A burn is a type of injury to flesh or skin caused by heat, electricity, chemicals, friction, or radiation. Burns that affect only the superficial skin are known as superficial or first-degree burns. When damage penetrates into some of the underlying layers, it is a partial-thickness or second-degree burn. In a full-thickness or third-degree burn, the injury extends to all layers of the skin. A fourth-degree burn additionally involves injury to deeper tissues, such as muscle or bone.
Common causes of burns from most to least common are:
• Scalding from steam or hot liquids
• Touching hot objects
• Electrical burns
• Chemical burns
Burns can be the result of:
• House fires
• Car accidents
• Playing with matches
• Faulty space heaters
• Unsafe use of firecrackers
• Kitchen accidents, such as a child grabbing a hot iron or touching the stove
You can also burn your airways if you breathe in smoke, steam, superheated air, or chemical fumes in poorly ventilated areas. If you have burned your airways, you may have:
• Burns on the head, face, neck, eyebrows, or nose hairs
• Burned lips and mouth
• Difficulty breathing
• Dark, black-stained mucus
• Voice changes
Physical Rehabilitation of Burns
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.
What Are The Aims of Burns Management?
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 minimize the adverse effects caused by the injury in terms of maintaining range of movement, minimizing contracture development and impact of scarring, maximizing functional ability, maximizing psychological wellbeing, maximizing social integration.
When To Start Physical Rehabilitation?
The rehabilitation for patients with burn injuries starts from the day of injury, lasting for several years and requires multidisciplinary efforts. A comprehensive rehabilitation program is essential to decrease patient’s post-traumatic effects and improve functional independence.
Rehabilitation of burns patients is a continuum of active therapy starting from admission. There should be no delineation between an ‘acute phase’ and a ‘rehabilitation phase as this idea can promote the inequality of a secondary disjointed scar management and/or functional rehabilitation team.
Patients may want to delay their rehabilitation until they feel better; however, every day without burn therapy intervention will make the eventual rehabilitation process more difficult and painful and may result in a poorer outcome. If windows are missed, they cannot be regained easily, since the inevitable sequelae of ever-increasing joint stiffness and tethered soft-tissue glide become more and more devastating with the passage of time.
What Does Physical Rehabilitation in Burns Entails?
Complications to expect when burns occur are:
1. Swelling of the head, neck, and upper airway
2. Fluid retention in the lungs and chest
3. Stiffness of the joints
4. Scar tissues formation
When a patient is admitted with severe burns, it is essential to reduce the risks, as far as possible, of further complications arising. Postural management of the patient by elevating the head and chest helps with chest clearance and reduces swelling of the head, neck and upper airway. In the early stages, significant oedema may be present particularly in the peripheries; poor positioning can lead to unnecessary additional morbidity which can be avoided. Elevation of all limbs affected is necessary in order to quickly reduce oedema; hands should be splinted or positioned and feet kept at 90 degrees, care and attention must also be given to the heel area which can quickly develop pressure. Legs should be positioned in a neutral position ensuring that patient is not externally rotating at the hip.
Patients who are unable to move should have passive movements completed to maintain range of movement (ROM) and prevent stiffness developing. If due to surgical intervention and skin grafting this is not possible on a daily basis, it may be achieved during change of dressings.
It is important that the patient is given comfort and reassurance that they are safe. Taking the time to listen to the patient’s concerns, demonstrating genuine empathy and compassion, providing adequate information and answering their questions can often go a long way to alleviating fears, which in turn can ease the treatment process for both patient and professional.
Anti-contracture positioning and splinting must start from day one and may continue for many months post-injury. It applies to all patients whether they have been skin grafted or not. Positioning is important to influence tissue length by limiting or inhibiting loss of ROM secondary to the development of scar tissue.
Splints are a highly effective method of helping prevent and manage burn contractures and are an integral part of a comprehensive rehabilitation program. Splinting helps maintain anti-contracture positioning particularly for those patients experiencing a great deal of pain, difficulty with compliance or with burns in an area where positioning alone is insufficient. If the injured site is over joint surfaces, special precautions should be taken to identify all possible joint contractures.
Joints affected by burns should be moved and stretched several times a day and the patient is likely to require assistance of members of the burn team and family to reach full range of movement. Therapists use clinical judgement based on the appearance of the tissue as to whether passive range of motion (ROM) or active ROM is performed and also to determine when ROM is resumed after immobilization.
Pain control is essential to make this process as easy as possible for the patient as it is common for patients to be extremely reluctant and fearful to move if this will cause severe pain. They should be encouraged to mobilise as soon as possible post-injury. Stiffness is common in burn patients both in joints effected by a burn injury and in other joints when immobilised for periods of time. Splinting should be accompanied by regular exercise regimes as contractures can occur, as well, in desirable positions if a patient is persistently splinted and restricted to that position.
Burn patients often feel a sense of loss of role and ability to participate in normal activities of life. Activities of daily living play an extremely important role in a burn patient’s successful outcome. If a patient can accept the responsibility of self exercise and activities of daily living, then the most difficult aspects of rehabilitation are easily achieved. It is crucial to involve patients in daily activities such as eating and washing themselves as soon as possible. Family members should be discouraged from completing these activities for the patient as this emphasises the ‘sick role’ and increases reluctance of the patient to actively participate in their rehabilitation. Highest levels of independence should be encouraged in all activities of daily living from as early as possible.
How To Manage Scar After Burns?
Hypertrophic scarring is common following a burn injury and may cause significant functional and cosmetic impairment. The longer a wound takes to heal, the greater the likelihood of hypertrophic scars developing; the risk increases significantly when a wound takes 21 days or longer to heal. Hypertrophic scars are an exaggerated response of the body’s healing process; they have a high blood flow and increased levels of collagen and are extremely active becoming raised, red and rigid. These scars tend to have a high rate of contraction and have other symptoms associated with them including itchiness, dryness and lack of pliability.
Scar management for post-burn injury is a long and often painful process; it is not something that can be carried out for a few weeks and then abandoned, it is something which must continue for many months to minimise post-burn complications from occurring.
Our Physiotherapists will continue to follow our highly specialized treatment protocols when you come to our out-patient department.
They will continue to involve you in:
3. Scar Tissue Management
4. Stretching and Exercise
5. Massage And Moisturizing
6. Swelling Management
7. Pressure Therapy
8. Activities of Daily Living Incorporation
9. Social Rehabilitation
10. Getting you back to Work
Our Treatment goals and strategies depend on the patient’s injury, stage of treatment, age, and co-morbidities; minimizing loss of range of motion (ROM) in the critically ill patient to establishing a work-hardening program in recovered patients.
At Ageless Physiotherapy Clinic, our overriding objective of burn care has become reintegration of the patient into the home and community. This goal has extended the traditional role of the burn care team beyond acute wound closure.
Three broad aspects are involved in this effort: rehabilitation, reconstruction, and reintegration. Because of this the importance of early and active focus on long-term rehabilitation goals cannot be overemphasized.
For comprehensive information on how you can benefit from our Highly Specialized Physical Rehabilitation programs for your Burns, use our hotline: 08139491652 and 08055463055 to get an appointment and book a spot.
#ImageCredit: Mercy Ship Organization