PT/OT abstracts needed.
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Abstracting and Indexing↗
Biomedical subjects
R S Ward
Publications and source records attributed to R S Ward.
Have you tried the sandwich splint? A method of preventing hand deformities in children.
The prevention of contractures of the burned hand is an arduous problem in the young pediatric burn patient. Difficulty in applying splints, along with the time-consuming fabrication of complex splints, led to the development of the "sandwich" splint. This easily produced splint provides a means of preventing and treating hand deformities in this patient age group. Positive results have been noted with the use of this splint in conjunction with the patient's usual active physical therapy program.
Burns↗
Use of positive plaster impressions to facilitate measurement of anti-burn scar support gloves for severely burned hands.
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Burns↗
Sensory loss over grafted areas in patients with burns.
We studied loss of cutaneous sensibility after grafting in 60 patients with burns who had applied for impairment assessment. Fifty-eight patients (97%) demonstrated markedly diminished or absent responses to sharp/dull, hot/cold, and light touch stimuli over grafted areas. However, all but one patient had intact perception over donor areas and over areas of healed (ungrafted) partial-thickness burns. Deep touch sensation was intact over both grafted and ungrafted areas in all patients. Loss of sensation was not related to patient age, burn size, or type of burn; nor did sensory loss correlate with the impairment rating received. Depth of burn injury appears to be the best predictor of altered sensation, and some abnormalities in patients appear inevitable after skin grafting. Patients should be counseled about possible outcomes. However, the decrease in sensation that was observed rarely contributed significantly to the long-term impairment rating of these burn victims.
Adult↗
Prosthetic use in patients with burns and associated limb amputations.
A review of 11 patients who sustained burns that were complicated by limb amputation was completed to determine their eventual ability to use prosthesis. Amputations included six below-elbow, four above-elbow, three below-knee, and three above-knee amputations. Ten of the 11 patients (91%) had open wounds on the stump limbs and nine patients (82%) required skin grafting procedures on the amputated limbs. Delays in prosthetic fitting because of continued surgeries, open wounds, skin grafts on the stump limb, and breakdown of the stump were identified. However, eight of these patients (73%) were eventually able to wear prosthetic devices. Fisher's exact test was used to test the influence of the number and site of the amputations and skin grafting on the stump on successful prosthesis use. None of these tested items were found to be significant. The results demonstrate that most patients with burns who require limb amputation can achieve successful prosthesis use.
Adult↗
Grease burns at fast-food restaurants. Adolescents at risk.
Intermountain Burn Center and Utah State Insurance Fund industrial records were reviewed to determine the incidence and consequences of grease burns among teenagers employed at fast-food restaurants. Burn center records reveal that 10 patients were admitted between 1977 and 1985, and that nine patients required surgery with mean burn care costs of $7389 per patient. State Insurance Fund records demonstrate that 81 grease-burn injuries were reported from 1982 through 1985, at an average burn care cost of $660 per patient. Causes of burn wounds included adding, filtering, or removing hot grease, dropping objects into hot grease, slipping on the floor, cleaning the grill or fryer, and splashing hot grease during cooking. Those treated as outpatients were off from work for as long as 10 days. These data identify an adolescent population at risk for work-related burn injury in fast-food restaurants.
Accidents, Occupational↗
Pressure therapy for the control of hypertrophic scar formation after burn injury. A history and review.
Devastating functional problems can result from the formation of hypertrophic scar tissue after burn injury. Although a patient with burns may have several medical problems to contend with because of the injury, most ongoing rehabilitation difficulties are a consequence of the continual wound contraction that occurs in immature burn scars. Treatment of hypertrophic burn scar consists of several surgical options and of pressure therapy, which traditionally involves wearing garments made from elasticized fabric. This article reviews the treatment of hypertrophic scar tissue, with emphasis on its history and on nonsurgical methods of managing the burn scar.
Burns↗
A technique for control of hypertrophic scarring in the central region of the face.
Various methods are available for applying pressure to the central portion of the face to reduce hypertrophic scarring after burn injury. Our center uses an elastomer insert with a thermoplastic backing, which is formed over a plaster mold of the patient's face. The insert is worn under a traditional anti-burn scar face mask. We reviewed the records of 26 patients with hypertrophic scarring to the central portion of the face to assess the effectiveness of the insert. Seventeen (65%) of these patients wore the insert until scar maturation. Three of these 17 patients later required reconstructive surgery of the central face. Our findings suggest that pressure to this part of the face may be effective in decreasing hypertrophic scar formation. The insert described in this article is inexpensive and relatively easy to fabricate.
Burns↗
Quantitative threshold changes in cutaneous sensation of patients with burns.
Decreased cutaneous sensation is common after burn injury. This study was designed to quantitate threshold sensory loss with the use of a microcomputer-based sensory testing device that generated precisely controlled stimuli. Threshold evaluations of two-point discrimination, pinprick, warming, touch, and vibration were performed on patients with burns (n = 16) and on control subjects (n = 42). All threshold measures in patients with burns were elevated above those for control subjects; threshold measures that reached statistical significance were two-point discrimination, warming, touch, and vibration. Unburned sites on patients with burns had higher thresholds than sites on control subjects, though only vibration was significant. A significant correlation was found between the magnitude of touch and vibration thresholds in control subjects, but there was no similar correlation found in patients with burns. When controls for age were applied, touch and vibration thresholds remained significantly elevated above control levels, and decreases in significance for two-point discrimination and warming were noted. It was concluded that sensory function is reduced in patients with burns. Alternative mechanisms that may have caused the sensory changes were discussed.
Adult↗
Reasons for the selection of burn-scar-support suppliers by burn centers in the United States: a survey.
Several companies currently market anti-burn-scar pressure garments to burn centers. Because of the numerous available choices, decisions about the reasons for selecting a garment are often confusing to those who are responsible for ordering the supports. This study was conducted to assist in decision making about garment selection by determining the relative importance of various factors in selecting brands of anti-burn-scar supports. A survey questionnaire was sent to 101 randomly selected burn centers in the United States, asking about the reasons for their choice of pressure-support suppliers. Sixty-two survey (61%) respondents indicated factors used in selection of a manufacturer. The factors included ease of accessibility for orders (97%), ease of measurement methods (90%), reliability of fit with the first garment ordered (90%), ability to fashion either a nonstandard support (77%) or special options into a garment (76%), provision of measurement materials (65%), and costs of the support (63%). Availability of standard garment options (50%) and/or choice of colors (31%) were listed less frequently. Twenty-four burn centers (39%) use only one company for orders, whereas 20 (31%) use two, 9 (15%) use three, and 9 (15%) use four different suppliers. Industry responses to these findings were gathered and presented as well. The results of this survey would indicate that burn staff have viable options of pressure-garment suppliers to assist them in responding to the scar-control needs of their patients.
Bandages↗
Evaluation of topical therapeutic ultrasound to improve response to physical therapy and lessen scar contracture after burn injury.
This study compared results of patients who received standard burn physical therapy and topical ultrasound with patients who received standard care alone to investigate the effect of topical therapeutic ultrasound on range of motion and pain in patients with burns. Fourteen burned extremities were studied. Eight joints were randomized to treatment with ultrasound followed by 10 minutes of passive stretching. Six joints received placebo ultrasound treatments and stretching. All treatments were performed every other day throughout a 2-week study period. Joint range of motion was measured before and after each treatment, and patients estimated the pain of the procedure. Patients and therapists were blinded to the treatment group. Analysis of the data revealed no differences in range of motion or perceived pain between the two groups. The effect of ultrasound on range of motion and pain was not predictable. We conclude that patients are not likely to improve from ultrasound treatment at our protocol parameters.
Adult↗
Uses of Coban self-adherent wrap in management of postburn hand grafts: case reports.
Coban wrap is a durable, elastic, self-adherent gauze that applies snugly without loosening. Coban does not stick to underlying tissue, making it excellent for early postoperative management of split- and full-thickness hand grafts. The wrap protects new grafts and decreases postoperative edema, permitting earlier mobility and facilitating accurate measurements for fitting of pressure garments. Wounds are judged suitable for Coban when the grafts are largely adherent and vascularized. Coban can be wrapped (1) directly over the graft, (2) over an ointment/adaptic dressing, or (3) over gauze padding for extra protection, or use as a "soft splint." Because of its inherent elasticity, Coban can be used to passively encourage desirable joint positions. The wrap is changed daily, and family members readily learn its use. Coban appears to encourage early, protected, active range of motion and early use of custom-fit pressure garments.
Adult↗
Cutaneous nerve distribution in adult rat hairy skin after thermal injury--an immunohistochemical study.
Regrowth of cutaneous nerves after thermal injury was examined in rat hairy skin with use of protein gene product 9.5, which has been shown to label nerves in skin preparations. Tissue biopsies were obtained from injured and control skin at postburn days 1, 7, 14, 28, and 120, fixed in 4% paraformaldehyde, cryoprotected, sectioned, and immunostained with rhodamine conjugated goat anti-rabbit immunoglobulin G. Immunoreactivity for protein gene product 9.5 was intense and illustrated the process of nerve regrowth in rat skin after thermal injury. No nerve growth was detectable in 1- and 7-day preparations. Variable regeneration was noted in 14-day preparations. The 28- and 120-day groups produced nerve counts that were similar to control sections. Results suggest that rat hairy skin has a capacity for nerve regrowth after thermal injury. Nerves were noted to regenerate from beneath the scar. Burn wounds in rats demonstrated vigorous cutaneous nerve regeneration.
Animals↗
Educational preparedness for physical therapists and occupational therapists in burn care.
The background of physical therapy (PT) and occupational therapy (OT) students in burn care training may be variable during their professional education. The purpose of this study was to evaluate whether professional programs in PT and OT are meeting the burn care educational needs of their students. PTs and OTs currently practicing in burn care were asked to give their opinion of the most important curricular topics related to burn care, report their perception of their own entry-level preparedness for burn care, recount therapy interns preparation for burn care internships, and recommend topics that should be included in a therapy program burn care curriculum. Therapists felt prepared in basic sciences and somewhat prepared in specific burn care practice topics. Study participants felt more prepared for burn practice if they completed an internship in burn care. Enhancing content on burn-related treatment interventions was the most common suggestion for curricular revision.
Adult↗
Effect of 3M Coban Self-Adherent Wraps on edema and function of the burned hand: a case study.
Edema and limited function are common acute problems associated with hand burns. This case study examined the effects of 3M Coban Self-Adherent Wraps on edema and function in a 59-year-old male (46% TBSA flame injury) with newly skin grafted dorsally burned hands. At the time of each dressing change, circumferential measurements were taken of both hands and weekly active range of motion and grip strength measurements were recorded. The nine-hole peg test was used to appraise dexterity. During the 4-week study period, there was less edema, greater active range of motion and grip strength, and greater dexterity in the hand with 3M Coban Self-Adherent Wraps as compared with the control hand. This case study suggests that 3M Coban Self-Adherent Wraps were effective in reducing edema in the skin-grafted hand after skin grafting. It further appeared that the reduced edema may have contributed to improved hand function and that 3M Coban Self-Adherent Wraps as a compressive dressing do not impede hand function
Burns↗
A nonsplinting approach to the care of the thermally injured patient.
The background and present elements of a nonsplinting approach to burn rehabilitation are presented. Traditionally most burned extremities were prophylactically splinted to prevent contracture, frequently resulting in patient dependence on the devices. Over the past 10 years a program of acute active exercise training, nonsplinting, independent activities of daily living, and ambulation was established for our burn patients to foster patient independence and responsibility. This program not only consists of the exercise protocols, but it also furthers patient and family education, only occasional intermittent use of splints for maintenance of achieved motion, and the use of antiburn scar supports. This approach has been a successful means of promoting increased patient compliance to physical therapy.
Activities of Daily Living↗
Development of a hybrid artificial pancreas with a dense polyurethane membrane.
We have synthesized a series of strong, elastomeric polyurethaneureas and have used them to fabricate non-porous film and hollow fiber membranes. The solvent cast membranes are non cytotoxic, angiogenic, and permeable to gases, nutrients, secretagogues, and cell products via purely concentration driven transport. Permeability to water, glucose, and protein increases monotonically with membrane water absorption above a threshold value. Water absorption increases with soft segment hydrophilicity, soft segment molecular weight, and soft segment volume fraction of the (dry) segmented polyurethanes. Cell lines (RAJI and MOPC-31C) and primary cells (porcine islets) contained within our membranes have been maintained in culture for up to 6 months with nutrients supplied only by the external media. Cells within membrane devices were protected from immune rejection when implanted into murine hosts. Simple, compact devices containing porcine islets restored normoglycemia and near normal response to glucose tolerance tests in diabetic mice for at least 2 months. Explants had a high degree of vascularization adjacent to the membrane, with little or no fibrous tissue. These properties, and the material's ability to support cell function and protect xenogeneic cells from immunologic rejection, suggest that it would be useful in the construction of hybrid artificial organs and in in vitro cell culture.
Animals↗