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PT - Ortho Class 2 > Lecture 21 - Burn Rehab > Flashcards

Lecture 21 - Burn Rehab Flashcards

1
Q

villa medica burn victim statistics

A
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2
Q

what are the 3 layers of skin and its functioning?

A
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3
Q

what are the functions of the skin?

A

protects from:

– Evaporation/dehydration (prevents shock)

– Protein loss (prevents loss of oncotic pressure and edema)

– Infection
– UV rays, wind, cold – Trauma

• Excretion, Absorption, Perception, VitD, Personal ID, Durability, Pliability

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4
Q

what are physical properties of the skin? - 2 fibre types - what is the most abundant fibre type?

A

1) Collagen: provides strength and foundation

– long aligned fibers

– extensible but very resistant

– tensile strength

– most abundant fiber

2) Elastin - interwoven with collagen fibres

– Thinner than collagen

– Brings stretched collagen back to its relaxed position

– Provides elasticity to skin
– Poorly regenerated in burn scar

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5
Q

what are the types of burns (what can cause burns)

A

Thermal (heat and cold)

Electrical
Chemical (from strong acid or base)
Allergic reaction

Skin infection (flesh eating disease - same treatment as burn victim)
Radiation
Friction (degloving - being dragged along the road)
Immune system reaction

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6
Q

what are the different burn degree depths?

A

Subcutaneous burns / 4 degree burn – Adipose layer
– Muscles
– Tendons

– Bone

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7
Q

how does % total body surface area affect healing?

A
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8
Q

describe inhalation burns

A
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9
Q

describe the process of surgical management of burns - define fasciotomy, escarrotomy, and debridement

A

note that sedation can last weeks or months!

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10
Q

describe the donor site for a skin graft - whre is it taken from - what to look out for - healing process

A

A hypertrophic scar is a cutaneous condition characterized by deposits of excessive amounts of collagen which gives rise to a raised scar

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11
Q

what are different sources of skin grafts?

A
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12
Q

what are the different types of skin grafts?

A

1) Split thickness graft - usually in emergrnt phase
2) Mesh graft
3) Full thickness graft
4) skin flap

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13
Q

pros and cons to split thickness grafts

A
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14
Q

pros and cons to mesh grafts

A
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15
Q

pros and cons to full thickness grafts

A
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16
Q

pros and cons to skin flap

A

for covering tendon = skin with its own blood supply - requires many surgeries, bulky

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17
Q

what is a z-plasty?

A

to lengthen a linear scar

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18
Q

problems faced by the burn survivor and team - what are some cutaneous issues?

A
19
Q

problems faced by the burn survivor and team - describe a hypertrophic scar (what tissue types it consists of)

A
20
Q

what increases the risk of hypertrophic scar contraction - how long can it last for?

A

Wound contraction leads to scar retraction

Scar contraction: can be present for many months after wound closure and can be active up to 2 years

21
Q

describe the maturation of a hypertrophic scar over time

A

– Color: mauve -> red -> pink -> white (for Caucasian skin)

– Elasticity: variable

– Thickness: with scar remodelling

– Pigmentation: variable

– Mature when the scar is pale, smoother, and more flexible

  • there is a mixed phase and a maturation phase
22
Q

what areas are more susceptible to contacture/cord development?

A
23
Q

what are other problems faced by the burn survivor and team?

A
  • sleep disorders (sleep helps with healing)
  • hypermetabolism (body trying to hel itself and therefore requiers more energy - take energy from muscle cells and muscles hypertrophy - after muscles, take energy from fat - need lots of protein to heal wounds - bc easier to convert muscle to sugar than fat)
  • cardiovascular issues (because of prolonged bedrest, stiff chest from scar tissue, inflammation not good for heart)
  • itchiness and Pruritus (severe itchy skin)
  • pain
  • musculoskeletal (correct as a result of scar tissue formation: Posture, Tendinitis / impingement syndromes, Capsulitis)
  • neurological
  • social (loss, grief, role changes)
  • physiological (self-image, self-esteem, depression, anxiety, PTSD)
  • complications (OP, Osteomyelitis, Septic arthritis, Fractures, Heterotopic bone formation - bone formation where there shouldn’t be - mostly at elbows, Joint dislocations, Amputations, Abnormal growth-growth plates in children can be shut down)
24
Q

what are the neurological problems faced by burn survivors?

A

CRPS = complex regional pain syndrome

25
Q

describe itch vs pruritis as experienced by burn victims

A

Itch

Post-burn itch is considered by some to be a form of neuropathic pain

  • especially on graft site - can last months-years

57-100% of children: 25-87% of adult burn survivors suffer from itch

45% c/o itch 47.3±22.9 months post-burn

Can be severely debilitating

European survey of burn survivors - #1 research priority

Pruritis

Pruritogenic (severe itching of skin!)

– Inflammatory process

– sebaceous/sweat glands/ingrown hairs/ transepidermal water loss

Neuropathic / Neurogenic (peripheral + CNS) • Psychogenic

***Important not to scratch - bc skin is more fragile - can create wound then infection

26
Q

describe pain porblems faced by burn victims (and importance of treating)

A

– Burn pain is considered as very significant

– Pain is very present in burn survivors, and can last a few months to a few years

– 20% of subjects experienced shooting pain in their burn scars at > 30 years post-burn

– Influenced by anxiety and depression

– Pain scores correlated with PTSD but not injury severity, TBSA, heart rate or blood pressure

– 18% of adult major burn victims report having chronic pain related to the burns 5 years post- burn.

– Pain in acute phase PTSD and general emotional distress

– Pain relative to burns is what most influences sleep, work and mood

– Major burn victims who are not working due to their burns report more pain than those who are working or who are retired.

27
Q

what are the types of burn pain?

A

Neuropathic pain

– Associated with nerve damage (central, peripheral, or mixed)

– Ex: tissue reorganization/regeneration

1-3 months for capsules to retract
1-4 days for burn tissue to retract

Muskuloskeletal pain (ex: articular)

Emotional/psychological pain
Persistent pain

28
Q

is the pain related to the depth od the burns?

A
29
Q

describe the subjective evaluation for burn victim rehab and the specific componenets to address

A

slides 1-12

– *Pain: VAS, description, McGill Pain Questionnaire, BSHS-B

– *Pruritus (5-D Pruritus scale)

– Numbness/ paresthesia

– Weakness

– Sleeping position and sleep quality

– Morale

– *QOL (burn specific health scale)

30
Q

what is assessed in the O section for a burn victim?

A

note: EF will come on much quicker and have less give

31
Q

PT - specific “O” evaluation componenets for the burn victim - skin

A
32
Q

PT - specific “O” evaluation componenets for the burn victim - scar tissue

A

Scar tissue

Contracture sites / cord locations

Modified Vancouver Scar scale (use sparingly)

– vascularity

– flexibility
– pigmentation
– height or thickness

POSAS: Observer scale and Patient scale (pt and PT have very different ratings of this!

*see slides p 23-27

33
Q

PT - specific “O” evaluation componenets for the burn victim - sensation

A
34
Q

PT - specific “O” evaluation componenets for the burn victim - face

A
35
Q

describe the overlap btw PT and OT for burn treatment

A
36
Q

education for burn victims

A
37
Q

what are pharmacologic pain modalities for burn victims?

A
38
Q

what are non-pharmacologic pain modalities for burn victims?

A

slides 38-45

39
Q

what are some pruritis modalities? - pharmacologic and non-pharmacologic

A

Pharmacologic
– Antihistamines(ex: Benadryl, Atarax, Doxepin cream)

– Naltrexone
– Local anasthetics
– Corticosteroid injections

Nonpharmacologic

– Avoid scratching!

– Moisturizer (can be put in fridge)

– Ice, cold compresses

– Distraction

– TENS (needs to be further studied)

– Vibration

– Massage

– Compression

– Hydration

– Air humidity control / avoid overheating

– Stress management

40
Q

what are some scar management techniques?

A

Goals of hypertrophic scar massage

  • Maintain joint mobility re contractures • Soften scar tissue
  • Break down adhesions
  • Promote remodeling of scar tissue
  • Desensitisation
  • Clinically, alleviate pruritis
41
Q

what are the goals of pressure garments?

A

– decrease oedema

– Minimise development and appearance of hypertrophic scars (decrease vascularity and collagen synthesis, reorients collagen)

– Improve esthetic aspect of the scar

– Avoid scar migration

– Limit loss of movement

– Favour optimal function

*slides 56-59

42
Q

what are some other modalities used for burn care?

A

– Therapeutic activities: biometrics, gait and stair training, biodex, functional balance, Wii (yoga, balance, sports, etc)

– Strengthening of weak muscles and/or opposite to contractures: weights, open and closed kinetic chain exercises, active, active- assisted, isometric and resisted exercises, motor control

– Endurance training: nu-step, elliptical trainer, treadmill, bike, Wii- be careful of altered thermoregulation!

– Edema control (elevation, AROM>PROM, compression (bandages->transition garments->made to measure), lymphatic drainage, Intermittent pressure?)

– Hydrotherapy: hand shower with waterproof stretcher-cleans skin, cleanses of the skin

Whirlpool bath: not used anymore due to risk of infection!

– Wound care:

  • High voltage current + laser
  • Basic dressings
43
Q

what is the in-patient/out-patient environment for burn victims?

A

In-patient and out-patient in same room

OT, PT, out-patient MD work in the same room aware of each other’s treatments-

  • Ex: PT notices hypertrophic scars during massage, OT can add compression
  • Ex: PT stretches in one direction and OT follows with AROM activities in the same direction

Psychologist, social worker, nursing and research teams are close by

Out-pt

Similar to in-patient approach: modalities and evaluation techniques focus on fine-tuning of function, movement, activities and sports

Slower progression

Can last for months- years depending on the number of reconstructive surgeries (5x/week to 1x/ few months)

Inter-disciplinary team approach

PT - Ortho Class 2 (9 decks)

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