International rehabilitation: Delivering seamless case management for a client living in Brazil

By Claudette Joint, Clinical Lead, Unite Professionals Case Management

When a young personal trainer sustained life-changing injuries in a UK road traffic accident, the expectation was that his rehabilitation journey would be challenging.

The complexity increased further when he returned to Brazil shortly after discharge, with no access to the therapy, specialist input or funding streams normally available to clients receiving rehabilitation in the UK.

This case demonstrates how coordinated, cross-border case management enabled continuity of care, multidisciplinary input and, ultimately, a return to independence.

The Accident and Early Aftermath

In May 2022, the client was involved in a severe hit-and-run collision, sustaining extensive degloving injuries to the left foot and traumatic amputation of multiple toes.

Emergency surgery resulted in amputation of the anterior two-thirds of the foot.

Although a below-knee amputation was considered, the client opted to retain the limb.

Despite referral for statutory physiotherapy and prosthetic support, his status as a visitor in the UK restricted access to ongoing rehabilitation.

By September 2022, he returned to Brazil and moved in with his brother, relying on family for personal care and financial support.

Previously a highly active personal trainer and competitive bodybuilder, he now struggled with pain, limited mobility, difficulty on stairs, social withdrawal and loss of identity.

Rehabilitation Planning Across Borders

A jointly instructed Occupational Therapy assessment was commissioned locally in Brazil, identifying key rehabilitation needs and highlighting a lack of accessible services.

Case management then shifted to close collaboration with the Brazilian OT to identify therapy providers, coordinate therapies, equipment and home adaptation needs.

Communication relied heavily on interpreting support, as none of the treating team spoke English.

Continuity of interpreter due to trust and rapport was an important factor given cultural and linguistic barriers. Regular team meetings including the client via videocall facilitated regular contact with and feedback from treating team.

Rehabilitation Interventions

Prosthetics

A specialist prosthetic centre located 90 minutes from the client’s home, was identified for assessment.

Travel costs and mobility issues created significant barriers, requiring funded taxi and Uber journeys.

Private funding was secured and provided for provision of a functional silicone prosthetic and carbon fibre orthosis through the specialist prosthetic clinic.

Once fitted with the appropriate prosthesis, the client experienced substantial functional improvements, including independent mobility, resumption of his normal activities and engagement in personal care, domestic, leisure and work activities and eventually resuming independent driving (manual and automatic vehicles).

Physiotherapy

Local physiotherapy provision was sourced to ensure safe prosthetic use, sensory and gait re-education and strength conditioning.

The OT acted as the central hub for liaison, sourcing practitioners and monitoring progress.

Psychological Therapy

The emotional impact of limb loss, trauma and disruption to the client’s lifestyle was profound. Funding was secured for face-to-face psychological therapy in Brazil, though UK-based remote intervention was also explored.

Weekly sessions enabled the client to address acceptance, adjustment, body image and motivation.

He later reported improved sleep, renewed confidence and re-engagement in daily routine.

Nutritional Support

To support weight management and return to fitness, the client attended a local integrative clinical nutritionist, receiving a structured plan tailored to rehabilitation, recovery and training goals.

Home Environment and Adaptive Equipment

Because gym attendance was limited by mobility, transport and confidence, the team focused on providing equipment that aligned with the client’s identity as a fitness professional and recognition of exercise being central to both physical and psychosocial recovery.

This included:

• A multi-station bodybuilding gym system
• Shower chair
• Grab rails and stair adaptations
• Non-slip stair treads

Home adaptations were completed to create an enclosed space for training, including the installation of sliding French-window style doors.

Daily use of the gym equipment became a cornerstone of his physical and psychological progress.

Return to Work and Independence

With improvements in mobility, confidence and routine, the client gradually returned to work, initially supporting his brother’s business part-time before increasing his hours to a full-time role and additionally regaining capacity to provide personal training sessions from home.

Challenges of International Rehabilitation

This case highlighted several systemic issues:

• Cross-border payments: Providers in Brazil often work independently, each with individual tax codes, creating administrative complexity.
• Therapy availability: Identifying reliable, local practitioners required persistent coordination.
• Medical record access: Limited access to Brazilian healthcare documentation complicated clinical oversight.
• Interpreter continuity: Essential for maintaining therapeutic rapport but dependent on availability.

What Enabled Success

• Early and transparent communication with referrers
• Rapid funding approvals
• Strong collaborative working between case manager and Brazilian OT
• Significantly lower therapy and equipment costs compared to the UK
• The client’s high motivation once given the necessary tools and structure

Conclusion

This case illustrates how proactive and culturally informed case management, creative problem-solving and integrated international collaboration can overcome geographical, linguistic and administrative barriers.

Despite significant logistical and financial  challenges, the client achieved meaningful gains in mobility, confidence, independence and return to work demonstrating that effective rehabilitation can transcend borders when supported by a flexible and coordinated multidisciplinary approach.

Learn more about Unite Professionals at uniteprofessionals.co.uk/