World physiotherapy day is celebrated on 8th September. The global observance of this day not only celebrated role of physiotherapy in healthcare but also promotes awareness about role of in prevention of injuries, recovery from health problems and improving the quality of life. Scope of physiotherapy is immense, benefiting people of all age group. Physiotherapy in burns plays is an essential part of healing process during both in-patient and out-patient care.
“Burn is most devastating injury a person can suffer. It affects physical, psychological, social and financial aspect of patient. WHO has reported that burns are among the leading cause of disability- adjusted life years. In India, over one million people are moderately or severely burnt every year. Factors like unsafe kitchen practices, unsafe cooking, homicides, dowry related conflicts and acid throwing makes women more vulnerable to burn,” shares Misha Ahir, Physiotherapist, BPT, MPT(Musculoskeletal), Burns, Plastic and Reconstructive Surgery at AIIMS, New Delhi.
The focus of physiotherapy is to help patient gain practical skill and therapeutic techniques needed to maximize functional independence, find confidence and get back to previous lifestyle and activity level.
Most people are unaware that physiotherapy should be started as early as patient’s vitals are stabilized by treating doctor, which can be day one in mild burn cases. Timely and early physical therapy prevent late complications such as deformities at joints, muscle weakness, hypertrophic scarring and post burn contractures. Physiotherapist as a part of burns team can not only improved the quality of burn survivor but can be critical in improving survival rates.
Role Of Physiotherapy In Burns
Inhalational burns in closed spaces or facial burns results in respiratory distress. such patient may require ventilator support or oxygen via face mask /nasal cannula. Chest Physiotherapy can help in removal of secretions or inhaled soot particles thus preventing chest complications like pneumonia and maintaining good breathing capacity.
Also Read: How To Treat A Burn Blister? Try These Effective Remedies
According to Misha Ahir, “a trained physiotherapist plans and provide interventions like incentive spirometry, secretion clearance techniques, breathing exercises based on patient condition. Physiotherapy intervention in a burn, can prevent severely burned patient from going on to ventilator support or early weaning off from ventilator.”
Skin is the largest organ in body. It provides protection against bacteria, virus, sunlight. Apart from protection, it provides sensations, regulates body temperature and is flexible enough to provide movement to joint. Early days in a burn wound there is swelling, fluid ozzes out of wounds, severe pain inhibits patients from performing movements and joint assumes the position of most ease resulting is deformity. Positioning of such burn wound is crucial.
As patient gets stabilized physiotherapist advices a Splint that maintain joint in specific positions referred as anti-deformity position. Eg.A burn while working in a kitchen, factory worker working with chemical in such cases face, front of neck and chest area are usually involve, in such cases physiotherapist advice is not to use pillow, use a neck collar or neck immobilization.
Patient feel that exercises should be done when wound heals but the exercises should be started earliest to maintain muscle strength, joint range of motion. further, improves circulation and reduces swelling. The type, duration and frequency of exercises is prescribed by therapist and progressively modified as the wound heals.Burn wound that are large and deep requires skin grafting which requires immobilization and exercise are modified accordingly.
Also Read: Expert Shares The Importance of Posture in Health and Wellbeing and Role of Physiotherapy
Burns and Complications
In deep burns it may take 12 to 18 months for scar to heal and mature. Two most common complications of a healing skin are Hypertrophic scarring and Scar contracture.
- Hypertrophic scarring is thick, tight, elevated healed skin. For this physiotherapist evaluate the scar on regular basis and recommends compression garments, stretching and splints. Customized compression garment maintains an optimal pressure and is recommended to be worn for 23 hours to prevents Hypertrophic scarring.
- Stretching prevents scar contraction and improves skin flexibility. Patients often reports full range after scar massage and stretching’s but after sleep in morning they wake up stiff and tightened up in limited range of motion, It is quite frustrating and tiring for patient and this last for month till scar matures.
- The newly healed skins lack its qualities of temperature regulation, flexibility for which physiotherapists trains the patient or care giver for scar massage that help in keeping skin moisturized, improves flexibility and prevent skin adherence to underlying tissue. Scar massage is an integral part of burns treatment and is continued throughout the healing phase.
How physiotherapy can help burn patients
In burns patients, Early mobility and functional training focusing of daily activities is an essential part. Burns is lower limbs make walking difficulty or in some cases result in amputation. Physiotherapist assess and prescribe appropriate walking aid. Upper-limb burns usually results in amputation or deformities, through training and use to splint or assistive devices patient is made to re-learn to grip and complete daily task like wearing clothes, holding spoon. Sometimes simple modifications like thick spoon handle, or bending a spoon works like magic and makes patient independent in the activity.
Home based exercises for burns patients include strength training, respiratory muscle training, endurance training, stretching’s, scar massage which patient need to follow for months to years.
The journey of burn injury is long and slow and as physiotherapist we walk alongside our patients as they face difficult work of recovery. Due to lack of awareness, lack of motivation and poor social support many patients end up with post burn contracture which require surgeries and physiotherapy support for functional recovery. The hospital stays end, but burn survivor journey last a lifetime.