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Introduction

The role of the physical therapist in wound care has evolved over the past several decades. The Academy of Clinical Electrophysiology and Wound Management’s white paper in 2017 outlined the role of physical therapists in wound management. This paper highlights the principles of normal tissue healing, examination, systems review, tests and measures, differential diagnosis, and interventions, which are covered in the entry-level curriculum. Skills for the entry-level clinician are foundational and include pressure redistribution, wound cleansing/irrigation, knowledge of nonsurgical débridement, and basic scar management. Clinicians in the postgraduate phase of their education will need to increase the depth of their knowledge for the type of integumentary disruption and demonstrate skill with advanced interventions such as sharp/ultrasonic débridement and use of advanced topical therapeutic agents (Woelfel & Gibbs, 2017). Physical therapists who desire to be active in wound management need to expand their knowledge through continuing education and, as with any specialty, competency-based training with a mentor. Pediatric clinicians need to be prepared to encounter a wide range of integumentary issues with children. Children are at risk for thermal injuries, pressure injuries, and traumatic wounds. There are also specific congenital integumentary impairments that will challenge the pediatric clinician’s ability to provide timely and age-appropriate interventions. This chapter will serve as an introduction to wound and burn management for the physical therapist as part of an interdisciplinary pediatric wound-management team.

Intervention Settings

Acute-care physical therapists play an integral role on the wound-management team. Therapists work closely with physicians and nurses to achieve wound closure using the various interventions that are discussed in this chapter. Acute-care clinicians also assist with wound risk assessment, functional mobility training, positioning, and direct wound management. In the rehabilitation setting, the physical therapist faces challenges regarding management of chronic wounds and burns after the acute healing process or after grafting. Additionally, the physical therapist must address how the patient will achieve independence with functional skills. For example, in the outpatient setting, therapists are often called on to maximize function and to decrease activity or encourage participation limitations in situations involving open wounds. Therapists also intervene with scar management techniques after wound closure (Woelfel & Gibbs, 2017).

School-based therapists need to have knowledge in the areas of wound and scar management because children with traumatic wounds, pressure injuries, and burns will eventually return to school after their acute care and rehabilitation episodes of care. Although school-based therapists may not provide direct wound care, other interventions usually need to be performed throughout the school day. Examples include using static or dynamic splints after a thermal injury, implementing pressure-relieving techniques for a child with a pressure injury or spinal cord injury, and reintegrating a child in school activities after an integumentary injury. Working with teachers and other classmates, the school-based therapist can assist in transitioning a child back to school after prolonged hospitalization. Such children may ...

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