Going home

Therapy is needed to help patients get well after a burn injury.

Therapy includes doing exercises, wearing splints and working to regain independence (being able to do things by yourself again). It may be a long time after a burn until a person is able to feed himself or to walk alone. It is important to start doing things independently. Some examples of doing things by yourself that might be difficult include dressing, eating and playing. It will also include additional new tasks in a daily routine like wearing:

• bandages
• compression garments
• transparent face masks
• mouth splints
• neck splints

After going home from the hospital, a type of exercise might be doing chores around the house such as:

• changing the oil in the car
• cooking
• fixing bike tires
• sweeping
• folding or carrying laudry
• doing dishes
• shoveling snow
• shopping
• getting up to turn on and off the TV
• vacuuming

The exercises that are learned in the hospital will also have to be fit into a normal daily routine. All of this will take a long time at first, but it will get easier with practice and time.

After going home a person with a burn injury will probably complain that it seems like his skin feels tight and doesn't want to move. This feeling is real and is normal after a burn injury. This is because as the burned skin heals, it shrinks and becomes tight and harder to move. This is very frustrating! The burned skin is most tight and stiff in the morning right after waking up. This is because when we sleep we are not exercising or moving and the burned or grafted skin has a chance to shrink and tighten. It is very important to work on exercises every day and especially every morning after getting up. This will help stretch the tight skin out so that moving the rest of the day will be easier.

Things that help a person to keep going and get well include:

• going for a walk
• playing a game like tossing a ball back and forth
• coloring a color book or playing a word game
• playing games
• smiling and laughing

Diet at home
Usually, by the time patients leave the hospital, the caloric needs are about the same as before the injury. A well-balanced diet following the guidelines on the Food Pyramid for the patient's age is recommended.

Protein requirements may remain high if small areas of skin still need to heal. If this is the case, one to two extra servings from the meat or dairy food groups, or one to two fortified supplements (such as instant breakfast, Boost, Ensure, NuBasics, or similar drink) will cover the temporary protein requirement.

Sometimes weight gain can be a problem if patients continues to eat the extra food they were encouraged to eat while in the hospital. Ideal body weight is a laudable goal, but it can be an unrealistic expectation. However, patients should monitor weight and continue an exercise program since a sudden ballooning of weight after the return home should be avoided. In addition to being unhealthy, an increase in weight will alter the fit of pressure garments. Often patients are measured for elastic garments that are sent to the home and arrive shortly after discharge. If there is a significant weight gain, the garments will not fit, necessitating another round of measuring and waiting for the company to manufacture and send the new set. Therefore, good dietary practices are important. A well-balanced diet is emphasized, with close monitoring of any weight gains (once a week weigh-ins are recommended). The amount of calories an individual needs is dependent on the amount of exercise routinely performed. A regular exercise program, planned with the help of the physician and rehabilitation therapist, is key to increase muscle mass that was diminished during the course of the hospitalization.