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Claiming for a hydrotherapy pool

Leigh Day recently settled a tetraplegic claim which included a capital cost claim of some £250,000 for a home hydrotherapy pool, plus annual running costs.  In this particular case the claimant suffered from daily neuropathic pain which could be severe.  The pain was exacerbated by factors such as stress, cold, sudden noises and car travel.  

Hydrotherapy was the only non-invasive treatment without side effects which alleviated the neuropathic pain.  It also had psychological benefits. 

Using an FES (functional electrical stimulation) bike, recommended by experts in his case, aggravated the pain, however the pain was reduced if he was able to have hydrotherapy immediately after an FES session. The claimant carried out physiotherapy exercises in the pool with assistance from his carers.  

The defendant did not agree to this part of the claim and argued that the claimant could mitigate his loss by continuing to use a public hydrotherapy pool (as he was doing during the course of the litigation).  They argued that the significant cost of a home pool was not a reasonable expense and that there were cheaper alternative pain relief treatments available such as Mindfulness therapy.  Alternatively in the event that Court allowed the claim they argued for a much smaller and cheaper home pool.

We counter-argued that whilst Mindfulness helped our client cope with the pain it did nothing to actually reduce it whereas in contrast hydrotherapy did produce actual pain relief for a period of time. The strong painkillers he had been prescribed had significant side effects.  He had been offered various invasive (surgical) treatments for his chronic pain but unsurprisingly preferred non-invasive and side-effect free pain relief.  

To support a claim for a home hydrotherapy pool it is helpful to obtain supportive expert evidence of clinical need. An expert report should be obtained from a suitable hydrotherapy pool specialist who can comment on the benefits of aquatic exercise, the types of home pool available, pool costings and the suitability of any available local hydro pools.  That report should then be sent on to the other relevant experts, for example, in the fields of spinal, care, physiotherapy and accommodation.  In this case since pain relief was a key issue we also obtained supportive evidence from the pain expert.  

Including a claim for a home pool will have a knock on effect on other parts of the claim, for example, a bigger building plot will be required for suitable accommodation so that there is room to build a pool.  This will have an impact on the purchase price and adaptation costs.  Any claim for hydrotherapy (whether using a home pool or at a public pool) may also impact the level of double-up care required. We obtained a manual handling expert’s opinion that all hoisted transfers required two carers meaning that two carers were needed for every hydrotherapy session in order to hoist the claimant in and out of the pool.  

Supportive witness statements will be needed from the claimant regarding the benefits they experience of hydrotherapy and its advantages over alternative therapies and, for example, from their current carers and case manager who can describe the benefits observed to claimant.

If a home pool is sought the lay evidence should also cover the location of the closest public hydrotherapy pool and, if relevant, why use of that facility  has proved unsatisfactory.  The statements should be sent to the experts being whether they  support the claim for a pool.

In our case the claimant had tried using public pools however the car journey negated the hydrotherapy benefit since it aggravated his neuropathic pain.  On several occasions the level of pain was such that the claimant simply could not face the journey.  

There were other problems with using public hydro pools including broken hoists and the air or water temperature being too cold.

There is evidence from a small 2004 study that hydrotherapy reduces spasticity and increases functional independence including self-care and mobility in patients with spinal cord injury 1.

Ultimately we negotiated an excellent settlement package for our client which will enable him to build a new suitable home which will include a large home hydrotherapy pool.
1. The use of hydrotherapy for the management of spasticity.  N. Kesiktas, N. Parker, N. Erdogan, G. Gulsen, D. Bicki, H. Yilmaz . The American Society of Neurorehabilitation, 2004.

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