Rehabilitation is an essential component in the management of patients with burns and should be commenced on the day of injury is sustained. The process of rehabilitation requires efforts from a multidisciplinary team of health professionals who specialise in burn care viz: physiotherapists, doctors, nurses, occupational therapists, dieticians, psychologists, plastic surgeons, psychologists, social workers etc. Family members and support groups should also be involved in the recovery process of these patients.
Aims of Rehabilitation
A thorough assessment to ascertain the patient's functional status should be done prior to the commencement of rehabilitation. This would help guide the development of a customized treatment plan for individual patients.
It is also important to provide education on what post-burn rehabilitation entails to both patients and their caregivers in order to carry them along and to encourage cooperation.
Generally, the aims of post-burn rehabilitation are geared towards the reintegration of the individuals back to society. The aims of rehabilitation may include:
️ Maintaining range of movement
Minimising development of contracture and the impact of scarring
️ Prevention of deformity
️ Maximising psychological well-being
️ Maximising social integration
️ Maximising functional ability and recovery
️ Enhancing quality of life
Stages of Rehabilitation
Post-burn management can span from inception to the hospital to several months or years, depending on the severity of the injury. Stages of rehabilitation can be divided into early and later stages although there is no clear cut time frame for each as they are both thought to overlap.
Early Stage
Also known as wound healing phase. Essentially, the aims of this stage are as follows:
Respiratory care - Physiotherapy techniques such as deep breathing exercises, vibrations, percussion, postural drainage, coughing and suctioning can be employed to clear excess secretions.
Prevention of oedema which can be gained by elevating all affected limbs must also commence on the day of injury to prevent sites of burns from deepening.
Prevention of contractures and stiffness. Splinting and proper positioning will help achieve this aim.
Also performing active or passive range of motion (ROM) exercises, depending on the patient's level of consciousness is crucial in the prevention of these complications.
Pain control is obtainable by performing therapies during wound dressing and debridement, if possible. Analgesics should also be administered prior to therapy sessions to encourage participation in movement activities.
The physiotherapist can use transcutaneous electrical nerve stimulation (TENS) to enhance pain relief.
Prevention of pressure sores.
Later Stage
This stage, also known as the post-healing stage, focuses more on the following:
An improvement in muscle strength, endurance, balance and coordination owing to prolonged bed immobilisation.
Scar management
Engaging in functional activities
Integration into society
Rehabilitation after Grafting
Skin grafting is a term used to describe the process of transferring skin from one part of the body (the donor site) to another area. Common donor sites for grafting are the upper arm and thighs. Other areas may include the back, buttocks or abdomen. A period of 5 to 7 days is allowed so that the graft can "take" and circulation would not be impaired. This means the movement is not encouraged in the grafted areas nevertheless, surrounding parts of the body can still be moved.
Physiotherapy Interventions In Post-burn Management
Therapeutic exercises to maintain and improve ROM as well as enhance muscle strength.
Transcutaneous Electrical Nerve Stimulation (TENS) to relieve pain and pruritus (itching).
Hydrotherapy to encourage ROM exercises especially when there is marked pain and patient is fearful to move limbs.
Paraffin wax therapy when applied to contractures in the extremities can improve ROM
Scar tissue massage to improve pliability of scars.
Laser therapy. especially ablative fractional lasers in the management of burns to improve the pliability, vascularity and overall burn scar appearance.
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC506862/
https://www.cuimc.columbia.edu/rehab/staywell/burns
Chamika Harshani
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