Burns: Classified according to depth and size of the burn.1stdegree (superficial) & 2nddegree (partial-thickness/burn top 2 layers). 2-3 weeks healing time.3rddegree (full-thickness/plus fatty tissue above muscle) & 4thdegree (skin/fat/muscle/bone), slow healing, produce severe scarring, loss of normal range of motionPatient’s hand = 1% body coverage.Thermal Burns:most common type of burns caused by fire, hot liquids, or a hot surfaceChemical Burns:direct contact with strong acids, alkaline agents, gases, chemicals. Freeze Injuries:frostbite, proprane. Radiation Burns: large doses cause damage. Electrical Burns:little external damage; causes extensive internal damage; can continue from point of contact; can continue to cause damage after. Inhalation Injury:injury to respiratory tract caused by smoke inhalation and carbon monoxide toxicity. Can lead to brain injury or death.1st& 2nd– thermal sources such as hot liquids or radiation (sunburn). 3rd& 4th:fire, flame or electricalAdjustment to burn injuries:85% return to former activities within 6 months; 15% require extensive intermittent reconstructive or cosmetic surgery for a period of about 2 years.Burn recoverySkin grafts:taken from healthy skin of individualSkin is recovered from back and legs from cadavers (only top 1.5 layers), donor skin is a temporary dressed. TransCytehuman fiberglass: artificial, temporary skin covering; not rejected by body, mainly for 2nd degree burns; too expensive and has been gone for 15yrs, starting to make a comeback, temperature regulation is difficult (especially with 3rd degree burns b/c thermos is burned away) made by cells from for-skin of babies. RECell: take small graph and scrape cells off tissue, goes into formula, and sprayed on (not the gun).Meshing is a small graph means putting graph through a mesher to slice it like a lettuce plastic wrap with holes in it. Tilapia skin is also being used in other countries (proteins and collagen). Pressure garments:23 hrs/day for 1 year; helps with scarring and mobilityPain is almost like neuropathic and can last for yearsInfections like pseudomonas (past, more deadly) and MRSA (present, less deadly) can be of concern. Stretching skin is important to keep from contractors.Vocational planning for burn injuries: Assess ability to perform past/future jobsCosmetic appearancePain management, Range of motion. “Big Burn” complete facial burn. Feel isolated, so occupation is beneficial. Functional limitationsMobility: contractures caused by shortening of tissues or scarringLower: walking, climbing, balancingUpper: reaching, fingering, handlingCosmetic disfigurementtolerance to heataesthetic appearanceability to meet the public self-image, trauma to injured skin and/or joints. Prevalence80% of adults will experience lbpMore than ¼ of adults reported experiencing in last 3 months. lbp common causes of job-related disability/leading contributor of days missed90% of patients experiencing LBP don’t have specific diagnosis:never identify the source. Posture is a big factor. Factors influencing recoverya high threat meter may not get better with regular PT approaches. Need to reduce threat meter 1st. Diagnostic approaches: Subjective: pain location, intensity, when it started, any injury. Objective: Strength testing, neurological testing, posture presentationDiagnoses are short on physical findings, must rely on history/level of reported discomfortTreatment of back pain:strategies to manage symptoms, educationSecond choice:manual therapy: joint immobilization, soft tissue mobilization, joint manipulation, modalities(ice, heat, electrical stimulation, traction)Last Resort: surgery, second opinions are encouraged,no benefit to help with chronic low back strainHigh Threat Meter:fear of pain, threat meter may need to be turned down first; higher threat meter with concurrent psyc disturbances (especially anxiety and depression)Prognosis90% of those experiencing LBP get better in about 3 months78% of those with history of LBP have a relapsePain is physical and mental present itself physical, may help with chronic pain progression. Sexuality cognitive disabilities75% of causes of ID unknown25% of all cases are known3% US. Pop. have cog disabilities (3 in 100 ppl)Risk Factors:Parent’s age w/conception, Hereditary factorsEnviron.factors30% of ppl with disabilities have psychological involvement: DepressionBipolarPTSDObsessive-CompulsiveAggressive Disorders. 40% of Students: Aggression 58%, Poor Sense of Safety 44%, No Sexual Information 40%, Inapp. Comments 30%, Withdraw into Fantasy 26%, Unusual Fam. Comments 26%, Self-Abuse 26%, Grooming 19%Abuse prevention strategies: Education:Relationship Understanding, Boundary Awareness/Assertiveness, Abuse Awareness and PreventionSocialization EducationHealthy Self ConceptThe Body: how it works, changes, good badExploitation Prevention Relationships: friends vs. friendly, friend vs. intimacy, social boundaries public vs. private, personal space. Social Skills: Privacy need to be taught.ID ppl need to socialize and learn appropriate social skills to elicit/receive. Taught to say yes/compliant. Don’t understand/know how to report abuse. Teach Using:Visual AidesRole-ModelingActivitiesOpportunitiesCommunity activities. Learn by: Hearing, TalkingSeeingExample/Non-exampleDoingWorkplace considerations62.5% of staff who work with people with ID report that consumers have expressed “offensive sexual behavior problems”. Staff report, 83.6% problems addressing these sexual behavior problems.Inappropriate social-sexual behavior has been cited as a primary reason that people with IDLose community employment opportunitiesTraining for individuals, staff, and the workplace. MANGERS:Can have rude/Poor verba; skills ID ppl need to work at real job sites/giveninstruction on behavior, dress, public/private talk, relationships, etc. Co-Workers (what they say about ID):Inappropriate dressHygiene IssuesSex TalkWhine and complain to anybodyRelationship mishapsBoundary IssuesDumpster/Bathroom Dating (Where sexual stuff is happening)Depressive Disorders:Types of mood disordersDepressionBipolar (bipolar I, bipolar II, cyclothymia).Bipolarenvironmental factors (bipolar is more common in high income than low income countries).