BURN REHABILITATION - a basic presentation on positioning and splinting

basic presentation on burn rehabilitation

1. Burn Rehabilitation Dr Mrinal Joshi MD(PMR) DNB MNAMS GcMskMed FIPM Rehabilitation Research Centre SMS Medical College & Associated Hospitals Jaipur

2. Burn Rehabilitation

3. Rehabilitation at Different Stages

4. During Unstable Vital Signs

5. Patients with Stable Vital Signs

6. Inpatient Rehabilitation Phase (Post-Healing Stage) Patient Condition: Wound healing is complete; physical condition significantly improved. Higher intensity therapies can be introduced. Therapeutic Focus: ADLs Training : Enhancing overall capability and independence. ROM, Strength, & Gait Training : Improving mobility and functional strength. Comprehensive Scar Management : Essential to address prominent scar issues. Pediatric Rehabilitation : Incorporating toys and games to engage children in therapy.

7. Outpatient Rehabilitation Phase (Post-Healing Stage)

8. Common contractures

9. Importance of proper positioning

10. Importance of proper positioning Elbow Positioning: Flexion Side Burns:  Elbow in extension. Extension Side Burns:  Elbow in 70-90° flexion. Circumferential Burns:  Alternate extension and flexion; maintain forearm in neutral/supination. Wrist & Hand:Dorsal Burns:  Position in flexion. Palmar Burns:  Position in extension. Circumferential Burns:  Functional/anti-contracture position with thumb opposition, wrist extension, MCP flexion, and IP full extension. Separate fingers with gauze. Hip Positioning:Hip /Perineum Burns:  Keep hips fully extended and abducted. Knee Positioning:Anterior Burns:  Adopt 10-20° flexion using pads. Posterior Burns:  Maintain knee in extension. Ankle Positioning:Ankle Burns:  Maintain neutral position with 90° dorsiflexion; use foam pads or splints to prevent plantar flexion.

11. Therapeutic exercises Importance of Therapeutic Exercises: Basic and essential strategy in rehabilitation. No special equipment required; relies on therapist expertise for diagnosis and exercise prescription. Types of Therapeutic Exercises: Maintain ROM:  Passive, active-assistive, and active ROM exercises. Enhance Muscle Strength:  Resistive exercises. Improve Endurance:  Cardiovascular and muscular endurance training. Improve Coordination:  Exercises targeting motor skills and coordination. Restore Balance:  Balance training exercises. Ambulation Training:  Encourages walking and mobility. Cardiopulmonary Function:  Exercises to improve heart and lung function.

12. Therapeutic exercises Post-Operative Exercise Timing: Skin Grafting:  Start exercises 5–7 days post-surgery; gentle ROM training. Allograft/Xenograft:  Begin ROM training the day after surgery; use bandages/splints as needed. Artificial Dermis:  Start exercises on unoperated limbs immediately; involve operated limbs 5–7 days post-operation if joint involvement. Sheet Autografting:  Initiate ROM training 5–7 days post-operation; adjust based on patient tolerance. Donor Sites:  Early post-op exercises (day 1); careful with grafted areas. Special Circumstances: Intraoperative Exercises:  ROM training under anesthesia ; cautious to avoid tissue damage. Consciousness-Sedation:  Applied for patients unable to tolerate standard exercises; 2–5 days per week.

13. Splinting Overview Purpose of Splints: Designed to maintain functional or anti-contracture positions of injured body parts. Fabricated by therapists or orthotists. Team Involvement: Requires collaboration between therapists, rehabilitation physicians, burn surgeons, nurses, patients, and caregivers. Monitoring and adjustments are critical. Monitoring and Application: Timetable:  Wear splints continuously except during dressing changes, skin examinations, and exercises. Checking Intervals:  Vary from once every hour to every 4–6 hours depending on splint type and skin conditions. Skin Conditions:  Any abnormal conditions caused by splints should be reported immediately to the clinical team.

14. Splinting Regimens and Cautions Continuous Regimen: Recommendation:  Wear splints continuously, except during specific activities. Applications: Maintain or improve outcomes of skin grafting. Maintain proper position for circumferential, cross-joint, and deep burns. Retain improvements in ROM. Alternative Application Regimen: Schedule:  10 hours on, 2 hours off. Applications: Position areas with superficial circumferential or cross-joint burns. Immobilize allografts and maintain proper positioning. Maintain splinting as long as feasible. Considerations:  Active and/or passive ROM should be done when splint is off; evaluate if the alternate regimen affects joint movement.

15. Comprehensive Scar Management Scar Formation Timeline: Initial Formation:  Begins within the first few months after a burn. Peak:  Around 6 months post-injury. Maturation:  Usually complete around 12–18 months. Characteristics:  Red, raised, rigid; symptoms include tightness, itching, pain, and neovascularization. Hypertrophic Scars: May cause joint contractures and deformity. No single strategy completely prevents hypertrophic scars; a combination of therapies is most effective.

16. Scar Management Techniques Key Therapeutic Strategies: Pressure Therapy:  To reduce edema , inhibit scar growth, and promote maturation. Positioning and Splinting:  To prevent contractures and maintain proper function. ROM Training & Therapeutic Exercises:  To improve scar flexibility and functional outcomes. Pressure Therapy: Purpose:  Relieves edema , inhibits scar growth, protects healing skin, alleviates itching and pain. Products:  Pressure garments, pads, bandages, facemasks, and splints. Guidelines: Start 2–3 weeks post-burn. Begin with lower pressure; adjust based on wound healing and tolerance. Continuously wear for 23 hours/day; adjust pressure garments every 2–3 months. Use in combination with anti-scarring creams and silicone sheets. Scar Massage: Benefits: Softens scar tissue, improves ROM, relieves itching and pain. Helps with collagen realignment and sensory recovery. Application:  Use creams or oils for moisturization; deep, circular massage to increase pliability.

17. Scar Management Techniques Silicone Sheets: Purpose:  Softens and hydrates scars. Usage:  Start with short application times to avoid irritation; best results when used with pressure garments. Intralesional Injection: Purpose:  Relieves symptoms and accelerates scar maturation. Common Medications:  Corticosteroids (e.g., triamcinolone acetonide, betamethasone). Guidelines: Inform patients about outcomes and side effects. Keep detailed records (e.g., scar imaging, pain/itching scales). Prioritize injections for scars with significant symptoms; adjust dosage and intervals based on response.

18. Comprehensive Pain Management Nature of Burn Pain: Burns are among the most painful injuries. Pain management must address three components: background pain, breakthrough pain, and procedural pain. Treatment Approaches: Background Pain:  Managed with long-acting opioids. Breakthrough Pain:  Addressed with short-acting narcotics during movement and therapy. Procedural Pain:  Requires anything from conscious sedation to general anesthesia depending on the procedure.

19. Comprehensive Pain Management

20. Four Categories Of Prosthetic System

21. Prosthetic terminology

22. Prosthetic terminology

23. Trans-radial prosthesis

24. Trans-radial prosthesis

25. Bionic Hand Motor & sensors for each digit Myoelectric signals are recorder Interpreted by computer All motors of digits move together Newer models have AI to smooth out the movement

26. Neuroprosthesis – Targeted Muscle Reinnervation Use unused nerves to functional muscles Muscles with no innervation point to pectorals Myoelectrode creates the interface for the prosthetic arm A signal processing algorithm is used