Burn Patient Rehabilitation Prof.Dr: Ehab Kamal Zayed. october 6 university Faculty Of Physical Therapy Lecture of Burn Patient Rehabilitation BURN PATIENT SPLINTING By Prof.Dr: Ehab Kamal Zayed.

SPLINTING

Uses of Splints in Rehabilitation Program of Burn Patient In all phases for: Protection. Prevention of deformity. Preservation and restoration of function.

Indications for Use Acute Phase: Immobilization and support of suspected tendons and joint damage. Aid in positioning the affected body part. Reducing edema in the hands.

Healing Phase: Splints may prevent the development of contracture and the disruption of newly applied skin grafts. Splints should be properly fit conforming, with appropriate length for leverage and edges rolled a way from the skin.

Rehabilitation phase: Contractile forces within a developing scar may remain active for up to 18 months. Splinting is used to: Reduce contracture nonsurgically, Prevent deformity, Maintain natural body contours, Complement pressure therapy.

Exercise may achieve normal ROM and splinting can maintain the gained range. Splints immobilize a joint at the end point of Joint range and are adjusted as range increases. If tensile strength of scar covering a joint is poor, wound breakdown secondary to pressure or excessive stretch of the soft tissue by splint should be closely monitored.

Reconstructive phase: Splints may be required following reconstructive procedures for restoring function or cosmoses. Contractile forces in a wound causes a progressive loss of motion, and disturb body contours if they are unopposed. Splints applied should be closely monitored for evidence of wound break down.

Side Table

Splinting Indications Protection of anatomic structure The goal of the early splinting is to securely stabilize a joint to eliminate all external stress applied to the Joint and tendon. Tendons should be splinted in a slack position to prevent rupture.

Prevention of deformity Splints maintain anti contracture position. Utilized to prevent prolonged posturing in undesirable positions in uncooperative patients. Splints prevent deformity by applying sustained stretch to the healing wound.

Therapist should monitor closely the burn wound or the scar underlying a splint for the evidence of disruption of healing or scar breakdown that may be due to stretch applied by splint. Frequent re-evaluation of the scar maturity to determine when a splint can be discontinued without further contracture development.

Preservation of Skin Graft Integrity Survival of a skin graft is dependent on the establishment of circulation between the underlying wound bed and the transplanted skin. To prevent any disruption of this process, the recipient site must be immobilized completely until the graft adheres.

skeletal traction, bulky dressing, means of splint. Immobilization can be accomplished by: skeletal traction, bulky dressing, means of splint. Splints are usually discontinued once graft adherence is assured.

Restoration of function Scar contractures can be reduced through splinting, thus avoiding surgical release or revision. The Key to non-operative resolution of contractures is sustained stretch and pressure. Splints should be revised to accommodate changes in ROM.

General splint considerations Splinting applies an external force to a body segment and should be considered whenever full passive ROM is not obtainable. The focus of a splinting program should be on those motions that are most difficult to regain.

Static versus dynamic forces During the early inflammatory stage, static splints are useful. Both dynamic and serial static splints may be indicated during the proflative stage. Although static and dynamic splints can be beneficial during the stage of scar maturation, serial static splits often prove superior.

Static Splint Support one or more Joint in a specific position for immobilization purpose. Serial static splinting can enhance ROM of a Joint through the principle of prolonged stretch.

Dynamic Splint Applies a specific force in a specific plane of motion through elastic traction while allowing the patient some joint motion. Should be considered for those joints that demonstrate the most resistance to passive stretch and not respond to positioning or intermittent stretch. Dynamic splints provide low load and prolonged stretch.

Types of splints

Anterior neck Soft collar: Molded neck splints: Halo neck splints: Foam circumferential neck orthosis, generally used when the tissue is fragile. Molded neck splints: Total contact rigid neck support. Halo neck splints: Thermoplastic orthosis.

Soft collar

Halo Splint

Watusi collar: Philadelphia collar: Series of cylindrical plastic or foam tubes fastened circumferential around the neck. Philadelphia collar: Prefabricated, circumferential, foam positioning orthosis.

Watsui collar “plastic tubes”

Five-ringed Watusi collar.

Feeding plastic tubes through the channels.

Appropriately fitted four-ring Watusi collar.

Assembled materials for Watusi collar construction – a Assembled materials for Watusi collar construction – a. vinyl tubing cut to length; b. fishing wire; c. hole puncher; d. loop Velcro cut into strips; e. tubigrip; f. scissors; g. measuring tape; h. velfoam; i. hook Velcro.

Philadelphia collar

Philadelphia collar

Sterno-occipital-mandibular Immobilization Device (SOMI)

Microstomia

Airplane Splint/Abduction Pillow

Anterior Elbow Splint

Static Wrist Splints

Principle of Prolonged Stretch

Whip Spacer Cock-Up

Abduction Pillow

Static Knee Splint

Long Leg Splint

Static Ankle Splint

Dynamic Foot Drop Splint

Airplane Splint

Dynamic Extension Splint

low load and prolonged stretch

The END!