Occupational Therapy — Transfer to Burns Rehab OT for Upper Limb Contracture Prevention
An acute care occupational therapist transfers a 29-year-old man with significant bilateral upper limb burns from the acute burns unit to specialist burns rehabilitation OT. The proficient challenge is presenting the contracture risk, the current splinting regimen, and the rehabilitation goals while cutting the acute medical management that is not OT-relevant.
Letter type
Transfer
Write to
Burns Rehabilitation Occupational Therapist
Target length
210–240 words
The case notes
Patient: Mr Isaac Mbeki, 29 years old; chef; sustained deep partial-thickness and full-thickness burns to both forearms and hands in a commercial kitchen fire 3 weeks ago
Burns: Bilateral forearms and dorsal hands; approximately 14% TBSA; split-thickness skin grafts applied day 5; grafts stable; wound dressings ongoing
Splinting regimen (active): Resting hand splints bilaterally: wrists in 30° extension, MCPs in 70-80° flexion, IPs in full extension, thumbs in palmar abduction — anti-contracture position; worn 23 hours/day; removed for therapy only
Current therapy: Passive range of motion maintained by OT and physiotherapy; beginning active-assisted finger flexion exercises (2 sessions daily); wrist range: 0–25° active extension bilaterally
Priority concerns: Dorsal hand grafts at highest risk of MCP extension contracture; thumb web space contracture risk (bilateral); functional hand use for grip requires active MCP flexion 60° minimum
ADL status: Dependent in all personal care and meal preparation; psychologically struggling with impact on career (chef); referred to liaison psychology
Equipment: Custom thermoplastic splints fitted and documented; splint wearing regimen included with this transfer
Goal: Maintain joint range for functional grip; progress to 60° MCP flexion bilaterally within 6 weeks; prepare for return to cooking activities as a long-term goal
Task: Write a transfer letter to the burns rehabilitation OT, Ms Niamh Hogan, providing the clinical information needed to continue the contracture prevention programme.
Writing task
Write a transfer letter to the burns rehabilitation OT, Ms Niamh Hogan, providing the clinical information needed to continue the contracture prevention programme.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
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The anti-contracture splinting position and the 23-hour wearing regimen
Splint discontinuity is the primary contracture risk at transfer. The receiving therapist must know the exact anti-contracture position to replicate the splint or adjust it safely. The wearing regimen — 23 hours/day, removed for therapy only — must continue without interruption.
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The current active extension range (0–25° bilaterally) and the 60° MCP flexion goal
The rehabilitation programme starts from this baseline and advances toward the functional grip goal. Without both numbers, the receiving OT cannot calibrate progression.
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The priority risk: dorsal hand grafts at highest risk of MCP extension contracture and thumb web space contracture
This tells the receiving OT where to concentrate monitoring and intervention. All burns have contracture risk; this letter identifies the specific high-risk sites for this patient.
Leave out
-
The acute burns medical management: fluid resuscitation, systemic infection management, anaesthesia
The medical team has transferred this to the burns rehabilitation unit. The OT transfer letter covers the splinting and functional rehabilitation programme — not the acute medical history.
-
The psychology referral detail
A separate care stream. One clause: 'referred to liaison psychology given the impact on his career identity.' The receiving OT is informed; they do not manage the psychological treatment.
Criterion in focus · Content
Burns OT transfer letters are graded on whether the anti-contracture programme can continue without interruption. The three non-negotiables: (1) the splint position in joint angles, (2) the wearing regimen, (3) the specific contracture risk sites. A letter that describes the burns without the splint position, or gives the wearing regimen without the anti-contracture angles, fails Content — the receiving therapist cannot safely continue from an incomplete handover.
Now write the letter — and find out what is blocking your Grade B
Write a 210–240 words transfer letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.