Burn Injuries - Types, Rehabilitation, Protocol, and Physiotherapeutic Interventions

Introduction:

Rehabilitation for burn patients should begin on the day of injury to prevent unwanted complications. The patient is evaluated for functional status before starting the rehabilitation protocol. The main aim of the rehabilitation process is to restore the form and function of the burnt areas. The scar formation is reduced, and any deformity can be prevented by immediate rehabilitation. Physical therapy helps to keep the integrity of the individual and enhance the quality of life post-burn injuries.

How Do Burns Occur?

Burns can be prevented by checking the cautious factors that can lead to burns. They are:

• Unsafe cooking devices.

• Gas cylinders, connecting pipes, and regulators that are leaking.

• Crowded houses and overcrowded kitchens.

• Cooking on the floor.

• Economically weaker status of the families.

• Unsafe cooking methods like using a kerosene stove.

• Chemicals that are kept in unsafe places.

• Homes close to high-tension wires can cause electrical burns.

• Wires and sockets that are unsafe.

• Use of unauthorized electronic gadgets.

What Are the Common Types of Burn Injuries?

1. Flame Burns: Accidental leaking of cylinder or gas pipe, and sometimes because of kerosene stove, can lead to flame burns. Burn occurs due to kerosene vapor getting sprayed on the face, clothes, and nearby items that complicate the existing burn injury.

2. Scalds: Scald is a common burn in children. Accidental exposure to hot liquids that may spill on the child is the cause of scalds.

3. Electrical Burns: It is mostly seen in overcrowded places with defective electrical sockets and by throwing a live wire onto a high-tension electric cable. Other than this, unsupervised children can become victims of electric burns that occur because of exposed wires or short circuits.

4. Chemical Burns: Accidental burns that occur as a result of spillage of strong acids like sulfuric and nitric acid. Chemical burns can be devastating as they can lead to loss of vision and appearance, sometimes leading to death.

How Is the Rehabilitation Protocol Done for Burns?

Rehabilitation is started as soon as possible after the accident and lasts for a long time, and there is no specific duration span for the rehabilitation. It is, however, done in the early and late stages

1. Early Rehabilitation: This is known as the wound healing phase. The following are done in this phase:

• Breathing and chest clearance are promoted by placing the patient’s head and chest at a raised level using a pillow. Deep breathing exercises, postural drainage, suctioning, coughing, and percussion are some of the methods used to clear the secretions that are in excess.

• Wound dressing and debridement are done to prevent the injury from getting infected.

• For pain relief, transcutaneous electrical nerve stimulation (TENS) is used. Analgesics are also given as pharmacological therapy.

• Early ambulation (movement) is encouraged in patients to prevent the occurrence of deep vein thrombosis.

• Early mobility and bed transfers in cases of serious injuries will help prevent pressure sores.

• Affected limbs also have to be kept elevated to prevent the formation of edema and also to prevent the injured sites from deepening.

• Proper positioning and splinting can help prevent stiffness and contractures. When the patient has undergone graft surgery, then immobilization is encouraged. In cases otherwise, ambulation and range of motion exercises are encouraged based on their consciousness level. Based on the organs affected and the deformity being caused, the patient can be positioned using the following techniques.

Positioning Techniques:

• Head and Neck: If there is a flexion deformity, the patient is placed in a slight hyperextended position or extended pose to prevent contracture. For this, a towel is rolled and placed under the neck.

• Elbow: If there is a flexion deformity, the patient is placed in a slightly extended or supine pose to prevent contracture. For this, arm troughs, splints, or pillows are used.

• Hip: If there is a flexion and external rotation deformity, the patient is asked to extend the fingers of the wrist and fingers to prevent contracture. For this purpose, the patient is asked to lie in supine or prone positions.

• Knee: If there is a flexion deformity, the patient is placed in an extended pose to prevent contracture. No pillows must be kept under the knees.

• Wrist and Fingers: If there is a flexion deformity, the patient is placed in a position where the hip is extended, and the lower limb is in a neutral position to prevent contracture. For this, arm troughs, splints, or pillows are used.

• Ankle: If there is a plantar flexion deformity, the patient is placed in a 90-degree dorsiflexed ankle posture to prevent contracture. Splints or pillows must be kept to support the ankle.

2. Late Rehabilitation: This is called the post-healing phase. The following are done in this case:

• Muscle strengthening exercises are incorporated in this stage to restore the form and function of the affected muscles.

• Other physical exercises that focus on balance, endurance, and coordination are also focused on in this phase.

• Patients are encouraged to move with assistance or no assistance based on the progression of healing.

• Functional activities are being incorporated into the rehabilitation protocol to improve the quality of life of the patients.

• Patients will develop independence at the end of the rehabilitation.

What Are the Various Physiotherapeutic Interventions Used in Treating Burns?

1. TENS (Transcutaneous Electrical Nerve Stimulation): Electrical stimulation is done at the affected areas to provide pain relief and prevent itching.

2. Therapeutic Exercises: Muscle strength and range of motion are improved by regular therapeutic exercises.

3. Hydrotherapy: Range of motion exercises are done in water to improve mobility and reduce pain.

4. ESWT (Extracorporeal Shock Wave Therapy): Traditional therapy, along with low-energy ESWT, can be used to relieve burn injuries, and the scar tissue appearance is also improved. Functional mobility and improved range of motion are also brought about through ESWT.

5. Paraffin Wax Therapy: They are applied to the extremities to prevent contractures and improve the range of motion.

6. Laser Therapy: Laser ablation has been used to treat scarred skin due to burns. The cellular vascularity and pliability in the burnt area are improved through laser therapy.

7. Scar Tissue Massage: Scar tissue massage techniques help improve the pliability of scar tissue in burnt areas.

8. Music Therapy: Music therapy has been proven to reduce anxiety and muscle tension and also helps in pain reduction.

9. Virtual Reality: Minor limb burns can be treated through virtual reality, a three-dimensional video game.

10. Robotics: Patients are trained for proper gait and improve gait functions through robot-assisted training.

Conclusion:

Many innovations have helped quicker rehabilitation for a wide range of disabling conditions. Burn injuries have to be taken seriously, and immediate rehabilitation should be started to prevent the occurrence of deformity and loss of function. Scarring and contractures can also be prevented through physiotherapy.