OT Skills for working with the Burn/Wound Population
Transcript of OT Skills for working with the Burn/Wound Population
![Page 1: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/1.jpg)
OT Skills for working with the
Burn/Wound Population
2021 KOTA Conference
Olathe, Kansas
![Page 2: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/2.jpg)
Burns in the United States
• Every year there are approximately 450,000 burns that require medical treatment
• 60% of those burns are seen in the 128 Burn Center in the U.S.
• Most common types of burns happen at home or at work/businesses
• Most common burns are scalds (hot liquid or steam), building fires and flammable liquids/gases. Inhalation injuries accompany many of those that are indoors
9/22/2021 2
![Page 3: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/3.jpg)
Depth of Injury
• The depth of the injury is not determined solely at the
time of the accident.
• Changes in the depth may occur as a result of infection or
vascular compromise.
9/22/2021 3
![Page 4: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/4.jpg)
Depth of Burn Classification
• Superficial 1st degree
• Partial thickness
➢Superficial Partial Thickness 2nd degree
➢Deep Partial Thickness 2nd degree
• Full Thickness 3rd degree
• Deeper Structures 4th degree
![Page 5: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/5.jpg)
Layers of skin
![Page 6: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/6.jpg)
First Degree
• Erythema
• No blisters
• Sensation is present
• Wound can heal
spontaneously
![Page 7: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/7.jpg)
Second Degree
• Erythema - deep red
• Blisters present, wet &
weeping
• Sensation present - very
painful
• Edema present
• Wound can re-epithelialize
in 14-20 days
9/22/2021 7
![Page 8: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/8.jpg)
Second degree: superficial partial thickness burns
• Erythema - deep red
• Blisters present, wet &
weeping
• Sensation present - very
painful
• Edema present
• Wound can re-epithelialize in
14-20 days
![Page 9: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/9.jpg)
Second degree: Deep Partial Thickness Burn
• Less wet and red +/-
blisters
• Minimal pain
• Wound can re-
epithelialize in 3-8
weeks with risk of
scar formation
9/22/2021 9
![Page 10: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/10.jpg)
Third Degree• Color is white/brown , charred, leather
like appearance
• No blisters
• Area is insensate to touch, but is painful
• Wounds require skin grafting
9/22/2021 10
![Page 11: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/11.jpg)
Fourth Degree
• Involvement of muscle, tendon, bone and fascia or exposure of deep structures
• Will often require local of distant tissue flaps for reconstruction-skin grafts must have a good bed for survival
• Often requires amputation of involved extremity or digit
9/22/2021 11
![Page 12: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/12.jpg)
Wounds: open areas
• Size/Area: measured in square cm for wounds (tunneling/shelving/lip, concave/convex +1, analog of clock, 12 o’clock at head); TBSA% (total body surface area) for burns
• Edema: min/mod/max, pitting vs non pitting
• Drainage: serous(clear), serosanganous(blood tinted), purulent (infection)
• Color: pink,red,black, with eschar, granulation/budding
• Moisture: dry/moist
• Infection: redness beyond boundaries, warm to touch,runningfevers, increased pain, swelling, purulent drainage, foul smell
• Other: amputations, tendons exposed, broken bones, vascularity9/22/2021 12
![Page 13: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/13.jpg)
Wound Healing Process
The cellular process begins from injury to full healing
This may take years!
9/22/2021 13
![Page 14: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/14.jpg)
Three Phases of Healing
• Inflammatory phase
• Proliferative phase
• Remodeling phase
9/22/2021 14
![Page 15: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/15.jpg)
Inflammatory phase
• When an injury occurs, different cells go into action
➢Platelets- assist with blood circulation and clotting injured vessels
➢Neutrophils- cleans the wounds
➢Macrophages: initiated angiogenesis, debrides wound to allow scar formation (Angiogenesis is the new blood vessel formation)
➢Fibroblasts- Protein fibres (collage-scar tissue)
➢Myofibroblasts- contains actin and myosin contractile system
9/22/2021 15
![Page 16: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/16.jpg)
Inflammatory Stage
9/22/2021 16
![Page 17: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/17.jpg)
Proliferative Phase
• Begins 3–5 days post injury and can continue up to 21
days
• Injury becomes shiny new tissue
• New capillaries form, supplies oxygen and nutrients to
allow healing
• If too aggressive and create bleeding – can go back to
inflammatory phase -
9/22/2021 17
![Page 18: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/18.jpg)
Proliferative Phase (continued)
• Fibroblasts continue to produce the skin network, which is
the scaffolding which supports blood vessel and tissue
growth
• The network includes elastin and collagen
– Elastin is fibers that stretch and recoil
– Collagen is the most dominant connective tissue
• Re-epithelialization
– Reforming intact epidermis (skin), very fragile
9/22/2021 18
![Page 19: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/19.jpg)
Proliferative Stage
9/22/2021 19
![Page 20: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/20.jpg)
Remolding Phase
• This phase can last from 6 months to 3 years post injury
• Collagen becomes stronger
• The collagen is a necessary evil, need it to heal but can
be a hindrance
• Starts out very vascular (immature scar) to avascular
(mature scar).
9/22/2021 20
![Page 21: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/21.jpg)
Remolding Phase (continued)
• Scar tissue doesn’t know to form the nice flat matrix we
were born with. It forms in bundles which can create
raised scars (hypertrophic).
• Collagen tissue 80% as strong as normal tissue
• During this phase you have collagen breakdown and
production
– If breakdown rate is greater than production – flat scar
– If breakdown is less than production – hypertrophic scar
9/22/2021 21
![Page 22: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/22.jpg)
Remodeling Stage
9/22/2021 22
![Page 23: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/23.jpg)
Scar Formation (happens as wound closed)
• Normal process to heal is through scarring
• Scarring is the fibrous tissue replacing normal tissues
• Goal is to minimize hypertrophic scars - improve
cosmesis, maintain full rom/function, and prevent
painful/itchy scars
9/22/2021 23
![Page 24: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/24.jpg)
Burn scars
• Hypertrophic scarring occurs within 4-8 weeks from
wound closure
• It has a rapid growth phase for upto 6-9 months
• Hypertrophic scars often develop in automatic location
with high tension
9/22/2021 24
![Page 25: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/25.jpg)
Ideal Scar
– Flat
– Supple
– Light in color
(vascularity)
– Regimentation to
natural color
9/22/2021 25
![Page 26: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/26.jpg)
Hypertrophic Scar
• Red, elevated, itchy, painful
• Stays within boundaries of wound
9/22/2021 26
![Page 27: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/27.jpg)
9/22/2021 27
![Page 28: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/28.jpg)
Factors Affecting Scar Formation
▪ 1. race= darker pigmented races scar more , 15 times
more likely to occur in darker-skinned individuals
▪ 2. age= tend to develop more readily during and after
puberty, pregnancy can exacerbate scarring.
▪ 3. location (sternum, deltoid region, buttocks scar more)
▪ 4. depth (deeper burns that involve the reticular dermis
scar more d/t the formation of granulation tissue and
prolonged healing time.
▪ 5. Individuals with ginger hair and freckles are also at an
increased risk of hypertrophic/keloid scars
9/22/2021 28
![Page 29: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/29.jpg)
Emphasis for Early ManagementHome, Rehab, or Skilled Facility
• Scar Management is Key!!!!
➢Compression
➢Scar Massage
➢ROM
➢Splinting
➢Desensitization
➢Sun Precautions
➢Pain
9/22/2021 29
![Page 30: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/30.jpg)
ADL’sOccupational Therapy Goals
![Page 31: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/31.jpg)
ADL Goals
• Increase functional independence
• Increase ROM and strength / endurance
• Combines with mobility goals when OOB
9/22/2021 31
![Page 32: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/32.jpg)
ADL’s/functional activities (FIM SCORES)
• Adaptive Equipment
– Built up handles
– Coban to drink cups
– Scoop plates
– Long straws
Be careful with Reacher, long handles, sock aides; Work more on stretching.
Same thing goes with walkers, canes.
9/22/2021 32
![Page 33: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/33.jpg)
ADL’s/functional activities (FIM SCORES)
• If we maintain the range of motion; the function will follow.
• If we compensate; we can cause or emphasize the
contracture and make surgery a definite for our patients
later
9/22/2021 33
![Page 34: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/34.jpg)
ADL’s/functional activities (FIM SCORES)
• Provide light built up
handles but be careful
with extending the
handles, Not needed in
left hand. Can also put
tubing in thumb web of
splint and still move
elbow/shoulder on her
right.
9/22/2021 34
![Page 35: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/35.jpg)
PLAY
9/22/2021 35
![Page 36: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/36.jpg)
Incorporate IADL
9/22/2021 36
![Page 37: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/37.jpg)
9/22/2021 37
![Page 38: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/38.jpg)
9/22/2021 38
![Page 39: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/39.jpg)
Treatment
• Night splints- PRAFO/night time progressive splints
• Towel stretches
• Standing stretches
• Refer to PT with continued problems/not progressing
9/22/2021 39
![Page 40: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/40.jpg)
Early mobility/ambulation/ADL
• Early mobility recommended
• Dependent position: inadequate venous returns, edema,
tissue engorgement, pain, bleeding
• Figure of 8 ace wraps/elastic bandages, or compresso
grips can help prevent the above. Always have
compression on for standing/walking
• Also, ROM exercises pre ambulation helps decrease the
throbbing pain in distal LE with dependent position
9/22/2021 40
![Page 41: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/41.jpg)
Transfers/self care mobility• Must have compressions on donor sites
• May need to consider platform if UE involve
• Initiate out of bed mobility as early as possible
9/22/2021 41
![Page 42: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/42.jpg)
Transfers/self care mobility
9/22/2021 42
![Page 43: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/43.jpg)
Contractures
• Eyelids
• Mouth
• Neck
• Axilla
• Elbow
• Palmar hand burns
• Knees
• Ankle
• Toes
9/22/2021 43
![Page 44: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/44.jpg)
Contractures and Considerations for Treatment
9/22/2021 44
![Page 45: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/45.jpg)
Eye Lids
9/22/2021 45
![Page 46: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/46.jpg)
Axilla
9/22/2021 46
![Page 47: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/47.jpg)
Hand contractures
9/22/2021 47
![Page 48: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/48.jpg)
Burn Claw Hand – 5th digit most common
9/22/2021 48
![Page 49: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/49.jpg)
• Check range of motion in all planes. It might appear good
in sitting position, but it may be limited in supine
• Don’t forget the mouth, eyes ROM
• Make them touch themselves to massage and have the
family demonstrate massage. Will the helper really be
around?
9/22/2021 49
![Page 50: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/50.jpg)
Neck contracture
9/22/2021 50
![Page 51: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/51.jpg)
Neck contracture
9/22/2021 51
![Page 52: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/52.jpg)
Neck contracture
9/22/2021 52
![Page 53: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/53.jpg)
Arm and trunk Contractures
9/22/2021 53
![Page 54: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/54.jpg)
Arm and trunk Contractures
9/22/2021 54
![Page 55: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/55.jpg)
Elbow contracture
9/22/2021 55
![Page 56: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/56.jpg)
Elbow and knee contracture
9/22/2021 56
![Page 57: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/57.jpg)
Knee contracture
9/22/2021 57
![Page 58: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/58.jpg)
Treatment Techniques
9/22/2021 58
![Page 59: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/59.jpg)
ROM & Exercise
• ROM should be performed EVERY DAY! Contractures can
form in 1 - 3 days.
• It’s best during bathing
• ROM is usually extremely PAINFUL.
• Pain control is a team effort !
9/22/2021 59
![Page 60: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/60.jpg)
ROM & Exercise (continued)
• Prevent skin contractures
• Maintain joint integrity
• Maintain tendon gliding
• Prevent adhesions
• Reduce edema
9/22/2021 60
![Page 61: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/61.jpg)
9/22/2021 61
![Page 62: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/62.jpg)
Paraffin
9/22/2021 62
![Page 63: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/63.jpg)
Fine motor activities
9/22/2021 63
![Page 64: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/64.jpg)
9/22/2021 64
![Page 65: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/65.jpg)
9/22/2021 65
![Page 66: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/66.jpg)
Scar Massage • Place a small amount of lotion on the area to be massaged.
• Use 2 fingers placed close together to do the massaging.
• Use firm circular motions deep enough to turn the scar from pink to
white. This is known as ‘blanching‘.
• You may also massage in a side -to-side motion. The area you massage
should be placed on stretch as instructed in clinic.
• Focus on areas that are already developing small, hard, raised and firm
scars.
• Massage scars for at least 10 minutes, 2-3 times a day.
• Scar massage should be continued until the scars have matured, which
can be anywhere from 9-18 months.
• Wearing compression along with scar massage is key to preventing
and/or minimizing scar bands and raised scars66
![Page 67: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/67.jpg)
Compression Options
9/22/2021 67
• Isotoner gloves
• Compressogrip/Tubigrip
• Ace wraps
• Coban
• Compression masks for
face/head
• Interim garments
(lycra/spandex
readymade
shirts/shorts/pants
• Custom compression
garments at outpatient
level
![Page 68: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/68.jpg)
9/22/2021 68
![Page 69: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/69.jpg)
9/22/2021 69
![Page 70: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/70.jpg)
9/22/2021 70
![Page 71: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/71.jpg)
Desensitization
• As the nerves regenerate, patients will complain of
increased pain, neuropathy which can be addressed both
pharmacologically as well as non pharmacologically
• Massage, massage, massage
• Neurontin, Lyrica
9/22/2021 71
![Page 72: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/72.jpg)
Splinting, braces, collars
• Position to prevent contractures
• Protect a new graft (4-5 days)
• Range of motion is decreasing
• Common Splints/braces: next few slides
9/22/2021 72
![Page 73: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/73.jpg)
Night time extension splinting
9/22/2021 73
![Page 74: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/74.jpg)
Wrap in fist position to tolerance 15-20 minutes
9/22/2021 74
![Page 75: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/75.jpg)
Soft neck collar to prevent neck contractures
9/22/2021 75
![Page 76: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/76.jpg)
9/22/2021 76
![Page 77: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/77.jpg)
Mouth splints/device
9/22/2021 77
![Page 78: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/78.jpg)
9/22/2021 78
![Page 79: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/79.jpg)
Risk for hand contractures contracture
9/22/2021 79
![Page 80: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/80.jpg)
Intrinsic plus splint: to maintain optimal position
9/22/2021 80
![Page 81: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/81.jpg)
Risk for webspace contracture: Web spacer splint to
prevent contracture
9/22/2021 81
![Page 82: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/82.jpg)
Risk for knee flexion contracture: Knee immobilizer
to prevent contracture
9/22/2021 82
![Page 83: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/83.jpg)
Risk for Ankle plantar flexion contracture:
PRAFO to prevent ankle contracture
9/22/2021 83
![Page 84: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/84.jpg)
9/22/2021 84
![Page 85: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/85.jpg)
Who Do You Call? ☺
• Problems or concerns when the patients are on the Rehabilitation
Unit, you may call the burn therapists or the Burn Unit/physicians.
•
• Anushree Sharma, OTR/L
• Anne Schwartz, DPT
• Traci Edwards, OTR/L
• BURN REHAB 588-6542
• BURN UNIT: 588-6540
9/22/2021 85
![Page 86: OT Skills for working with the Burn/Wound Population](https://reader035.fdocuments.us/reader035/viewer/2022081404/62932e88e4a8d3242f462a8c/html5/thumbnails/86.jpg)
QUESTIONS??
9/22/2021 86