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Fact Sheets

2.4 million people per year seek medical attention for burn injuries just in the United States (Pedretti, 2001). Most common cause of burns is due to skin exposure to hot liquids called scalding (Ethicon, 2003). 75% of all burns in children are preventable. Treatment is expensive and extensive. Burns that cover 30% of the body can cost $200,000 to treat.

Definition of a burn: An injury that damages and/or destroys skin layers usually caused by heat, electricity, chemicals, radiation, and extreme colds is classified as a burn (Ethicon, 2003).

Types of burns: Medical professionals classify burns into four categories or “degrees” to provide quicker and more effective treatment.

• First Degree – also known as superficial burns involves the top layer of skin (epidermis) only.
• Second Degree – also known as partial thickness burns. There are two subcategories of second-degree burns. Superficial – involves epidermis only and skin develops large fluid-filled blisters. Deep – involves the epidermis as well as the underlying layer of skin (dermis). The skin looks mottled white or red or may be wet-looking. Nerve endings may still be intact and scarring can involve keloid scarring (uneven and thick scar tissue that extends beyond the burn site) or hypertrophic scarring (elevated or raised scar tissue).
• Third Degree – also known as full thickness burns affect the epidermis, dermis, and may involve tendons and subcutaneous tissues. There may be eschar scaring (black-crusty looking scars), dryness, visibility of blood vessels, and minimal pain due to nerve damage with no presence of blisters.
• Fourth Degree – Usually caused by electrical burns and is the most serious and life threatening, often resulting in amputation. Damage involves muscles/bones, blood vessels, nerves, and all three layers of skin. Extensive scarring (Kessler-Rogers, 2001).

Medical Management: Stabilization of client, correct fluid deficits or dehydration, cleans wound, apply topical agents to fend off infection and moisturize the wound, possible grafting depending on wound degree, and multidisciplinary therapy. A common burn assessment that is utilized is the Rule of Nines. This assessment divides the body area into different percentages. The medical team can determine the degree of burn by determining the percentage of body surface area involved (Pedretti, 2001).

Occupational Therapy Involvement

During the acute, postoperative, rehabilitative, and outpatient phase of burn recovery, Occupational Therapists (OT) play an important role. OT’s can work to increase appearance by decreasing the effects of scarring, increase movement of affected limbs through splinting, exercises, and activities, assist with coping skills and psychosocial concerns, educate client and family on services and products available to them, help resume independence through developing skills in personal care, leisure activities, and community re-entry. OT’s are also trained in fitting and wear schedules of pressure garments, edema management, scar massage techniques, and fabrication and fitting of splints to decrease contractions and disfigurements.

References

• http://www.skinhealing.com/2_0_skinburnsscars.shtml
  Ethicon, Inc. (2003). Skin, burns, and scars. (January 20, 2004).
• Kessler-Rogers, A. (2001). Occupational sciences lecture notes. Burn Management. 10, Nov. 2001.
• Pedretti, L.W. & Early, M.B. (Ed.). (2001). Occupational therapy practice skills for physical dysfunction (fifth ed.). Missouri: Mosby Inc.

How OT Makes a Difference: Evidence-Based Practice

This article supports Occupational Therapists (OT) and their use of dynamic splinting to help manage contractures that lead to decreased ROM in an individual recovering from a burn. Dynamic splints were taken to facilities that had home hand therapy programs, and the clients were instructed to use the splints on a daily basis. OTs were able to fit and monitor the progress made using the dynamic splinting along with stretching, massage, and range of motion exercises. It was found that by OTs and their knowledge of using splints the client has a better chance at tendon gliding, control over edema, avoidance of muscle disuse, contractures, and deformities.

Van Straten, O. & Sagi, A. (2000). Supersplint: a new dynamic combination splint for the burned hand. Journal of Burn Care Rehabilitation . 21, 71-73.

Anecdotal Reports

“S” was standing near a fire when her clothing caught on fire. Her young nephew tried to throw a bucket of water onto her, but the bucket was filled with gasoline instead of water. “S” threw herself into a nearby pool and was rushed to the hospital with over 65% of her body burned. “S” was only 14 years old at the time and does not remember how long she was in the hospital. However, she does remember her rehabilitation team—most of all, her Occupational Therapist (OT). “S” says, “my OT gave me a chance to deal with what had happened to me. She asked me what I wanted and what I thought was important to me, and that made me stay motivated.” “S” mentions having to “start all over again with my life”. She says that she and her OT had to work on her personal ADLs, role playing, finding activities that she enjoyed again, as well as developing coping strategies to deal with the traumatic experience that she had been through. “If it hadn’t have been for her (the OT) taking the time to listen to what I thought was important, I would have never been able to be this independent in my life.” “S” also reports that she still keeps her splints that her OT made for her as a reminder of just how far she has come.

Client Handout

• Scar Control (PDF File)

Web Links

• http://www.skinhealing.com/2_0_skinburnsscars.shtml
  The Ethicon Inc. site is a wealth of information on burns, types of turns, medical breakthroughs and procedures, and survivor stories. This site has detailed illustrations and diagrams that are very helpful and informative.
• http://www.chkd.com/Burns/classify.asp
  Children’s Hospital of the King’s Daughters has put together a site that not only contains information on statistics and types of burns, but it also contains information on what a burn survivor can expect or do when they return home from the hospital or rehabilitation setting. There are also contact numbers and support groups for clients and family members to utilize.
• http://www.nysota.org/burns.html
  This site is constructed New York State Occupational Therapy Association (NYSOTA) and gives a nice overview of what roles an Occupational Therapist can play in a burn survivor’s recovery process. The NYSOTA gives information on support groups and larger Occupational Therapy Associations that may be consulted for additional information.