Morbidity from burn scars can include contractures, amputations, chronic pain, hypertrophic scarring, and psychological sequelae. To minimize these, a strategic rehabilitation protocol is implemented to help patients return home and participate in the activities of daily living. An optimal rehabilitation strategy may be divided into phases: acute burn rehabilitation, late acute rehabilitation, and long-term rehabilitation. Management of burn scar–associated pain is particularly crucial for patients.
With advances in burn resuscitation, infection control, and early debridement there has been an increase in the survival of patients who suffer from severe burn injury. In the pediatric population, patients with a 99% total body surface area (TBSA) now have a mortality risk of 50%.1 Morbidity from these injuries, however, is significant and requires long-term therapy (both physical and occupational). These patients often have contractures, amputations, chronic pain, hypertrophic scarring, and psychological sequelae from their initial injury that require multiple, repeated revisional surgical procedures, readmissions with prolonged hospital stays, and aggressive therapy. The ultimate goal for these patients is to return home and be able to participate in activities of daily living. To help patients achieve this, burn centers must have a strategic rehabilitation protocol to prevent the known long-term effects of burn injury. Furthermore, many of these patients suffer from severe pain following their injuries, which can limit their quality of life as well. Preventive strategies are paramount and should be implemented starting from the day of admission.
ACUTE BURN REHABILITATION
Contractures over joints are particularly debilitating, as they lead to a decrease in range of motion (ROM), deformities, and ultimately disability. Prolonged immobility following burn injury leads to skin contractures, shortening of tendons and muscles across joints, and long-term disabilities.2 Patients at increased risk for contractures are those with a longer hospital stay, higher TBSA, inhalation injury, and those with amputations.3 The principles of prevention are similar all over the body and include patient positioning, splinting, pressure, and ROM exercises. Splinting is a common intervention to prevent contractures and has been shown to correct contracture deformities in combination with serial casting.4 Splints should be inspected on a regular basis to evaluate for proper fit, function, and any signs of skin breakdown. The length of time a patient should wear a splint and the effectiveness of different splinting devices have not been well studied. In general, nurses or physical therapists should perform passive ROM of all joints twice daily.2 More recent data also suggest that the duration of tissue elongation may be more important than the number of times therapy is implemented. Premedication can also decrease pain and prevent anxiety surrounding ...