rehabilitation following a burn injury sunny chirieleison, mpt unm burn center adult & pediatric...

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• Mobility training

• Gait training• Strengthening• Desensitization• ADL training• ↑ endurance,

coordination, balance• Scar management• Pt/family education

Burn Classification Depth

Appearance Sensation

Healing Time

Scar formation

Current terminology

Common terminology

Superficial First degree Dry (no blisters)

VERY PAINFUL

3-7 Days –generally no skin graft needed

Pigment changes only

Superficial partial thickness

Second degree

Red (blanches) Blisters, weeping

VERY PAINFUL

7-21 Days - generally no skin graft needed

Minimal scarring and pigment changes

Burn Classification (cont.)

Depth

Appearance Sensation

Healing Time

Scar formation

Current terminology

Common terminology

Deep partial thickness

Second or third degree

Variable color (mottled white, pale pink, cherry red with decreased blanching)

VERY PAINFUL

21-35 Days- may require skin graft

Will have scarring and pigment changes

Full thickness

Third or fourth degree

Leathery with variable color (white, waxy, pearly, dark, charred – no blanching)

Decreased or no pain

Can require months to heal – probable skin graft

Will have significant scarring – likely hypertrophic

*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

The position of comfort is most

often the position of 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• 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)

This deformity could have been be prevented…

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

• 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

Optimal position for dorsal hand burns

Boutonniere Deformity

Rupture of central extensor tendon or lateral bands

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

• 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 Scar

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

Adult & Pediatric Injury

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…

one child burned, is one child too many!

Sunny Chirieleison, MPT

UNM Burn CenterAdults & Pediatrics

from tragedy… hope!