Can the use of 3-Dimensional Gait Analysis (3DGA) assess the functional gait outcome of Burns Patients with Complex Movement Disorders?

Mrs Michelle McGrath1, Mrs  Estelle Corr1, Mr James Wood1, Prof Robyn Grote1

1Queensland Motion Analysis Centre, Herston, Australia

Abstract:

Background:In the past due to limitations in healthcare the aim for persons who had suffered a burn was survival. Now as medicine advances, with many options to improve recovery, the focus has moved from survival to maximising functional outcome for the person who experienced a burn. A common outcome of severe burnt individuals is the loss of joint range of movement due to contractures which affects their gait. Three-Dimensional Gait analysis (3DGA) is a useful tool used to investigate various gait abnormalities and has the potential to provide an in-depth understanding of burn’s gait patterns for intervention, planning and monitoring.
Methods:The current study will investigate the gait of 20 burns patients who have suffered from severe burns (>20% total skin surface) using 3DGA. Each burns patient will attend the Queensland Motion Analysis Centre where kinematic and kinetic data will be collected from a 10 camera Vicon MX motion analysis system and floor mounted AMTI force plates. The data collected will be compared to gender and age matched controls and analysed by a gait physiotherapist.
Discussion: It is anticipated that the burn’s population will display difference in gait kinematics and kinetics when compared to the control population specifically in the range of motion in joints which in-turn will affect the joint moments and power generation.


Biography:

Michelle is a senior medical engineer at the Queensland Motion Analysis center and has recently completed her masters in medical engineering concentrating on the analysis of newborn movements using 3D motion analysis and mathematical pattern recognition technique, Fuzzy entropy. In her spare time she likes hanging out with family and friends, travelling, hiking and sailing.

Case Review: The use of Telehealth Services for Specialist Facial Burn.

Ms Hannah Leitch1, Ms Dallas Gillespie2, Ms Rebecca Schrale3

1Tasmanian Health Organisation, Hobart, Australia, 2Tasmanian Health Organisation, Hobart, Australia, 3Tasmanian Health Organisation, Hobart, Australia

Abstract:

Background: Meeting best practice guidelines to minimise contracture development in a full thickness, low voltage lip burn in a rural setting utilising Telehealth with the Tasmanian Burns Unit and the Burns Multidisciplinary team

Clinical Case: A 21-year-old man presented to his local community hospital with a full thickness electrical burn to his lower lip. The patient was appropriately managed in the emergency department and referred to the Tasmanian Burns Unit. After initial management at the local hospital the patient was followed up through Telehealth with the Tasmanian Burns Unit. He required weekly outpatient follow up at the satellite Burns Clinic with an Occupational Therapist with support from the Tasmanian Burns Unit- including the Plastic Surgeon, Burns Clinical Nurse Consultant, and Speech Pathologist.
Through extensive patient education- including nutrition, smoking cessation, wound care, mouth exercises and stretching a positive outcome resulted with a significant increase in vertical and lateral range.
The patient will continue to require ongoing follow up for scar management with the Burns Multidisciplinary team – including the local occupational therapist through the utilisation of Telehealth.

Conclusion: Telehealth services were important in contributing to positive outcomes for a rural patient requiring specialist burns input due to facial burns.


Biography:

Hannah Leitch, Senior Speech Pathologist at the Royal Hobart Hospital. Currently working on the Burns Unit and Inpatient Rehabilitation at the Royal Hobart Hospital.

Retrospective audit of analgesia for 1ST SSG Surgery in the Victorian adult burns service The Alfred Hospital 2014-2017

Dr Kerry Mclaughlin1, Dr Kevin Pan1, Dr Kieran Bates1

1The Alfred, Prahran, Australia

Abstract:

Background:Management of Burns pain is challenging.1,2,3,4,5,6 Patients report that donor surgical site is the most debilitating.7,8 and often neuropathic in nature. There has been increasing interest in treating the neuropathic component of burns pain.9 Globally there is a drive to reduce the reliance on opioid based analgesic regimes.5
Poorly controlled acute pain is a risk factor for chronic pain10 and its associated reduction in physical, psychological and social functioning.11,12
Aims:Comparison of pain scores pre and post 1st SSG surgery in patients with burns injury.
Method:All patients with ≥10% burn requiring SSG admitted to the Victorian Adult Burns Service over a 4 year period were identified by the burns registry. Data was collected 24hrs pre SSG to 24hrs post SSG and included size of burn, pain scores, opioid and antineuropathic use including ketamine and lignocaine infusions.

Data:138 patients with >10%TBSA burns
20 Patients received lignocaine at time of SSG
The lignocaine group had larger TBSA burn 33.3% vs 27.7%, had longer hospital stays 43.5 days vs 33.4 days and more surgical encounters 5.45 vs 4.22
The difference between pre and post op pain scores was compared. The non-lignocaine group showed a significant post-operative increase (1.68, SE=0.32, p<0.001). The difference was lower for the lignocaine group (0.18, SE=0.79, p=0.822).
Preoperative pain scores were comparatively higher in the lignocaine group 4.83 Vs 2.88 suggesting this group had harder to manage pain. This supports the hypothesis that there is a trend towards improvement in pain management in the lignocaine group.

Conclusion:Lignocaine infusion may reduce burns associated pain.
We propose a prospective randomised placebo controlled trial to assess the efficacy of IV lignocaine on donor site pain related to burns injury.
Bibliography
1. James DL, Jowza M, Principles of Burn Pain Management Clin Plastic Surg. 2017;44:737–747
2. Hyeong Tae Yang. Improvement of burn pain management through routine pain monitoring and pain management protocol. Burns(2013);39:619–624
3. Retrouvey H, Shahrokhi S. Pain and the Thermally Injured Patient—A Review of Current Therapies Journal of Burn Care & Research2015;36(2):315–323
4. Alencar de Castro RJ, Leal PL, Sakata RK. Pain Management in Burn Patients Rev Bras Anestesiol. 2013;63(1):149-158


Biography:

Kerry McLaughlin works as  a VMO Pain Specialist and Anaesthetist at the Alfred Hospital. Burns pain management is her areas of specialist interest.

“Its All Very Complex!”

Ms Nicole Alexander1, Ms Alison Baillie2, Ms Anna  Lucia3

1The Royal Children’s Hospital , Parkville , Australia, 2The Royal Children’s Hospital , Parkville , Australia, 3The Royal Children’s Hospital , Parkville , Australia

Abstract:

This eco map is a visual presentation of the complex systems surrounding a child who experienced a 20% flame burn to his neck, chest and arm and the linkages made to ensure best outcomes during and post admission at The Royal Children’s Hospital.
The patient presented with an intellectual disability and significant speech delay. The extent of his cognitive and speech delay was not fully understood by his family which initially impacted on our care. He has a complex social situation including history of family violence, substance abuse, and limited supports. He resides with his father and mother resides interstate.
This visual map highlights the complexity surrounding this patient and the multiple interventions accessed during his admission at RCH.
The complex nature of this patient resulted in non-compliance in post burns care with limited participation in therapy. Despite thorough discharge planning, minimal compliance continued in relation to stretches and scar management. He has significant bilateral anterior axilla and neck contractures resulting in restricted movement and limited function.
The ongoing work with this patient and family post discharge are represented with local supports working closely with the patient, family and RCH. This patient faces life long consequences in his physical appearance and mobility if the next stage of his treatment is not successful. By linking with local supports, networks and services our goal is to best prepare the patient and family both emotionally and developmentally for the next stage of his recovery and to reduce the risk of continued non-compliance post-surgery.


Biography:

Anna has been a Social Worker for the past 18 years across community and health and worked within the Burns Unit at The Royal Children’s Hospital as a Senior Social Worker for the past 4 years.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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