Key of Rehabilitation

Post Burn Injury

Rubiyanto Warja
Bilqiss Medika Clinic Wound Care Division

05-12-2021
Out line

A Prevalence

B Emergent

C Acute wound care

D Rehabilitation
Prevalence
Burn trauma is one of the worst form of trauma and has a wordwide
incidence approximately 2 million case annually.

Approximately 450.000 burn injuries US hospital emergency each years

( WOCN, 2016) Flame 43% and scald 34%. Electrical burn 4%, Chemical
burn 3%.

Vast majority burn injuries at home 72%, increased risk of burn children
< 4 years and adult older than 65 years.

Complication burn after injuries are hypertrophic scar or keloid,

contracture and itching. Important management during rehabilitation
phase
 Burn care is devided into three
overlapping phases of recovery:
Emergent, acute wound care,
rehabilitation

1. Emergent :
 First 72 hours after injuries, focusing
on assessment and initial
management
 ABCDE assessment (primary)
 Possible regarding incident, medical
history cause (secondary)

Chemical Burn
 Event Manage

Pain

Nonpharmacologic :
Pain management (pharmacologic) :  Positioning, elevation
Gold standard Opioid such as morphine extremity of burn
 Mild to moderate short acting oral  Relaxation technic
such as oxycodone & acetaminophen  Cognitive strategies
 Moderete to severe continuous  Adjuvant technic therapy;
infusion (patient control analgesia) acupuncture
 Properly fitted splints
 Event Manage

Emotional support ; focusing

on reducing patient and
family’s anxiety.

Pediactrics method
Promoting coping skills &
Behavioral response typicaly;
minimizing adverse effect of
anxiety, agitation, anger, fear,
hospitalization (American Academy of Pediatrics, 2014)
regression
 2. Acute Wound Care

Method Debr.
 Autolytic Aproppriate
 Enzymatic Frame work
 Sharp Debridement Dressing  TIME
 TIMES
 Mechanical & Cleansing selection  DIMES
 TRIANGLE OF WOUND
 Chemical  TIMERS

 Biological Acute  MOIST

 Surgical Wound Care

Phases
Agent Topical &
Wound Healing Support Nutrition
Vitamin
Bioburden & Sytemic
Inflammatory Phase; Vit A, Vit C, Support Infection Antimicrobial Topical:
Curcuma Silver, Charcoal, DACC,
Proliferative Phase; Vit A, Vit C,
Glucosamine, Zinc
management Honey, Iodine, NaOCl,
PHMB
Remodeling Phase; Amino Acid Antibiotic oral & Infused
Protein; Albumin, Colagen
3. Rehabilitation Phases

“
Begins once wound healing is
The goal “ restore or complete and may last several
miximize the patient
Function capacity complication manifest after
healing such as scarring,
“
years. Skin and wound related

contractures, itching.
 Two types of Scaring

Hypertophic scar are

red or pink, raised,
painful, itchy and lack
elasticity.
Original injury regress
with time more
frequently seen after
burn injuries

Keloid are firm, fibrous

Contracture nodules extend
beyond the original
wound margin
Risk Factor: (surrounding tissue)
 a strong family history and often
 Age 10 to 30 years hyperpigmentation
 Darkly pigmentation skin
Exercise After Burn Injury
Why exercise important
 Help your breathing
 Improve heart function
 Help body to fight
infection like
pneumonia
 Improve flexibility and
ability to move
 Lower risk of
Exercise or Movement is developing scar or
contracture
important activities make Fact: for each day of
 Make it easy to take
muscle, bone stronger and bed rest people can care everyday activities
keep joints movement lose 1% of their  Give sense of wellbeing
muscle mass
Keypoint Treatment Goal

Range of motion ( join mobility, skin mobility)

Scar quality (Aesthetic, pruritus, pain, prevention
hypertropihic scarring)
Restoration function status (ADL, ambulation ability)
Prevent deconditioning (muscle wekness,
cardiovascular deconditioning)
Prevent metabolic sequale (insulin resistance,
hyperglycemia)
 Type of Exercise
Aerobic Strengthening Recreational
Contents Title
Stretching Activities
Activities Activities
Contents Title

Important for Walking Make Muscle Strong • Playing sports,

exercise program gardening and
• Walking outside /
Exercise using weight, dance can help
treadmill
• Increase flexibility elastic bandage, own
• Start slow build strength
body weight.
• Goal stretching to • Increase the time walk 1 and endurance.
e.g Yoga, Tai Chi or
move joint where minute perday
pilates ways to make • Children using
the skin stretches • Build up walking 30 video games
muscle stronger and
• Hold the stretch for minute to 1 hours three
kep moving
time a week.
20 secomd to 2
Try Using stationary bike
minutes Elliptical
Swimming
 Stretching Exercise

Face Chest Elbow Knee

 Lie on back with a ball or

 Look into mirror facial expression cushion in the middle of
like smiling back:
 Close eyes tightly & massage  Start with hand on hips
skin around eyes  Arch back
 Stretch open mouth & massage  Stretch both arm out to
edge mouth side or over head to
 Say alphabet increase the amount
stretch on chest
Neck Shoulders
 Combine stretching neck with
face  Hold stretch band with
 Stertch in the opposite each hand, use one
directional of tightness arm to hold the other
 Lie on back on bed, look up to arm at the point of pull.
stretch front the neck, let head  Prop arm on back of
out over the edge of bed the couch or chair
when sitting
 To help get knee
Sit with elbow all the
straight, sit with leg
way straight and
propped up
palm facing
 Increase the amount of
foreward or up
stretch by pressing on
All bodies thigh or knee with hand
burn injuries
Hand Toes Ankle
 Stretch finger at knuckle Toes tend to
to help get the hand into curl up. First  Standing help stretch
a fist massage the ankle to get feet
 For a longer stretch, wrap scar, using hand flatter on the ground
hand fisted position to stretch the  Stand on a step and
 To get open hand position toes lower heel off the
step
 Special Cosideration

Fluid
Tolerances

Pain Exercising
Burn
Accidental Management Method Healing
Management

Wound Care
& Skin Care
THANK YOU
 Reference

1. Bryant Ruth A, Acute and Cronic Wound currant Management concepts.(2012) fifith Edition.
Elsevier,Washington ,USA .
2. Chen G-Y, Chang C-P, Wang P-H. Burn wound and therapeutic challenge. J chin med assoc. (2019)
82:10.
3. Kowalske K,Holavanahalli R, Suman O. Exercise after burn injury. The Model systems knowledge
translation center.Feb 2021.pg 1-3.
4. MC Nichole Laurie L.Wound Management.Wound Ostomy & Continence Nurse Society (2016).Wolter
Klower,Philadelphia.
5. Schieffelers D.et al. Status of adult inpatient burn rehabilitation in Europe: Are we neglecting metabolic
outcomes?.Burn & Trauma Risearch article DOI: 10.1093/burn/tkaa039 pg1-13.