Therapy Management of Burns

The ‘Northern Network of International Rehabilitation (NNIR)’, formerly ‘ADAPT:North’ recently organised an evening Lecture on the topic of Therapy Management of Burns. This was our first joint therapy evening lecture, with input from Occupational Therapy, Physiotherapy, and the students of the Leeds Beckett Physiotherapy Society. The evening was a great success, and well attended by both students and qualified Physiotherapists and Occupational Therapists.

Our speakers for the evening were Ann Sanderson- Physiotherapist specialising in Burns, Leanne Dowding- Occupational Therapist specialising in burns, and Rachel Burnett- Physiotherapist who was worked with Interplast in countries such as Sri Lanka, Pakistan, Uganda, and India.

Burns Therapy- Ann Sanderson and Leanne Dowding
Ann began the lecture by explaining that a Burn is defined as; tissue damage from excessive heat, electricity, radio-activity, or corrosive chemicals that destroy, or denature the proteins in the exposed cells. Ann explained that the World Health Organisation (WHO) report 180,000 deaths per year due to burns, and that 96% of these occur in low to middle income countries (LMICs). Burns are more common in children, and 80-90% of injuries occur in the home.

Assessment
There are three main categories for defining a burn; Superficial, Partial thickness, and Full thickness.

Superficial: This affects the epidermis only, and usually heals within 2 weeks.
Partial thickness: Affects part of the dermis. May heal within two weeks, but may require skin grafts.
Full thickness: Affects all of the dermis and possibly the underlying subcutaneous layer. This will not heal on its own and will require skin grafts.

The Lund and Browder chart can be used as an assessment tool for burns.

2263_275_44-lund-and-browder-chart-for-burns

The Role of the Therapist in Burn Care
Leanne explained that the main roles of the therapist in the management of burns is to prevent contracture, reduce oedema, maintain range of movement,promote independent function, and minimise the appearance of scarring.

trauma-arm-sling[1]
Bradford Sling to help reduce oedema

Methods of reducing oedema include applying dressings or bandages to help compress and reduce oedema, elevating the affected limbs with positioning of pillows or use of Bradford slings, maintaining active range of movement of all affected joints, and using splints to keep the affected limbs in an appropriate position to prevent contractures.

Maintain range of movement
Early mobilisation of joints is important to maintain range of movement and prevent contractures. Leanne explained that the therapist can help with active and passive stretches, with and without dressings, and teach the patient and family members how to carry out these stretches at home. Functional activities are encouraged, and this can also help to reduce oedema.

Promote Independent Function
Physiotherapy and Occupational Therapy are important in promoting independence of the burns patient through assessment of transfers, mobility, stairs, washing and dressing, and feeding. Leanne explained that members of the Occupational Therapy team, or Physiotherapy team even offer the service of giving talks/lectures to schools or the workplace of the burns patient to increase understanding, and help with reintegration.

Equipment/Splinting
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Equipment such as collars, axilla tables, and splints are important in maintaining joint range of movement following a burn. Things to consider when splinting are pressure areas, location of wounds and dressings, and the weight of the material used to splint. It is also important to consider infection control and a wearing regime when providing splints.

Minimise appearance of scars
Massage of the affected area following a burn three times per day is important to minimise the appearance of scars, and soften scar tissue. Sun care, pressure garments, and touch to help desensitise the affected area will also be taught to the patient by the therapy team.

Experience from Overseas- Rachel Burnett
Rachel Burnett has worked with the charity Interplast for 15 years in countries including Sri Lanka, Pakistan, Uganda, and India. When thinking of working overseas, Rachel explained that it is important to think about what the purpose of your role will be, and why you want to work in this area.

Challenges
Rachel explained that working overseas involves lots of new challenges, such as working in an entirely new environment where you may not know the culture or language, working long days with little rest treating hundreds of patients, and limited equipment compared to the hospitals you may be used to at home.  You may arrive with an expectation of what your role will involve, only to find that you end up working in something entirely different! It is important to consider if you wish to work on a short term or long term project, and how you will fund these options.

Benefits
Rachel discussed the benefits of working overseas, such as experiencing things you would never have the option of seeing or working with at home. The situations you come across may challenge your thinking clinically and professionally, as well as who you are personally.  Rachel described the appreciation she had for the NHS upon returning home from working overseas, and described the appreciation those overseas had for the treatment the charity could provide. As well as this, working overseas adds a new dimension to your level of clinical experience and enhances your CV!

Top tips for working overseas
Rachel then explained what her role involved in each of the countries she had worked in and gave some tips for those thinking of working overseas.

  • Be flexible and be aware of what is already established and how you fit with the local work force.
  • Take any equipment you can fit in your suitcase with you, such as slide sheets, dressings, or even balloons!
  • Understand that you may not work in a purely Physiotherapy or Occupational Therapy role, but be prepared to get stuck in with the team and help out in any way you can.
  • Consider how long you want to work overseas at a time, whether this is for short or long periods of time.
  • Finally, enjoy yourself! The experiences you have overseas will shape and develop who you are as a clinician, as well as a person, so enjoy every moment and learn as much as you can!

 

The evening lecture was considered a great success, and NNIR are so grateful to our speakers and all those who attended the event. If you have any questions about this lecture, or are interested in becoming a member of the committee, email cloverseasclaire@gmail.com.

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