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. Detailed recommendations for evaluation and treatment of torture survivors, as well as precautions to be used when working with survivors, are included in this article. 
PT Examination:
  • Task of the physiotherapist is to correct physical dysfunctions the patient is experiencing and to decrease pain. When engaged with the patient the physical therapist needs to be calm, confident, open, provide empathy, and be engaged with the patient. Additionally the therapist needs to explain what treatment involves and keep in mind that patient expectation of treatment is generally very high so the therapist needs to provide realistic expectations and goals as well as open the patient’s eyes to even the smallest amount of progress to help avoid patient frustration and hopelessness (page 9)
  • At the first meeting the patient should indicate on a body map where their pain is as well as their pain characteristics (Visual Analog Scale) in each mapped area. The patient may experience several types of pain including severe burning and tingling all over the body to feeling as if their limb(s) is (are) no longer part of their body. On torture survivors pain is generally the most intense in the head, shoulders, hands and feet (page 9-10)
  1. Precautions (Page 10-11):
  • Patient should be in a private room containing no electric appliances. Rooms should include soft lighting, plants, and picture on the walls
  • Therapists need to keep in mind that many of the survivors were naked and often humiliated as they were forced to undress in front of their torturers and fellow prisoners and is therefore advised to limit undressing and exposure of the body
  1. Touching and body contact (page 11):
  • A gentle and reassuring touch should be used when touching the patient is necessary
  • Fast provoking movements should be avoided and a quiet rhythm massage is encouraged
  • Negative reactions to touch are often the look of emptiness in the patient’s eyes, absent mindedness, suppressing their normal reactions, rapid pulse, increased/decreased respiration, perspiration, and shaking. Therefore, therapist attention to patient reaction is crucial
  1. Analysis of gait and movement:
  • Many survivors have experienced Falanga (type of beating to the bottom of the feet). In order to avoid pain their gait is often compensated to the inside/outside of their feet and results in reduced walking distance. Balance and standing are generally effected as well and often need of form of external support (page 11)
  1. Breathing:
  • Breathing often is limited due to blows to the chest and thoracic spine resulting in musculoskeletal issues of the thoracic spine and ribcage (page 12)
  1. Resource-oriented assessment of the body (page 12-13):
  • During evaluation of the patient, the client’s reaction pattern should be observed because depression, fear, anger, sorrow, guilt and shame is common finding in survivors and can influence physiological and musculoskeletal function
  • Assess physical findings as a whole and be aware of patient emotions/reaction can affect physical findings
  • Monitor patient response to change
Treatment methods (page 13-15):
  • Show confidence in your treatment
  • Patient may open up inner feelings with therapist in which a neutral professional approach by the therapist needs to be employed. Processing of this information is outside the realm of the physical therapist
  • Be aware the patient may become attached and dependent on the therapist
  1. Massage
  • Massage and other soft tissue techniques are often effective due to common complaints of muscular pain in survivors
  1. Joint mobilization and stabilization:
  • Commonly used to improve faulty joint mechanics
  1. Other treatments to be considered:
  • Balance and coordination training
  • Body awareness training
  • Training in warm water to help relax patient’s neuromuscular system
  • Ergonomic guidance
  • Aid device training and guidance
  • Electric apparatus – caution needs to be taken and patient reaction and instruction is highly advised. Postpone until patient trust and confidence has been established
 

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