Burn rehab

Question 1

Determine what information needs to be collected in the assessment (PEO-Person)

Answer 1

1. OT profile
2. Wound assessment
3. Joint mobility
4. Strength
5. Sensation
6. Psychological aspect
7. Pain level
8. Cognitive/Psychological Assessment and History

Question 2

What, how and why to assess OT profile?

Answer 2

What:
the location
the severity
the type of burn
the percentage of damage
wound care, reconstructive surgery, grafting, and precautions (i.e. limited to no range of motion, no weight-lifting, etc.)

How:
Interview

Why:
understand background information, client-centred treatment planning

Question 3

What, how and why to assess wound?

Answer 3

What:
- extent and depth of injury (epidermis, dermis, nerve, muscles)
- any blisters

How:
Observation

Why:
affect wound recovery time, pain, sensory loss, can perform ROM? etc.

*No passive or active ROM with exposed tendons or recent grafts

Question 4

What, how and why to assess joint mobility?

Answer 4

What:
passive range of motion (PROM), active range of motion (AROM)

How:
goniometer

Why:
Baseline deficit

*pain, edema, tight eschar, or bulky dressings impacting ROM

*No passive or active ROM with exposed tendons or recent grafts

Question 5

What, how and why to assess muscle strength?

Answer 5

What:
UL and LL muscle strength

How:
Manual muscle testing

Why:
affect functional performance

Question 6

What, how and why to assess sensation?

Answer 6

What:
- light and deep touch
- hot and cold discrimination
- 2-point discrimination

How:
- monofilament
- Sensation Discriminator
- Hot and cold discrimination kit

Why:
safety concern
functional performance

Question 7

What, how and why to assess psychological aspect?

Answer 7

What:
- depression
- PTSD post-traumatic stress disorder
- anxiety
- body image

How:
- Interview
- Questionnaire

Why:
- affect recovery rate

Question 8

What, how and why to assess pain level?

Answer 8

What:
At rest, with activity, pain description (inflamed, stinging, etc.) and the specific bodily locations

How:
- Interview
- Questionnaire

Why:
- affect recovery rate

Question 9

What, how and why to assess Cognitive/Psychological Assessment and History?

Answer 9

What:
Cognitive/Psychological Assessment and History

How:
- Interview
- Cognitive assessment

Why:
- how burn injuries occur and whether the patient will adhere to current and future interventions, safety awareness

Question 10

What, how and why to assess ADL?

Answer 10

What:
how the patient is performing relevant activities of daily living, currently and prior to injury

How:
- Interview
- ADL Assessment
- COPM

Why:
- affect ADL treatment plan

*general activities as well as activities of importance or interest to the patient

Question 11

Determine what information needs to be collected in the assessment (PEO-Environment)

Answer 11

Physical environment:
any environmental adaption/modification needed? e.g. stairs, ramp…

Social environment:
caregiver support

Question 12

Determine what information needs to be collected in the assessment (PEO-Occupation)

Answer 12

1. hand dominance?
2. ADL performance level and functional status
3. Occupation (work, school)
4. Hobby, social participation

Question 13

Occupational Performance issues

Answer 13

1. Contracture formation
2. Edema
3. Limited ROM and mm strength w/ pain
4. psychological impact
5. lack of information
6. Cannot perform functional ADL and IADL
7. scar

Question 14

Treatment goal & Treatment plan
(Contracture formation)

Answer 14

Tx goal: prevent early contracture formation
Tx plan:
1. Splinting
- Wear times are determined by tolerance and functional ability to use involved extremity
- Generally, any joint with superficial partial-thickness or worse has potential for contracture and is usually splinted

2. Positioning
   - Anti-deformity position: used as adjunct to splinting for preventing contractures
   - minimize upper extremity edema

Question 15

Treatment goal & Treatment plan
(Edema)

Answer 15

Tx goal: prevent edema formation
Tx plan:
1. Elevation of extremities
2. AROM exercises, if movement is allowed
3. Wrapping with elastic bandage

Question 16

Treatment goal & Treatment plan
(Limited ROM and mm strength w/ pain)

Answer 16

Tx goal: restore ROM and mm strength

Tx plan:
- Active, active-assisted, or passive exercises (depending on the client’s condition)

• Remedial activity

Address pain:
- Pain is often a limiting factor → coordinating with nursing on scheduled pain medications or short-term breakthrough pain relief. Treat 30 minutes after pain medication is administered.

• techniques to minimize pain e.g. visual imagery and relaxation
• Respect pain –> Stop before the client reaches the limits of pain tolerance
• Explain procedures before starting an exercise or activity and allow the client to control the time limit on painful
• education and training in lifestyle modification and compensatory strategies to change movement and participation

Question 17

Treatment goal & Treatment plan
(psychological impact)

Answer 17

Tx goal: Support psychosocial adjustment

Tx plan:
1. Identify strengths
2. Validate sadness and fear
3. Assist goal achievement
4. Instill belief

Question 18

Treatment goal & Treatment plan
(lack of information)

Answer 18

Tx goal: Client and caregiver education and training

Tx plan:
1. Stages of burn recovery
2. Importance of activity and exercise participation
3. Pain management techniques
4. ROM exercises, safety precautions, and contracture preventions
5. Education for members of support system
a. Ways to interact with and support patient (physically and emotionally)
b. Potentially serve as source of information and resource

Question 19

Treatment goal & Treatment plan
(Cannot perform functional ADL)

Answer 19

Tx goal: Early participation of ADL and IADL

Tx plan:
- adaptive strategies and equipment while waiting for burn injuries to heal
→ Gradually discontinue use of adaptive equipment to encourage active movement

Question 20

Treatment goal & Treatment plan
(Scar)

Answer 20

Tx goal: Scar compression

Tx plan:
compression garment