ROLE OF PHYSIOTHERAPY ROLE OF PHYSIOTHERAPY IN MANAGEMENT OF IN MANAGEMENT OF

BURNS BURNS

BASHORUN O.M. ( PT, MNSP)PHYSIOTHERAPIST

HAVANA SPECIALIST HOSPITAL, SURULERE

INTRODUCTONINTRODUCTONThe most important rehabilitative

commitment after a serious burn trauma, is to RESTORE to the patient maximum

autonomy and functionality so as to ensure the best possible quality of life in

the social, family, and working enviroNmentS.

To achieve this, physiotherapists use a wide range of techniques which would be

discussed briefly.

AIMSAIMS

Clear airway Prevent respiratory complicationsMaintain joint range of movement Prevent contractures and deformitiesMaintain soft tissue length Maintain muscle strengthRegain maximum functionMinimize scarringHelp patient regain independence and return

to an active lifestyle

MEANSMEANSRespiratory Care:

Clearing secretions is achieved by ◦shaking,◦clapping, ◦postural drainage, ◦coughing and suction.

Joint range of movement:

Aimed at Prevention of Contractures and Deformities through:◦Positioning, ◦splinting and◦ exercise

Positioning:

Patients with burns injury feel comfortable in the position of contractures (mostly flexion). Positions of necessity are, therefore, as follows:

Head and Neck

Small roll (towel) under the neck and/or a pillow under the shoulders to maintain extension. The patient may be in lying (chest and leg burns) or in half–lying with facial burns (because of facial edema).

Upper limbs

Elevation of the limbs with the shoulder in abduction and slight flexion, elbows and wrists in extension, metacarpophalangeal joints in flexion, IP joints in extension and thumb in abduction.

Lower limbsHips in extension and slight

abduction, knees in extension and ankles in 90 degree dorsiflexion.

Elevation is obtained by raising the end of the bed, not by placing pillows under the legs which would put the hips into flexion.

Splinting:

Splints may be static or dynamic.

Static Splints:Static splints are used where it is

essential to hold the position until movement can start.

Dynamic Splints:

Dynamic splints permit controlled movement of various joints. For example, a foam roll placed in the hand allows extension and some flexion of the fingers, so allowing damaged extensor tendons to move in a limited range but not to be overstretched

Exercises◦ Active exercise◦Assisted active◦Free active exercise

Regaining range involves controlled passive stretching, hold–relax, repeated contractions and assisted active exercises.

As soon as possible patient must be encouraged to be independent in self–care and ADL.

Muscle Strength:

Muscle working over joints which are fixed can be worked isometrically.

As soon as possible the patient should be up and about and following an exercise/activity programmes in the gym and hospital locality.

Regaining maximum function:

Once the wound condition is stable, patient should go to the physiotherapy gym.

Dressings are bandaged on securely and lower limb burns are supported by elastic bandages to control edema.

An individual circuit is worked out which involves free exercise /equipment work.

Contractures must be prevented by regular passive stretching, and

Mobility of scar tissue is maintained by kneading with the fingers of palm of hand.

GraftingGraftingSkin grafts may be used for any part

of the body in areas where there has been extensive damage by burns, lacerated wounds, ulceration, pressure sores, or for healed contracted scars.

Types of skin graft are: Free grafts & Flaps and pedicles.

Free graft:◦Split-skin graft◦Full-thickness graft

Physiotherapy for skin graftsPhysiotherapy for skin graftsOnce the grafted skin is established–

at least 14 days later, finger kneading round the edges with lanolin is used to mobilize the tissues.

The donor area of a split skin graft may be treated with ultraviolet rays (UVR) to promote healing 3–4 days after operation.

Joints and muscles:

Joints and muscles near the graft should be exercised through as full a range as possible and all other joints and muscles should be put through a general full–range movement programmes.

The muscles near the graft over the immobilized joints should be moved isometrically, e.g. five contractions per muscle every hour.

This eases some of the discomfort and maintains fluid flow through the tissues. These exercises usually start 5–7 days after grafting.

ConclusionConclusionThe rehabilitation of burns patients

is a continuum of active therapy.

There should be no delineation between an “acute phase” and a “rehabilitation phase”—instead, therapy needs to start from the day of admission.

Education is of paramount importance to encourage patients to accept responsibility for their rehabilitation.

A consistent approach from all members of the multidisciplinary team facilitates ongoing education and rehabilitation.

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