It can be said that without scars there is no wound healing, scars change the appearance, deformity affects the function, and cause great trauma psychologically, leaving a lot of consequences for self-care, socialization, and return to work.
Before burn rehabilitation treatment, you should be familiar with the type, depth and healing of burns. Narrowly speaking, burn rehabilitation is the treatment of struggling with scars.
Scars are classified as follows
Proliferative type: long and heavy proliferation.
Non-proliferative type: Very rare, short proliferation time, weeks to months, and light proliferation.
Scar formation to maturity goes through two periods
1. Proliferative period; within 1~3 months after wound healing, reaching the peak of proliferation around 6 months. The color changes from light red – bright red – deep red – purple red. Capillary proliferation in the dermis layer, collagen nodular masses, fibroblasts, inflammatory cells, and myofibroblasts appear.
2.Mature stage; 6~24 months, few 3~4 years. The color changes from deep red or purple-red to — purple or brown eventually similar to the adjacent skin color. Capillaries are occluded, collagen nodular masses disappear, and collagen fibers are arranged parallel to the skin surface.
Factors affecting scar proliferation;
1.Age; young and heavy, old and light
2, race and heredity; darker skin color is heavier than lighter.
3.Infection; aggravate the hyperplasia.
4.Surgery and implantation; implantation is the lightest immediately after scabbing, thicker than thin, and large than small.
5. Site; face, neck, hand, web, elbow, axilla, hyperplasia heavy.
6. Tension; because the scar lacks elasticity, the collagen fibers are easy to pull off and can be repeatedly pulled off, resulting in excessive collagen proliferation and aggravating the scar.
Rehabilitation is convalescence? Actually, it is not. What is rehabilitation?In 1981, the WHO Expert Committee on Medical Rehabilitation held that “rehabilitation refers to the application of measures to alleviate the effects of disability and the reintegration of people with disabilities into society.” The word rehabilitation is translated from the English word rehabilitation, which means “to recover”, “to restore the original power, qualification, status, dignity”, etc. Rehabilitation focuses not only on the disease itself, but also on the functional impairment caused by the disease, with an emphasis on improving the quality of life and restoring the patient’s ability to live, learn and work independently.
Rehabilitation therapists should not only implement treatment, but also carry out rehabilitation assessment and rehabilitation prevention. Burn treatment must not be narrowly understood as simple wound healing and preservation of life, but should include early treatment and rehabilitation.
There are three reasons that restrict the development of rehabilitation treatment for burns.
1, the ideological understanding of the problem, the cure to save life as the only purpose, trauma healing even if the task is completed. The quality of rehabilitation of doctors and patients is low.
2.Insufficient human and material resources, and the inability to carry out new business and new technology.
3, do not know the rehabilitation technology, do not know where to start.
Foreign countries have integrated the early treatment of burns, physical therapy, body therapy and occupational therapy into one, becoming a routine treatment, with dedicated personnel and equipment, a sound system, depending on the pre and post equally important, so that the burn patient’s body and mind are maximally rehabilitated.
Burn injury rehabilitation content
I. Rehabilitation assessment
1. Burn area assessment
2.Burn degree assessment
(1)Mild burns
①<15%, children 10%.
②<2% third-degree burns (excluding eyes, ears, face, perineum)
(2)Moderate burns
①<15~25％, children 10~20％.
②2~10% third degree (excluding eyes, ears, face, perineum)
(3) Severe burns
①>25% adult, pediatric >20%.
②>10% adult third degree.
③Eye, ear, face, perineum, electric burns.
④Inhalation burns.
⑤ and fracture or large tissue trauma.
⑥Age or with previous primary disease.
3.Burn clinical stage (according to rehabilitation treatment)
(1) Acute stage; burns to epithelialization or surgery.
(2) Braking phase; from the time of skin implantation to the end of skin vascularization.
(3) Late recovery phase; trauma healing with scar formation to maturity.
4.Assessment of daily life (ADL)
5.Prognosis estimation
(1) Estimation of ability to handle life
(2) Estimation of employability
6.Efficacy assessment
Burn injury rehabilitation treatment
The content of burn rehabilitation is divided into.
1.Functional rehabilitation: the first and the most important treatment. The basic goal is to achieve self-care (basic right to life), to participate in the work that can be done (self-reliance), and to benefit society.
2.Appearance rehabilitation
3.Psychological rehabilitation: the process of psychological disorder after burn injury;
(1)Euphoria period
(2)Fear period
(3)Denial period
(4)Mourning period
(5)Adaptation period
4.Physical rehabilitation: energy depletion, muscle atrophy, physical strength, deformity.
5.Vocational rehabilitation: the basic ones should be done: reconstruction of non-functional ones, training of functional ones, and maximizing and utilizing their conditions.
(1) Vocational assessment
(2)Functional assessment
Work endurance determination; work capacity assessment.
(3) Development of vocational rehabilitation plan.
6. Social rehabilitation.
Functional rehabilitation is the top priority in rehabilitation treatment. Functional rehabilitation should be the most important after limb burns, and the principle of functional rehabilitation: is the combination of prevention and treatment, and prevention is the main focus.
1.Medical staff is the main body to implement rehabilitation treatment.
2, only the cooperation of the patient can achieve the purpose of treatment.
3.Family care is the guarantee of rehabilitation treatment.
Rehabilitation should be implemented in practice: to mobilize the enthusiasm of three parties
1.Medical and nursing staff
2.Patients
3 family members
One of the three is indispensable.
(I) Acute rehabilitation of medium and large burns
(1) Respiratory care
(2) Blood volume replenishment via intravenous infusion; urine volume 50~100ML/H, children 1ML/KG/H
(3) Monitoring
(4) Prevention of infection
(5) Trauma treatment
(6) Surgery
(7) Limb placement;
Correct body position placement.
Keep the joints of each limb in the functional position and against contracture.
Neck: small pillow for neck and shoulder, neck in extension, no rotation and no lateral flexion.
Shoulder: Shoulder joint abduction up to 90. Prone position should be used sparingly to prevent injury to the brachial plexus nerve.
Elbow: elbow joint should be placed on pillow and in straight position, dorsal burn, elbow joint flexion 70. to 90., forearm kept in neutral position.
Hand: for dorsal hand burns, the wrist joint is placed in the palmar flexion position. Circumferential burns of the palm or wrist, with dorsiflexion predominant.
(8) Exercise therapy.
Breathing Emphasis on abdominal breathing to prevent pneumonia and improve gastrointestinal function.
Active movement of healthy limbs
Active or static muscle isometric contraction of the limb, several times. Active or passive exercise with the assistance of a therapist.
Exercise in warm water; for those who are not operated, after the acute period, use the buoyancy and temperature of water to exercise, the pain is less than the general way of exercise. The water temperature is 1 degree higher than the body temperature is appropriate for 30~60 minutes each time.
(II) rehabilitation treatment of burn healing and braking period
(1) Braking
(2) Exercise therapy
(3) medication
(C) rehabilitation treatment for the mature burn healing period
(1) Out-of-bed activities
(2) Orthotic devices
(3) Compression therapy; bandages, compression garments
(4) Exercise therapy
(5) Daily activities and occupational therapy; A; daily life training B; occupational therapy
(6) Medication therapy
Treatment of burn scars
Compression therapy
A method to prevent and reduce scar proliferation by applying continuous compression to the healed burn site with elastic fabric after the burn wound has healed.
1. Mechanism of action.
(1) Tissue ischemia, helical collagen rearrangement, Pco2 rise Po2 fall in tissues, capillary reduction, lumen narrowing, endothelial cell degeneration, nuclear fragmentation, etc., scar proliferation is hindered.
(2) Hypoxia, swelling and vacuolization of mitochondria, hindered fibroblast proliferation, and reduced collagen production. (3) Ischemia, aM globulin is reduced, which facilitates the appearance of collagenase and destroys collagen fibers.
(4)Ischemia,the enzyme of mucopolysaccharide synthesis decreases,mucopolysaccharide synthesis and deposition decreases,collagen production decreases,and the scar is reduced.
2.Methods.
(1)Elastic bandage: pressure 10~15mmHg, wrap from the distal end of the limb.
(2) Elastic sleeve: 10~18mmHg, application should be “one early, two tight and three lasting”.
(3) Stretchy clothes: choose according to the size of the body.
3.Discontinuation time.
After stopping use, the scar is no longer congested, the color is similar to normal skin, flat, soft and elastic, and the itchy and painful symptoms disappear.
Precautions.
(1)Lasting wear.
(2) 12~24 hours to change, clean and restore elasticity.
(3) Suspend treatment when broken, or bandage before treatment.
(4)Place 1~2 layers of soft cloth or gauze in the inner layer before pressing to avoid rubbing and low concave disposal of soft cushions before pressing.
(5) pediatric application pressure should be moderate, do not affect bone development.
Physical therapy
It is the application of light, electricity, sound, magnetism, heat, cold, mechanical and other physical factors to treat disease and functional recovery.
Types
Physical factors are ubiquitous and can be divided into natural physical factors and artificial physical factors. Natural physical factors are applied to treat diseases such as sunbathing, airbathing, hot spring bathing, seawater bathing, and mud therapy. Artificial physical factors for treating diseases include electric therapy, light therapy, magnetic therapy (pulse magnetism, spin magnetism, paste magnetism), ultrasonic therapy, biofeedback therapy, heat therapy (wax therapy, herbal fumigation), and mechanical methods.
Strictly speaking, exercise therapy belongs to the category of physical therapy. Exercise therapy is a method to treat and prevent diseases and restore functions by using the mechanics of physics with bare hands or with the help of equipment. Exercise therapy includes both active and passive exercise therapy. Active exercises are those that require active participation of the patient, such as joint movements, muscle strength training, and training of daily life movements. Passive exercise therapy is the use of mechanical force or unaided methods of treatment, the patient does not need or can not actively move, such as traction, massage, joint loosening manipulation, muscle pulling.
Methods of exercise therapy
1.Training to maintain and increase joint mobility
①Passive activities
②Active and active-assisted movement
③Stretching activities
2.Training to enhance muscle strength and muscle endurance
①Resistance training: basic resistance exercises, progressive resistance exercises
② Isometric exercises
3.Training to restore balance
①Sitting balance training
②Standing balance training
③Kneeling balance training
4.Gait training
5.Training to enhance cardiopulmonary function
Including walking, jogging, swimming, cycling, rowing, rope skipping, stair climbing, excursions, various ball games, martial arts, etc.
6.Massage, traction, manual therapy
7, exercise relearning therapy, etc.
The main functions of exercise therapy are
①Maintain and improve the range of motion of joints;
②Enhance muscle strength;
③Enhance endurance;
④relieve pain;
⑤Improve coordination of movement;
⑥Improve cardiopulmonary function;
⑦correct deformity;
⑧Improve the ability to perform activities of daily living