Burn Rehabilitation for the Unburned

First Author(s)

• JC

  Jill Cancio, OTD, OTR/L, CHT

  United States Army Institute of Surgical Research
  Jbsa Ft Sam Houston, Texas

  Disclosure information not submitted.

  Slides and Audio

Co-Author(s)

• 

  Leopoldo Cancio, MD, FCCM

  Director
  United States Army Institute of Surgical Research
  San Antonio, Texas

  Disclosure information not submitted.
• WD

  William Dewey, PT, CHT

  Chief, Burn Rehabilitation
  United States Army Institute of Surgical Research Burn Center
  Ft Sam Houston, Texas, United States

  Disclosure information not submitted.
• CQ

  Charles Quick, OTD, OTR/L, CHT

  Occupational Therapist
  United States Army Institute of Surgical Research Burn Center
  Ft Sam Houston, Texas, United States

  Disclosure information not submitted.

Title: Burn Rehabilitation for the Unburned

Case Report Body:

Introduction:
Burns are among the most devastating forms of trauma, with immediate and long-lasting physiological and functional effects. Given the complex nature of burn injury, a team approach is essential to include early occupational and physical therapy. Therapy begins upon admission to the burn intensive care unit (BICU) and continues throughout the hospital stay and beyond. Our burn center rehabilitation department is staffed 365 days per year, with services available 16 hours per day. It is unknown whether the same intensive approach to rehabilitation of patients with severe non-burn injuries and burn-like illnesses is appropriate. The late Dr. Basil A. Pruitt, Jr. published “Burn Treatment for the Unburned.” We propose the concept of “Burn Rehabilitation for the Unburned.” We hypothesize that critical-care rehabilitation of certain patients who have sustained complex life-threatening non-burn injuries is also ideally performed in a burn center. The purpose of this project is to review a series of such patients.

Description:
We report a series of 5 patients who sustained life-threatening non-burn injuries (necrotizing soft tissue processes and high velocity orthopedic and neurological trauma) who were treated at our burn center. On average, 68% of their hospital stay was on the BICU with 18.4 operations. An average of 3.7 hours of direct rehabilitation was provided per day and therapy sessions were completed an average of 95% of the days during their inpatient stay. For reference, data are reported for all patients who sustained burn injury and completed a burn center inpatient stay for a recent 6-month period. On average, burn size was 4.8% TBSA with 1.2 operations. They received therapy an average of 94% of days during inpatient stay with .7 hours of treatment daily.

Discussion:
The burn center is a model for how rehabilitation of critically ill patients should be accomplished in the ICU. Reflecting their severity of illness, these patients received more rehabilitation than the average burn patient at our burn center. Compared to published data regarding rehabilitation in ICUs, these patients received considerably more rehabilitation per day and over their lengths of stay. Early intensive rehabilitation of the severely injured, integrated into interdisciplinary ICU care, is essential for optimal outcomes.