Goals of Burn

Rehabilitation

Overall Goal Short Term Goals

Return to pre- injury Assist Wound Healing
Level of function with Prevent Complications
Best possible cosmoses (muscloskeletal)
 I. Positioning
By definition positioning is:
The proper alignment and adjustment of
body parts.

Positioning is a fundamental portion of burn

rehabilitation.
 Benefits of
Positioning in
Burn Rehab.

Prevents Controls Edema Prevent Localized Maintain elongated

Contracture Neuropathies Position of soft
Tissues
 Burn patient has tendency to assume flexed
adducted position (Fetal position) most probably
as a reaction to pain.

Positioning program is maintained and/ or

modified according to:
Patient medical condition.

ROM

Skin condition.
 Positioning program should be individualized.
However, generally speaking, body parts should be
positioned as to maintain burned tissue in their
elongated state.

Typically limbs should be positioned in extension-

abduction alignments.

Positioning is maintained using splints, pillows,

and/ or foam wedges.
 Specific Burn Sites

Body Segment

Anterior or
Asymmetrical neck Head Burn that Posterior neck Burn
Circumferential
burn Includes the ear Ear not involvd
burns
 NECK BURNS
Burn types Expected Position HOW to Maintain?
Deformity

Anterior or Flexion Extension/ - Towel under shoulders or

Circumferential Contracture Hyperextension between scapulae
burns - Foam cervical collar

Asymmetrical Lat. Fl. Towards Mid line --Towel roll, sand bag,
neck burn burned side Or rotated away wedges on affected side.
- Prone lying head rotated
opposite side.

Head burns that Folding of the Avoid any - Foam or gel filled bag is
include the ear Helix and pressure over used to elevate the ear
condritis the ear from the bed.

Posterior neck Hyperextension Head in midline - Pillows are used to

burns- Ear not of the neck elevate the head and
involved lengthen posterior tissues.
 Trunk burns
Burn types Expected Position HOW to Maintain?
Deformity
Clavicular & shoulder girdle - A square towel or
pectoral protraction and shoulder retraction blanket between
glenohumeral scapulae.
adduction - Fig. of 8 wrapping
From pectoral same as above Same as above
region to below plus Same as above with upper with towel extended
umblicus kyphosis downwards.
Back hyperextension
Burns of the Exaggerated Using pillows under
lower back lordosis Midline position knee to flatten back

Lateral trunk Scoliosis concave Towel roll, sand

burn to burned side Maintain trunk straight bag, wedges on
affected side
 Shoulder
Burn types Expected Position HOW to Maintain?
Deformity
Anterior axilla Shoulder Shoulder Abd. / Ext. Rot. /
Adduction & Flexion. - Towel roll, sand bag,
Int. Rotation 90 Abd. /15- 20 horizontal wedges between
Add. affected axilla and side.
Above 90 Abd. And Ext. - Wrist cuff hanged or
Rot. Should be attempted stockinet to I.V. pole
temporary. (Murphy splint)
- Aero plane splint

Anterior chest Fl. / Add. Ext. & Abd. Shoulder.

and anterior Arm. Ext. of dorsal spine - Towel roll, sand bag,
arm. kyphosis wedges between
scapulae for dorsal Ext.
- Same as above for
Ext. Abd. Shoulder.
 ELBOW
Burn types Expected Position HOW to Maintain?
Deformity
Anticubital or Elbow fl. Elbow extension Arm troughs are used
circumferential Forearm Supination or neutral to maintain elbow
pronation position. extension
over bed table can be
used if patient can
voluntarily extend his
elbow.
Elbow splints can be
used in positioning

Posterior extension Elbow semiflexion same as above.

surfaces of the deformity Supination or neutral
upper position.
extremities (not
common)
 Forearm And Wrist
Burn types Expected Position HOW to Maintain?
Deformity

Volar surface Forearm wrist in functional Wrist splint

pronation position (from neutral to 30 Towel or gauze placed
Wrist degree extension. in the hand while
flexion Forearm supinated or forearm supinated.
neutral.
Dorsal surface Wrist ext. Functional position of the Wrist splint
contracture wrist

Circumferential Wrist wrist in functional Wrist splint

burns flexion. position (from neutral to 30 Towel or gauze placed
Forearm degree extension. in the hand while
pronation Forearm supinated or forearm supinated.
neutral.
 Hands
Burn types Expected Position HOW to Maintain?
Deformity
Palmar surface MCP hand positioned with In acute palmer burn
flexion/ IP all fingers extended cases use dorsal splints.
extension and the thumb web when healing progress
Thumb space on a slight use silicone pad to
opposition. stretch provide both positioning
& pressure.
Dorsal surface MCP hyper Wrist extension A gauze roll is wrapped
extension MCP flexion. into the palm extending
IP flexion IP extension. into the thumb web
space.
Thumb Thumb palmer Hand splint (Volar)
adduction abduction or
opposition
Circumferential contracture wrist in functional Wrist splint
burns towards the position (from neutral Towel or gauze placed
most deeply to 30 degree in the hand while
burned side. extension. forearm supinated.
Forearm supinated/
neutral.
 HIP
Anterior or Posterior
Hip Burns

Deformity
Position
Flexion/ External Maintaining position
Slight Abduction
Rotation
Mid rotation
And or Adduction

Towel roll or sand foam wedge

bag lat. To Thigh Blanket between legs
For neutral rotation For hip abduction

Prone lying Knee ext. splint

minimize Reduce hip flexion
Hip flexion With prone lying
 KNEE
Burn Expected Position HOW to Maintain?
types Deformity
Anterior Rarely
Burns causes
extension
contaracture
Posterior Flexion Extension position bulky dressing to
burns contracture impede knee flexion
knee extension
splints.
Prone lying bed
outside bed (Prone
hang) achieve full
extension.
 Ankle & Foot
Burn types Expected Position HOW to Maintain?
Deformity

Posterior or Plantar Neutral or dorsiflexion but use foot board

Circumferential flexion neutral is optimal Sponge booties or
contracture custom splints with a
(heel cord cut out heel.
tightness)
Isolated Rarely Plantarflexion position patient in prone lying
anterior causes with foot outside the
surface dorsiflexion bed, will rest on slight
Contracture. plantarflexion.
 II. Splinting
By Definition:
Tools to support burned area, maintain joint
position and correct or prevent deformity.

Mostly in use are thermoplastic materials,

still there are some other materials in use such
as leather, fiberglass, and metals.
 Indications
Indications differ
with
different phases
of rehabilitation

Acute Phase Wound Healing Rehabilitation Reconstruction

phase Phase Phase
 Acute Phase

Uses of Splints
Prophylactic role if tendons &
joint damage is suspected
N.B.
Because of fluctuating edema at
This phase, splints should be
MOdulable
Not Constrictive
 Wound Healing
Phase

Uses N.B.
Avoid interference with healing
prevent development of by proper Fitting
Contractures Proper Length
Protect newly applied Edges rolled and flared away
Skin grafts From skin
 Rehabilitation
Phase

Uses
Reduce contracture non
surgically N.B.
prevent deformities If Scar tissue tensile strength is poor
provide sustained stretching of Monitor for wound break down
Scar tissues.
Maintain gained ROM
 Reconstructive
Phase

Uses
For fixation following release of N.B.
Contractures or reconstruction Monitor for wound Maceration
surgery
 Examples Of Splints In Use
Region Splints
Cervical Soft neck collar (foam)
Philadelphia collar
Molded neck splint
Watusi collar (plastic tubes)
Halo- neck collar

Ear Semi- rigid oxygen mask

Mouth mouth spreader
External traction hook

Axilla and anterior chest Axilla air plane splint

Clavicle figure of eight splint
 Region Splints
Elbow And Knee Gutter or trough splint
Airslpint

Hip hip spica

Abduction splint
Spreader Bar

Ankle Posterior foot drop

High top gym shoe
Anterior & posterior ankle conformer

Wrist & Hand Wrist splint

Thumb spica
Thumb web spacer
III. Electrotherapeutic Modalities
Several electrotherapeutic modalities
provide assistance in wound healing
process BASICALLY including:
HVPGS.
US THERAPY.
ULTRAVIOLET RADIATIONS
LASER
 HVPGS
There are several possible explanations of its
effect on wound healing:
1- Positive electrical stimulation stimulates repair
process.
2- Negative pole stimulation will destroy any
bacteria.
3- Increasing superficial circulation hastens
healing
 Application
Parameters

Intensity Rate setting Electrodes Treatment Time

According to Continuous Active (Usually Time of treatment
patient tolerance. Surged Pulse Anode) cover 20-30 minutes.
rate 80 pulse/sec. treatment area.
Dispersive (~
Cathode.) on the
back
 ULTRASOUND THERAPY
Effects of US on wound healing include:
1- Promotion of formation of granulation tissue.
2- Accelerated re- epithelization.
3- It reduces wound infection, through improving
circulation (?!).
4- It improves scar pliability ( thus used in
hypertrophic scars).
5- Phonophoresis can be used to introduce wound
healing medications.
 APPLICATION

IN CONTACT SUB- AQUATIC

Using coupling media as
Paraffin oil, aquassonic gel,
Or aquasonic gel pad.
Usually applied at wound
edges
Using suitably sized water
container and previously
boiled water.
Usually applied to wound bed.
Distance 1-5 cm from skin
.
 ULTRAVIOLET RADIATIONS
UVR
1- Accelerates healing through facilitating mitosis
in the germinal layers of the skin.
2- Help in maintaining sterility through destroying
surface bacteria.

N.B.: High doses should be avoided at growing

wound edges as it may induce more skin
damage.
 Application
Apply sensory test for erythema (E) (?!!!!!!).
Calculate Erythema dose (?!!!!!!).
Apply 25% of (E1) then progress in the
same rate (25% of the preceding dose.
Then shift to E2 (2.5 x E1) and progress by
50% of the preceding dose.
Then shift to E3 (5 x E1) AND PROGRESS
BY 75% of the preceding dose.
Notice
When the main aim of treatment is to facilitate
mitosis gradual progression from E1 doses
through E3 can be afforded.
If the condition shows wound infection high
exposure doses would be initially implemented.

Avoid UVR in early stages of burn rehabilitation

(inflammatory stage of healing) as it may
aggravate the burn insult
 LASER

Increase
Prostaglandins

Enhance Quicken Collagen

Fibroplasia Synthesis

EFFECTS
Bio-stimulation

Enhance immune
Increase ATP
Cells to attack
Synthesis
Pathogens
Types Of Laser In Use For Wound Healing

Types

Helium- Neon Galium- Aresnide Argon Carbon Dioxide

(He-Ne) (Ga As) (Ar) (CO2)
632.8 nm Or Infrared Laser 488 514 nm 10.6 nm
(IR)
904 nm