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Fizjoterapia po oparzeniach – cele i metody

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Urazy oparzeniowe mogą się wiązać z poważnymi powikłaniami, w tym również z trwałymi dysfunkcjami ruchu. Z tego względu rehabilitacja ruchowa to niezwykle istotny element procesu rekonwalescencji po oparzeniach. Jakie działania obejmuje i jakie są jej cele?

Cele rehabilitacji u pacjentów po oparzeniach

Urazy termiczne mogą prowadzić do dysfunkcji narządu ruchu. Czynnikami sprzyjającymi tego rodzaju powikłaniom są ciężki stan ogólny pacjenta, spinający charakter tkanki martwiczej, obrzęk kończyny, która uległa urazowi, długotrwały okres leczenia oraz przykurczający charakter blizny.

Celem rehabilitacji ruchowej pacjenta po oparzeniu jest nie tylko zapobieganie deformacjom stawowym i przykurczom, ale również innym powikłaniom, takim jak zaniki mięśniowe, powikłania oddechowe, odleżyny. Rehabilitacja przyspiesza ponadto proces gojenia rany oparzeniowej i wpływa na uelastycznienie blizny,co ma znaczenie nie tylko ze względów zdrowotnych, ale również kosmetycznych.

Podstawowe metody rehabilitacji po urazach oparzeniowych to: leczenie ułożeniowe, kinezyterapia, fizykoterapia, presoterapia.

Okres choroby oparzeniowej a metody rehabilitacji

Rehabilitacja powinna być wdrażana już w pierwszych dobach po urazie, natomiast jej metody powinny być dostosowane do okresów choroby oparzeniowej,a także do stanu i możliwości pacjenta. W okresie wstrząsu pooparzeniowego należy stosować jedynie rehabilitację bierną (leczenie ułożeniowe). W okresie reakcji katabolicznej oprócz leczenia ułożeniowego wdraża się również ćwiczenia bierne, bierno-czynne i czynne, których celem jest odciążenie zagrożonych przykurczami stawów. Stosuje się również ćwiczenia izometryczne i oddechowe. W okresie reakcji anabolicznej (regeneracji) dołącza się ćwiczenia bloczkowe, manualne i ogólnousprawniające, a także zabiegi fizykoterapeutyczne i presoterapię. Regenerację blizn należy wspierać w tym okresie wcierkami z maści lub żeli na blizny oraz opatrunkami żelowymi.

Fizykoterapia w leczeniu oparzeń

Zabiegi fizykoterapeutyczne mają zapobiegać obkurczaniu się blizny po oparzeniu i powstawaniu przykurczów. Podstawowe metody fizykoterapii, które wykorzystuje się w leczeniu oparzeń, obejmują:

  • terapię ultradźwiękową,
  • fonoforezę,
  • jonoforezę,
  • biostymulację laserową,
  • magnetoledoterapię,
  • presoterapię.

Oczekiwany efekt fizykoterapii to rozluźnienie, uelastycznienie i zmiękczenie blizny.

W przypadku pacjentów z oparzeniami dróg oddechowych istotna jest fizjoterapia oddechowa mająca na celu utrzymanie prawidłowej wentylacji płuc, zwiększenie siły mięśni oddechowych oraz zapobieganie przykurczom mięśni klatki piersiowej w okolicy urazu.

Źródło: J. Białożyt, „Zasady postępowania fizjoterapeutycznego u chorych po urazie termicznym”, „Chirurgia Plastyczna i Oparzenia” 2019, 7(1): 29-35.

Przeczytaj także: Jak pandemia koronawirusa wpłynęła na opiekę nad pacjentami z cukrzycą?

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Chirurgia Plastyczna i Oparzenia”:

Postępowanie przeciwbakteryjne (antyseptyka) u pacjentów oparzonych

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