Phases of music therapy treatment in a severe paediatric burns case

Mrs Aniek Janssen1, Mrs Clare Kildea1

1Lady Cilento Children’s Hospital, South Brisbane, Australia

Abstract:

Historically, music therapy research in burns has focused on music analgesia, where music therapy interventions and techniques are used to ease the sufferings of the burns patient (Whitehead-Pleaux, 2013). However in more recent developments, the role of music therapy appears to be changing as clinical procedures such as debridement and dressing changes are conducted under a general anaesthetic.

This case study will describe the application of music therapy techniques in the acute and sub-acute care of patient ‘Jack’, during a lengthy hospital admission for severe burn injury. It will distinguish six different stages in music therapy treatment for severe burn injury, with musical interventions and goals in each phase.

During Jack’s stay in Paediatric Intensive Care Unit music therapy assisted with settling and pain management and it provided family with a sense of being included in his cares when he was sedated and intubated. Music therapy provided support and assistance while sedation was weaned and Jack emerged from his delirious state. Music therapy helped Jack deal with his lengthy admission and it helped him safely explore the trauma and grief around the loss of a sibling. Music therapy also supported in the physical rehabilitation by providing Jack with opportunity to playfully increase moments of purposeful movement to achieve an extended range of motion in his upper limbs and regain fine motor skills.

This presentation explores the changing role of music therapy in paediatric burns care and invites clinicians to consider modifying and adapting techniques in order to meet patient needs in an evolving clinical practice area.


Biography:

Aniek Janssen is music therapist at the Lady Cilento Children’s Hospital, working across a range of acute paediatric caseloads including burns care and paediatric intensive care.

Clare Kildea is Clinical Lead Music Therapy at the Lady Cilento Children’s Hospital, managing the acute care team and working predominantly in critical care.

 

 

 

Predictors of Moderate to Severe Itch 12 Months Following Admission to Hospital for Burn Injury

Dr Lincoln Tracy1, Associate Professor Dale Edgar2,3, Ms Rebecca Schrale4, Miss Heather Cleland5, Professor Belinda Gabbe1,6

1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, 2State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Australia, 3Burn Injury Research Node, The University of Notre Dame, Fremantle, Australia, 4Tasmanian Burns Unit, Royal Hobart Hospital, Hobart, Australia, 5Victorian Adult Burns Service, The Alfred, Melbourne, Australia, 6Farr Institute, Swansea University Medical School, Swansea University, Swansea, Wales

Abstract:

Introduction: Itch is a common complaint of patients with burn injuries, and can significantly impact on their lives. This study aimed to describe the prevalence and predictors of moderate/severe itch, and establish the association between itch and patient-reported outcomes to 12-months post-burn.

Methods: Adult burns patients were recruited from five BRANZ sites and were followed-up at 1-, 6-, and 12-months post-injury. Moderate/severe itch was defined as a global itch score ≥4 on a specially-developed scale with anchors of 0 (does not interfere) to 10 (completely interferes). Multivariable mixed effects regression modelling was used to identify key predictors of moderate/severe itch at follow-up.

Results: 328 patients were included, with a mean (SD) age of 42.1 (16.7) years. Most patients were male (70%) and had sustained a flame burn (47%). The median (IQR) %TBSA of the burn was 5% (1-12%). The prevalence of moderate/severe itch increased from 26% at 1-month, to 36% at 6-months, and 48% at 12-months. The adjusted odds of reporting moderate/severe itch were 1.77 (95% CI 1.14, 2.75) and 3.41 (95% CI 2.10, 5.54) times higher at 6- and 12-months respectively compared to 1-month. The adjusted odds of reporting moderate/severe itch were 38% lower for patients who received a skin graft.

Discussion and conclusions: Almost half of patients reported moderate/severe itch at 12-months, and time since injury and grafting status were important predictors of itch. Additional research is required to enhance our understanding of potentially modifiable factors that impact itch, which may lessen the overall burden of burn injuries.


Biography:

Dr Lincoln Tracy is a Research Fellow in the School of Public Health and Preventive Medicine at Monash University, where he currently works on the Burns Registry of Australia and New Zealand (BRANZ). He completed his PhD at Monash University in 2017, focusing on modulating the psychological and physiological aspects of pain experience.

Post-discharge Analgesia in Burns Patients

Dr Rachel Khoo1, Dr Annette Camer-Pesci1, Dr Helen Douglas1, Prof Fiona Wood1, Dr Suzanne Rea1

1State Adult Burns Unit, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch WA 6150

Abstract:

Background:Burn wound pain management is challenging and complex. Traditionally, the use of opioid analgesia has been the mainstay approach. However, the use of such analgesia is not without side-effects and risks. A nationwide restriction on over-the-counter purchase of codeine products was recently introduced due to widespread concerns regarding risks of addiction and abuse. In contrast, the use of non-opioid analgesia, physiotherapy, oedema control, and non-pharmacological techniques have increased amongst practices. Most of our smaller injuries are discharged on Paracetamol and Celecoxib; with the use of Pregabalin and Tramadol considered on a case-by-case basis. We wished to discover what analgesia our inpatients with smaller burn injuries (<10% TBSA) were taking post-discharge.

Methods:Looking at a cohort of inpatients with burn injuries (<10% TBSA), a 4-week prospective community-based telephone survey of discharged inpatients was carried out. Questions regarding analgesia requirements, pain scores and adequacy of pain control in the acute period were assessed on discharge, at 48hrs, one week, and at six weeks post-discharge.

Discussion: Adequate pain control in a burn patient is paramount for their journey to recovery. The increasing problems seen with painkiller addiction, has led us to question whether we are over or under prescribing such analgesia and what our population requirement is in the smaller burn injury. In assessing our practice, we aim to discover the level of adequate analgesia to control patient pain, allow therapy, and a return to activity vital to their rehabilitation.


Biography:

Rachel is currently a service registrar at Royal Perth Hospital. Her interests lie in the pathophysiology of wound healing, anatomy, and rock climbing.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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