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Burns_and_rehabilitation.pptx
- 1. Goals of Burn Rehabilitation OverallGoal Return to pre- injury Level of function with Best possible cosmoses Short Term Goals • Assist Wound Healing • Prevent Complications (muscloskeletal)
- 2. I. Positioning Bydefinition positioning is: The proper alignment and adjustment of body parts. Positioning is a fundamental portion of burn rehabilitation.
- 3. Benefits of Positioning in BurnRehab. Prevents Contracture Controls Edema Prevent Localized Neuropathies Maintain elongated Position of soft Tissues
- 4. Burn patienthas 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 programshould 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 BodySegment Anterior or Circumferential burns Asymmetrical neck burn Head Burn that Includes the ear Posterior neck Burn Ear not involvd
- 7. NECK BURNS Burn typesExpected Deformity Position HOW to Maintain? Anterior or Circumferential burns Flexion Contracture Extension/ Hyperextension - Towel under shoulders or between scapulae - Foam cervical collar Asymmetrical neck burn Lat. Fl. Towards burned side Mid line Or rotated away --Towel roll, sand bag, wedges on affected side. - Prone lying head rotated opposite side. Head burns that include the ear Folding of the Helix and condritis Avoid any pressure over the ear - Foam or gel filled bag is used to elevate the ear from the bed. Posterior neck burns- Ear not involved Hyperextension of the neck Head in midline - Pillows are used to elevate the head and lengthen posterior tissues.
- 8. Trunk burns Burn typesExpected Deformity Position HOW to Maintain? Clavicular & pectoral shoulder retraction From pectoral region to below umblicus Same as above with upper Back hyperextension - A square towel or blanket between scapulae. - Fig. of 8 wrapping Same as above with towel extended downwards. Burns of the lower back shoulder girdle protraction and glenohumeral adduction same as above plus kyphosis Exaggerated lordosis Midline position Using pillows under knee to flatten back Lateral trunk burn Scoliosis concave to burned side Maintain trunk straight Towel roll, sand bag, wedges on affected side
- 9. Shoulder Burn types Expected Deformity PositionHOW to Maintain? Anterior axilla Shoulder Adduction & Int. Rotation Shoulder Abd. / Ext. Rot. / Flexion. 90 Abd. /15- 20 horizontal Add. Above 90 Abd. And Ext. Rot. Should be attempted temporary. - Towel roll, sand bag, wedges between affected axilla and side. - Wrist cuff hanged or stockinet to I.V. pole (Murphy splint) - Aero plane splint Anterior chest and anterior arm. Fl. / Add. Arm. kyphosis Ext. & Abd. Shoulder. Ext. of dorsal spine -Towel roll, sand bag, wedges between scapulae for dorsal Ext. -Same as above for Ext. Abd. Shoulder.
- 10. ELBOW Burn types Expected Deformity PositionHOW to Maintain? Anticubital or circumferential Elbowfl. Forearm pronation Elbow extension Supination or neutral position. Posterior surfaces of the upper extremities extension deformity (not common) Elbow semiflexion Supination or neutral position. Arm troughs are used to maintain elbow extension over bed table can be used if patient can voluntarily extend his elbow. Elbow splints can be used in positioning same as above.
- 11. Forearm And Wrist Burntypes Expected Deformity Position HOW to Maintain? Volar surface Forearm pronation Wrist flexion Wrist splint Towel or gauze placed in the hand while forearm supinated. Dorsal surface Wristext. contracture wrist in functional position (from neutral to 30 degree extension. Forearm supinated or neutral. Functional position of the wrist Wristsplint Circumferential burns Wrist flexion. Forearm pronation wrist in functional position (from neutral to 30 degree extension. Forearm supinated or neutral. Wrist splint Towel or gauze placed in the hand while forearm supinated.
- 12. Hands Burn types Expected Deformity PositionHOW to Maintain? Palmar surface MCP flexion/ IP extension Thumb opposition. hand positionedwith all fingers extended and the thumb web space on a slight stretch Dorsal surface MCP hyper extension IP flexion Thumb adduction In acute palmer burn cases use dorsal splints. when healing progress use silicone pad to provide both positioning & pressure. A gauze roll is wrapped into the palm extending into the thumb web space. Hand splint (Volar) Circumferential burns contracture towards the most deeply burned side. Wrist extension MCP flexion. IP extension. Thumb palmer abduction or opposition wrist in functional position (from neutral to 30 degree extension. Forearm supinated/ neutral. Wrist splint Towel or gauze placed in the hand while forearm supinated.
- 13. HIP Anterior or Posterior HipBurns Deformity Flexion/ External Rotation And or Adduction Position • Slight Abduction • Mid rotation Maintaining position Towel roll or sand bag lat. To Thigh For neutral rotation ▲ foam wedge Blanket between legs For hip abduction Prone lying minimize Hip flexion Knee ext. splint Reduce hip flexion With prone lying
- 14. KNEE Burn types Expected Deformity Position HOW toMaintain? Anterior Burns Posterior burns Rarely causes extension contaracture Flexion contracture Extensionposition bulky dressing to impede knee flexion knee extension splints. Prone lying bed outside bed (Prone hang) achieve full extension.
- 15. Ankle & Foot Burntypes Expected Deformity Position HOW to Maintain? Posterior or Circumferential Neutral or dorsiflexion but neutral is optimal use footboard Sponge booties or custom splints with a cut out heel. Isolated anterior surface Plantar flexion contracture (heel cord tightness) Rarely causes dorsiflexion Contracture. Plantarflexionposition patient in pronelying with foot outside the bed, will rest on slight plantarflexion.
- 16. II. Splinting By Definition: Toolsto 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 ofrehabilitation Acute Phase Wound Healing phase Rehabilitation Phase Reconstruction Phase
- 18. Acute Phase Uses ofSplints Prophylactic role if tendons & joint damage is suspected Because of fluctuating edema at This phase, splints should be • MOdulable • Not Constrictive
- 19. Wound Healing Phase Uses • preventdevelopment of Contractures • Protect newly applied Skin grafts Avoid interference with healing by proper Fitting • Proper Length •Edges rolled and flared away From skin
- 20. Rehabilitation Phase Uses • Reduce contracturenon surgically • prevent deformities • provide sustained stretching of Scar tissues. • Maintain gained ROM If Scar tissue tensile strength is poor Monitor for wound break down
- 21. Reconstructive Phase Uses • For fixationfollowing release of Contractures or reconstruction surgery Monitor for wound Maceration
- 22. Examples Of SplintsIn Use Region Cervical Ear Mouth Axilla and anterior chest Splints Soft neck collar (foam) Philadelphia collar Molded neck splint Watusi collar (plastic tubes) Halo- neck collar Semi- rigid oxygen mask mouth spreader External traction hook Axilla air plane splint Clavicle figure of eight splint
- 23. Region Elbow And Knee Hip Ankle Wrist& Hand Splints Gutter or trough splint Airslpint hip spica Abduction splint Spreader Bar Posterior foot drop High top gym shoe Anterior & posterior ankle conformer 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 areseveral 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 According to patient tolerance. Ratesetting Continuous •Surged Pulse rate 80 pulse/sec. Electrodes •Active (Usually Anode) cover treatment area. •Dispersive (~ Cathode.) on the back Treatment Time Time of treatment 20-30 minutes.
- 27. ULTRASOUND THERAPY Effectsof 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 •Using couplingmedia as Paraffin oil, aquassonic gel, Or aquasonic gel pad. •Usually applied at wound edges SUB- AQUATIC •Using suitably sized water container and previously boiled water. • Usually applied to wound bed. • Distance 1-5 cm from skin .
- 29. ULTRAVIOLET RADIATIONS UVR 1 Accelerateshealing 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. Notice If thecondition 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
- 31. LASER Enhance Fibroplasia Enhance immune Cells toattack Pathogens IncreaseATP Synthesis Quicken Collagen Synthesis Increase Prostaglandins EFFECTS “ Bio-stimulation”
- 32. Types Of LaserIn Use For Wound Healing Types Helium- Neon (He-Ne) 632.8 nm Galium- Aresnide (Ga As) Or Infrared Laser (IR) 904 nm Argon (Ar) 488 – 514 nm Carbon Dioxide (CO2) 10.6 nm