Citations
To explore and determine the reorganizational changes in the cortical neural circuits associated with pruritis, this study was undertaken to compare the electroencephalography (EEG) changes in burn patients having primary symptoms of chronic itching (pruritis) and their paired healthy subjects.
Eight subjects were recruited for this exploratory pilot study: 4 patients with pruritus after burn injury matched by gender and age with 4 healthy subjects. EEG recordings were analyzed for absolute alpha, low beta, high beta, and theta power for both groups.
The mean age of the burn patients was 41.75 years; while the mean age for the matched healthy subjects was 41.5 years. All subjects were male. A decreased alpha activity was observed in the occipital channels (0.82 vs. 1.4; p=0.01) and a decreased low beta activity in the frontal area (0.22 vs. 0.4; p=0.049) in eyes closed conditions. An overall decreased theta trend was observed in both the eyes open and eyes closed conditions in burn patients, compared to healthy individuals.
This preliminary study presents initial evidence that chronic pruritus in burn subjects may be associated with brain reorganizational changes at the cortical level characterized by an EEG pattern.
Citations
We present the case of a 33-year-old man who experienced a 10,000-V electrical shock when working with electrical wiring. He suffered third-degree burns on his scalp at the right occiput (entry wound) and on his left arm (exit would), and a second-degree burn on his left foot (exit wound). He presented with severe spasticity of both lower extremities, motor weakness with a Medical Research Council grade of 3, and sensory impairments below thoracic level 11 that included an inability to sense light touch and defects in proprioception. Initial magnetic resonance imaging (MRI) scans of his spine and brain showed no definite abnormalities. However, tractography obtained by diffusion tensor imaging of the brain showed absence of the right medial lemniscus tract. A cervical MRI scan 1 month later showed spinal cord swelling from cervical 1-5 levels, and signal changes in the lateral and posterior white matter in the axial view. After 6 months of rehabilitation, he recovered almost normal degree of motor function in his lower extremities and disappearance of spasticity. However, since the sensory impairments persisted, especially defects in proprioception, he was unable to walk independently.
Citations
To evaluate the effect of a modified hand compression bandage in patients with a post-burn hand edema.
Patients were recruited from burn centers. We classified the patients into two groups: the modified hand compression bandage group comprising of 22 patients who had a modified hand compression bandage and received conventional physical therapy and the conventionally treated group, comprising of 20 patients who received only conventional physical therapy during the 4-week period post-burn. Hand circumference, hand skin thickness, and hand function were evaluated by grip strength, active range of motion (ROM), Jebsen hand function test, and visual analogue scale (VAS). These assessments were used to evaluate treatment effectiveness prior to the first treatment, 2 weeks after the first treatment, 4 weeks after the first treatment, and 4 months after the first treatment.
As a result of repeated-measures analysis of variance on hand circumference, skin thickness, VAS, and each metacarpophalangeal joint ROM, we found significant differences that corresponded to time effect (p<0.05) and time×group (reciprocal action) effect (p<0.05). The results of grasp power, Jebsen hand function test, and each proximal interphalangeal joint ROM, show significant differences in accordance with the time effect (p<0.05), however, there was no reciprocal action effect (p>0.05).
The modified hand compression bandage will be clinically useful for the treatment of patients with post-burn hand edemas.
Citations
To understand the injury pattern of contact burns from therapeutic physical modalities.
A retrospective study was done in 864 patients with contact burns who discharged from our hospital from January 2005 to December 2008. The following parameters were compared between patients with contact burns from therapeutic modalities and from other causes: general characteristics, burn extent, cause of burn injury, place of occurrence, burn injury site, treatment methods, prevalence of underlying disease, and length of hospital stay were compared between patients with contact burns.
Of the 864 subjects, 94 patients were injured from therapeutic modalities. A hot pack (n=51) was the most common type of therapeutic modality causing contact burn followed by moxibustion (n=21), electric heating pad (n=16), and radiant heat (n=4). The lower leg (n=31) was the most common injury site followed by the foot & ankle (n=24), buttock & coccyx (n=9), knee (n=8), trunk (n=8), back (n=6), shoulder (n=4), and arm (n=4). Diabetes mellitus was associated with contact burns from therapeutic modalities; the odds ratio was 3.99. Injuries took place most commonly at home (n=56), followed by the hospital (n=33), and in other places (n=5).
A hot pack was the most common cause of contact burns from therapeutic modalities, and the lower leg was the most common injury site. Injuries took place most commonly at home. The patients with contact burns from therapeutic modalities showed high correlation to presence of diabetes mellitus. These results would be helpful for the prevention of contact burns due to therapeutic modalities.
Citations
To assess the effectiveness of modified dynamic metacarpophalangeal joint flexion orthoses for treatment of post-burn hand contractures.
We enrolled 42 hand burn patients with limited range of motion at the metacarpophalangeal joints in this study. The patients were randomly assigned into either a control or an orthotic group. Both groups received the standard rehabilitation therapy focused on hand therapy; 21 subjects in the orthotic group wore a splint for 3 hours per day for 8 weeks. Hand function was measured by active range of motion, grip strength and other assessment tools. All parameters were estimated using the Mann-Whitney U test at the beginning and the end of the treatment after 8 weeks.
The 21 subjects that had an orthotic intervention showed significant improvement in the range of motion at 2nd, 3rd, 4th and 5th metacarpophalangeal joints (p<0.05). However, the grip strength was not significantly increased after the 8 weeks of treatment compared to control group (p>0.05). There was a significant difference in the hand function scales between the 2 groups (p<0.05).
The modified dynamic metacarpophalangeal joint flexion orthoses provide continuous flexion to metacarpophalangeal joint that is needed for the restoration of range of motion in post-burn hand contractures. For the clinical application of hand orthoses in patients with hand disorders, additional research into its affects are required.
Citations
Objective: Many amputees do not use their prostheses consistently because of the unhelpfulness or discomfort. In this point, this survey was to assess the prosthetic problems in their function and willingness to use.
Method: We investigated the 18 burn induced upper extremity amputees of Hankang Sacred Heart Hospital Burn Center with the questionnaire or interview.
Results: The mean age was 39.6 years at the time of amputation & 43.3 years at the time of survey. Their amputation levels were composed of 72.2% of below elbow and 27.8% of above elbow. The using time of prosthesis was revealed that 'all day long' use in 50%, 'going out' use in 33.3% and 'living activity' use in 11.1%. Their complaint for prosthetic problems were discoloration (38.9%), poor appearance (27.8%), sweating (27.8%) and inadequate function (22.2%). Considerable number of them suffered from residual burn wound or scar in contact with a socket (27.8%) and itching and tingling sensation (22.2%). Employment was not accomplished in 61.1% of the amputees.
Conclusion: The information thus obtained in this investigation would be expected to be helpful in the prosthetic prescription and rehabilitation training of upper extremity amputees for their welfare.
Objective: To know the category, incidence, severity and clinical correlation, we evaluate the patient with neuropathy due to electrical burn on the basis of the electrodiagnostic findings and clinical feature.
Method: We reviewed the electrodiagnostic findings of 30 patients who had been referred for the evaluation of the neuromuscular symptoms due to electrical burn. The clinical factors such as the input and output of the electrical current, current pathway, associated injury, neuromuscular symptoms and signs were investigated by the chart review and phone interview.
Results: 1) The 67% of the cases had the peripheral neuropathy and the 40% had the central nervous system lesion. 2) The median nerve was the most frequent injured nerve by electrical burn and then ulnar nerve was the next. 3) The 82% of the mononeuropathies were related to the entrance site of the electricity and the 35% were related to the exit site. 4) The central nervous system lesion was highly correlated with the current pathway through the head.
Conclusion: The mononeuropathy, one of the peripheral neuropathies is closely related to the entrance and exit site of electrical injury. The central nervous system lesion was highly related to the current pathway through the head.
Burn patients with associated limb amputations present demanding rehabilitation problems, many of which might lead them to chronic issues. The authors studied 77 male and 9 female burn patients with amputations. Most amputations occurred with high voltage electrical burns. The fingers were the most frequent target for amputations. The most frequent site of amputation was the entrance at the right side and multiple amputation in nature.
The prosthetic fittings were delayed because of burn wounds and grafts and fragile skin at the stump. Also, limited range of motion, decreased strength, hypertrophic scar contracture, heterotopic ossification and bony overgrowth were additional limiting factors.
We conclude that early rehabilitation intervention would be critical to prevent complications and to improve rehabilitation outcome of burn amputee patients.
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