Burn Patient Rehabilitation Prof.Dr: Ehab Kamal Zayed. october 6 university Faculty Of Physical Therapy Lecture of Burn Patient Rehabilitation Soft Tissue Management & Exercise By Prof.Dr: Ehab Kamal Zayed.

Soft Tissue Management and Exercise

Exercise, positioning ,and splinting are essential in burn patient’s rehabilitation program. Static splinting and positioning are used to maintain a patient’s ROM or to prevent further loss of motion. Exercise preserve or restore movement and improve the patient’s physiologic and functional status.

Exercises are designed to avoid - scar contracture, - muscle atrophy, - cardiopulmonary difficulties, and - self-care limitations.

Timelines for Development of Various Tissue Tightness Tissue Type Days Burn scar contracture 1- 4 Intramuscular adhesion from bleeding 3- 5 Tendons and sheaths 5- 21 Muscle adaptive shortening without trauma 14- 21 Ligaments and joint capsule 30- 90

Close monitoring of a patient’s ROM will enable the therapist to determine which tissues are causing restrictions. An exercise program should begin immediately following injury. Exercises are used to keep the wound from contracting so that additional scar tissue can be produced to fill the wound.

Goals of Burn Patient Exercise Program Reduce edema and promote circulation. Prevent scar tissue contractures and deformity. Preserve muscle strength and joint mobility. Promote maximum functional independence.

Burn Patient Exercise Precautions Significant past medical history: Cardiac or orthopedic patient conditions should be screened carefully. Patients with pre-existing cardiac or pulmonary problem. Joint disease: Elderly, patients should be screened for arthritis and other limitations.

Exposed tendons: Caution when performing ROM exercises in areas involving exposed tendons. There is a significant difference between a “button-hole” type of tendon exposure and one in which the entire length of the tendon is exposed. Dystrophic calcification: Forced exercise is contraindicated. AROM is permitted. IV lines or ventilatory support

Burn Patient Exercise Contraindications Exposed joints: The joint should be immobilized in a neutral position or functional position. Tendon exposure: over the proximal interphalangeal joint of the finger Thrombophlebitis or DVT. Compartment syndrome. Fresh skin graft.

Types of Exercise ROM Exercises. Conditioning Exercises. Functional Exercises. ROM Exercises Passive ROM Exercises PROM: is a useful to obtain full ROM, in restricting movement. PROM should be performed gently, slowly, and avoid overstretching joint structures.

Scar tissue responds well to passive force when applied in a steady, controlled manner over a prolonged period of time. PROM is indicated when an escharotomy has been performed. Considerations for Use of PROM Ex: Patient level of consciousness. Medication level. Severity of condition.

Decreased ROM. Scar contractures. Peripheral nerve injury. Preservation of joint mobility. Anesthetized patient. Area of escharotomy. Preservation of tendon glide.

Active-Assistive ROM Exercises AAROM exercises is performed when a patient has difficulty completing full ROM. This lack of motion may be due to weakness, fear pain, or tight tissue and usually occurs near the end of joint range.

Considerations for Use of AAROM Exercises. Limited ROM. Scar contractures. Area of escharotomy. Skin graft adherence. Increased physiologic demands. Decreased cardiac reserve. Poor ventilation and respiratory status. Decreased strength secondary to prolonged hospitalization.

Active ROM Exercises AROM is the preferred type of exercise in several situations. AROM may be less painful for a patient than AAROM or PROM. AROM can assist in edema reduction. AROM promote circulation in and prevent circulatory problems.

Considerations for Use of AROM Exercises Edema reduction from muscle pumping. Increasing circulation. Initiation of ex. first week after grafting. Conditioning of uninvolved areas Exposed tendons. Prevention of soft tissue shortening. Prevention of muscle atrophy.

Functional Exercises Conditioning Exercises strengthening ex endurance ex Functional Exercises Functional exercises can begin early in a patient’s hospital course. Reinforce the ultimate goal of physical independence for the burn patient.

Functional Exercise Considerations Reinforce exercise program. Achievement of maximal ROM. Increase patient self-satisfaction. Increase patient endurance. Joint Mobilization Joint mobilization and distraction techniques can be used effectively with a burn patient.

Capsular involvement can not be seen in the acute stage of a burn injury. Usually the capsule becomes affected during the scar maturation phase after an extended period of decreased ROM. Joint mobilization is contraindicated for an open joint or a joint with exposed tendons.

The END!