11.6 Burns, Endocrine/Metabolic & Medical Complications Rehabilitation

ABPMR Physical Medicine and Rehabilitation Board Exam Study Guide Exam

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1 Chapter 1: Introduction & Exam Overview

1.1 ABPMR Part I Exam Overview & Format 1.2 Board Review Strategy & Content Blueprint Breakdown

2 Chapter 2: Musculoskeletal Medicine

2.1 Shoulder & Upper Extremity Diagnostics 2.2 Knee, Hip & Lower Extremity Conditions 2.3 Spine Pathology, Radiculopathy & Myelopathy 2.4 Inflammatory Arthritis, Tendinopathies & Concussion 2.5 Bone Health, Osteoporosis & Metabolic Bone Disease 2.6 Thoracic Outlet Syndrome & Peripheral Nerve Entrapment 2.7 Fracture Rehabilitation & Immobilization Complications 2.8 Overuse Tendinopathies & Regenerative Medicine 2.9 Gait Analysis & Abnormal Gait Patterns

3 Chapter 3: Spinal Cord Injury Rehabilitation

3.1 ASIA Examination & Impairment Scale 3.2 Spinal Cord Injury Syndromes 3.3 Autonomic Dysreflexia & Acute Complications 3.4 Neurogenic Bladder, Bowel & Secondary Complications

4 Chapter 4: Stroke & Neuromuscular Rehabilitation

4.1 Stroke Vascular Syndromes & Acute Assessment 4.2 Stroke Motor Recovery & Hemiplegic Complications 4.3 Spasticity Assessment & Multimodal Management 4.4 ALS, GBS, CIDP & Neuromuscular Disease Rehab 4.5 Multiple Sclerosis & Demyelinating Disease Rehabilitation 4.6 Parkinsonism, Movement Disorders & Functional Neurologic Disorder

5 Chapter 5: Electrodiagnostics (EMG/NCS)

5.1 Nerve Conduction Studies Principles & Physics 5.2 Needle Electromyography & MUAP Analysis 5.3 Mononeuropathies & Radiculopathy Patterns 5.4 Neuromuscular Junction Disorders & Myopathies

6 Chapter 6: Traumatic Brain Injury

6.1 TBI Severity Classification, Glasgow Coma Scale, and Pathophysiology 6.2 Rancho Los Amigos Levels of Cognitive Functioning and Disability Rating Scale 6.3 Neurobehavioral Sequelae and Agitation Management 6.4 Concussion Evaluation, Vestibular-Ocular Dysfunction, and Return-to-Play/Work Protocols

7 Chapter 7: Chronic Pain & Interventional Spine

7.1 Fluoroscopic Spine Interventions 7.2 Opioid Stewardship & Controlled Substance Compliance 7.3 Complex Regional Pain Syndrome, Fibromyalgia & Myofascial Pain 7.4 Spinal Cord Stimulation & Intrathecal Therapy

8 Chapter 8: Amputee Rehabilitation & Prosthetics

8.1 Amputation Surgical Levels & Medicare K-Levels 8.2 Socket Designs & Suspension Systems 8.3 Prosthetic Feet & Microprocessor Knee Mechanisms 8.4 Post-Amputation Care, Residual Limb & Phantom Pain

9 Chapter 9: Pediatric Rehabilitation

9.1 Cerebral Palsy Classification & GMFCS 9.2 Spina Bifida & Myelomeningocele Management 9.3 Muscular Dystrophies & Neuromuscular Disease in Children 9.4 Pediatric Brachial Plexopathy & Congenital Disorders

10 Chapter 10: Prosthetics, Orthotics & Assistive Technology

10.1 Lower Limb Orthoses — AFOs & KAFOs 10.2 Spinal & Upper Extremity Orthoses 10.3 Upper Limb Prosthetics — Body-Powered vs Myoelectric 10.4 Wheelchairs, Seating Systems & Pressure Mapping

11 Chapter 11: Medical Rehabilitation & Outcomes

11.1 Dysphagia Assessment & Management 11.2 Neurogenic Bladder & Bowel Management 11.3 Pressure Injuries & Wound Management 11.4 Outcome Measures & Medical Complications 11.5 Cancer Rehabilitation & Oncologic Rehabilitation 11.6 Burns, Endocrine/Metabolic & Medical Complications Rehabilitation

12 Chapter 12: Cardiopulmonary Rehabilitation

12.1 Cardiac Rehabilitation Phases & Metabolic Equivalents 12.2 Pulmonary Rehabilitation & COPD Management

13 Chapter 13: Foundational Rehabilitation Concepts

13.1 Kinesiology, Biomechanics & Functional Anatomy 13.2 Rehabilitation Pharmacology & Medication Management 13.3 Research Methodology, Biostatistics & Evidence-Based Practice 13.4 Nutrition, Metabolism & Energy Expenditure in Rehabilitation 13.5 Diagnostic Procedures: Imaging, MSK Ultrasound, Urodynamics & Neuropsych Assessment

11.6 Burns, Endocrine/Metabolic & Medical Complications Rehabilitation

Key Takeaways Explain This Topic AI

Burn depth determines healing and rehab need: superficial partial-thickness (epidermis/upper dermis) heals within ~2 weeks with minimal scarring; deep partial-thickness heals in >3 weeks with hypertrophic scarring risk; full-thickness requires excision and grafting.

Total body surface area (TBSA) is estimated in adults by the Rule of Nines (head/each arm 9%, anterior trunk 18%, posterior trunk 18%, each leg 18%, perineum 1%); Lund-Browder charts refine pediatric estimates.

Burn rehabilitation targets contracture prevention (positioning, splinting in anti-deformity positions, early and sustained ROM), hypertrophic scar management (pressure garments ~23-24 hr/day for many months), and functional reintegration; edema, pruritus, and heterotopic ossification are common complications.

Endocrine and metabolic rehab considerations include diabetic foot ulceration and glycemic control impact on wound healing, thyroid dysfunction and myopathy, and post-bariatric/immobility-related metabolic bone disease; malnutrition and edema impede wound healing.

Last updated: July 2026

Burns, Endocrine/Metabolic & Medical Complications Rehabilitation

Burns (Domain E condition) and endocrine/metabolic disorders plus delirium, edema, malnutrition, sleep, and wound care (Domain E rehab management) are consolidated here.

Burn Depth & Classification

Depth Layers Healing Rehab Implication
Superficial (1st degree) Epidermis ~3-6 days, no scar Symptomatic care

Superficial partial-thickness (2nd) Epidermis + upper dermis, blanching, moist, painful ~1-2 weeks, minimal scar Wound care, ROM

Deep partial-thickness (2nd) Into reticular dermis, less blanching, may be less painful >3 weeks, hypertrophic scar risk Grafting often considered; aggressive scar/contracture mgmt

Full-thickness (3rd) Full dermis, dry, leathery, insensate No spontaneous healing; excision/grafting Surgical + intensive rehab

4th degree Into fascia/muscle/bone Surgical Limb salvage vs amputation
TBSA Estimation (Adult Rule of Nines) Head & neck 9% Anterior trunk 18%
Each upper arm 9% Posterior trunk 18%
Each lower leg 18% Perineum 1%
(Rule of Nines; Lund-Browder chart adjusts pediatric proportions.)

TBSA guides fluid resuscitation (Parkland formula: 4 mL x kg x %TBSA in first 24 hr, half in first 8 hr) and prognosis.

Burn Rehabilitation Priorities

Anti-deformity positioning : splint and position joints to oppose the tendency toward contracture (e.g., axillary abducted ~90°, elbow extended, wrist neutral-to-slightly extended, MCPs flexed ~70° with IPs extended, knees extended, ankles dorsiflexed). Contracture prevention begins during acute care.

Range of motion : early, sustained, and frequent; coordinate with pain control and graft integration (immobilize freshly grafted areas per burn team).

Hypertrophic scar management : pressure garments worn ~23-24 hours daily for many months to a year; silicone gel sheeting; massage and moisturization.

Edema : elevation, compression once grafts stable, active exercise.

Pruritus : moisturizers, antihistamines, cooling agents.

Heterotopic ossification : elbow most common; prophylaxis (early ROM) and management.

Functional reintegration : scar maturation (up to 1-2 years), psychological support, return to work/school, prosthetics if amputation.

Endocrine & Metabolic Considerations in Rehab

Condition Rehab-Relevant Issue

Diabetes mellitus Diabetic foot ulcers (offloading, total-contact casting), neuropathy, glycemic control essential for wound healing

Thyroid Hypothyroid myopathy (proximal weakness, slowed reflexes); hyperthyroid myopathy
Glucocorticoids Steroid myopathy, osteoporosis, hyperglycemia impairing healing
Post-bariatric / malabsorption Vitamin D/calcium deficiency, osteoporosis, neuropathy (B1/B12)
Immobility Hypercalcemia (esp. young SCI/children), disuse osteopenia
Chronic kidney disease Renal osteodystrophy, sarcopenia, anemia limiting exercise
Medical Complications Across Rehab (Delirium, Edema, Malnutrition, Sleep)

Delirium : common in inpatient rehab (older adults, postop, infection, medication); screen (CAM), address precipitants, orient, mobilize, normalize sleep-wake cycle; avoid deliriogenic sedatives.

Edema : dependent edema, venous insufficiency, lymphedema, cardiac/renal causes; compression, elevation, exercise, and treatment of underlying cause.

Malnutrition : impairs wound healing and increases pressure injury risk; protein intake ~1.2-1.5 g/kg/day for wound/healing, screen (MNA/SNAQ), dietitian referral.

Sleep : pain, depression, nocturia, medications, and respiratory disorders impair recovery; sleep hygiene and treating underlying causes.

Wound care : covered in the pressure-injury section; principles—debridement, moisture balance, offloading, infection control.

Burn Severity, Inhalation Injury & Systemic Response

Major burn severity reflects TBSA, depth, inhalation injury, comorbidity, age, and location (face, hands, feet, perineum, joints). Inhalation injury (soot, hoarseness, singed nares, carbonaceous sputum, enclosed-space injury) substantially increases mortality and requires airway vigilance; early intubation for impending airway compromise. The hypermetabolic response persists for months, with hyperthermia, tachycardia, catabolism, and insulin resistance; beta-adrenergic blockade (propranolol) and anabolic agents (oxandrolone) attenuate catabolism in select centers.

Scar Maturation, Pruritus & Psychological Recovery

Hypertrophic scars mature over 1-2 years; pressure garment therapy (~23-24 hr/day for 9-12 months or until scar maturity), silicone sheeting, massage, moisturization, and sun protection optimize appearance and pliability. Pruritus is nearly universal and managed with moisturizers, antihistamines, counter-irritants, and gabapentinoids for neuropathic itch. Psychological recovery addresses pain, body image, sleep disturbance, PTSD, and reintegration into work/school; psychologic support is integral from admission through outpatient reintegration.

Endocrine Myopathies & Rehab Recognition

Endocrine disorders produce characteristic patterns the physiatrist should recognize: hypothyroid myopathy (proximal weakness, delayed reflexes, myoedema, elevated CK), hyperthyroid myopathy (proximal weakness with normal CK), steroid myopathy (chronic glucocorticoid proximal weakness, often type II fiber atrophy, improve with taper and exercise), and parathyroid/myopathy patterns. Recognition prompts endocrine evaluation and management of the underlying disorder, with rehabilitation of residual weakness.

Delirium Prevention & Sleep Optimization in Inpatient Rehab

Delirium Risk Factor Intervention
Infection, hypoxia, metabolic derangement Identify and treat precipitants
Polypharmacy (anticholinergic, benzodiazepine) Deprescribe deliriogenic agents
Sensory impairment, disorientation Glasses/hearing aids, orient, clocks/calendars
Immobility, restraint use Mobilize early; minimize restraints
Sleep disruption Normalize sleep-wake cycle, reduce nocturnal disruptions

Sleep optimization in rehab addresses pain, nocturia, sleep apnea, anxiety, medication timing, and environmental noise. Recognizing and treating delirium and sleep disorders accelerates participation and functional gains, making them core—not peripheral—rehabilitation medical-management tasks.