BURNS and the role of Physical therapy
Burns can be debilitating injuries, both physically and psychologically.
The tightening of the skin due to burns and the development of scar tissues can limit movement, particularly if the burn affects a large area or the area around a joint.
In such a case, Physiotherapy plays a major role in the recovery process. Rehabilitation must begin immediately.
Physiotherapy can help to combat these adverse effects, maintaining the range of motion in the patient’s joints, preserving muscle tone, minimizing the development of keloids, hypertrophic scars, and skin contracture; and giving the patient a sense of empowerment and support to help overcome the psychological effects of suffering burns.
This recovery treatment should always be done with the help and supervision of a licensed physiotherapy professional.
Rehabilitation involves 2 stages, basically the early stage and the later stage.
Physical therapy management involves the following:
Early stage:
Respiratory care must be provided by breathing techniques, postural drainage, coughing and suctioning. Extra caution must be applied in handling in case of burns affecting the chest area.
Prevention of Oedema by elevation
Prevention of contractures and stiffness by splinting and proper positioning techniques and range of motion exercises
Pain management - TENS enhances pain relief.
Prevention of pressure sores by frequent positioning while on bed.
Prevention of Deep Vein Thrombosis by early ambulation.
Later (post healing)Stage:
Improvement in mobility, muscle strength, endurance, balance and coordination owing to prolonged bed immobilization.
Management of scar tissue
Ambulation with little or no assistance
Engaging in functional activities
Integration into society
In case of a skin graft
Skin graft is a process in which the skin from one part of the body (donor) is transferred to another part(recipient), where it is damaged due to burn.
A period of 5 to 7 days is allowed so that the circulation would not be impaired.
Therefore care must be given that no movement is encouraged in the grafted areas. Nevertheless, surrounding parts of the body can still be moved.
Physical Therapy interventions in Post-burn management includes:
Therapeutic exercises to maintain and improve ROM as well as enhance muscle strength.
Transcutaneous Electrical Nerve Stimulation (TENS) to relieve pain and pruritus (itching).
Hydrotherapy to encourage ROM exercises especially when there is marked pain and patient is fearful to move limbs.
Paraffin wax therapy when applied to contractures in the extremities can improve ROM
Extracorporeal shockwave therapy (ESWT). Low-energy ESWT along with traditional physiotherapy has been shown to relieve burn scar pain, pruritus and improve health-related quality of life. It can also be used to improve scar appearance and functional mobility in patients with severe burns.
Scar tissue massage to improve the pliability of scars. The video below shows different scar tissue massage techniques.
Laser therapy. Willows et al (2017) recommend the use of laser therapy, especially ablative fractional lasers in the management of burns to improve the pliability, vascularity and overall burn scar appearance.
Therapeutic adjuvants like Music Therapy, Virtual reality, Robotics and Cognitive behavioral therapy also can be used to relieve symptoms like pain, itching, paresthesia and sleep disorder.
Matrix Rhythm Treatment (MRT) was found to be more effective in the restoration of sensory functions than Laser Treatment (LT), whereas LT was more effective in reducing pain than Ultrasound Therapy (UT). No significant difference was observed in terms of skin elasticity according to the results of three treatment modalities as per the study. Long term effects to be studied.
At Valley Healing Hands, Brownsville, Texas we provide the best Physical Therapy and Occupational Therapy care for Burns. Our specially trained physical therapists and occupational therapists will assist you throughout the program and provide you with the best assistance to see you through your efforts with us, as well as will be your beacon to the rest of your journey. Our patients are totally satisfied with our services. You may learn about what they have to say about us here and also get connected to us here. Our patients love us and you too, will!!!