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31-10-2011 | Physical rehabilitation | Article

Purposeful activity achieves best outcome for children with hand burns


Free abstract

MedWire News: Children with hand and wrist burns have less pain and achieve better hand function when rehabilitative therapy includes carrying out meaningful tasks rather than repetitive rote exercises, report researchers.

"Hand burns do not often play a major role in mortality, but they can cause crippling deformities and disabilities, including loss of sensation, pain, loss of digits and decreased range of motion, or a combination of all these problems," explain Mohammed Omar (Cairo University, Giza, Egypt) and colleagues.

All these problems can "affect one's ability to perform activities of daily living, such as grooming, dressing and eating, as well as fine motor tasks such as writing, typing and occupational activities, and quality of life," they add.

Children are particularly badly affected by such injuries and motivating them to undergo essential physical therapy can be difficult, mostly due to pain.

To test whether the type of task or exercise used in physical therapy influences outcomes in such children, Omar and colleagues recruited 30 Egyptian children with superficial and deep partial and full-thickness burns to take part in a study comparing the efficacy of rote exercises versus purposeful tasks for minimizing pain and achieving improving hand function.

The children were aged 8 to 14 years and had total burns covering less than 25% of their body area. They were randomly assigned to receive either therapy involving purposeful activity, which included games the children enjoyed, such as those involving toys in water, play dough, or wooden puzzles, or to undertake rote hand exercises designed to improve flexibility and motion.

Measurements of pain severity (self-report faces scale and analogue scale), total active hand motion (using standard dorsal hand goniometer), and hand function (Jebsen-Taylor hand function test) were carried out at 72 hours, and 1, 2, and 3 weeks post-injury, at discharge, and at 3 months post-injury. Therapy took place 6 days a week during the children's stay in hospital.

The pain experienced by the children was significantly higher at all time points during rote exercise compared with during purposeful tasks, as recorded by the researchers after each session on consultation with the children.

In addition, the children in the purposeful tasks group achieved significantly greater improvements in total active hand motion and significantly quicker times (indicating improvement) in the Jebsen-Taylor test than the children in the rote exercise group over the 3 months.

"This study supports the belief that the purposeful activity based on playing and games can reduce pain, improve hand movement and functions better than rote exercise," write the authors in the journal Burns.

These results suggest "another option in the rehabilitation of children with hand burn," they conclude.

By Helen Albert

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