Burn Rehabilitation

Significant advances in management have resulted in an increase in survival after burn injury. As a consequence, burn survivors, who tend to be young adults, have long-term sequelae that impact return to work and community reintegration.Acute burn pain is typically significant and is magnified by procedural pain associated with change dressing, mobility, stretching, and surgery. Opioids remain the mainstay of acute pain management. Treatment requires frequent reassessment because an individual’s pain may change drastically around events, such as wound closure or participation in therapies.Approximately 10% of burned individuals will develop peripheral neuropathies from a variety of etiologies, such as direct thermal injury, electrical current, compression, and metabolic derangements. The physiatrist performing electrodiagnostic testing on burned individuals should be mindful that the changes after burn injury can alter the results of both nerve conduc-tion testing and electromyography.In individuals with burn injuries greater than 30% TBSA, there is a risk of development of heterotopic ossification (HO). The most common site of HO in burned individuals is the posterior elbow.Hypertrophic scarring is the most common complication after burn injury, with a prevalence of 67%.The best treatment is to prevent the scar through adequate wound care. The first-line treatment for any burn scar is regular moisturizer cream, applied several (four to six) times per day, avoidance of mechanical insults, and the minimization of direct heat and sun exposure.Contracture after burn injury is common, with the shoulder, elbow, and knee being the most common joints affected in individuals discharged from the burn unit.Some individuals require admission to an inpatient rehabilitation facility (IRF) to maximize function. Individuals who are admitted to IRFs tend to be older individuals and have larger burn injuries (> 40% TBSA burned).