This is necessary for both in and out patients. In–patients may be in a special ward, intensive care unit or a regional burns unit. The last is best because the patient receives highly specialist attention. The physiotherapist together with other team member must recognize the devastating effect a bad case of burning can have on the family. It is important to recognize moods of guilt, depression, anger, bewilderment and bitterness which can arise in the patient and family. The cause of the accident clearly has a bearing on these moods. The physiotherapist has to gauge what is the appropriate reaction–sympathy, cajoling, encouragement or optimism whilst achieving the aims of treatment. Given the long–stay nature of the recovery period, staff and patients develop a special relationship which must remain professional for the emotional well–being of all concerned.

Respiratory Care
Clearing secretions is achieved by shaking, clapping, postural drainage, coughing and suction. If it is very uncomfortable for the patient to have hand pressure on a chest burn, then a piece of foam may be used under the hands. Tipping is contraindicated if there is facial edema but the patient may lie supine or on either side. A ventilated patient usually requires suction and humidification. A little treatment, often, is the general theme. Steam inhalations may be necessary for the non–ventilated patient especially when there has been inhalation of smoke or fumes. Breathing (expansion) exercises are also important to maintain ventilation of all lung areas. The physiotherapist must not be afraid to treat with the vigor required to achieve the aims even when the chest skin is burnt.
Intensive respiratory care is required in the following situations:

1. Elderly patients.
2. Burns affecting face, mouth and inhalation burns.
3. Immobile patients.
4. A history of a chronic respiratory condition.
5. Pre–and post–operatively.
6. Patients with full–thickness burns on the chest–breathing exercises to keep the eschar mobile.

Prevention of Contractures and Deformities
Positioning, splinting and exercise are used for maintaining and gaining joint range.

Positioning
Unfortunately for the patient, the position of comfort is the position of contractures (mostly flexion). Positions of necessity are, therefore, as follows.

Head and Neck
Small roll (towel) under the neck and/or a pillow under the shoulders to maintain extension. The patient may be in lying (chest and leg burns) or in half–lying with facial burns (because of facial edema)... Upper limbs.

Elevation (over 900) of the limbs with the shoulder in abduction and slight flexion, elbows and wrists in extension, metacarpophalangeal joints in flexion, IP joints in extension and thumb in abduction.

Lower limbs
Hips in extension and slight abduction, knees in extension and ankles in 900 dorsiflexion. Elevation is obtained by raising the end of the bed, not by placing pillows under the legs which would put the hips into flexion.