Background: Severe burns require multidisciplinary care, including early physiotherapy to prevent complications such as contractures and functional limitations. This case highlights the role of structured physiotherapy in improving outcomes for a patient with 41% partial-thickness burns.

Case Presentation: A 26-year-old male sustained burns to the face, neck, upper limbs, lower limbs, and external genitalia due to a gas explosion. Initial management included wound care and antibiotics, followed by referral for specialist rehabilitation. Key challenges included reduced cardiopulmonary function, edema, pain (NPRS: 6/10), and impaired mobility (Barthel Index: 12/20).

Intervention: A 10-week physiotherapy program focused on chest physiotherapy, joint mobilization, muscle strengthening, and functional re-education.

Outcomes: Post-intervention, pain reduced to NPRS: 3/10, muscle strength improved from grade 3 to 4, and functional independence increased (Barthel Index: 17/20). The patient achieved independent ambulation.

Conclusion: Early, tailored physiotherapy reduces functional decline in burn patients. This case underscores the need for integrated rehabilitation protocols in burn care.

Keywords: Burns rehabilitation; Physiotherapy; Functional outcomes; Contracture prevention.

Copy right Statement: Content published in the journal follows Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0). © Ndubuaku MC (2025)

Journal: Open Journal of Clinical and Medical Case Reports is an international, open access, peer reviewed Journal mainly focused exclusively on the medical and clinical case reports.

Citation: Ndubuaku MC, Ekechukwu NE, Ogbuniro JC. Early physiotherapy intervention in a 26-year-old male with 41% total body surface area burns: A case report on functional rehabilitation and outcomes. Open J Clin Med Case Rep. 2025; 2348.

Burn injuries are a major global health burden and are a leading cause of morbidity in low- and middle-income countries (LMICs), with Nigeria reporting an annual incidence of 8.1 per 100,000 population (Isiguzo et al., 2020). Burn is an injury to the skin or other body tissue that could be as a result of heat, prolonged exposure to heat, chemical agents, electrical current or radioactive materials [5]. Its complications include infection, scarring, and functional impairment. Partial-thickness burns exceeding 20% Total Body Surface Area (TBSA) necessitate multidisciplinary management to address systemic inflammation, infection risk, and functional decline. Over 40% of burns involve the extremities, often leading to reduced mobility and independence [1]. Physiotherapy is critical for preserving Range of Motion (ROM), strength, and cardiopulmonary function. However, evidence on optimal rehabilitation strategies for extensive burns remains limited, particularly in low-resource settings. This case report details the rehabilitation journey of a patient with 41% total body surface area (TBSA) burns, emphasizing the role of early physiotherapy in improving functional outcomes.

Patient information

The patient was a 26-year-old Nigerian male who was admitted to ESUTH Parklane after suffering significant burn injuries a day prior. The patient recently graduated from the University of Nigeria, Nsukka, was living alone and was apparently healthy until he sustained a 41% TBSA partial-thickness burns from a gas explosion in his kitchen.

The explosion involved ignition of leaked gas, resulting in flame burns to the face, neck, bilateral upper/lower limbs, and external genitalia but there was no loss of consciousness. He was rushed to a private hospital in Enugu State where he was initially managed with wound dressings, IV antibiotics (cefloxacine, meropenem), and analgesics before referral to ESUTH Parklane for expert management the following day.

Clinical findings

On observation and examination, the patient was met in semi-fowler’s position, afebrile to touch, acyanosed, anicteric and in no obvious respiratory distress. Burns on the face and right side of the neck and Clean wound dressing on the bilateral forearm to hand and lower limbs were also observed. His vital signs were 128/96 mmHg blood pressure, 118 beats per minute (bpm) pulse rate, 24 cycles per minute respiratory rate, and 98% of oxygen saturation.

On physical examination, inhalational injuries were observed as evidenced by the singed hairs, nasal flaring and difficulty with breathing. Physical assessment of the thorax and abdomen showed fine crackles in bilateral lower lobes of the lungs and reduced air entry globally. Musculoskeletal assessment showed edema in hands, limited/painful ROM in elbows, wrists, and ankles (Numerical Pain Rating Scale, NPRS: 6/10) and Muscle strength graded 3/5 using the Oxford Muscle Grading Scale. Functional Status was assessed using Barthel Index score. (Barthel Index score: 12/20, indicating severe dependence).

Laboratory and radiological investigations, Hb level=12.5 mg/dl. Clinical Impression;

1. Reduced Functionality + Pain 20 partial thickness burn following gas explosion flame.

2. Reduced cardiopulmonary function 20 mild inhalation injury

Treatment plan and therapeutic intervention

Our short-term goals (4 weeks) were to improve air entry globally, reduce edema, relieve pain and improve grip and muscle strength. In the long term, we planned to prevent contractures, achieve standing and walking and to improve functional independence.

To achieve both the short- and long-term goals, we used chest physiotherapy techniques (Incentive spirometry, deep breathing exercises), joint mobilization protocols (passive ROM exercises for neck, elbows, wrists, and ankles), soft tissue mobilization, strengthening exercises (resisted exercises, static quadriceps, and grip strengthening with softballs), positioning and progressive ambulation (sitting, standing, and ambulation training using a Zimmer frame).

Outcomes

Edema resolved in the hands with no pitting. Patient’s pain on joint mobilization reduced from NPRS 6 to 3/10 while his strength improved to grade 4/5 Oxford scale in upper/lower limbs. Patient’s function (Barthel Index) improved to 17/20; this indicates that independent ambulation was achieved. Also, no contractures or infections were observed.

Table 1: Outcome (pre-intervention).

Pelvis and perineum
Burns at the external genitalia

Table 2: Physiotherapy intervention protocol (Weeks 1–10).

Table 3: Outcome (post-intervention).

Table 4: Outcome (post-intervention).

This case aligns with evidence supporting early physiotherapy in burn care (Cartotto et al., 2023; Cinar et al., 2019; [6,9]. Dewey et al. [3] emphasize positioning and splinting to prevent contractures, which were prioritized in this patient’s regimen. The observed improvement in ROM and strength mirrors findings by Shah et al. [10], who noted the efficacy of active/passive exercises in hand rehabilitation. It also aligns with Patsaki et al. [8]’s findings that structured physiotherapy improves functional outcomes in burns. However, the absence of contractures contrasts with Nthumba [7]’s report of 32% contracture rates in sub-Saharan Africa, this could be attributed to early splinting and positioning of this patient.

Key challenges

Pain Management: Analgesics and graded exercises minimized discomfort during mobilization. Adherence: Caregiver education ensured compliance with home exercises.

Limitations

Single-case design and short follow-up period restrict generalizability.

This case demonstrates that structured physiotherapy initiated during acute burn care improves functional outcomes and prevents complications. Future research should focus on standardizing burn protocols in LMICs and explore cost-effective rehabilitation strategies in resource-limited settings and also, integrating tele-rehabilitation to address follow-up challenges.

Ethics statement: Informed consent was obtained and patient was anonymized as «Mr. O.P.» Institutional ethics approval waived for retrospective case reports at ESUTH Parklane.

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