Burn Rehab Flashcards
Three phases of rehabilitation management of burn survivors
- acute care phase
- surgical and postoperative phase
- inpatient and outpatient phase
The acute care phase usually lasts how long?
The first 72 hours after a major burn injury
OR
time from injury until epithelial healing (for superficial partial thickness injury that heals spontaneously in less than 2 weeks)
How long does the surgical and postoperative phase last?
Varies, depends on size of burn, presence of associated medical complications.
- vulnerable to: wound infection, sepsis, septic shock
- medical tx: promote healing, minimize infection
When does the inpatient/outpatient phase occur, how long does it last?
Why is it challenging?
After post-grafting period, medically stable, most open wounds healed. Duration is indeterminate length of time.
Challenging due to quality of wound healing, scar formation, need for aggressive rehab (can be difficult for both pt and therapist).
Acute care phase (phase 1)
- primary goal of OT
- rehab goals for deep partial or full thickness wounds
- primary goal of OT: preventative
- rehab goals:
- provide cognitive reorientation and psychologic support
- reduce edema
- prevent loss of joint and skin mobility
- prevent loss of strength and activity tolerance
- promote occupational performance, such as independence in self-care skills
- patient and caregiver education
Surgical and postoperative phase (phase 2)
- general rehab goals
- specific rehab goals
-general: preserve/enhance performance skills and patterns, support surgical objectives
- specific:
- promote cognitive awareness (orientation activities), cont. psychologic support
- protect/preserve graft and donor sites (fabricate splints and establish positioning to support surgeon’s orders)
- prevent muscular atrophy and loss of activity tolerance/reduce risk for thrombophlebitis (exercise for areas not immobilized)
- increase independence in self-care (alternative techniques/AE)
- educate/reassure pt, family
Rehab phase (phase 3)
- general rehab goals
- emphasis before leaving hospital
- general: maximize function and participation in occupations, promote physical and emotional independence, manage scar formation to prevent or correct deformity and contracture formation.
- emphasis before leaving hospital: independence, self-mgmt, education.
Rehab phase (phase 3): specific goals
- cont. psychologic support
- improve joint mobility and reduce contractures
- restore muscle strength, coordination, activity tolerance
- initiate compression therapy, scar mgmt program
- promote independent self-care skills or the ability to direct others to assist
- instruction & opportunities to practice IADLs
- instruction on scar development
- implementation of post-discharge plan
Components of initial OT evaluation
- cause of burn
- %TBSA (total body surface area)
- depth of burn
- area(s) involved
- age, hand dominance
- functional status (pre injury and current)
- occupations (through interview with pt and/or family)
- ROM (A&P), muscle strength, sensation, functional use of involved and uninvolved areas
- presence and severity of edema
- gross/fine motor coordination
- changes in sensation
- level of cognitive awareness
Components of inpatient rehab OT evaluation
- graft adherence
- skin or scar condition
- contracture concerns
- edema (if present)
- ADL performance level
- work skills
- AROM, PROM, TAM (total active motion)
- strength and activity tolerance
- developmental level (child)
- psychologic status
- social support
- leisure activities
- compression garment needs
- home management
Components of outpatient rehab OT evaluation
- skin or scar condition
- compression garment fit
- volumetrics if needed
- ADL performance level
- work skills
- AROM, PROM, TAM
- strength and activity tolerance
- developmental level (child)
- psychologic status
- social support
- leisure activities
- compression garment needs
- home management
- home care understanding
- return-to-work capacity
- return-to-school potential/need for re-entry program
OT intervention: acute care phase-preventative positioning
- purpose
- typical position of comfort that can lead to contractures
- reduce edema, maintain involved extremities in an anti deformity position
- adduction and flexion of UEs, flexion of the hips and knees, plantar flexion of the ankles, toes pulled dorsally. watch for “claw hand” held by edema these positions lead to CONTRACTURES
OT intervention: acute care phase, antidefomity positioning
-position, equipment and technique (E&T)
Neck
position: neutral to slight extension
E&T: no pillow, soft collar, neck conformer, or triple-component neck splint
OT intervention: acute care phase, antidefomity positioning
-position, equipment and technique
Chest and abdomen
position: trunk extension, shoulder retraction
E&T: lower the top of the bed, towel roll beneath the thoracic spine, clavicle straps
OT intervention: acute care phase, antidefomity positioning
-position, equipment and technique
Axilla
position: shoulder abduction 90-100*
E&T: arm boards, airplane splint, clavicle straps, overhead traction
