Burns

The most important rehabilitative commitment after a serious burn trauma is to guarantee to the patient maximum autonomy and functionality in order to ensure the best possible quality of life in the social, family, and working environments.

People who have had a significant burn usually start having physiotherapy early in their treatment. The main reasons for having physio are to:

• Keep the joints moving
• Reduce or avoid the joint tightening up (called a ‘ joint contracture’)
• Keep the muscles working for normal movement
• Prevent or reduce scars.

Role of Physiotherapy with an inpatient (when in hospital)

1. Positioning: Staff may use splints, pillows and positioning to keep your joints straight when in bed. The purpose of careful positioning is to prevent or reduce the joints from getting stiff or contracting.
2. Stretches: It is essential to have regular stretching of the affected joints. This is also done with splints and positioning in the beginning.
3. Active exercises: Bed exercises are important in the early days and weeks of recovery to keep your muscles working. The effects of pain and any surgery need to be considered when planning exercises.
4. Functional exercises: You will be helped to start moving and walking as soon as possible. This depends on which areas of the body have been burned.
5. Mobilization: It includes: Assisted active mobilization, Active mobilization, Mobilization against resistance.
6. Bandaging – compression therapy: Adhesive bandaging can be applied (this is useful also during postural sequences in the acute phase for the reduction of circulation disorders) before the use of girdles, since the adhesive bandaging can be applied directly on the dressing; the only disadvantage is a further reduction in range of motion.
7. Massotherapy: It reorganizes the capillary network and local circulatory flow, reduces oedema and itching, makes the skin more elastic, frees adhesions, and makes the new skin stronger, helps the patient to regain sensitivity, relaxes neighbouring tissues. Massaging must be gentle and superficial.
8. Electro therapy: Ultrasounds improve the detachment of adherences and reduce oedema. Transcutaneous electrical nerve stimulation (TENS) decreases pain during the process of scar healing. Vacuum therapy uses different-size nozzles that go over all the scars lengthwise. The action is exerted on the circulation in the scar, by increasing and reducing pressure.
9. Respiratory Care: Clearing secretions is achieved by shaking, clapping, postural drainage, coughing and suction. Breathing (expansion) exercises are also important to maintain ventilation of all lung areas.
10. Splinting: Splints may be static or dynamic. Static splints are used where it is essential to hold the position until movement can start. Splinting may be required only at night to prevent soft–tissue tightening whilst the patient is asleep. Sometimes joints are stabilized to facilitate the function of others. Dynamic splints permit controlled movement of various joints. A soft material may be adequate for dynamic and a firmer one used at night.

Role of Physiotherapy with an Out–patient

This continues to involve gym 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. Pressure garments are fitted by the physiotherapist. These are used to reduce hypertrophic scarring which is excessive formation of collagen resulting in thick, rope–like, uneven scars which both limit function and look unsightly. Pressure by an elasticated garment worn more or less continuously for up to 2 years reduces this scarring. Your physiotherapist will give you information and instructions for ongoing care at home – exercises, positioning, stretches and bandages or garments to wear.