October 22, 2001
Physical Therapists Continue Healing Process for Burn
Patients From World Trade Center and Pentagon
- The men and women who sustained burn injuries from the terrorist
attacks on the World Trade Center and the Pentagon on September 11 are
taking the first steps toward recovery -- a rehabilitation process that may
take years, says the American Physical Therapy Association (APTA).
Approximately 25 patients were treated at New York Presbyterian Hospital.
Most of these men and women had third-degree burns covering 25 to 90 percent
of their bodies. For these people, physical therapy began immediately.
The immediate concern was to assess the patients' range of motion and
function, begin exercises to prevent muscle atrophy and contractures, and
manage inhalation injuries. Hope Laznick, PT, assistant chief of physical
therapy at New York Presbyterian Hospital, said, "For those people who were
able, we encouraged them to sit, stand up, or even walk. They were
encouraged to perform active and active assistive exercises to help prevent
muscle atrophy and to control the formation of scar tissue. Physical
therapists also intervened by putting patients in positions to minimize
potential contractures. This was achieved by the use of positioning devices
"We also helped teach patients deep breathing exercises and performed chest
physical therapy in order to reduce the dangers of pneumonia that can result
from inhaling toxic air," Laznick explained.
After the immediate danger had passed, physical therapists focused on scar
management. Depending on how severe the burn injury is, scar management
usually begins after the wounds are closed. The entire scarring process
could take a year -- or longer," said physical therapist Heather Hunter, PT,
assistant professor at New York University's School of Physical Therapy.
"The techniques of scar management are used to normalize collagen and blood
flow to the affected area," Hunter explained. Scarring is fundamentally a
prolonged inflammatory response. Physical therapists apply therapeutic
massage combined with stretching to reduce the effect of scar formation.
Pressure garments, often made of elastic materials and silicon, are designed
and worn specifically to support the newly scarred area. Some patients may
wear these garments for at least a year.
Ron Lassiter, PT, director of burn rehabilitation at Washington Hospital
Burn Center, is working with patients with burn injuries from the Pentagon
tragedy. Lassiter is providing scar management for his patients.
"Both massage and pressure garments combat the hypersensitivity of the scar.
Pressure garments also control scar hypertrophy," Lassiter explained. "Any
touch on the skin can be extremely uncomfortable. We use skin conditioning
techniques so patients can tolerate touch."
Physical therapy is crucial to minimizing the extent to which the scar
contracts. "A contracted scar, especially a large one, can severely
interfere with the functioning of the affected limb or area," said Hunter.
"This process begins in the earliest stages of treatment, by splinting and
positioning the areas of the body to enable the skin to stretch as much as
possible. Splinting is also crucial after skin graft surgery, where the area
needs to be completely immobile for at least five days," Hunter added.
Long-term recovery for many burn patients may take years after the initial
medical danger has passed. During this phase, physical therapists perform
scar massage and therapeutic exercise to maintain a patient's range of
motion, flexibility, strength and endurance.
"These patients need as much support as humanly possible from health
professionals, families, friends, and the larger community," Hunter said.
"We've been humbled by the overwhelming support we've witnessed to date."