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Fanstone R, Price P. Global perspectives on risk factors for major joint burn contractures: A literature review. Burns 2024; 50:537-549. [PMID: 37977897 DOI: 10.1016/j.burns.2023.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/31/2023] [Accepted: 09/22/2023] [Indexed: 11/19/2023]
Abstract
Contractures are a frequent consequence of burn injuries, yet our knowledge of associated risk factors is limited. This paper provides an extensive review of relevant literature from both High-Income Countries (HICs) and Low-Middle Income Countries (LMICs). Ninety-four papers (up to June 2019) and eight subsequent publications (up to March 2022) were included, 76% of which were from HICs. The majority of publications were either descriptive studies (4 from HICs, 9 from LMICs) or papers citing putative risk factors (37 from HICs, 10 from LMICs). Seventeen publications (all from HICs) reported on the effects of individual non-surgical therapeutic interventions, often with conflicting results. Two published systematic reviews emphasised the poor quality of evidence available. Only fifteen studies (3 from LMICs) examined potential contracture risk factors with statistical comparisons of outcomes; significant findings from these included demographic, burn, comorbidities, and treatment risk factors. LMIC papers included socioeconomic and healthcare system factors as potential risks for contracture; these were rarely considered in HIC publications. Methodological issues identified from this review of literature included differences in contracture definitions, populations studied, standards of care, joints included and the timing and nature of contracture assessments.This review is the first to collate existing knowledge on risk factors for burn contractures from both HIC and LMIC settings, revealing a surprising lack of robust evidence for many accepted risk factors. In LMICs, where burns are particularly common, universal health provision is lacking and specialist burn care is both scarce and difficult to access; consequently, socioeconomic factors may have more immediate impact on contracture outcomes than specific burn treatments or therapies. Much more work is indicated to fully understand the relative impacts of risk factors in different settings so that context-appropriate contracture prevention strategies can be developed.
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Affiliation(s)
- RuthAnn Fanstone
- Centre for Global Burn Injury Policy and Research, Swansea University, UK.
| | - Patricia Price
- Centre for Global Burn Injury Policy and Research, Swansea University, UK
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Fanstone R, Price P, Bodger O, Potokar T, Khan MRK. Risk factors for burn contractures: A cross-sectional study in a lower income country. Burns 2024; 50:454-465. [PMID: 37980272 DOI: 10.1016/j.burns.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/31/2023] [Accepted: 09/09/2023] [Indexed: 11/20/2023]
Abstract
Risk factors for burn contractures require further study, especially in low and middle-income countries (LMICs); existing research has been predominantly conducted in high income countries (HICs). This study aimed to identify risk factors for burn contractures of major joints in a low-income setting. Potential risk factors (n = 104) for burn contracture were identified from the literature and a survey of clinicians with extensive experience in low and middle-income countries (LMIC). An observational cross-sectional study of adult burn survivors was undertaken in Bangladesh to evaluate as many of these risk factors as were feasible against contracture presence and severity. Forty-eight potential risk factors were examined in 48 adult patients with 126 major joints at risk (median 3 per participant) at a median of 2.5 years after burn injury. Contractures were present in 77% of participants and 52% of joints overall. Contracture severity was determined by measurement of loss of movement at all joints at risk. Person level risk factors were defined as those that were common to all joints at risk for the participant and only documented once, whilst joint level risk factors were documented for each of the participant's included joints at risk. Person level risk factors which were significantly correlated with loss of range of movement (ROM) included employment status, full thickness burns, refusal of skin graft, discharged against medical advice, low frequency of follow up and lack of awareness of contracture development. Significant joint level risk factors for loss of ROM included anatomical location, non-grafted burns, and lack of pressure therapy. This study has examined the largest number of potential contracture risk factors in an LMIC setting to date. A key finding was that risk factors for contracture in low-income settings may differ substantially from those seen in high income countries, which has implications for effective prevention strategies in these countries. Better whole person and joint outcome measures are required for accurate determination of risk factors for burn contracture. Recommendations for planning and reporting on future contracture risk factor studies are made.
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Affiliation(s)
- RuthAnn Fanstone
- Centre for Global Burn Injury Policy and Research, Swansea University, UK.
| | - Patricia Price
- Centre for Global Burn Injury Policy and Research, Swansea University, UK
| | - Owen Bodger
- Faculty of Medicine, Health and Life Sciences, Swansea University, UK
| | - Tom Potokar
- Centre for Global Burn Injury Policy and Research, Swansea University, UK
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Hartl G, Fletchall S, Velamuri SR. Burn Injury Cutaneous Functional Units: Allocating Occupational Therapy Resources and Influencing Practice. J Burn Care Res 2023; 44:1117-1124. [PMID: 36918955 DOI: 10.1093/jbcr/irad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Indexed: 03/16/2023]
Abstract
Burn injury severity is currently determined by estimating the total body surface area (TBSA) burned, but this method fails to capture the severity of subsequent functional consequences. Alternatively, cutaneous functional units (CFUs)--skin segments that accommodate for movement and commonly become contracted--can be used to more accurately estimate burn severity based on functional consequences. Bilateral hands account for 81.3% of the body's CFUs, though only account for 5% of TBSA. However, hand burn survivors can have worse physical outcomes (ie, contractures, deformities) after burn injury, leading to subsequent loss of function, global occupational participation deficits, and poor psychosocial outcomes. This study, conducted at a verified American Burn Association burn center, explores how CFU involvement among adult burn survivors with uni and bilateral hand and upper extremity burns influenced occupational therapy practice in regards to time spent completing scar and soft tissue elongation techniques from the elbow to the digit tips per patient. The data showed, on average, burn occupational therapists require 0.8 minutes per CFU for an average total of 38.7 (SD = 29.5) minutes each session to complete scar and soft tissue elongation techniques to the upper extremities. The results of this study can be used to educate burn centers on the clinical utility of CFUs, burn occupational therapists regarding best-practice in terms of utilization of therapist time and resources, as well as support the justification for increasing occupational therapy services for patients with upper extremity and hand burns, and increasing staffing to meet patient need.
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Affiliation(s)
- Grace Hartl
- Sargent College of Health and Rehabilitation Sciences at Boston University, Boston, Massachusetts, USA
| | - Sandra Fletchall
- Regional One Health, Firefighters Burn Center, Memphis, Tennessee, USA
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Parry IS, Yelvington ML, Warthman R, Richard R. JBCR Letter to the Editor regarding Cutaneous Functional Units. J Burn Care Res 2023; 44:1260. [PMID: 37586815 DOI: 10.1093/jbcr/irad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
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Liu C, Xie H, Wei P, Gong T, Wu G, Xu Z, Chen S. Clinical study of early rehabilitation training combined with negative pressure wound therapy for the treatment of deep partial-thickness hand burns. Front Surg 2023; 10:1040407. [PMID: 36843993 PMCID: PMC9952234 DOI: 10.3389/fsurg.2023.1040407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/04/2023] [Indexed: 02/10/2023] Open
Abstract
Objective This study aims to explore the clinical effect of early rehabilitation training combined with negative pressure wound therapy (NPWT) for treating deep partial-thickness hand burns. Methods Twenty patients with deep partial-thickness hand burns were randomly divided into an experimental group (n = 10) and a control group (n = 10). In the experimental group, early rehabilitation training combined with NPWT was performed, including the proper sealing of the negative pressure device, intraoperative plastic brace, early postoperative exercise therapy during negative pressure treatment, and intraoperative and postoperative body positioning. Routine NPWT was conducted in the control group. Both groups received 4 weeks of rehabilitation after wounds healed by NPWT with or without skin grafts. Hand function was evaluated after wound healing and 4 weeks after rehabilitation, including hand joint total active motion (TAM) and the brief Michigan Hand Questionnaire (bMHQ). Results Twenty patients were involved in this study, including 16 men and 4 women, aged 18-70 years, and the hand burn area ranged from 0.5% to 2% of the total body surface area (TBSA). There was no significant difference in TAM and bMHQ scores between the two groups after negative pressure removal. After 4 weeks of rehabilitation training, the TAM scores and bMHQ scores were significantly improved in both groups (p < 0.05); among them, those of the experimental group were both significantly better than those of the control group (p < 0.05). Conclusion The application of early rehabilitation training combined with NPWT to treat deep partial-thickness hand burns can effectively improve hand function.
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Affiliation(s)
- Canbin Liu
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hongteng Xie
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Pei Wei
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Teng Gong
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guohua Wu
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhaorong Xu
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China,Correspondence: Shun Chen Zhaorong Xu
| | - Shun Chen
- Burn & Wound Repair Department, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Institute, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou, China,Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Medical University Union Hospital, Fuzhou, China,Correspondence: Shun Chen Zhaorong Xu
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Schouten HJ, Nieuwenhuis MK, van Baar ME, van der Schans CP, Niemeijer AS, van Zuijlen PPM. The degree of joint range of motion limitations after burn injuries during recovery. Burns 2022; 48:309-318. [PMID: 34955294 DOI: 10.1016/j.burns.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/01/2020] [Accepted: 01/08/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim of this study was to determine the degree of ROM limitations of extremities, joints and planes of motion after burns and its prevalence over time. METHOD The database of a longitudinal multicenter cohort study in the Netherlands (2011-2012) was used. From patients with acute burns involving the neck, shoulder, elbow, wrist, hip, knee and ankle joints that had surgery, ROM of 17 planes of motion was assessed by goniometry at 3, 6 weeks, 3-6-9 and 12 months after burns and at discharge. RESULTS At 12 months after injury, 12 out of 17 planes of motion demonstrated persistent joint limitations. The five unlimited planes of motion were all of the lower extremity. The most severely limited joints at 12 months were the neck, ankle, wrist and shoulder. The lower extremity was more severely limited in the early phase of recovery whereas at 12 months the upper extremity was more severely limited. CONCLUSION The degree of ROM limitations and prevalence varied over time between extremities, joints and planes of motion. This study showed which joints and planes of motion should be watched specifically concerning the development of scar contracture.
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Affiliation(s)
- H J Schouten
- Association of Dutch Burn Centers, Burn Centre, Red Cross Hospital Beverwijk, The Netherlands; Burn Centre and Dept of Plastic & Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Department of Physiotherapy, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Science's Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; The Dutch Working Group on Burn Rehabilitation, The Netherlands.
| | - M K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Centre, Martini Hospital Groningen, The Netherlands; Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands; The Dutch Working Group on Burn Rehabilitation, The Netherlands
| | - M E van Baar
- Association of Dutch Burn Centers, Burn Centre, Maasstad Hospital Rotterdam, The Netherlands; Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - C P van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, The Netherlands; Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, The Netherlands; Health Psychology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - A S Niemeijer
- Association of Dutch Burn Centers, Burn Centre, Martini Hospital Groningen, The Netherlands; Research Institute, Martini Hospital Groningen, The Netherlands
| | - P P M van Zuijlen
- Burn Centre and Dept of Plastic & Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Science's Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands; The Dutch Working Group on Burn Rehabilitation, The Netherlands; Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
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Diverse Treatments for Deep Burn Wounds: A Case Report. Adv Skin Wound Care 2021; 34:1-6. [PMID: 33739953 DOI: 10.1097/01.asw.0000734392.64937.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Patients with extensive deep burns usually experience infections and organ dysfunction. Proactive and effective wound repair is key to treatment. If large wounds remain open, systemic infection and multiple organ dysfunction syndrome can occur, threatening the lives of patients. Current wound repair methods include skin grafts, flap repair, negative-pressure wound therapy, and cellular and/or tissue-based products. For deep, complex burn wounds, a single form of treatment is usually ineffective. This article reports a rare case of burn wound repair. The patient was burned by a charcoal flame on multiple parts of his body after carbon monoxide poisoning. Pneumothorax and acute renal failure occurred after the injury, accompanied by multiple osteonecroses of the trunk and lower limbs. A multidisciplinary team formulated an individualized treatment plan; the diverse treatments included closed chest drainage, continuous renal replacement therapy, infection control, analgesia, wound debridement, negative-pressure wound therapy, cellular and/or tissue-based products, autologous dermal scaffold graft, skin grafts, flap transposition, platelet-rich plasma, and rehabilitation, which ultimately saved the patient's life and led to healing of all the wounds.
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Schouten H, Nieuwenhuis M, van Baar M, van der Schans C, Niemeijer A, van Zuijlen P. The prevalence and development of burn scar contractures: A prospective multicenter cohort study. Burns 2019; 45:783-790. [DOI: 10.1016/j.burns.2019.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 11/30/2018] [Accepted: 03/03/2019] [Indexed: 11/28/2022]
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Tan J, Chen J, Zhou J, Song H, Deng H, Ao M, Luo G, Wu J. Joint contractures in severe burn patients with early rehabilitation intervention in one of the largest burn intensive care unit in China: a descriptive analysis. BURNS & TRAUMA 2019; 7:17. [PMID: 31139664 PMCID: PMC6526598 DOI: 10.1186/s41038-019-0151-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/22/2019] [Indexed: 01/17/2023]
Abstract
Background Joint contracture is the major clinical complication in burn patients, especially, the severe burn patients. This study aimed to investigate the number and severity of joint contractures in patients with burns affecting greater than or equal to 50% of the total body surface area (TBSA) undergoing early rehabilitation in a burn intensive care unit (BICU). Methods We analyzed burn patients with burns affecting greater than or equal to 50% of the TBSA admitted to a BICU who received early rehabilitation within 7 days post-injury from January 2011 to December 2015. Demographic and medical information was collected. The range of motion (ROM) of different joints was measured 1 month post-admission. Spearman’s correlation coefficient and logistic regression analysis was used to determine predictors of the presence and severity of contractures. Result The average affected TBSA of the included burn patients was 67.4%, and the average length of stay in the BICU was 46.2 ± 28.8 days. One hundred and one of 108 burn patients (93.5%) developed at least one joint contracture. The ROM in 67.9% of the affected joints was mildly limited. The majority of contractures in severe burn patients were mild (37.7%) or moderate (33.2%). The wrist was the most commonly affected joint (18.2%), followed by the shoulder, ankle, hip, knee, and elbow. A predictor of the presence of contractures was the length of hospital stay (p = 0.049). The severe contracture was related to the area of full-thickness burns, the strict bed rest time, and the duration of rehabilitation in BICU. The length of rehabilitation stay (days) in patients with moderate contracture is 54.5% longer than that in severe contracture (p = 0.024) Conclusion During the long stay in BICU, the length of rehabilitation stay in a BICU could decrease the severity of contractures from severe to moderate in the patients with equal to 50% of the TBSA. Hence, this research reveals the important role of early rehabilitation interventions in severe burn patients. Electronic supplementary material The online version of this article (10.1186/s41038-019-0151-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jianglin Tan
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China
| | - Jian Chen
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China
| | - Junyi Zhou
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China
| | - Huapei Song
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China
| | - Huan Deng
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China
| | - Ming Ao
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China
| | - Gaoxing Luo
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China
| | - Jun Wu
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injuries, Chongqing Key Laboratory for Disease Proteomics, Southwest Hospital, Third Military (Army) Medical University, Chongqing, 400038 China.,2Department of Burns, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 China
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Jacobson K, Fletchall S, Dodd H, Starnes C. Current Concepts Burn Rehabilitation, Part I: Care During Hospitalization. Clin Plast Surg 2017; 44:703-712. [PMID: 28888296 DOI: 10.1016/j.cps.2017.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This article summarizes current interventions for several of the most common challenges faced by patients during their rehabilitation from burn injury. These include preservation of range of motion through scar contracture management, and achieving maximal independence through exercise, and training in activities of daily living.
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Affiliation(s)
- Keith Jacobson
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA.
| | - Sandra Fletchall
- Burn Rehabilitation, Firefighters Burn Center, 890 Madison Avenue, TG 043, Memphis, TN 380103, USA
| | - Heather Dodd
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA
| | - Carrie Starnes
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA
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