Verticalization and gait training in burn patients

Author(s): Nowak-Wrozyna A, Bialozyt J, Materniak K, Kawecki M, Glik J, Werner M, Nowak M

Introduction: Burns belong to the most dramatic injuries that may affect a human being. Due to their severe functional and aesthetic complications, they pose a serious challenge for physicians, physiotherapists and psychologists. The therapeutic process in patients after thermal injuries is difficult and involves a great risk, including a loss of life. The patients’ recovery to full ability requires their patience, engagement and regularity in practising rehabilitation exercises. Aim of the study: The aim of the study is a presentation of consecutive stages of patient verticalization after thermal burns and an assessment of their functional ability in general motor skills. The study is an attempt to describe the complex process of rehabilitation management to prepare a patient for verticalization on the basis of the authors’ own experience of work with burn patients. Material and methods: The study covered 95 patients, aged from 27 to 65, with burn injuries of grade IIb/III extending on over 30% of TBSA with accompanying lower limb burns. The group consisted of 15 women and 70 men. The hospitalization period ranged from 8 to 12 weeks. The surgical treatment in the study group involved fasciotomy, necrectomy, and skin autografts of medium thickness. All the patients were in danger of possible motor difficulties. The management included positional treatment, exercise adjusted to the treatment stage and to the patient’s ability, verticalization and gait training. For an evaluation of functional ability in general motor skills, the Rivermead Motor Assesment was applied. The Rivermead Mobility Index is a motor-functional scale that evaluates mobility and locomotion, e.g. position changing, transfers, gait and stair climbing ability. Conclusions: 1. Early verticalization is an important component of the therapeutic process in burn disease. 2. A patient’s adequate preparation for verticalization involves a range of obligatory procedures and rehabilitation measures. 3. Verticalization is a gradual process where the correct sequence of stages must be maintained.