Injuries due to intense heat are hard to manage for a number of reasons. In the case of second or third degree burns, the risk of developing complications is fairly high. These complications include infections, dehydration and development of troubling scars or contractures. Physicians and healthcare providers suggest early rehabilitation to hasten recovery in acute burn patients to minimize the risk of complications. Every year, more than 100,000 patients spend almost 20,000,000 days in a tertiary care setting for the management and treatment of burn and burn related injuries.
Most common burn related injuries include damage to airways as a result of inhalation of hot gases that may burn delicate and sensitive respiratory mucosa, dehydration due to damage to skin lining leading to evaporation of body fluid, moderate to severe burn victims are at high risk of developing wound infections and in the absence of optimal antibiotic coverage and exposure to sick contacts, the risk of septicemia is significantly high, and multi-organ failure is seen in patients who develop multiple full thickness burns. The risk of multi-organ failure is high because of septicemia and partly due to the massive release of tissue breakdown products (hemoglobinuria and myoglobinuria).
In most America hospitals, burn patients require mandatory physical therapy unless restricted by the physician for a specific reason. This is because early physical therapy has immense benefits in the early recovery of patients. Aggressive physical therapy helps in early mobilization of patients, who are otherwise bed-ridden. The primary aim of physical therapy in burn patients is fast recovery of patients by restoration of blood supply and return of healthy circulation. This is helpful in planning early grafting and tissue surgery. Aggressive physical therapy in burn patients also helps in decreasing the thickness of scars and offers great help in the prevention of contracture formation. Most burn patients are unable to move much due to severe pain and discomfort. Physical therapy helps in the prevention of bed sores and stasis related issues in burn patients. The duration of hospitalization is prolonged in moderately severe burn injuries and if no movement or mobility is instituted, the risk of metabolic, circulatory and physiological complications is fairly high. Most physicians immobilize patients after skin grafting procedures and this is required for the graft to adhere properly and optimally to underlying connective tissue. Generally this immobilization lasts for a period of about 5 to 14 days (depending upon the size, location and nature of graft). However, during this period of immobilization, disuse atrophy and degenerative changes begin to set in muscles that may lead to decreased range of motion, decreased endurance and improper muscle coordination. After early grafting period, aggressive physical therapy is needed to restore muscle strength and power.
After the patient is stabilized, physical therapy should be instituted along with rehabilitation to hasten recovery. Physical therapists need extra caution and care while dealing with burn patients, primarily because most burn patients are agitated, in severe pain and battling with psychological issues and a depression like state. Physical therapy in burn patients should be performed in regular small sessions. Each session should have a regular structure and must be associated with frequent rest periods to maintain patient compliance. Regular counseling and motivation is as important as the therapy itself. Painful exercises or activities that may induce pain must be performed in a later part of the session.
For optimal benefits, it is important that the physical therapist speaks to the on-duty nurse regarding patient positioning during day and while sleeping at night, the speech and recreational therapist regarding activities that improve physical mobility, and the primary care physician regarding chest physiotherapy.
Physical therapy in burn patients include mostly repetitive activities of hands/ extremities and gradually increase in range and extent with recovery and patient compliance. Physical therapy procedures may also include the use of splints and traction devices in cases where the risk of disabling contracture is very high (if burn injuries involve joints). Other positioning devices are also used especially when postural edema is a problem that is affecting joint mobility and range of motion.
Physical therapy exercises are dependent upon the nature, severity and extent of the burns, overall mental and physical condition of patient and the nature of dressing. A variety of exercises are advised in burn patients like active exercises in which the patient is asked to perform muscle activity in response to a command (like lifting a cup) and passive exercise is used in patients with low compliance or severe pain that limits activity. The physical therapist assists the patient in muscle movement activities. Active- assistive exercises are performed when patient is showing good progress and healing. Stretching exercises are helpful in restoring muscle power after grafting and in regaining full range of movement. Stretching exercises can be performed manually or with the help of machines and devices.
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