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. Examination and treatment methods for treating various sequelae from torture are described in detail. 
 
Treatment Methods-
  • Hands-on:  effleurage myofascial release, specific mobilizing of joints in the spine or extremities, and Proprioceptive Neuromuscular Facilitation (PNF)
  • General physical training and Body Awareness Therapy (BAT):  pasture/balance, proprioceptive training, and sensory/motor skills by means of rhythmic and coordination exercises.
  • Medical Training Therapy:  neuromuscular training (stabilization, coordination, and postural balance), joint mobility, and circulation-enhancing exercises
  • Training to improve the general physical condition:  walking on a treadmill, bicycle ergometer, row machine, etc.
  • Relaxation:  autogenic training (patient learns to evoke an experience of heaviness and a feeling of warmth and calm) and progressive relaxation (patient tightens and relaxes groups of muscles in a defined order until complete relaxation of the whole body is obtained.
  • Self-management of neurogenic pain:  TENS (transcutaneous nerve stimulation) can be used with relieve pain if the patients are given sufficient oral and written information and instruction in the self-treatment with TENS
  • Hydrotherapy:  warm water has a pain-relieving effect and the water makes movement easier and allows freer movements.
  • Individual aid devices and ergonomic guidelines:  the PT can help pt apply for aids such as:  lumbar elastic corsets, shoes with supporting heels and shock absorbing soles, shock absorbing foot orthoses, and beds/mattresses.
Special Treatment Methods -
  • Falanga sequelae
    • Manual treatment of the feet and lower legs, mobilizing exercises of ankle and small joint of feet, stretching lower legs and feet, exercises to enhance circulation, balance training, gait training, guidance in TENS
  • Suspension sequelae
    • Manual treatment of neck/shoulder girdle/upper limbs, stabilizing exercises of the scapula, coordination exercise of the scapula/shoulder joint/upper limb, stretching and strengthening of muscles, exercises to enhance circulation, guidance in TENS
Examination - history, general objective findings, shoulder examination after suspension, and examination after falanga torture
Assessment of physical capacity - Disability Rating Index (DRI), disability rating by the physiotherapist, balance test, ergometric bicycle test, walking distance on a treadmill
Assessment of pain - Visual Analog Scale (VAS)

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