Burn Rehabilitation: Classifications and Anatomy

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Questions and Answers

During the rehabilitation phase for a client recovering from a burn, what is the primary goal of community reentry activities?

  • To promote the client's return to typical daily routines and participation in society. (correct)
  • To improve the client's skin tolerance to friction and shear during activities.
  • To ensure the client can tolerate compression garments for extended periods.
  • To address symptoms of posttraumatic stress disorder through counseling.

What is the MOST effective intervention to prevent or reverse contracture deformities resulting from burns?

  • Postponing interventions until the scar is fully mature to assess the extent of the contracture.
  • Focusing solely on improving skin tolerance for friction and shear.
  • Administering pain management and relaxation techniques.
  • Early implementation of anticontracture positioning along with continuous exercise and activity programs. (correct)

A client is experiencing hypersensitivity following a burn injury. What intervention is MOST appropriate during the client's transition from hospital to home?

  • Implementing desensitization techniques. (correct)
  • Initiating compression therapy to manage hypertrophic scarring.
  • Providing education on independent skincare protocols.
  • Prescribing a continuing exercise and activity program.

What is the expected timeline for a hypertrophic scar to be most active after wound closure?

<p>4-6 months (C)</p> Signup and view all the answers

A client with facial burns is having difficulty with oral hygiene and eating due to tightening around the mouth. What specific type of contracture is MOST likely affecting this client?

<p>Microstomia (D)</p> Signup and view all the answers

During the rehabilitation phase, a client reports difficulty tolerating compression garments due to friction and shear. What intervention should the therapist prioritize?

<p>Implement skin-conditioning activities and exercises (D)</p> Signup and view all the answers

What is the MOST appropriate initial action for an OT to take when a client demonstrates atypical movement patterns after a burn injury?

<p>Identify the atypical movement pattern and facilitate relearning normal movement patterns. (D)</p> Signup and view all the answers

What is the expected duration for scar maturation following a burn injury?

<p>1-2 years (B)</p> Signup and view all the answers

Which of the following is the MOST appropriate initial temporary compression method for managing edema in a patient's fingers following a burn?

<p>3M Cobanâ„¢ wrapping (D)</p> Signup and view all the answers

A patient is being fitted for custom-made compression garments following a burn. What is the PRIMARY reason for wearing these garments?

<p>To manage scars on donor, grafted, and burn wounds taking over 2 weeks to heal (A)</p> Signup and view all the answers

When should a patient, who has custom-made compression garments, typically remove them?

<p>During bathing, massage, or skin care, once skin is healed (C)</p> Signup and view all the answers

Which of the following is the MOST accurate method for calculating Total Body Surface Area (%TBSA) burned, especially in children?

<p>The Lund-Browder chart (A)</p> Signup and view all the answers

Why are flexible inserts or conformers often added under custom-made pressure garments?

<p>To conform to body contours and distribute pressure evenly (D)</p> Signup and view all the answers

A patient has burns on their entire left arm and the front of their trunk. Using the Rule of Nines, what is the estimated %TBSA burned?

<p>27% (C)</p> Signup and view all the answers

What is the MOST important aspect to consider when progressing therapeutic exercise and activity for a burn patient?

<p>Progressive grading to regain strength and tolerance (A)</p> Signup and view all the answers

What type of skin care should a client be taught to perform before engaging in an exercise and activity program?

<p>Skin lubrication and gentle massage (C)</p> Signup and view all the answers

Which layer of skin is affected in a superficial burn?

<p>Epidermis (C)</p> Signup and view all the answers

What is the typical healing time for a superficial burn?

<p>3–7 days (B)</p> Signup and view all the answers

In burn management, what is the primary purpose of anticontracture positioning?

<p>To prevent the formation of contractures (A)</p> Signup and view all the answers

For a patient with dorsal hand burns, what is generally the best splinting position advised?

<p>Volar surface splint of the hand. (D)</p> Signup and view all the answers

Which of the following is NOT a characteristic of a superficial burn?

<p>Blistering (A)</p> Signup and view all the answers

Following a superficial burn, what is the likelihood of developing hypertrophic scars or contractures?

<p>No potential (C)</p> Signup and view all the answers

Which component of the dermis provides structural support and elasticity to the skin?

<p>Collagen and elastin (C)</p> Signup and view all the answers

What is the primary reason scar tissue becomes firmer and thicker after a burn?

<p>Increased vascularity causes the scar to rise. (A)</p> Signup and view all the answers

A patient is admitted with a burn caused by brief exposure to hot liquid. The burn is red, painful, and dry, without blisters. How should this burn be classified?

<p>Superficial burn (C)</p> Signup and view all the answers

In the case of Heterotopic Ossification (HO), after a confirmed diagnosis what is the MOST appropriate course of action regarding passive stretching?

<p>Discontinue passive stretching and initiate AROM within a pain-free range. (B)</p> Signup and view all the answers

Why is coordinating with nursing staff on scheduled pain management important for burn rehabilitation?

<p>To improve the client's compliance with the therapy program. (C)</p> Signup and view all the answers

A client who has had a split-thickness skin graft is experiencing heat intolerance. What physiological change is MOST likely causing this issue?

<p>Loss of sweat glands in the grafted area. (D)</p> Signup and view all the answers

What is the primary purpose of using scar gel pads or inserts in burn scar management?

<p>To provide compression to the scar. (C)</p> Signup and view all the answers

A client is experiencing rapid loss of ROM, localized and severe pain, and a hard end feel during PROM after a burn. These are MOST indicative of what condition?

<p>Heterotopic ossification. (A)</p> Signup and view all the answers

What is the MOST critical education point to emphasize to a client and their family regarding pain management and ROM exercise following a burn?

<p>The need to perform frequent ROM exercises and activities despite the pain. (C)</p> Signup and view all the answers

A burn survivor is preparing to return to work in an outdoor environment. What is the MOST important precaution they should take regarding sun exposure?

<p>Minimize time spent outdoors during peak sun hours. (A)</p> Signup and view all the answers

Which type of skin graft involves transplanting the patient's own skin from an unburned area to the burn site?

<p>Autograft (B)</p> Signup and view all the answers

What is the primary purpose of escharotomy and debridement in acute burn care?

<p>To remove dead or burned skin and allow closure of new vascularized skin. (B)</p> Signup and view all the answers

During which phase of burn management is infection control the MOST critical, often involving both nonsurgical and surgical interventions?

<p>Acute Phase (B)</p> Signup and view all the answers

What is a key advantage of using split-thickness skin grafts compared to full-thickness skin grafts?

<p>Has a higher probability of graft survival because it includes a partial dermal layer. (B)</p> Signup and view all the answers

A patient with extensive full-thickness burns requires a skin graft. Due to the large area that needs to be covered, which type of graft is MOST likely to be utilized?

<p>Split-thickness meshed graft (C)</p> Signup and view all the answers

In the emergent phase of burn care, what is the PRIMARY focus in the initial 72 hours?

<p>Pain management with narcotic analgesics (D)</p> Signup and view all the answers

What would be the MOST appropriate dressing for a burn if the goal is to use a biosynthetic product as a skin substitute?

<p>Biobrane® (A)</p> Signup and view all the answers

What would be the expected treatment choice for a full-thickness burn?

<p>Escharotomy followed by split-thickness skin graft. (B)</p> Signup and view all the answers

Why is it important to exercise caution to avoid composite flexion when treating dorsal hand burns?

<p>To protect the boutonniere mechanism and prevent extensor hood rupture. (B)</p> Signup and view all the answers

In a patient with a deep partial-thickness burn, when should sensory testing for peripheral nerve damage be performed?

<p>As soon as the wounds are closed. (D)</p> Signup and view all the answers

What is the MOST important consideration for children who have sustained burns when creating an intervention plan?

<p>Using structured play to achieve full range of motion. (B)</p> Signup and view all the answers

What role do child-life specialists play in the rehabilitation of children with burn injuries?

<p>They help reduce fear and stress during treatment. (C)</p> Signup and view all the answers

What is a common emotional response observed in parents of children who have sustained burn injuries, that occupational therapists need to be aware of?

<p>Feelings of guilt and incompetence. (B)</p> Signup and view all the answers

What is the MOST important action an occupational therapist should take to promote a healthy parent-child relationship during burn rehabilitation?

<p>Establishing a balance between scar management, exercise, and nurturing the parent-child relationship. (A)</p> Signup and view all the answers

Why might children experience greater difficulty reintegrating into student and playmate roles after a burn injury compared to adults?

<p>Children's social roles are centered around physical appearance and activity, making them more vulnerable to issues related to altered appearance and physical limitations. (A)</p> Signup and view all the answers

What intervention is most helpful in aiding a child's return to school after a burn injury?

<p>Providing a community-based therapist working in the school system to help with adjustment issues. (C)</p> Signup and view all the answers

Flashcards

Dermis

The inner layer of skin, made of connective tissue including collagen and elastin.

Epidermis

The outermost layer of skin, consisting of four or five layers of epithelial cells.

Burn

A thermal injury that damages one or more layers of the skin.

Total Body Surface Area (%TBSA)

A measurement used to estimate the extent of burn injuries over the surface of the body.

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Rule of Nines

A method to estimate the %TBSA burned; it divides the body into sections, each representing 9% or multiples.

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Lund-Browder Chart

A more accurate way to assess TBSA burned, adjusted for age group.

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Superficial Burn

A burn that affects only the superficial epidermis, often with short-term pain and no blistering.

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Burn Scar Potential

The likelihood of developing hypertrophic scars or contractures after a burn injury.

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Xenograft

A graft using skin from another species, like bovine or pig.

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Allograft

A graft using skin from a human cadaver.

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Nonbiological skin-substitute

Biosynthetic dressings like Biobrane® used in wound care.

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Acute phase

The critical 72 hours post-injury focusing on infection control and grafting.

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Nonsurgical infection control

Maintaining wound care without surgical intervention.

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Escharotomy

Surgical removal of burned or dead skin to promote healing.

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Autograft

Skin transplant using the patient's own skin from another area.

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Meshed graft

A graft stretched and prepared to cover a larger area.

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Compression therapy

A treatment method using pressure to control edema and scar formation.

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Elastic bandages

Flexible bandages used to apply compression temporarily.

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Custom-made compression garments

Garments tailored to provide gradient pressure and support healing.

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Gradient pressure

Pressure that decreases from one area to another, aiding in fluid redisposition.

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Anticontracture positioning

Positioning strategies to prevent joint contractures in recovery.

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Dynamic splint

A type of splint that allows movement while providing support to prevent contractures.

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Skin lubrication and massage

Skin care techniques before exercises to improve skin health and flexibility.

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Therapeutic exercise

Exercises that are graded to improve strength and activity tolerance for healing.

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Adaptive Strategies

Techniques or tools used to promote independence in daily activities.

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Atypical Movement Patterns

Unusual ways of moving that need to be corrected for normal functioning.

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Skin Care Protocol

Guidelines for maintaining skin health, especially post-injury.

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Scar Management

Techniques used to treat and improve the appearance of scars.

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Posttraumatic Stress Disorder (PTSD)

Mental health condition triggered by traumatic experiences.

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Contracture

A permanent shortening of muscles or tendons, hindering movement.

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Hypertrophic Scar

A type of scar that is raised and often appears weeks after healing.

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Scar Formation

Scarring occurs due to increased vascularity and can be thicker than the original skin.

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Heterotopic Ossification

Formation of bone in abnormal locations, often around joints.

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Loss of ROM

Rapid decrease in range of motion and localized severe pain linked to heterotopic ossification.

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Pain Management

Essential for rehabilitation; scheduled interventions can improve therapy compliance.

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Skin Care Post-Burn

Important to educate on skin care to prevent damage during activity.

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Heat Intolerance

Loss of sweat glands can lead to difficulty in regulating temperature.

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Sun Exposure Risks

Increased risk of sunburn after burns due to skin damage.

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Boutonnière Precaution

Precaution to prevent composite flexion of fingers in dorsal hand burns.

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ROM to MP

Range of motion exercises for metacarpophalangeal joints with IPs straight.

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Sensory Testing

Assessment for peripheral nerve damage after wounds are closed.

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Electrical Burn Screening

Conducting a gross sensory screening on the limb post-electrical burn.

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Child-life Specialists

Professionals helping reduce fear and stress in treating children.

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Parental Emotional Impact

Parents may feel guilt or incompetence after child sustains a burn.

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Community-based Therapist

Therapist working in schools to assist children's reintegration post-burn.

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Study Notes

Burn Rehabilitation

  • General Considerations: Various resources, such as textbooks and online dictionaries, offer detailed information on burns and burn rehabilitation. These resources include information on skin anatomy, burn classifications by size, depth, and mechanism and different types of burns (superficial, partial-thickness, and full-thickness) as well as medical management.

Skin Anatomy and Definitions

  • Skin Layers: Skin consists of two layers: dermis (composed of collagen and elastin) and epidermis (outermost layer with varying thicknesses depending on location and skin type).

Burn Classifications

  • Burn Size: The Rule of Nines, a method for calculating total body surface area (TBSA) affected by burns, divides the body into sections representing 9% or multiples of 9%. The Lund-Browder chart is a more precise method accounting for variations in body size and age groups.

  • Burn Depth: Burn wounds are categorized based on clinical assessment of appearance (e.g., erythema, blisters), sensitivity, and pliability. This includes superficial burns (epidermal involvement), superficial partial-thickness burns (epidermal and partial dermis involvement), deep partial-thickness burns (epidermal and deeper dermis layers involved including hair follicles and sweat glands), full-thickness burns (all layers including nerve endings), and subdermal burns (involving underlying tissues like fat, muscles, and bone).

Medical Management

  • Initial (0-72 hours): Emergent care focuses on maintaining life, controlling infections, and managing pain. This includes intravenous fluids, intubation (if needed), surgical procedures like escharotomy and fasciotomy to relieve pressure. Wound dressings and antimicrobial ointments are used.

  • Sustaining life: Skin acts as a moisture barrier and the client may face dehydration risks depending on extent of burn. Hypo- or hyperthermia may be issues if the skin is no longer intact., Fluid resuscitation may also be needed for the body to regulate temperature.

  • Infection Control: Nonsurgical and surgical interventions may be needed to care for the wound

  • Grafts: Autografts (using the client's own skin as transplant), split-thickness skin grafts (using superficial layers of skin), and full-thickness skin grafts (using the deeper layers of skin from the client's intact skin) may be used. Skin graft methods depend on the condition, size, and injury of the burn site and are vital for repair.

Surgical Excision and Controlling Infection

  • Surgical excision of the eschars/incisions into the fascia can release pressure within the fascia compartments

  • Wound-dressing products protect the wound, superficially debride the wound and provide comfort (e.g., topical antibiotics, biologic dressings, and nonbiological skin substitutes).

Rehabilitation Phase

  • Acute Phase (0-72 hours to wound closure) Focuses on infection control and grafts, and biological dressings. Communication between medical providers and a team is critical.

  • Components from preceding phases:

  • Psychosocial support is crucial.

  • Occupational therapists manage components of preceding phases (such as pain management) and newly emerged needs.

  • Physical Evaluation: Obtain detailed history of burn etiology, medical and secondary diagnoses, wound assessment (extent, depth), joint mobility, strength, sensation, and functional limitations (ADL and IADL).

  • Positioning and Splinting: Anti-deformity positioning for prevention of contractures, splints, or positioning devices, and exercises to facilitate ROM (range of motion) are involved.

Activities of daily living, communication, cognition, and pain management are also crucial parts of the rehabilitation.

  • Contractures: These result from tight scars or immobilization and may limit joint movement. Treatment involves early intervention and ongoing anti-contracture positioning.
  • Hypertrophic scars: Form due to increased vascularity weeks to months after wound closure, becoming firmer and thicker than normal skin. Management includes compression therapy and ongoing care.
  • Heterotopic ossification: Bone forming in abnormal areas, often around joints, leading to loss of ROM.
  • Pain: Respect the client's pain and address it appropriately.
  • Psychosocial considerations: This stage of recovery can be emotionally challenging for the individual and their family.
  • Skin tolerance: Ensure the client can tolerate compression or adaptive clothing.

Postoperative Management

  • Immobilization:

    • Critical for graft adherence.
    • Duration varies, determined by the surgeon.
  • Positioning: Same or similar positions to maintain joint positioning are prescribed.

  • ROM and Exercise: Gentle, pain-free exercises maintain mobility and flexibility of unaffected body parts.

  • Wound Care: Maintaining proper wound care with appropriate dressings is vital for healing.

  • ADLs: Assisting with activities of daily living (ADLs) using adaptive equipment and training.

  • Psychosocial Support: Addressing any psychological distress is very important

  • Edema Management: Elevation, compression therapy, and/or specific devices are implemented to manage edema.

  • Scar Management: Managing scars during healing.

  • Pain Management: Addressing any pain or discomfort.

  • Therapies: Occupational and physical therapy is provided as part of treatment.

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