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REHABILITATION FOLLOWING A BURN INJURY. Sunny Chirieleison, MPT. UNM Burn Center Adult & Pediatric Injury. from tragedy… hope!. Rehabilitation begins on the day of admission…. Evaluation Assessment Wound care Prevention of contractures Positioning/splinting ROM Edema control

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rehabilitation following a burn injury

REHABILITATION FOLLOWING A BURN INJURY

Sunny Chirieleison, MPT

UNM Burn Center

Adult & Pediatric Injury

from tragedy… hope!

rehabilitation begins on the day of admission
Rehabilitation begins on the day of admission…

Evaluation

Assessment

Wound care

Prevention of contractures

Positioning/splinting

ROM

Edema control

Mobility training

Gait training

Strengthening

Desensitization

ADL training

↑ endurance, coordination, balance

Scar management

Pt/family education

contracture prevention
*Contracture Prevention*

Splints (& wearing schedules)

Daily assessment of ROM

Positioning

Elevation to minimize edema

Prevent tissue destruction

Maintain soft tissues in an elongated state

Influence scar formation

↑ active movement (esp. hands & ankles)

Exercise program

Compression

areas at risk for contracture
Areas at ↑ risk for contracture

Neck

Axilla

Hand

Require special attention by the therapist to prevent long term impairments and functional limitations

anterior neck burns
Anterior Neck Burns

NO Pillows under head

Frequent Cervical ROM

Use cervical collar (soft or rigid) for positioning

If tolerated - hyperextension with head over edge of mattress

(generally only in ICU when pt sedated and monitored)

axillary burns
Axillary Burns

POSITIONING

In ICU patient can be positioned using pillows or bedside tables 2° to sedation

Airplane splint

Monitor sensation changes – adjust splint PRN

ROM

Patient/family education

dorsal hand burns
Dorsal Hand Burns

Splint ASAP

Exposed tendons immobilized in a position of slack to prevent rupture – and future Boutonniere deformity

ROM – isolated joint flexion (no full fist) until healed or grafted

slide13

Boutonniere Deformity

Rupture of central

extensor tendon or

lateral bands

indications for splint use
Indications for splint use

Prevention of contractures

Protection of a joint or tendon

Immobilization following a skin graft

Decreased ROM

Maintenance of ROM achieved during an exercise session or surgical release

Poor patient compliance

Dorsal hand burns should be splinted as soon as possible to prevent deformity !!!

scar management prevention
Scar Management / prevention

Remember: fibroblasts work a 24 hour shift – every minute spent on scar management is worthwhile

Imagine scar tissue as cement – Early on, wet cement can be poured and molded. Once it dries, it is as hard as stone.

-a little work today will result in major

changes down the road (long term benefits)

hypertrophic scar17
Hypertrophic Scar

Risk factors

Age of patient – younger more likely to develop scar 2° to growth factor

Depth of injury – involvement of dermis

Length of time to heal (>21 days)

h/o of hypertrophic scar formation

Genetic predisposition

UNM Burn Center: from tragedy… hope!

custom compression garments
Custom Compression Garments

Adult & Pediatric Injury

final thoughts
Final Thoughts

Early splinting and positioning are crucial to minimize impairments and maximize function

Many impairments are preventable!

Burn patients will require long-term follow-up for ROM, scar management, etc., (even if initial ROM and mobility are normal) to maximize functional outcomes

Please remember special considerations (hands, LE’s, and areas at high risk for contracture)… and if in doubt consult with Burn Therapist

THANK YOU!!!

questions
Questions…

one child burned, is one child too many!

Sunny Chirieleison, MPT

UNM Burn Center

Adults & Pediatrics

from tragedy… hope!