OCCUPATIONAL THERAPY'S ROLE IN REBUILDING A BURN SURVIVOR'S LIFE
By: Adrienne Lauer, MS, OTR/L

Rehabilitation after sustaining burn injuries requires the care and
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expertise of many healthcare professionals. As a member of the

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multidisciplinary burn care team, Occupational Therapists (OT) play many key, important roles at various points on the continuum of care delivered in the recovery process. From splinting in ICU, wound care, massage or scar management in acute rehabilitation and providing adaptive equipment to increase independence along the way are a few such interventions by OT's. Another very important essential role, is assisting the Burn Survivor in returning to the community. This is an essential role in the complete rebuilding of their lives.

Occupational Therapy is defined as an allied health profession that is concerned with restoring or maintaining "skills for the job of living". Specifically, this means skills necessary to engage in self care, work and leisure activities.

After practicing as an Occupational Therapist for some time in a variety of areas in adult rehabilitation, I eventually found myself involved in the care of Burn Survivors. I was fortunate to learn my skills in the treatment of Burn Survivors from some very gifted and experienced Occupational Therapists who were specialists in hand therapy and orthopedic conditions of the upper extremity. As those of you reading this undoubtedly are aware, these are often useful, if not necessary when providing services to persons who have been burned.

My involvement in learning more about the care of burn survivors stemmed first from a strong desire to continue building my already existing skills as a therapist and secondly to learn more about the personal stories of this special group of people who had survived incredible catastrophes. By effectively listening to the needs and concerns of Burn Survivors about returning to their prior life, I was able to become clearer on what the role of OT is in rebuilding their lives following injury.

While I indeed learned the expertise and technical skills from other senior therapists which were necessary to manage scars, heal wounds, increase range of motion, etc., I also gained incredible insight to perhaps the more important role occupational therapists in the delivery of services to Burn Survivors. And that role was learned from my clients.
Often, it seems a lot of attention is paid to the physical rehabilitation of the Burn Survivor and little, or at least not enough, is paid to their psychosocial needs and or worker-productivity
needs. A critical role occupational therapy plays in rehabilitation is one of helping to coordinate and help in the redesigning of the survivor's life. Lifestyle redesign involves helping the Burn Survivor find the strength not only in damaged muscles and limbs but internally as well. Finding the self esteem and self image necessary to return to prior roles, interests, routines, relationships, habits, etc. These issues are an extremely critical aspect of rehabilitation.

There are a number of ways in which OT can assist in community re-entry. Plans for intervention are dependent on the age of the client and their ability to participate in the therapeutic process. When the survivor is unable to plan for him/herself, the therapist may work with the family, parents, or significant others to achieve goals. First, the occupational therapist must assess the occupational performance issues of the survivor. That is, what roles, interests have been halted or interrupted that the survivor identifies as wanting to return to? Through detailed, purposeful interview, the therapist can help identify the most important performance issues the survivor desires to be dealt with first.

Secondly, a home evaluation should be performed by an OT, and perhaps at different interim's as the person continues to regain movement, strength, determination, and is able to set new goals. A work or school environment evaluation also may need to be performed to assess not only the physical surroundings but also to address the needs of co-workers, students, teachers, supervisors' etc. The occupational therapist can play the role of educator, helping to desensitize people who will be in contact with or have previously known the survivor prior to their injury. The need here is perhaps most apparent in cases where the burn survivor has sustained burns to his/her face, and or hands, being most visible. However, the OT can also assist in discussing the seriousness of burns that are may easily be concealed by clothing and perceived as being "easier to deal with". The devastating psychological effect they are to likely have on an individual cannot be overlooked.

The role of OT also includes introducing the Burn Survivor to things such as cosmetics (permanent and concealing), support groups (face to face and on-line), and introducing them to otherBurn Survivors and accompanying them on community re-entry outings (work, restaurant, bank, store, etc.), armed with the tools necessary to respond to staring, curious or overbearing individuals, etc.

I am reminded of one of my clients telling me a tragic story of her experience in returning to work and seeing colleagues for the first time. She had been burned over 65% of her body in an airplane crash. Her entire face, upper torso and both upper extremities were involved. She returned to work to make connections with co-workers she had not seen in months, her entire appearance having changed dramatically. As she sat across a desk from a male colleague, she suddenly became caregiver and "first responder" as he fainted, falling out of his seat in stunned reaction to her now "changed" appearance. Occupational therapists can play a major role in the desensitization of employers and employees to help avoid such instances.

While the physical deficits of the Burn Survivor may be alleviated within the first two to three years following incident, new psychosocial issues are likely to continue to arise again and again as the survivor encounters new people in different situations throughout their lifespan. An Occupational Therapist trained in helping persons with lifestyle redesign, and their mental health will be able to help address these important issues through counseling and goal development. In cases of children who have sustained burns, occupational therapy can assist in helping parents get information regarding burn camps, cosmetics, appropriate play activities, skin care, etc.

In cases of adults who have been forced to seize their worker role (either that of full-time parent, adult student, caregiver, etc.), work conditioning and work hardening are two areas requiring attention by the Occupational Therapist. Often, the client cannot return to the work he or she previously did,

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but can remain employed in an area different from their prior experience. A vocational questionnaire may be used at this time in order to establish the interests and desires of the survivor. OT's can also conduct work capacity evaluations to determine what type and at what intensity of work a person can feasibly return to.

Again I am reminded of an important lesson learned from my clients as a practicing therapist. That was to not underestimate the will and determination of the persons in relation to getting back to work. One individual I had treated, burned over 78% of his body and in a coma for nine months, revealed his long term goal to me as returning to school to become a lawyer, and then ultimately run for county sheriff! Prior to his relating this to me (some years into his rehabilitation) I don't think I can honestly say I had explored the "worker role" with him. Rather, knowing he was classified as permanently disabled and would receive a lawsuit settlement, I viewed him as not being interested in returning to work. Although we had never truly discussed the issue, I had definite preconceived notions regarding his ever returning to be a fully productive member of society…….a huge oversight on my part.

Hopefully, I have shared with you some information that is or will be important to you or your loved ones now or in the future regarding the role Occupational Therapy can play in community re-entry with burn survivors. I have learned a great deal about life and myself by working with this population, for which I am grateful. For more information regarding OT and Occupational Therapists, check out BSTTW's Medical Links: US & Mexico and the web site for the American Occupational Therapy Association.

Adrienne Lauer is an Assistant Professor of Occupational Therapy at Nova Southeastern University in Ft. Lauderdale, Fl. She has a bachelor's degree in occupational therapy and a master's degree in health services administration. She is currently pursuing her doctorate in education. She has been an OT for 13 years. Send your questions to: info@burnsurvivorsttw.org

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