OT in the burn unit

Last Friday I spent the day with the occupational therapists who work in a burn unit. While the overall goal of OT is always to help patients do what they need and want to do in life, recovering from severe burns has some unique challenges. We usually don't think too much about our skin because it doesn't seem effect our ability to function. However, skin grafts tend to scar as they heal which means the skin becomes thick and hard rather than flexible and it also contracts. Much of what OT does for a patient in the burn unit is meant to counteract those tendencies.

One of the patients was a little three-year old I'll call "Andy." I met Andy as he was riding a trike down the hallway as he came to the OT room. His head was shaved and quite red since grafts had been taken from there to be used elsewhere on his body. He also wore a clear plastic mask which puts pressure on the grafts to prevent them from becoming thick and hard. He wore pressure garments on his arms and hands for the same purpose. For over an hour, Andy lay on his back with his shoulders propped up enough that his head was tilted back. This stretched out his neck where there were more grafts. If the skin in those grafts shrinks too much he won't be able to tilt his head back to catch a fly ball, guzzle a drink, look up at the stars or see what is on the top shelf. The OT sat on one side of him and worked on stretching out the skin around his shoulder and arm pit. At the beginning of the session he couldn't put his arm above his head. The grafted skin on the front of his shoulder became white as his arm stretched up. With some gentle massage and lots of lotion rubbed in, the whiteness went away and it could be stretched a bit further. By the end of his afternoon session he could put his arm straight above his head. This type of stretching needs to be done every day until the grafts are completely healed which can take over a year.

The most difficult thing for Andy was his mouth. To help stretch out his cheeks and lips, he put  different sizes of tubes between his cheek and teeth. He did alright with the smaller ones but he just held the bigger ones in his hand and said, "It's going to hurt." Yes, it would. It is hard to make a child suffer, but in this case it must be done. If it isn't he will end up having a mouth so small that he can't lick an ice cream cone or take a bite of a thick sandwich, and so inflexible that he won't be able to whistle or more importantly, use his cheeks to help move the food around in his mouth as he chews. I helped one of the adult patients stretch out his hands and when we finished he thanked me for helping to torture him. If a man in his 50s considers the necessary stretching to be torture (even if he was half joking) you can imagine what it is like for a child. One of the therapists I shadowed when I was volunteering told me she had worked in the burn unit for several years. Eventually she needed to move to another area of practice because it was so hard for her to work with children, who seem to be burned more often than adults.

I doubt I will work in a burn unit because there are fewer and fewer around the country. However, I'm thankful for the opportunity to learn from those who have learned to make "torture" manageable to even a three year old.