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Resident Orientation Manual

Produced by Galveston Shriners Burn Hospital and
The University of Texas Medical Branch Blocker Burn Unit.
Contributors:  Sally Abston MD, Patricia Blakeney PhD, Manubhai Desai MD,
Patricia Edgar RN, CIC,John P Heggers PhD, David N Herndon MD,
Marsha Hildreth RD, Ray J Nichols Jr. MD

REHABILITATION SERVICES RESIDENT ORIENTATION cont'd

Basic Treatment Procedures

Splinting - Pressure - Positioning - ROM/Strengthening - Ambulation
Activities of Daily Living (ADL's)

Splinting

Static Splint:  Have no movable parts and maintain joint in one position.

Preventative:  Prevents deformities.  Usually we allow patient to be free of splint wear during ADL's and dressing changes.

Protective:  Post-operative to prevent disruption of newly applied skin grafts.

Supportive:  Immobilize, protect, and position damaged tendons and joints.

Corrective:  To gradually/serially correct a contracture by assisting to maintain joint following active and passive exercises.

Dynamic Splinting:  Applies specific force in a place of motion through elastic traction while allowing the patient some motion of the joint.  These splints should be considered for those joints that demonstrate the most resistance to passive stretch and positioning.  Splints that are commercially available work best when this problem occurs over large joints.

ADL's:  We provide adaptive equipment as needed, and train patients in achieving maximum independence in performing activities of daily living.

Focus on splinting should be on those motions that are most difficult to regain:
 

Neck extension/rotation	MCP flexion
Shoulder flexion/abduction	IP extension of the hand
Elbow/Knee extension	Ankle dorsiflexion
MPT flexion

Positioning
Positioning is one of the fundamental practices necessary for successful burn patient rehabilitation.  Positioning in bed and in sitting is important.

Pressure
Pressure is used as treatment of scar management and can vary by use of:
Ace Bandages - Tubigrip - Interim Garments (pre-fabricated) - Custom Garments - Coban (elastic woven wrap that can be used for the hand and fingers as a temporary glove).

When a healed burn surface is able to tolerate a minimal shearing force, a tubular bandage or garments can be used.  Tubular bandages may be used as an interim compression device or used as a definitive appliance.

Inserts:  Due to body makeup, inserts are sometimes necessary to achieve adequate pressure in certain body areas.  These devices help to apply even pressure over the scar.

The effectiveness of pressure garments is under evaluation at Shriners Burns Hospital-Galveston.  We are conducting a study where patients with small burns are randomized to receive, or not receive, pressure garments after informed consent is obtained.  Patients with large burns (> 10% grafted area) will receive pressure only to one extremity vs. no pressure to the contra-lateral extremity.  All patients will remain in ace wraps to burned/grafted areas 1 month post-discharge.

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