NBCOT Content

Superficial Burns

involves the superficial epidermis only

  1. Minimal pain and edema, but no blisters.

  2. Healing time is three to seven days (e.g., sunburn).

Superficial partial-thickness burn

  1. Involves the epidermis and upper portion of der mis (e.g., severe sunburn or radiation burn).

  2. Appearance, red, blistering, and wetl

  3. Painful, no grafting necessary, heals on its own.

  4. Healing time is 7-14 days.

Deep partial-thickness burn

  1. Involves the epidermis and deep portion of dermis, hair follicles, and sweat glands.

  2. Appearance: red, blotchy and white?

  3. Severe pain at burn site.

  4. Sensation may be impaired.

  1. Healing time is 21-35 days, May require skin grafts to hasten healing and minimize hypertrophic scarring.

  2. Because of the depth of the burn and the potential for hypertrophic scarring, deformities may develop.

Full-thickness burn

  1. Epidermis and dermis are completely damaged; hair follicles, sweat glands, and nerve endings also involved.

  2. Appearance: white, waxy, leathery, and nonelastic.

  3. Sensation is absent.

  4. Hypertrophic scar.

  5. Healing time can take months.

  6. Full-thickness burns require surgery; i.e., skin grafts (Kurakazu & Hira, 2018; Ozlie, 2021).

Full-thickness burns with complications

Electrical burns involve destruction of nerve along their pathway and damage to fat, muscle, and bone.

Burn Recovery Phases

Emergent phase: from initial burn injury to 72 hours

  • The focus during this stage is medical management

OT may be ordered for positioning and orthotic fabrication

Acute phase follows the emergent phase and continues until wounds are closed

a. Depending on the severity of the burns and the number of grafting surgeries this phase can lasts from 1 week to months

  1. The period after surgery for a skin graft is known as the perioperative period.

  2. Occupational therapy evaluation includes the fol-lowing.

  1. Occupational profile,

  2. ROMP

  3. Cognitive screens

  4. Pain

  5. Sensation, when wounds are healed

  6. Strength, when wounds are healed

  7. ADL, when possible

Occupational therapy intervention includes the following:

(1) Fabrication of anti-deformity orthoses as needed (e.g., for skin grafted areas)

(a) The person stays immobilized in the ortho-sis/orthoses for 5-14 days (as per the surgeon and graft type).

  1. ROM is contraindicated during this period. ROM is resumed when the surgeon/burn team determine the stability of the graft.

  2. Wound care may require debridement, sterile whirle pool, and dressing changes.

  3. Gentle AROM/PROM to the individual's tolerance. AROM is preferred.

  4. Edema control elevation and AROM.

  5. Basic ADI, such as feeding with a built-up utensil, may be started.

(7) Patient and family education

Rehabilitation phase: follows the acute phase and continues until scar maturation!

Occupational therapy evaluation: same as acute phase. Occupational therapy intervention the focus is to return the person to their prior level of functioning.

(1) Pain free A/PROM to prevent contractures. Passive. stretching 10 end range (blanching and no pain)

(2) Strengthenings using

therapeutic exercises and

functional, purposeful, occupation-based activities

(3) Scar managements once burns/wounds heal they are at risk for developing hypertrophic scar.

(a) Hypertrophic scar is disorganized collagen that can raise up, appear red, inelastic, and can develop cords; can be very disfiguring

• Scarring can continue for 1-2 years after

wounds heal

(b) A routine for scar management should include the following.

  • Massage? performed several times daily to improve cosmetic appearance and elasticity of the scar.

  • AROMI to reorganize disorganized scar tissues

  • Pressure therapy

  1. Orthotics, continue to monitor orthoses for any needed modifications.

  2. Sensations with skin grafts and as wounds heal, the person may experience hypersensitivity.

(a) Desensitization techniques

  1. Occupational role activities and ADL

  2. Psychosocial activities that are meaningful and that the person will be able to successfully achieve (Group therapy for social support)

Burn splints

Burns to the dorsal surface of hand = Intrinsic plus splint

  1. Wrist in 20°=30° extensiom

  2. MCP joints in 70° flexion. c.(IP joints in full extension.?

d. humb abducted and extended (Hock & DeMou,

2021).

Burns to the volar surface of hand = palmar extension splint.

a. Wrist in 0°-30° extension

b. MCP joints in neutral to slight extension ands abducted (monitor collateral ligaments).

  1. IP joints in full extension.

  2. Thumb abducted and extended.

Web space burn = Web spacer orthosis

Anti-contracture Positioning

  • Neck in extension with a towell to support

  • Knees extended

  • Shoulders abducted (120 degrees)

  • Elbows fully extended

  • Hips slightly abducted

  • Ankles in neutral to prevent drop foot

  • Hand/wrist in anti-deformity splint to prevent contractures (claw-hand)