Burn injuries are more common than most people realize. Fire, hot water, road accidents, electricity, and chemicals are some of the most common causes.
Most of the patients tend to suffer from permanent psychological and functional complications. Prompt and efficient post-burn physical therapy rehabilitation can help you decrease the level of physical limitations and improve your functional status.
Keep reading to find out everything about what physical therapy looks like in the buns ward.
Post-burn Physical Therapy Rehabilitation Process
Physical therapists in the burns ward begin treating patients from the first day after their injury and admission into the ward. Here’s the overview of the post-burn physical therapy rehabilitation process:
Assessment & Counseling
As always, physical therapy for post-burn patients begins with a detailed history to get an idea of pre-existing conditions and physical assessment. This includes checking: (Reference)
- Functional movements and mobility (gait, ambulation, limb movements)
- Range of motion of healthy joints and those involved in burn injury.
- Concomitant trauma (secondary injuries) such as fractures, dislocations, and lacerations
- Muscle strength of limbs involved in the burn injury and healthy areas
- Bony abnormalities (pre-existing and new)
- Cardiopulmonary endurance (ability to tolerate activity and exercise)
- Contractures around joints and burned areas (in patients with old burn wounds)
- Inhalation injury based on physical signs such as burned eyebrows, facial hair, soot sputum
- Postural assessment to establish a baseline for future goals
The purpose of the assessment is to understand the medical background and history of the patient. That information influences our treatment plan for rehab.
We also counsel the patient in the initial days after the injury. This is to help them understand the level of rehab they can expect, to explain long-term impairments, and emphasize the importance of exercise to get them to achieve their goals
Setting Post-burn Physical Therapy Treatment Goals
Afterward, we set treatment goals by using the findings of your physical assessment as a guide.
We encourage active participation of patients during goal setting (especially long-term goals) because these are personalized and based on the priorities and lifestyles of the individual patient.
For example, the goals for most people include gaining the ability to perform their activities of daily living such as dressing themselves and ensuring personal hygiene.
But goals can also include specific details such as holding a paintbrush again or swimming.
Here are some of our treatment objectives. All of our exercises are designed to achieve the goals listed below:
- Scar management
- Inhalation injury management
- Skin and joint Contracture prevention
- Hypertrophic scarring prevention
- Prevent abnormal gait
- Maintain range of motion
- Prevent muscle strength loss
- Maintain endurance
- Return to pre-burn wound functional levels
Post-burn Physical Therapy Management and Treatments
We start treating patients from day 1 post-burn injury. That is, of course, if they’re a physical therapy rehab candidate.
Patients with extensive (more than 40% total body surface area) burns are often placed in the ICU for close monitoring and stabilization. Once they’re out of immediate danger, we can start our post-burn physical therapy rehabilitation program with them.
Here are the PT managements and treatments we use in the burns wards and ICU:
1. Positioning and Limb Elevation
Often the most comfortable position after an injury is a flexion posture where you bend your limbs, torso, or chest. Unfortunately, while the position may be comfortable, it leads to the development of secondary problems such as contractures and swelling.
We use foam wedges, pillows, and rolled bedsheets, and change the bed positions to keep the soft tissues stretched, limbs elevated to avoid swelling, and for better breathing. (Reference)
Some of these positions might seem unusual to you. For example, someone who has a burn injury to the front of their neck extension will be placed in a neck extension position. We will remove the pillow from underneath the head and let the head fall back a bit to keep the front of the neck extended.
2. Pressure Sores Prevention
Every bed-bound patient is at risk for developing pressure sores. But those with a burn injury are more prone because the protective layers of skin are gone.
We use special mattresses, such as static air mattresses, to prevent pressure sores around the hip, ankle, calf, torso, and shoulders. We also advise position change every hour to provide sufficient airflow around areas that are prone to pressure sores and early mobilization out of bed.
3. Respiratory Therapy
Active Cycle of Breathing Technique (ACBT), chest percussions, incentive spirometer, positional drainage, deep breathing, and sitting up — these are all chest physical therapy techniques that improve breathing and the health of your lungs.
4. Splinting
Maintaining your joints in a specific position is necessary to prevent contractors and improve the healing of the burn wound. Splinting is a technique where we immobilize or stabilize your limb(s) in specific positions by using bandages or hard materials made of plaster of Paris.
It is usually used for patients who have a hard time following commands and maintaining dealing in prescribed positions. It’s also temporary so your physical therapist can remove it during exercises or tell you to only wear it while you sleep.
5. Exercises to Maintain the Range of Motion
Low-intensity general mobility exercises are prescribed to ensure that we maintain the available range of motion around the joint that is burned so it doesn’t deteriorate further.
These exercises include opening your fingers and making a fist, moving your ankle up and down, and moving your limbs to do a full range of motion.
6. Stretching and Strengthening Exercises
It’s best if the patient can do the stretching and strengthening exercises actively. If that’s not possible then we do active-assisted or passive exercises.
Stretching has a positive psychological impact, improves blood flow, and ensures flexibility in the new skin that forms after a burn injury.
Being bed-bound affects muscle strength so strengthening exercises help keep the body in shape for a return to full activity.
You can perform these exercises in bed, in a chair, or in the physical therapy department in the burns unit.
These exercises also don’t have to be traditional ones. We often include super simple strengthening exercises for burns ward patients such as standing in place, walking, sitting and standing a few times, lifting your blanket or a jug of water, etc.
The goal is to ensure enough strength to perform activities of daily living and be independent.
7. Walking
Just getting out of bed and walking around the ward for a few minutes can do wonders for a patient with a burn injury.
It increases blood flow, stretches multiple joints and muscles, works on cardiovascular endurance, improves breathing, and instills a sense of independence. That’s why walking is one of the best exercises we almost always include in post-burn physical therapy rehabilitation programs.
8. Massage Therapy for Contracture Reduction
After wound closure, we use various massage techniques to prevent contracture development. We use similar techniques along with stretching and splinting to reduce contractures after they’ve formed.
Why is treating contracture so important?
The healing skin (scars) that forms over a joint after a burn injury has a habit of taking the shortest route to develop. It also has a lot of collagen in it which is pulled by the healing tissue, resulting in a shortened scar. That is a skin contracture that leads to limited ROM of the joint. (Reference)
Consider your fingers for example. The healing skin will try to keep your finger straight (in extension). But if you don’t intervene in the healing process, your finger will be fixed in that position and won’t bend. That’s why it’s essential to be proactive about contracture management.
9. Pressure Therapy to Manage Scar Formation
Pressure garments are clothing made of different materials that apply a compressive force. You can wear it in any area.
Burns scars have excessive collagen so they tend to be extremely obvious once they’re fully healed. Compression and massage therapy distribute collagen and improve the cosmetic appearance of the wound.
10. Long-Term Rehabilitation
Cardiopulmonary endurance training, strength training, area-specific functional training, and occupation-specific training are included in long-term post-burn physical therapy rehabilitation.
You’ll complete this stage in an outpatient department or in a physical therapist’s clinic. Home exercise programs have a big role here because appointments with your physical therapist become less frequent toward the end of your rehab.
We always have to maintain cardiovascular stability and body temperature while exercising. The body’s thermoregulation takes a hit after a burns injury, more so if the sweat glands are damaged.
Progressing Post-burn Physical therapy Rehabilitation
Timely progression of physical therapy rehabilitation ensures swift recovery and reintegration into society.
We track the progress of your rehab through
- Before and after pictures.
- Range of motion with a goniometer
- Muscle strength with the Oxford muscle grading scale
- Walking distance in meters
It’s important to note that physical therapy rehabilitation is not divided into stages with generalized time markers to indicate progression for any of the exercises such as one week in bed exercises before equipment-based exercises or two days of walker-assisted walking before the independent walking.
Post-burn physical therapy rehabilitation is a continuous process and a big reason for that is that each patient’s recovery is different depending on the area burnt and overall health status. That’s why we can’t have generalized criteria to progress everyone’s rehab.
We use each patient’s baseline status to determine the appropriate progression in their treatment plan.
Discharge From Physical Therapy Rehab
Some physical therapy-related indicators for discharge from the burns ward or acute care are independent walking, achieving the maximum range of motion, independent functional ADLs, self-management of rehab, and an understanding of the importance of sticking to the physiotherapy home plan.
Discharge from acute care depends on the extent of injury, secondary complications, vital signs, and speed of recovery — to name a few factors.
Physical therapy will continue for a long time after you’ve left the hospital.
You graduate from the post-burn physical therapy rehabilitation program once you’ve achieved all your treatment goals, gained functional independence, and can successfully perform tasks at your workplace and activities at home.
Why Do You Need Physical Therapy After a Burn Injury?
Physical therapy after burn injury is essential to:
- Maintain and improve the range of motion lost due to injury
- Regain functional mobility to perform activities of daily living and return to work
- Gain independence
- Ensure efficiency in cosmetically appropriate healing of the skin.
- Reduce comorbidities reached into worsening patient outcomes
Physical therapy is an integral part of the first Burn rehabilitation team which includes physicians, plastic surgeons, dermatologists, psychiatrists, nurses, occupational therapists, and physical therapists.
In Summary
Starting physical therapy at the right time after a burn injury can be the difference between gaining full functional mobility back and not achieving it. If your hospital didn’t include it, then you should contact a physical therapist’s clinic or visit the outpatient department to get your burn wound evaluated.
Your skin takes a long time to heal completely after a burn injury, the exact duration depends on the extent of the burn. So you can contact a therapist months after the initial injury and still improve your functional outcomes.
It’s never too late to contact a physical therapist to improve your joint and muscle health after a burn injury.
Disclaimer: This article is for informative purposes only. We provide well-researched and authentic information. Do not consider this personalized health advice. Please contact a licensed healthcare professional for medical issues and health concerns.
