Burn Rehabilitation Clinical Guideline

To establish standardized, evidence-based rehabilitation practices for adult and pediatric burn patients to optimize functional recovery, prevent complications (e.g., contractures), and improve patient outcomes.

This guideline applies to all adult and pediatric patients admitted to the Miami Burn Center who require Physical Therapy (PT) and/or Occupational Therapy (OT) services.

Anti-contracture positioning: Therapeutic positioning to prevent loss of range of motion.
AMS: Altered Mental Status.
HEP: Home Exercise Program.

4.1 Initial Evaluation

• All patients with PT/OT consults will be evaluated within 36 hours of admission unless clinically unstable.

4.2 Early Rehabilitation & Positioning

• ICU/PICU patients will have formal positioning orders placed within 72 hours.

4.3 Splinting / Anti-Contracture Devices

• Adult ICU and Pediatric ICU patients with lower extremity burns or AMS will have anti-contracture splints ordered within 72 hours.
- Splinting will be individualized based on burn location and risk of contracture.

4.4 Post-Operative Rehabilitation

• PT/OT will resume within 24–36 hours post-operatively once cleared for range of motion at the surgical site.

4.5 Pain & Edema Management

• For patients with dependent pain and/or edema, figure-eight compression wrapping over dressings may be recommended in collaboration with the burn team.

4.6 Pediatric-Specific Interventions

• All admitted pediatric burn patients will receive a music therapy consult to enhance participation and engagement with rehabilitation therapies.

4.7 Discharge Planning & Education

• All patients will receive a home exercise program prior to discharge.
- All patients will receive Burn Model Systems (MSKTC) educational materials.

Physical Therapy / Occupational Therapy:

• Perform evaluations and implement treatment plans.
• Provide patient/family education.

Burn Team:

• Collaborate on splinting, positioning, and pain management strategies.

Nursing:

• Reinforce positioning, splint compliance, and patient education.

• PT/OT evaluation within 36 hours
• Positioning orders within 72 hours
• Splinting orders within 72 hours (when indicated)
• Post-operative therapy resumption within 24–36 hours
• Documentation of discharge education (HEP + materials)
• Pediatric music therapy consult compliance

• Initial PT/OT evaluation note within 36 hours
• Therapy notes for all treatment sessions
• Documentation of positioning and splinting interventions
• Discharge education documentation including HEP

1. American Burn Association (ABA) Practice Guidelines.
2. International Society for Burn Injuries (ISBI) Guidelines.
3. Burn Model Systems Knowledge Translation Center (MSKTC).
4. NSW Agency for Clinical Innovation. Burn physiotherapy and occupational therapy: Clinical practice guide. Agency for Clinical Innovation. Published online.
5. Dewey WS, Richard RL, Parry IS. Positioning, splinting, and contracture management. Phys Med Rehabil Clin N Am. 2011;22(2):229-247. doi:10.1016/j.pmr.2011.02.001