Physical therapy treatment

Some resources below, such as the second and third parts of the Traumatic Head Injury (THI) webinar series, are included because while they do not directly describe physiotherapy, they are very relevant to PT practice.

Torture survivors introduction to physiotherapy: Torture and sequelae after torture

Prip, K & Amris, K. (2003), Rehabilitation and Research Centre for Torture Victims, 45 pages.
 
This booklet was reviewed by Brittany Burton, doctoral physical therapy student at the University of Minnesota, 2014.
 
Link is to the article from the Dignity-Danish Institute Against Torture library. 
 
Introduction: Explanation of what the Rehabilitation and Research Centre for Torture Victims (RCT) is and the objectives of this organization which is based in Denmark.

Building Clients’ Trust Through Physiotherapy

Since I joined CVT in 2015, I have had the opportunity to see healing and change happen. I see torture survivors who come into the program afraid, with limited mobility and an inability to talk about what has happened to them. But by the end of the ten-week cycle, I see them talking, helping each other and increasing their movements – I believe that building trust is one of the most important things that leads to healing....

Chronic Pain and PTSD: The Perpetual Avoidance Model and its Treatment Implications

This article examines the interplay between chronic pain and PTSD and treatment implications. Various risk factors, models and treatment recommendations are explored. The authors conclude that the treatment for traumatized patients suffering from PTSD and chronic pain should include a biopsychosocial approach, combining education about the maladaptive behaviors leading to disability, as well as exposure therapy, relaxation, biofeedback, and therapeutic exercise.

Complementary therapies for treating survivors of torture

Vargas, C., O’Rourke, D. & Esfandian, M. Refuge: Canada’s Periodical on Refugees, 22(1), 129-137.
 
This article was reviewed by doctoral physical therapy student from the University of Minnesota, Angela Pitar, 2014.
 
Link to full text article from the Dignity-Danish Institute Against Torture is below.
 
Background - the assumptions that physical pain, unexplained by medical or physical findings, is psychosomatic in nature has been long standing and pervasive as was pain reported by survivors of torture attributed to psychological trauma.

Creating a Safe Space for the LGBTI Community in Nairobi

At CVT Nairobi, our counseling staff has been helping LGBTI clients with mental health care for several years. Most recently, we integrated physiotherapy after clients were raising concerns about the well-being of their physical health. From the counseling group cycle, a 10-week physiotherapy cycle was developed, focused on a safe space for LGBTI clients to address functional issues such as chronic back pain, musculoskeletal disorders and pelvic floor disorders.

Finding the Most Effective Ways to Help Children Affected by War

At CVT Jordan, one of the most powerful and successful things that we are doing on the physiotherapy team is the children’s group sessions. During my three and a half years as a physiotherapist at CVT, I have come to understand how important it is to include the parents in their children’s healing journey. In order to get the best results, at CVT we have modified our approach as we’ve learned from the children and their parents.

Helping Physiotherapists Examine the Ways Torture Survivors Think About Pain

Pain is one of the many problems to be addressed in survivors of torture. And in my work as a physiotherapist trainer at CVT, every day I attend to clients with chronic pain as a result of torture.

I recently had the privilege of presenting at the International Conference of Physical Therapy in Psychiatry and Mental Health in Madrid. Along with Julie Phillips, from the Department of Physiotherapy at University of the Western Cape, South Africa, I presented on the “Cross Cultural Adaptation and Validation of the Pain Catastrophizing Scale (PCS) among Victims of Torture.” The role of catastrophization in the development of chronic pain has gained a considerable amount of attention in research over the past few decades, so our topic was quite timely.

Helping Torture Survivors with Fear as Well as Pain

When I work with survivors of torture, I keep in mind that they are not only dealing with pain and problems with mobility or functioning. They are also dealing with memories and fear. As a physiotherapist, I understand that a survivor who is unable to move in specific ways may be avoiding the torture position. At CVT, I help survivors move past these fears.

Increasing Activity and Improving Function in Chronic Pain Management

Chronic pain is a condition of complexity that requires a multi-dimensional approach. Unfortunately, not many patients who suffer from chronic pain are able to use a clinic or program that addresses chronic pain management due to their location or finances. The goal of this article is to give an overview of approaches that may be helpful to physiotherapists in their own practice relating to chronic pain.

Interaction between patient and physiotherapist in psychiatric care : The physiotherapist's perspective

Gyllensten, A., Gard, G., Hansson, L., & Ekdahl, C. (2000), Advances in Physiotherapy, 2(4), 157-167.
This article was reviewed by Charlotte Hoium, physical therapy doctoral student at the University of Minnesota, 2014.
The article may be obtained free of charge from Dignity-Danish Institute Against Torture by emailing them at library@dignityinstitute.dk and including a list of desired articles.
Purpose:  to investigate what factors the physiotherapy experts in psychiatric physiotherapy believed to be important in the interaction between the patient and the physiotherapist.

Mind and body-Physiotherapy and complementary therapy

Hough, A. (1992). Paper presented at the International Conference of Centres, Institutions and Individuals Concerned With the Care of Victims of Organized Violence: Health , Political Repression and Human Rights, Santiago, Chile. 
 
This article was reviewed by University of Minnesota physical therapy doctoral student, Angela Pitar, 2014. 
 
The article may be obtained free of charge by emailing library@dignityinstiture.dk
 
Background - Torture victims often present with a multitude of problems and complementary therapy seeks to address each problem using a comprehensive and

Muscular imbalance found in examination of posture in torture victims

Skylv,G. (1992). Poster presented at 2nd World Congress on Myofascial Pain and Fibromyalgia, Copenhagen, Denmark. 
 
This article was reviewed by Brittany Burton, doctoral physical therapy student at the University of Minnesota, 2014.
 
A free copy of the article may be requested from Dignity-Danish Institute Against Torture, by emailing library@dignityinstiture.dk.
 
Background: The aim of torture is not only physical but psychological as well, and globally seems to be focused on the vulnerabilities of the victim.

Pain: physiologic mechanisms used in physical therapy

 Skjoerboek, I. (1994). Torture Quarterly, Suppl. 1, 33-35.
 
This article was reviewed by Angela Pitar, doctoral physical therapy student at the University of Minnesota, 2014. 
 
The link to the article from the Dignity-Danish Institute Against Torture, is below.
 
Background - the definition of pain is an unpleasant sensory and emotional experience associated with the actual or potential tissue damage, or described by the patient in terms of such damage. Detailed descriptions of mechanisms of pain and treatment implications are made.
 
Physiology of pain - the perception of pain is

Physical Therapy for Survivors of Torture

Description

Some specialized torture treatment centers have observed benefits among their patients from physical treatment modalities such as physical therapy or massage. Primary care or other clinics treating torture survivors may also consider such interventions when addressing complaints of chronic pain and physical symptoms.  Because torture is usually directed in part toward the physical being of the victim, attention to the body can be especially therapeutic, both emotionally and physically.

Physical Therapy in Nairobi

Last November, I made my fourth trip to Nairobi to visit our CVT project. As a physical therapy advisor to our Kenya staff, I serve as a consultant, supervisor and colleague to Jepkemoi Kibet, our physical therapist/trainer in Kenya. Jep, in turn, supervises and trains our local physical therapists, Stephen, Jennifer and Collins.

We have four treatment sites where we lead physical therapy sessions: at our main offices in the Westlands neighborhood we work with young women; in the Eastleigh neighborhood we work with Somali refugees; and in the Riruta and Kayole areas we see mixed groups of refugees from Rwanda, Burundi and the Congo.

Physiotherapy and rehabilitation of the common complaints and findings in torture victims

Mayanja, F. (1996). African Centre for the Treatment and Rehabilitation of Torture Victims. 26 pages. 
This booklet was reviewed by Stephanie Green, doctoral physical therapy student at the University of Minnesota, 2014. 
The booklet is available free of charge from Dignity-Danish Institute Against Torture. Please email them at library@dignityinstitute.dk to request this booklet. 
Introduction
The African Centre for the Treatment and Rehab of Torture Victims in Uganda is continuing to grow and become recognized by various institutions.

Physiotherapy as empowerment : Treating women with chronic pelvic pain

Mattsson, M., Wilkman, M., Dahlberg, L. & Mattson, B. (2000). Advances in Physiotherapy, 2(3), 125-143.
reviewed by Aaron O’Donnell, University of Minnesota doctoral physical therapy student, 2014
This article is available free of charge from Dignity-Danish Institute Against Torture. Please email them at library@dignityinstitute.dk and include a list of desired articles and your mailing address.
 
Background: A large group of CPP (chronic pelvic pain) patients are “inexplicable” from a medical point of view.

Physiotherapy examination and treatment

Jacobsen et al.
Link and reference information will be posted soon.
This article was reviewed by Mark Deschepper, physical therapy doctoral student at the University of Minnesota, 2014.
 
Introduction:
Most torture survivors complain of pain the locomotor system with many experiencing pain through all daily routines including sleep. Living with pain and performing daily tasks are significantly difficult for survivors. Physical torture leads to damage in the muscles, joints, and neurovascular system, concentration, and memory.

Physiotherapy for survivors of torture

Hough, A. (1992). Physiotherapy, 78(5), 323-328.
This article was reviewed by Mark Deschepper, doctoral physical therapy student at the University of Minnesota, 2014.
A link to the full text of the article is below.
 
Background:
Through physical contact and the trust built in the physiotherapy relationship, physiotherapy is a vital link of rebuilding the personality of torture survivors.

Physiotherapy for torture victims I: Chronic pain in torture victims: Possible mechanisms for the pain

Prip, K. & Amris, K. Torture Quarterly: Journal on Rehabilitation of Torture Victims and Prevention of Torture, 10(3), 73-76.
 
This article was reviewed by doctoral physical therapy student, Angela Pitar, from the University of Minnesota, 2014. 
 
A link to the article from the Dignity-Danish Institute Against Torture library is below.
 
Background - Throughout the years, several chronic muscular pain syndromes have been described in victims of torture with common findings of:  regional or diffuse pain in the musculoskeletal system often associated with poor sleep, tiredness,

Physiotherapy for torture victims II: Treatment of chronic pain

Amris, K. & Prip, K. (2000), Torture Quarterly: Journal on Rehabilitation of Torture Victims and Prevention of Torture, 10(4), 112-16.
 
This article was reviewed by Stephanie Greer, University of Minnesota doctoral physical therapy student.
 
The link to the article from the Dignity-Danish Institute Against Torture, follows below.
 
Background - Several studies of torture victims have shown that physical complaints are common even years after torture and that pain in relation to the musculoskeletal system is a dominating symptom.

Physiotherapy Helps Individuals and Communities

Hope is hidden within client stories, even when those stories are full of wounds. After surviving war and torture, clients’ lives have changed, and this really affects the whole family. But after clients go through the rehabilitative care cycle with CVT, I see change and hope. I see mothers helping their children after the trauma they’ve experienced. The children become comfortable with their mother again, and the mothers have told me they feel like mothers again to their children. The whole family is once again affected, but in a positive way.

Physiotherapy Outcomes at the Center for Victims of Torture-Nairobi program

Since CVT’s physiotherapy program began in Nairobi, around 260 clients have been assessed at both intake and six month follow up on the Pain and Discomfort Inventory (PDI). On all items, clients showed statistically significant improvements in levels of pain and functionality. Approximately 130 clients have been assessed at both time periods with the Disability Rating Index (DRI) and we observe statistically significant improvements in functional ability for 10 of the 12 activities.

Nearly all of the clients are also receiving, or have received psychosocial counseling services as well.

Physiotherapy to Help Survivors of Torture in Their Darkest Hours

Most people will have the experience of having a nightmare at some time. It’s not pleasant, but we deal with it. For a survivor of torture, however, a nightmare can be an extremely difficult situation. During a nightmare, the torture survivor relives his trauma. And by “relive” I mean it’s like a video he is watching of the experience. His body reflects this in his sleep. He may wake up in the same position as when he was tortured. This is one of the things I help people with in my work as a physiotherapist at CVT.

Psychosomatic group treatment helps women with chronic pelvic pain

Albert, H. (1999). Journal of Psychosomatic Obstetrics and Gynaecology, 20(4), 216-225.
 
Reviewed by Brittany Burton, doctoral physical therapy candidate from the University of Minnesota, 2014. 
 
This article is available free of charge from Dignity-Danish Institute Against Torture. Please email them at library@dignityinstitute.dk and include a list of desired articles and your mailing address.
 
Background: In this study, group treatment for women with chronic pelvic pain based on physical, psychosomatic and behavioral therapeutic principles of treatment was assessed.

Restoring Hope and Childhoods

Ahmad*, an 11-year-old Syrian boy, was having a hard time managing his anger. In Syria, he had survived a grenade attack when he was mistaken for a soldier. His family sought safety in Amman, Jordan, but life was still not peaceful. Ahmad had violent outbursts. He was aggressive and hit his siblings. He had internalized the violence from his experiences in Syria into his own young body. Increasingly, our staff in Jordan is seeing children and young people like Ahmad who need mental health and physical therapycare to cope with their traumatic experiences. Now, more than a third of our clients in Jordan are under the age of 18. Syrian adults report that the well-being and potential of their children constitute their greatest source of stress. Parents worry constantly about what their children have seen and experienced.

Sequelae in Soft Tissues after Beating, Suspension, and Fixation

Prip, K. (1994), Torture Quarterly, Suppl. 1, 28-31.
 
This article was reviewed by University of Minnesota doctoral physical therapy student Angela Pitar, 2014. 
 
The link to the full text from Dignity-Danish Institute Against Torture is below.
 
Background: Many movement impairments are found in torture survivors, since they were placed in fixed positions for prolonged periods of time.  This article discusses the effects of tissue stress/strain, the phases of injury, and different management approaches for the different phases. 
 
 
Background -
  • when tendons are loaded, all the

Survivors of torture and trauma: A special group of patients with chronic pain

Roche, P. (1992). Australian Physiotherapy, 38(2), 156-157.
This article was reviewed by a physical therapy student at the University of Minnesota. More information is to follow. 
A copy of the article may be obtained free of charge from Dignity-Danish Institute Against Torture by emailing them at library@dignityinstitute.dk and including your mailing address.
This brief letter describes where physical therapists may find more information about the special needs of torture survivors as well as common sequelae from torture and recommendations for physical therapy treatment.
 
Two major

THI Part 2 of 3: Screening for Traumatic Head Injury in a Basic Clinic Setting

Don't miss the other two parts of this webinar series!

History and Evidence of Traumatic Head Injury (THI): Basic Concepts and Principles in the Care of Torture Survivors with THI (THI Part 1 of 3)

Family and Patient Support: New Approaches to Fostering Dialogue and Hope (THI Part 3 of 3)

In the 1950's Dr. Ettinger and later in the 1980s Goldfeld and Mollica identified Traumatic Head Injury (THI)/leading to Traumatic Brain Injury (TBI) as a common and severe sequelae of trauma and other forms of external violence.

THI Part 3 of 3: Family and Patient Support: New Approaches to Fostering Dialogue and Hope

In the 1950's Dr. Ettinger and later in the 1980s Goldfeld and Mollica identified Traumatic Head Injury (THI)/leading to Traumatic Brain Injury (TBI) as a common and severe sequelae of trauma and other forms of external violence. THI/TBI is now likely recognized as the signature injury in American combat troops returning from the wars in the Middle East. Yet THI/TBI related to medical and psychiatric problems are difficult to diagnose and treat even in specialized clinics for survivors of torture and combat veterans.

Don't miss the other two parts of this webinar series!

History and Evidence

Tortured Refugees' Expectations of a Multidisciplinary Pain Rehabilitation Programme

Refugees have often been exposed to torture in their countries of origin. Rehabilitation of tortured refugees living in Denmark is offered by the specialized Rehabilitation and Research Centre for Torture Victims in Copenhagen. After an interdisciplinary assessment eligible patients are recommended rehabilitation. In this article, it is noted that there is diversity among refugees in their expectations from pain programs and that the clients expect to have dialogue with the members of their health care team about participation in recommended activities, and to question and not just to accept professional suggestions.

WCPT Congress - Focused symposium: Pain Management

Video of WCPT Congress 2011 - Focused symposium: Teaching people about pain

Speakers: Lorimer Moseley (Australia), David Butler (Australia), Michael Thacker (United Kingdom), Adriaan Louw (United States of America)

This symposium brought several world leaders in pain education together. Every physiotherapist will deal with someone in pain. Evidence demonstrates that if they understand the true biology of pain instead of an outdated understanding of pain, their outcomes will be better. Taking this symposium will enable you to gain a basic understanding of what is currently known about the biology of pain and to be familiar with principles of conceptual change theory and evidence based strategies to teach people about pain. Integration of the International Association for the Study of Pain core curriculum and modern concepts of pain biology into clinical reasoning were also addressed.