ROLE OF PHYSIOTHERAPY IN MANAGEMENT OF BURNS

BASHORUN O.M. ( PT, MNSP) PHYSIOTHERAPIST HAVANA SPECIALIST HOSPITAL, SURULERE

INTRODUCTON
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.
The

AIMS
Clear airway Prevent respiratory complications Maintain joint range of movement Prevent contractures and deformities Maintain soft tissue length Maintain muscle strength Regain maximum function Minimize scarring Help patient regain independence and

to an active lifestyle

return

MEANS
Respiratory Clearing

Care:

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 halflying 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

limbs Hips 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 Static Static

may be static or dynamic.

Splints: splints are used where it is essential to hold the position until movement can start.

Dynamic Dynamic

Splints:

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, holdrelax, repeated contractions and assisted active exercises. As soon as possible patient must be encouraged to be independent in selfcare and ADL.

Muscle Muscle

Strength:

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 Once

maximum function:

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

Mobility

Grafting Skin 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 grafts

Once

the grafted skin is establishedat 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 34 days after operation.

Joints Joints

and muscles:

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 fullrange 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 57 days after grafting.

Conclusion
The

rehabilitation of burns patients is a continuum of active therapy. should be no delineation between an acute phase and a rehabilitation phaseinstead, therapy needs to start from the day of admission.

There

Education

is of paramount importance to encourage patients to accept responsibility for their rehabilitation. consistent approach from all members of the multidisciplinary team facilitates ongoing education and rehabilitation.

THANK YOU