عن النعمان بن بشير ,قال: قال عن النعمان بن بشير ,قال: قال رسول اللة ص�لى اللة علية رسول اللة ص�لى اللة علية

وسلم : ” ترى المؤمنين فى وسلم : ” ترى المؤمنين فى تراحمهم , وتوادهم, وتعا تراحمهم , وتوادهم, وتعا طفهم، كمثل الجسد ,ا ذا طفهم، كمثل الجسد ,ا ذا

اشتكى عضوا, تداعى لة سائر اشتكى عضوا, تداعى لة سائر جسدة بالسهر و الحمى“ جسدة بالسهر و الحمى“

كتاب األدبكتاب األدب7878اخرجة البخارىفى –اخرجة البخارىفى –

Positioning Approach for Positioning Approach for Burned PatientsBurned Patients

Positioning Approach for Burned Positioning Approach for Burned PatientsPatients

Definition (s) of positioning. Definition (s) of positioning. Objectives of positioning program .Objectives of positioning program .

Indications for positioning of burned patients .Indications for positioning of burned patients .Basic and general concepts for positioning Basic and general concepts for positioning

program.program.Specific consideration in positioning program.Specific consideration in positioning program.

Procedures of positioning of different areas Procedures of positioning of different areas and techniques of application.and techniques of application.

Education and communication for teaching Education and communication for teaching positioning program .positioning program .

Positioning is awareness of relation Positioning is awareness of relation of different body parts to each of different body parts to each other and in relation to space.other and in relation to space.

Proper positioning can be defined Proper positioning can be defined as proper arrangement of different as proper arrangement of different body parts, that was necessary for body parts, that was necessary for

successful burn patients successful burn patients rehabilitation. rehabilitation.

Goals (Objectives) of positioningGoals (Objectives) of positioningTo minimize & control post burn edema . To minimize & control post burn edema . To facilitate good wound healing care and To facilitate good wound healing care and prevent contracture.prevent contracture.To prevent soft tissue destruction & maintain it To prevent soft tissue destruction & maintain it in an elongate state.in an elongate state.To maintain function ROM .To maintain function ROM .To prevent localized Neurological and To prevent localized Neurological and neuropathies deficit.neuropathies deficit.To facilitate function recovery. To facilitate function recovery.

N.B(1-5 STO) & (6-LTO)N.B(1-5 STO) & (6-LTO)

Indications for Positioning Burned Indications for Positioning Burned PatientsPatients

Loss of consciousness & ventilatory Loss of consciousness & ventilatory dependent patients.dependent patients.Patient's who is unable or unwilling to Patient's who is unable or unwilling to cooperate to exercises program.cooperate to exercises program.Children have difficulty to understand Children have difficulty to understand exercises procedures.exercises procedures.Immediate post-grafting and reconstructive Immediate post-grafting and reconstructive procedures.procedures.Complications may impose limitation or Complications may impose limitation or contractures.contractures.

General and Basic Principle for General and Basic Principle for Positioning of Burned patientsPositioning of Burned patients

Good and proper positioning program is effective for immobile and active Good and proper positioning program is effective for immobile and active patients.patients.

Burn will induce losses of motion, contracture, and scar, according to Burn will induce losses of motion, contracture, and scar, according to location, extent, depth, pain, prolonged period of immobility, delayed and location, extent, depth, pain, prolonged period of immobility, delayed and improper physical and occupational therapy.improper physical and occupational therapy.

Daily monitoring of the patients medical status , ROM, and Daily monitoring of the patients medical status , ROM, and skin conditions will assist the therapists in deciding how long skin conditions will assist the therapists in deciding how long positions are to be maintained and necessary modifications.positions are to be maintained and necessary modifications.

Positioning program must be individualized to the patients need and Positioning program must be individualized to the patients need and should be modified throughout hospitalizationshould be modified throughout hospitalization..

The basic role for positioning burned area is place and The basic role for positioning burned area is place and maintain the affected part in the opposite plan and direction maintain the affected part in the opposite plan and direction to which it will potentially contract.to which it will potentially contract.

Specific Consideration in Specific Consideration in Positioning Burned PatientsPositioning Burned Patients

Positioning program for post burn edema Positioning program for post burn edema reduction .reduction .

-Head and Neck edema .-Head and Neck edema . -Extremities Edema.-Extremities Edema.

Positioning following reconstructive surgeryPositioning following reconstructive surgery -Skin graft-Skin graft

-Reconstructive procedure for head &neck-Reconstructive procedure for head &neck -Ankle planter flexion contracture-Ankle planter flexion contracture

-Burn –Acquired deformities-Burn –Acquired deformities

Teaching and communication program for Teaching and communication program for positioning positioning

Burn team members who should bBurn team members who should b involved in involved in burned care, positioning programburned care, positioning programPhysicians.Physicians.Physical therapist.Physical therapist.Nursing staff.Nursing staff.CaregiversCaregiversFamily membersFamily members

Method for Teaching and communication Method for Teaching and communication for positioning programfor positioning program

Simple positioning diagram at bed side.Simple positioning diagram at bed side.Comprehensive positioning chart.Comprehensive positioning chart.Writing in medical record.Writing in medical record.Photographing the correct position Photographing the correct position Plastic slider holder to display diagrams Plastic slider holder to display diagrams Video displayVideo displayDirect patient and staff education during round. Direct patient and staff education during round. Batty stickers with pictures Batty stickers with pictures

This is second degree contact burns to a handThis is second degree contact burns to a hand

This is second and third degree contact burns to a handThis is second and third degree contact burns to a hand

.. Second Degree Hand Burn Second Degree Hand Burn

.. Second Degree Hand Burn Second Degree Hand Burn

I-Explained the Following Statements:-I-Explained the Following Statements:-A-Deep dermal burn sustained greater loss of A-Deep dermal burn sustained greater loss of

motion and contracture than with superficial motion and contracture than with superficial dermal burn, and put difficulties during dermal burn, and put difficulties during

positioning program.positioning program.

B-Daily monitoring of medical status, ROM, , and B-Daily monitoring of medical status, ROM, , and Skin conditions help therapists in deciding how Skin conditions help therapists in deciding how

long position and necessary modification during long position and necessary modification during rehabilitation process.rehabilitation process.

C- Location , extent and associated pain will C- Location , extent and associated pain will affect capacity to move and positioning program.affect capacity to move and positioning program.

II-Put (T) in front of correct sentence & (F) in front of II-Put (T) in front of correct sentence & (F) in front of false one:-false one:-

1-Positioning program must focus on edema 1-Positioning program must focus on edema reduction rather than maintaining anti-contracture reduction rather than maintaining anti-contracture

during acute phase.during acute phase.

2-Edema of head and neck causing upper airy way 2-Edema of head and neck causing upper airy way obstructions.obstructions.

3-Positioning & splinting must be delayed during 3-Positioning & splinting must be delayed during emergency phase until statistic edema formation.emergency phase until statistic edema formation.

4-In asymmetrical neck burn ,use of environmental 4-In asymmetrical neck burn ,use of environmental stimuli encourage correction of faulty positionstimuli encourage correction of faulty position

5-The use of donut is recommended in case of head 5-The use of donut is recommended in case of head &neck burn&neck burn

6-Elevation and positioning should maintain even 6-Elevation and positioning should maintain even while patient isambulating .while patient isambulating .

7-Positioning program must be individualized and 7-Positioning program must be individualized and modified to the patients need.modified to the patients need.

8-Patients with the acceptable ROM and good skin 8-Patients with the acceptable ROM and good skin condition require positioning for 24 hours.condition require positioning for 24 hours.

9-Asymmetrical trunk burn will induce scoliosis with 9-Asymmetrical trunk burn will induce scoliosis with concavity opposite to burn site.concavity opposite to burn site.

10-Lateral neck burn will induce tertecollis for 10-Lateral neck burn will induce tertecollis for children.children.

III-Complete the Following Statements:- III-Complete the Following Statements:- A-Peroneal neuropathy may occur secondary to;A-Peroneal neuropathy may occur secondary to;

1-……………………………………………………………………...1-……………………………………………………………………...2-……………………………………………………………………...2-……………………………………………………………………...3-……………………………………………………………………...3-……………………………………………………………………...4-……………………………………………………………………...4-……………………………………………………………………...

B-Indication for positioning program includeB-Indication for positioning program include1-……………………………………………………………………...1-……………………………………………………………………...2-……………………………………………………………………...2-……………………………………………………………………...3-……………………………………………………………………...3-……………………………………………………………………...4-……………………………………………………………………...4-……………………………………………………………………...

C-Improper position of upper extremity with complete extension of elbow predispose C-Improper position of upper extremity with complete extension of elbow predispose to …………………………&…………………………to …………………………&…………………………

D- The objective of positioning program following reconstructive phase areD- The objective of positioning program following reconstructive phase are1-……………………………………………………………………...1-……………………………………………………………………...2-……………………………………………………………………...2-……………………………………………………………………...3-……………………………………………………………………...3-……………………………………………………………………...

E-Halo neck splint can be used following neck contracture release to keep child E-Halo neck splint can be used following neck contracture release to keep child ……………………………………………………………………………………………………………………………………

F- To correct planter flexion contracture therapist can use ..................F- To correct planter flexion contracture therapist can use ..................…………………………………………………………………………………………………………………………………………………………....

III-Complete the Following Statements:- III-Complete the Following Statements:- G- Skeletal suspension can be used to …………………………………..G- Skeletal suspension can be used to …………………………………..

………………………………………………………………………………...&…………………………………...&…………………………………H-Positioning of head and neck in extension should be delayed until H-Positioning of head and neck in extension should be delayed until

maintaining of …………………………………………………………....maintaining of …………………………………………………………....I-Methods of teaching positioning program includeI-Methods of teaching positioning program include

1-……………………………………………………………………...1-……………………………………………………………………...2-……………………………………………………………………...2-……………………………………………………………………...3-……………………………………………………………………...3-……………………………………………………………………...4-……………………………………………………………………...4-……………………………………………………………………...

J-The neuropathic deficit may occur secondary toJ-The neuropathic deficit may occur secondary to1-……………………………………………………………………...1-……………………………………………………………………...2-……………………………………………………………………...2-……………………………………………………………………...3-…………………………………………………………3-…………………………………………………………

K- Brachial plexus neuropathy may results fromK- Brachial plexus neuropathy may results from1-……………………………………………………………………...1-……………………………………………………………………...2-……………………………………………………………………...2-……………………………………………………………………...3-……………………………………………………………………...3-……………………………………………………………………...4-……………………………………………………………………...4-……………………………………………………………………...