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An Easy Guide to Outpatient Burn Rehabilitation

Burn Rehabilitation
NIDRR Research Results

By
Rocky Mountain Model System for Burn Injury Rehabilitation
University of Colorado Health Sciences Center
Department of Preventive Medicine and Biostatistics
Section of Medical Informatics
4200 East Ninth Avenue, Campus Box B-119
Denver, Colorado 80206
Phone: (303) 315-6873
Fax: (303) 315-3183

Contact Person: Rebecca Sloan, Project Coordinator
(303) 315-0320
Rebecca.Sloan@uchsc.edu

Table of Contents

Introduction
Scar Control
Therapeutic Exercise
Manually Resisted Exercise
Work Hardening
Modalities
Activities of Daily Living
Splints
Outcomes and Interviews
References and Further Information

This information was prepared as a part of a NIDRR grant (H133A30015) to the University of Colorado Health Sciences Center. Views expressed do not necessarily represent the policy of SEDL, NIDRR, or the ED; do not assume endorsement by the Federal Government. ©UCHSC, 1996


The video and manual set was developed by the Rocky Mountain Model System for Burn Injury Rehabilitation project to help therapists work with burn survivors on an outpatient basis. The NCDDR has prepared the text and some sample clips of the video as a demonstration of NIDRR grantee's research results that are available for further dissemination.

Introduction

As the designated adult burn rehabilitation center in the State of Colorado, our facility relies on rural health care providers to continue the essential outpatient rehabilitation phase. This video, accompanied by a written informational booklet, provides visual assistance to those professionals who may not be familiar with treating a burn survivor.

More and more, our burn survivors are being discharged and treated as outpatients earlier. This outpatient care requires complex nursing and Physical and Occupational Therapy services closer to the patient's home. Communication between the burn center and the outpatient team is essential. The video and educational booklet were designed to provide assistance on common outpatient issues. Through the use of brief segments, the outpatient health care provider can view only those areas needed. By the conclusion of the video, the viewer will be able to:

  1. Identify hypertrophic scarring.
  2. Differentiate between an active and a mature scar.
  3. Prioritize a burn survivor's exercise needs.
  4. Describe the proper fit and care of custom pressure garments and splints.
  5. Adapt self-care items for independent Activities of Daily Living.
  6. Understand several patients' views of rehabilitation.

It should be noted, there is not just one correct way to approach burn rehabilitation. The information in this video is based on approaches and techniques used at University Hospital. By using these few precautions and ideas, a safe and comprehensive program can be established to help the burn survivor return to living as a productive member of the community.



Scar Control

The formation of a scar is an ongoing process for the burn survivor. Scars are dynamic and continue to grow and change throughout the maturation process. It is the responsibility of both the patient and health care provider to manage scars and decrease the potential for contractures.

HYPERTROPHIC SCARRING - Hypertrophic scarring develops due to tissue tension, persistent inflammation, and the exaggerated response of the fibroblasts to healing. Fibroblasts deposit excessive amounts of disorganized collagen which then become adhesive to other structures. The scar is characterized by three R's:

The scars are metabolically active for approximately eighteen months. After that time the scar is mature, as shown in the video with Harry (burn1.mov). Hypertrophic scarring is more pronounced in African Americans, Native Americans, Asians, and Hispanics secondary to increased pigmentation.

SCAR MASSAGE - Scar massage has several important functions:

The video demonstrates the appropriate technique (burn2a.mov, burn2b.mov), as well as the following handout on scar massage (see page 4 in the printed booklet).


SCAR MASSAGE INSTRUCTIONS

  1. Apply lotion to all burned or grafted skin and donor sites, once they are healed.
  2. Massage the lotion in, applying enough pressure to make the area blanch (turn white).
  3. Massage in all three directions:
    • Circles (counterclockwise)
    • Vertical (up-and-down)
    • Horizontal (side-to-side)
  4. Do this three to four times each day.

Lotions

If you have any question or problems, please call your primary therapist (insert name, number).

This information sheet was developed and funded by:
Rocky Mountain System for Burn Injury Rehabilitation
Sponsored by the National Institute on Disability and Rehabilitation Research
U.S. Department of Education Grant #H133A3001594
June, 1995
* University of Colorado Health Sciences Center * Ninth Avenue at Colorado Boulevard *
* Denver, Colorado * 303-329-3066 *
Committed to equal employment opportunity and affirmative action.


CUSTOM PRESSURE GARMENTS - Pressure applied to a scar decreases the excessive collagen formation and helps to realign the present collagen. The custom pressure garments are made to conform to a patient's normal body contours, thus limiting abnormal scar formation and deformity. It is important that the garments fit properly to assure maximal benefit of wearing them and avoid complications such as swelling, increased scarring, or abraded areas. Some clues for proper fit:

It is TOO small if:

  1. It binds or digs into the skin
  2. The fingers or toes become swollen, blue or numb
  3. The garment rides up or down with motion

It is TOO Big if:

  1. There is any bagging or sagging noted
  2. The garment can easily be pinched away from the skin
  3. The scar appears larger in one area

The goal is to wear the custom pressure garments twenty-three hours a day, removing them only for scar massage and bathing. Many times when a garment covers a concave area, (i.e., between the breasts, shoulder blades, or fingers) adequate pressure is not applied. Foam padding and inserts made from silicone gel or elastomer can be used to fill in the concave areas and apply appropriate pressure to scars in those areas.

Garments that have rips or holes no longer apply consistent pressure and should be replaced. It is also important to note that the garments should not be cut or altered in any way except by the vendor who has provided the garment.

Following are information sheets with instructions on the care and wear of custom pressure garments (see pages 5-7 in the printed booklet). Colorado residents may contact the JOBST ©Service Center for custom pressure garments at (303) 744-2286 to find the JOBST ©representative closest to you, or contact us at University Hospital for other resources.


CARE AND USE OF YOUR CUSTOM PRESSURE GARMENTS

You have just received your custom pressure garments. These garments were made specially for you to fit your normal body contours. Their job is to apply pressure to your burned areas to help your scars lie flat. (That is why they are so tight.)

Care of Your Garment

Your garment should be washed daily in warm water either by hand or in the washing machine. Do not use harsh detergents or bleach in cleaning your garments. They should be air dried flat. Do not put them in the dryer, or in direct sunlight.

When to Wear Your Garment

Your garment should be worn 23 hours a day. You can take them off to have a bath or shower and to perform your scar massage. You can do all regular activities in your garments, including work and sports! (and therapies!)

Problems with Your Garment

If you have problems with your garments, such as swelling, numbness in your hands or feet, or if your skin is breaking down, call or see your primary therapist immediately. If your therapist is not available (after hours or on the weekend) take the garment off until you can reach your therapist. Do not try to cut or alter the garment by yourself. If you do, it may no longer be effective. Your therapist, (insert name), may be reached at (insert number).

This information sheet was developed and funded by:
Rocky Mountain System for Burn Injury Rehabilitation
Sponsored by the National Institute on Disability and Rehabilitation Research
U.S. Department of Education Grant #H133A3001594
June, 1995
* University of Colorado Health Sciences Center * Ninth Avenue at Colorado Boulevard *
* Denver, Colorado * 303-329-3066 *
Committed to equal employment opportunity and affirmative action.

APPLYING CUSTOM PRESSURE GARMENTS

Apply your garments after you have done your scar massage.

To put on your footies:

To put on your pants:

To put on your gloves:

To put on your vest/bodysuit:

To put on your face mask:

This information sheet was developed and funded by:
Rocky Mountain System for Burn Injury Rehabilitation
Sponsored by the National Institute on Disability and Rehabilitation Research
U.S. Department of Education Grant #H133A3001594
June, 1995
* University of Colorado Health Sciences Center * Ninth Avenue at Colorado Boulevard *
* Denver, Colorado * 303-329-3066 *
Committed to equal employment opportunity and affirmative action.

Therapeutic Exercise

Exercise should begin on the day of the patient's burn injury and should continue until all wounds are closed and the scars are no longer metabolically active (See segment on scarring). Fibroblasts, which are responsible for wound contracture, enter a burn wound in the first twenty-four hours and remain active for up to two years after the patient's injury. Exercising several times throughout the day helps to counter the decreased strength and decreased joint range of motion that may occur from scar contracture.

By the time a burn survivor returns to his/her community, he/she will be ready for an aggressive outpatient rehabilitation program designed to:

  1. increase strength;
  2. increase endurance;
  3. increase range of motion in the involved regions;
  4. promote functional independence; and
  5. promote return to work.

A comprehensive circuit training type program has proven very effective at our facility. Continuing the following components in a gym setting helps promote patient independence and responsibility for his/her own outcome by allowing him/her to work as independent as possible on most segments, receiving guidance and assistance only in those areas needed.

STRETCHING - Stretch is most effective when performed slowly and until the scar blanches. A prolonged stretch with a light load of two to three pounds placed at the end of a lever helps to elongate shortened soft tissue. It is important to remember, that if a burn covers more than one joint, the scar should be elongated at both ends to promote a maximal stretch. Use blanching as your guide for how far to push. (See Hypertrophic scarring video segment).

STRENGTHENING - Active and resistive range of motion can and should be used frequently, using resistance whenever possible and as early as tolerated. A progressive program using pulleys, theraband(, free weights, eccentric exercises and weight bearing exercises are started early in the rehabilitation process, even when burn wounds are still open. Be aware that many burn survivors have weakness in the proximal muscles of the shoulders and hips as a result of decreased activity and immobilization. Extra attention should be paid to those areas.

ENDURANCE - Many burn survivors have decreased muscle bulk and low endurance as a result of a prolonged hospital stay, possible ventilator dependency, and periods of immobilization after skin grafting. Training on the bike, upper body ergometer, or something as simple as repetitions of ascending and descending stairs, help to build endurance. Twenty minutes of aerobic activity, performed at 60% of maximal heart rate three times a week, can help to retrain the cardiovascular system.

NOTE: Many burn survivors complain of feeling fatigued throughout the day or of being unable to stay active all day. This is not uncommon. It may take months for a burn survivor to feel that their energy will return to normal. Performing endurance training and helping the burn survivor return to a normal sleep cycle (i.e., decreasing naps in the day, increase longer periods of sleep at night) will assist with returning the patient to a "normal" level of activity.

COORDINATION - Again, long periods of immobilization and burn scarring can lead to decreased torso rotation and the ability to perform reciprocal activities. Proprioceptive Neuromuscular Facilitation and the therapeutic ball are great activities to promote these motor skills.

FINE MOTOR SKILLS - Many times, burn survivors suffer from decreased dexterity even when the hands are not burned. Patients with grafting to the upper arm require immobilization, which limits use of that hand and facilitates small muscle atrophy. Including pinch, grip and fine motor activities in your exercise program will facilitate good fine motor control and assist with independence in activities of daily living.

HOME EXERCISE PROGRAMS - Even the most aggressive outpatient program needs to be supplemented by a home exercise routine. Scars contract every minute of every day. Exercising one hour three to five times a week will not be enough to prevent contractures and deformities. Patients are instructed in written home exercise programs prior to discharge from the hospital and are expected to perform these exercises and stretches prior to coming to the outpatient appointments. That way, outpatient therapies can focus on problem areas and exercises that patients are unable to perform at home because of equipment needs.

Manually Resisted Exercise

Proprioceptive Neuromuscular Facilitation (PNF) is the method of promoting or hastening a desired response through stimulation of the proprioceptors. As taught by Knott and Voss, PNF uses stimulation through tactile, auditory, visual and verbal cues to elicit movements in normal patterns. The patient learns to move in a coordinated, skilled way as facilitated by the therapist. The goals of PNF treatment with a burn survivor are to decrease muscular guarding, facilitate normal movement patterns, encourage reciprocal and rotational movement of the head, neck, torso, upper and lower extremities, and to strengthen proximal musculature, thereby facilitating distal coordination.

The video briefly shows some PNF techniques (burn3.mov) that are effective in treating the burn survivor. They are as follows:

  1. Contract-Relax: a repeated effort is used without sustained effort from the patient to stimulate a response in the lengthen range of motion. Contract-Relax can be used to increase passive range of motion.
  2. Rhythmic Initiation: repeated movement without sustained effort from the patient in order to stimulate muscle contractions and purposeful movement. This technique is used to teach the patient how to move and increase strength.
  3. Diagonal 1 (D1) and Diagonal 2 (D2) Movement Patterns: for both the upper and lower extremities, with a flexion component and extension component. Facilitation of rotation is key to a coordinated movement. Diagonal Patterns work well for home exercise programs and increasing active range of motion.
  4. Developmental Postures - Manual Resistance: facilitating your patient through the developmental postures is a great way to gain proximal stability, strength of all extremities, and range of motion in all joints.

Review the Demonstration of a Home Exercise Program in the PNF upper extremity diagonal patterns (see pages 11-17 in the printed booklet). [Graphics version ] [Text version ]

If you would like to learn more about Proprioceptive Neuromuscular Facilitation, please refer to the Reference List provided.


Work Hardening

In today's society, feelings of self worth and personal identity are tied to the role he or she plays as a wage earner. When a person has sustained a burn injury, there are several legal, financial, and psychosocial factors that can facilitate or prevent a person's return to work. Work Hardening and Work Conditioning programs can help to identify a patient's abilities and potential problems with re-entering the work force.

APPROPRIATE REFERRAL:

  1. All wounds closed
  2. Patient wearing custom pressure garments
  3. Most surgeries completed
  4. Patient understands precautions
  5. Patient off all pain medications
  6. Patient independent with orthotics/prosthetics
  7. PT/OT goals met

Review Facts about the Americans with Disabilities Act (ADA) which can impact the burn patient's reintegration to work and society.

INTERDISCIPLINARY TEAM APPROACH:

VOCATIONAL COUNSELOR:
A professional vocational counselor can be employed through the State Department of Vocational Rehabilitation or through a private agency. They can assist the burn survivor in identifying if they are able to return to the same job. They can also provide retraining for other employment as well as counseling on career changes.

PSYCHOLOGISTS:
41% of work related burn injuries and 30% of non-work related injuries report having emotional difficulty with returning to work. Common concerns are a preoccupation with safety issues, self esteem, and adjustment to a different level of functioning. Psychologists can assist burn survivors in the return to work process by working on coping and relaxation strategies as well as addressing self esteem issues. A referral to your local psychologist can facilitate a burn survivors adjustment to returning to the community.

SOCIAL WORK:
Social workers are an excellent resource to assist the burn survivor in both legal and financial recovery. A social worker can make referrals to the appropriate agencies to provide the patient with such services as temporary housing or clothing vouchers, which can be available through the local Red Cross in the event of a house fire. Social workers can also assist the burn survivor in applying for appropriate government funding for covering medical bills.

PHYSICAL/OCCUPATIONAL THERAPISTS:
Therapists are the trouble-shooters in assisting the burn survivor in returning to work. They can help to promote maximal physical functioning for return to work. By obtaining a job description, a therapist can simulate worker roles in the clinic. By having a patient perform repetitive, simulated motions for four to eight hours per day, a therapist can identify problem areas and provide treatment to address those areas. Many times these problems can be missed in the outpatient clinic if the tasks are not performed for an appropriate amount of time. For instance, many patients will not have a problem with friction or shearing against their garments during short periods of activities, but performing the same activities for longer periods of time can cause skin breakdown.

COMMON INTERVENTIONS:

TEMPERATURE EXTREMES:
Many burn survivors will have difficulty regulating their body temperature in weather extremes. Those persons working in a persistently cold environment should wear many layers of clothing for insulation. By layering their clothing, they can easily remove what is no longer necessary once their body warms up. Many patients will complain of increased stiffness in the burned regions in cold temperatures. It would be recommended these patients perform additional stretching exercises immediately prior to beginning work.

Those burn survivors who work in a particularly hot environment need to take several precautions to prevent heat exhaustion or heat stroke. These patients should drink plenty of non-alcoholic, non-caffeinated beverages throughout their work shift. Additional suggestions for keeping cool would include the use of a fan in their work space, and dampening their garments with a water bottle throughout their shift. Placing a cold pack on the head or the wrist can help to cool the entire body.

SKIN PROTECTION:
Burn survivors need to take extra precautions to protect their skin whether they are working or playing. The use of a sunscreen with SPF of 15 or higher is recommended on all burned regions, as they tend to burn more readily. When working with detergents and/or chemicals, rubber gloves and/or a protective suit should be worn over the person's custom pressure garments.

SKIN INTEGRITY:
Hypertrophic scars tend to have problems with friction and shearing. The areas most commonly affected are the elbows, metacarpal phalangeal joints, knees and heels. To help prevent shearing, a patient can wear panty hose under their garments. While this can get a bit warm, it decrease shearing and makes the application of the garments easier. Patients can also use silicone gel pads or telfa pads on high friction areas. See the splinting catalogs listed in the SPLINTS section for availability of gel pads.


Modalities

As with any other patient, modalities are an excellent way to assist in preparing a region for treatment. However, burn survivors require a note of caution when using certain modalities.

COLD MODALITIES:
It has been our experience, that few burn survivors can tolerate the use of cold modalities, such as cold packs, ice massage, etc. The initial vasoconstriction that accompanies a cold modality reportedly makes the burned region feel stiffer. It is more comfortable for the patient to use cold modalities on other concurrent injuries. As always, be sure to check skin tolerance where sensation may be impaired.

HEAT MODALITIES:
An area that has hypertrophic scarring also has impaired sensation and an altered vascular system. It is important to be cautious when using heat modalities over these areas, as the scarred region will have difficulty dissipating heat and can more readily sustain an additional burn injury. As shown on the video, use extra toweling with hot packs. Use a lower intensity with other heat modalities, such as ultrasound. Check the skin frequently for blistering.

ELECTRICAL STIMULATION:
TENS can be used for pain control with burn survivors. Be aware that newly healed skin may be more sensitive than other areas. Also, burned areas contain many unmyelinated nerve endings which can be hypersensitive and can cause great discomfort when using electrical current. Be sure to test the TENS on a small area on the patient's intact skin before using it on burned areas. It has been our experience, that using TENS on nerve roots for more diffuse pain control works very well. F.E.S. can be used for muscle re-education using the same precautions.

PARAFFIN:
The use of paraffin has several benefits when used properly. It works well to heat the collagen fibers of the scar in preparation for stretching. It reportedly relieves superficial stiffness and aches. Also, it contains mineral oil which moisturizes the scar. As with the other heat modalities, use a lower temperature and check the skin frequently for signs of burning. Paraffin works especially well when used in conjunction with a prolonged, low load stretch.

IONTOPHORESIS:
There has been little research in the use of iontophoresis with hypertrophic burn scars. Dexamethasone has traditionally been injected into persistent hypertrophic scars. This process is painful. Our facility has had some success with iontophoresis using dexamethasone over scarring to decrease the local inflammation. Also, acetic acid in a 2% solution (distilled vinegar) has been used with the same results. A low intensity should be used to protect the patient's skin from burns.

FLUIDOTHERAPY:
Can be used with the same precautions as other heat modalities once the wounds are completely closed. Even superficial open areas are a contraindication with fluidotherapy.


HOME PARAFFIN TREATMENT

MATERIALS NEEDED

  1. Crock Pot
  2. Paraffin Wax
  3. Candy Thermometer - Essential
  4. Saran Wrap
  5. Towels

DIRECTIONS FOR APPLICATION

  1. Heat paraffin wax in crock pot to approximately 120 degrees F. Use candy thermometer to measure temperature.
  2. Turn off crock pot. Let paraffin cool approximately 1-2 minutes.
  3. Place affected area on stretch position.
  4. Using your hand (unburned) or a paintbrush, paint wax onto a 1/4" thick coat.
  5. Wrap coated area with saran wrap and two layers of towels.
  6. Leave wrapped area on stretch for twenty minutes.
  7. You can do this safely once a day. Exercise immediately after paraffin treatment.
  8. Paraffin wax is reusable, but only for one patient. No sharing with family or friends.

Any questions or concerns, please call your therapist (insert name, number).

* University of Colorado Health Sciences Center * Ninth Avenue at Colorado Boulevard *
* Denver, Colorado * 303-329-3066 *
Committed to equal employment opportunity and affirmative action.

Activities of Daily Living

Activities of Daily Living, or ADL's, are the foundation to a burn survivor's successful outcome. The ability to perform ADL's provides us with increased self-esteem, self worth, and a sense of independence. When performing activities such as feeding, grooming, or dressing, it is important to realize the burn survivor is working on all of his/her therapeutic goals such as: increase range of motion, increase strength, increase fine motor coordination, increase balance, etc. As a care provider, we must encourage him/her to reach the highest level of independence in all ADL's - this may require adaptive equipment, change in a routine and modification of the task, as well as lots of encouragement due to frustration and pain.

The video demonstrates a small portion of activities, modifications and equipment.

ADL's include:

Modifications - This may include lowering frequently used items from a high shelf, moving a bathroom mirror for better visibility, or moving furniture for increased safety in mobility. Modifying a person's environment involves creativity and common sense. The patient may be your best resource to adaptations that they have thought of in their home.

Equipment - As therapists, we try to anticipate the burn survivor's equipment needs. However, we can not always know what they may need when actually at home, or their functional status may change as mobility and range of motion increase.

See References for Adaptive Equipment (See page 30 in the printed booklet.)


Splints

Splinting of a joint or multiple joints is used to:

  1. prevent contractures;
  2. prevent deformities;
  3. apply pressure/stretch to the burn areas for scar control.

Remember, the position of comfort is also the position of contracture for the burn survivor. Therefore, he/she may not like to wear the splint provided - it is important to encourage and insist on splint wear as it will place the joint in a therapeutic and functional position. Education is the key to compliance with splint wear.

The splints shown in the video (burn4.mov) are the most commonly used on an outpatient basis.

Positional hand splint: a prefabricated splint to put the hand and wrist in a position of function. Keep in mind the splint has full contact with the palm and web space of the hand.

Neck conformer: custom-made for the burn survivor, this places the neck in slight extension to decrease the potential for a neck flexion contracture and webbing of the neck. Again, the splint must be in full contact with neck in order to be effective.

Axillary conformer: A custom-made splint to prevent contractures of the shoulder. Although not very comfortable, this splint is of utmost importance to stretching the region. Non-compliance with this splint often results in surgery to release axilla contractures.

Splinting and Positioning are to be performed continuously until the burn survivor can easily perform range of motion of the joint within a normal limit; at that time splinting and positioning can be decreased or discontinued.

A Product/Materials List is also provided for additional products and splints your facility may want to use to assist with proper positioning. (See pages 35 and 36 in the printed booklet.)

See the following information on proper positioning for additional positioning ideas (from the University Hospital).

POSITION OF COMFORT = POSITION OF CONTRACTURE

Neck
Position of Comfort: Flexed

THERAPEUTIC POSITION: Extended: towel roll, conformer

Shoulder
Position of Comfort: Flexed, adducted

THERAPEUTIC POSITION: Abduct 90 degrees: wedge,
Position of Comfort: Int. Rotated

THERAPEUTIC POSITION: conformer, lat. arm support

Elbow
Position of Comfort: Flexed

THERAPEUTIC POSITION: Extended -5 degrees pillow, splint
Position of Comfort: Supinated

THERAPEUTIC POSITION: Pronated

Wrist
Position of Comfort: Flexed

THERAPEUTIC POSITION: Extended 30-60 degrees splint, washcloth

Hand
Position of Comfort: Clawed: MCP ext

THERAPEUTIC POSITION: MCP flexed 70 degrees, splint
Position of Comfort: PIP + DIP flex

THERAPEUTIC POSITION: PIP, DIP extended, splint

Position of Comfort: Thumb adducted

THERAPEUTIC POSITION: Thumb opposed; splint, washcloth

Hip
Position of Comfort: Flexed, IR.

THERAPEUTIC POSITION: Extended, Neutral Rotation
Position of Comfort: Adducted

THERAPEUTIC POSITION: Abduct; Towel roll

Knee
Position of Comfort: Flexed

THERAPEUTIC POSITION: Full Extension

Ankle
Position of Comfort: Plantarflexed

THERAPEUTIC POSITION: Dorsiflexed 0 degrees
Position of Comfort: Inverted

THERAPEUTIC POSITION: Neutral Ever/Invers foot pillow, splint


CARING FOR YOUR SPLINT

Your splint was custom made for you. Please read the following instructions to learn about the care of your injured area and your splint. Your splint serves the purposes of assuring proper body position and preventing contractures. If you have any doubt as to how it fits, please contact your primary therapist (insert name, number).

Precautions
Contact your therapist if your splint causes any of the following:

Adjustments
Please notify your therapist if you feel an adjustment is necessary.

Care of Your Splint

Cleaning your Splint

Wearing Your Splint

Your splint should be worn:

___ Full-time, day and night.

___ Full-time, except for brief periods of exercises, as instructed by your therapist or physician.

___ At night only.

___ Other schedule:

Note: Your therapist or physician should give you instructions on wearing your splint.

This information sheet was developed and funded by:
Rocky Mountain System for Burn Injury Rehabilitation
Sponsored by the National Institute on Disability and Rehabilitation Research
U.S. Department of Education Grant #H133A3001594
June, 1995
* University of Colorado Health Sciences Center * Ninth Avenue at Colorado Boulevard *
* Denver, Colorado * 303-329-3066 *
Committed to equal employment opportunity and affirmative action.

Outcomes and Interviews

Note: The outcomes and interviews described are presented in the video tape (burn5.mov).

The first two patient outcomes are examples of two patients who have similar injuries. Both patients were burned over 50% total body surface area primarily to the upper body and requiring multiple skin grafts to close their wounds. It is important to note that Rob required skin grafts to his face while Harry's face healed spontaneously. Also, Rob's hands were more severely involved. Both were treated by the same therapist, however Rob refused therapy intervention for the majority of this burn rehabilitation.

The last two interviews are designed to give various examples of other patients views of burn rehabilitation. These segments assist the care providers and the burn survivor in understanding the comments and perspectives on surviving a burn injury and the rehabilitation process.


The team at University Hospital Burn Unit appreciates your help in assisting the burn survivor in returning to the community and work. If you have any questions or problems, feel free to contact us at the following locations.

Burn Unit
University Hospital
4200 East Ninth Ave
Denver, CO 80262
(303) 372-0001

Tracy Gamage, RPT/Paulette C. Cooley, PT
Department of Rehabilitation Medicine
4200 East Ninth Avenue C-243
Denver, CO 80262-0243
(303) 372-8478

Lisa Haynes, OTR
Department of Rehabilitation Medicine
4200 East Ninth Avenue C-243
Denver, CO 80262-0243
(303) 372-8485

Selected References for the video tape and manual set "An Easy Guide to Outpatient Burn Rehabilitation" are found in the Resources section. These were collected by the Rocky Mountain Model System for Burn Injury Rehabilitation at the University of Colorado Health Sciences Center.





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NIDRR Project Number: H133A031402
Last Updated: Wednesday, 07 October 2009 at 01:43 PM.

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