Physical medicine and rehabilitation clinics of North America
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Burn rehabilitation cannot be reviewed without a significant focus on the hand. Although the surface area of the hand is only 3%, the functional consequences cause extreme impairment. A comprehensive team approach from initial evaluation through long-term follow up is essential to maximize the functional outcome in this population.
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Hypertrophic scars are common complications of burn injury and other soft tissue injuries. Excessive extracellular matrix combined with inadequate remodeling of scar tissue results in an aesthetically and functionally unsatisfactory, painful, pruritic scar that can impair function. ⋯ An interdisciplinary clinical program is necessary for best outcomes. Challenges to be met by the rehabilitation community include research into the quantification of burn scar measurement, the effects of mechanical forces on wound healing and scar management, and the best combination of surgical, pharmacologic, and therapy interventions to maximize outcome from reconstructive procedures.
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Whether a patient with burn injury is an adult or child, contracture management should be the primary focus of burn rehabilitation throughout the continuum of care. Positioning and splinting are crucial components of a comprehensive burn rehabilitation program that emphasizes contracture prevention. The emphasis of these devices throughout the phases of rehabilitation fluctuates to meet the changing needs of patients with burn injury. Early, effective, and consistent use of positioning devices and splints is recommended for successful management of burn scar contracture.
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It is important to focus on community integration, including return to work and school, early during treatment after burn injuries. A careful analysis of the potential barriers to return to activities can help focus a treatment team and provide appropriate support for a return to work or school plan. ⋯ Vocational rehabilitation counselors and school reentry coordinators are valuable assets to coordinating with a treatment team and communicating with a workplace or school. A successful return to work or school is often achieved with a coordinated and supportive approach.
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Phys Med Rehabil Clin N Am · May 2011
ReviewPsychosocial recovery, pain, and itch after burn injuries.
Burn patients face complex rehabilitation issues including physical, emotional, social, and vocational challenges. Problems with anxiety, depression, sleep, pruritis, and body image can affect the burn patient's ability to return to an acceptable quality of life. ⋯ This article reviews the nonpharmacologic treatments available and discusses their scope and limitations. More research needs to focus on treatment options and prevention of long term issues.