Clare, aged 32, dislocated her right shoulder when she fell down a flight of five stairs at a Lake District restaurant after catching the heel of her shoe on some frayed carpet

It was on returning to her home in Manchester the following afternoon that she discovered that the upper part of her right arm was numb.

The accident happened in 1997. Clare had recently completed a degree in business studies and was working as a flight attendant before starting a job in London at the Ministry of Defence.

What followed were years of hospital visits, difficult decisions on high risk operations,various pain relief strategies, and living with her parents because she was unable to live independently and unable to work.

Today, the nerve damage in her arm still causes her continuous pain which means she will have to take an assortment of drugs for the rest of her life. And when the pain flares up on occasions, Clare says her pain management strategies are insufficient.

Last year, due to her compensation settlement, she was able to buy her own house.

She is hopeful she may be able to find part-time work but accepts it will be difficult for employers to accept the unpredictable nature of her condition. "My accident put a massive strain on all my relationships," she says.

"For years I was unable to go out because I was afraid of people bumping into me and hurting my shoulder. I also found stairs impossible to manage.

"I became almost totally dependent on my mother which then put a strain on my parents' marriage and they are now separated.

" I could not go into shops, wash my hair, visit friends - there were several times when I considered taking my own life."

Kynixa was invited to assess and suggest a rehabilitation programme for Clare on the instigation of the restaurant's insurers who, by this stage, were also using surveillance operatives to monitor Clare's behaviour and movements.

Her weight had gone down to seven stone - she is 5ft 9 - and the morphine she was being prescribed was making it almost impossible for her to eat.

Kynixa chief executive and consultant in rehabilitation medicine, Dr Edmund Bonikowski, devised a plan for Clare addressing both medical and psychological objectives.

There were only certain elements of the plan which Clare was prepared to accept, however.

Kynixa case manager and chartered clinical psychologist, Karen Varney, began working with Clare on building her confidence to enable her to start driving again, going out, socialising and to be able to contemplate going back to work and living independently.

Clare had already attended regular sessions with a clinical psychologist and had made significant progress.

"From the beginning, the psychologist was positive and used to give me homework to do," she says.

"I had to write down why I felt I could not go to visit my friend, or walk to the corner shop. He made me realise I was not thinking rationally and began to suggest ways of coping with situations which, looking back, were blatantly obvious but didn't seem so at the time to me.

"I could not go anywhere where there were other people because I was afraid of being banged against. The psychologist gradually built up my confidence and made me see I did not always have to have my mum with me, everywhere I went.

"He also encouraged me to look backwards and think about my experience - because then I could appreciate how far I had come."

Working with Varney, Clare began to believe she could live independently of her mother and manage her self-care.

"There were a range of issues surrounding self-esteem and confidence which we addressed," says Varney.

"The reality of Clare's life was that she was subsisting, just getting through each day. We encouraged her to continuously evaluate the progress she was making and move forward."

Varney arranged a gym membership for Clare, which improved her fitness and had a positive impact on her sleep patterns.

After working with Varney for two years, Clare slowly changed from a person easily prone to tears to one who viewed life optimistically and believed her life was worth living.

She now has a boyfriend and is managing to live independently. She still sees a clinical psychologist through the pain relief clinic, which she attends twice a year for routine check-ups.