Rehab: Burns

Burns – Key Concepts

Types of Burns & Related Diseases

  • Types of Burns: Heat, Chemical, Electrical, Frostbite

  • Diseases: Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis

  • Trends: Rules of 9s

  • Greater than 15% leads to hospitalization

  • Impact of PMH, chronic conditions

Burn Classification by Depth

Degree 

Skin Layer Affected

Description 

1st Degree

Epidermis 

Redness, mild pain

2nd Degree

Dermis

Blistering, moderate pain

3rd Degree 

Hypodermis (all layers) 

Full-thickness, may be painless due to nerve damage

Skin Anatomy 

  1. Epidermis: Environmental protection, temperature regulation

  2. Dermis: Contains keratinocytes (infection control)

  3. Subcutaneous/Fatty Tissue: Cushioning and insulation

Phases of Burn Recovery

Phase 

Timeline

Process 

OT Role

Inflammatory 

6 days or longer

Painful, vascular/cellular response, wound debridement

Positioning, edema management, pain control

Proliferation 

2 weeks or longer

Skin regrowth, vascularization, collagen deposition

Encourage gentle ROM, prevent contractures

Maturation 

Up to 2 years

Fibroblasts leave, collagen strengthens (80% of original strength)

Scar management, functional training

5. Scar Formation & Impact on Function

Hypertrophic Scars: Raised, thick, rigid → tightness & ↓ ROM
Keloid Scars: Thick, raised, extend beyond injury area, slow to develop, often unsightly

OT Role in Scar Management:

  • Team Members: MD, RN, PT/OT, RT, nutritionist, SW, psychologist, SLP, orthoptist, rec therapy, clergy, cultural support

  • Goals: Promote healing, prep for self-care, reinforce AROM, patient education

Phases of Care: Acute Care Phase, Surgical/Post-Op Phase, Rehab Phase, Reconstructive Phase

6. Complications of Burns & Functional Impact

  • Respiratory: Smoke inhalation, facial/internal damage

  • Infection Control: Sepsis prevention essential

  • Pain Management: Multimodal approach

  • Cardiovascular: Shock risk

Additional Complications:

Heterotopic Ossification → bone formation limiting joint movement
Neuromuscular issues → peripheral neuropathy from metabolic or infectious causes
Disfigurement → affects self-image and function

7. Psychological Implications of Burns

Scarring may cause social withdrawal and low self-esteem.

  • PTSD Stages:

    1. Impact: Immediate shock, disbelief

    2. Denial: Refusal to accept event

    3. Short-Term Recovery: Acceptance, initial coping

    4. Long-Term Recovery: Therapy/support groups aid reintegration

8. OT Role in Splinting for Burns

Continuous Use (Acute & Early Rehab):

  • Protect joints/tendons (especially full-thickness dorsal hand burns)

  • For uncooperative/unconscious patients

  • Post-skin grafting

  • Reduce edema and prevent contractures

Intermittent Use (Rehab & Beyond):

  • Maintain ROM gains

  • Alternate splints for burns on both sides of the hand

  • Night use for joint range maintenance

9. Early Mobilization in Burn Rehabilitation

  • Promotes healing, circulation, and ROM

  • Prevents stiffness and contractures

  • Supports psychological recovery and independence

10. OT Role in Wound Care & Prevention

Prevention:

  • Activity analysis, positioning, appropriate equipment usage, environmental modifications, and lifestyle/risk reduction- we can help keep skin intact.

  • Activities and roles- but ensuring it in a safe and skin-protecting manner is an area that many OTs can identify with.

Wound Management:

  • Monitor/observe skin condition

  • Accurate assessment and documentation

  • Educate clients on high-risk areas and self-monitoring

  • Positioning to prevent pressure and friction

Lifestyle Modification:

  • Address wounds while maintaining engagement in daily roles

  • Teach ongoing skin care after healing (self or caregiver-administered)

  • Support long-term prevention of re-injury

Additional Key Points

Burns involving >15% of body → hospitalization required
Rule of 9s: Used to estimate body surface area affected
PMH/Chronic Conditions: May complicate healing and rehabilitati