Rehabilitation in the Acute Versus Outpatient Setting

Abstract

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.

Status of adult inpatient burn rehabilitation in Europe: are we neglecting metabolic outcomes?

“…It is during the early phase of recovery that burn-induced metabolic derangements and prolonged inactivity are most prominent and combine to cause unwanted effects such as muscle wasting and glucose intolerance [ 2 , 4 , 5 , 38 ]. Maximum exercise stimuli during this early phase, in particular through resistance and aerobic exercise, would seem most intuitive to lessen the negative sequelae of the metabolic imbalance [ 22 , 42 ]. However, our data indicates that early exercise in European burn care does not categorically include resistive and aerobic components, both of which appear secondary to range-of-motion or functional exercise components.…”

Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020

“…Early rehabilitation for all patients with burn injuries with support from rehabilitation specialists should be encouraged [ 78 ]. Rehabilitation specialists are potentially also well suited to take over the care of burns patients once surgical intervention and wound care has been completed.…”

“…Rehabilitation recommendations should be considered for all patients (based on burn severity and location of burn) on their arrival at the first receiving hospital [ 78 , 80 , 82 ]. Depending on need, rehabilitation interventions may include: Scar management; Respiratory physiotherapy; Anti-contracture positioning; Range of movement exercises; Splinting; Stretching; Ambulation; Strength and coordination exercises; and Activity of daily living/functional retraining.…”

Return to employment for working-aged adults after burn injury: a scoping review protocol

“…1 Consistent with International Classification of Functioning, Disability and Health (ICF), 2 3 in the short term, burn injuries have the potential to result in physical impairment, activity limitations, participation restrictions and environmental barriers making return to employment difficult on a person-by-person basis. 4 5 Physical impairments such as scarring, contractures, chronic pain and itch and thermoregulation problems can result in long-term disability post burn. 6–9 Psychological issues resulting from disfigurement, anxiety, depression and post-traumatic stress disorders also contribute to the long-term disability experienced by people with burn injuries.…”