Burn
Rehabilitation

Burn rehabilitation is a very difficult and time consuming process and must begin at the outset of burn care to achieve optimal long-term function. Treatment goals and strategies vary, depending on the patient's injury, stage of treatment, age, and comorbidities. Burn rehabilitation is focused on minimizing loss of range of motion, establishing a work-hardening program after recovery and ultimately reintegrating the patient into the home and community. The importance of early and active focus on long-term rehabilitation goals cannot be overemphasized. Physiotherapy support patients through the rehabilitation phase using specialized physiotherapy handling techniques. Our program is a supplement to outpatient therapy available through the hospital but which is never adequate to achieve full recovery after a burn. 

Burn rehabilitation can may be divided into the following four general phases. Phase I involves initial evaluation and resuscitation. Phase II focused on initial wound excision and biologic closure. Definitive wound closure happens in Phase III. Phases I to III typically occurs in a hospital Burn Care Unit. Phase IV includes

rehabilitation, reconstruction, and reintegration stage. A study of over 90 patients who survived large burns found that an average of 17 years following the burn injury, patients continued to report joint pain and stiffness, as well as difficulty in walking or running, fatigue, and weakness in the arms and hands. Moreover, 68 out of 93 patients (73%) had limited motion, including in the neck (47%), hands (45%), and arm pit (38%).

As you recover from critical illness and the wounds progressively close, our physiotherapist will help you become more aware of what has happened to you, and reduce your fears with participating in rehabilitation due to the associated and potentially uncomfortable treatment procedures. The principal components of burn therapy that characterize burn physiotherapy includes the following:

• Progressive stretching and strengthening

• Evaluation of evolving problem areas

• Specific postoperative therapy after reconstructive operations

• Scar management

​Burn physiotherapy play a central role in planning and performing reconstructive procedures in the months and years after acute discharge. It helps to identify needed surgeries, plan sequencing of surgeries and educating patients and families about perioperative care. Planning appropriate postoperative rehabilitation activities helps patients to optimize surgical outcome.

During the consultation with your physiotherapist, an extensive assessment would be be completed to and involves evaluating various aspects to determine the extent of injury, functional limitations, and your specific needs. The key components typically involved in a burn rehabilitation assessment includes:

• Medical History and Initial Assessment including burn severity, associated Injuries and any concurrent injuries or conditions, and pre-existing conditions.

• Physical Examination focused on the wound, range of motion targeting joint mobility and function affected by burn scars and contractures, and strength and function.

• Psychosocial Assessment to evaluate emotional and psychological adjustment to the burn injury, social support system and potential barriers to recovery, coping strategies for pain, stress, and rehabilitation challenges.

• Pain Assessment in terms of pain levels and management strategies and their effectiveness.

• Functional Assessment including Activities of Daily Living (ADLs), and work and leisure Activities. 

• Scar Assessment to evaluate scar characteristics and contractures limiting range of motion.

• Weight and BMI monitoring to identify changes in weight and body mass index, which can affect healing.

• Formulation of rehabilitation goals that are patient-centered, SMART, and functional to improve mobility, independence, and quality of life.

• Team Assessment and Care Planning by collaborating with specialists such as burn surgeons, physiotherapists, occupational therapists, psychologists, and dietitians.

• Creating an individualized rehabilitation plan based on assessment findings and patient goals.

• Follow-Up and Monitoring by regularly assessing progress towards rehabilitation goals and modifying the rehabilitation plan as needed based on patient response and changes in condition.

Each component of the assessment contributes to a comprehensive understanding of the patient's needs and guides the development of an effective burn rehabilitation program tailored to their specific requirements.