Burns

Burns are injuries to the skin or other bodily tissues caused by heat, chemicals, electricity, or radiation. Burns are described based on surface area and depth. They are typically classified as either superficial thickness, superficial partial thickness, deep partial thickness, or full thickness burns.

Symptoms

Physical

  • Scars / open wounds
  • Contractures
  • Shock
  • Eschar
  • Pain
  • Muscle weakness
  • Decreased range of motion
  • Edema
  • Infection
  • Decreased sensation, peripheral neuropathy

Cognitive

Affective

  • Depression
  • Anxiety

Assessments

Physical

  • Rule of 9’s
  • Lund and Browder Scale
  • Rang of motion
  • Brief Pain Inventory
  • Visual analogue pain scale
  • Burn Scar Index / Vancouver Scar Scale

Cognitive

Affective

  • Beck’s Depression Inventory
  • Beck’s Anxiety Inventory

Function

  • Canadian Occupational Performance Measure (COPM)

Common Occupational Performance Issues (OPIs)

Self-Care

  • Difficulty sleeping due to pain
  • Decreased functional mobility due to pain, contractures, decreased range of motion, muscle weakness
  • Difficulty dressing, grooming, bathing, feeding, and toileting due to pain, decreased motivation, and decreased functional mobility
  • Risk for further skin damage due to changes in sensation

Productivity

  • Difficulty with community mobility
  • Absenteeism, presenteeism, decreased work performance due to anxiety about body appearance
  • Difficulty with shopping, home maintenance, meal preparation, and caring for others due to pain, decreased functional mobility, anxiety and depression

Leisure

  • Social isolation due to anxiety and depression
  • Decreased occupational engagement

Frames of Reference

  • Biomechanical
  • Cognitive Behavioural

Interventions

Self-Care

Education: education regarding wound care, infection prevention, wound management, edema control, compensatory strategies for sensory loss, orthotic care

Wound Care: scar massage, pressure garments, silicone pads, orthotics for contractures, edema management, range of motion and strengthening exercises, desensitization

Pain, Anxiety, Depression: Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), Motivational Interviewing (MI), support groups, pain journals

ADLs: energy conservation, assistive devices, education for safe and proper use of assistive devices, task modification and simplification

Productivity

Community Integration: assistive devices for mobility and required education, public transportation, gradual community exposure

Work / School: job demands analysis (JDA), functional mobility evaluation (FAE), advocate to employer for necessary accommodations or modifications, assertiveness training for client to help manage difficult social situations

Home: energy conservation strategies for IADLs, assistive devices for IADLs and necessary education, assertiveness training to help manage home and caregiver tasks, task simplification and modification

Leisure

Leisure Exploration: support groups, meaningful occupation

Leisure Participation: gradual exposure, task simplification and modification