Rehabilitation After a Severe Burn: Reducing the Risk of Hand Deformity
Jun 18, 2019
Rehabilitation After a Severe Burn: Reducing the Risk of Hand Deformity

Recovering from a second or third degree burn related injury can be a daunting process, especially when our hands are affected. It’s easy to overlook, but the ability or inability to use our hands has deep effects on every area of our lives, from self care to self esteem.

The hand is ranked as one of the three most frequent sites of burn related deformity(1). Functional loss of hand use can lead to a reduction in life skills functionality by up to 57% (2) Fortunately with medical intervention as well as long term commitment to rehabilitation protocols, disability is often preventable.
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Typically, an Occupational therapist with a specialized certification in hand therapy will guide you through the rehab process. Ultimately the goal of treatment is to ensure that you can continue to live life to the fullest by taking steps to prevent loss of motion and deformity. During the phases of healing you may notice symptoms including:

  • poor joint mobility and increased stiffness

  • edema(swelling)

  • excessive scar formation

  • Pain

  • Changes in sensation

    One of the most common patient complaints is that the hand feels tight making it hard to move, this is often due to the way in which the body is healing itself and the type of scar tissue that is forming. Scarred tissues are significantly less elastic than unaffected skin and can restrict joint mobility and movement(3) making daily tasks difficult. Since scars take one to three years to fully mature(3), participation in rehab during this time is vital to reducing the risk of harmful scar formation.

Treatment approaches that promote positive healing patterns and reduce scarring include:

  1. Pressure garments- specialty bandages or gloves can be used to provide pressure over healing burns and grafts. This technique minimizes the development of scars by interfering with the production of collagen, helping to realign the collagen fibers and putting pressure on contracture bands to increase skin length. Additionally pressure garments protect fragile skin. promoting better circulation and decreasing pain and itching
  2. Massage- Massage can help soften and desensitize the scar as well as reduce pain and itching associated with healing. Using lotion during massage can help prepare the skin for the stretching required during mobility exercises.Talk to your therapists to learn about specific massage techniques and safe products.
    Massage-hand-4--1-
  3. Skin integrity maintenance -Keeping the skin clean, moisturized and out of the sun can help increase healing time, reduce hyperpigmentation and prevent further injury to fragile tissue.
  4. Good positioning- Scar tissue that forms over joints can harden causing a condition called contractureswhich is a permanent decrease in joint mobility. Preventing contractures starts with keeping the hand positioned to ensure lengthened tissues and reduced swelling. Your therapist may make a cast or splint to help position your hand in a stretched position. You may also receive information about how to prop your arm to encourage lymphatic drainage.
  5. Proper nutrition- Healing tissues have different nutritional needs including increased protein and calories. Experts also recommend eating a diet rich in vitamin C, E, D, zinc and copper to better equip your body to heal itself after a burn. Check out this fact sheet for more information.
    fruits-and-vegetables
  6. Exercise and Continued Use - Perhaps most important of all, once you are cleared by your medical team, it is essential to start a program of daily mobilization and exercise. Inactivity causes shortening of healing tissue, increases stiffness and puts you at risk for contracture deformities. Consistent movement can also help decrease pain and swelling as well as help to normalize sensation.

Establishing and sticking to an exercise routine is never easy. Check out these tips to make the process a little bit easier

  • Stretch! Stretching should be performed a minimum of 5-6 times per day. Hold the stretch for 20 seconds to 2 minutes. Stretch each joint, then each finger, then the hand as a whole.
  • Repeat! Gentle stretching should be followed by exercise that includes active movement in repetitive functional patterns.
  • Keep doing your daily routine! Brushing your teeth or getting dressed can be the best exercise. Participating in these tasks may look different at first but dont let that stop you.
  • Spread it out! Even short periods of inactivity can give skin the chance to shrink or tighten. Spread your exercises throughout the day by setting alarms or creating text or email alerts to help keep you on track.
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  • Make it fun! Healing from a burn can be a stressful, painful process. Create games and rewards for your progress and dedication to your process.
  • Keep records!. Sometimes it is hard to visualize your progress. Taking pictures or measurements daily or weekly can help maintain a sense of accomplishment as you move through your program.
  • Take advantage of technology! Products like the Neofect Smart glove can help gamify repetitive exercises. Sensors within the smart glove measure your range of motion during exercise, making it easy to see how far you have come and keep you motivated. To find out about more about the Neofect Smart Glove please call us at 888-623-8947 or email contactus@neofect.com.

References

  1. Sabapathy SR, Bajantri B, Bharathi RR. Management of post burn hand deformities. Indian J Plast Surg. 2010;43(Suppl):S72–S79. doi:10.4103/0970-0358.70727
  2. Abu-Sittah GS, El Khatib AM, Dibo SA. Thermal injury to the hand: review of the literature. Annals of Burns and Fire Disasters. 2011;24(4):175–185.
  3. Bayat A, McGrouther DA, Ferguson MW. Skin scarring. BMJ. 2003;326(7380):88–92. doi:10.1136/bmj.326.7380.88
  4. Esselman, Peter C. (2007) Burn Rehabilitation: An Overview. Archives of Physical Medicine and Rehabilitation, 88.2. S3-S6
  5. “Living with Burn Injury.” Living with Burn Injury | Model Systems Knowledge Translation Center (MSKTC), msktc.org/burn.
Siena Conde
Clinical Manager / Occupational Therapist

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