Activities of Daily Living (ADLs) and the Severity of Injury in a Personal Injury Case

Activities of daily living (ADLs) are routine tasks that individuals perform as part of daily living and self-care. These activities are essential for maintaining basic health, hygiene, and well-being. Completing these tasks allows individuals to care for themselves without relying on others and gives them a sense of control and independence.

ADLs include:

  • Personal hygiene: Bathing, grooming, and toileting.
  • Dressing: Putting on clothes, fastening buttons, and putting on shoes.
  • Eating: Preparing meals, feeding oneself, and drinking.
  • Mobility: Moving from one place to another, transferring from location to location, and driving.
  • Toileting: Controlling bowel and bladder functions and maintaining personal hygiene related to toileting.
  • Exercise: Walking, running, working out, or any other form of exercise.

ADLs play a crucial role in personal injury cases. Accurate documentation and consistent presentation of the client’s injury effects on daily life can significantly strengthen or weaken a client’s case. A qualified personal injury legal nurse consultant can collect evidence from the medical records and strategically present the impact on a client’s ADLs to highlight the severity of the injury and aid the attorney in seeking maximum compensation.

Some examples of how impact on ADLs can strengthen or weaken a personal injury case include:

StrengthsWeaknesses
Demonstrating impactInconsistencies
Quantifying damagesPre-existing conditions
Building SympathyPossible defense arguments
Expert TestimonyGaps in medical treatment

Additionally, locating the activities of daily living within the medical records can be highly challenging due to various factors:

  • Scattered documentation: Information about these activities can be spread throughout different sections of the medical record, making it time-consuming to compile.
  • Diverse terminology: Different healthcare providers use different terms or abbreviations to describe ADLs.
  • Prioritization: ADLs might not be the primary focus of the medical records, leading to limited or implicit mentions of the impact in acute or long-term care settings.
  • Subjective VS. Objective nature: ADLs are often described subjectively; however, one must quantify or objectively match those impairments to build a stronger case. This can be confusing and time-consuming.

Lastly, gathering, organizing, and summarizing relevant ADL information from the medical records can be daunting in complex personal injury cases. Presenting ADL limitations concisely and contextually requires experience and a meticulous approach.

Our nurses at Bridge Point Legal Nurse Consulting are experienced in finding and presenting the extent of a client’s ADL impairment. Having an organized document with all details indexed and in layman terms can assist an attorney throughout the litigation process.

Case Study:

A 48-year-old man was riding his bicycle when a compact car side-swiped him. Emergency medical technicians arrived on the scene and noted an obvious deformity in his left upper leg. Upon his arrival at the emergency department, imaging was taken and revealed an open compound fracture of the femur [the femur is the long bone of the leg, or thigh bone].

A compound fracture is when a bone breaks and the bone fragments stick out through the skin. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments.

Figure 1: Compound Fracture

Mr. Z required the insertion of a metal pole, known as an intramedullary rod, into the center of his femur. This helps reconnect and stabilize the two ends, which are then secured with screws above and below the fracture.

Figure 2: Intramedullary Rod

Following Mr. Z’s surgery and hospitalization, he was discharged home with orders for daily physical and occupational therapy and follow-up doctors’ visits with the orthopedic surgeon.

Before his accident, Mr. Z was an active man who liked to exercise, travel, spend time with his family, and actively participate in his children’s extracurricular activities. Our Bridge Point Legal Nurses reviewed the medical records and provided evidence that assisted the attorney in finding the impacts of daily living:

  1. Initial Post-Surgery Period: Mr. Z was ordered to be non-weight bearing for eight to ten weeks. He was wheelchair bound and required maximal assistance with any physical activity. We highlighted all restrictions and limitations in Mr. Z’s movement.
  • Pain and discomfort: We highlighted pain scales, medication regimen changes, and physical examinations that proved Mr. Z’s physical discomfort during his recovery period.
  • Psychological impact: All statements regarding Mr. Z’s anxiety, fear, confidence, or depressive symptoms were brought forward.
  • Loss of consortium: Mr. Z commented that his family was in distress due to his injury, as his wife had to carry the weight of the household during his recovery. He stated his wife had to exhaust all her paid time off and was on extended family medical leave until further notice. This caused Mr. and Mrs. Z to begin developing signs of anxiety and depression.

The impact of intramedullary rods is individualized. Some people may experience minimal disruption, while others may experience more challenges in the varying stages of recovery. A legal nurse consultant can help bring together all the information about the activities of daily living in an organized, compiled manner in the most cost-effective and timely manner.

Valerie Creel

Valerie Creel

Valerie Creel is the owner of Bridge Point Legal Nurse Consulting. Valerie has been an RN since 2013 and has extensive experience with Critical Care, having been in ICU for the entirety of her Nursing career. Valerie has worked with Trauma, Neuro, and Medical ICU patients including providing care through the Covid-19 pandemic. In addition to her nursing experience, she worked providing prehospital care in the 911 system of San Mateo County from 2007-2014. She had the opportunity to work with complex trauma and multi-casualty incidents including the Asiana Airline Crash at SFO in 2013. Valerie holds her board certification in Critical Care and earned her Bachelors Degree from Grand Canyon University. She has been working in the legal nursing field since 2021 and has completed her coursework to specialize in Strangulation. She will also complete her Forensic Nurse Certification by the beginning of 2023. In her spare time, she loves spending time with her family and two young daughters and husband. She also enjoys being outdoors, fitness, and cooking.