Physical Medicine and Rehabilitation, can often be helpful in case preparation, as well as trial testimony.

A physiatrist as a rehabilitation expert is able to diagnose and evaluate disabling conditions. This would include assessment of the impact of disability in the life of the injured and on those who are close to the injured, such as family members. This assessment must also include the impact of injury on many facets of life; physical, psychological, educational, vocational, avocational, social. economic, and spiritual. The early development of a comprehensive rehabilitation treatment program is imperative if optimal outcomes are to be expected.

The rehabilitation expert (physiatrist) determines the extent to which a disability exists, its relationship to injury, and develops a comprehensive rehabilitation plan to optimize outcomes, to minimize overall negative impact, and to bring about maximum recovery of function and quality of life. The overall analysis might include a study of potential and actual economic loss, a prognostication of future employability or under-employability, and cost analysis of the rehabilitation program and its' implementation.

Some of the more difficult cases encountered by personal injury attorneys involve clients who have apparently minor injury related physical disabilities, but seem to face greater problems in view of certain psychological sequelae and, all to often, chronic pain residuals. Not only will a qualified rehabilitation expert be instrumental in assisting the client in the recovery from, as well as, adaptation to potentially disabling injury, he or she is able to document the nature of psychological trauma and pain.

Often the attorney will become aware of a significant personal injury case while the client is still in a health care facility which may not be able to provide appropriate or the necessary rehabilitation services. In addition, a review of medical records may not identify anyone coordinating health and rehabilitation services as required. These situations compel immediate action, review and analysis in order that the appropriate recommendations are brought to the client and family, and that implementation is expedient and timely. A knowledgeable and reputable rehabilitation consultant can persuade the present health care providers to participate in a coordinated long-term rehabilitation treatment program. The rehabilitation consultant is also able to make appropriate recommendations, redirect therapy efforts, or consider alternative placements with the long-term perspective.

This also underlines the importance of early engagement of the rehabilitation expert (physiatrist) consultant. As a general rule, a personal injury attorney should select or have in mind the rehabilitation expert as soon as the file is opened. Current concepts of rehabilitation recognize the importance of starting the rehabilitation process as early as possible. In minor injuries, however, there is less urgency to consult with a rehabilitation expert until the extent of any residual disability can be assessed. It should be understood that in any case involving potentially disabling conditions, factors can arise indicating the need for rehabilitation expertise early in the recovery process.

The rehabilitation expert (physiatrist) is the most qualified to participate in the development of life care planning, and to provide critique to assure thoroughness and appropriateness of every aspect of the life care plan. This would include medical care needs, rehabilitation therapy programming, transportation needs, specialized equipment or home modifications, and educational and vocational considerations. Furthermore, the rehabilitation expert is the most qualified to explain and justify the life care plan in deposition or trial testimony.

The consulting rehabilitation expert (physiatrist) should be able to work with the attorney on an ongoing basis, providing periodic reports and updates, written or verbal, and when needed, assist in obtaining insurance coverage benefits. In addition, the rehabilitation expert is able to help in trial preparation, providing the attorney with insight into the presentation of evidence at trial, and to insure that testimony preceding the expert's testimony sets the proper foundation and support for the opinions of the expert.

During the trial, the rehabilitation expert (physiatrist) is one of the most qualified witnesses to present objective testimony with respect to non-economic damages of the case. This would include but not be limited to psychological trauma and it's consequences, difficulty adapting to specific disabling conditions, and chronic pain residuals of injury. The many almost and seemingly insurmountable problems encountered by the catastrophically injured client in the acute recovery phase and the long-term rehabilitation process can be explained in compelling language and detail by the rehabilitation expert's testimony.

The rehabilitation expert (physiatrist) will usually have many ideas to offer the attorney in the presentation of trial testimony. He or she can review with the attorney the strengths and weaknesses of the case, and how to best present the evidence and testimony to emphasize the strengths based on the historical information, injuries and progression of recovery and/or disability.

Finally, the rehabilitation expert (physiatrist) is the most qualified to diagnose disability, to differentiate causation in disability, to rate disability at maximum medical improvement, to prognosticate potential secondary medical and physical complications in the future, and to define appropriate treatment where it will be of benefit and where treatment will no longer be beneficial. Make your local physiatrist your friend, he or she can be of immeasurable help and support in personal injury rehabilitation and litigation.

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E. Franklin Livingstone, MD, MRM, FAAPM&R, FAADEP, FACFM, DAAPM, is a Physical Medicine and Rehabilitation specialist (Physiatrist). Dr. Livingstone practices General Physiatry (Rehabilitation Medicine) and Electrodiagnosis (EMG). He provides a unique perspective having been in a motor vehicle accident resulting in spine and spinal cord injuries and L-2 paraplegia at the age of eighteen. Dr. Livingstone's certifications include the American Board of Physical Medicine and Rehabilitation, the American Academy of Pain Management, and the American Board of Forensic Examiners.

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