Restoration of Function

Restoration of function is crucial to the performance of activities of daily living, vocational and recreational activities, as well as to community integration and psychosocial aptitude. Strategies to optimize restoration of function include both physical considerations as well as metabolic considerations that can significantly impact physical capacity. Given the breadth of this topic, Drs. Herndon and deLateur focused on two of the most critical facets of restoration of function: metabolic support of the burn patient and exercise/fitness. Advances in knowledge about effective means of providing early support for the hypermetabolic response to trauma have contributed significantly to the dramatic decrease in burn mortality during the past 20 years as well as benefiting early restoration of function for the individual with large burn injury. The hypermetabolic response that occurs in response to burn injury >40% TBSA1 and lasts for approximately 1 year after burn2 is characterized by a number of events that are life-threatening to the patient, for example, tachycardia and cardiac dysfunction, increased cardiac output, increased resting energy expenditure, increased protein catabolism and peripheral protein wasting, hyperpyrexia, and increased lipolysis. The erosion of body mass that occurs with catabolism can lead to impaired immune function, decreased wound healing, pneumonia, pressure sores and, eventually, death. Children with large burns suffer arrested vertical growth.3 Bone formation is slowed, and bones are weakened.4 Even when the patient survives, the debilitating effects of hypermetabolism delay and limit restoration of function for the patient.