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| EDITORIAL |
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| Year : 2021 | Volume
: 29
| Issue : 1 | Page : 1-3 |
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Postburn rehabilitation and improvement of body image
Vijay Kumar
Department of Plastic Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| Date of Submission | 15-May-2022 |
| Date of Acceptance | 15-May-2022 |
| Date of Web Publication | 08-Jun-2022 |
Correspondence Address:
Vijay Kumar
Department of Plastic Surgery, King George Medical University, Lucknow, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijb.ijb_11_22
Improvement in quality of life and optimum functional recovery after burn injury is the final goal of burn care. After major burn injuries, look (body image) and functionality changed a lot. How a person perceive himself or herself, how confident about his/her looks, and how much confident about his/her body appearance are collectively known as body image. Severe distress is present in 30% of burn survivors and perceives their distorted body image after their first hospitalization. Pre- and postoperative physiotherapy and occupational therapy provide alternative ways for these problems of burn patients. Almost everyone has certain degree of changes in their recovery phase, but most of them get used to the change in their appearance over the time.
Keywords: Body image, burn deformities, burn rehabilitation, postburn physiotherapy
How to cite this article:
Kumar V. Postburn rehabilitation and improvement of body image. Indian J Burns 2021;29:1-3 |
| Introduction | |  |
Rehabilitation for the burn injury patients starts from very beginning, from the day of injury and it may last for several years later the incident and requires a multidisciplinary team approach. About one-third of burn survivors have severe distress and perceive their distorted body image after their first hospitalization.[1] A multidisciplinary and comprehensive rehabilitation protocol is needed to decrease the post-traumatic effects and improve the functional outcome of the patients.[2] It is the shared responsibility of the burn care team on their part to optimize the rehabilitation, maximize the benefit to the patient and improved body image. To improve the outcome as a result of rehabilitation we require a dedicated multidisciplinary team with their commitment towards the patient care and to improve quality of life.
| Methods | | |
Stages of rehabilitation
Rehabilitation of burns patients is an important and critical aspect of burn care and it is a continuum of active management of burn; starting from the admission of burn patient to the burn care unit. To make the rehabilitation more effective and practical should start immediately with and continue from acute phase to rehabilitation phase.[3] To make the process of rehabilitation more easy and convenient, the stages of rehabilitation divided into early stages and late stages of rehabilitation. Although there is significant crossover between these two stages which may vary patient to patient.
Causes of body image concerns
Body image concerns after a burn injury are caused by many factors. These factors include person's feeling about his or her burns, gender, mental health history, and social support network. Body image distress may involve the following.
- Profound grief or sadness about their changed appearance
- Anxiety about scars visibility
- Anxiety about the expected questions about disfigurement and the incident
- Worry about people's reaction after seeing the scars and disfigured body.
Early stage of rehabilitation
The early phase of rehabilitation may last from few days to several months depending on the extent of burn and body surface area involved, patient's age, and other premorbid conditions. These patients may be treated as an indoor patient or treated as outdoor patients.
Regular and sustained pain relief is essential to ally the patient anxiety, especially before any interventions such as change of dressing. The aim of analgesia is good; effective baseline pain control which allow and facilitate the functional movement and activities of daily living to occur.[3] Inadequate pain relief can lead the patient to complete reluctance phase of their rehabilitation program.
Early start of rehabilitation is the key to compliance with treatment and to gain maximum long-term outcomes.
Do not delay rehabilitation
Pain is the most devastating than the burn injury itself patients usually patient delay their rehabilitative phase until they feel them free from pain; even single day delay in their burn, physical therapy program will make the rehabilitative process more difficult and painful which ultimately leads to poorer outcome. If this short window period is missed, the joints become stiff and tethered which ultimately lead to loss of function with the passage of time.[4] Due to excessive pain and lack of knowledge, patients try to refuse treatment; in this hard time, they need constant support and encouragement of the burn care providers in improving their quality of life and to restore positive body image.
Critical care
After admission of burn patient, every attempt should be made reduce the risks of possible further complications. Maintain a good semi-upright posture to reduce the edema of the head, neck, and upper airway and improve chest conditions. Limb elevation is effective to quickly reduce edema; hands and leg should be splinted and kept elevated above the level of heart. Care and attention must be given to all the pressure wearing area, such as heel area, which can quickly develop pressure sore.
Patients who are unable to move should need more attention to maintain range of movement (ROM) at all the joints, prevent stiffness and pressure sore.
Psychological impact
We always should respect the privacy and comfort level of the patient and reassurance about their safety. Ample amount of time should be given to record the patient's history and concerns, demonstrating genuine empathy and compassion, providing adequate information, and answering their questions and doubts; it will make treatment process more easy and genuine for both patient and health-care providers.
Positioning
Patient should follow a positioning regime in the early phases of healing and this will require teamwork and dedication of both patient and health-care providers. Health-care providers should encourage the patient to maintain anti-contracture position all of the time especially at night followed by daytime physiotherapy. Regard to this family member of the burn patient play a key role in whole process of recovery. Invest sufficient time in educating the patient and family members about the benefits of participating in therapy is essential and involving family for early stage of rehabilitation.
Splinting
Splints are essential and effective to prevent and manage burn contractures and are an integral part of a comprehensive rehabilitation program.[5] A well-designed splintage program incorporated with active and passive mobilization is essential to prevent and convert joint contractures and deformities.[2] It is always better to provide early splintage for prevention of the development of postburn scar contracture.[2]
Stretching and early mobilization
In the early stages of burn recovery, the scar formation process is extremely active; and dynamic and the contractile forces are maximum. Burns near or over the joints must be stretched regularly in a controlled and guided way to avoid any decrease in ROM and prevention of postburn contracture. Stretching in conjunction with a splinting of the affected joints is necessary to counteract the contracture forces and prevent restriction in ROM.
Encourage daily activities
Patients should be motivated and encouraged to return to their normal daily routines as early as possible so that they can improve their self-esteem and body image comparable to preinjury period.
Social interactions after burns
Sometimes, burn victims may have difficulty in facing the public gatherings and may feel bad about their scars and usually avoid contact, or having fear of being ask some wired questions about their appearance and incident.
Some tips to face these situations
- Do not be shy
- Feel more confident and make eye contact. while talking to someone
- Be ready with answer ahead of time to explain your incident and condition
- Ignore if you do not want to discuss about your appearance or try to learn no, I do not want to discuss.
Burn injury and intimacy
Patient may be worried about their burn scars during intimate experiences. Here are some practical tips that may help you to feel more comfortable and confidant:
- Talk to your partner. Regular talking and generous discussion with your partner usually solve your problems even without your conscious knowledge. The partner should learn about the different stages of healing and recovery he or she have gone through. These are being irritable with you, withdrawal, and avoidance
- Moisturizing or massaging of scars can help both of you to overcome any hesitation or the “fear of rejection.” Regular talking and a healing touch can alley his/her anxiety
- Can take help of the grooming centers/spa to improve the quality of skin; because these will improve your well-being and early readjustments in body image
- Read good motivational books and about war survivors.
Teasing of child survivors
Parents and teachers need to closely watch how child burn survivors act and interact with other people and help him/her at difficult situations. Sometimes, parents may not be aware about the severity of teasing of burn survivor. Children who are teased may become depressed or anxious when meeting new people. The teachers and adults can also teach the children how to treat a burn survivor with friendly environment and dignity. This will definitely create a supportive environment for a burn survivor child. Schools should have policies and strict rules to minimize teasing and bullying and create a supportive learning environment for everyone.
School reentry and burn camp programs
Burn centers often have some especially designed programs to help burn survivors and help them in returning to school. This program may require school previsit before the child's reentry. The burn expert should explain the burn recovery process to the teachers and classmates of burn survivor so that they can easily understand the process well in advance and act accordingly.
Later stage of rehabilitation
After burn injury, some patients may feel alone and may be very difficult to integrate back into society. They always have a sense of inferiority and should be encouraged to re-establish themselves in their life after a burn injury; these patients can lead a full life with ease and modesty only with the support of family and society.
| Conclusion | | |
Rehabilitation of a burn injury survivor is long process, which starts from the day of incident and it is a continuous process of care from acute management to wound management to the posttreatment physiotherapy and other rehabilitation. It requires a full harmony between the dedicated multidisciplinary team of professional, family, and the victim. The path of rehabilitation and recovery is not an easy task, but with the right support and therapeutic intervention and commitment of the team,[4] will prepare a roadmap for the patients maximum physical, psychological, and functional outcome and to achieve his or her positive body image.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Blakeney P, Partridge J, Rumsey N. Community integration. J Burn Care Res 2007;28:598-601.  |
| 2. | Kwan MW, Ha KW. Splinting programme for patients with burnt hand. Hand Surg 2002;7:231-41. |
| 3. | Edgar D, Brereton M. ABC of burns rehabilitation after burn injury. Br Med J 2004;329:343-5. |
| 4. | Fess EE, McCollum M. The influence of splinting on healing tissues. J Hand Ther 1998;11:157-61. |
| 5. | Richard R, Ward RS. Splinting strategies and controversies. J Burn Care Rehabil 2005;26:392-6. |
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