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Resident
Orientation Manual (Feb. 2000)
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, Janet A
Marvin RN, MSN,
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.
Next - How to Use the
Dictation System
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