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