From the Guidelines
Hand physical therapy after a burn injury should begin as soon as medically possible, typically within 24-48 hours after injury, to minimize morbidity and mortality and improve quality of life. The primary goal of hand physical therapy is to prevent contractures, promote healing, and restore functional ability. According to the experts, advice from specialists is required for burns involving certain anatomical areas, including the hands 1.
Key Components of Hand Physical Therapy
- Elevation of the hand above heart level to reduce edema
- Gentle range of motion exercises performed 5-10 times hourly while awake
- Custom-made thermoplastic splints to maintain the hand in a functional position
- Active exercises, strengthening with putty or small objects, and scar management techniques as healing progresses
Scar Management and Pain Control
- Compression garments worn 23 hours daily for 6-12 months to reduce scarring
- Silicone gel sheets applied to healed burn areas for 12-24 hours daily
- Massage with unscented moisturizer performed 3-4 times daily using firm pressure in circular motions
- Pain medication taken 30 minutes before therapy sessions to maximize participation
Duration and Outcome
Therapy should continue until maximum functional recovery is achieved, which may take 6-18 months depending on burn severity. The benefits of a multidisciplinary approach, including hand physical therapy, have been reported to improve survival, facilitate rehabilitation, and reduce complications, length of hospital stay, and costs 1.
From the Research
Hand Physical Therapy after Burn Injury
The recommendations for hand physical therapy after a burn injury are focused on maintaining mobility, preventing contractures, and promoting functionality of the hand. Some key aspects of hand physical therapy after a burn injury include:
- Active and passive range of motion exercises to preserve and restore function of the burned hand 2
- Use of splints to correct contractures and maintain proper positioning of the hand 3, 2, 4
- Strengthening exercises to improve muscle force and coordination 3
- Management of cicatrix (scar tissue) to prevent hypertrophic scarring 3
- Desensitization programs to improve sensation and reduce pain 4
Timing and Approach
The approach to hand physical therapy after a burn injury should be early and aggressive, with intervention starting as soon as possible after the injury 2, 4. The initial evaluation should include a careful analysis of the extent and depth of the hand burn, as well as any concomitant injuries 2. A planned treatment program should be developed, taking into account the individual needs of the patient and the severity of the burn injury 5.
Goals of Treatment
The goals of hand physical therapy after a burn injury include: