Burn rehabilitation,
The rehabilitation for patients with burn injuries starts from the day of injury, lasting for several
years and requires multidisciplinary efforts. A comprehensive rehabilitation programme is
essential to decrease patient’s post-traumatic effects and improve functional independence.
STAGES OF REHABILITATION
Rehabilitation of burns patients is a continuum of active therapy starting from admission. There
should be no delineation between an ‘acute phase’ and a ‘rehabilitation phase. rehabilitation
have been divided into early stages and later stages of rehabilitation;
EARLY STAGES OF REHABILITATION
Depending on the size and severity of the injury, the patient’s age and other pre-morbid
factors, this stage can last from a few days to several months. The patient may be undergoing
regular dressing changes, which are often painful for the patient.
Regular pain relief is essential, in particular prior to all interventions such as change of dressing
and exercise; this needs to be given in adequate time to take effect before commencing the
procedure. The aim of analgesic drugs should be to develop a good baseline pain control to
allow functional movement and activities of daily living to occur at any time during the day.
Patients may want to delay their rehabilitation until they feel better; however, every day
without burn therapy intervention will make the eventual rehabilitation process more difficult
and painful and may result in a poorer outcome.
CRITICAL CARE
When a patient is admitted with severe burns, it is essential to reduce the risks, as far as
possible, of further complications arising. Postural management of the patient by elevating the
head and chest helps with chest clearance and reduces swelling of the head, neck and upper
airway.
PSYCHOLOGICAL IMPACT
It is important to remember that burn patients have often experienced a very frightening event
leading to their burn injury and that the hospital experience itself can be frightening. Patients
and family members may be experiencing significant feelings of guilt, anger and despair; they
may also be having nightmares and flashbacks of the event. While professionals may treat
many people in one day, the experience for each individual patient is personal and their
experience can impact on their mental wellbeing and readiness to participate in their
treatment. It is important that the patient is given comfort and reassurance that they are safe.
Taking the time to listen to the patient’s concerns, demonstrating genuine empathy and
compassion, providing adequate information and answering their questions can often go a long
way to alleviating fears, which in turn can ease the treatment process for both patient and
professional.
SPLINTING
Splints are a highly effective method of helping prevent and manage burn contractures and are
an integral part of a comprehensive rehabilitation programme. Splinting helps maintain anti-
contracture positioning particularly for those patients experiencing a great deal of pain,
difficulty with compliance or with burns in an area where positioning alone is insufficient.
ENCOURAGE ACTIVITIES OF DAILY LIVING
Burn patients often feel a sense of loss of role and ability to participate in normal activities of
life. Activities of daily living play an extremely important role in a burn patient’s successful
outcome. If a patient can accept the responsibility of self exercise and activities of daily living,
then the most difficult aspects of rehabilitation are easily achieved. It is crucial to involve
patients in daily activities such as eating and washing themselves as soon as possible.
EDUCATION
It is essential that the patient is educated at every stage as to the reasons for the various
aspects of their burn rehabilitation and why their participation is crucial to ensure the best
possible outcome.
LATER STAGES OF REHABILITATION
SCAR MANAGEMENT
Hypertrophic scarring is common following a burn injury and may cause significant functional
and cosmetic impairment.The longer a wound takes to heal, the greater the likelihood of
hypertrophic scars developing; the risk increases significantly when a wound takes 21 days or
longer to heal. Hypertrophic scars are an exaggerated response of the body’s healing process;
they have a high blood flow and increased levels of collagen and are extremely active becoming
raised, red and rigid. These scars tend to have a high rate of contraction and have other
symptoms associated with them including itchiness, dryness and lack of pliability. Hypertrophic
scars are generally at their most active for the first 4–6 months post-healing.
Splinting
Splints prescribed are not only essential for positioning but also for stretching and lengthening
the contracted scar tissue. Continued early splintage removed only for exercise and specific
functional activities can maximise long-term outcome and can be continued for 6 months post-
healing to 2 years or sometimes longer in children.
Stretching and exercise
In the early stages, post-wound healing scars are extremely active and dynamic and the
contractile force is at its highest. If the burn is close to or over a joint, it must be stretched to
avoid loss of ROM and to prevent a post-burn contracture developing. Preventative and
maintenance exercises and splinting programs, employed prior to the development of
contractures, are crucial to preserving required functional soft tissue length and glide.
Massage and moisturising
Scar massage is widely advocated as an integral part of burn scar management; while the exact
mechanisms of its effects are not known, burn scars are often lacking in moisture depending on
the depth of the injury and the extent of the damage to the skin structures. They can become
very dry and uncomfortable and this can lead to cracking and breakdown of the scar. By
massaging with an unperfumed moisturiser or oil, the upper layer of the scar becomes softer
and more pliable and therefore more comfortable; this also helps to reduce itching which can
also be a common problem.
Activities of daily living
Individuals should be encouraged to return to their normal daily routines as soon as possible
and should re-establish themselves in their roles in life prior to their burn injury as much as
they can.
Social rehabilitation
After a burn injury some individuals can feel isolated and alone. They may find it difficult to
integrate back into society and take up life as they knew it prior to their injury. They may feel
like they are the only one who has suffered such an injury and they may not know how to re-
enter society, particularly if they have visible burns scars. These individuals should be
encouraged in order to re-establish themselves in their social and vocational lives as soon as
they are able to, and their family members should be encouraged to promote this behaviour.
