[Hydrogen sulfide balneotherapy in comprehensive sanatorium-resort treatment of post-burn scars in children]. / Serovodorodnaya bal'neoterapiya v kompleksnom sanatorno-kurortnom lechenii posleozhogovykh rubtsov u detei.

Thermal lesions in children leave behind cicatricial contractions, contractures, deformations of the wrists, feet, face. Sanatorium-resort treatment using balneotherapy is an integral part of rehabilitation measures in such patients. OBJECTIVE: To analyze the results of hydrogen sulfide balneotherapy in children with consequences of thermal injury. MATERIAL AND METHODS: A single-center observational retrospective non-controlled study was carried out, in which sanatorium-resort treatment concerning post-burn scars in 812 children aged 5-17 years was analyzed. Hydrogen sulfide balneotherapy was prescribed to patients depending on the age in mild (5-6 years) or moderate-to-high (7-17 years) exposure modes. The imported hydrogen sulfide mineral water from the T-2000 well of the Matsesta field with the H2S total concentration of 410-420 mg/l was used for treatment. The applications were performed to children alternate days, 8 procedures of balneotherapy per course. RESULTS: Lightening of the affected areas of the skin, reduction of the sensation of contraction and tension of the scars, which became softer, more elastic and more mobile with regard to the subjacent tissues have been noted in patients after the course of balneotherapy. The head mobility increased after applications in the presence of scars. The large joints' range of motion grew up. In addition, an increase in the mobility of the fingers of wrists and feet, a decrease in the stiffness of movements, increase or recovery of the affected skin's tactile sensitivity have been observed. Children well tolerated procedures, adverse events were seen in 0.7% of cases in the form of mild reactions at the beginning of the applications' course, namely of balneological (0.6%) and toxico-allergic (0.1%) nature. CONCLUSION: Hydrogen sulfide balneotherapy in combination with rehabilitation exercises and other sanatorium-resort factors is an effective mean of post-burn scars correction in children.

Inspiratory muscle training impact on respiratory muscle strength, pulmonary function, and quality of life in children with chest burn: A randomized controlled trial.

PURPOSE: Respiratory muscle function is compromised in children recovering from chest wall burns, which potentially leads to more impact on exercise capacity and quality of life. This study investigates the effects of an inspiratory muscle training intervention accompanied with a pulmonary rehabilitation program on respiratory muscle strength, lung function, functional capacity, and quality of life in chest burned children. METHODS: Forty children with burns, aged from 10 to 18 years old and total body surface area of 30% to 50%, were randomly allocated to the inspiratory muscle training group (IMT- G: n = 20) or control group (CG: n = 20). They received IMT plus pulmonary rehabilitation or pulmonary rehabilitation with sham IMT, respectively for eight weeks. The outcomes were the respiratory muscle strength measured by maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP); lung functions (FEV1, FVC and FEV1/FVC ratio); functional capacity as well as Pediatric Quality of Life to measure physical and psychosocial functioning. outcome measures were assessed at before and after intervention (after eight weeks). RESULTS: Based on the pre-intervention assessments, we found no significant difference between both groups (p > 0.05). Significant post-intervention differences were reported between both groups in MIP (P = .003), MEP (P = .017), FVC (P = .001), FEV1 (P = .007), FEV1/FVC ratio (P = .028), functional capacity (P = .003), physical domain of QoL (P = .006) and psychological domain of QoL (P = .002) in favor of the IMT group. CONCLUSIONS: Eight weeks of inspiratory muscle training combined with pulmonary rehabilitation program improved children with chest burns' respiratory muscles strength, lung functions, functional capacity, and quality of life. Inspiratory muscle training may be employed in burn rehabilitation programs. It is a safe and effective therapy in chest burned children.

Moderation Effects of Daily Behavior on Associations Between Symptoms and Social Participation Outcomes After Burn Injury: A 6-Month Digital Phenotyping Study.

OBJECTIVE: To examine the moderation effects of daily behavior on the associations between symptoms and social participation outcomes after burn injury. DESIGN: A 6-month prospective cohort study. SETTING: Community. PARTICIPANTS: Twenty-four adult burn survivors. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Symptoms and social participation outcomes were assessed weekly using smartphone surveys, including symptoms of pain (Patient-Reported Outcomes Measurement Information System [PROMIS] Pain Intensity and Pain Interference), anxiety (PROMIS Anxiety), and depression (Patient Health Questionnaire), as well as outcomes of social interactions and social activities (Life Impact Burn Recovery Evaluation [LIBRE] Social Interactions and Social Activities). Daily behaviors were automatically recorded by a smartphone application and smartphone logs, including physical activity (steps, travel miles, and activity minutes), sleep (sleep hours), and social contact (number of phone calls and message contacts). RESULTS: Multilevel models controlling for demographic and burn injury variables examined the associations between symptoms and social participation outcomes and the moderation effects of daily behaviors. Lower (worse) LIBRE Social Interactions and LIBRE Social Activities scores were significantly associated with higher (worse) PROMIS Pain Intensity, PROMIS Pain Interference, PROMIS Anxiety, and Patient Health Questionnaire-8 scores (P<.05). Additionally, daily steps and activity minutes were associated with LIBRE Social Interactions and LIBRE Social Activities (P<.05), and significantly moderated the association between PROMIS Anxiety and LIBRE Social Activities (P<.001). CONCLUSIONS: Social participation outcomes are associated with pain, anxiety, and depression symptoms after burn injury, and are buffered by daily physical activity. Future intervention studies should examine physical activity promotion to improve social recovery after burns.

The role of multiplatform messaging applications in burns care and rehabilitation: A systematic review.

BACKGROUND: Multiplatform messaging applications also referred to as cross-platform instant messaging play an important role in delivery of healthcare and education with its low cost, ease of use and accessibility. AIM: To evaluate the existing evidence regarding the use of multiplatform messaging applications in facilitating consultations and decision-making processes in the context of burns care, as well as to assess the impact of such applications on burns care and rehabilitation. METHOD: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and PROSPERO protocol CRD42021265203. The CASP and JBI tools were used to evaluate the quality of the studies. Eight hundred fifty-three papers were retrieved from PubMed, CINAHL, Scopus, EMBASE and LILACS published up to July 2022 (updated August 2023) with no time restrictions applied. RESULTS: An analysis of the seven studies included in this review, inclusive of 16 Multiplatform messaging applications, revealed six themes. These encompassed the utilization of social media for directing and managing clinical practice, as a mode of communication, for evaluating the quality-of-care provision, for investigating available platforms and their technological features, measuring quality of life and for examining issues related to confidentiality. CONCLUSION: Multiplatform messaging applications offer a solution for individuals with burn injuries to stay in direct contact with burn specialist clinicians for their follow-up and subsequent rehabilitation phase of recovery.

The efficacy of therapeutic interventions on paediatric burn patients' height, weight, body composition, and muscle strength: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the efficacy of therapeutic interventions on pediatric burn patients' height, weight, body composition, and muscle strength. METHODS: A systematic literature search was conducted in PubMed, Embase, and Web of Science up to March 2021. Eligible interventional studies reported metrics on the height, weight, body composition, or muscle strength of pediatric burn patients in a peer-reviewed journal. Meta-analyses were performed if ≥ 2 trials of clinical homogeneity reported on an outcome measure at the same time point post-burn. RESULTS: Twenty-six interventional studies were identified, including twenty-two randomised controlled trials and four non-randomised trials. Most studies were conducted by a single institution. On average, the burn covered 45.3% ( ± 9.9) of the total body surface area. Three categories of interventions could be distinguished: rehabilitative exercise programs, pharmacologic agents, and nutrition support. CONCLUSIONS: Each of the interventions had a positive effect on height, weight, body composition, or muscle strength. The decision to initiate an intervention should be made on a case-by-case basis following careful consideration of the benefits and risks. In future research, it is important to evaluate the heterogeneity of intervention effects and whether participation in an intervention allowed pediatric burn patients to reach the physical and functional status of healthy peers.

Effects of rehabilitation treatments jointly considered by physiatrists and rehabilitation therapists in patients with severe burn injury.

Rehabilitation treatments for patients with severe burn injury (SBI) are difficult owing to the lack of knowledge, skills, and experience among clinicians and physical and occupational therapists, resulting in serious patient disability. This study retrospectively evaluated the effectiveness of rehabilitation treatments jointly considered by physiatrists and rehabilitation therapists (Physiatrist and Registered therapist Operating rehabilitation: PROr) for patients with SBI admitted to our hospital's burn intensive care unit (BICU). Eligible patients were classified into the PROr and standard rehabilitation (SR) groups. Contents of the rehabilitation program in the BICU, the functional ambulation categories (FAC), and the Barthel index at the first rehabilitation, BICU discharge, and hospital discharge were collected. Of the 184 patients with severe burns admitted to the BICU, 29 (PROr group, n = 16; SR group, n = 13) met the eligibility criteria. The PROr group received more types of exercise interventions for a longer time than the SR group. No significant differences in the FAC and Barthel index scores at the first time of rehabilitation were found between the two groups; however, the scores of FAC and Barthel index at BICU and hospital discharges were higher in the PROr group than in the SR group. The PROr program may help in the functional improvement of patients with SBI.

[Regenerative rehabilitation: the effects of physical factors on regeneration].

Wound regeneration and repair is one of the primary research fields in burn and wound repair surgery. In recent years, with the continuous advancement of treatment concept and technologies in the field of rehabilitation, the connection between rehabilitation treatment and wound regeneration and repair has become closer, forming a new concept "regenerative rehabilitation". This article discussed the concept formation and development status of regenerative rehabilitation, and the future development and potential leading value of regenerative rehabilitation field.

Recovery of functional independence following major burn: A systematic review.

BACKGROUND: Major burn injury, despite advancements in care and prevention, can have a profound impact on long-term morbidity, affecting quality of life and socioeconomic standing. We aim to explore factors predicting recovery of independence, the expected rate and time in majorly burned patients, and the measures of progress used. METHOD: A systematic search of four databases (MEDLINE, EMBASE, COCHRANE, CINAHL) was conducted for studies reporting outcomes pertaining to physical ability indicative of independent function in adult (>15 y) cohorts who had suffered a major burn (>20% TBSA) up to 30 years after treatment in a developed specialised burn service. Data extracted included factors affecting rate of and time to achievement of function in five independence domains, as well as the outcome measures used. RESULTS: 21 eligible studies were included comprising 1298 major burns survivors with a combined mean age of 39.6 y and a mean TBSA of 25.8%. The most significant recurring factors impacting recovery of independent function were older age, female gender, burn severity, prolonged ICU and hospital admission, preceding mental health conditions, and post-acute psychological issues. Exercise-based rehabilitation conferred benefits on major burn patients even over 2 years following injury. Discharge to independent living from hospital occurred in 27% to 97% of patients, while reported return to work rates varied from 52% to 80%. Burns Specific Health Scale-Brief, Functional Independence Measure, and Physical Composite Score (SF-36) were the most widely used outcome scoring systems. CONCLUSION: Major burn survivors have protracted recovery with potential for persistent chronic impairments, remaining consistently below baseline levels of function. Non-modifiable factors such as age and gender, and disease characteristics such as burn size with associated physical, physiological and psychosocial sequelae are contributory. Further research is required to explore achievement of specific milestones of major burn and polytrauma critical care patients, while early targeted rehabilitation addressing physical, psychological, and vocational needs has promising potential benefit.

Associations between burn care services and impairment at discharge after burn injury: Analysis of the Global Burn Registry.

BACKGROUND: Throughout the world, burn injury is a major cause of death and disability. In resource-limited countries, burn injury is one of the leading causes of permanent disability among children who survive traumatic injuries, and burn injury is the fourth leading cause of disability worldwide. This study applied Andersen's model of health care access to evaluate if patient characteristics (predisposing factors), burn care service availability (enabling factors) and injury characteristics (need) are associated with physical impairment at hospital discharge for patients surviving burn injuries globally. Specifically, access to rehabilitation, nutrition, operating theatre, specialized burn unit services, and critical care were investigated as enabling factors. The secondary aim was to determine whether associations between burn care service availability and impairment differed by country income level. METHODS: This is a cross-sectional secondary analysis of prospectively collected data from the World Health Organization, Global Burn Registry. The outcome of interest was physical impairment at discharge. Simple and multivariable logistic regressions were used to test the unadjusted and adjusted associations between the availability of burn care services and impairment at hospital discharge, controlling for patient and injury characteristics. Effect modification was analyzed with service by country income level interaction terms added to the models and, if significant, the models were stratified by income. RESULTS: The sample included 6622 patients from 20 countries, with 11.2% classified with physical impairment at discharge. In the fully adjusted model, patients had 89% lower odds impairment at discharge if the treatment facility provided reliable rehabilitation services compared to providing limited or no rehabilitation services (OR.11, 95%CI.08,.16, p < .01). However, this effect was modified by county income with the strong and significant association only present in high/upper middle-income countries. Sophisticated nutritional services were also significantly associated with less impairment in high/upper middle-income countries (OR=.04, 95% CI 0.203, 0.05, p < .01), but significantly more impairment in lower middle/low-income countries (OR=2.01, 95% CI 1.50, 2.69, p < .01). Patients had 444% greater odds of impairment if treated at a center with specialty burn unit services (OR 5.44, 95%CI 3.71, 7.99, p < .01), possibly due to a selection effect. DISCUSSION: Access to reliable rehabilitation services and sophisticated nutritional services were strongly associated with less physical impairment at discharge, but only in resource-rich countries. Although these findings support the importance of rehabilitation and nutrition after burn injury, they also highlight potential disparities in the quantity or quality of services available to burn survivors in poorer countries.

The Integration of Physical Therapists and Occupational Therapists into Burn Wound Care Increases Therapist Productivity, Job Satisfaction, and Multidisciplinary Collaboration.

When attempting to deliver specialized rehabilitation therapy interventions, physical therapists (PTs) and occupational therapists (OTs) must account for dynamic and logistical patient factors such as daily wound care, pain, difficulty progressing range of motion with dressings donned, and ongoing surgical interventions. Additionally, they must attain institution-specific productivity standards. Given burn patients often require considerable multidisciplinary interventions, efficiently planning and delivering rehabilitation therapy interventions within productivity expectations may prove difficult. The purpose of this study was to assess the feasibility of integrating rehabilitation therapists, PTs and OTs, into daily burn wound care by investigating therapist productivity and multidisciplinary perceptions of this practice change. The quality improvement project involved 6 rehabilitation therapists (3 PTs and 3 OTs) practicing exclusively in the burn unit within an American Burn Association (ABA)-verified burn center at an urban, tertiary care academic medical center. One rehabilitation therapist was responsible for providing interventions within the burn wound care team 5 days a week. General duties included wound assessment, functional wound dressings, and skilled therapeutic interventions such as manual therapy, therapeutic exercise, and compression interventions. The primary outcome was changes in group productivity and individual therapist productivity, as measured by total billed Current Procedural Terminology (CPT) codes per hour worked, which were tracked 22 weeks preimplementation and 28 weeks postimplementation. Program feasibility and general perceptions were assessed by a qualitative questionnaire. For both the entire group of therapists and each individual rehabilitation therapist, billed CPT codes per hour increased postimplementation, 1.81 vs 1.54 (P = .005) and a matched increase of 0.27/h (P = .003). Of the 23 survey respondents, 96% had a favorable impression of the program and reported it eased staffing demands. All respondents reported improved unit workflow and multidisciplinary communication. The majority of multidisciplinary burn team members actively supported the pilot program and commented on improvements in patient care. Full-time rehabilitation therapy participation in wound care increases therapist productivity and job satisfaction. Future efforts, however, should focus on measuring specific patient outcomes and costs as a result of therapist integration into daily wound care practice.

Adult Burn Survivors and Burn Care Staff Perceptions Regarding Transitioning From the Burn Unit: A Cross-Country Qualitative Study in Ghana and China.

Rehabilitative care for burn patients in developing countries is often wrought with several issues. Post-discharge support is equally challenging as there is often limited rehabilitative care as the burn survivors and their families transition. To inform practice, this study sought to explore the perspectives of adult burn survivors and burn care staff regarding transitioning from the burn unit and the development of a transitional rehabilitation programme. We employed interpretive description for this study. Semi-structured face-to-face interviews were conducted with adult burn survivors and burn care staff across two tertiary healthcare facilities in Lanzhou, Gansu Province of China, and Ghana. The thematic analytical approach was employed to analyse the data. Forty-six participants comprising 26 adult burn survivors and 20 burn care staff participated in this study. Two themes and five subthemes emerged from the data. Transitioning from the burn unit to the home was described as complex with varied biopsychosocial needs emerging. However, available support was not comprehensive to resolve these needs. Existing pre-discharge support is limited across both settings. Burn survivors expressed interest in taking on an active role in the rehabilitation process and being able to self-manage their post-burn symptoms following discharge. Transitional rehabilitative support should include an active follow-up system, ensure patient- and family-centred support, and offer a bundle of comprehensive rehabilitative services using locally available items which do not financially burden burn survivors and their families. In conclusion, transitioning from the burn unit is filled with varied health needs. Transitional rehabilitative care is required to bridge the pre-discharge and post-discharge periods.

Effect of anti-gravity treadmill (Alter G) training on gait characteristics and postural stability in adult with healed burns: A single blinded randomized controlled trial.

BACKGROUND: Burns constitute one of the foremost contributors to premature mortality and morbidity, and the recovery process from burn injuries is characterized by its intricate and protracted nature. OBJECTIVE: The principal aim of this study was to assess the influence of an anti-gravity treadmill (Alter G) training program on both gait characteristics and postural stability indices (PSI) in adult individuals who have recovered from burns. DESIGN: This study followed a single-blind, randomized, controlled design. METHODS: A total of 45 adults, aged 18-35 years, with healed lower extremity burns that were circumferential and encompassed 35-50% of their total body surface area (TBSA) were randomly allocated to either the anti-gravity treadmill (Alter G) Training group (n = 22) or the traditional physical therapy program (TPTP) group (n=23). The TPTP group received conventional physical therapy, while the anti-gravity treadmill (Alter G) training group engaged in anti-gravity treadmill exercises alongside the traditional physical therapy program. The primary outcome measures, evaluated at both baseline and the conclusion of the 12-week intervention, included gait characteristics assessed using the GAITRite system and PSI measured by the Biodex Balance System (BBS). RESULTS: The anti-gravity treadmill (Alter G) training group exhibited significantly greater enhancements than the TPTP group in terms of mean values and percentage changes in gait characteristics and PSI. Specifically, the percentage changes for the Alter G group were as follows: stride length (20.57%), step time (22.58%), step length (20.47%), velocity (15.67%), cadence (23.28%), and double support time (29.03%). In contrast, the TPTP group's percentage changes were: 6.73%, 8.19%, 7.65%, 7.75%, 8.89%, and 9.37%, respectively. Concerning PSI, the Alter G group exhibited percentage changes of 55.17% for the medio-lateral stability index (MLI), 48.21% for antero-posterior stability index (API), and 48.48% for the overall stability index (OSI). The TPTP group's corresponding percentage changes were 20%, 14.03%, and 16.41%. CONCLUSIONS: The amalgamation of anti-gravity treadmill training with the traditional physical therapy program yields greater efficacy than TPTP in isolation. Consequently, the findings underscore the efficiency of anti-gravity treadmill (Alter G) Training as a valuable tool for rehabilitating patients with burn injuries.

Understanding return-to-employment experiences after burns: Qualitative scoping review findings.

INTRODUCTION: Participation in work and employment is a milestone of adulthood. People returning to work after burn injury may have physical, psychological, social, and environmental barriers to overcome in order to resume their pre-injury employment. The aim of this paper is to evaluate qualitative findings regarding return-to-employment after burn injury. METHODS: A qualitative synthesis was conducted based on the qualitative findings of an earlier mixed methods review. A pre-determined scoping review protocol was used in the earlier review to search MEDLINE, CINAHL, Embase, PsycINFO, PubMed, Scopus, CCRCT, and CDSR databases between 2000 and Aug 2021. Any papers presenting qualitative data from previously employed adults with cutaneous burn injuries were included. FINDINGS: A total of 20 papers with qualitative data on return-to-employment after burn injury were found. Only six included studies focused on return-to-employment outcomes and the remaining studies reporting on quality of life and life experiences after burn injury. Common themes included impairments that develop and change over time; occupational identity and meaning; temporal aspects of burn recovery; burn rehabilitation services and interventions; attitudes, knowledge and support of service providers; workplace environments supporting work re-engagement after burn injury; usefulness of work accommodations; family and social supports, individuals attributes that influence re-engaging in employment; and accepting and rebuilding. CONCLUSION: Resumption of work after burn injury is regarded as a key marker of recovery for working-aged adults by burn survivors and burn care professionals. Support at transition points during the burn recovery process and peer-led programmes were important. However, limited information currently exists regarding clinical practices, service gaps, and understanding of return-to-employment outcomes after burn injury.

Las redes sociales: nuevos desafíos en el tratamiento del niño quemado / Social media: new challenges in pediatric burn treatment

Introducción y objetivo: El uso de las redes sociales está ampliamente difundido en los adolescentes y es sin duda una de las formas más comunes de vinculación social con sus pares. La información e imágenes utilizadas para construir el perfil se seleccionan para favorecer lo que se quiere mostrar de cada uno. Las secuelas estéticas del paciente quemado tradicionalmente han sido motivo de preocupación para el cirujano plástico. El amplio uso de las redes sociales ha aumentado notablemente la exposición física, por lo tanto, nos preguntamos cómo influyen las secuelas visibles de las quemaduras en esta forma de relación entre adolescentes. Material y método: Identificamos los niños quemados asistidos en el centro de referencia para el tratamiento de quemaduras pediátricas de Uruguay (UNIQUER) entre 2015 y 2022 con lesiones de gravedad funcional o vital. Seleccionamos aquellos que en el momento de realizar este estudio tuvieran 10 o más años de edad. Confeccionamos un cuestionario digital (Google Forms) que enviamos por mensajería instantánea (Whatsapp) previa autorización de un adulto responsable, y analizamos los datos recuperados. Resultados: Reunimos 51 pacientes que cumplieron los criterios de inclusión, de los cuales logramos contactar con 32 y obtuvimos 22 respuestas al cuestionario, con edades entre 10 y 19 años. Todos presentaban cicatrices: 9 en cara o cuello (40.9%) y 9 en manos (40.9 %); el resto en zonas menos visibles. De ellos, 17 (77.3 %) requirieron autoinjertos en el episodio agudo y 7 (31.8%) cirugías para tratamiento de secuelas.Encontramos 21 niños (95.4%) que utilizaban al menos una red social. En orden decreciente de frecuencia, la más utilizada era Whatsapp (17, 81%), Tik Tok (13, 61.9%), Instagram (9, 42.9%), Facebook (5, 23.8%), Twitter (3, 14.3%) y otra (3, 14.3%). Además, 18 niños (85.7%) no posteaban fotos con sus cicatrices y 5 (23.8%) utilizaban efectos siempre o algunas veces para disimular sus cicatrices en redes...(AU)

Background and objective: Social media is widely used by teenagers, in fact, it represents one of the main means of communication between them. The images used to construct a profile are specially selected in order to show only what they want to share about themselves. Aesthetic sequelae after burns have traditionally been a concern for reconstructive surgeons. We would like to find out if visible sequelae influence the way these patients interact with social media given the vast physical exposure that they include. Methods: Burned children with severe vital o functional injuries treated between 2015 and 2022 in the national reference center for pediatric burn treatment in Uruguay (UNIQUER) were identified. Those aged 10 or above were selected. We designed a digi-tal form (Google Forms) that was sent by instant messaging (Whatsapp) to the selected population with an adult previous authorization and we analyzed the collected data. Results: Fifty-one patients met the inclusion criteria, we contacted 32 and obtained 22 responses to the questionnaire; patients aged between 10 and 19 years. All had scars: 9 in face or neck (40.9%) and 9 in hands (40.9 %). The rest of the scars were in less visible places. Of them, 17 (77.3%) required autografts in the acute episode and 7 (31.8%) required surgeries to treat sequelae. We found 21 children (95.4%) who used at least one social network.The most used was Whatsapp (17,81%), Tik Tok (13,61.9%), Instagram (9,42.9%), Facebook (5,23.8%), Twitter (3,14.3%) and other (3,14.3%). Furthermore, 18 children (85.7%) do not post photos with their scars and 5 (23.8%) always or sometimes used effects to hide their scars on social networks. Of the total, 12 patients (54.5%) reported having felt discrimination because of their scars and 9 (40.9%) had been victims of bullying; 14 (63.6%) would be interested in participating in campaigns to prevent discrimination against people with scars...(AU)

[Construction of the burn rehabilitation system].

Burn rehabilitation is an important part of burn discipline. As the goal of burn treatment has changed from saving lives and wound elimination to high-quality recovery of body function, burn rehabilitation has been integrated into all levels of burn treatment. In clinical practice, with the establishment of the concept of early preventive rehabilitation, the remodeling of the concept of functional reconstruction in wound repair, and the clarity of the concept of overall rehabilitation, the concept of burn rehabilitation has changed fundamentally. Burn rehabilitation system is not a simple accumulation of directional medical technologies, but an additive expression of multiple medical technologies, covering multi-disciplinary content, including the introduction and application of interdisciplinary new technologies, and involvement of subspecialties. Burn rehabilitation runs throughout the whole process of burn treatment, including early body positioning, later targeted physical and chemical treatments, and even the neurocognitive treatment, which is accompanied by the evaluation of rehabilitation quality throughout the entire process of rehabilitation.

[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.

[Prospective study on the effects of resistance training with elastic band at home on muscle function and walking ability of severely burned children].

Objective: To explore the effects of resistance training with elastic band at home on muscle function and walking ability of severely burned children. Methods: A prospective non-randomized controlled study was conducted. From January 2022 to April 2023, 40 children with severe burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital. According to the willingness of the children or their families, the children were assigned to conventional rehabilitation group and combined rehabilitation group. During the study, 8 children dropped out of the study, 17 children were finally included in the conventional rehabilitation group with 6 males and 11 females, aged (8.5±2.4) years, and 15 children were included in the combined rehabilitation group with 5 males and 10 females, aged (9.6±2.5) years. The children in the 2 groups received conventional burn rehabilitation treatment in the hospital, including active and passive activity training, scar massage, and pressure therapy. The children in combined rehabilitation group received resistance training with elastic band of 3 to 5 times per week after discharge, and the children in conventional rehabilitation group received daily activity ability training after discharge. Before home rehabilitation training (1 week before discharge) and 12 weeks after home rehabilitation training, the grip strength was measured using a handheld grip dynamometer, the muscle strengths of the upper and lower limbs were measured using a portable dynamometer for muscle strength, lean body mass was measured by bioelectrical impedance measuring instrument, and the 6-min walking distance was measured. Data were statistically analyzed with independent sample t test, paired sample t test, Mann-Whitney U test, or Fisher's exact probability test. Results: After 12 weeks of home rehabilitation training, the grip strengths of children in combined rehabilitation group and conventional rehabilitation group were (15±4) and (11±4) kg, respectively, which were significantly higher than (10±4) and (9±4) kg before home rehabilitation training (with t values of -9.99 and -11.89, respectively, P values all <0.05); the grip strength of children in combined rehabilitation group was significantly higher than that in conventional rehabilitation group (t=3.24, P<0.05). After 12 weeks of home rehabilitation training, the muscle strengths of upper and lower limbs of children in combined rehabilitation group (with t values of -11.39 and -3.40, respectively, P<0.05) and the muscle strengths of upper and lower limbs of children in conventional rehabilitation group (with t values of -7.59 and -6.69, respectively, P<0.05) were significantly higher than those before home rehabilitation training, and the muscle strengths of upper and lower limbs of children in combined rehabilitation group were significantly higher than those in conventional rehabilitation group (with t values of 3.80 and 7.87, respectively, P<0.05). After 12 weeks of home rehabilitation training, the lean body mass of children in combined rehabilitation group was significantly higher than that before home rehabilitation training (t=0.21, P<0.05). After 12 weeks of home rehabilitation training, the 6-min walking distances of children in conventional rehabilitation group and combined rehabilitation group were significantly longer than those before home rehabilitation training (with t values of -5.33 and -3.40, respectively, P<0.05), and the 6-min walking distance of children in combined rehabilitation group was significantly longer than that in conventional rehabilitation group (t=3.81, P<0.05). Conclusions: Conventional burn rehabilitation treatment in hospital and home resistance training with elastic band for 12 weeks after discharge can significantly improve the muscle function and walking ability of severely burned children.

Rehabilitation Management of the Burned Hand.

Burns to the hands constitute a small total surface area burn, but can result in significant functional challenges and disability. The complexity of multiple anatomical structures and intricate interplay of bones, muscles, and connective tissues requires specialized knowledge of how burns of the hand can affect function and independence. This article will provide an evidence-based overview of rehabilitation of the burned hand across the burn care continuum including a focus on evaluation, pain management, treatment interventions, and outcome assessment. Additionally, various deficits that can put the hand at significant risk for loss of function will be discussed. Finally, the authors will address the special considerations and treatment caveats of addressing the pediatric hand burn.

Key Exercise Concepts in the Rehabilitation from Severe Burns.

This article presents information on the benefits of exercise in counteracting the detrimental effects of bed rest, and/or severe burns. Exercise is key for maintaining physical function, lean body mass, metabolic recovery, and psychosocial health after major burn injuries. The details of an exercise training program conducted in severely burned persons are presented, as well as information on the importance of proper regulation of body temperature during exercise or physical activity. The sections on exercise and thermoregulation are followed by a section on the role of exercise in scarring and contractures. Finally, gaps in the current knowledge of exercise, thermoregulation, and contractures are presented.