Systematic Review and Expert Consensus on the Use of Orthoses (Splints and Casts) with Adults and Children after Burn Injury to Determine Practice Guidelines.

The objective of this review was to systematically evaluate the available literature addressing the use of orthoses (splints and casts) with adult and pediatric burn survivors and determine whether practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. A summary recommendation was made after the literature was retrieved using a systematic review and critical appraisal by multiple authors. The level of evidence of the literature was determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Due to the low level of evidence in the available literature, only one practice guideline could be recommended: orthotic use should be considered as a treatment choice for improving range of motion or reducing contracture in adults who have sustained a burn injury. To address the rehabilitation-specific gaps found in the literature regarding orthotic use in burn rehabilitation and provide guidance to clinicians, a formal expert consensus exercise was conducted as a final step to the project. The resultant manuscript provides a summary of the literature regarding orthotic use with burn patients, one practice guideline, proposed orthotic terminology and additional practice recommendations based on expert opinion. The limitations in the current literature are also discussed, and suggestions are made for future studies in the area of orthotic use after burn injury.

Practice Guidelines for Cardiovascular Fitness and Strengthening Exercise Prescription After Burn Injury.

The objective of this review was to systematically evaluate the available clinical evidence for the prescription of strength training and cardiovascular endurance exercise programs for pediatric and adult burn survivors so that practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. Summary recommendations were made after the literature was retrieved by systematic review, was critically appraised by multiple authors and the level of evidence determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Although gaps in the literature persist and should be addressed in future research projects, currently, strong research evidence supports the prescription of strength training and aerobic conditioning exercise programs for both adult and pediatric burn survivors when in the presence of strength limitations and/or decreased cardiovascular endurance after evaluation.

Self-esteem measurement before and after summer burn camp in pediatric burn patients.

Pediatric burn injury results in significant mortality and morbidity, from which some children will experience prolonged psychological and social difficulty. As early as 1967, it was noted that participation in a group was important in the resolution of problems caused by severe disability and stressful experiences. Since 1982, there have been summer burn camps for children and adolescent burn survivors. The primary focus of camp is to have "fun" at the various daily activities. The principal goal, however, is psychosocial readjustment. Fifty-three burn survivors attended the 1-week duration annual summer camp. Campers were invited to complete a Rosenberg Self-Esteem Scale on the first day of summer burn camp and shortly after the camp ended. Younger children were assisted with the survey tool by their parents. Of the 53 campers, 45 completed both pre- and postcamp surveys. The age of the campers ranged from 6 to 18 years (mean, 12.8 years). Burn size ranged from 1% to 90% TBSA (mean, 30.4% TBSA). The interval from date of injury to camp attendance was 2 months to 15.5 years. Nine campers had never attended burn camp before this year. Twenty- nine percent of the campers had an increase in self-esteem score. Fifty-eight percent had no change, and 13% demonstrated a decrease. The burn camp experience though an enriching summer activity, did not necessarily increase self-esteem in the majority of campers as measured by the survey tool employed.