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. It has the following objectives: To treat and rehabilitate any persons who have subjected to torture of any form, to receive voluntary contributions for distribution to aid those who have been tortured, to collect documents and research on torture, to finance training for specialists to treat victims, to campaign against mental or physical torture, to educate and give advice to survivors, to educate communities on human rights, and to cooperate with and support other agencies with similar objectives. In this article, suggestions for physical therapy examination and treatment are provided.
Torture
“Extreme, deliberate form of violence inflicted upon an individual who experiences it consciously but has no control over its form and duration.” Can be physical, psychological, or a combination. Techniques include: Deprivation (can be essential needs or certain things that affect his/her mental capability), coercion, communication, drug abuse, and sexual torture.
  • Deprivation: Victim may be denied essential needs or certain things that affect mental health. Those affecting mental health may include perceptual deprivation, sensory deprivation, or social deprivation.
  • Sexual Torture: Victims often tied, suspended, or fixed in positions that are painful. Three types exist: sexual torture by other human beings, animals introduced trained to inflict sexual violence, or tools and weapons to hit the sexual organs.
  • Physical torture may include: pharmacological torture, dental torture, systematic beating, amputation, burning, suffocation, suspension, etc.
Common Complaints and Findings
  • Muscle pain, especially at night and in the morning, muscle weakness, joint pain, poor posture
  • Amputation, paraplegia/quadriplegia
  • Nerve injuries: radial nerve palsy with victims who are tied by ropes around mid 1/3 of upper limbs
International Findings
  • Out of 86 victims, 22 neurological problems
  • Out of 54, 16 sexual/genital problems
  • Out of 92, 92 have musculoskeletal problems
Physiotherapy
  • Physical treatment including exercise, massage, electrotherapy machines, hydrotherapy, postural drainage, etc
  • Therapist should follow treatment principles: establish trust, show respect, avoid situation that may remind victim of traumatic events, and explain everything thoroughly and do not force treatment onto patient
  • Common appliances provided for Rehab:
    • Leg length discrepancy: orthotic device to raise shoe
    • Nerve injury involving wrist drop or foot drop: splints or calipers
    • Back Injuries: Corsets or soft/firm cervical collar
    • Paraplegic: Wheelchair
    • Walking aids: axillary crutch, elbow crutch, walking sticks, walking flames, parallel bars, etc
Amputations and Prosthetics
  • Amputation level (7 listed) will dictate prosthesis prescribed
  • Prosthesis Alignment: static (bench alignment), dynamic alignment
  • Rehabilitation: type of exercises will depend on strength gauged from manual muscle testing, passive range of motion given to those who lack strength, muscle stimulator may be used, mobilizations used for joint stiffness, manual postural correction in front of a mirror, bandages are given to properly fit prosthesis, and lastly education is given on how to use prosthesis and crutch walking.

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