The level of burn treatment in China has always attracted the attention of the world. For demographic and social reasons, the number of burn patients in China is huge, and in the late 1950s, burn workers in China were the first to break through the then international death zone for large burns. Since then, a large number of burn specialties have sprung up in China, and burn surgery has been rapidly developed and the level of treatment has been continuously improved. By the 1990s, a large sample of statistics showed that half of the healed burns in China had reached 96.99%. Up to about 95%, much higher than developed countries in Europe and the United States …. However, for a long time, burn treatment in China has mainly focused on early treatment and trauma repair, with insufficient attention to late rehabilitation, and the overall rehabilitation level still has a large gap with the international advanced ranks. In this paper, several issues related to burn rehabilitation are discussed with a view to attracting the attention of domestic counterparts and jointly pushing the level of burn treatment in China to a new height. 1.The concept and content of rehabilitation The modern concept of rehabilitation refers to the comprehensive use of medical, social, educational and vocational means to reduce the physical, mental and social dysfunction of patients, so that they can be fully rehabilitated and thus maximize the return to society. The concept of comprehensive rehabilitation includes four aspects: (1) Medical rehabilitation. That is, to help patients restore their health through various medical treatment means. For burn patients. It mainly includes life saving treatment, trauma repair, functional rehabilitation, cosmetic rehabilitation and psychological rehabilitation. (2) Social rehabilitation, that is, to take various effective measures to help patients adapt to society, so that they can not only survive, but also learn and develop. Fully participate in social life. Realize their own value. (3) Education rehabilitation, that is, through education (4) vocational rehabilitation. That is, through various means to help patients return to work or obtain a suitable occupation. Due to social and economic reasons, burn surgery in China has long paid insufficient attention to rehabilitation, and a large number of patients are left with serious disfigurement and functional impairment, making it difficult for them to return to normal life and becoming a burden to their families and society. Although rehabilitation has started to receive attention in recent years, it is mainly limited to medical rehabilitation contents such as functional exercise and scar treatment, and the concept of comprehensive rehabilitation including psychological, vocational, educational and social is generally not well understood, and many fields are still in a blank. This limitation in the understanding of the concept of burn rehabilitation reflects the gap in the level of burn rehabilitation in China. 2.Burn rehabilitation treatment timing Traditionally, domestic burn treatment is divided into two major parts: early treatment and late rehabilitation, with the main focus on life saving and trauma repair in the early post-injury period, and functional exercise and scar treatment only after basic trauma repair. It is only in recent years that we have come to realize that rehabilitation should not be separated from early treatment, and that rehabilitation should be “continuously extended to become an integral part of the acute treatment of burns”. Internationally, rehabilitation has long been considered an important part of burn treatment and is integrated throughout the treatment process. Immediately after admission, patients are assessed for possible functional and psychological impairments, and a rehabilitation plan is developed and implemented. Rehabilitation begins on the day of the patient’s injury; passive functional exercises are also given early in severe burns to prevent joint stiffness and contracture due to prolonged edema and braking. The results of a comparative study involving 104 1CU patients showed that patients on ventilators who were given rehabilitation therapy after daily suspension of sedation not only recovered better than the control group, but also showed improvement in signs such as respiration and consciousness, while only 4% of patients interrupted therapy due to unstable systemic conditions. In comparison, the timing of the start of rehabilitation treatment in China is still relatively conservative and needs to be further strengthened. 3.Multidisciplinary collaborative treatment model with the goal of comprehensive rehabilitation Burns have always belonged to the category of surgery in Western medicine. Modern burn specialty wards were first seen in the United Kingdom and the United States in the 1940s, and the centralized treatment of burn patients has facilitated the use of medical and nursing operations and specialized facilities, and the level of treatment has been significantly improved. Since burn treatment includes many fields such as systemic treatment, trauma treatment, complications, and rehabilitation, which require the participation of personnel from multiple disciplines, a treatment team with physicians, nurses, rehabilitation therapists (physiotherapists and occupational therapists) and dieticians as the core has been formed in the burn ward; in addition, anesthesiologists, respiratory therapists, pharmacists, psychologists, social workers (referred to as social workers), etc.; for children For children, teachers and child life specialists are often involved; the broader burn team also includes the patient’s family and social volunteers. In addition to physicians and nurses, members of burn treatment centers in Western countries are administratively affiliated with other hospital departments, such as rehabilitation, anesthesia, respiratory, nutrition, and social work departments, but they work mainly in burn wards in terms of operations. In some large burn centers in the United States, such personnel may be directly affiliated with the burn unit. Each specialty assesses the patient’s condition from the time of admission and develops a treatment plan from their own perspective, allowing for early intervention in rehabilitation. The multidisciplinary collaborative treatment model has significantly improved the overall level of treatment, and the level of comprehensive rehabilitation, including life-saving treatment, trauma treatment, cosmetic and functional recovery, analgesia, psychological and social rehabilitation, has been maximized. Some burn treatment units in China started to carry out burn rehabilitation treatment in the 1990s, but the contents were mainly limited to medical rehabilitation items such as scar prevention and treatment, functional exercise and brace treatment, and so far there are still few comprehensive rehabilitation contents such as psychological, social, vocational and educational contents, while the multidisciplinary team treatment model has not been established basically. Since the departments in domestic hospitals are very independent in terms of personnel management and economic accounting, it is difficult for inter-departmental professional collaboration to reach the level of western countries. How to break the difficulties of interprofessional collaboration will be the key to introduce the multidisciplinary team treatment model for burns in China. In addition, the high labor cost of multidisciplinary team treatment is also an important reason why it is still difficult to carry out. 4.Rehabilitation of post-burn scar contracture and dysfunction After the healing of deep burn wounds, scar growth and contracture often occur, resulting in deformity and functional limitation of physical activities. In addition to surgery, prevention and non-surgical treatment of scarring is important, and proven effective methods include compression therapy, silicone gel, pharmacotherapy, laser and radiation therapy. Physiotherapy and occupational therapy (also known as occupational therapy) for functional impairment are the main elements of traditional burn rehabilitation, including prevention and treatment of scar and its contracture, functional exercise, life and labor training, etc. Physiotherapy refers to the physical factors such as sound, light, heat, water and electricity to achieve the purpose of treatment and rehabilitation, and also includes massage and exercise therapy which belong to mechanical energy. Massage and active and passive exercise can reduce tissue edema and prevent joint stiffness due to fibroplasia. Various physical factors, such as ultrasound, audio, waxing, cold therapy and electrotherapy, can prevent or reduce scar growth. Scar massage and active and passive motion therapy are important in controlling scarring and improving joint mobility. Static and dynamic braces are important for preventing joint contracture and dysfunction. Occupational therapy starts with self-care training, focusing on labor and occupation-related skills, in order to help patients regain self-care and eventually return to work. Occupational therapy first began in the 18th century and was widely used in the 20th century in many fields of rehabilitation, and has also become an important part of burn rehabilitation treatment. In recent years, foreign countries have developed to the application of computerized virtual therapy that simulates work and life scenarios to burn patients. Occupational therapy was introduced into China’s rehabilitation profession in the late 1970s, but so far it has rarely been carried out in burn treatment and is an area that needs to be developed urgently. 5.Burn injury psychological rehabilitation Burn injury can not only endanger the patient’s life, but also cause serious consequences such as disfigurement, which often leads to post-injury psychological problems such as tension, depression, depression, anxiety and sleep difficulties. The incidence of psychological disorders in burn patients is 10% to 65%, and even up to 100% has been reported.121; 20% to 38% of patients have post-traumatic stress disorder 1 year after injury; 50% of patients have moderate or severe depressive symptoms in the early stage of hospitalization, and some patients can last until 2 years after injury. These psychological problems can have a serious impact on the treatment and quality of life of burn patients. Psychological rehabilitation is the application of systematic psychological theories and methods, from a biological, psychological and social perspective. Psychological rehabilitation is the application of systematic psychological theories and methods to treat patients with psychological interventions from a biological, psychological and social perspective. Common methods include supportive psychotherapy, cognitive therapy, behavioral therapy, relaxation therapy, music therapy, pharmacotherapy, family therapy, hypnosis and virtual reality. Hypnosis and music therapy are used abroad to reduce pain, alleviate psychological problems such as anxiety and depression to reduce the use of medications. Psychological rehabilitation of burn injuries can be divided into 3 stages: (1) Early admission. At this time, the patient’s life or death is uncertain, and a series of psychosomatic manifestations such as anxiety, worry, delirium, pain, and sleep disturbance will occur. (2) In-hospital recovery period. At this stage, the patient is basically out of life danger, the treatments are gradually reduced, and the patient becomes depressed as he begins to realize the long-term effects that the burn will bring. (3) Early stage of social reintegration. Patients return to their families and society after being discharged from the hospital for l to 2 years. Patients are often depressed because of the cosmetic changes caused by the burn scar, and in severe cases, they are even completely isolated from society. Patients who do not receive appropriate psychosocial support often find it difficult to return to their normal work and life status. There are various forms of psychosocial support for patients after discharge, including psychological counseling, organizing group activities such as recreational and outdoor activities to help patients rebuild their self-confidence. Hospitals in many countries are equipped with social workers to provide employment counseling, vocational introduction and vocational training for patients to help them return to work and social life. Currently, the psychological rehabilitation of burn patients in China is mainly performed by nurses on a part-time basis. That is, the so-called psychological care. Due to the extremely complicated work tasks undertaken by nurses, psychological care is often only available in addition to nursing work. Psychological care can often only be carried out slightly in addition to nursing work, which is not professional enough and difficult to implement in practice. The introduction of psychological treatment professionals in the burn treatment team will be one of the development directions of the domestic burn center. 6.Burn patients’ mutual aid organizations and children’s summer camps The cosmetic changes and functional disorders caused by scarring often make patients isolated by society, and patients with the same disease often gather together to support each other and restore their confidence in life. Nowadays, professional-directed or patient-directed organizations for burn victims have spread all over the world, and some of the more famous ones are “F.A.N. Club” and “Burn Survivors Online” in the United States. The “Group by mail” in the U.S. conducts similar group psychotherapy activities by mailing letters, specifically for those who do not want to appear publicly to participate. The rapid development of the Internet has made it easier than ever for patients to connect with each other and may be the main mode of communication in the future. The third hospital in Wuhan initiated the first patient support organization in China, “Huazhong Burn Patients Association”, whose main activity is to use instant messaging software (such as QQ patient groups and patient blogs) for communication; in addition, it also serves burn patients through hotlines, newsletters and other forms, and organizes fellowship and outdoor activities, which are very popular among patients. In addition, we also provide services for burn patients through hotline and newsletter, and organize activities such as social and outdoor activities, which are very popular among patients. Compared to adult patients, scarring, for example, is more psychologically damaging to children and can affect their normal personality development and education. Bringing burned children together in the form of summer camps can help them gain courage and self-confidence, reduce isolation, gradually adapt to the changes brought about by burns and rejoin school and society. Summer camps for burned children were first seen in 1982 with the Camp Celebrate weekend camp in North Carolina, USA. Since then, the format has spread and summer camps for burned children are held regularly around the world, mainly in the United States, Canada and Europe. Taiwan, China, has held annual summer camps for burned children since 1995, and in recent years has also attracted burned children from other regions of China, including Hong Kong, as well as from Korea and other countries, which has played a positive role in helping burned children recover psychologically. For various reasons, burn victims in China receive little social support after discharge from the hospital. For the huge number of burned children in China, summer camps should be a very popular format, but due to the lack of funding and human and material resources, how to promote it needs to be further explored. 7.Economic and social problems involved in burn rehabilitation Severely burned patients are discharged from the hospital with long-term or even lifelong scarring, along with functional impairment and psychosocial problems. Patients often suffer from low self-esteem due to disfigurement, autism due to rejection by others, and self-blame due to the burden on their families, leading to long-term isolation from society. Child patients are unable to receive normal education and cannot develop a healthy personality and psychology, and are unable to acquire the necessary knowledge and life skills. They feel that their life prospects are bleak. For these patients, it is not only necessary to help them build up the courage to live with self-respect and self-improvement, and let their family members master the necessary knowledge of care and rehabilitation, but also to make the patients’ units, schools, communities and even the whole society understand, help and accept them through publicity and education. The quality of survival of people with disabilities, including severe burns, is a yardstick to measure the civilization of society. As our economy and society are developing at a rapid pace, burn professionals should view burn rehabilitation from a new height and not only help patients at an international standard level, but also take on the unenviable task of promoting and educating society. With the lack of guaranteed funding for the treatment of many patients today, there are undoubtedly huge financial difficulties in helping patients to fully recover and return to society. Foreign experience in raising funds from society through foundations to support burn rehabilitation is worth learning from. China’s charitable fundraising system and channels are not yet perfect, and there are strict requirements for the establishment of foundations, so there is a lack of well-run burn injury foundations in China. In recent years, Shanghai, Wuhan and Kunming have made useful attempts in establishing relief funds for poor burn patients. Burn injuries mostly occur among low-income people, and China’s medical insurance system is unable to meet the treatment and rehabilitation needs of patients in the short term. Raising donor funds through the establishment of a standardized and sustainable burn injury foundation will be an important way to comprehensively improve the level of burn injury rehabilitation in China with the help of social power. Summary With the development of China’s economy and society, burn treatment is no longer limited to saving lives and repairing wounds. The ultimate goal of treatment is to improve healing quality, overcome cosmetic disfigurement, functional and psychological barriers, promote comprehensive rehabilitation, and allow patients to return to society. China’s burn treatment has made brilliant achievements, but it started late in burn rehabilitation, and the understanding of burn rehabilitation is not deep enough, and the projects carried out are not comprehensive enough, and the timing of rehabilitation treatment, treatment mode, and psychosocial rehabilitation need to be improved and enhanced. How to narrow the gap with the international advanced level as soon as possible and further improve the comprehensive rehabilitation level of burns will be a new challenge for Chinese burn medicine.