Secondary injuries caused by ill-suited rehabilitation treatments: Five case reports

BACKGROUND Increasing attention is being given to burn rehabilitation,and an increasing number of burn patients are undergoing rehabilitation.However,little attention has been given to secondary injuries caused by ill-suited rehabilitation practices.Patients,especially those in undeveloped countries,sustain injuries due to inadequate burn rehabilitation practices and the nonstandard implementation of rehabilitation treatments.CASE SUMMARY This study reports 5 cases of secondary injuries caused by ill-suited burn rehabilitation practices in our institute,including first web space contracture caused by a single orthosis treatment,finger deformity caused by improper compression therapy with a self-adhering bandage,developmental impairment of the affected limb caused by continuous improper compression therapy,and fracture caused by overly intensive rehabilitation exercise.CONCLUSION More attention should be given to burn rehabilitation to reduce the incidence of secondary injuries caused by ill-suited rehabilitation practices.Burn rehabilitation system should include specialized hospitals(burn rehabilitation centers),community hospitals,and family rehabilitation clinics.Precise instruments and equipment,accurate measurement methods,objective monitoring indicators and standardized guidelines and recommendations will help improve the quality of burn rehabilitation.Additionally,more attention should be given to burn rehabilitation in children.

Status of adult inpatient burn rehabilitation in Europe: are we neglecting metabolic outcomes?

Background:Hypermetabolism,muscle wasting and insulin resistance are challenging yet important rehabilitation targets in the management of burns.In the absence of concrete practice guidelines,however,it remains unclear how these metabolic targets are currently managed.This study aimed to describe the current practice of inpatient rehabilitation across Europe.Methods:An electronic survey was distributed by the European Burn Association to burn centres throughout Europe,comprising generic and profession-specific questions directed at therapists,medical doctors and dieticians.Questions concerned exercise prescription,metabolic management and treatment priorities,motivation and knowledge of burn-induced metabolic sequelae.Odds ratios were computed to analyse associations between data derived from the responses of treatment priorities and knowledge of burn-induced metabolic sequelae.Results:Fifty-nine clinicians with 12.3±9 years of professional experience in burns,representing 18 out of 91 burn centres(response rate,19.8%)across eight European countries responded.Resistance and aerobic exercises were only provided by 42%and 38%of therapists to intubated patients,87%and 65%once out-of-bed mobility was possible and 97%and 83%once patients were able to leave their hospital room,respectively.The assessment of resting energy expenditure by indirect calorimetry,muscle wasting and insulin resistance was carried out by only 40.7%,15.3%and 7.4%respondents,respectively,with large variability in employed frequency and methods.Not all clinicians changed their care in cases of hypermetabolism(59.3%),muscle wasting(70.4%)or insulin resistance(44.4%),and large variations in management strategies were reported.Significant interdisciplinary variation was present in treatment goal importance ratings,motivation and knowledge of burn-induced metabolic sequelae.The prevention of metabolic sequelae was regarded as the least important treatment goal,while the restoration of functional status was rated as the most important.Knowledge of burn-induced metabolic sequelae was linked to higher importance ratings of metabolic sequelae as a therapy goal(odds ratio,4.63;95%CI,1.50–14.25;p<0.01).Conclusion:This survey reveals considerable non-uniformity around multiple aspects of inpatient rehabilitation across European burn care,including,most notably,a potential neglect of metabolic outcomes.The results contribute to the necessary groundwork to formulate practice guidelines for inpatient burn rehabilitation.

Perspectives of caregivers towards physiotherapy treatment for children with burns in Harare, Zimbabwe: A cross-sectional study

Background:Physiotherapy is an integral part of treatment for paediatric burns.In Zimbabwe,children are admitted in paediatric burn unit with their caregivers,who play important roles such as providing explanation and obtaining cooperation of the child during physiotherapy,which is often uncomfortable or painful to the patient.The aim of this study was to determine the perspectives of caregivers towards physiotherapy interventions administered to hospitalized children at central hospitals in Harare,Zimbabwe.Methods:A descriptive cross-sectional study was conducted using self-administered questionnaires.The study was carried out at two large central hospitals(Parirenyatwa Hospital and Harare Central Hospital).The study targeted all the caregivers of children below the age of 12 years with a diagnosis of burns,irrespective of severity or area affected,who were admitted in the two paediatric burn units.Of the 34 caregivers eligible to participate,31(91.1%)questionnaires had complete data and were analysed.The analyses were done using Statistica version 12.0.Results:The median age of the caregivers was 28 years(IQR=24–33 years).Female caregivers constituted 90.3%of the sample.The majority of the caregivers(n=26,83.9%)were biological mothers to the hospitalised child.The majority of children(n=20,64.5%)hospitalised were between 0 and 4 years.The commonest cause of burns was scalding(n=19,61.2%).The burns were mainly in the upper extremities(n=11,35.5%).Physiotherapy for the burns was mainly active and passive joint range of motion exercises(n=30,96.8%).The caregivers’perceptions towards physiotherapy were mainly positive(n=20,64.5%)indicating that physiotherapy plays an important role in burn management.Of the 21 caregivers given a ward exercise programme,13(61.9%)were not compliant.Conclusions:Caregivers’perspectives towards physiotherapy were largely positive and are similar to those found in other studies.The majority of the caregivers indicated that physiotherapy was important in the overall management of burns leading to proper healing of the wounds without complications.

Effect of robot-assisted gait training on the biomechanical properties of burn scars:a single-blind,randomized controlled trial

Background:Robot-assisted gait training(RAGT)is more effective in the range of motion(ROM)and isometric strength in patients with burns than conventional training.However,concerns have been raised about whether RAGT might negatively affect the scars of patients with burns.Therefore,we investigated the effects of RAGT-induced mechanical load on the biomechanical properties of burn scars.Methods:This was a single-blind,randomized clinical trial conducted on inpatients admitted to the Department of Rehabilitation Medicine between September 2020 and August 2021.RAGT was conducted for 30 min per day,five days a week for 12 weeks and the control group received conventional gait training for 12 weeks.The pre-training ROM of lower extremity joints was evaluated and the levels of melanin,erythema,trans-epidermal water loss,scar distensibility and elasticity were assessed before training and at 4 and 12 weeks after training.Finally,19 patients in the gait assistance robot(GAR)group and 20 patients in the control group completed the 12-week trial and all evaluations.Results:There were no significant differences in the epidemiologic characteristics,pre-training ROM of joints and pre-training biomechanical properties of the burn scar between the groups(p>0.05 for all).None of the patients experienced skin abrasion around the burn scar where the fastening belts were applied or musculoskeletal or cardiovascular adverse events during the training.Scar thickness significantly increased in both groups(p=0.037 and p=0.019)and scar distensibility significantly decreased in the control group(p=0.011)during the training.Hysteresis was significantly decreased in the GAR group during the training(p=0.038).The GAR and control groups showed significant difference in the change in the values of hysteresis between pre-training and 12 weeks after training(p=0.441 and p=0.049).Conclusions:RAGT significantly decreased hysteresis in hypertrophic burn scars and did not cause a significant decrease in skin distensibility.Moreover,no skin complications around the burn scars were detected during RAGT.