DEMOGRAPHIC DATA:-
Name:- Vinaya Vaykar
AGE/GENDER:- 14yrs /Female
Address:- Rahata
Occupation:- Student
DOAd:- 23th August 2024
DOEx:- 8th August 2024
CHIEF COMPLAINT:-
Pain while performing movements of B/L lower limbs since 6 days.
Associated Complaint:-
Burning sensation over the burnt areas since 6 days.
HOPI:-
PERSONAL HISTORY:
Sleep:- sound
Appetite:- unaltered
B/B:- continent
Allergy:- none
PRESENT DRUG HISTORY:-
Inj. Augmentin
Inj. Pan 40
Inj. Periset
Inj. Tramadol
SURGICAL HISTORY:- none
GENERAL EXAMINATION:-
Patient is conscious, cooperative, well oriented to time, place and person.
Built:- Mesomorphic
Height:- 150 cms
Weight:- 50 kgs
BMI:- 22 kg/m2 (23rd percentile as per growth chart suggesting healthy weight)
Temp:- Afebrile
Pallor/ Icterus:- Absent
Cyanosis:- Absent
Clubbing/ Oedema:- Absent
PALPATION:-
Tenderness:- Present, Grade 1 over the burnt areas.
ON OBSERVATION:-
Surrounding skin:
LEGS:
base:- areas of eschar and some granulation tissue is visible.
edge:- irregular, erythematous skin.
margin:- indistinct with some areas showing a clear demarcation between healthy skin and
burnt tissue.
HEAD AND FACE 0%
LEFT UL: 0%
RIGHT UL: 0- 3 -4%
POST AND ANT TRUNK : 0%
RIGHT LL : 8-9%
LEFT LL: 8-9%
Total: 19 – 22%
Rom:
JOINT MOVEMENT AROM AROM PROM PROM
RIGHT LEFT RIGHT LEFT
SHOULDER FLEXION 0-170 0-170 0-175 0-175
EXTENSION 0-30 0-30 0-40 0-40
ABDUCTION 0-160 0-160 0-165 0-165
ADDUCTION 160-0 160-0 165-0 165-0
ELBOW FLEXION 0-130 0-130 0- 130 0-130
EXTENSION 130-0 130-0 0-130 0-130
JOINT MOVEMENT AROM AROM PROM PROM
RIGHT LEFT RIGHT LEFT
WRIST FLEXION 0-50 0-50 0-50 0-50
EXTENSION 0-45 0-42 0-50 0-50
HIP FLEXION 0-95 0-95 0-100 0-100
EXTENSION 0- 25 0-25 0-30 0-30
ABDUCTION 0-25 0-30 0-30 0-35
ADDUCTION 25-0 30-0 30-0 35-0
AROM AROM PROM PROM
JOINT MOVEMENT
RIGHT LEFT RIGHT LEFT
KNEE FLEXION 0- 95 0-95 0-100 0-100
EXTENSION 90-0 90-0 100-0 100-0
ANKLE DORSIFLEXION 0-10 0-10 0-15 0-15
PLANTARFLEXION 0- 20 0-20 0-25 0-25
RESPIRATORY SYSTEM :-
Movement of chest:- B/L symmetrical
RR:- 16 cpm
Type of breathing:- Thoracoabdominal
O/A:- Air entry reduced in B/L Lower lobes. No adventitious sounds heard.
INVESTIGATIONS:-
Blood examination:- (23 August 2024)
• S.K+ -(potassium blood test)- 5.55 (3.7to5.2mEq/L) this is because severe injuries like
burns causes extra potassium to leak from body cells into the bloodstream.
• Alkaline phosphatase (ALP) -188(44-147IU/L) levels can increase in burn patients
due to burn-associated cholestasis (BAC)
• BSL 175 mg/dL suggesting elevated BSL due to increased metabolic rate, stress
response.
• Calcium level are reduced 6.9 (8.5-10.2mg/dl) the level of cytokines in the blood
increase secondary to the inflammatory response and these elevated cytokines act on
the parathyroid gland to upregulate the membrane-bound CaR. This leads to reduced
circulating calcium and reduced PTH secretion and results in renal calcium wasting.
DIAGNOSIS: - The patient Vinaya Vaykar 14yrs/F is a diagnosed case of 19- 22 % mixed
thermal burn.
ICF:
STRUCTURAL CLINICAL INVESTIGATIONS
IMPAIRMENTS REASONING
Bruising over the burnt Due to vascular damage On observation
areas.
Scar formation Due to healing On observation
( granulation tissue
formation)
FUNCTIONAL CLINICAL REASONING INVESTIGATIONS
IMPAIRMENTS
Slight burning sensation. Due to activation of On Assessment
nociceptors.
Pain over the burnt areas. Due to activation of On Assessment
nociceptors.
Decreased ROM. Due to pain. On ROM Assessment
Elevated TLC and BSL levels. Due to inflammatory On Blood Investigations.
response.
Activity limitation
Barthel index 95
Participation restriction
Not able to go to school
Not able to attain social gathering
Not able to go to religious places
Not able to go out with friends
Problem list
• Range of motion of left lower limb affected
• Pain in burn sites
• Problem during walking
MANAGEMENT:-
SHORT TERM GOALS:-
1. Patient Education.
2. To improve range of motion
3. To prevent oedema.
4. To improve lung capacities.
5. To maintain joint integrity.
6. To maintain overall circulation of the body.
LONG TERM GOALS:-
7. Scar Management.
8. To maintain flexibility.
9. Strengthening.
10. To maintain cardiovascular fitness.
11. Home advise.
Short-Term Goals (Acute Phase)
1. Patient Education:
•Educate the patient and caregivers about proper wound care techniques to prevent
infection.
•Highlight the importance of maintaining optimal positioning to reduce the risk of
contractures. For example, advise against keeping joints in positions of comfort (e.g.,
flexion) as it may lead to stiffness.
•Inform about the necessity of early mobility and compliance with the therapy plan.
2. Improve Range of Motion (ROM):
•Initiate gentle active-assisted ROM exercises for all affected joints within pain
tolerance to prevent stiffness.
•Perform exercises at least 2–3 times daily, gradually progressing to active ROM as
healing permits.
•Emphasize movements in all planes to preserve joint function.
3. Prevent Edema:
•Encourage elevation of the affected limb(s) above heart level to facilitate venous and lymphatic
drainage.
•Apply compression bandages or wraps if prescribed, ensuring they are not too tight to impede
circulation.
4. Improve Lung Capacities:
•Practice deep breathing exercises, such as diaphragmatic breathing or using an incentive
spirometer, multiple times a day.
•Include coughing exercises to enhance airway clearance and prevent pulmonary complications.
•Add chest physiotherapy techniques like percussion or vibration if needed.
5. Maintain Joint Integrity:
•Use splints to prevent deformities in high-risk areas (e.g., hands, elbows, knees). Splints should
be applied during rest and adjusted regularly to prevent pressure sores.
•Monitor closely for signs of discomfort or improper fit.
6. Maintain Circulation:
•Encourage gentle, active exercises for unaffected body parts to maintain circulation.
•Begin progressive mobilization activities, such as sitting up in bed, dangling legs, and eventually
walking short distances as tolerated.
Long-Term Goals (Rehabilitation Phase)
1. Scar Management:
•Apply pressure garments or silicone gel sheets to reduce hypertrophic scarring, as prescribed by the
healthcare provider.
•Teach scar massage techniques using moisturizing creams or oils to soften the scar tissue and improve
mobility.
•Ensure consistent use of sunscreen to protect healing skin from harmful UV rays.
2. Maintain Flexibility:
•Incorporate passive and active stretching exercises for affected joints and surrounding soft tissues daily.
•Focus on prolonged stretches to improve tissue length and flexibility.
•Utilize dynamic or static splints if required for more resistant areas of tightness.
3. Strengthening:
•Introduce resistance training using light weights or resistance bands to regain muscle strength in affected
areas.
•Progress to functional strength training exercises that mimic daily activities (e.g., lifting, pushing, pulling).
•Perform strengthening exercises at least 2–3 times per week, gradually increasing intensity.
4. Cardiovascular Fitness:
•Begin low-impact aerobic activities, such as walking or cycling, for 10–15 minutes per
session.
•Gradually increase the duration and intensity to improve endurance while monitoring vital
signs to ensure safety.
•Engage the patient in enjoyable activities to promote adherence.
5. Home Advice:
•Provide a home exercise plan including self-ROM exercises, stretching routines, and basic
strengthening activities.
•Educate on the importance of consistent scar management and daily use of pressure
garments.
•Offer guidance on avoiding prolonged sun exposure and maintaining proper hydration of the
skin.
