Physical Dysfunction: Burn Rehabilitation

Burn
Edited by:
Md. Yeasir Arafat Alve
PhD Candidate
Division of Occupational Therapy
Graduate School of Human Health Sciences
Tokyo Metropolitan University
7-2-10 Higashiogu Arakawa-ku Tokyo 116-8551 JAPAN
Email: alve_crp@yahoo.com
Developed by: Abdul Almalty PhD, PT
09/05/2016 1HI/Rehabmonitor/Alve/Burn/OT/2016

Contents
1. Pre-Lesson quiz
2. Introduction
3. Types of burns and etiology
4. Burn first aid
5. Acute management of burn
6. Post-lesson quiz
7. References

Introduction to burn
• Burn injury has a devastating potential and it
is one of the major health problems of the
industrial world.
– In United States more than 2 million persons are
burned each year.
– One-fourth requires medical attention and
approximately 5000 deaths are related to burn
injury.
• However, Low and middle income countries
suffer of higher mortality and morbidly rates
related to burns

The etiology of the burn injury
1. Thermal injury
– Flame burn
– Scald
– Contact burn
– Flash burn
2. Electrical injury
– High voltage
– Low voltage
3. Chemical injury
– Acids
– Alkali
– Organic compounds

Thermal injury
• Flame burn
– Common from various causes including house fire the burn
wound Can be of any depth and is usually a mix of different
depths.
• Scald burn
– Caused by hot fluid, about 60% of ‘burns’ in children are scalds.
• Contact burn
– Caused by contacting heat sources include radiator, glass front
of gas fires and irons. may cause full-thickness burns in those
lost sensation, elderly, post-convulsion or toxicated by drugs and
alcohol.
• Flash burn
– Usually caused from ignition of a flammable substance that
causes a ball of fire.
– Commonly results in superficial flame burn usually to the face,
neck and upper limbs.

Electrical injury
• Low voltage
–Causes by domestic electrical supplies <240volts,
usually caused small area burns in the extremities.
• High voltage
– From industrial power cables (>1,000 volts) or
lightening strikes lead to significant systemic
injuries and causes muscular damage that often is
much greater in extent than the overlying
cutaneous injury.

Burn Injury amount of heat Vs. time
• The amount of skin destruction or cellular dysfunction
is based on temperature and time of heat exposure
(Williams, W. 2002).
• At 44°C (111°F) and below:
– Local tissue damage will not occur unless the exposure is
for prolonged periods.
• Between 44°C to 51°C (111°F and 124°F )
– Short exposures will lead to cell destruction.
– The rate of cellular death doubles with each degree rise in
temperature
• Over 51°C (124°F)
– Extremely brief exposure time will damage the tissues.

What are the Effects of burn on the body?
• Increase vascular permeability; results in
formation of oedema, compartment
syndrome.
• Loss of water or hypovolaemia, electrolytes,
proteins and heat (shock phase).
• Immunosuppression which causes infection.
• Impairment of barrier function of the gut
leading to translocation of bacteria.
• Systemic inflammatory response.

Burn First Aids
1. Ensure your own safety and Avoid self harm.
2. Stop the burning process.
– Flame source; stop, drop, cover face & roll.
– Remove heat sources: hot fluid, scalding or
charred clothing or remove patient from the
source of injury.
– In electrical injuries, disconnect the person from
the source of electricity.

Burn First Aids Cont…
3. Cooling down the burn:
– Cool with running tap water (8–25°C) for at least
20 minutes; Ideal temperature is 15°C.
– It’s believe cooling is effective up to 3 hrs after
injury, however, some studies showed no effects
of cooling after 60 minutes (Nguyen et al).
– Ice should not be used as it causes
vasoconstriction and hypothermia. Ice can also
cause burning when placed directly against the
skin.

Acute Management
• The acute management of burn injury usually
takes place at emergency room or burn unit (A
B C D E F):
– Airway maintenance with cervical spine control.
– Breathing and Ventilation.
– Circulation with Hemorrhage Control.
– Disability: Neurological Status.
– Exposure with Environmental Control.
– Fluids Resuscitation.

Pos-lesson quiz: Question # 1
True or False:
• Scald burn mostly affects adults.
1. True
2. False
• It is mostly affect children (about 80% of scald
burn)

References
• Peck M, Kruger, G, van der Merwe, A, Godakumbura, W, & Ahuja R. Burns and fires from
non-electric domestic appliances in low and middle income countries Part I. The scope
of the problem. Burns 2008;34(3):303-11.
• Williams, W. 2002, Pathophysiology of the burn wound, in Herndon, D.(ed) Total Burn
Care, 2nd edition, Saunders, London, pp 514-521.
• Hudspith J, Rayatt S (2004) First aid and treatment of minor burns. Br Med J 328:1487–9
• Nguyen, N., Gun, R., Sparnon, A. & Ryan, P. 2002, The importance of immediate cooling
– a case series of childhood burns in Vietnam, Burns, Vol28, No 2, pp 173-176.
• World Health Organisation (WHO), Facts about injuries: Burns, accessed from
http://www.ameriburn.org/WHO-ISBIBurnFactsheet.pdf on 19 February 2010.
• Monstrey S, Hoeksema H, Verblenen J, Pirayesh A, Blondeel P (2008) Assessment of
burn depth and burn wound healing potential. Burns 34: 761–9
• Hasselt E (2008). Burns Manua; la Manual for Health Workers, 2008, Nederlandse
Brandwonden Stichting, Holand; Pp 44-45.
• The injury chartbook: A graphical overview of the global burden of injuries.
• Geneva, World Health Organization, 2002.
• Marshall SW et al. Fatal residential fires: who dies and who survives? Journal of the American
Medical Association, 1998, 279:1633–1637.
• Haddix AC et al. Cost-effectiveness analysis of a smoke alarm giveaway program in Okalahoma City,
Oklahoma. Injury Prevention, 2001, 7:276–281.

Epidermis
• The outer layer exposed to
the environment
• Composed of stratified
squamous epithelium
• Thickness varies depending
on the area (0.07 - 0.12
mm).
• Thickest at palmar and
planter surfaces (0.8 -1.4
mm).
• Contains no blood vessels

Dermis
• 20 to 30 times thicker than the epidermis.
• Contains blood vessels, lymphatics, nerves,
sweat and sebaceous glands, and hair follicles.
• It is composed of interwoven collagen and
elastic fibers provide the skin with tensile
strength and elasticity.
• The dermis can be subdivided into two major
regions :
1. Papillary layer (superficial)
2. Reticular layer (deep).

Dermis

Pre-Lesson Quiz: 2
Chose the most appropriate answer:
• The degree of a pale pink burn with intact fine
blisters and very painful burn wound that highly
sensitive to temperature changes or light touch
is:
• 1st degree
• 2nd degree Superficial partial-thickness
• 2nd degree Deep partial-thickness
• 3rd degree
• Answer ____

Burn Wound Healing Process

Epidermal Healing
• The epithelial cells stop migration when
they are completely in contact with other
epithelial cells at the wound margins.
• This process needs to provided by
adequate nutrition and blood supply, or
else the new cells will die.

Dermal Healing
• Scar formation occurs.
• Scar formation can be divided into:
–Inflammatory
–Proliferative
–Maturation.

INFLAMMATORY PHASE
• Inflammation begins at the time of injury,
ends in about 3 to 5 days.
• Characterized by:
–Redness, edema, warmth, pain, and
decreased ROM.
–blood vessel is ruptured
• Platelets aggregate, and fibrin is deposited
clot formation
• Blood vessels contract  decrease blood flow.

PROLIFERATIVE PHASE
•  formation of granulation tissue contains
large numbers of fibroblasts macrophages,
collagen, and blood vessels.
– Fibroblasts are the cells that synthesize scar tissue
in random alignment
• The newly formed blood vessels bring a rich
blood supply to the area and encourage
further wound healing.
• Excess granulation tissue may lead to
increased hypertrophic scarring and wound
contraction occurs.

MATURATION PHASE
• During the maturation phase
– There is a reduction in the number of
fibroblasts
– Decrease in vascularity due to a lesser
metabolic demand
– Remodeling of collagen, which becomes more
parallel in arrangement and forms stronger
bonds.
• The ratio of collagen breakdown to
production determines the type of scar that
forms.
– Hypertrophic scar may result (keloid).

Burn classification
• The depth of injury is one of the most important
determinants of outcome.
• Burns can be categorized according to the extent
of damage to the skin and expressed in terms of
degrees.
• The following common classifications are used:
• First degree
• Second degree
• Superficial
• deep
• Third degree

First Degree Burns
• It may termed as Superficial or
Epidermal*
* The Australian and New Zealand Burn Association (ANZBA)

Superficial Burn
Epidermal
• Cell damage to epidermis and intact
dermis
• Causes: sunburn.
• Symptoms and signs
– Erythema
– Dry surface, no blisters, may slight edema.
– Short term inflammatory reaction
– Delay pain, till the area becomes tender to
the touch.
– Desquamation (peel off) in 2 to 3 days.
• skin will heal on its own, and no scar
will be present.

Second Degree Burns
• Superficial partial-
thickness
• Deep partial-thickness
• Superficial dermal*
• Mid dermal*
• Deep dermal*
* The Australian and New Zealand Burn Association (ANZBA)

2nd Degree Burns
• The second degree
Burn used to and still
subcategorized to:
1. Superficial partial-
thickness
2. Deep partial-
thickness
Deep dermal

2nd Degree Burns
• For more accuracy in burn
depth description, the
ANZBA subcategorized the
by to: 2nd degree burn to:
1. Superficial dermal*
2. Mid dermal *
3. Deep dermal *

Superficial partial-thickness
Superficial dermal
• Involves the epidermis and superficial
portion of the dermis.
• Causes: Scald (spill or splash), short
flash
• Signs and symptoms:
– Pale pink, intact fine blisters, very painful.
– Blanch because of intact circulation.
– The skin is highly sensitive to temperature
changes, exposure to air, and light touch.
• Healing:
– epithelialisation in 1-2 weeks
– Low risk of scarring

Partial thickness
Mid dermal
• Involve epidermal and mid dermal
• Causes: Scald (spill), flame, oil or grease
– Dark pink with large blisters
– Sluggish blanch
– some of the nerve endings remain, May be
painful
• healing :
– 14–21 days
– Moderate risk of hypertrophic scarring

Deep partial-thickness
Deep dermal
• Involve epidermis and dermis into
reticular layer (most of nerve endings,
hair follicles, and sweat glands are
damaged).
• Causes: Scald (spill), flame, oil or grease
• Pale, or red, No blanche and No pain.
• Healing occurs through scar formation.
• Healing:
– 3 to 5 weeks
– High risk of hypertrophic scaring.09/05/2016 32HI/Rehabmonitor/Alve/Burn/OT/2016

Third Degree Burns
Full-thickness burn

Full-thickness burn
• Damage extend below dermal layers
– All hair follicles and nerve endings and vascular
system are damaged
• Causes: Scald (immersion), flame, steam, oil,
grease, chemical, high-volt electricity.
• dense white, waxy or even hard eschar tissues
• No pain, No blisters, No capillary refill.
• interstitial fluid leaking beneath eschar tissues
• Healing:
– not spontaneous, graft needed,
– Hypertrophic scar formation.

Full-thickness burn
 Edema that forms in an area of circumferential burn can
cause compression of the underlying vasculature 
increase necrosis.
 Escharotomy may be necessary.
 No sites available for re-epithelialization skin grafting
of tissue over the wound will be necessary.

Total body surface area
• Expressed as a percentage of the total body
surface area (TBSA),
• It is a basic element in the management of
patients with burns. It is used to establish
• The need for fluid resuscitation,
– The calculation of fluid requirements,
• Evaluation of prognosis
– Monitoring the progress of healing

Assessed Methods
• BSAP is assessed by three methods:
1. the rule of nines chart (Johnson and
Richard, 2003).
2. the area measured in units based on the
patient’s hand surface area (Polaski and
Tenisson, cited in Knaysi et al 1968).
3. The Lund and Browder (LB) char t (Lund
and Browder, 1944).

Body Surface Area Estimation
Role of Nine - Adult
– 9% for whole head
– 9% for left arm
– 9% for right arm
– 9% for anterior abdomen (lower back)
– 9% for posterior abdomen (lower back)
– 9% for anterior thorax (chest)
– 9% for posterior thorax (upper back)
– 9% for anterior right leg
– 9% for anterior left leg
– 9% for posterior right leg
– 9% for posterior left leg

Body Surface Area Estimation
Role of Nine - Child
• Rule of Nines for pediatrics
• For each year over 1 year,
subtract 1% from head and
add 0.5% to each leg.
• by the time a child has
reached the age of 10 years
it has the proportions of an
adult.

Palm size
• in small burns
estimate the extent of
the burn with the
palm size (from the
fingertips to the
wrist), it is
approximately 1% of
the TBSA

Lund and Browder chart

Lund and Browder (LD) chart
• The LB char t consists of two drawings of the
human body — one of the anterior and the
other of the posterior aspect of the human
body
• The Body Surface Area Percentage (BSAP) of
the various parts of the body appears on
either the corresponding part of the drawing
and/or a separate table that goes alongside
the drawings.

Burn Severity
• Burn severity can be determined by burn depth,
size, location, and patient age. Burn size is
defined by the percentage of total body surface
area (TBSA) that is burned.
• Location is very important component and some
time is critical e.g. burn injury to hands, feet,
face, ears and genital area.
– because of their complexity and the crucial function
of these areas

Sever Burn Criteria
• 3o > 10% BSA
• 2o > 30% BSA
• 2o >20% pediatric
• Burns with respiratory injury.
• Hands, face, feet, or genitalia.
• Burns complicated by other trauma.
• Underlying health problems.
• Electrical and deep chemical burns.

Moderate Burn Criteria
• 3o :2-10% BSA
• 2o :15-30% BSA
• 2o : 10-20% pediatric
• Excluding hands, face, feet, or genitalia.
• Without complicating factors.

Minor Burn Criteria
• 3o < 2% BSA
• 2o < 15% BSA
<10% pediatric
• 1o < 20% BSA
• Excluding hands, face, feet, or genitalia.
• Without complicating factors.

Escharotomy Locations
• Escharotomy incisions are
routinely performed on
both sides of the torso or
the medial and lateral
sides of each affected
limb.

Surgical Excision
• Escharotomies release the constriction caused
by burn eschar but do not remove the eschar.
• Excision
– Is removing or excising the eschar to the level of
viable underlying tissue.
– Can be done to scar tissues
– Prepare the patient for skin graft.
– generally performed between the 2nd to 7th days
postburn, because after one week there is and
increased dermal blood flow and granulation
under eschar

Excision
• Excision is a surgical procedure
requiring incision through the deep
dermis and removal of all necrotic
tissue in open wound and burn
eschar.
• This procedure can be performed on
burn scars in preparation for surgical
reconstruction.

Surgical Managements

Introduction
• Is a part of healthy skin is taken from a ‘donor
site’, and implanted at the damaged ‘recipient
site’.
• The skin could be from the same or another
person or animal.
• Usually performed in a hospital under general
anesthesia.
• Healing time depend on size and severity of
injured area.
• Additional surgery may be require

Aims of skin graft
• To facilitate optimal and rapid healing of
the wound, minimizing deleterious
consequences such as scar contracture
• Maximizing the best functional and
cosmetic outcomes.
• Ameliorate the body’s systemic responses,
especially the immune and metabolic
systems.

Skin graft
• An autograft is a patient’s own skin, taken
from an unburned area and transplanted to
cover a burned area.
• An allograft (or homograft) is skin taken from
an individual of the same species, usually
cadaver skin.
• Xenograft (or heterograft), is skin from
another species, usually a pig. Allografts or
xenografts are used until there is sufficient
normal skin available for an autograft.

Autograft
1. Pinch grafts
–Small pieces of skin
are placed on the
injured site to grow
and cover it.
–Grow even in areas of
poor blood supply and
resist infection.

Autograft Cont….
2. Split-thickness grafts
• The surface layer of the skin
(epidermis) is removed along
with a portion of the deeper
layer of the dermis.
• Once the graft is in place, the
area may be covered or left
exposed.
• Most commonly used and can
cover large areas especially
when meshed.
• Used for non-weight-bearing
parts of the body.

Autograft Cont….
3. Full-thickness grafts
– The entire dermis and its overlying
epidermis is removed which
contains all of the layers of the skin
including blood vessels.
– Within 36 hours new blood vessels
will begin to grow into the
transplanted skin.
– Are used for weight-bearing
portions and friction prone areas
of the body such as, feet and
joints.

Autograft Cont….
4. Skin Flap
–Portion of the skin used from the donor site
will remain attached to the donor area and the
remainder is attached to the recipient site.
–The blood supply remains intact at the donor
location and removed after new blood supply
has completely developed.
–Used for hands, face or neck areas of the body.

Allograft
• It is a skin graft that has been taken from
one individual and transplanted into
another.
• Done when no enough skin for an autograft
is available (e.g. Case for serious burn
victims).
• It is treated much the same way as any
other organ transplant.

Xenografts
• Xenografts are skin grafts that are obtained
from another species.
• Most xenografts come from pig tissue, and in
many cases, are cultured or mixed with
growth factors and proteins to enhance their
ability to be integrated with human skin.
• Used as temporary in the treatment of large
wounds.
• Quick implantation may prevent bacterial
infection and excessive blood loss.

OT/PT Post Surgery
• Grafts and donor sites should be kept clean, moist
and covered.
• Splinting and dressing for about 5 days following
skin grafting
• May be reapplied to maintain proper positioning.
• Therapeutic exercise by physical and occupational
therapy
– Range of motion, strength and endurance
• Encouraged to resume as much independent
activity as possible.

Pre-lesson Quiz # 1
True or false
• A contracture of the mouth can be treated by
specialized splint.
A. True
B. False
• Answer____

Pre-lesson Quiz # 2
True or false
• The proper positioning for infant hips is full
extension, 0° rotation and symmetric abduction of
15–20°.
A. True
B. False
• Answer____

Introduction to
Rehabilitation of burn patient
• Physical and occupational therapists and O&P play
an essential role in the acute management of all burn
injured patients.
• Realistic rehabilitative care plan and goals should be
devised with multidisciplinary burn team and patient
and his/her family.
• The short-term rehabilitation goal is:
– to preserve the patient’s range of motion and functional
ability.
• Long-term rehabilitation goals are:
– to return patient to independent living.
– to train patients on compensating functional loss.09/05/2016 64HI/Rehabmonitor/Alve/Burn/OT/2016

Acute Phase Rehabilitation
• To prevent deformity and contractures:
–Performing passive ROM.
–Splinting and antideformity positioning.
• Reduce edema
• Establishing a long-term relationship with
the patient and family members to:
–ensure compliance with therapy goals.
–increase the patient's morale for recovery.

Range of Motion Exercise
• Performed twice a day.
• Exercises should be started on the first
day after admission.
• Joint ranges of movement and muscle
power must be documented on a chart
on day one.
• Assessed and recorded on a daily basis
until full active range of movement is
achieved.09/05/2016 66HI/Rehabmonitor/Alve/Burn/OT/2016

Positioning
• Therapeutic positioning is designed to reduce:
– oedema by elevation of extremities,
– to preserve function by proper body
alignment,
– the use of anti contracture positions.
• assessed and managed within 24 hours of the
admission.
• Contractures associated with the flexed position
of comfort.

Anti-Contracture positioning
• Anti-Contracture positioning can be achieved
through :
• Splinting
• mechanical traction
• cut out foam troughs and mattresses
• Pillows
• Strapping
• serial casting
• surgical application of pins.

Burn Patient Position
09/05/2016 69
HI/Rehabmonitor/Alve/Burn/OT/2016

Splinting
• Positioning splints need not always be applied
prophalactically.
– If a patient is unable to maintain proper position, and
start losing ROM, splinting should be initiated.
• Positioning and splinting is an essential part of
acute burn treatment regime and used for:
– Protecting joints at risk of developing contracture or
deformity.
– Preserving function.
• When splinting
– the burn OT must be aware of the anatomy and
kinesiology of the body surface to be splinted.

Splinting
• Indications for Splints
– Prevention or Correction of deformity.
– Positioning - post grafting.
– Protection of exposed tendons and joints.
– Aiding in controlling edema, inflammation, or
infection.
• Warning signals of bad splinting:
– Pain.
– Sensory impairment.
– Wound maceration.

Requirements for All Splints
• Proper fit and Secure application
– Must be secured with straps or bandage.
– too loose and without adequate contour will not
maintain proper position.
– A splint too tight causes pressure necrosis or
nerve compression.
• Avoidance of pressure over a bony
prominence
• Periodic removal and performing exercise.
• Daily checking and re-evaluation.
• Cleansing with each re-application.

Splinting and positioning
• In general, positioning and splinting must be
designed to:
1. Reduce edema.
2. Support, protect and immobilize joints and
Maintain joint alignment
3. Elongated tissues and maintain and increase
range of motion.
4. Remodel joint and tendon adhesions.
5. Promote wound healing.
6. Assist weak muscles to counteract the effects of
gravity and assist in functional activity.
7. Strengthen weak muscles by exercising against
springs or rubber bands.
09/05/2016
73

Head
–Elevate the head of the bed at
30–45° if the when hips not
involved.
–Tilt bed to 12–16 inches when
hips involved; it helps to
prevent hips flexion
contractures.
–Internal ear canal splints
ears
use ear cups for protection and preventing ear
rim to contract toward the head.

Head Cont…
Mouth:
• Mouth splints are
utilized to prevent
oral microstomia.
• mouth splint could
be:
–horizontal
–Vertical

Neck
• burns to the anterior surface
–The neck is positioned in
neutral or in slight extension
of approximately 15°
– in midline no rotation
–no pillows behind the head
–extension by using small
towel roll behind the
shoulder or second mattress
–custom thermoplastic collar

Axilla
• maintained at 90° abduction as a
minimum or 110° if possible.
• Ensuring no pressure points
– produce brachial plexus compression
– ulnar nerve palsy at the elbow.
– 10° of shoulder flexion to prevent
brachial plexus injury.
• Positioning of the axilla can be
difficult if the chest has also been
grafted.
• Axillary roll or modified hip wedge
can be used

Shoulder and chest
• Maintenance of a semi-erect
position will assist in movement of
odema away from the chest wall to
more dependent tissues.
• Attain maximum chest expansion
using deep breathing technique.
• Elevation of the arms should be in
the corono-sagittal plane with the
glenoid humeral joint at
approximately 15–20° of horizontal
flexion
– Airplane splints

Elbow
• burns to the flexor aspect of
the joint should be positioned
in extension and supination on
either pillows or in splints.
• The arms are elevated in the
Bradford sling and should be
removed for 10 minutes every
hour and stretched into
extension.

Hand
• Palmar burns
– should be elevated on pillows to
help reduce oedema.
– The wrists at 30 degrees
extension and the MCPs and
fingers supported in extension.
• Functional Splints should be made to
maintain an optimal functional
position.
– Wrist in 0-30 degrees extension,
MCP joints in 70-90 degrees
flexion, IP joints in full extension.
09/05/2016
80

Hips and Knees
• Hips
– should be positioned in neutral and
in 20° abduction.
– This can be done with pillows
/towels / sandbags.
– For infant: full extension, 0° rotation
and symmetric abduction of 15–
20°.
• Knees
– should be positioned in extension.
– No pillow underneath the knee
joint.
– Posterior knee slap splint can be
used09/05/2016 81HI/Rehabmonitor/Alve/Burn/OT/2016

Genital Area
• lower limbs should
be positioned as for
hip/ knee burns
because patients will
tend to flex hips and
knees.

Ankles / feet
• Place in neutral position
– This is usually achieved by a
pillow at the base of the foot
holding the position or splints.
• The foot should be checked
daily for pressure soles at the
heels.
• Sheepskin or water filled
surgical glove can be used as a
protective cushioning.

Establishing a relationship
• burn is the beginning of a long-term
relationship.
– Introduce your self to the patient and the family.
– Explain your essential role as professional health
care provider.
– Communicate with patient and the family share
your treatment plan, treatment and updated
progress.
– This information helps to ensure compliance with
therapy goals.
09/05/2016 HI/Rehabmonitor/Alve/Burn/OT/2016 84

Intermediate Phase Rehabilitation
• Transferred from intensive or high
dependency care to a ward setting
• A patient is medically stable and the
amount of therapy depending on severity
of the injury
• continue respiratory, circulatory,
positioning and splinting until the child has
regained full active range of movement and
mobility.

Therapist Aim at Intermediate Phase
• The therapist aim in this stage is to
continue:
–Daily treatments- endurance, strengthening
–Rom exercise and promote active rom
–Strengthening and stretching exercise
–Reduce edema
–Scar management
–Focus more on restoring function and initial
scar management
–Preparation for work, play, or school09/05/2016 HI/Rehabmonitor/Alve/Burn/OT/2016 86

Activities of Daily Living (ADL)
• Therapist should complete an assessment of the
patient’s functional activities of daily living such as
dressing, feeding and hygiene.
• relearn/ adapt skills and/ or educate new
strategies.
• Assess and Provide patient’s need of specialized
equipment e.g. supported seating, adapted cutlery
• Assess and aid the ability to participate in leisure
activities especially for children
• Prepare and coordinate the return to work,
school,…09/05/2016 HI/Rehabmonitor/Alve/Burn/OT/2016 87

Scar Management
• Once the burn has almost healed and swelling
has resolved
• scar management will be considered using.
– pressure garments, and silicone massage therapy.
• Tubigrip may be be applied as a temporary
measure if till the custom garment being
ready.
• Use moisturizer prior massage
• Patient and family education

Roll of OT in Community
• Understand the main causes of burn injury in
the community.
• Educate community about its role in preventing
burn injury by safe use to source of heat,
electrical energies or chemicals.
• Educate the community what they should do
when injury occurs (first aid) based on the
causes.
• Refers patient to specialized care if needed.

• Educate the community about the danger of
burn and the consequences complication.
• Inform the community about levels of burn
severity (minor v.s sever burns)
– What kind of burn you could treat and which one
you should seek a professional care.
• Never disrespect their traditional medicine in
dealing with burn, however, gradually and
politely you can change their believe if there is
any concern in their practice.

• Train the volunteers in the community about
how to deal with minor burns including
cleansing, dressing, exercising and scar
management using available resources such as:
– Using boiled-cooled water for wound cleansing,
alternative dressing
– Splinting mostly is not accessible in the community,
figure out how to use available simple material in the
community such as wood, stakes, plaster of Paris
(POP) to modulate splints
 Vocational assessment and training
 Employment and community empowerment09/05/2016 HI/Rehabmonitor/Alve/Burn/OT/2016 91

References
• Robert L Sheridan (2012), Burn Rehabilitation,
http://emedicine.medscape.com/article/318436-
overview#aw2aab6b5
• Whitehead, C. & Serghiou, M. (2009) A 12- Year Comparison
of common therapeutic interventions in the burn unit; Journal
of Burn Care Rehabilitation 30: 281- 287.
• Vehmeyer- Heeman, M. et al (2005) Axillary burns: extended
grafting and early splinting prevents contractures 26 (6): 539-
542.
• Leveridge, A (1991) Therapy for the burn patient: Chapman &
Hall, London.
• Okhovatian, F. & Zoubine, N. (2006) A comparison between
two burn rehabilitation protocols 33: 429- 434.

Physical Dysfunction: Burn Rehabilitation

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