Burns Physiotherapy Management

Burns are injuries to the skin caused by material which are exposed to heat, chemicals, friction, ice, electric shock or radiation.

Burns Physiotherapy

Physiotherapy Management

Treatment of burns cases can be divided into 3 phases:

• Acute Phase (Acute)
• Sub-acute phase (Subacute)
• Healing and scar maturation Phase (Post Epithelial healing)

Acute phase

Respiratory Care

Help to maintain or regain optimal respiratory function. Respiratory care is very important especially for cases of inhalation injury and burns to the chest. Chest physiotherapy is very important and the techniques are: ·  

• Breathing exercises
• ACBT (active cycle of breathing technique)
• Manual techniques of chest physiotherapy – Percussion, Vibration
• Postural drainage or Modified Postural Drainage
• Suction (if necessary)
• Thoracic mobility exercises
• Positioning
• Adjunct: Incentive spirometer, flutter if necessary

Positioning to the joint Involved

The correct position is at odds with the comfortable position and contractures. Performed on the first day of the patients admitted to hospital until the scars mature. Joint involved are positioned correctly to achieve goals such as:

• Reduce swelling
• Prevent deep vein thrombosis
• Prevent further damage to the joints or exposed tendons
• Avoid damage to new skin graft.
• Avoiding pressure sores occur in certain area – such as the styloid process, the medial malleolus, the lateral malleolus and the Achilles tendon.
• Maintain range of motion to prevent contractures Positioning Techniques:

Therapeutic Exercise

Exercise should be done on the first day of admission until the scars mature. The purpose is to:

• Maintain Joint integrity
• Maintain muscle flexibility and elasticity of the skin
• Maintain range of motion to prevent contractures 
• Increase muscle strength and endurance.
• Restore the musculoskeletal function to optimal level.

Soaked During Exercise

• The ideal time to exercise is when soaked in warm water to soften the tissue and provide comfort to patient. 

Sub-acute phase

• Continue with respiratory care
• Continue with therapeutic exercise
• Continue with the joint involved in the correct position
• Do mobility movement / ambulation

Ambulation

Ambulation will start once:

• Haemodynamic status is stable
• There are no signs of  active bleeding in the joint involved
• Bandaging of affected area is done

Healing and scar maturation phase (Post Epithelial Healing)

1. Therapeutic exercise for circuit training so that patients are more independent.
2. Stretching exercises
3. Muscles strengthening exercise such as using Theraband, weights, dumbbells, etc
4. Exercise to increase endurance. Examples of aerobic exercise such as climbing stairs.
5. Exercise to improve coordination such as Proprioceptive Neuromuscular facilitation (PNF)
6. Home exercise

• Do exercise continuously until scars are matured
• Elevation of the joints involved if there is swelling,
• Encourage to do activities of daily living. 

Scar Care

Scarring of burn wound is a continuous process. Scar will stop when the skin is ripe. Understanding patient’s care related to scarring should be intensified to prevent the growth of hypertrophic scar Clinical presentations of a matured scar:

• Soft
• Align       
• No tension in the scar
• Scars return to original skin tone 

Hypertrophic scar have clinical features as below: 

• Redness of surface
• Surface scars arising
• Less flexibility
• Pain and itch

Scar massageScar management: 

The manipulation of soft tissue combined with stretching can reduce scar formation. The manipulation of scars:-

• Encourage the restoration of collagen
• Helps to reduce irritation
• Maintains moisture and elasticity

Scars Massage Technique:

• Apply the lotion on the affected area. Use unscented lotion.
• Apply pressure to the skin sufficiently
• 3-way massage which is rounded up and down, and side to side
• Sort through friction techniques more effective if combined with stretching and exercise.
• Perform 3-4 times per day. 

Skin care 

I. Hygiene

• Test the water temperature before entering the tub or shower because the new skin more sensitive to the water temperature.
• Clean out by using a plain water to shower.
• Use a soft, clean towel to wipe

II. Dry skin

The skin looks dry and scaly as a result of the destruction of oil refineries.

• Use lotion or moisturizer to keep the skin moist.
• Stay away from oils containing lanolin and alcohol resulting blister burns / blisters on the skin that is new.

III. Sun light

New heal skin is more easily injured when exposed to sunlight – ultraviolet rays. 

• Wear long-sleeved dress, trousers, big hats to protect the wound. Do activities in the early morning or late afternoon.
• Avoid exposure to direct sunlight. Apply cream / lotion to prevent ultraviolet ray 

IV. Cold weather

Patients will experience a spectrum of sensory numbness in the tips of the toes and hands.

• Wear thick clothing and stay away from exposure to cold weather too long. 

V. Itchy skin

Dry skin will cause the patient to experience irritation.

• Wear loose clothing to avoid sweating• Avoid scratching the heal skin because it is very thin, sensitive and easily hurt
• Use lotion intensively. 

VI. Burns / blisters

The new skin is easy to burn / blister caused by pressure and friction.

• Avoid wearing clothes or shoes that are too tight.