Original Article

A Comparison of Three Different Physiotherapy

Modalities Used in the Physiotherapy of Burns
Zübeyir Sarı, PT, PhD,* Mine Gülden Polat, PT, PhD,* Bahar Özgül, PT, MSc,*
Onur Aydoğdu, PT,* Burcu Camcıoğlu, PT, MSc,* Ahmet Hakan Acar, MD,†
Saadet Ufuk Yurdalan, PT, PhD*

The present study compared the effectiveness of matrix rhythm therapy, ultrasound treat-
ment (UT), laser treatment (LT) used in the physiotherapy of burns. The study was
conducted at the Wound and Burn Healing Center, Dr. Lütfi Kırdar Kartal Education and
Research Hospital (Turkey) from June 2009 to January 2012. The case series comprised
39 individuals with second- and third-degree upper-limb burns, whose burn traumas
ended approximately 1 to 3 months previously. Participants were separated into three
groups: matrix rhythm treatment (MRT), UT and LT; each group was also applied a treat-
ment p ­ rotocol including whirlpool and exercise. Pain, range of motion (ROM), muscular
strength, skin elasticity, and sensory functions were evaluated before and after the treat-
ment. Pressure sense and passive ROM were higher in the MRT group than in the LT group
(P < .05). Pain was lower in the LT group than in the UT group, and passive ROM was
higher in the UT group than the in LT group (P < .05). Active ROM was found to increase
in all treatment groups, whereas passive ROM increased only in the MRT and UT groups;
pressure sense increased only in the MRT group, and pain decreased only in the LT group
(P < .05). MRT was found to be more effective in the restoration of sensory functions than
LT, whereas LT was more effective in reducing pain than UT. No significant difference
was observed in terms of skin elasticity according to the results of three treatment modali-
ties. It is suggested that further research with more cases should be conducted to examine
the long-term effect of treatment modalities. (J Burn Care Res 2013;34:e290–e296)

Burn traumas are the second most common trauma-
related cause of death after traffic accidents in both
developed and developing countries.1 Survival rates
after burn traumas have increased, indicating the
importance of the rehabilitation process.2 Physical and
psychological recovery in individuals surviving burns
lasts for months and even years. However, physiother-
apy evaluation methods and approaches applied after
burns differ in many health centers. The approaches
used during the rehabilitation process include elec-
trotherapeutic modalities such as heat, sound and
mechanical waves, light and electrical currents.3
Accepted for publication September 28, 2012
From the * Department of Physiotherapy and Rehabilitation, Fac-
ulty of Health Sciences, Marmara University, Istanbul, Turkey;
†Wound and Burn Healing Center, Dr. Lütfi Kırdar Kartal
Education and Research Hospital, Istanbul, Turkey
The authors declare no conflict of interest.
Address correspondence to Zübeyir Sarı, PT, PhD, Marmara
University, Health Sciences Faculty, Department of
Physiotherapy and Rehabilitation, Istanbul, Turkey.
Copyright © 2013 by the American Burn Association
1559-047X/2013
DOI: 10.1097/BCR.0b013e3182789041
General physical symptoms of burns include
pain,4,5 sensory disorders, irritation,5 loss of physical
strength,4,5 and reduced joint mobility.4 Burns
require complex and long-term rehabilitation
because of the formation of scar tissues, contracture,
amputation, neuropathy, heterotrophic ossification,
and pain.2 Despite very good treatment, scar tissue
is inevitable in all severe burns, except superficial
dermal burns.1 Healing of a burn injury depends
on the formation of scar tissue with the help of
injured tissue collagen fibers.6 Although scar tissue
cannot be completely removed, it can be minimized
via various physiotherapy approaches.1 All of the
physical problems resulting from a burn injury result
in reduced daily functionality, limitation of physical
roles, and pain.7
It is important to focus on alternative treatment
methods that will shorten the healing period of the
injury and enable the formation of a quality scar.
Therapeutic ultrasound is a common treatment used
in wound healing. It can be used in the inflamma-
tory, proliferative, and remodeling phases of wound

e290
Journal of Burn Care & Research
Volume 34, Number 5 Sarı et al   e291
healing at 0.125 to 3 watt/cm2, 1 to 3 MHz. The
basic feature of the ultrasound enabling tissue healing
is its mechanical effect.8 Electric stimulation and laser
treatment (LT) also facilitate and accelerate wound
healing. LT is used in decubitus ulcers, open wounds,
venous ulcers, graft ulcers, incisions, lacerations, and
burns.8 LT accelerates biochemical reactions, fibro-
blast activity, collagen metabolism, neovasculariza-
tion, and quality scar and wound formation.9,10
A new therapeutic and clinic modality, matrix
rhythm treatment (MRT), which activates and rebal-
ances specific physiological vibrations of skeletal
muscles and nervous system was improved by Dr.
Ulrich Georg Randoll.11 It is applied by an electri-
cally powered oscillator (resonator) comprising an
asymmetric (cam type) head whose mechanical oscil-
lations are being supplemented by a magnetic sinu-
soidal phase synchronized field. These mechanical
oscillations produce a visually detectable longitudi-
nal motion in the musculature similar to that under
muscle strain.11 There is no previous study in the lit-
erature on the alleged effects of this new treatment
modality on burn injuries, such as cell regeneration
and fast healing at a cellular level.
Main purposes of physiotherapy are to increase
the range of joint motion, develop the functions,6
increase local circulation and scar flexibility, enable
muscle relaxation to increase mobility, increase hydra-
tion of scar tissue, and to reduce pain.3 Therefore,
physiotherapy applications are of great significance
in the rehabilitation of patients who have suffered
burns.12 The present study compared the short-term
effects of ultrasound treatment (UT), LT, and a new
application, MRT modalities, which are used in the
physiotherapy of burns patients.
METHODS
The study was conducted at the Wound and Burn
Healing Center, Dr. Lütfi Kırdar Kartal Education
and Research Hospital (Istanbul, Turkey) between
June 2009 and January 2012. Participants were
chosen randomly from patients attending the Cen-
ter, who were aged 18 to 65 years and had second-
or third-degree upper-limb burns. Forty-five burn
patients were randomly allocated to three groups
via sealed-envelope technique: MRT,14 UT,14 or
LT.11 Six patients who could not keep on the treat-
ment owing to transportation problems or weather
conditions, were excluded from the rest of the study
(n = 39). All participants gave signed informed con-
sent, and the present study was approved by the
Local Ethics Committee at the Dr. Lütfi Kırdar Kar-
tal Education and Research Hospital (4/26.03.09).
Participants underwent physiotherapy after a mini-
mum 1-month and maximum 3-month period after
the burn trauma, and their treatment protocol began
when the first evaluations were completed. All par-
ticipants were assessed two times in pre- and post-15
sessions treatment via same protocol. Pain, range of
motion (ROM), muscle strength, skin elasticity, pres-
sure sense, and two-point discrimination sense were
evaluated via visual analog scale, goniometer, myom-
eter (J-Tech, Powertrack Commander II), durometer
(Schmidt Control Instruments), Semmens-Weinstein
Monofilaments (Touch-TestTM Sensory Evalua-
tor Instructions) and Touch-TestTM discriminator
(Touch-TestTM, North Coast Medical, Inc., CA). All
participants were wearing burn garment.
Joints including burn tissues are assessed with
goniometer and are reported as “degree.” ROM of
shoulder flexion, extension, abduction, internal and
external rotation, elbow flexion, extension, pronation
and supination, wrist flexion, extension, ulnar and
radial deviation, thumb flexion, extension, abduction,
adduction, 2 to 5 metacarphalangeals flexion, exten-
sion, proximally and distally interphalangeal flexion,
extension, abduction, adduction are assessed because
of including only upper extremity burn cases in the
study. Average values of the measurements in the
joints were calculated for burned injured extremity.
Muscle strength of muscles of the body parts
including burn tissue, were measured via myometer
and recorded as newton. Measurement of muscle
strength at pre- and posttreatment was performed as
triplicate, and average value of three measurements
was calculated. Skin elasticity was measured via
durometer by determining three areas that were in
the burned tissue of participants and was recorded
as millimeter by calculating the average value of
three measurements. Monofilament assessment was
applied to 12 seperated areas; anterior–posterior and
medial–lateral parts of arm, forearm and hand, and 10
seperated areas; and palmar–dorsal parts of fingers.
The distribution of burned areas of the partici-
pants is shown in Tables 1, 2, and 3.
The same treatment protocol was applied to
all participants of three groups during 3 weeks of
therapy of five sessions per week. The treatment
protocol began with the whirlpool application, fol-
lowed by either matrix rhythm, ultrasound or LT;
all treatments concluded with a stretching and exer-
cise regime. Whirlpool application is applied for 15
minutes to all participants. MTR was applied to the
region of scar tissue and the surrounding tissues
at a frequency range of 8 to 12 Hz. The applica-
tion was conducted from proximal-to-distal and
central-to-peripheral tissues for 15 to 45 minutes
 Journal of Burn Care & Research
e292   Sarı et al September/October 2013

Table 1. Distribution of burned areas of the participants of MRT group

Burn Area

Subjects Age (yrs) Right hand Left hand Right forearm Left forearm Right arm Left arm

1 39 + + + + + +
2 39 + + + + + +
3 41 − + − − − −
4 24 + + − − − −
5 39 − − − − + −
6 36 + − + − + −
7 45 + − + − − −
8 40 + − + − + −
9 60 − + − + − +
10 55 + − + − − −
11 35 + − + − − −
12 50 + − + − − −
13 58 + − + − − −
14 58 − + − + − −

by physiotherapists qualified in MTR. Continuous
ultrasonic waves of 1 MHz frequency and intensity
of 1 W/cm2 were applied with a 5-cm diameter appli-
cator for 5 minutes per session. LT was applied with
a continuous 808-nm GaAlAs laser for 10 minutes
at 960 joule. The region of scar tissue was separated
into 10 equal areas, each of which received 1-min-
ute continuous LT; care was taken to not apply the
laser to open wounds or bony tissue. The treatment
was completed with active assistive ROM and passive
ROM, strengthening, stretching, and proprioceptive
neuromuscular facilitation exercises in the period of
15 minutes for all joints of the burned area. Pro-
prioceptive neuromuscular facilitation exercises were
used to reduce the joint limitations.
SPSS 15.0 (SPSS Inc, Chicago, IL) was used for
statistical analysis. Variables were determined as mean
± SD (X ± SD), frequency, and percentage. Statistical
significance was determined to be P < .05. Wilcoxon
and Kruskal–Wallis tests were used for intragroup
and intergroup comparisons of pain, ROM, muscle
force, elasticity, and sense evaluations. Significant
intergroup data were compared in two groups via
the Mann–Whitney U test with a Bonferroni correc-
tion method.
RESULTS
Ten of 39 participants (25.6%) were women, whereas
29 cases (74.4%) were men, and the average overall

Table 2. Distribution of burned areas of the participants of UT group

Burn Area

Subjects Age (year) Right hand Left hand Right forearm Left forearm Right arm Left arm

1 36 − + − + − +
2 58 − + − − − −
3 26 + − + − − −
4 56 − + − − − −
5 16 − + − + − +
6 16 + − + − + −
7 21 − + − + − −
8 50 − + − − − −
9 44 + − + − + −
10 25 − + − + − −
11 25 + − + − − −
12 41 − + − + − +
13 41 + − − − − −
14 36 − + − + − +
Journal of Burn Care & Research
Volume 34, Number 5 Sarı et al   e293

Table 3. Distribution of burned areas of the participants of LT group

Burn Area

Subjects Age (year) Right hand Left hand Right forearm Left forearm Right arm Left arm

1 51
2 36
3 50
4 16
5 16
6 25
7 25
8 49
9 30
10 30
11 24
+ −
− +
− +
+ −
− +
− +
+ −
− +
− +
+ −
− +
− −
− −
− −
− −
− −
− −
− −
− −
− −
− −
− −
− −
− −
− −
− −
− −
− −
− −
− −
− −
− −
− −−

age was 37.48 ± 13.29. Physical characteristics of
participants are shown in Table 4.
The case series included 12 individuals with sec-
ond-degree burns (30.76%) and 27 cases with third-
degree burns (69.23%), and 30 cases had undergone
grafting surgery. Sex, severity of burn, and grafting
distributions of the cases are given in Table 5.
Treatment groups were similar in terms of the
first measurements of age, pain, pressure sense,
two-point sensory discrimination, active and passive
ROM, muscular strength, and skin elasticity evalua-
tions (P > .05; Table 6).
Kruskal–Wallis comparison of pre- and posttreat-
ment data showed no statistically significant inter-
group differences for active and ROM, two-point
discrimination, muscular strength, and skin elasticity.
(P > .05; Table 7).
A statistically significant difference was found
between pre- and posttreatment measurements of
pain, pressure sense, and passive ROM (P < .05). The
Mann–Whitney U test with a Bonferroni correction
was used to determine the group to which these
differences belong.
No significant difference was observed between
the pre- and posttreatment data for the MRT and
UT groups (P > .017; Table 8). Pressure senses and
passive ROM of the MRT group were significantly
Table 4. Physical characteristics of participants
Body Body
Age (yr) Weight (kg) Height (cm)
MRT 44.21 ± 10.56 71.85 ± 15.31 168.14 ± 8.21
group
UT group 35.07 ± 14.00 72.71 ± 17.73 170.64 ± 9.98
LT group 32.00 ± 12.93 66.18 ± 10.73 170.90 ± 11.59
MRT, matrix rhythm treatment; LT, laser treatment; UT, ultrasound
treatment.
higher than that of the LT group (P < .017). Passive
ROM of the UT group was significantly higher than
the LT group, and severity of pain in the LT group
was significantly less than in the UT group (P < .017).
The variations between pre- and posttreatment
measurements of the MRT group were compared via
Wilcoxon test, and statistically significant increases
were found for pressure sense, active ROM, passive
ROM, and muscle force (P < .05; Table 9). The UT
group showed significant increases in active and passive
ROM (P < .05; Table 9); The LT group showed a
significant posttest decrease in pain evaluation, and a
significant increase in active ROM (P < .05; Table 9).
DISCUSSION
This study compared existing ultrasound and LTs
with a new MTR in the physiotherapy of burns. Pre-
and posttreatment data were evaluated via intra-
group and intergroup comparisons.
Pre- and posttreatment data were compared on
terms of pain, pressure sense, discriminative sense,
ROM, muscle force, and skin elasticity, and sig-
nificant differences were found for pain, pressure
sense, and passive ROM. Intergroup comparisons
(MRT–UT; MRT–LT; and UT–LT) were made
of these three significant parameters. Passive ROM
in the MRT and UT groups increased significantly
more than the LT group. However, no significant
differences were observed between the changes in
the MRT and UT groups. These results indicate
that MRT and UT modalities have a similar effect
on passive ROM. Similarly, there was a significant
posttreatment increase in active and passive ROM in
the MRT and UT groups; however, the LT group
only showed a significant increase in terms of ROM.
Loss of motion is one of the most common com-
plaints after scar and contracture development in
 Journal of Burn Care & Research
e294   Sarı et al September/October 2013

Table 5. Sex, severity of burn, and grafting distributions of the cases

Sex Degree of burn Grafting

Female Male 2 3 Yes No

MRT group 4 10 2 12 13 1
UT group 4 10 7 7 11 3
LT group 2 9 3 8 6 5

MRT, matrix rhythm treatment; LT, laser treatment; UT, ultrasound treatment.

burn patients.13 A previous study examined changes
in ROM in burn patients during physiotherapy, com-
paring the effects of different exercise approaches
rather than different treatment modalities.12 That
study found that scar contractures were less likely
to develop in the group that performed exercises
simultaneously with electric stimulation, followed by
stretching exercises, compared with patients follow-
ing a standard physiotherapy program.12 However,
in the present study, all the treatment groups per-
formed the same exercise program, to determine the
effectiveness of different treatment modalities. The
increase in the passive ROM in the MRT group may
result from the microstretching characteristic of the
treatment on the scar tissue.14 There is insufficient
evidence of the clinical effectiveness of therapeutic
ultrasound, which is used for the treatment of pain
and musculoskeletal injuries, to support soft-tissue
healing. In another study of therapeutic ultrasound
on ROM and pain in burn patients, no significant
difference was found between placebo and therapeu-
tic ultrasound.13 However, in the present study, the
increase in movement in the UT group compared
with the LT group was thought to result from one of
the nonthermal effects of the ultrasound, namely its
mechanical characteristic;8 this may result from the
finding that it increases skin elasticity on soft tissue.
On examination of the distributions of other
parameters of pain and sense evaluations between
which a significant difference was observed, the
increase in the monofilament values evaluating the
pressure sense in the MRT group before and after the
treatment was found to be higher than the LT group.
The change between pre- and posttreatment pressure
sense was significantly greater in the MRT group than
in the LT group. The significant increase in the senses
of the MRT group was determined to be parallel to
the abovementioned result. Sensory impairment is a
common result of burn injuries.15 Previous studies
suggested an increase in the thresholds of pressure
and two-point discrimination senses in the unburned
extremity by considering it as the control region.16–19
Malenfant et al16 reported that the decrease in the
threshold may result from peripheral mechanisms,
as the loss of senses in the burned region affects
the nerve endings of the scar tissue; the nerve fibers
are damaged; and as the nerve fiber healing is not
completed in the burned region. No previous study
has examined the effects of physiotherapy modalities
on sensory functions. The present study determined
that the MRT has a positive effect on restoring sensory
function. This may result from the suggestion that
MRT rebalances the cellular microprocesses upon
which cell regeneration and cellular healing depend.14
However, further studies should be conducted to
determine the effect of MRT on sensory functionality
in the physiotherapy in burns.
Pain is another common complaint of burn patients
undergoing physiotherapy.16 The visual analog scale
used in the present study showed that pain was signif-
icantly lower in the LT group than in the UT group
at the end of a 15-session treatment program. This

Table 6. Pretreatment evaluation

MRT group UT group LT group χ2 P

Age (yr) 44.21 ± 10.56 35.07 ± 14.00 32.00 ± 12.93 5.407 .067

Pain 4.77 ± 2.22 3.07 ± 3.05 2.67 ± 1.69 5.926 .052
Pressure sense 4.89 ± 7.42 2.28 ± 7.94 11.95 ± 32.37 5.097 .780
Discrimination 10.44 ± 2.84 9.84 ± 3.06 9.20 ± 3.83 2.492 .288
Active ROM 53.49 ± 29.80 49.63 ± 13.42 48.27 ± 14.92 0.144 .931
Passive ROM 71.78 ± 24.57 65.15 ± 8.87 69.93 ± 18.50 1.771 .413
Muscle strength 67.76 ± 25.15 82.50 ± 31.19 83.77 ± 27.00 2.447 .294
Skin elasticity 17.50 ± 6.56 23.09 ± 7.88 18.77 ± 7.02 3.733 .155

MRT, matrix rhythm treatment; LT, laser treatment; UT, ultrasound treatment.
Journal of Burn Care & Research
Volume 34, Number 5 Sarı et al   e295

Table 7. Pre- and posttreatment comparison of patient groups

MRT group UT group LT group χ2 P

Pain −1.53 ± 2.62 0.26 ± 1.40 −1.75 ± 2.48 8.279 .016*

Pressure sense −3.46 ± 6.08 0.08 ± 0.33 3.34 ± 7.37 8.909 .012*
Discrimination −0.02 ± 1.42 −0.32 ± 3.08 −1.32 ± 1.98 2.812 .245
Active ROM 13.18 ± 9.45 11.79 ± 11.34 10.65 ± 9.11 0.195 .907
Passive ROM 12.84 ± 8.62 8.75 ± 6.34 1.25 ± 3.10 13.820 .001*
Muscle strength 10.02 ± 16.98 4.12 ± 23.41 27.54 ± 49.71 0.965 .617
Skin elasticity −0.99 ± 4.08 1.52 ± 5.74 −0.48 ± 3.51 1.527 .466

MRT, matrix rhythm treatment; LT, laser treatment; UT, ultrasound treatment.
*P <.05.

may result from the previous finding that LT reduces CONCLUSION

pain.20 Similarly, Baxter21 suggested that laser applica-
tion stimulates serotonin and serum glucocorticoids The results for the three treatment modalities indi-
in reducing pain, and stimulates fibroblastic activity. cate that the matrix rhythm therapy was more effec-
tive in restoring sensory function compared with
The results for muscle force show a significant
the LT, whereas LT was more effective in reducing
increase only in the MRT group. This suggests that
pain compared to the UT. No significant difference
MRT is more effective in restoring muscular strength
was found between the three treatment modalities
compared with other treatment modalities.
in terms of skin elasticity after the short 15-session
The durometer data showed that different treat-
treatment program.
ment modalities had no significant effect on skin
It is suggested that further studies should be con-
elasticity. This is probably because the healing pro-
ducted with more cases to examine the long-term
cess of the scar tissue includes the occurrence of the
effects of treatment modalities.
scar tissue itself, not its elasticity.
The most important limitation of our study was
the lack of a control group. We could not discuss the ACKNOWLEDGMENTS
findings of the three treatment groups with a control
All authors in this study do not have any financial and
group. Another limitation of the study is the lim-
personal relationships with other people or organizations
ited number of cases participating in each treatment that could inappropriately influence their work. There is
group. A further limitation is that the effects of the no role of study sponsors, in the study design, in the col-
treatment modalities are compared only in 15-ses- lection, analysis and interpretation of data; in the writing
sion applications, and that their long-term effects are of the manuscript; and in the decision to submit the manu-
still unknown. script for publication.

Table 8. Dual comparison of treatment groups via Bonferroni correction

MRT group UT group Z P

Pain −1.53 ± 2.62 0.26 ± 1.40 −2.239 .025

Pressure sense −3.46 ± 6.08 0.08 ± 0.33 −2.115 .034
Passive ROM 12.84 ± 8.62 8.75 ± 6.34 −1.241 .215

MRT group LT group Z P

Pain −1.53 ± 2.62 −1.75 ± 2.48 −0.274 .784

Pressure sense −3.46 ± 6.08 3.34 ± 7.37 −2.739 .006*
Passive ROM 12.84 ± 8.62 1.25 ± 3.10 −3.260 .001*

UT group LT group Z P

Pain 0.26 ± 1.40 −1.75 ± 2.48 −2.732 .006*

Pressure sense 0.08 ± 0.33 3.34 ± 7.37 −1.123 .261
Passive ROM 8.75 ± 6.34 1.25 ± 3.10 −3.040 .002*

MRT, matrix rhythm treatment; LT, laser treatment; UT, ultrasound treatment.
*P < .05
 Journal of Burn Care & Research
e296   Sarı et al September/October 2013

Table 9. Intragroup comparison of pre- and posttreatment evaluations

S Pretreatment Posttreatment Z P

MRT Group
 Pain 4.77 ± 2.22 3.24 ± 3.10 −1.855 0.064
  Pressure sense 4.89 ± 7.42 1.43 ± 2.63 −2.589 0.010*
 Discrimination 10.46 ± 2.84 10.44 ± 2.20 −0.140 0.889
  Active ROM 53.49 ± 29.80 66.68 ± 29.43 −3.181 0.001*
  Passive ROM 71.28 ± 24.57 84.13 ± 24 −3.059 0.002*
  Muscle strength 67.76 ± 25.15 77.78 ± 22.54 −2.040 0.041*
  Skin elasticity 17.50 ± 6.56 16.51 ± 3.88 −0.722 0.470
UT Group
 Pain 3.07 ± 3.05 3.34 ± 3.09 −1.130 0.258
  Pressure sense 2.28 ± 7.94 2.36 ± 8.23 −0.280 0.780
 Discrimination 9.84 ± 3.06 9.51 ± 2.61 −1.413 0.158
  Active ROM 49.63 ± 13.42 61.42 ± 11.11 −2.794 0.005*
  Passive ROM 65.15 ± 8.87 73.90 ± 10.50 −3.171 0.002*
  Muscle strength 82.50 ± 31.19 86.62 ± 27.42 −0.471 0.638
  Skin elasticity 23.09 ± 7.88 24.61 ± 6.11 −0.848 0.396
LT Group
 Pain 2.67 ± 1.69 0.91 ± 1.30 −2.092 0.036*
  Pressure sense 11.95 ± 32.37 15.30 ± 37.73 −1.428 0.153
 Discrimination 9.20 ± 3.83 7.88 ± 2.76 −1.956 0.050
  Active ROM 48.27 ± 14.92 58.92 ± 19.48 −2.667 0.008*
  Passive ROM 69.63 ± 18.50 70.89 ± 16.37 −1.070 0.285
  Muscle strength 83.77 ± 27 111.31 ± 61.74 −1.784 0.074
  Skin elasticity 18.77 ± 7.02 18.29 ± 8.59 −0.623 0.533

MRT, matrix rhythm treatment; LT, laser treatment; UT, ultrasound treatment.
*P<0.05

REFERENCES in Space Medicine into Health Care Practice and Indusrty”

1. Goel A, Shrivastava P. Post-burn scars and scar contractures.
Indian J Plast Surg 2010;43(Suppl):S63–71.
2. Esselman PC, Thombs BD, Magyar-Russell G, Fauerbach
JA. Burn rehabilitation: state of the science. Am J Phys Med
Rehabil 2006;85:383–413.
3. Richard R, Baryza MJ, Carr JA, et al. Burn rehabilitation
and research: proceedings of a consensus summit. J Burn
Care Res 2009;30:543–73.
4. Giuliani CA, Perry GA. Factors to consider in the rehabilita-
tion aspect of burn care. Phys Ther 1985;65:619–23.
5. Dyster-Aas J, Kildal M, Willebrand M. Return to work and
health-related quality of life after burn injury. J Rehabil Med
2007;39:49–55.
6. Serghiou M, Cowan A, Whitehead C. Rehabilitation after a
burn injury. Clin Plast Surg 2009;36:675–86.
7. Parry I, Walker K, Niszczak J, Palmieri T, Greenhalgh D.
Methods and tools used for the measurement of burn scar
contracture. J Burn Care Res 2010;31:888–903.
8. Demir H, Menku P, Kirnap M, Calis M, Ikizceli I. Compari-
son of the effects of laser, ultrasound, and combined laser +
ultrasound treatments in experimental tendon healing. La-
sers Surg Med 2004;35:84–9.
9. Posten W, Wrone DA, Dover JS, Arndt KA, Silapunt S, Alam
M. Low-level laser therapy for wound healing: mechanism
and efficacy. Dermatol Surg 2005;31:334–40.
10. Demir H, Balay H, Kirnap M. A comparative study of
the effects of electrical stimulation and laser treatment on
experimental wound healing in rats. J Rehabil Res Dev
2004;41:147–54.
11. Randoll UG, Hennig FF. Coherent rhythms (timing
frequencies) in biologicial systems as a basis for the Matrix-
Rhythm-Therapy. 2nd European Congress “Achievements
Berlin, Germany; March 27–29, 2003.
12. Okhovatian F, Zoubine N. A comparison between two burn
rehabilitation protocols. Burns 2007;33:429–34.
13. Ward RS, Hayes-Lundy C, Reddy R, Brockway C, Mills
P, Saffle JR. Evaluation of topical therapeutic ultrasound
to improve response to physical therapy and lessen scar
contracture after burn injury. J Burn Care Rehabil 1994;
15:74–9.
14. Dr. Ulrich Randoll, MD. Available from http://www.ma-
trix-center.de/matrix_therapie.htm; Internet; accessed 29
Mar. 2012.
15. Hamed K, Giles N, Anderson J, et al. Changes in cutaneous
innervation in patients with chronic pain after burns. Burns
2011;37:631–7.
16.
Malenfant A, Forget R, Amsel R, Papillon J, Frigon JY,
Choinière M. Tactile, thermal and pain sensibility in burned
patients with and without chronic pain and paresthesia prob-
lems. Pain 1998;77:241–51.
17. Hermanson A, Jonsson CE, Lindblom U. Sensibility after
burn injury. Clin Physiol 1986;6:507–21.
18. Ward RS, Saffle JR, Schnebly WA, Hayes-Lundy C, Reddy
R. Sensory loss over grafted areas in patients with burns.
J Burn Care Rehabil 1989;10:536–8.
19. Ward RS, Tuckett RP. Quantitative threshold changes in cu-
taneous sensation of patients with burns. J Burn Care Reha-
bil 1991;12:569–75.
20. Fariba E, Seyyed KS, Morteza G, Ozra EN, Bina E. Effects
of low-level laser treatment in combination with sphysio-
therapy in the management of rotator cuff tendinitis. Lasers
Med Sci 2012;27:951–8.
21. Baxter GD. Low-intensity laser therapy for pain relief. In: Bax-
ter GD, editor. Therapeutic lasers: theory and practice, 4th
edn. London, UK: Churchill Livingstone; 2004. p. 150–87.