The Monday Memo
November 26th, 2018 PITT DPT STUDENTS
Comprehensive Rehabilitation for Burn Patients
In my recent experiences, I have encountered numerous patients who have suffered from severe burns which have required skin grafts. Think about when you get a big cut and the scab that forms may crack open when you move, this scar formation is similar to the tissue of a patient who had a severe burn. The skin shrinks to have the least resistance possible, a Physical Therapist’s role should guide movement of these joints focusing on tissue extensibility along with reduction of edema and scar management.
In regard to the rehabilitation plans for a patient with a severe burn, the primary focus is prevention of contracture. Begin by educating the patient and their caregivers on positioning and postural management. Burns that are on the flexor aspect of a joint are at greater risk of contracture because it will reduce tissue stresses and feel more comfortable for a patient. During the early stages of rehabilitation, advise the elevation of an affected limbs to reduce edema. If a burn is located over a joint, it is good to consider splinting the affected joint to provide prolonged tissue stretch and facilitate the formation of scar tissue while maintaining anatomical contour.
Often, Physical Therapists aid in scar management with scar massage. This intervention increases the moisture of tissue and the pliability of skin while enhancing the remodeling process of a scar. When performing a scar massage use non-scented lotion and massage in a circular pattern to avoid shearing forces. Increasing the length of a patient’s tissue range of motion range of motion must be a component of rehabilitation incorporated early. Both active and passive ROM are beneficial. For example, a patient with a burn on the posterior aspect of their lower extremity will work with a Physical Therapist on gait training focusing on proper heel strike – a functional task that is improving the extensibility of new tissue.
These patients require intense rehabilitation programs, but movement can be immensely painful. While working to enhance their functional independence remember their phycological state should be addressed as well. Create a safe and productive work environment for these patients by being empathetic. Simply listen to the patient about possible fears and anxieties then discuss how you can help them progress.
-Jennifer Hadfield, SPT