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When I was six years old, I was playing in my family’s dry-cleaning business when a drunk driver crashed through the front window. I was pinned beneath the hot metal of the car and exposed to steam from burst pipes which left me with substantial burns to my face, hand, and leg.
Back in the 1960s, skin grafting—in which healthy skin from one part of the body is moved to replace the surgically removed burned skin—was less common in children and it took a long time for my body to heal the deep burn wounds and build new tissue. I spent weeks in the hospital recovering from the burns, which turned into scars that changed my appearance.
Burn rehabilitation programs as they exist today were not yet in wide practice. There were no formal support programs to help with the psychosocial aspects of burn recovery. I had to rely on myself and support from my family to cope with the emotional changes of returning to society. People looked at me differently, and I developed coping mechanisms like avoiding short pants and keeping my hands in my pockets to prevent drawing attention to myself.
Burn rehabilitation has vastly improved since I was a child, and the Burn Center at MedStar Washington Hospital Center—which celebrated its 50th anniversary in August 2022—is one of the top institutions in the world for burn rehabilitation. From the initial burn wound care through physical and emotional rehabilitation, we treat the whole patient, not just burned skin.
Every patient who comes to the Burn Center is cared for by a team of experts including the burn rehabilitation occupational and physical therapists. We give every patient a personalized care plan based on the severity of their injury, their loss of function and their personal, professional, and social goals.
First steps: Assessment and determining goals.
Burns are more than skin deep—severe wounds can damage the muscles and in extreme cases involve bone, making recovery more difficult. After a patient is stabilized from the initial burn injury, we start planning for their recovery.
Care begins with an evaluation to assess motion, strength, and mobility. We assess functional abilities, including whether the patient can stand, walk, climb stairs, and dress themself. This baseline helps us start a plan of care that centers around the patient’s recovery goals.
We talk with every patient about their daily activities, home responsibilities, work skills, and hobbies. This conversation is critical to recovery—to give us an understanding of their daily activities so we can help them return to a fulfilling life.
Move with purpose: Physical rehabilitation.
Healing from a burn can require an extended hospitalization with multiple surgeries. Once burn wounds have healed the patient has the challenge of exercising to stretch the areas of scar tissue that naturally want to tighten and inhibit flexibility and motion.
My colleagues in physical and occupational therapy work with every patient to help regain pre-injury function. For example, range-of-motion exercises can help patients rebuild flexibility and stretch scar tissue to improve freedom of movement.
Therapeutic activities such as getting in and out of bed, standing from a sitting position, getting dressed, preparing meals, and bathing help patients adjust to performing self-care activities differently than they did before a burn. Therapy can help patients:
- Prevent scar contracture
- Regain independence with self-care activities
- Learn to work through painful stretching exercises
- Regain motion and strength
- Regain natural contouring through scar management
Healing the body requires fuel—healing from a burn can require more than double the calories a person is used to consuming each day. All of our patients receive nutritional support to help them choose foods that are high in nutritional value, such as whole grains, lean meats, vegetables, and fruits.
As patients begin to make physical progress in recovery, they naturally start to shift focus to what life will be like when they return to school, work, or social circles. A substantial part of our approach to burn rehabilitation is supporting patients emotionally and connecting them with long-term resources to approach re-entering society with the tools and confidence to handle potentially uncomfortable situations.
Own the scar: Emotional rehabilitation.
As patients begin to prepare for leaving the hospital, our rehab staff helps them identify their concerns regarding social reintegration. It is common for patients to worry about people staring at them. We help them prepare for encounters with people who are curious, confused, or even hostile at the sight of a burn scar.
Our therapists are experienced in The Phoenix Society’s Social Skills Training. This is a set of tools to help patients develop new strategies for navigating social situations. This includes preparing responses to specific questions people might ask, such as “What happened to you?” Many burn survivors find that if they prepare ahead for social encounters such as these, they are more confident and in control of the situation.
To make interpersonal encounters less disruptive therapists discuss with patients the value of having a short and long answer when asked questions. It’s ok to offer a short response and move on. This is the patient’s prerogative. Therapists also encourage our patients to remember the acronym STEP to help them be intentional about how they present themselves in social situations:
- Self-talk: It is easy for patients to develop negative thoughts, so we work on strategies to edit their internal monologue. Mantras such as “I can do this” can improve self-confidence.
- Tone of voice: Speaking clearly and starting the conversation can help patients stay in control. They can decide how much to share, if anything, on their own terms. Taking the initiative to smile and say hello can go a long way.
- Eye contact: Looking people in the eye can help patients feel more confident while helping people they talk with focus on the conversation.
- Posture: Sitting or standing with the shoulders back is shown to naturally improve the emotional state. Maintaining good posture can help boost confidence and dispel negativity along with gaining more positive reactions from others.
One way we help patients build confidence is to provide one-on-one education regarding what’s going on with their newly healed skin, the process of scar development, the purpose of compression garments, and continued exercise. Regaining full motion and preventing scar contracture is a process that continues for months after injury.
Recovering from a burn can feel isolating, and peer support is invaluable in learning how to cope with the challenges of rehab and reintegration. The Phoenix Society for Burn Survivors, a Michigan-based non-profit that supports and empowers people after burn injuries, manages a peer support program to which we refer patients. Several of our former patients are now giving back to the burn community as trained peer supporters.
Our burn rehabilitation program includes peer group outings to local outdoor recreational activities. Twice a year, we take a small group of patients to Crested Butte, CO, to the Adaptive Sports Center for a week of outdoor adventure. These programs are provided at no cost to our patients thanks to the financial support of the D.C. Firefighters Burn Foundation, a nonprofit founded by active and retired Washington, DC, firefighters to support burn research, treatment, and reintegration.
All together: The power of team medicine.
The Burn Center at MedStar Washington Hospital is successful in part because our multidisciplinary team follows patients for years after injury, when needed. The rehab staff works closely with the burn surgeons and providers over the long term.
We offer several treatment options to provide the best outcomes for our patients. These include:
- Compression: Elastic bandages or compression garments can apply pressure over healing burns and grafts to minimize development of scars.
- Laser scar revision: This non-invasive treatment involves using a laser to break down scar tissue, resulting in increased range of motion and smoother skin.
- Massage: Burn-specific techniques can improve range of motion while helping limit pain, itching, and scar tissue development.
- Surgical reconstruction: Reconstructive surgery is performed in the Burn Center’s dedicated operating room when required.
- Aftercare programming: We provide opportunities for patients to connect with others recovering from burn injuries, including local outdoor programming, burn retreats, and conferences. Patients can gain a better understanding of the effects of trauma and the emotional challenges they face in recovery. Learning new skills can increase confidence and promote post-traumatic growth.
- Image enhancement: Patients can schedule an appointment with a burn occupational therapist to learn product application techniques to provide an even pigment or coloring to visible burn scars.
When it comes to treating and rehabilitating from a burn injury, things have changed a lot since that car came through the window of my parents’ shop in the 1960s. From minor burns that can be treated with outpatient care to full-spectrum rehabilitation of severe burns we’re proud to help our patients develop the function and confidence they need to thrive.