Denise Slack, clinical lead (OT), gives an introduction to vocational rehabilitation in this short video:
Vocational rehab (VR) encompasses interventions that are focused on helping individuals with a health condition or impairment to overcome barriers to work and so remain in, access or return to
Posted on: 18th May 2015
Catrin Pugh is 1 of only 2 people in Europe to have suffered 96% burns and lived to tell the tale. She tells us hers…
Catrin Pugh is 1 of only 2 people in Europe to have suffered 96% burns and lived to tell the tale. She tells us hers…
Catrin Pugh turned 21 earlier this year: she had a big party, wore a beautiful dress and had a fantastic time with her friends and family. Two years earlier, while Catrin was laying in a critical condition in hospital, her mum Sara promised to throw her a massive 21st birthday party if she pulled through. “My mum thought I would forget that but I didn’t,” laughs Catrin.
On 16th April 2013, after working in a hotel for the skiing season in Alpe d'Huez, France, Catrin started the long journey home to England by coach. “We were coming down the mountain road away from the resort, which is notorious for its bends and is used for the Tour de France,” says Catrin, “it was very windy and on the final bend the coach crashed into the mountain side. We’re still unsure exactly what happened.”
Catrin blacked out. She doesn’t remember the crash or the initial moments afterwards, when the coach set alight. “Apparently my friends managed to pull me out of the fire. I was lying on the side of the road, not really knowing what had happened to me,” recalls Catrin. “I remember looking at my hands; I could see some of my skin hanging off. I felt like I was in pain but I didn’t understand what kind of pain it was – a sort of severe stinging pain.” It would later be confirmed that Catrin had suffered burns across 96% of her body.
Her friends, who were not as badly injured, tried to look after Catrin and put clothes under her head. “They managed to get in touch with the paramedics, who came down as soon as possible. I think they came down from the resort, so it didn’t take too long for them to get to us.” The paramedics stabilised and sedated Catrin before she was airlifted to Grenoble hospital. From there she was immediately transferred to Lyon, where she was put into an induced coma.
Catrin’s mum and brother flew out the next day. “Over the phone, the French doctors couldn’t properly explain to my family what had happened,” explains Catrin, “so they were under the impression initially that I’d just burnt my left arm. They were later made aware of how seriously injured I was, before they flew over.” When the severity of Catrin’s condition became clear, the rest of the family flew over to see her. Catrin’s parents Sara and Carl got a call from the Medical Repatriation team to say that Catrin’s chances of survival were very slim but she was stable and a bed was available at Whiston hospital in Liverpool. “My dad asked the person on the phone what they would do if it was their daughter,” says Catrin, “and they said they would fly me over to be at home. So I was flown back to England on the Saturday.” Once at Whiston hospital, doctors confirmed that as well as 96% burns, Catrin had 3 broken ribs and internal bruising.
Catrin was in intensive care, in a coma for 3 months. During that time she underwent over 200 procedures, including multiple skin grafts. “My hair was shaved 5 times, so they could take skin for grafts,” says Catrin. “My scalp was the only place that hadn’t been burnt, except for the soles of my feet. They couldn’t take skin from my feet because I probably wouldn’t have been able to walk afterwards.”
After 8 weeks in a coma, it took another 4 weeks to bring Catrin fully out of it. “I only remember a few things,” says Catrin, “I had hallucinations because of all the drugs I was on – I would see things in my room – and I remember being in pain and being covered in bandages. My mum and dad sat with me every single day.”
Once Catrin was well enough she started her physiotherapy, beginning with the physiotherapist moving her limbs for her. At the end of her time in intensive care, they were starting to get Catrin up on her feet again. She recalls her transfer from the intensive care unit to the burns unit being repeatedly deferred: “I kept being told ‘today’s the day you’ll be going on to the burns unit’ and then it wouldn’t happen because I’d take a turn for the worse and wasn’t well enough. They had to take it day by day.”
Once in the burns unit, she had physiotherapy every day, ranging from hand therapy to learning to walk again. Throughout her time in intensive care, Catrin’s nerves and muscles had degenerated. “I was originally about 9½ stone and had gone down to 5 stone because I was so poorly,” says Catrin. “The nerves all down my arms and legs had to regrow and I had to learn to feel things again – to feel different textures and to move my fingers again. It was very painful – especially standing on my feet. They started me off with standing for 5 seconds and sitting back down; I was being walked in a big harness on a big frame and people would move my legs for me to begin with. The next phase was trying to move my legs myself and then I moved onto a different frame where I didn’t have as much support. By the time I left hospital I still had to have one person either side of me, holding on to me, to be able to walk and I could only walk a short distance.”
Catrin was discharged on 7th December 2013 after approximately 8 months in hospital. Her therapy continued at home with 4-hour sessions 4 times a week, with a physiotherapist who had been taught by the burns team. Initially the focus was on Catrin being able to walk unaided and later they moved on to improving Catrin’s hand function so that she could carry out daily tasks like cooking and shopping.
“The first time I walked without support (except foot splints to hold my ankle in place) was at the end of February 2014,” says Catrin, “so it took me nearly a year to learn to walk again. It was good for me because it meant I could do things without calling for mum, dad or my physiotherapist to help all the time. I had some independence back! I got rid of the splints in June 2014 and I can now comfortably walk for about a mile on my own. I still need the wheelchair for long trips but if I’m just going shopping locally, I can do it without a wheelchair – I just take frequent breaks, sitting down to rest.”
As well as regular physiotherapy, hand therapy and occupational therapy sessions, Catrin has weekly home visits from district nurses and has to travel to Whiston hospital for check-ups very 6 weeks (reduced from weekly trips during her first year back at home). Catrin continues to need support at home and when out and about, as she still has some issues with mobility and hand function. “I have a carer – I call her my PA – who’s more like my companion,” says Catrin, “so if I want to go shopping she’ll come with me, instead of my physiotherapist. She also helps me with getting ready in the morning, as there are still some things I can’t do on my own.”
Just before Catrin was discharged from Whiston hospital, her solicitor instructed Sharon Parry to provide her with case management support and Sharon has worked with Catrin and her family ever since.
“When this all started”, says Catrin, “I didn’t have a clue what case management was but Sharon’s been brilliant! She was there anytime mum or I had queries or needed extra help. She helped to source my hand therapist, occupational therapist and carer – if I hadn’t had their input I wouldn’t be where I am today – and we wouldn’t have been able to find them without Sharon. She’s co-ordinated so many things for us – all the stuff that my mum would have had to deal with herself, like paperwork and benefits. It’s taken a big weight off my parents.”
Catrin now has blurred central vision in both eyes, which means she’ll never be able to drive again. Sharon set up a taxi account for her, which gets paid monthly through her claim. “All I need to do is give them a ring when I need a taxi,” says Catrin, “and Sharon keeps on top of it. It means that if I want to go somewhere on my own, I can be seen into the taxi from my house and then my friends can meet me at the other end. I’m not restricted and my parents don’t have to give me lifts everywhere. It’s been so useful and absolutely key to my independence – being able to do things that I used to be able to do.”
Catrin is keen to get involved with charities working with people who have suffered severe burns. “I found there’s not a lot of information out there for burns victims about what a severe burn can do to you,” says Catrin, “things like critical care neuropathy and my hands being like this. You’ve got representatives like Katie Piper and Simon Weston but the majority of their burns were to their face and their injuries didn’t really affect their ability to walk or use their hands. I’d like to go into speaking publicly about what’s happened to me.”
“The Katie Piper Foundation have invited me to speak at a lunch in the House of Lords in October 2015. I’ve also been contacted by a charity called Changing Faces, which mostly deals with facial injuries and disfigurements – though they do also deal with disfigurements in other areas of the body. I’ve applied to be a media volunteer for them, so if the media contact them for a story, I might be picked for it. I’m keen to support other causes that deal with non-facial burns and the effects of these on health, mobility, hand function, vision and neurological function.”
Catrin first met Katie Piper through one of the doctors at Whiston Hospital, who’s the chairman of the Katie Piper Foundation, one of the biggest organisations supporting burns victims in the UK. The foundation arranged for a holistic therapist to visit Catrin in hospital and do massages once a week, as part of their research into how holistic therapy affects patients’ physical and mental wellbeing. The foundation also provided funding for Catrin to spend some time at a specialist clinic for burns, scars and other skin disorders in France, where Katie Piper herself had stayed.
Since the accident and throughout her recovery, Catrin has welcomed the media attention she’s received. “I’ve always been interested in the media and, actually, what’s happened to me has made me even more interested because I’ve been a subject of the media – I’d like to turn it around and actually be part of it, rather than just a subject.”
ITV filmed Catrin again during a skiing holiday with family and friends for Christmas 2014 – a tradition from which they had taken a break while Catrin recovered. Catrin prepared for the trip by having indoor skiing lessons and getting some specially made ski boots, skis and other equipment – all with adaptations to allow her to ski. “We went to Val Thorens in France, where we’ve been to quite a few times before,” says Catrin. “It was the first time I’ve been in that situation [driving up mountain passes] since the accident, so it was a bit scary but I just put my head down in my hands for the whole journey.”
“On the first day I skied for about 2 hours on the gentle (green) runs but the next day my feet were really hurting, so I only skied for about an hour. Then I had a day off to give my feet a rest, so I walked round the village with my mum instead, which was really nice. I skied for quite a while on Christmas Eve and for about 4 hours on Christmas Day – I did 2 blue runs (the next level up from green) so I was very proud of myself and very happy! Every time I skied, I was with my family and friends and we skied in a unit - a diamond formation with me in the centre - so they could protect me from other skiers. It was a really nice holiday and good to restart our tradition and get back to a bit of normality. Hopefully we can go back next year.”
Catrin attended the specialist clinic in France from the end of October 2014 for 3½ weeks. “I had a daily timetable of different therapies and treatments, including skin treatments,” says Catrin. “I had a lot of hand therapy, which is one thing the clinic’s famous for: 45 minutes of hand manipulation, where the therapist would pull my fingers and bend my joints, and two 45-minute occupational therapy sessions. These took place in a room with a big table in the middle, with different toys and crafts – the idea was to play games instead of doing mundane exercises all the time.”
Catrin and her doctors saw a big improvement in her skin condition and hand function after her time at the clinic, so Sharon Parry arranged for her to return in January 2015 for 4½ weeks. This time Catrin had to fund it herself. “I did the same sort of things as the first time but I also did cooking as part of my hand therapy,” says Catrin. “They have a special kitchen where you carry out tasks, bespoke to your needs. A fellow patient and I made tarts and quiches together – she would make the pastry while I peeled and sliced apples. I find it difficult to do this sort of thing, so it was really good to work at it. Before I went to the clinic, I could hardly bend my lowest knuckle joints but now I can bend them quite far. I can do a lot more things with my right hand too, such as pinching with my thumb and forefinger. One of my goals is to be more independent, so it’s great to be able to do some of these tasks for myself. I’m waiting for a few bits of equipment and then I’ll be able to really help out with the cooking at home.”
“I want to go back to the clinic in the summer because I haven’t experienced really warm weather since the accident,” says Catrin. “As a result of the burns, I can’t regulate my body temperature and I can’t go in the sun unless I’ve got factor 50 sun lotion on. If I go back to the clinic in the summer, then I’ll get to experience heat in an environment where I’m surrounded by burn injury specialists who can advise me and deal with any issues. That way, if I want to go on holiday to somewhere warm in future, I’ll know what to do.”
“My goal now is to move into public and motivational speaking, so I can help people who are going through a similar thing to what I’ve been through,” says Catrin. “I’m just taking any opportunity that comes up at the moment. If it gets to a point where I have too many opportunities, then I’ll start picking and choosing but I don’t want to turn down something that could end up being a big opportunity. I’d also like to write a book but I wouldn’t know how to go about that either. It’s all new territory to me.”
“I’ve got physiotherapy twice a week, personal training three times a week, hand therapy once a week and at least one medical appointment a week, so I’m really busy at the moment. My rehab does take up quite a lot of time – for my mum too; I’m her full time job! I’m not at 100% yet, so I’m still focused on my rehab more than anything else. I don’t want to start any new ‘venture’ in case it takes away from that. Once my rehab is at the point where I’m not doing very much each week, I’ll be able to really start planning what I want to do in the future.
“To people who have suffered injuries similar to mine,” says Catrin, “I’d say focus on the end result rather than the very next day. When I was in hospital I used to focus too much on what I was like at the time and that didn’t do me any good. Now I tend to think, ‘in 6 months time I’m going to be here and I’m going to be doing this, this and this, so I’m going to be loads better’. Try to stay as positive as possible, even though it’s really difficult. I’m lucky that I’ve got a close family and a big group of good friends who have helped me – some people don’t have that. It’s easy for me to say ‘be positive’ but just try as hard as possible – and you’ll get there!”