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A burn is an injury to the skin primarily caused by heat or due to radiation, electricity, friction or contact with chemicals (WHO).

Causes of burns (types):

  • Scald (Hot liquid)

    • Water, steam, cooking oil, etc.

  • Open flame

    • Longest delay in return to work

    • Hot surface contact

    • E.g, iron

  • Electrical and chemical injuries

    • 5-10% of all burns

    • Largely the result of occupational accidents (work)

  • Radiation:

    • X-rays, UV lights, etc.

  • Friction:

    • Mainly car accidents


Burns can be classified according to:

  1. Depth (Degree)

  2. Extent (%)

  3. Severity

1. Depth

  1. Superficial: effects only epidermis and heal within days

  2. Superficial Partial Thickness: Epidermis and dermis, excluding all dermal appendages (include hair follicles, sweat glands, sensory receptors)

  3. Deep Partial Thickness: Epidermis and most of dermis (minimal dermal appendages)

  4. Full Thickness: Epidermis and all of dermis

2. Extent

Burn injuries are also classified in terms of the percentage of the skin surface injured (TBSA)

Rule of 9’s: A relatively simple, but not totally accurate, method for determining the extent of injury

  • Head = 9%, (18% for the child)

  • Arms = 9%,

  • Legs = 18% (each) (13.5% for the child)

  • Anterior trunk = 18%  

  • Back = 18%

  • Perineum/Genitalia = 1%


3.Severity Grading of Burn


  • First-degree (superficial) burns. It affects only the outer layer of skin, the epidermis. The burn site is red, painful, dry, and with no blisters. Painful ++. and No scarring/ Conservative therapy

  • Second-degree (partial thickness) burns. involve the epidermis and part of the lower layer of skin, the dermis. The burn site looks red, blistered, and may be swollen and painful. Painful+++. No scarring, might be discoloration/ Conservative therapy

  • Third-degree (full thickness) burns. destroy the epidermis and dermis. They may go into the innermost layer of skin, the subcutaneous tissue. The burn site may look white or blackened and charred and wet. Painful +. Scarring/ Surgery

  • Fourth-degree burns. it goes through both layers of the skin and underlying tissue as well as deeper tissue, possibly involving fat, nerve, muscle, and bone. There is no feeling in the area since the nerve endings are destroyed. Leathery, dry, waxy, charred. Painless. Scarring/ Surgery

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Our assessments include:

  • Dysphagia:

  • ROM

  • Observe for scars

  • Hand function and strength

    • Hand function screening

    • Dynamometer, pinch meter

  • Edema

    • Figure of 8

  • Sensory functions

    • Sensory screening

We give our services to both inpatients and outpatients.

The intervention depends on the type of the burn (electrical, thermal, etc.)

Mainly our interventions will include positioning and splinting to avoid contractures.

Splinting and positioning:

Note: for more information about splints, check therapist page of hand therapy,

or check assistive devices.

Benefits of splints:

  • Increase and maintain ROM

  • Prevent contractures and stiffness

  • Supporting joints to increase strength

  • Positioning the hand appropriately

  • Reducing stress on joints

  • Reducing pain

  • Providing a cue about how to use the joint more carefully and others to be careful

  • Immobilize the joint.

Types of splints (mostly used):

  • Wrist splint

  • Elbow splint

  • Airplane splint (Axillar splint)

  • Finger splint

  • Mouth splint


Range of motion exercises:

To avoid contractures, the patient has to move the joints.

Depending on the location of the burn, the therapist has to do some ROM exercises to the affected joints. Which includes active and passive ranges and stretching to increase the range (sometimes most of the session time will be stretching)

Dysphagia management:

Mainly due to skin being affected not brain (cognitive) or congenital issues as in other areas. Also, it might include splinting. click here to go to dysphagia page 

Scar and adhesion management:

Having burns leads to scar formation. Although scar formation is important for healing, too much scar irritates the healing process.

One of the effective techniques used by occupational therapists to manage this problem is massaging the scar. It is an intervention used to soften and flatten the hard scar tissue. Scars may feel sensitive, tingle or pain when touched so regular massage can help to control this.

The method of scar massaging is:

  1. Apply a non-perfumed moisturizing cream on the area of the scar.

  2. Place the pad of your thumb on the scar and massage using a slow, circular motion so that the skin moves on the underlying scar tissue.

  3. Repeat this process across the entire scar using firm pressure without causing any damage to the skin.

  4. Keep doing this for at least 10 minutes, or until you feel the adhesion getting softer.

Hand function retraining:

Hand functions include:

  • Grips/ grasps:

    • Cylindrical

    • Spherical

    • Hook

    • Diagonal Span

    • Cascading

    • Cupping

  • Pinches

    • Tip to Tip

    • Lateral Pinch

    • 3-Jaw Chuck/ Tripod

  • In hand manipulations

    • Translation- Finger to Palm

    • Translation- Palm to Finger

    • Rotation - Simple

    • Rotation - Complex

    • Shift with stabilization

    • Shift without stabilization

  • Non prehensile skills

    • Clapping

    • Tapping

    • Scratching

    • Pushing/ Pulling

  • Reaching

  • Sensory desensitization (increase sensation) or sensitization (decrease exaggerated sensations)

Facial exercises:

Edema management:

If acute patient he might have edema, which is a local or generalized condition in which the body tissues contain an excessive amount of tissue fluid.

An increase in the interstitial fluid in intercellular tissue spaces. Edema becomes apparent when the interstitial fluid is at least 30% above normal

Localized edema:

Tends to be limited to one area of the body


  • Pitting edema: When pressing on skin causes an indentation that persists for some time. ◦ Causes: Systemic diseases, pregnancy, heart failure, Or local conditions such as varicose veins, insect bites, and dermatitis.

  • Non-pitting Edema: Observed when the indentation does not persist. Associated with conditions such as lymphedema, lipedema, and myxedema.

Treatment of edema:

Light retrograde massage

Is to reduce swelling in the hand. The massage is done manually by applying moisturizer and moving fluid from the tips of the fingers back toward the heart (from distal to proximal).


  1. Elevate the hand above heart level

  2. Administer for almost 10 min.

  3. Use a moisturizer to reduce friction

  4. Keep the wrist in a neutral position

  5. Massage from the tips of the fingers down toward the elbow, both the front and back of the hand.

Psychological intervention:

The patients might have post-traumatic stress disorder (PTSD) or depression, so we have a role to prepare them to go back to work/job or home as we consider the psychological aspect of the person, but we do not really give treatment. we refer them to psychologist based on the case (if needed).

Sensory desensitization/ sensitization:

Using tough textures provide cues to the affected limb to reconnect the neural pathways between the brain and the limb to improve sensation.

Rough ball and sponge can be used to give the patient sensory input.

You can put the ball on the patient's hand and manipulate it all over the area of decreased sensation for several minutes.

For desensitization you have to give soothing and calming inputs to increase sensory awareness whereas you have to give rough inputs for sensitization

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