Burn rehabilitation

A short description, information, types of burn and preventive measure for burn

2. •Burnsareoneofthemostdevastingcondition
encounteredinmedicine.
•Burnisatypeofinjurythataffectonlythe
epidermaltissueandthedermisandrarelythe
deepertissuessuchasmuscles,bonesandblood
vesselsduetoexposuretophysicalformofenergy,
certainchemicalsorradiation
Definition:

3. Types of burn
Superficial thickness1.
Superficial Partial thickness2.
Deep-partial thickness3.
Full-thickness4.
4
th
Degree5.

4. Causes:
Heat
Electricity
Cold
Chemicals
Friction
Radiation

5. Management
-Remove the person from source and burning process must be
stopped.
-Addressing inhalation injury with 100% oxygen
-Remove heated source like rings, bracelet, chain, watch, etc.
-Pouring water with room temperature advisable only upto15 min
beyond which it can lead to hypothermia.
-Pain relief
-Maintenance of fluid balance.
-Reassurance and explanation for the patient.
-Transfer to a burn unit or admission to an ICU.

6. Physical rehabilitation:
Rehabilitation starts on the day of injury

7. Aims
Preventionofadditionalordeeperinjuries
Rapidwoundclosure
Preservationofactiveandpassivemotion
Preventionofinfectionorlossoffunctionalstructures
Earlyfunctionalrehabilitation
Preventrespiratorycomplications
Maintainmusclestrength

8. Short Term Goals:
• Assist Wound Healing
• Prevent Complications
(musculoskeletal)
Goals
Overall Goal:
Return to pre-injury level
of function with best
possible cosmoses

9. Positioning
It is the proper alignment and adjustment of body
parts.
It is a fundamental portion of burn rehabilitation.

10. Benefits of Positioning in Burn Rehabilitation:
•Prevents Contracture
•Controls Edema
•Prevent Localized Neuropathies
•Maintain elongated Position of soft Tissues

11. Positioning program is maintained and/ or modified according to:
1) Patient medical condition.
2) ROM
3)Skin condition.
Burn patient has tendency to assume flexed adducted position
(Fetal position) most probably as a reaction to pain.

12. •Positioningprogramshouldbeindividualized.
However,generallyspeaking,bodypartsshouldbe
positionedastomaintainburnedtissueintheirelongatedstate
•Typicallylimbsshouldbepositionedinextension-
abductionalignments.
•Positioning is maintained using splints, pillows, and or
foam wedges.

13. Burn Patient Positioning:

14. Splinting
By Definition:
•Tools to support burned area, maintain joint position and
correct or prevent deformity.
•Mostly in use are thermoplastic materials, still there are
some other materials in use such as leather, fiberglass,
and metals.

15. Splintsmaybestaticordynamic
•Staticsplints-areusedwhereitisessentialtoholdthepositionuntil
movt.canstart.
-Requiredonlyatnighttopreventsofttissuetightening.
•Dynamicsplints-permitcontrolledmovt.Ofvariousjoints.E.g.-
Foamrollplacedinthehandallowsextensionandsomeflexionof
thefingers,soallowingdamagedextensortendonstomoveina
limitedrangebutnottobeoverstretched.

16. Indications

21. Early Rehabilitation
Preventionofscarringshouldbetheaimofburnmanagement.Forevery
memberoftheburnteam,rehabilitationmuststartfromthetimeofinjury.
Havingasubstantialburninjuryisfrightening,particularlyaspatientswill
notknowwhattoexpectandwillbeinpain.Consistentandoften
repetitiveeducationisavitalpartofpatientcare.Oedemamanagement,
respiratorymanagement,positioning,andengagingpatientsinfunctional
activitiesandmovementmuststartimmediately.Patientsneedtobe
encouragedtoworktotheirabilitiesandacceptresponsibilityfortheirown
management.Functionaloutcomeiscompromisedifpatientsdonot
regularlyengageinmovement.

22. Inordertoachievedesiredoutcomesandmovementhabits,
ensuringadequatepaincontrolisimportant.Theaimofanalgesic
drugsshouldbetodevelopagoodbaselinepaincontroltoallow
functionalmovementandactivitiesofdailylivingtooccuratany
timeduringtheday.Theuseofcombinedanalgesicssuchas
paracetamol,non-steroidalanti-inflammatorydrugs,tramadol,and
slowreleasenarcoticsreducestheneedforincreasingdosesof
narcoticsforbreakthroughpain.Codeineshouldbeavoidedif
possiblebecauseofitsnegativeeffectsongutmotility.Otherpain
controlmethodsthatmaybehelpfulincludetranscutaneous
electricalnervestimulation(TENS).
*Paincontrol

23. *Inhalationalinjury
Aggressive,prophylacticchesttreatmentshouldstartonsuspicionofan
inhalationalinjury.Ifthereisahistoryofburninaclosedspaceorthe
patienthasareducedlevelofconsciousnessthenfrequent,shorttreatments
shouldbeginonadmission.Treatmentshouldbeaimedatremovinglung
secretions(oedema),normalizingbreathingmechanics,andpreventing
complicationssuchaspneumonia.
Initialtreatmentshouldinclude:
•Normalizationofbreathingmechanics—suchasusingapositive
expiratorypressuredevice,intermittentpositivepressurebreathing,
sittingoutofbed,positioning
•Improvingthedepthofbreathingandcollateralalveolarventilation—
suchasbyambulationor,whenthatisnotpossible,atilttable,
facilitationtechniques,inspiratoryholds.

24. *Movementandfunction
Movementisahabitthatshouldbeencouragedfrom
admissiontotheburnsunit.Ifapatientcanacceptthe
responsibilityofselfexerciseandactivitiesofdailyliving
thenthemostdifficultaspectsofrehabilitationareeasily
achieved.Ifthereissuspectedtendondamagefromtheburn,
thenprotectedmovementisappropriateandrestingsplints
maybenecessary.

25. *Oedemamanagement
Oedemaremovalshouldbeencouragedfromadmission.Theonlybody
systemthatcanactivelyremoveexcessfluidanddebrisfromthe
interstitiumisthelymphaticsystem.Oedemacollectioninthezoneof
stasisofaburnmaypromotetheprogressionofdepthofaburn.
Theprinciplesofreductionofoedemashouldbeadheredtointotality
andnotjustinpart:
•Compression—suchasCoban,oedemagloves
•Movement—rhythmic,pumping
•Elevationorpositioningoflimbsforgravityassistedflowofoedema
fromthem
•Maximizationoflymphaticfunction
•Splintingdoesnotcontroloedemaexcepttochannelfluidtoan
immobilearea.

26. *Immobilization
Stoppingmovement,function,andambulationhasitsplace.Itshouldbeenforced
onlywhenthereisconcomitantinjurytotendonorboneorwhentissueshave
beenrepaired(includingskinreconstruction).Ifabodypartmustbe
immobilized—toallowskingraftadherence,forexample—thenthepartshouldbe
splintedorpositionedinananti-deformitypositionfortheminimumtime
possible.

27. *Skinreconstruction
Skinreconstructionistailoredtothedepthofburnfoundatthetimeof
surgery.Theapplicationandtimeframesofreconstructiontechniques
utilizedwillbedependentonattendingsurgeon’spreference.Other
factorsinfluencingchoiceofmanagementincludeavailabilityandcost
ofbiotechnologicalproducts.

28. *Scarmanagement
Scarmanagementrelatestothephysicalandaestheticcomponentsaswellas
theemotionalandpsychosocialimplicationsofscarring.
Hypertrophicscarringresultsfromthebuildupofexcesscollagenfibres
duringwoundhealingandthereorientationofthosefibresinnon-uniform
patterns.
Keloidscarringdiffersfromhypertrophicscarringinthatitextendsbeyond
theboundaryoftheinitialinjury.Itismorecommoninpeoplewithpigmented
skinthaninwhitepeople.
Scarringisinfluencedbymanyfactors:
•Extraneousfactors—Firstaid,adequacyoffluidresuscitation,positioning
inhospital,surgicalintervention,woundanddressingmanagement
•Patientrelatedfactors—Degreeofcompliancewithrehabilitation
programme,degreeofmotivation,age,pregnancy,skinpigmentation.

29. Long term Rehabilitation
Thelongtermstageofrecoverytypicallybeginsafterdischargefrom
hospital,whenpatientsbegintoreintegrateintosociety.Forpatientswith
severeburns,thisstagemayinvolvecontinuedoutpatientphysical
rehabilitation,possiblywithcontinuationofproceduressuchasdressing
changesandsurgery.Thisisaperiodwhenpatientsslowlyregainasense
ofcompetencewhilesimultaneouslyadjustingtothepracticallimitations
oftheirinjury.Thefirstyearafterhospitalizationisapsychologically
uniqueperiodofhighdistress.

30. Physicalproblems—Patientsfaceavarietyofdailyhasslesduringthis
phase,suchascompensatingforaninabilitytousehands,limited
endurance,andsevereitching.Severeburninjuriesthatresultin
amputations,neuropathies,heterotopicossification,andscarringcanhave
anemotionalandphysicaleffectonpatients.
Psychosocialproblems—Inadditiontothehighdemandsof
rehabilitation,patientsmustdealwithsocialstressorsincludingfamily
strains,returntowork,sexualdysfunction,changeinbodyimage,and
disruptionindailylife.Manypeoplecontinuetohavevividmemoriesof
theincident,causingdistress.Patientsmayalsodevelopsymptomsof
depression.Thereisevidencethatadjustmenttoburninjuriesimproves
overtimeindependentoftheinjurysize.Socialsupportisanimportant
bufferagainstthedevelopmentofpsychologicaldifficulty.

31. Treatment
•Outpatient counselling
•Social skills training
•Support groups
•Peer counselling
•Vocational counselling
•Psychotherapy

32. References
•Physical rehabilitation, 5
th
edition-Susan B O’ Sullivan
•Tidy’s physiotherapy, 12
th
edition

33. Thank You