REHABILITATION FOLLOWING
A BURN INJURY
Sunny Chirieleison, MPT
UNM Burn Center
Adult & Pediatric Injury
from tragedy… hope!
Rehabilitation begins on the day of
admission…
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•
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•
•
Evaluation
Assessment
Wound care
Prevention of
contractures
Positioning/splinting
ROM
Edema control
Mobility training
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•
•
•
•
Gait training
Strengthening
Desensitization
ADL training
↑ endurance,
coordination, balance
• Scar management
• Pt/family education
Burn Classification
Depth
Healing
Time
Scar
formation
Appearance
Current
Common
terminology terminology
Sensation
Superficial
First degree Dry (no
blisters)
VERY
PAINFUL
3-7 Days –
generally
no skin
graft
needed
Pigment
changes
only
Superficial
partial
thickness
Second
degree
VERY
PAINFUL
7-21 Days generally
no skin
graft
needed
Minimal
scarring
and
pigment
changes
Red
(blanches)
Blisters,
weeping
Burn Classification (cont.)
Depth
Current
terminology
Common
terminology
Deep partial
thickness
Full
thickness
Healing
Time
Scar
formation
Appearance
Sensation
Second or
third degree
Variable color
(mottled white,
pale pink,
cherry red with
decreased
blanching)
VERY
PAINFUL
21-35 Daysmay require
skin graft
Will have
scarring and
pigment
changes
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 Center
Adults & Pediatrics
from tragedy… hope!