THE ROLE OF THE OCCUPATIONAL THERAPIST IN THE TREATMENT OF BURNS

Annals of Burns and Fire Disasters - vol. XV - n. 3 - September 2002

THE ROLE OF THE OCCUPATIONAL THERAPIST IN THE TREATMENT OF BURNS

Petiot J.

Centre de Pédiatrie et de Rééducation, Bullion, France


SUMMARY. The author of this paper, an occupational therapist working in France, presents a concise account of his work with burned children and outlines some of its main aspects, including the use of pressure garments and special corrective apparatus. The aims and methods of occupational therapy are briefly summarized, with reference to the successive phases of treatment.


Introduction

Since 1990 Jean Petiot has worked as an occupational therapist at the Centre de Pédiatrie et de Rééducation at Bullion in France.

Ninety per cent of his work regards post-operative rehabilitation techniques in extensively burned patients (children aged 0 to 16 years), special equipment, pressure masks, pressure garments, and showers and baths, as well as rehabilitation by play and work activities aimed at the recovery of the patients’ autonomy.

He is active in training activities and in 1999 took part in a mission to Vietnam in the context of action promoted by the humanitarian organization “La chaîne de l’espoir”, dedicated to surgical operations on burned patients and to the creation of post-operative facilities for the rehabilitation of extensively burned patients (Saigon and the Mekong Delta).

Jean Petiot has prepared this introductory text in the hope that it will stimulate discussion among all those who work in the field of occupational therapy.

Introduction to burns therapy

Burns therapy presents a number of difficulties due to various factors, including:

  • the duration of the period of care during which postural corrective equipment has to be worn - this can last up to two years;
  • the rigidity of the devices, which at first can be worn only for 24 h and often limit the patient’s autonomy;
  • the necessary co-ordination and cohesion between the various professional figures involved in treating the patient (nurses, physicians, psychologists).

Re-education is basically in two phases:

  1. Wearing of the postural device.
  2. Partial suspension of wearing of the device: in children permanently, in adults for some hours followed by mobilization.

Phase 1: wearing of the postural apparatus


Aims

  • elimination of existing contractures
  • maintenance of good cutaneous capacity and stabilization of contracture phenomena
  • avoidance of cutaneous hypertrophy and action against decubitus sores and pain

Methods

  • progressive plasters, resins, splints made heat-mouldable material
  • Orien masks, temporary pressure garments, silicone, pressure rubber

The occupational therapist’s role

The occupational therapist participates in the construction of most of the equipment and, when possible, contributes to its installation in bed, at mealtimes.


Phase 2: partial suspension of wearing of apparatus


This must be done as soon as possible, when articular amplitude has stabilized.

The pressure garments and masks are worn permanently, while posture apparatuses are removed progressively during the day.


The occupational therapist’s role

The occupational therapist makes a general assessment of the following aspects: loss of physical status, muscular deficit, remaining scar tissue, autonomy in everyday life, the child’s psychological state, the family environment.

Objectives

  • Action against compensatory reactions and the development of bad habits (analytical work and play activity)
  • Muscular reinforcement
  • Exploitation of maximum functional capacity (action against exclusion of one or more fingers or of the entire upper limb)
  • Development of related activities permitting the accomplishment of everyday act (opening drawers, carrying objects, washing hands)
  • Reacquisition of ability to use hot or dangerous objects (electric iron)
  • Greater self-expression by improvement of these skills
  • Personal toilet (mirror), dressing, meals (if necessary, with help)
  • Preparation for discharge from burns centre (final pressure garments, psychological work)

Conclusion

The occupational therapist plays a central role:

  1. in the making of equipment;
  2. in providing psychological support and in the process of adaptation during retraining;
  3. in the assessment and development of functional skills.

RESUME. L’Auteur de cet article est un ergothérapeute qui travaille en France. Il décrit brièvement son activité avec les enfants brûlés et en indique les aspects principaux, y inclus l’emploi des vêtements compressifs et les appareils spéciaux correctifs. Il décrit aussi en manière synthétique les buts et les méthodes de l’ergothérapie, pour ce qui concerne les phases successives du traitement.


For further reading (in French), click:
http://www.medbc.com/annals/review/vol_2/num_3/text/vol2n3p123.htm

This paper was received on 21 December 2001.

Address correspondence to: Jean Petiot, Centre de Pédiatrie et de Rééducation, Bullion, France.



 

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