The overall goal of burn rehabilitation is to return the patient to their pre-injury level of function with the best possible cosmetic outcome. Short term goals include assisting wound healing and preventing complications like contractures. Proper positioning is fundamental to burn rehabilitation as it prevents contractures, controls edema, prevents localized neuropathies, and helps maintain the elongated position of soft tissues. Positioning should be individualized but generally involve extending and abducting limbs to maintain burned tissues in their elongated state.

1. 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)

2. I. Positioning
 By definition positioning is:
The proper alignment and adjustment of
body parts.
 Positioning is a fundamental portion of burn
rehabilitation.

3. Benefits of
Positioning in
Burn Rehab.
Prevents Controls Edema Prevent Localized Maintain elongated
Contracture Neuropathies Position of soft
Tissues

4.  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.

5.  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.

6. Specific Burn Sites
Body Segment
Anterior or
Asymmetrical neck Head Burn that Posterior neck Burn
Circumferential
burn Includes the ear Ear not involvd
burns

7. 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. Mid line --Towel roll, sand bag,
neck burn Towards Or rotated away wedges on affected side.
burned 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.

8. 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 Back hyperextension downwards.
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

9. 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.

10. 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)

11. 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
 Wrist degree extension. placed 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
 Forearm degree extension. placed in the hand while
pronation  Forearm supinated or forearm supinated.
neutral.

12. 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
extension  MCP flexion. wrapped into the palm
 IP flexion  IP extension. extending 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.

13. 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

14. 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.

15. 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.

16. 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.

17. Indications
Indications differ
with
different phases
of rehabilitation
Acute Phase Wound Healing Rehabilitation Reconstruction
phase Phase Phase

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

19. 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

20. 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

21. Reconstructive
Phase
Uses
• For fixation following release of N.B.
Contractures or reconstruction Monitor for wound Maceration
surgery

22. 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

23. 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

24. III. Electrotherapeutic Modalities
 Several electrotherapeutic modalities
provide assistance in wound healing
process BASICALLY including:
 HVPGS.
 US THERAPY.
 ULTRAVIOLET RADIATIONS
 LASER

25. 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

26. 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

27. 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.

28. APPLICATION
IN CONTACT SUB- AQUATIC
• Using coupling media as • Using suitably sized water
Paraffin oil, aquassonic gel, container and previously
Or aquasonic gel pad. boiled water.
• Usually applied at wound • Usually applied to wound bed.
edges • Distance 1-5 cm from skin
.

29. 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.

30. 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.

31. 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

32. LASER
Increase
Prostaglandins
Enhance Quicken Collagen
Fibroplasia Synthesis
EFFECTS
“ Bio-stimulation”
Enhance immune
Increase ATP
Cells to attack
Synthesis
Pathogens

33. 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