Occupational therapy after burn injury

Burn is a common and horrifying accident in Bangladesh. It is the major causes of childhood illness in Bangladesh and it is the third leading cause of illness of one to four year-old children. According to World Health Organization (WHO), nearly 173000 Bangladeshi children are moderately or severely burnt every year.  In Bangladesh, Colombia, Egypt and Pakistan, 17% of children with burns have a temporary disability and 18% have a permanent disability.

These big number of burn patients need occupational therapy for making independent their daily activities and occupational therapist play a vital role for increasing level of performance of these disable person by providing occupational therapy treatment.

According to WFOT-World Federation of Occupational Therapy (2007), Occupational Therapy is a health care profession based on the knowledge that purposeful activity can promote health and well-being in all aspects of daily life. The aims are to promote, develop, restore and maintain abilities needed to cope with daily activities to prevent dysfunction. The essential feature of occupational therapy is the active involvement of the person in the therapeutic process.

Occupational Therapist plays an important role in the functional outcome following a burn injury. The entire rehab process can begin 24-48 hours after hospital admission and last one to two years. During this time frame, there are three main phases in which the goals of occupational therapy are modified and progressed to achieve the best functional outcome. These stages can be referred to as the acute phase, surgical phase, and rehabilitation phase.

Acute or pre-grafting stage

In the acute phase, the goals of occupational therapy are to promote wound healing and prevent loss of motion. Occupational therapy is also initiated acutely to prevent loss of skin and joint mobility through proper positioning and splinting.

Surgical or grafting stage

In the surgical phase, the medical goal is healing. The rehab goal is to increase function while supporting the surgical objectives. The joint proximal and distal to the graft site are generally immobilized for 5to 7 days. Cast and splint is used to maintain proper position.

Gentle active ROM exercise can commence after 7 -10 days and should be done without dressing to avoid shearing on the new graft.

Rehabilitation of post- grafting stage

As the burns heal, the patient begins the rehabilitation phase. The OT’s goals include independence with activities of daily living (ADL’S) such as self-care: grooming, feeding, dressing, toileting. Productivity such as Handwriting,  job environment modification & leisure such as  reading newspaper, memory training game etc through the use of therapeutic exercise, special equipment, purposeful activity, skills training and environmental modification to maximize the person’s ability to attain independence in daily living and minimization of scarring, prevention of contractures, increased muscle strength

and endurance, increased coordination, aid in psychological adjustment, and education in care needed for discharge from the hospital.

Prevention

Burns are preventable. High-income countries have made considerable progress in lowering rates of burn deaths, through a combination of prevention strategies and improvements in the care of people affected by burns. Most of these advances in prevention and care have been incompletely applied in low- and middle-income countries. Increased efforts to do so would likely lead to significant reductions in rates of burn-related death and disability.

Prevention strategies should address the hazards for specific burn injuries, education for vulnerable populations and training of communities in first aid. An effective burn prevention plan should be multisectoral and include broad efforts to:

Improve awareness

Develop and enforce effective policy

Describe burden and identify risk factors

Set research priorities with promotion of promising interventions

Provide burn prevention programmes

Strengthen burn care

Strengthen capacities to carry out all of the above.

 

Occupational therapy after burn injury

Burn is a common and horrifying accident in Bangladesh. It is the major causes of childhood illness in Bangladesh and it is the third leading cause of illness of one to four year-old children. According to World Health Organization (WHO), nearly 173000 Bangladeshi children are moderately or severely burnt every year. In Bangladesh, Colombia, Egypt and Pakistan, 17% of children with burns have a temporary disability and 18% have a permanent disability. These big number of burn patients need occupational therapy for making independent their daily activities and occupational therapist play a vital role for increasing level of performance of these disable person by providing occupational therapy treatment. According to WFOT-World Federation of Occupational Therapy (2007), Occupational Therapy is a health care profession based on the knowledge that purposeful activity can promote health and well-being in all aspects of daily life. The aims are to promote, develop, restore and maintain abilities needed to cope with daily activities to prevent dysfunction. The essential feature of occupational therapy is the active involvement of the person in the therapeutic process. Occupational Therapist plays an important role in the functional outcome following a burn injury. The entire rehab process can begin 24-48 hours after hospital admission and last one to two years. During this time frame, there are three main phases in which the goals of occupational therapy are modified and progressed to achieve the best functional outcome. These stages can be referred to as the acute phase, surgical phase, and rehabilitation phase. Acute or pre-grafting stage In the acute phase, the goals of occupational therapy are to promote wound healing and prevent loss of motion. Occupational therapy is also initiated acutely to prevent loss of skin and joint mobility through proper positioning and splinting. Surgical or grafting stage In the surgical phase, the medical goal is healing. The rehab goal is to increase function while supporting the surgical objectives. The joint proximal and distal to the graft site are generally immobilized for 5to 7 days. Cast and splint is used to maintain proper position. Gentle active ROM exercise can commence after 7 -10 days and should be done without dressing to avoid shearing on the new graft. Rehabilitation of post- grafting stage As the burns heal, the patient begins the rehabilitation phase. The OTs goals include independence with activities of daily living (ADLS) such as self-care: grooming, feeding, dressing, toileting. Productivity such as Handwriting, job environment modification leisure such as reading newspaper, memory training game etc through the use of therapeutic exercise, special equipment, purposeful activity, skills training and environmental modification to maximize the persons ability to attain independence in daily living and minimization of scarring, prevention of contractures, increased muscle strength and endurance, increased coordination, aid in psychological adjustment, and education in care needed for discharge from the hospital. Prevention Burns are preventable. High-income countries have made considerable progress in lowering rates of burn deaths, through a combination of prevention strategies and improvements in the care of people affected by burns. Most of these advances in prevention and care have been incompletely applied in low- and middle-income countries. Increased efforts to do so would likely lead to significant reductions in rates of burn-related death and disability. Prevention strategies should address the hazards for specific burn injuries, education for vulnerable populations and training of communities in first aid. An effective burn prevention plan should be multisectoral and include broad efforts to: Improve awareness Develop and enforce effective policy Describe burden and identify risk factors Set research priorities with promotion of promising interventions Provide burn prevention programmes Strengthen burn care Strengthen capacities to carry out all of the above.