Axillary Burns: Extended Grafting and Early Splinting Prevents Contractures

The objective of this study was to assess current practice patterns and attitudes toward pediatric sedation and analgesia in United States (US) burn centers for critically ill patients. Survey-based questionnaire was sent to 119 Directors at US burn centers that care for pediatric patients. Forty-one surveys (34%) were analyzed. 48.8% of responding centers mandate pediatric consultation for pediatric burn patients based on factors such as age and burn size. The most common sedation and analgesic agents used were midazolam, fentanyl, morphine, ketamine, and diphenhydramine. Written sedation policies exist at 63.4% of centers. 90.2% of centers employ scoring systems to guide agent titration. 60.9% of respondents practice sedation holidays "always" or "usually." 90.2% of centers perceive the medications they routinely use are "always" or "often" efficacious in pediatric sedation and analgesia. 53.7% of respondents reported the presence of withdrawal signs and symptoms in their patient population. The lack of consensus guidelines for sedation and analgesia delivery to pediatric intensive care unit patients results in practice variation. The majority of centers perceive their sedation and analgesia strategies to be efficacious despite the heavy reliance on propofol and midazolam, both of which have questionable safety profiles in critically ill children.

mentioning

confidence: 99%

mentioning

confidence: 99%

A Pilot Prospective Randomized Control Trial Comparing Exercises Using Videogame Therapy to Standard Physical Therapy

Parry

Painting

Bagley

et al. 2015

“…Only seven (17%) of the extremity contracture studies indicated the methods that were used to measure contracture. 1,2,5,10,20,21,22 Six of the seven used goniometry and one used 3D motion analysis. The six studies that used goniometry reported five different methodologies used: Norkin and White, 23 American Medical Association's "Guides to the Evaluation of Permanent Impairment," fourth edition 24 (which was adopted for the Model System for Burn Injury Rehabilitation National Database Data Dictionary), American Association of Orthopedic Surgeons guidelines, 25 and two unpublished methodologies.…”

Section: Burn Literature Review Resultsmentioning

confidence: 99%

Methods and Tools Used for the Measurement of Burn Scar Contracture

Parry¹,

Walker²,

Niszczak³

et al. 2010

After burn injury, scar contracture can cause significant impairment and functional deficit. Many studies have investigated the treatment and prevention of burn scar contracture, but few studies have focused on the methods for measuring contracture. The purpose of this study was to determine whether consistent and objective methods of measurement are used to quantify scar contracture in the clinical evaluation of burn patients and in burn research. A survey was administered to 407 burn therapists to determine the methods and tools used clinically to measure scar contracture, while a review of recent burn literature was conducted to determine the methods and tools used in burn research. The results of the survey indicate that there is a lack of consensus in the methods and tools used for the measurement of scar contracture, both clinically and in research. Instead, a variety of measurement methods was reported, each with varying degrees of objectivity. Clinically, the methods are rarely checked for reliability or performance competency. In burn research, the methods and tools vary, and contracture data obtained are often reported in an inconsistent manner. If the measurement of scar contracture is not done objectively and consistently, then it is difficult to determine reliability, validity, and responsiveness of the measurement methods. Development of standard protocols with reliable measures of scar contracture would improve the quality of burn care and research.

“…The previously recommended 5 to 7 days of immobilization before exercise 26,55 has decreased to 3 to 5 days. 14,16,56,57 PROM should begin as the graft takes and progresses to monitored active ROM. 14 …”

Section: Heterotopic Ossificationmentioning

confidence: 99%

Select Practices in Management and Rehabilitation of Burns: A Survey Report

Holavanahalli

Helm

Parry

et al. 2011

The purpose of this study is to document the organization and current practices in physical rehabilitation across burn centers. An online survey developed for the specific purposes of this study sought information regarding a) logistics of the burn center; b) inpatient and outpatient treatment of patients with burn injury; and c) specific protocols in the treatment of a few complications secondary to burn injuries. Of the 159 responses received, 115 were received from the United States, 20 from Australia, 16 from Canada, and 7 from New Zealand. The overall sample included responses from 76 physical therapists (PTs) and 78 occupational therapists. Seventy-three of those surveyed considered themselves primarily a burn therapist. Nurses (86%) were reported as primarily responsible for wound care of inpatients, followed by wound care technicians (24%). Ninety-seven percent of the therapists reported following their own treatment plans. The trunk and areas of head and neck were treated by both PTs and occupational therapists, whereas the lower extremities continue to be treated predominantly by PTs. Some common practices regarding treatment of a few complications secondary to burn injuries such as splinting to prevent contractures, treatment of exposed or ruptured extensor tendons, exposed Achilles tendons, heterotopic ossification, postoperative ambulation, conditioning, scar massage, and use of compression garments are described. Opportunities exist for 1) developing a common document for practice guidelines in physical rehabilitation of burns; and 2) conducting collaborative studies to evaluate treatment interventions and outcomes.