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Burns managment in a regional physiotherapy outpatient setting providing…
Burns managment in a regional physiotherapy outpatient setting providing therapeutic riding
FACTS
At the time of incidence
Target group at the centre is kids up to 18 years. This group also has a peak in burns (scolds) incidences at the 0-4 years of age. This could be sibling of the patient that is attending.
potential areas of high risk within the setting or kitchen area with hot water and kettle as well as the shower area.
Initial managment would include DRABCD, running cold water on the wounds for 20 minutes whilst waiting for the ambulance. Removing of clothing covering the wounds. History taking and education/re-assurance given to parents.
At the rehabilitation pase
This would be post 6-8 weeks as wounds will need to be healed prior to attendng therapeutic riding as infection risk would be too high
deep burns will still be undergoing scar formation changes for up to 7 months post incident
At the initial assessment, outcome measures and align them with the ICF framework. Using for UL QuickDash, LL the functional index and for QOL, the SF-36.
In the disability sector, important to have parent do the functional survey eg LL functional index based on a week before the burn incident. This can be used as the recovery function needed to achieve.
The rehabiliation should include CV fitness, ROM, resistance training, balance, proprioception, dexterity training, posture and core stability training
Team work to involve dietician, social worker, GP, OT, specialist team,.. to ensure a multifaceted approach for patient and family
Strict and ongoing observation of posture and quality of movement during therapy
education and motivation provision
Home exercise program to be functional and as integrated into daily lives as possible
OVERVIEW
To have a look at the possible two points of contact with a burns victim in a therapeutic riding centre setting
one point of contact could be at the time of incidence
the other point of contact could occur in the rehabilitation phase
FEELINGS
very happy with the information provided
keen to be seen as part of the team, even though I was not part of the acute physiotherapy team, I can still make a difference
feeling good about the possibility of treating a client post 6-8 weeks. Good to know help is available by contacting the specialist team.
DIFFICULTIES
Contractures might prevent participation of therapeutic riding
pain could prevent participation of therapeutic riding
delayed wound healing and increased risk of infection could prevent participation of therapeutic riding
not all resistance training can occur on the horse
standing posture training will need to occur on land
functional retraining such as reaching is harder to achieve on horseback
OPPORTUNITIES
There is an opportunity to include therapeutic riding as part of the rehabilitation for burns victims
As part of a physiotherapy team as some aspects of the rehab such as posture training, dexterity training, some resistance exercises or functional retraining is harder on the horse or can not be achieved sucessfully
To be part of the team managing burns victims
to be an educator and motivator
BENEFITS
for the client and family, social integration and participation in community program
to become a more well rounded physiotherapist
therapeutic riding to help with increasing well-being and decreasing anxiety
to provide rehabilitation in a fun way, voluntary compliance for children who do not always understand the long term benefits of exercises
to provide a different community setting to the client, under professional guidance of a physiotherapist that can observe, monitor and adapt exercises with the aim of achieving patient directed goals
as physiotherapist, to be able to be part of the multi-disciplinary team looking after the client, compared to riding for the disabled which is run by volunteers
therapeutic riding can provide the CV fitness, proprioceptive input, ROM exercises, seated posture correction and core stability training