Burn Injuries, Low Back Pain, Cognitive Disabilities, and Mood Disorders: Impact and Management

Posted on Dec 31, 2024 in Medicine & Health

Burn Injuries: Classification, Treatment, and Rehabilitation

Burns are classified according to their depth and size. The classifications are:

  • First-degree (superficial)
  • Second-degree (partial-thickness): Affects the top two layers of skin. Healing time is typically two to three weeks.
  • Third-degree (full-thickness): Extends through all skin layers and includes fatty tissue above the muscle.
  • Fourth-degree: Involves skin, fat, muscle, and bone. These burns result in slow healing, severe scarring, and loss of normal range of motion.

A patient’s hand represents approximately 1% of their body’s surface area.

Types of Burns

  • Thermal Burns: The most common type, caused by fire, hot liquids, or hot surfaces.
  • Chemical Burns: Result from direct contact with strong acids, alkaline agents, gases, or chemicals.
  • Freeze Injuries: Such as frostbite.
  • Radiation Burns: Caused by large doses of radiation.
  • Electrical Burns: Often cause extensive internal damage with little external damage. The damage can continue from the point of contact and may persist afterward.
  • Inhalation Injury: Damage to the respiratory tract caused by smoke inhalation and carbon monoxide toxicity, potentially leading to brain injury or death.

First and second-degree burns are commonly caused by thermal sources like hot liquids or radiation (e.g., sunburn). Third and fourth-degree burns are typically caused by fire, flame, or electrical sources.

Adjustment and Recovery from Burn Injuries

Approximately 85% of individuals return to their former activities within six months. However, 15% require extensive intermittent reconstructive or cosmetic surgery for about two years.

Burn recovery often involves:

  • Skin grafts: Taken from the individual’s healthy skin.
  • Cadaver skin: Skin recovered from the back and legs of cadavers (only the top 1.5 layers) can be used as a temporary dressing.
  • TransCyte: An artificial, temporary skin covering made from cells from the foreskin of babies. It is not rejected by the body and is mainly used for second-degree burns. However, it is expensive and has been unavailable for 15 years, though it is starting to make a comeback. Temperature regulation can be difficult, especially with third-degree burns.
  • RECell: A small skin graft is taken, cells are scraped off, put into a formula, and sprayed onto the burn.
  • Meshing: A small skin graft is put through a mesher to create a lattice-like structure with holes.
  • Tilapia skin: Used in some countries due to its protein and collagen content.
  • Pressure garments: Worn 23 hours a day for one year to help with scarring and mobility.

Pain from burns can be similar to neuropathic pain and may last for years. Infections such as Pseudomonas (historically more deadly) and MRSA (currently less deadly but still a concern) can complicate recovery. Stretching the skin is crucial to prevent contractures.

Vocational Planning for Burn Injuries

Vocational planning involves:

  • Assessing the ability to perform past and future jobs.
  • Addressing cosmetic appearance.
  • Managing pain.
  • Maintaining range of motion.

Individuals with severe facial burns (“Big Burn”) may feel isolated, making occupation beneficial.

Functional Limitations

  • Mobility: Contractures caused by shortening of tissues or scarring.
  • Lower extremities: Difficulty walking, climbing, and balancing.
  • Upper extremities: Difficulty reaching, fingering, and handling.
  • Cosmetic disfigurement.
  • Reduced tolerance to heat.
  • Concerns about aesthetic appearance.
  • Difficulty meeting the public due to self-image issues.
  • Trauma to injured skin and/or joints.

Low Back Pain: Causes, Diagnosis, and Treatment

Prevalence: 80% of adults will experience low back pain (LBP) at some point. More than 25% of adults reported experiencing LBP in the last three months. LBP is a common cause of job-related disability and a leading contributor to missed workdays.

Diagnosis: 90% of patients with LBP do not have a specific diagnosis, meaning the source is never identified. Posture is a significant factor.

Factors Influencing Recovery

A high “threat meter” may hinder recovery with regular physical therapy approaches. Reducing the threat meter is often necessary first.

Diagnostic Approaches

  • Subjective: Assessing pain location, intensity, onset, and any related injuries.
  • Objective: Strength testing, neurological testing, and posture assessment.

Diagnoses often lack physical findings and must rely on the patient’s history and reported discomfort.

Treatment of Back Pain

  1. First choice: Strategies to manage symptoms and education.
  2. Second choice: Manual therapy, including joint immobilization, soft tissue mobilization, joint manipulation, and modalities (ice, heat, electrical stimulation, traction).
  3. Last resort: Surgery. Second opinions are encouraged, as surgery has shown no benefit for chronic low back strain.

High Threat Meter: Fear of pain can elevate the threat meter, which may need to be addressed first. A higher threat meter is often associated with concurrent psychological disturbances, especially anxiety and depression.

Prognosis

90% of those experiencing LBP recover in about three months. 78% of those with a history of LBP experience a relapse. Pain has both physical and mental components, and addressing the mental aspect may help with chronic pain progression.

Sexuality and Cognitive Disabilities

Prevalence: 75% of causes of intellectual disability (ID) are unknown. 25% of all cases have known causes. Approximately 3% of the US population has cognitive disabilities.

Risk Factors

  • Parent’s age at conception.
  • Hereditary factors.
  • Environmental factors.

30% of people with disabilities have psychological involvement, such as depression, bipolar disorder, PTSD, obsessive-compulsive disorder, and aggressive disorders.

Statistics Among Students with ID

  • Aggression: 58%
  • Poor sense of safety: 44%
  • No sexual information: 40%
  • Inappropriate comments: 30%
  • Withdrawal into fantasy: 26%
  • Unusual family comments: 26%
  • Self-abuse: 26%
  • Grooming: 19%

Abuse Prevention Strategies

  • Education: Relationship understanding, boundary awareness and assertiveness, abuse awareness and prevention, and socialization education.
  • Healthy Self-Concept: Understanding the body, exploitation prevention, relationships (friends vs. friendly, friend vs. intimacy, social boundaries, public vs. private, personal space).
  • Social Skills: Teaching the need for privacy. Individuals with ID need to socialize and learn appropriate social skills. They are often taught to be compliant and may not understand how to report abuse.

Teaching Methods

  • Visual aids
  • Role-modeling
  • Activities
  • Opportunities
  • Community activities

Learning is achieved through hearing, talking, seeing, examples/non-examples, and doing.

Workplace Considerations

62.5% of staff working with people with ID report that individuals have expressed “offensive sexual behavior problems.” 83.6% of staff report problems addressing these behaviors. Inappropriate social-sexual behavior is a primary reason people with ID lose community employment opportunities. Training is needed for individuals, staff, and the workplace.

Managers: Individuals with ID may have poor verbal skills. They need to work at real job sites and receive instruction on behavior, dress, public/private talk, relationships, etc.

Co-Workers (concerns about individuals with ID):

  • Inappropriate dress
  • Hygiene issues
  • Sex talk
  • Whining and complaining
  • Relationship mishaps
  • Boundary issues
  • Dumpster/bathroom dating (where sexual activity may occur)

Mood Disorders

Types of Mood Disorders

  • Depression
  • Bipolar disorder (Bipolar I, Bipolar II, Cyclothymia)

Bipolar disorder is more common in high-income countries, suggesting environmental factors play a role.