By Kendra M. Duckworth, MS*
*Kendra is a 25 year burn survivor and dedicates this booklet not only to the
survivors of September 11th, but to burn survivors everywhere.

How do you accommodate an employee who is returning to work following a burn injury? The answer to this question depends on several factors: the extent of the burns, the total body surface involved, the amount of scarring the individual has, and the resulting limitations. Burns are classified in three ways: first, second and third degree.

First degree burns are the most common type of burn injury. This involves only the top layer of skin and is characterized by pain, redness, and swelling. Sunburn is a typical first degree burn.

Second degree burns involve the first and second layer of skin. They are characterized by blistering of the skin, redness, and swelling and are very painful.

Third degree burns are the most severe and often result in extensive scarring. They can require a long recovery time and may result in severe limitations.

Individuals with burn injuries may have motor impairments, temperature sensitivities, and deal with psychosocial issues.

QUESTIONS TO CONSIDER

1. What limitation is the individual with the burn injury experiencing?

2. To what degree do these limitations affect the person and his/her job performance?

3. What specific job tasks are problematic as a result of these limitations?

4. Have you consulted with the individual regarding accommodation needs?

5. What accommodations are available to reduce or eliminate these problems? Are all resources such as the Job Accommodation Network being used to identify possible accommodations?

6. Has the person with the burn injury met with his/her supervisor(s) to evaluate the effectiveness of existing accommodations and to determine if others are needed?

7. Have you provided education in the form of sensitivity training to supervisory personnel?

MOTOR IMPAIRMENTS

Motor impairments often result from a type of scar called a contracture. A contracture scar is a permanent tightening of skin that may affect the muscles and tendons and can limit mobility.

Severe burns to the legs and feet can result in difficulty standing and walking. Burns to the hands and arms can result in difficulty reaching, lifting, and carrying, as well as fine motor movements such as grasping and writing. Many accommodations exist for individuals with gross and fine motor impairments.

Gross Motor Impairment:

Modify the work-site to make it accessible
Provide parking close to the work-site
Provide an accessible entrance
Install automatic doorrs
Provide an accessible restroom and break room
Provide an accessible route of travel to other work areas used by the employee
Modify the workstation to make it accessible
Adjust desk height if wheelchair or scooter is used
Make sure materials and equipment are within reach range
Move workstation close to other work areas, office equipment, and break rooms
Provide material lifts
Provide stand/lean stools
Provide anti-fatigue matting

Fine Motor Impairment:

Implement ergonomic workstation design
Provide alternative computer access
Provide alternative telephone access
Provide arm supports
Provide writing and grip aids
Provide a page turner and a book holder
Provide a note taker
Provide ant vibration gloves
Provide tool balancers

TEMPERATURE SENSITIVITY

A severe burn can compromise the body’s ability to regulate temperature effectively. An individual’s ability to circulate blood may be damaged, therefore affecting the body’s ability to adjust to cold temperatures. Also, if scarring is extensive, the individual may not be able to sweat effectively and can easily become overheated.

Heat Sensitivity:

Reduce work-site temperature
Use cool vest or other cooling clothing
Use fan/air-conditioner at the workstation
Allow flexible scheduling and flexible use of leave time
Allow work from home during hot weather

Cold Sensitivity:

Increase work-site temperature
Use portable space heaters
Dress in layers using thermal material or fleece
Wearing gloves
Provide heated clothing
Allow work from home during cold weather

PSYCHOSOCIAL ISSUES

An employee who is recovering from a burn injury may be dealing with a variety of emotional issues such as grief, depression, anxiety, and post traumatic stress disorder (PTSD).

Grief and depression can be a result of loss of body image and fear of interactions with other people. The individual may feel anxious about returning to the site of the accident if the burns are a result of an on the job injury. The person may also be concerned about limitations that prevent performing the job as before. PTSD can occur after an individual recovers form a traumatic event. People who have burn injuries and PTSD often avoid places or people associated with the accident. The individual may have nightmares, difficulty concentrating, and flashbacks.

Working Effectively with Supervisors:

Provide positive praise and reinforcement
Provide written job instructions
Develop written work agreements that include the agreed upon accommodations
Delegating clear expectations of responsibilities and the consequences of not meeting performance standards
Allow forcommunication to managers and supervisors
Establish written long term and short term goals
Develop strategies to deal with problems before they arise
Develop a procedure to evaluate the effectiveness of the accommodation

Interacting with Coworkers:

Educate all employees on their rights to accommodations
Provide sensitivity training to coworkers and supervisors
Do not mandate that employees attend work-related social functions
Encourage all employees to move non-work related conversations out of work areas

Difficulty Handling Stress and Emotions:

Provide praise and positive reinforcement
Refer to counseling and employee assistance programs
Allow telephone calls during work hours to doctors and others for needed support
Allow the presence of a support animal
Allow the employee to take breaks as needed

Sleep Disorder:

Allow flexible work hours
Allow frequent breaks
Allow work from home

EXAMPLE ACCOMMODATION IDEAS FOR INDIVIDUALS WITH BURN INJURIES

Note: Persons who have burn injuries may develop some of these limitations, but seldom develop all of them. Also, the degrees of limitation will vary among individuals. Be aware that not all people who have burn injuries will need accommodations to perform their jobs and others may only need a few. The following is only a sample of accommodation possibilities. Numerous other accommodation solutions exist as well.

A drafting engineer has third degree burns to 80% of his body. He is limited in sitting for extended periods. JAN provided him information on sit/stand work stations.

A school teacher with burn injuries to both hands was having trouble writing, particularly when she has to reach overhead to write on the chalkboard. JAN provided information on assistive writing aids such as pen/pencil grips and devices to make holding a pen/pencil easier. A desktop tablet that projected onto a screen in front of the classroom allowed her to do traditional board writing using a pen/tablet computer system.

A person employed as a ground maintenance laborer was recovering from severe burns of his head, neck, and back. His job required him to work outside during most of the day. Due to the scars he was unable to sweat to cool his body temperature and he was concerned about getting sunburned. His employer provided him with a hat, long sleeved light cotton shirts and a cool vest. He was given a portable beach umbrella to provide him shade and he was encouraged to take breaks as often as he needed them. The employer also changed his schedule to an earlier start time so that he could work mainly during the morning hours.

A consultant employed by a federal agency has severe limitations in fine motor movements as a result of burns to her hands. She has difficulty writing and typing. Her job requires her to use a computer to enter data and maintain files. She was accommodated by installing an articulating keyboard tray to her desk that allows her to bring the keyboard closer to her body. She was also given a split keyboard and a trackball mouse that allows her to use her fingers to move the curser and type, eliminating the need for her to use her thumbs. The individual combined these devices with speech recognition.

To discuss further possible accommodations for persons with burn injuries contact:

Job Accommodation Network
800-536-7234 (Voice and TTY)
800-ADA-WORK (Voice and TTY)
http://www.jan.wvu.edu