500 Vibrotactile Stimulation and Pain Modulated Range of Motion Gains in Burn Scars

Abstract

With an increase in survivability from burn injuries over the past couple of decades comes the challenge of managing post-burn scars. When scar tissue impairs joint function, range of motion (ROM) may be limited. Management of post-burn scar tissue offers many challenges for burn therapists including tolerance to ROM, particularly during the proliferative phase when the scar tissue is vascular, contracting, and the patient may be experiencing dysesthesia. When managing scars during this phase of healing, we investigated an alternative modality that may reduce pain and can be applied in conjunction with ROM to facilitate tissue elongation. We conducted trial runs of two outpatient post-burn survivors, both with right axilla involvement. Patient 1 had been discharged from the burn center for 94 days and patient 2 for 28 days. Both patients spent time at inpatient care facilities upon discharge. Patients were given protocol-based standardized treatments for ROM and measurements taken at conclusion of same, with patient reporting pain at maximal ROM attained. At that point, ROM was resumed with application of vibration for a dosage of 2–3 minutes per square inch of scar with use of skin lubricant. ROM was then measured and pain assessed at maximal ROM attained, and differences compared within each session. The handheld corded vibratory massager used during these trials produces 120 V / 60 Hz of power with adjustable intensity through a three pinpoint triad head. Intensity was adjusted to patient tolerance. The total contact area of the head was 2 cm2. Patient 1 was treated 3 times per week for 19 weeks and was 5 months post-burn at time of first session. Patient 2 was treated 3 times per week for 19 weeks and was 2 months post-burn at time of first session. At the completion of 4 weeks of treatment, patient 1 increased right shoulder flexion by 25 degrees (18.51%) and right shoulder abduction by 18 degrees (12.86%). Patient 2 increased right shoulder flexion by 18 degrees (12.86%), R shoulder abduction by 28 degrees (19.72%), and right shoulder extension by 17 degrees (34%). Both patients 1 and 2 reported less pain with use of vibration, with averages of 5/10 -> 0/10 and 4/10 -> 2/10, respectively. Preliminary data suggests that using a targeted vibratory stimulus during passive ROM may enhance analgesia and ROM gains in the outpatient setting. Reported pain during ROM was found to decrease for both patients. A prospective randomized trial is needed. This study could offer practitioners an alternate modality to use in conjunction with ROM to promote ROM gains while providing vibratory analgesia during the proliferative phase of healing. A prospective, randomized trial is needed.