[A randomized controlled trial on the effect of exercise prescription based on a progressive mode in treating elderly patients with lower limb dysfunction after deep burns].

Objective: To explore the effect of exercise prescription based on a progressive mode in treating elderly patients with lower limb dysfunction after deep burns. Methods: A randomized controlled trial was conducted. From January 2021 to January 2023, 60 elderly patients with lower limb dysfunction after deep burns who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. The patients were divided into conventional rehabilitation group (30 cases, 17 males and 13 females, aged (65±3) years) and combined rehabilitation group (30 cases, 16 males and 14 females, aged (64±3) years) according to the random number table. For patients in both groups, the red-light treatment was started after the lower limb wounds healed or when the total area of scattered residual wounds was less than 1% of the total body surface area. After 2 weeks of red-light treatment, the patients in conventional rehabilitation group were given conventional rehabilitation treatments, including joint stretching, resistance, and balance training; in addition to conventional rehabilitation treatments, the patients in combined rehabilitation group were given exercise prescription training based on a progressive mode three times a week, mainly including dumbbell press, Bobath ball horizontal support, and high-level pulldown trainings. The training time for patients in both groups was 12 weeks. Before training (after 2 weeks of red-light treatment) and after 12 weeks of training, the upper limb and lower limb motor functions of the patients were evaluated using the simple Fugl-Meyer scale, the physical fitness of patients was evaluated using the simple physical fitness scale, and the patient's risk of falling was evaluated by the time consumed for the timed up and go test. The adverse events of patients that occurred during training were recorded. After 12 weeks of training, a self-designed satisfaction survey was conducted to investigate patients' satisfaction with the training effect. Data were statistically analyzed with independent sample t test, paired sample t test, Mann-Whitney U test, Wilcoxon signed rank test, and chi-square test. Results: Before training, the scores of upper limb and lower limb motor functions of patients between the two groups were similar (P>0.05). After 12 weeks of training, the scores of upper limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -11.42 and -13.67, respectively, P<0.05), but there was no statistically significant difference between the two groups (P>0.05). The score of lower limb motor function of patients in combined rehabilitation group was 28.9±2.6, which was significantly higher than 26.3±2.6 in conventional rehabilitation group (t=-3.90, P<0.05), and the scores of lower limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -4.14 and -6.94, respectively, P<0.05). Before training, the individual and total scores of physical fitness of patients between the two groups were similar (P>0.05). After 12 weeks of training, the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in conventional rehabilitation group and combined rehabilitation group were significantly increased compared with those before training (with Z values of -4.38, -3.55, -3.88, -4.65, -4.58, -4.68, -4.42, and -4.48, respectively, P<0.05), and the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in combined rehabilitation group were significantly increased compared with those in conventional rehabilitation group (with Z values of -3.93, -3.41, -3.19, and -5.33, P<0.05). Before training, the time consumed for the timed up and go test for patient's risk of falling in the two groups was close (P>0.05). After 12 weeks of training, the time consumed for the timed up and go test for patient's risk of falling in combined rehabilitation group was (28.0±2.1) s, which was significantly shorter than (30.5±1.8) s in conventional rehabilitation group (t=4.94, P<0.05). Moreover, the time consumed for the timed up and go test for patient's risk of falling in both conventional rehabilitation group and combined rehabilitation group was significantly shorter than that before training (with t values of 14.80 and 15.86, respectively, P<0.05). During the training period, no adverse events such as muscle tissue strain, edema, or falling occurred in any patient. After 12 weeks of training, the satisfaction score of patients with the training effect in combined rehabilitation group was 13.5±1.2, which was significantly higher than 8.5±1.4 in conventional rehabilitation group (t=21.78, P<0.05). Conclusions: The exercise prescription training based on a progressive mode can significantly promote the recovery of lower limb motor function and physical fitness of elderly patients with lower limb dysfunction after deep burns, and effectively reduce the patient's risk of falling without causing adverse events during the training period, resulting in patient's high satisfaction with the training effect.

A six-week physical therapy exercise program delivered via home-based telerehabilitation is comparable to in-person programs for patients with burn injuries: A randomized, controlled, non-inferiority clinical pilot trial.

BACKGROUND: Exercise programmes are essential for burn rehabilitation, however patients often have barriers accessing these services. Home-based telerehabilitation (HBT) may be an alternative. This study aimed to determine if exercise programs delivered via HBT were as effective as in-person (IP) programs with respect to clinical outcomes and participant and therapist satisfaction. METHODS: A single center, randomized, controlled, non-inferiority pilot trial with blinded assessment was undertaken. Forty-five adults with ≤ 25% total body surface area (TBSA) burns were randomized to receive a 6-week exercise program delivered either by HBT or IP. The primary outcome was burn-specific quality of life (Burn Specific Health Scale - Brief). Secondary outcomes included health-related quality of life, burn scar-specific outcomes, exercise self-efficacy, pain severity, muscle strength and range of motion (ROM). Participant and therapist satisfaction, technical disruptions and adverse events were also recorded. RESULTS: We found no significant within- or between-group differences for any outcome measures except ROM. Achievement of full ROM was significantly different between groups at Week 12 (IP=100% vs HBT=70%, p = 0.005). Non-inferiority was inconclusive. Participant satisfaction was high (median ≥ 9.8/10), with no significant between-group differences. Therapist satisfaction was high (median ≥ 8.9/10), major technical disruptions low (8%) and no adverse events reported. CONCLUSION: HBT is a safe, effective option to deliver exercise programs for patients with burn injuries ≤ 25% TBSA with comparable clinical outcomes to in-person programmes. Ongoing research is required to further analyze ROM and investigate the effectiveness of HBT for patients with larger burns.

Yoga and Cutaneous Functional Unit Recruitment for a Patient with Cervical and Upper Extremity Burn Scar Contracture: Case Report.

Burn scar contracture greatly limits function for burn survivors, particularly when the scarring crosses multiple joints. Previous research has identified fields of skin recruited during single joint motion, called cutaneous functional units (CFU), indicating that impairments may be seen distal to the injured tissue. This case report connects the principles of CFU and yoga-inspired therapy modalities in improving clinical outcomes for a burn survivor. The patient is a 38-year-old male who sustained deep partial-thickness electrical burns to his neck, chest, and bilateral upper extremities, presenting with significantly decreased range of motion. The patient attended physical therapy 4 days a week, where he performed a specific yoga asana program during each session. Outcomes including standard range of motion measures, the Vancouver Scar Scale (VSS), and the Neck Disability Index (NDI), which were recorded every 10 sessions. CFUs of cervical extension and shoulder flexion were analyzed via photographs comparing cutaneous position during specified yoga poses and resting anatomical position in standing. Over 30 visits, cervical and shoulder range of motion increased, although the VSS and NDI did not show significant improvement. Yoga poses showed overall cutaneous recruitment distal to the targeted joints, and burned skin was recruited similarly to nonburned skin in positions of stretch. Incorporating multijoint approaches for stretching, like yoga, appears to contribute to improved clinical range-of-motion outcomes when paired with traditional burn-rehabilitation interventions. Yoga poses involving multiple joints align with the principle of CFUs, warranting continued investigation.

Developing a national trauma research action plan: Results from the Burn Research Gap Delphi Survey.

BACKGROUND: The 2016 National Academies of Science, Engineering and Medicine call for a national integrated, military-civilian trauma action plan to achieve zero preventable deaths and disability after injury included a proposal to establish a National Trauma Research Action Plan to "strengthen trauma research and ensure that the resources available for this research are commensurate with the importance of injury and the potential for improvement in patient outcomes." The Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma/burn care from prehospital to rehabilitation. The Burn/Reconstructive Surgery group represents one focus area for this research agenda development. METHODS: Experts in burn and reconstructive surgery research identified gaps in knowledge, generated research questions and prioritized questions using a consensus driven Delphi survey approach. Participants were identified using established Delphi recruitment guidelines to ensure heterogeneity and generalizability with military and civilian representatives. Literature reviews informed the panel. Panelists were encouraged to use a PICO format to generate research questions: Patient/Population; Intervention; Compare/Control; Outcome. Participants ranked the priority of each question on a nine-point Likert scale, which was categorized to represent low, medium, and high priority items. Consensus was defined based on ≥60% panelist agreement. RESULTS: Subject matter experts generated 949 research questions in 29 Burn & 26 Reconstruction topics. Five hundred ninety-seven questions reached consensus. Of these, 338 (57%) were high-priority, 180 (30%), medium-priority, and 78 (13%) low-priority questions. CONCLUSION: Many high-priority questions translate to complex wound management and outcomes. Panel recognition that significant gaps in knowledge exist in understanding functional outcomes after injury underscores the importance of long-term recovery metrics even when studying acute injury or interventions such as resuscitation or inhalation injury. Funding agencies and burn/reconstructive surgery researchers should consider these gaps when they prioritize future research. LEVEL OF EVIDENCE: Expert consensus, Level IV.

Impact of Adding Protein Supplementation to Exercise Training on Lean Body Mass and Muscle Strength in Burn Patients.

Protein catabolism is a common complication after burn injury, leading to a loss of muscle mass and a decrease in muscle strength. The present study was aimed to evaluate the efficacy of combining exercise training with protein supplementation on lean body mass and muscle strength in patients with severe burn. Sixty participants with severe burn >30% of TBSA were randomly distributed into four equal groups of 15 participants per group. Group A (Exercise and Protein) received oral protein supplementation (Inkospor X-TREME; 1.5-2.0 g/kg/d), exercise program, and traditional burn care; group B (Protein) received oral protein supplementation and traditional burn care; group C (Exercise) received exercise program and traditional burn care; and group D (Control) received traditional burn care. Lean body mass was measured using dual-energy x-ray absorptiometry, whereas muscle strength was measured using Biodex 3 Dynamometer System before treatment and 12 weeks after treatment. A significant increase in lean body mass was found in group A compared with that of group B, group C, and group D post-treatment (P < .001). Also, a significant increase was recorded in peak torque of group A compared with that of group B, group C, and group D post-treatment (P < .001). Exercise training can significantly increase lean body mass and peak torque. Protein supplementation can significantly increase lean body mass but cannot significantly increase muscle strength, whereas protein + exercise group has a great impact on lean body mass and muscle power than exercise group and protein group in burn patients.

"On the Recovery Journey:" An Integrative Review of the Needs of Burn Patients From Immediate Pre-Discharge to Post-Discharge Period Using the Omaha System.

BACKGROUND: To establish a conceptual understanding of the needs of burn patients, the specific research question asked is: "What are the needs of burn patients from 1-week pre-discharge to the post-discharge period?" METHODS: Whittemore and Knafl's integrative review approach was used to answer the review question. The databases searched were the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, and Scopus. Thirty-two primary studies were retained at the end of the screening process. Directed content analysis was undertaken, with the Omaha system as an organizing framework. RESULTS: Recovery after burns is not a linear process, but an intricate one filled with varied needs in the physiological (pain, skin, neuro-musculo-skeletal, and infection), psychosocial (social contact, role changes, spirituality, grief, mental health, and sexuality), health-related behavior (nutrition, sleep and rest patterns, and physical activity), and environmental (income) domains of the Omaha system. The nature and intensity of these needs change over time, suggesting that recovery for the burn patient is an ongoing process. CONCLUSIONS: Several needs exist from 1 week before discharge to the post-discharge period. The mutual relationship and evolving nature of these needs create an avenue for a flexible, regular, holistic transitional program, similar to the support offered to persons living with chronic conditions. CLINICAL RELEVANCE: Hospital discharge does not imply an end to the recovery of burn patients, and burn survivors still require holistic care even after discharge. The review shows the applicability of the Omaha system in exploring and classifying the needs of burn survivors and situates nursing at the core of such a program. It is possible that a nurse-led program of care needs to be considered.

Burn Survivor Artist Changes Artistic Approach by Sharing How Other Survivors of Traumatic Events Can Use Art to Heal Themselves by Helping Others Heal.

When creating art, the mind becomes free of physical barriers, no longer feeling broken or different. These same results can be sustained long term over large populations of survivors of traumatic events by grouping individuals into teams to create art of all types with the focus being on helping others. Long-term sustainability can occur with the concept of dedicated centers such as art studios and performing art centers with others that believe in art's healing potential. The simple activity of healing yourself while helping others heal, in whatever large or small way, can help us thrive beyond just surviving. No matter how long ago a traumatic event occurred in someone's life, those lessons learned should be shared with new burn survivors as they go through the long and difficult healing process by having a place that they can go and be with others who have been through the same process.

Impact of the implementation of a therapy dog program on burn center patients and staff.

Animal-assisted interventions have been implemented in both inpatient and outpatient settings and have demonstrated positive outcomes on patients and hospital staff. Animal-assisted interventions have not been previously reported in any burn center. A therapy dog program was established at our burn center with the intent of improving duration and quality of rehabilitation sessions and physical therapy. Satisfaction surveys were distributed to patients and staff. After one year, 14 patient surveys and 23 staff surveys were collected. Implementation of this program was feasible and patients worked with the therapy dogs in all environments of the burn center: outpatient, ward, and ICU. Most patients reported improved pain and anxiety after working with the therapy dogs. All patients reported that they would like more sessions with the therapy dogs. All staff members were satisfied or very satisfied with their therapy dog visit and all enjoyed having the therapy dogs present. Most reported an improved mood after seeing the therapy dogs and wanted that additional therapy dog visits. One year after the implementation of the therapy dog program, we have demonstrated feasibility, acceptability, and desirability of this type of program at our burn center. Given the paramount importance of rehabilitation in the recovery of burn patients, further investigation into therapy should be performed and longer term outcomes assessed.

Microstomia: Aplicação da fotogrametria para mensurar a eficiência da órtese oral associada à terapia fonoaudiológica / Microstomy: Application of photogrammetry to measure the efficiency of oral orthosis associated with speech therapy

OBJETIVO: Esse estudo teve como propósito verificar, por meio da fotogrametria computadorizada, a eficácia do uso da órtese oral como auxiliar na terapia fonoaudiológica. MÉTODO: Após a documentação fotográfica, cada paciente foi submetido a terapia fonoaudiológica, por meio da terapia miofuncional orofacial, associada ao uso da órtese oral, confeccionada segundo Borges et al. (2011). Ao término do tratamento, foi realizado novo registro fotográfico, em seguida, a mensuração da dimensão vertical (distância entre lábio superior/inferior) e horizontal (distância entre comissuras direita/esquerda), com o uso do programa Corel Draw X3. RESULTADOS: As médias da abertura bucal aumentaram da avaliação inicial para a avaliação final, tendo aumentado 5,1 mm no sentido horizontal (67,3 mm para 72,4 mm) e 13,9 mm no sentido vertical (de 32,7 mm para 46,6 mm). Essas diferenças se revelam significativas para as avaliações (p <0,05). CONCLUSÃO: O uso da órtese oral associado a terapia fonoaudiológica demonstrou ser eficaz como mais um instrumento na prevenção da microstomia.

OBJECTIVES: The aim of this study was to through computerized photogrammetry, the efficacy of oral orthosis as an aid in speech therapy. METHODS: After the photographic documentation, each patient underwent speech therapy, through orofacial myofunctional therapy, associated with the use of an oral orthosis, made according to Borges et al. (2011). At the end of the treatment, a new photographic record was taken, then the vertical dimension measurement (distance between upper lip) and horizontal (distance between corners right/left), using the program Corel Draw X3. RESULTS: The mean mouth opening increased from the initial evaluation to the final evaluation, increasing 5.1 mm in the horizontal direction (67.3 mm to 72.4 mm) and 13.9 mm in the vertical direction (from 32.7 mm to 46.6 mm). These differences are significant for the evaluations (p<0.05). CONCLUSION: The use of oral orthosis associated with speech therapy proved to be effective as another tool in the prevention of microstomia.

Identifying patient concerns during consultations in tertiary burns services: development of the Adult Burns Patient Concerns Inventory.

OBJECTIVES: Identifying the issues and concerns that matter most to burns survivors can be challenging. For a number of reasons, but mainly relating to patient empowerment, some of the most pressing concerns patients may have during a clinical encounter may not naturally be the focal point of that encounter. The Patient Concerns Inventory (PCI) is a tried and tested concept initially developed in the field of head and neck cancer that empowers patients during a clinical encounter through provision of a list of prompts that allows patients to self-report concerns prior to consultation. The aim of this study was to develop a PCI for adult burns patients. DESIGN: Content for the PCI was generated from three sources: burns health-related quality of life tools, thematic analysis of one-to-one interviews with 12 adult burns patients and 17 multidisciplinary team (MDT) members. Content was refined using a Delphi consensus technique, with patients and staff members, using SurveyMonkey. SETTING: Within outpatient secondary care. PARTICIPANTS: Twelve adult burns patients and MDT members from two regional burns centres. RESULTS: A total of 111 individual items were generated from the three sources. The Delphi process refined the total number of items to 58. The main emergent domains were physical and functional well-being (18 items), psychological, emotional and spiritual well-being (22 items), social care and social well-being (7 items) and treatment-related concerns (11 items). CONCLUSIONS: The Adult Burns Patient Concerns Inventory is a 58-item, holistic prompt list, designed to be used in the outpatient clinic. It offers a new tool in burn care to improve communication between healthcare professionals and patients, empowering them to identify their most pressing concerns and hence deliver a more focused and targeted patient-centred clinical encounter.

Evaluation of leap motion control for hand rehabilitation in burn patients: An experience in the dust explosion disaster in Formosa Fun Coast.

Hand burns cause functional impairment. Leap motion control (LMC), a kind of virtual reality games, employs a novel system that provides biofeedback and training of fine motor function and functional skills. In this study, we hypothesized that LMC would improve burned hand function. Sixteen participants were allocated to either the LMC group or the control group. The LMC group played 20min identical leap motion video games after 40min traditional occupational therapy (OT). The control group received traditional OT for 60min. Both groups received interventions 2 days a week for 4 months. A series of questionnaires were administered, including BSHS-B, QuickDASH, iADL, and Barthel index. Data on baseline characteristics including joint range of motion (ROM), grip and pinch strength, and scar thickness were obtained. Furthermore, we used the Mann-Whitney U test and Wilcoxon signed-rank test for comparison, as appropriate. We found improvements in BSHS-B, QuickDASH, and iADL in the LMC group (all p<0.05) compared to those in the control group. In the LMC-trained hand, the ROM of the thumb IP joint and pinch strength increased, whereas the scar thickness over the first dorsal interossei muscle decreased (p<0.05). In conclusion, leap motion training could help patients with hand burns to increase finger ROM, decrease scar thickness, and improve hand function.

Reabilitação motora orofacial em queimaduras em cabeça e pescoço: uma revisão sistemática de literatura / Orofacial rehabilitation in head and neck burns: a systematic review of the literature

RESUMO Objetivos Investigar estudos sobre o tratamento das queimaduras em cabeça e pescoço, nas diversas áreas da saúde envolvidas na assistência a queimados (médica, enfermagem, fonoaudiologia, fisioterapia e terapia ocupacional), avaliando a eficácia das técnicas empregadas, principalmente no que se refere à reabilitação da funcionalidade da musculatura em cabeça e pescoço. Estratégia de pesquisa Os artigos foram selecionados por meio da base de dados PubMed, utilizando os descritores "burn and face and speech-language pathology", "burn and face and speech language", "burn and face and rehabilitation", "burn and face and myofunctional rehabilitation", "burn and face and myofunctional therapy", "nonsurgical and scar and management", "burn and face and nonsurgical" e "burn and face and scar and management". Critérios de seleção Foram incluídos artigos que investigaram os tratamentos das queimaduras em cabeça e pescoço, associados à reabilitação da funcionalidade da musculatura em cabeça e pescoço, utilizando exercícios musculares e/ou terapias manuais. Resultados A maioria dos tratamentos descritos apresentou efeitos benéficos para pacientes com queimaduras. Foi observada grande variabilidade da metodologia adotada para a aplicação e verificação dos efeitos dos tratamentos. Conclusão Apesar do crescente número de pesquisas, ainda não existe consenso quanto à melhor técnica terapêutica e ao real benefício de cada uma delas. Existe uma grande diversidade nos protocolos de tratamento, sendo que um número pequeno de estudos de tratamento visa a funcionalidade do sistema miofuncional orofacial. A maioria dos estudos tem, como foco, atividades motoras isoladas, que visam à mobilidade mandibular.

ABSTRACT Purpose Analyze studies addressing the treatment of head and neck burns in different fields of health care, especially treatments that involve the functional rehabilitation of the head and neck muscles. Research strategy This qualitative review of the literature analyzed international scientific publications in the PubMed database that used the following keywords: "burn and face and speech-language pathology", "burn and face and speech language", "burn and face and rehabilitation", "burn and face and myofunctional rehabilitation", "burn and face and myofunctional therapy", "nonsurgical and scar and management", "burn and face and nonsurgical", and "burn and face and scar and management". Selection criteria Scientific publications on treatment strategies for head and neck burns associated to functional rehabilitation of the head and neck muscles using muscle exercises and/or manual therapy were included in this study. Results Overall, most of the treatments described in the investigated studies presented positive outcomes for patients with head and neck burns. The studies showed wide variability in terms of treatment proposals and methodologies used to verify treatment efficacy. Conclusion Although a growing number of publications on the rehabilitation of head and neck burns were observed, the best therapeutic technique and its real benefits remain unclear. There is a wide range of treatment protocols, and very few focus on the functional treatment of the orofacial myofunctional system. Most of the studies propose isolated motor activities to improve the mandibular range of movements.

[Initiation, development, and achievements of burn rehabilitation therapy in China].

Burn rehabilitation in China started from compression therapy in the mid-1970s, which showed the dual effects of prevention and treatment of hypertrophic scars. It not only promoted functional rehabilitation but also strengthened the confidence of patients in rehabilitation treatment. Thereafter, more therapies were brought into practice, such as intra-scar injection of triamcinolone acetonide, application of plastic splints, hydrotherapy, exercises with equipment, skin care, local therapeutic massage, active and passive exercises, as well as external use of drugs for inhibiting scars and pigments. Since the beginning of the 21st century, rehabilitation therapies have been gradually increasing. Psychological rehabilitation, occupational therapy, external use of silicone gel, wax therapy and sound, light, electricity, and radiation therapy have been carried out. Many hospitals have established foundations and held summer camps for children. As far as the whole country is concerned, compared with the huge demand, we still face a number of problems such as shortage of working staff, limited working space, capital chain rupture, lack of multi-disciplinary cooperation, untimely treatment, and incomplete rehabilitation. Nowadays, with increasing knowledge of burn rehabilitation and number of practitioners, improvement of equipment and economic situation, the pace of rehabilitation has accelerated, and the overall implementation of burn rehabilitation therapy has shown great vitality. Patients with burn injury involving over 80% total burn surface area (TBSA) of total burn area or full-thickness burn over 60% TBSA were cured and recovered in different levels of hospitals nationwide, which not only reflects the superb level of burn treatment in China but also reflects the overall improvement of rehabilitation level of the country.

Terapia miofuncional en quemaduras orofaciales de segundo y tercer grado / Myofunctional therapy for 2nd and 3rd degree orofacial burns

Las quemaduras constituyen lesiones traumáticas que comprometen la piel. Aquellas que involucran la región facial son las más complejas, dada la relevancia estética y funcional de esta zona, afectando la expresión de emociones, así como procesos fundamentales como la visión, habla, alimentación, entre otros. Pese a la escasa evidencia, se ha demostrado que la terapia fonoaudiológica miofuncional disminuye las secuelas en pacientes con quemaduras orofaciales. En este contexto, la presente investigación tiene como objetivo describir y evidenciar los efectos de la terapia fonoaudiológica miofuncional en quemaduras orofaciales de 2° y 3er grado. Para ello, se incluyeron 10 sujetos con quemaduras orofaciales de 2° y 3er grado ingresados al Centro de Referencia Nacional de Quemados en Santiago de Chile, quienes recibieron evaluación y terapia miofuncional por un fonoaudiólogo durante su hospitalización. El 80% de los sujetos presentaban quemaduras de 2° grado y 20% de 3° grado, el 30% requirió injerto facial. En la evaluación inicial se observó disminución de la apertura bucal vertical y horizontal, además de disminución en los movimientos de la mímica facial en la totalidad de los casos. Luego de la intervención se evidenciaron mejorías en todos los parámetros, incluido además el nivel de autopercepción de retracción pre y post terapia fonoaudiológica; todos con diferencias estadísticamente significativas (p<0,05). Los resultados nos permiten concluir que la terapia fonoaudiológica miofuncional favorece parámetros como apertura bucal y movilidad facial en pacientes con quemaduras orofaciales. La inclusión de fonoaudiólogos capacitados en el abordaje de estas personas, sería beneficioso para aminorar secuelas y beneficiar su calidad de vida.

Burns are traumatic injuries that compromise skin. Facial burns are the most complex burns, because of this area's aesthetic and functional relevance. This kind of injuries affect emotion expression and relevant processes such as vision, speech, and feeding, among others. Despite scarce evidence, it has been shown that myofunctional speech-language therapy decreases sequelae among patients with orofacial burns. This study, therefore, set out to describe the myofunctional speech-language therapy intervention in 2nd and 3rd degree facial burns. 10 patients with 2nd and 3rd degree facial burns admitted to National Burn Center in Santiago, Chile, were recruited for this study. 80% of subjects had 2nd degree burns and 20% 3rd degree burns. 30% of subjects required a facial skin graft. At initial assessment, there was a decrease in the vertical and horizontal mouth opening, as well as a decrease in facial movements in all cases. All the subjects received a myofunctional speech-language therapy intervention during the hospitalization period. On the completion of myofunctional intervention, patients improved inall parameters, with statistically significant differences (p<0,05), in addition to self-perception level of retraction pre and post therapy. The results of this study show that myofunctional speech-language therapy improves the performance in parameters such as mouth opening and facial movements among patients with orofacial burns. The inclusion of trained Speech-language therapists is helpful for interventions focused on persons with burns, inasmuch as decreases sequelae and improves quality of life.

[Retrospect of development and progress over the past 60 years and going further while carrying out practice].

This article briefly describes the establishment and development of Department of Burns and Reconstructive Surgery of Xiangya Hospital of Central South University. Over the past 60 years, our department has achieved great achievements in the treatment of burns by the combination of traditional Chinese medicine with western medicine, treatment of severe burns, and burn wounds repaired by flaps, and established Hunan burn rescue medical collaboration network. With the development of society and the change of disease spectrum, the future development direction of our department mainly focuses on treatment of severe burns, scar prevention, and treatment of acute and chronic wounds.

[Review of 60 years' development of Department of Burns and Plastic Surgery in West China Hospital of Sichuan University].

Burn medicine of China started in 1958. Over the past 60 years, through the efforts of numerous burn discipline scholars, China's burn clinical and scientific research have reached the world's advanced level. Department of Burns and Plastics Surgery of West China Hospital of Sichuan University was founded in 1963. Department of Burns of our hospital was established earlier in China. In the past 60 years, professor Yu Baoliang, Ren Linsen, and Cen Ying had been working hard for the development of our department. Department of Burns and Plastic Surgery in West China Hospital of Sichuan University has developed from a pure therapeutic specialty group into one of the burn centers with strong technical force, first-class medical level, advanced instruments and equipment, rich scientific research achievements, and integrated medicine, teaching, and research in southwestern China, which enjoys high prestige at home and abroad.

Ansiedade e enfrentamento em familiares cuidadores de crianças hospitalizadas com queimaduras / Anxiety and coping in family caregivers of children hospitalized with burns

Esta pesquisa buscou identificar os níveis de ansiedade e as estratégias de enfrentamento de familiares cuidadores de crianças hospitalizadas com queimaduras. Participaram 30 familiares cuidadores que estavam acompanhando a criança nos primeiros cinco dias de hospitalização. Estes familiares responderam o Inventário de Ansiedade de Beck, a Escala Modos de Enfrentamento de Problemas e questionário sócio demográfico numa enfermaria de queimados. Os dados foram analisados por meio de médias, correlações bivariadas e testes para comparações entre grupos. Os cuidadores apresentaram indicador leve de ansiedade e as estratégias de enfrentamento foram focalizadas na prática religiosa, suporte social, problema e emoção. Verificou-se correlação significativa entre estratégias focalizadas na emoção e práticas religiosas. Maiores níveis de ansiedade foram identificados nos cuidadores que não trabalhavam, se comparado ao grupo que tinha ocupação. Estes resultados possibilitam orientar a equipe de saúde para o desenvolvimento de intervenções psicossociais para a promoção da saúde nas ações de integralidade da assistência.(AU)

This research aimed to identify the levels of anxiety and the coping strategies of family caregivers of children hospitalized with burns. The participants were 30 family caregivers who were accompanying the child in the first five days of hospitalization. These family members answered the Beck Anxiety Inventory, theWays of Coping Scale, and a socio-demographic questionnaire in a burn unit. The data were analyzed through means, bivariate correlations, and tests for comparisons between groups. Caregivers presented indications of mild anxiety, and coping strategies were focused on religious practices, social support, problem and emotion. Significant correlation between coping strategies were found. Higher anxiety levels were found in caregivers who did not work, compared to the group of individuals who had a job. These results make it possible to provide guidance to health teams for the development of psychosocial interventions aimed at health promotion and comprehensive care.(AU)

Influence on clinical parameters of depressomassage (part I): The effects of depressomassage on color and transepidermal water loss rate in burn scars: A pilot comparative controlled study.

OBJECTIVE: Depressomassage is a non-invasive massage technique using a mechanical suction device that is used in the treatment of traumatic or burn scars. Since color and transepidermal water loss (TEWL) are respectively the most important physical and physiological characteristic of hypertrophic scar formation, we wanted to investigate the effects of depressomassage on the recovery of color and TEWL in burn scars compared to the traditional physiotherapy. METHODS: In this pilot comparative controlled study a total 43 burn patients were included and allocated into 2 groups. All patients received standard physical therapy, and the test group received additional depressomassage during 6 months. Color was assessed using the POSAS questionnaire (for color, vascularity and pigmentation) and the Minolta Chromameter. TEWL was measured using DermaLab. RESULTS: Patients of both groups were evaluated at baseline, after 1, 3 and 6 months and after 1year. The evidence for a difference in evolution of color and TEWL between both groups in our study was minimal. CONCLUSIONS: In practice, precise indications to begin depressomassage have to be kept in mind. Perhaps other scar abnormalities such as decreased elasticity, increased thickness, excessive pain or itching could be sufficient reasons to begin depressomassage and should be assessed.

Moisturisers in scar management following burn: A survey report.

Scar management is a recognised key component of rehabilitation following burn. Moisturising often combined with massage is commenced once healing tissue has gained sufficient strength to tolerate surface friction, with the aim being to hydrate the dry scar. The studies on various moisturisers and creams provide some guidance on moisturiser selection, but many are inconclusive. OBJECTIVE: This survey aimed to determine the current expert opinion regarding moisturiser recommendations, including the basis for these recommendations, across the burns community. METHODS: A brief web-based survey was distributed to burn therapists via mailing lists of the Australian and New Zealand Burn Association (ANZBA), and American Burn Association (ABA) 'Occupational and Physical Therapist Burn Special Interest Group'. RESULTS: The fifty three respondents indicated that there were 29 different moisturisers commonly recommended in practice. Three main themes were indicated as influencing recommendations for moisturiser: the perceived effects on the scar/skin (48%); the general properties of the moisturiser (38%); the ingredients (14%). Therapists reported that the principle stimuli determining their recommendations were patient feedback and the choice of the previous burn therapist in their service. Many were also guided by medical staff, pharmacists and sales representatives. Only three respondents were able to provide citations for published evidence supporting their recommendations. CONCLUSIONS: There is a paucity of evidence currently to support optimal moisturiser choice. This survey demonstrates that conflicting opinions are held on the ideal moisturiser brand, properties and ingredients. The recommendations made are based on low level evidence. Further research is required to inform clinicians which moisturiser to recommend to their clients. An ideal moisturiser should be one that is conducive to scar maturation, non- or minimally irritant, prevent skin drying, minimise transepidermal water loss and have no negative effect on barrier function.