Maximizing Stretching Exercises in Burn Rehabilitation with Mechanical Assistance: How Can Equipment Help?
- Vita Yu-Hsien TU
- May 8
- 6 min read
Vita Yu-Hsien TU, Occupational Therapist and Project Manager
Sunshine Social Welfare Foundation
The article Seven Recommendations to Ensure Safe and Effective Stretching Exercises in Burn Rehabilitation highlighted that stretching exercises are an essential component of burn rehabilitation, helping to elongate scar tissue and improve joint mobility. Therapists can employ various approaches, including manual stretching and utilizing external tools to supplement treatment. While manual stretching allows for precision and direct feedback, it can be physically demanding and time-consuming for therapists, especially when working with multiple patients, dealing with severe contractures or involvement of scars over an extensive area, or maintaining sustained stretches over long periods.
Patients, on the other hand, may struggle with adherence or fail to achieve adequate results through independent exercises alone. Some patients may have difficulty performing effective stretches independently due to fatigue, limited range of motion, or lack of guidance.
This is where equipment and devices play a crucial role in bridging the gap. By leveraging the properties of mechanical assistance, therapists can effectively extend treatment duration, target specific joints or muscle groups, and optimize therapeutic outcomes. Incorporating such tools in stretching exercises in burn rehabilitation not only alleviates the physical demands on both therapists and patients but also opens the door to innovative and efficient rehabilitation strategies.
What Are the Advantages of Using Equipment for Stretching Exercises in Burn Rehabilitation?
Using equipment or machines to assist with stretching exercises provides several significant benefits that can enhance both the quality and efficiency of rehabilitation. These include:
1. Reduced Fatigue for Therapists and Patients
Manual stretching, while effective, often requires sustained effort from therapists, which can lead to fatigue during prolonged sessions. For patients, maintaining consistent and effective self-directed stretches can be challenging, especially in the presence of soreness or stiffness. Equipment reduces this burden by applying consistent, controlled force, allowing both therapists and patients to focus on other aspects of treatment or recovery.
2. Increased Frequency and Total Duration
Stretching effectiveness is often dependent on frequency and duration. Equipment enables longer and more frequent stretching sessions without placing excessive strain on the therapist or patient. This is particularly beneficial for targeting stubborn contractures or extensive scar areas that require sustained stretching over time.
3. Simultaneous Stretching of Multiple Areas
With careful planning, equipment can facilitate the simultaneous stretching of multiple joints or body regions. For instance, devices such as CPM machines or sandbags can be applied to different limbs concurrently, maximizing the time spent in therapy sessions and allowing for greater efficiency in rehabilitation protocols.
4. Enhanced Patient Comfort and Control
Many devices allow adjustments to accommodate individual patient tolerance and comfort levels. For example, CPM machines can be set to pause at specific angles or limit the range of motion, ensuring that stretching remains within a tolerable threshold for the patient.
5. Accessibility for Independent Home Exercises
Certain types of equipment, such as elastic bands or dynamic splints, are portable and easy to use, making them ideal for patients to incorporate into their home exercise routines. This promotes greater independence and compliance with therapy, extending the benefits of rehabilitation beyond clinical settings.
By understanding and leveraging these advantages, therapists can design more effective and sustainable rehabilitation programs, particularly in settings with limited resources or high patient volumes. Equipment not only enhances the rehabilitation process but also empowers both therapists and patients to achieve better outcomes with fewer barriers.
What Are the Types of Equipment Used for Stretching Exercises in Burn Rehabilitation?
1. Elastic Bandages
Elastic bandages are often used for their elasticity and ease of fixation to assist with stretching. For example, the methods described in the articles Use of crepe elastic bandage for passive stretching of dorsal scars of the hands and Use of crepe elastic bandage for wrist extension passive stretching use elastic bandages to provide sustained multiple joint stretching. Elastic bandages can also be applied to other joint movements, such as elbow flexion stretching.
2. Sandbags and Weights
External force for stretching can also be applied using sandbags or weights. The direction of this gravitational force, relative to the joint movement, needs to be carefully designed by the therapist. For instance, a sandbag can be secured near the elbow on the upper arm. When lying down, the gravitational pull of the sandbag creates a stretching force for shoulder abduction. Understanding this principle allows therapists to design similar methods for other areas. For example, in a prone position, a sandbag can be secured to the ankle to facilitate knee extension stretching.
3. Splints
Dynamic splints should not be overlooked as tools for joint stretching. Splints with rubber band tension are most used to stretch MP joint flexion but can also be adapted for other joints, such as PIP joint flexion.
4. Electric Devices
Continuous Passive Motion (CPM) devices are commonly used post-surgery to assist with passive range of motion (PROM) exercises. Based on our clinical experience, by properly securing the limb on the CPM device and pausing the movement when the joint reaches its maximum range for a few minutes before continuing, stretching effects can be achieved. If the range of motion can be slightly beyond the maximum stretchable range—within the patient’s tolerance—the stretching effect will be even better.
What Are the Precautions When Using Equipment and Devices?
While using equipment to perform stretching exercises offers numerous benefits, it is essential to adhere to certain precautions to ensure safety and effectiveness. Therapists should keep the following in mind:
1. Comprehensive Assessment Before Use
Before incorporating any equipment, a thorough patient assessment is crucial. Evaluate the patient’s scar condition, joint mobility, pain tolerance, and overall health status to assess whether the patient is suitable for stretching exercises (Refer to the blog article Maximizing Burn Recovery with AROM and Stretching: A Guide to Burn Therapeutic Exercises). Stretching should not be performed if there are contraindications such as active infection, open wounds, or significant pain.
2. Gradual Progression
Stretching intensity and duration should be increased gradually to prevent injury or over-stretching. Begin with low resistance or shorter durations and adjust based on the patient’s tolerance and progress. (Refer to the blog article Seven Recommendations to Ensure Safe and Effective Stretching Exercises in Burn Rehabilitation)
3. Monitor for Signs of Over-Stretching
Therapists should monitor patients closely for signs of over-stretching, such as sharp pain, increased swelling, or skin damage. Equipment should allow for quick adjustments or removal if necessary.
4. Customization for Patient Needs
Equipment settings, such as force levels, angles, and duration, should be tailored to individual patient needs. Avoid a one-size-fits-all approach, as stretching requirements vary greatly depending on the severity of the contracture or scar tightness.
5. Patient Education
If patients will be using equipment independently at home, like dynamic splints, ensure they are adequately trained on proper setup, usage, and safety measures. Provide clear instructions and emphasize the importance of stopping if they experience discomfort or complications.
6. Regular Reassessment
As the patient’s condition improves or changes, reassess their stretching regimen and adjust equipment settings accordingly. Regular reassessment ensures the exercises remain effective and aligned with therapeutic goals.
7. Integration with Other Therapies
Stretching with equipment should not replace manual therapy or other rehabilitation modalities but rather complement them. Combine equipment-based stretching with active range of motion exercises or other interventions for comprehensive care.
By observing these precautions and reminders, therapists can maximize the benefits of using equipment while minimizing potential risks. This approach ensures that stretching exercises are both safe and effective, fostering better outcomes for burn survivors.
Conclusion
Stretching exercises are a cornerstone of burn rehabilitation, playing a vital role in improving mobility and addressing scar contractures. By incorporating equipment into stretching routines, therapists can enhance the efficiency and effectiveness of rehabilitation while reducing the physical burden on both them and their patients. This approach maximizes rehabilitation efficiency, especially when resources are limited.
However, the successful integration of equipment requires thoughtful planning, proper assessment, and adherence to safety guidelines. Each patient’s unique needs must be considered to ensure stretching exercises remain both safe and effective. When used appropriately, equipment not only maximizes therapeutic outcomes but also empowers patients to actively participate in their recovery journey.
Ultimately, combining manual techniques, independent exercises, and equipment-assisted stretching allows therapists to deliver comprehensive care that optimizes function and quality of life for burn survivors.
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