Role of Physiotherapy in Burn Injury
1. Role of Physiotherapy in Pain and Wound Management in Burn Injury:
Dressing changes are also horror sessions of pain and bleeding for the patient. This can be significantly minimized by hydrotherapy.
Hydrotherapy in Burn- A Treatment Option:
Hydrotherapy in burn management involves both immersions in a tub or showers in running warm water of the burnt body part to help in the healing process.
Hydrotherapy starts on day 3-5 postburn when patients have overcome the initial shock and their general condition has stabilized. Though the actual hydrotherapy is done under the supervision of the physiotherapist.
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| Fig. 1: Hydrotherapy for burn patients |
Advantages of hydrotherapy are:
Improvement of the burn wound, i.e, separation of the soiled dressing, Escher and other tissue debris from the wound surface, cleaning of the wound, and drainage of pus with a minimum of bleeding and damage to fragile new skin.
Facilitation of physical therapy and mobilization with the help of buoyancy.
Pain relief and comfort of patients due to the soothing effect of warm water on the raw area.
2. Role of the Physiotherapist in the Critically-ill Burn Patient
Performing ROM
Splinting and antideformity positioning
Establishing a long-term relationship with the patient and family members and to increase the patient's motivation for recovery.
Passive ROM exercise is performed twice daily, with the therapist taking all joints through a full ROM.
These procedures should be performed in coordination with the ICU staff. Attention to the security of endotracheal tubes, nasogastric tubes, and arterial and central venous catheters.
Proper antideformity positioning minimizes the shortening of tendons, collateral ligaments, and joint capsules and reduces edema.
Flexion deformities of the neck can be minimized with thermoplastic neck splints, conformers, and split mattresses. In critically-ill patients, positioning the neck in a slight extension.
3. Role of the Physiotherapist in the Recovering Burn Patient:
The principal components of burn therapy that characterize the recovering period include the following:
Continued passive ROM exercises
Increasing active ROM
Strengthening exercises
Minimizing edema aggressively through massage, mechanical and electrotherapeutic compression techniques
ADL training
Initial scar management
Preparing for work or play or school.
Gait training
Burned and grafted extremities commonly have lingering edema that can contribute to joint stiffness. Reducing this edema facilitates rehabilitation efforts.
Wrapping the fingers with self-adherent elastic helps reduce digital edema.
Tubular elastic dressings, elastic wrap dressings, pneumatic compression splints, elevation, and retrograde effleurage massage also help reduce extremity edema.
Local silicone pressure pads may be used to minimize evolving hypertrophic scar.
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