Phases of Burn Rehab, Bed Rest & Biomechanics - Class 5 Flashcards
timeline for development of tissue restrictions
burn scar contracture
muscle adhesion
tendons and sheaths
adaptive muscle shortening
ligament and joint capsule
burn scar contracture
1-4 days
muscle adhesion
3-5 days
tendons and sheaths
5-21 days
adaptive muscle shortening
2-3 weeks
ligament and joint capsule
1-3 months
precautions/contraindications for tissue restrictions
finger burns
extremely resistive or combative pts
exposed tendons
finger burns
of in determinant depth or until wound closure
esp over PIP joint
exposed tendons
only AROM exercises
LE burns and ambulation
vascular concerns
vascular concerns
blood stasis/clotting
hydrostatic pressure
dependent position
dependent position
inadequate venous return
tissue engorgement
edema
bleeding
pain
inadequate venous return
leads to venous stasis
how can we counter these vascular concerns
pressure wrappings
pressure wrappings
ace wraps
tubular elastic supports
unna’s boot
ace wraps
figure 8
spiral
more pressure distally w/ decreasing amounts of pressure proximally
tubular elastic supports
tubi-grip
TEDS stocking
effects of bed rest on multi organ systems
integumentary
respiratory
CV
edema formation
decreased CO
MS system
integumentary
scar contraction
abnormal scarring
cosmesis
abnormal scarring –> integ
keloid
hypertrophic
respiratory system
inhalation injury
decreased respiratory ventilation/perfusion ration = SOB
inhalation injury –> respiratory system
major cause of burn death
edema in lungs –> alveolar collapse –> decreased perfusion –> hypoxemia
CV system
physiology of fluid balance and edema formation
edema formation has
increased vascular permeability
histamine from mast cells, basophils, platelets
endothelial cells and blood vessels swell
proteins leak from intravascular to intestinal
water follows change in pressure gradient
when is edema accumulation the greatest
first 8 hrs
how long may edema continue
24-36 hrs
when does edema resolve
7-10 days
edema may persist for
2-3 weeks
decreased CO
increase HR
resting HR increases
decreased SV
reduced mean arterial pressure
MS system –> what happens to muscle protein
metabolized
d/t decreased in circulating proteins from edema
what do we need muscle proteins for
wound healing
how much strength is lost
3% per day
19-20% per week
50% in 3-5 weeks
body weight –> MS system
loss of BW
> 20% is fatal
what occurs –> MS
osteoporosis from disuse
normal skin is composed of
collagen fiber
elastic fibers
surrounded by an amorphous ground substance
collagen fibers are
long
individual
coiled
what are collagen fibers responsible for
tensile strength of tissue
resiliency
elastic fibers are
straight
branched
interconnected
what are elastic fibers responsible for
skin tension
provide tissue recoil
what do GAGs do
lubricate tissue
act as a buffer to dampen force
normal content of GAG
41.5% hyaluronic acid
55% dermatan sulfate
4.5% chondroitin 4 sulfate
altered content GAGs after burn
18.5% hyaluronic acid
55.1% dermatan sulfate
26.4% chondroitin 4 sulfate
stress strain curve
strain
elongation
strain
elongation
change in length of tissue divided by original tissue length and multiplied by 100
strain to maturity
16% –> 4% at maturity
curve
divided into 2 primary portions
2 portions of curve
plastic
elastic
plastic portion
permanent change in physical constitution of tissue
when does plastic begin and end
begins at yield point
ends at break point
elastic portion
recoverable deformation
fibers lost in burn scar
when does elastic portion start/end
beings at the time of force application
ends at the peak of curve (yield point)
the elastic portion is divided into
3 phases
3 phases of elastic portion
complaint
transitional
linear
compliant
tissue elongation w/ application of little force
transitional
greater application of force is required to gain a further increase in tissue length
linear
further elongation of tissue requires a much greater increase in force
when force is applied to skin –> curve
fibers align in the direction of the load
ground substance is displaced b/w fibers
hysteresis
delay in tissue resuming its original length
successive length induction
increase in tissue length
occurs with repeated elongation of tissue
what is successive length induction also referred to as
pre-conditioning
repeated stretching
stress relaxation
progressive reduction in the amount of force required to maintain a tissue at a particular length
positioning and static splinting
tissue creep
progressive elongation of tissue overtime
in response to the application of constant force
dynamic splinting, tissue expanders
strain rate
force applied to tissue per unut of time
