Rehabilitation of the burn patient

Abstract

Rehabilitation is an essential and integral part of burn treatment. It is not something which takes place following healing of skin grafts or discharge from hospital; instead it is a process that starts from day one of admission and continues for months and sometimes years after the initial event. Burns rehabilitation is not something which is completed by one or two individuals but should be a team approach, incorporating the patient and when appropriate, their family. The term 'Burns Rehabilitation' incorporates the physical, psychological and social aspects of care and it is common for burn patients to experience difficulties in one or all of these areas following a burn injury. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. The aims of burn rehabilitation are to minimise the adverse effects caused by the injury in terms of maintaining range of movement, minimising contracture development and impact of scarring, maximising functional ability, maximising psychological wellbeing, maximising social integration.

Keywords: Burn rehabilitation; post burn physiotherapy; range of movements; splintage.

Figure 1

Burn wound not being nursed in anti contracture position with impending neck and axillary contracture

Figure 2

The flexion contracture of the neck can be avoided by having a pillow under the shoulder and nursing with neck in extension. There should be no pillow under the head

Figure 3

This extension contracture of the neck can be avoided by sitting with head in flexion ane lying with pillows behind the head

Figure 4

This axillary contracture can be prevented by lying and sitting with arms abducted at 90 degrees supported by pillows or foam blocks between chest and arms and figure of eight bandaging or strapping to provide stretch across chest

Figure 5

Flexion contracture at the elbow can be avoided by keeping the elbow in extension by an extension splint

Figure 6

Clawing of fingers can be avoided by keeping the MP joints in flexion, IP joints in extension, thumb mid palmar radial abduction

Figure 7

The thumb in palm deformity is avoided by keeping the wrist extended with minimal MCP flexion and keeping the fingers extended and thumb abducted

Figure 8

Flexion contracture of the hips can be prevented by lying prone with legs extended. Limit sitting and side lying. Supine lying with legs extended, no pillow under knees. Nursing in this position will cause flexion contractures in the hip and knee joints

Figure 9

Flexion contracture of the knee can be avoided by keeping the legs extended in lying and sitting and by using knee extension splints

Figure 10

Dorsal contracture at the ankle can be prevented by keeping the ankles at 90 degrees - use pillows to maintain position and encourage sitting with feet flat on floor as long as no oedema is present

Figure 11

Complex bilateral lower limb contractures which can be avoided by proper anti deformity splintage

Figure 12

This gross mandibular deformity, malocclusion and neck contracture can be prevented by proper nursing and splintage. A well padded tube can be inserted into the mouth to combat mouth contracture

Figure 13

Materials used for making splints

Figure 14

Cardboard hand splints made of discarded dressing boxes

Figure 15

(a,b) Foam and blown polystyrene along with PVC pipes used to make hand splints

Figure 16

(a) PVC pipes and elbows cut, (b) padded and (c) fabricated into axillary splints

Figure 17 a and b

Fabrication of elbow extension splint

Figure 18

Fabrication of hand splints from PVC sheets

Figure 19 a - d

Fabrication of neck splints from garden pipes

Figure 20

A scarf used for postural support and to stretch pectoral scar