Rehabilitation Phases

OT Dude Academy’s Free NBCOT® Exam Prep Course Burns Rehabilitation Phases

Burn rehabilitation can be classified as acute, intermediate, and long-term. The acute phase begins at admission until 50% wound closure or skin grafting has begun. The intermediate phase involves the time for complete wound closure. The long-term phase starts at wound closure and continues onwards, including reconstructive surgery. Some of these phases may overlap depending on the stage of healing and the presence of multiple wounds.1 

Acute Phase

  • Managing edema during the first few days of a burn is a high priority for the burn team. Edema peaks within 12-48 hours after a burn.2 3 
  • Proper positioning by elevation helps to control edema throughout the body. Non-injured parts of the body are also susceptible to edema.4 
  • Elevate hands and feet above elbows and knee, which should be above heart level.5 6 7 
  • Position and splint to prevent pressure sores.

Intermediate Phase8 

  • Continue positioning and splinting with a focus on protecting skin grafts, facilitating wound healing, and preventing contracture.
  • Continue to manage edema.
  • Static splints are primarily used.
  • Immobilize after a split-thickness or full-thickness skin graft. Options include prefabricated splints, negative pressure wound dressings, or custom thermoplastic splints.

Long-term Phase

  • Prevent, minimize, and correct contractures.2 
  • Promote ROM with tissue lengthening.
  • Static progressive and dynamic splints are used as corrective devices.9 
  • Reassess the effectiveness of the splinting and positioning program and make adjustments as necessary.
  1. Richard R, Hedman T, Quick C, et al. A clarion to recommit and reaffirm burn rehabilitation. J Burn Care Res 2008;29:425–32.[↩]
  2. Hedman TL, Quick CD, Richard RL, et al. Rehabilitation of burn casualties. In: Lenhart MK, editor. Textbooks of military medicine, care of the combat amputee. Falls Church (VA): Office of the Surgeon General, Department of the Army; 2009. p. 277–380.[↩][↩]
  3. Kramer G, Lund T, Herndon D. Pathophysiology of burn shock and burn edema. In: Herndon DN, editor. Total burn care. 2nd edition. New York: WB Saunders; 2002. p. 78–87.[↩]
  4. Demling RH. The burn edema process: current concepts. J Burn Care Rehabil 2005;26:207–27.[↩]
  5. Hedman TL, Quick CD, Richard RL, et al. Rehabilitation of burn casualties. In:
    Lenhart MK, editor. Textbooks of military medicine, care of the combat amputee.
    Falls Church (VA): Office of the Surgeon General, Department of the Army; 2009.
    p. 277–380[↩]
  6. Apfel L, Irwin C, Staley M, et al. Approaches to positioning the burn patient. In: Richard R, Staley M, editors. Burn care and rehabilitation: principles and practice. Philadelphia: F.A. Davis Company; 1994. p. 221–41.[↩]
  7. Hildebrant W, Herrmann J, Stegemann J. Vascular adjustment and fluid absorption in the human forearm during elevation. Eur J Appl Physiol Occup Physiol 1993;66:397–400.[↩]
  8. Dewey, W. S., Richard, R. L., & Parry, I. S. (2011). Positioning, splinting, and contracture management. Physical Medicine and Rehabilitation Clinics, 22(2), 229-247.[↩]
  9. Richard R, Staley M, Miller S, et al. To splint or not to splint-past philosophy and present practice: part I. J Burn Care Rehabil 1996;17:444–53.[↩]
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