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The Role of OT in Burn Rehabilitation @ St. John's Rehab
Transcript of The Role of OT in Burn Rehabilitation @ St. John's Rehab
@ St. John's Rehab Laura Kim, Student OT What is Occupational Therapy? Holistic, client-centred profession
Promote health and well being through occupation
To enable people to participate in the activities of everyday life
Achieved by working with people and communities
Modify the occupation or environment to support their occupational engagement
Enable participation in activities of everyday life by restoring function and regaining independence
Collaborate with the interdisciplinary team, patient, families, third party workers Conclusion University of Toronto: Fieldwork Placement II December 12, 2012 Criterion for admission: Sustained severe burns or electrical injuries
Stable medical status
Motivated to set active rehab goals and participate in 2 active rehab therapy sessions (5-7 days/ week)
Sit unsupported for 30 min minimum
Mental health: cognitively intact 7 beds dedicated to burn patients
LOS dependent on complexity of needs Physiotherapists
Speech-language pathologists How is OT Significant to Burn Rehabilitation? Theories/ Frames of Reference Biomechanical Outcome measures (Sunnybrook Health Sciences Centre, 2012) (Sunnybrook Health Sciences Centre, 2012) (WFOT, 2012) Focus: Goal: Principles of human movement and posture
OT perspective: movement and posture during occupation
Used with patients with limited movement, decreased muscle strength, loss of endurance Treatment
- PROM/ AROM exercises
- Splinting/ positioning
- Exercise activities:
clothes pegs, hand grippers/ web,
ROM arc, armbike, etc
- Adaptive equipment: built-up
utensils, reacher, sock aid Psychosocial (Carrougher, 1998; Hubick, 2003; Simons, King & Edgar, 2003) Principles of psychological, social, emotional well-being
OT perspective: health, quality of life and well-being to participate in occupation Treatment - Refer to psychologist
- Spiritual care
- Burn support groups
- Social support: family, friends
- Education & resources
- Therapeutic use of self
- Pain management (relaxation, breathing)
- Consult acute burn specialists Neurodevelopmental Principles of neurology and physiology
Uses positioning and handling techniques
OT perspective: posture, positioning, movement and breathing to support functional mobility and participation in occupation Treatment - Scar management: massage/ stretching, education, pressure garments, Cica care
- Wound management: compression gloves, tubi grip, Coban, elevation, positioning
- Pain management: relaxation, breathing Hand Ax: 9 hole peg test, JAMAR, dynanometer, grip and pinch gauge
Functional Ax: Functional Independence Measure (FIM), goniometry
Burn Ax: Vancouver Scar Scale - Age
- Pain and fatigue
- Activity tolerance
- Cultural/ language barriers
- Compliance Considerations: Use outcome measures
Client-centered, individualized treatment
Educate patients and provide resources
Ongoing professional development
Collaborate with the team, patient, families, third party for the patients optimal recovery
Explore new treatment/ intervention
Need for best practice burn rehabilitation research References (Staley & Richard, 1997; Field et al, 2000; So et al, 2003; Edgar & Brereton, 2004;
Gault, 2008; Richard et al, 2009; NDTA, 2012) Domains: self-care, leisure, productivity (Kania & Boersen-Gladman, 2010; WFOT, 2012) (Cole & Tufano, 2008) Canadian Practice Process Framework Occupations people need, want, expected to do Holistic, client-centered approach
Hypertrophic scars Occupational performance goal: Limitations: decreased hand grasp Goal of intervention: increase ROM in elbow, Intervention: massage/ stretching, splinting decreased elbow flexion brush teeth independently (Baryza & Baryza, 1995) strengthen hand grasp PROM/ AROM exercises Outcome measures: JAMAR dynamometer FIM, goniometry (So et al, 2003; Simons, King & Edgar, 2003; Edgar & Brereton, 2004; Richard & Ward, 2005; Yohannan et al, 2012) Baryza MJ, Baryza GA. (1995). Vancouver Scar Scale: an administration tool and its inter-rater Reliability. Journal of Burn Care & Rehabilitation, 16(5):535-538.
Carrougher, G. J. (1998). Burn care and therapy. St. Louis, Mo: Mosby.
Cole, M.B. & Tufano, R. (2008). Applied theories in occupational therapy: A practical approach. Thorofare, NJ: SLACK Incorporated.
Edgar, D. & Brereton, M. (2004). ABC of burns rehabilitation after burn injury. British Medical Journal, 329(7461): 343-345. doi: 10.1136/bmj.329.7461.343
Field, T., Peck, M., Hernandez-Reif, M., Krugman, S., Burman, I., & Ozment-Schenck, L. (2000). Postburn itching, pain, and psychological symptoms are reduced with massage therapy. Journal of Burn Care & Rehabilitation, 21(3):189-193.
Gault, G.M. (2008). Neurodevelopmental theory - NDT Treatment for the person with a neurological injury. Retrieved from, http://EzineArticles.com/937718
Hubick, K.K. 2003). Psychosocial factors in burn care. Advance for Occupational Therapy Practitioners, 19(14), 13. Retrieved from, http://occupational-therapy.advanceweb.com/Article/Psychosocial-Factors-in-Burn-Care-1.aspx
Kania, A, & Boersen-Gladman, K. (2010). Burn rehabilitation. Massage Therapy Canada. Retrieved from, www.massagetherapycanada.com/content/view/1411/38/
So, K., Umraw, N., Scott, J., Campbell, K., Musgrave, M. & Cartotto, R. (2003). Effects of enhanced patient education on compliance with silicone gel sheeting and burn scar outcome: A randomized prospective study. Journal of Burn Care & Rehabilitation, 24: 411-417. doi: 10.1097/01.BCR.0000095516.98523.04
Moyer, C. (2004). Massage Therapy: Meta-analytic evidence for a contextual model. Psychological Bulletin, 130: 3-18.
Polatajko, H., Craik, J., Davis, J. & Townsend, E. A. (2007). Canadian Practice Process Framework. In E.A. Townsend and H.J. Polatajo, Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation, p. 233, Ottawa, ON: CAOT Publications: ACE.
Richard, R., Baryza, M.J., Carr, J.A., et al. (2009). Burn rehabilitation and research: proceedings of a consensus summit. Journal of Burn Care & Research, 30:543–73.
Simons, M., King, S., & Edgar, D. (2003). Occupational therapy and physiotherapy for patients with burns: Principles and management guidelines. Journal of Burn Care & Rehabilitation, 24: 323-335. doi: 10.1097/01.BCR.0000086068.14402.C6
Sunnybrook Health Sciences Centre (2012). Burn rehabilitation. Retrieved from, http://sunnybrook.ca/content/?page=SJR_patvis_prog_burn
Staley, M.J., & Richard, R.L. (1997). Use of pressure to treat hypertrophic burn scars. Advanced Wound Care, 10(3):44-6.
World Federation of Occupational Therapists (2012). Definition of occupational therapy. Retrieved from, http://www.wfot.org/AboutUs/AboutOccupationalTherapy/DefinitionofOccupationalTherapy.aspx
Yohannan, S.K., Tufaro, P.A., Hunter, H. et al. (2012). The Utilization of Nintendo® Wii™ During Burn Rehabilitation: A Pilot Study. Journal of Burn Care & Research, 33(1), 36–45. doi:10.1097/BCR.0b013e318234d8ef Factors that effect
the burn patient: - Nintendo Wii - splinting vascularity, height, pigmentation, pliability