Arms holding on to each other

Welcome to the Pediatric Burn Injury Rehabilitation Model System

Administered by The University of Texas Medical Branch at Galveston and Shriners Hospitals for Children - Galveston Burn Hospital

NIDILRR Grant Number: 90DP0043

Funding Cycle: October 1, 2012 to September 30, 2017

Severe burns are one of the most complex forms of trauma injury. Promoting survival, recovery, and rehabilitation of burn patients is extremely challenging. Long-term rehabilitation is expected and significant disability is common. Rehabilitation focuses on major problematic areas of both recovering normal physical function and providing psychosocial adaptation. This situation becomes more complex in pediatric patients where consideration must be given to physical growth and development, cognitive development and differing motivations at each developmental period, and the longer life span over which rehabilitation interventions are likely to affect outcome. At Shriners Burns Hospital- Galveston, Texas, we have endeavored for more than 40 years to develop new techniques to improve the outcome of children with major burns. Mechanisms are currently in place for the interdisciplinary care, rehabilitation and follow up of over 300 acutely burned children. The burn patient population consists of many different countries and cultures referred to our hospital each year. Our comprehensive treatment plans are directed toward achieving the best possible long-term outcome in our patients. We have a strong history of conducting excellent research that translates into the best care we can provide to improve physical, functional and psychological outcomes from burn injury.

We will continue our current longitudinal assessments of patients. Our local database is extensive, including measures of cardiopulmonary function, physical growth and maturation, bone density, range of motion, activities of daily living, scar formation, reconstructive needs, and psychosocial adjustment.

We treat and follow a significant number of burn survivors with severe injuries. The problems addressed in this proposal are those that would prevent these patients from enjoying normal lives. A hypermetabolic/catabolic response occurs from severe burn injury and lasts up to 1 year post-burn. This stress response is characterized by tachycardia and cardiac dysfunction, increased resting energy expenditure, increased protein catabolism and peripheral protein wasting. For our first study, we propose a collaborative project assessing the efficacy of long term use of propranolol in the treatment of burn injury (adults and children) with endpoints of improved survivability, improved cardiovascular condition, greater energy, improved muscle endurance, improved growth in children, and decreased anxiety. For project 2, we propose, at this site only, to improve rehabilitative outcomes for children with burns ≥40% total body surface area burned by combining an anabolic agent (oxandrolone or Ketoconazole or propranolol) with a 3 month intensive outpatient rehabilitation program. The supervised exercise program has shown to be effective in ameliorating effects of the hypermetabolic response. We will assess the effectiveness of combining the anabolic agents and the exercise program with the expectation that the effects will be additive and will improve linear growth, bone mass, muscle strength, lean body mass, physical function and general well-being. The last study, also site specific, is a continuation from the previous funding cycle. It focuses on Acute Stress Disorder and Post Traumatic Stress Disorder, a problem that impairs the well-being of burn patients. The study proposes to follow children with ASD to access the relationship of the two disorders and to elucidate a history of the development of PTSD. This center is well suited to conduct this study because of our experience, patient population, and expertise in research.

National Institute on Disability, Independent Living, and Rehabilitation   Research</a>(NIDILRR)

In 1993, The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) sponsored three burn injury model systems for a period of four years. In 1997, NIDILRR enhanced the above priorities to include children. Now, there are four Burn Injury Rehabilitation Model Systems in the United States.

Model Systems are specialized programs of care in spinal cord injury (SCI), traumatic brain injury (TBI) and burn injury, funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) to pool information and conduct research with the goal of improving long-term functional, vocational, cognitive and quality-of-life outcomes in these populations. NIDILRR grants model system designation to institutions that are national leaders in medical research and patient care and provide the highest level of comprehensive specialty services, from the point of injury through rehabilitation and re-entry into full community life.