A Clarion to Recommit and Reaffirm Burn Rehabilitation

Richard, Reg; Hedman, Travis L.; Quick, Charles; Barillo, David J.; Cancio, Leopoldo C.; Renz, Evan M.; Chapman, Ted T.; Dewey, William S.; Dougherty, Mary Ellen; Esselman, Peter C.; Forbes-Duchart, Lisa; Franzen, B; Hunter, Hope; Kowalske, Karen; Moore, Merilyn L.; Nakamura, D. Y.; Nedelec, Bernedette; Niszczak, Jonathan; Parry, Ingrid; Serghiou, M.; Ward, Robert S.; Holcomb, John B.; Wolf, Steven E.

doi:10.1097/bcr.0b013e318171081d

Cited by 51 publications

(29 citation statements)

References 39 publications

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“…But still, fifteen years after the first call for change, the Guidelines for the Operation of Burn Centers [91] do not speak to these matters in any detail. Richard and twenty-two other authors [92] described the situation in some detail but suggestions to remedy the situation were sketchy. There are many possibilities but several warrant discussion.…”

Section: Discussionmentioning

confidence: 99%

Harborview Burns – 1974 to 2009

et al. 2012

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BackgroundBurn demographics, prevention and care have changed considerably since the 1970s. The objectives were to 1) identify new and confirm previously described changes, 2) make comparisons to the American Burn Association National Burn Repository, 3) determine when the administration of fluids in excess of the Baxter formula began and to identify potential causes, and 4) model mortality over time, during a 36-year period (1974–2009) at the Harborview Burn Center in Seattle, WA, USA.Methods and Findings14,266 consecutive admissions were analyzed in five-year periods and many parameters compared to the National Burn Repository. Fluid resuscitation was compared in five-year periods from 1974 to 2009. Mortality was modeled with the rBaux model. Many changes are highlighted at the end of the manuscript including 1) the large increase in numbers of total and short-stay admissions, 2) the decline in numbers of large burn injuries, 3) that unadjusted case fatality declined to the mid-1980s but has changed little during the past two decades, 4) that race/ethnicity and payer status disparity exists, and 5) that the trajectory to death changed with fewer deaths occurring after seven days post-injury. Administration of fluids in excess of the Baxter formula during resuscitation of uncomplicated injuries was evident at least by the early 1990s and has continued to the present; the cause is likely multifactorial but pre-hospital fluids, prophylactic tracheal intubation and opioids may be involved.Conclusions1) The dramatic changes include the rise in short-stay admissions; as a result, the model of burn care practiced since the 1970s is still required but is no longer sufficient. 2) Fluid administration in excess of the Baxter formula with uncomplicated injuries began at least two decades ago. 3) Unadjusted case fatality declined to ∼6% in the mid-1980s and changed little since then. The rBaux mortality model is quite accurate.

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Section: Discussionmentioning

confidence: 99%

Harborview Burns – 1974 to 2009

et al. 2012

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“…The field of burn rehabilitation has yet to define optimal treatments for the prevention or correction of burn scar contracture and subsequent deformity, impairment, and dysfunction. 1,2 The development of burn scar contractures previously has been associated with burn depth and burn extent. [3][4][5] In addition, the relative location of the burn wound to a joint and its associated skin crease is an important factor related to rehabilitation efforts.…”

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confidence: 99%

Identification of Cutaneous Functional Units Related to Burn Scar Contracture Development

Richard

Lester

Miller

et al. 2009

Journal of Burn Care & Research

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The development of burn scar contractures is due in part to the replacement of naturally pliable skin with an inadequate quantity and quality of extensible scar tissue. Predilected skin surface areas associated with limb range of motion (ROM) have a tendency to develop burn scar contractures that prevent full joint ROM leading to deformity, impairment, and disability. Previous study has documented forearm skin movement associated with wrist extension. The purpose of this study was to expand the identification of skin movement associated with ROM to all joint surface areas that have a tendency to develop burn scar contractures. Twenty male subjects without burns had anthropometric measurements recorded and skin marks placed on their torsos and dominant extremities. Each subject performed ranges of motion of nine common burn scar contracture sites with the markers photographed at the beginning and end of motion. The area of skin movement associated with joint ROM was recorded, normalized, and quantified as a percentage of total area. On average, subjects recruited 83% of available skin from a prescribed area to complete movement across all joints of interest (range, 18-100%). Recruitment of skin during wrist flexion demonstrated the greatest amount of variability between subjects, whereas recruitment of skin during knee extension demonstrated the most consistency. No association of skin movement was found related to percent body fat or body mass index. Skin recruitment was positively correlated with joint ROM. Fields of skin associated with normal ROM were identified and subsequently labeled as cutaneous functional units. The amount of skin involved in joint movement extended far beyond the immediate proximity of the joint skin creases themselves. This information may impact the design of rehabilitation programs for patients with severe burns.

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“…Early physical therpay preserves joint mobility, promotes edema resolution, and prevents muscle atrophy, disuse osteoporosis, as well as respiratory and cardiac complications (13), while reducing functionally impairing scar contractures (19,35). …”

Section: Acute Rehabilitation Phasementioning

confidence: 99%

Rehabilitation in the Acute Versus Outpatient Setting

Hundeshagen

Suman

Branski

2017

Clinics in Plastic Surgery

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Rehabilitation of the burn patient aims to restore strength, coordination and mobility as closely to normal as possible and should begin immediately after initial admission. In the acute phase, baseline assessments are made against which all subsequent rehabilitation success is held. Splinting of joints at risk of developing scar contracture into favorable position is done aggressively and persistently as correction of contractures is more difficult than prevention. Exercise to preserve range of motion consists of passive but complete motion. In the intermediate phase, active full ROM movement and ambulation of steadily increasing distances, as well as resistive exercise and stretching aid in the prevention of muscle and bone atrophy and preserve muscle memory and coordination. In the long-term outpatient rehabilitation phase, individualized patient-centered exercise programs can be advantageous in achieving measurable and lasting positive rehabilitation outcomes. A defined combination of aerobic and resistive exercise is helpful to enable a physical transition towards independent living and performance of activities of daily life, as well as return to work as soon as possible. Rehabilitation is a continuum of equally essential steps, which extends over the whole course of inpatient and outpatient treatment of the burn patient.

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A Clarion to Recommit and Reaffirm Burn Rehabilitation

Cited by 51 publications

References 39 publications

Harborview Burns – 1974 to 2009

Harborview Burns – 1974 to 2009

Identification of Cutaneous Functional Units Related to Burn Scar Contracture Development

Rehabilitation in the Acute Versus Outpatient Setting

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