What Is Torture?
Torture is described as the intentional or systematic imposition of physical or mental pain on another person in order to compel information, punish them, or destroy their identity. The goal of physiotherapy for torture survivors is to cure or lessen pain, repair musculoskeletal dysfunctions, teach the client how to cope with suffering, and reclaim body awareness.
What Types of Tortures and Abuses Are Encountered by the Victims?
Torture is a sort of harsh, deliberate violence done on a person who is aware of it but has no control over its form or length. It could be physical, psychological, or both. Deprivation, which might be necessary necessities or specific things that affect their mental competence, coercion, communication, drug abuse, and sexual torture are some of the techniques used.
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Deprivation: The victim may be denied basic requirements or things that negatively impact their mental health.Perceptual deprivation, sensory deprivation, and social deprivation are some of the factors that affect mental health.
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Sexual Torture: Victims are frequently bound, suspended, or locked in agonizing postures. There are three sorts of sexual torture: torture by other humans, animals taught to inflict sexual cruelty, and instruments and weapons used to strike sexual organs.
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Physical Torture: This can involve pharmaceutical torture, dental abuse, systematic beatings, amputation, burning, suffocation, suspension, and other forms of physical torture.
Other forms of torture are severe forms of cruel and humiliating verbal abuse, prolonged isolation, blindfolding, forced abduction from home, beatings with hands or blunt weapons (non-systematic and systematic), sleep deprivation, burning (with cigarette), electric shock torture, mock execution, waterboarding, food or water deprivation, and being forced to listen to others being tortured. Some of the effects of torture that require physiotherapy include joint mobility restriction, bursitis, general body pain/aches, tendonitis, sequelae of breaking bones, tearing ligaments, pain due to postural defects, lingering pain at the site of injury, backache, shoulder pain, neck pain, and post-surgery pain.
What Factors Are Important for Good Interaction in Physiotherapy Treatment With Persons Who Have Undergone Torture?
The elements that influence a positive interaction can be divided into two categories: Requirements for a positive interaction and interaction factors. Personal traits, professional and therapeutic skills and support, linguistic considerations, time, and frameworks were discovered to be five conditions for a productive relationship with those who have been tortured. Cultural elements, treatments customized to the patient's needs, the ability to create confidence and trust, religious influences, and the capability to handle unpleasant emotions were all key factors in the interaction situation. All of these issues must be examined in order to improve the connection between physiotherapists and torture survivors.
What Is Trauma-Informed Care For Tortured Patients?
Because torture survivors have such complex requirements, a multidisciplinary approach to rehabilitation guarantees that they are treated holistically, and interventions offered in individual or group settings in conjunction with other disciplines, particularly counseling, are beneficial. Combination multidisciplinary sessions can be offered when appropriate to enable shared aims and improve the biopsychosocial response to the disorders being treated.
Sometimes patients' torture history may or may not be aware, given the high prevalence of torture among refugees and the numerous reasons why they may be hesitant to reveal owing to fear of humiliation or lack of confidence. As a result, regardless of known torture status, it is advised to employ a trauma-informed approach with all patients. Trauma-informed care (TIC) is also beneficial for people who have experienced trauma that is not torture, such as sexual assault, domestic abuse, and so on.
Recognize the various ways in which a traumatic event can impact all areas of care, from communication to clinical reasoning, by applying the concepts of trauma-informed care to your treatment strategy.
The following are the fundamental principles of TIC:
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Create a secure, connected, respected, knowledgeable, empowered, and hopeful recovery environment for the client.
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Apply trauma understanding and recovery pathways to practices, policies, and procedures.
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Recognize and find out the signs and symptoms of trauma in staff, clients, families, and other stakeholders.
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Work purposefully with individuals, families, friends, and other social service providers to encourage and defend the client's autonomy.
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Understand the notion of re-traumatization and apply what you have learned in terms of practices, rules, and procedures to your services.
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Use rules, methods, and practices that are culturally sensitive and non-discriminatory.
What Are the Common Complaints and Findings in Abused and Tortured Patients?
They include:
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Muscular soreness, particularly at night and in the morning, muscle weakness, joint pain, and poor posture.
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Paraplegia, quadriplegia, and amputation.
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Nerve damage, such as radial nerve palsy, can occur when patients are bound by ropes around the mid-third of their upper limbs.
What Is the Role of Physiotherapy for Abused and Tortured Patients?
Physiotherapy is crucial to survivors' recovery because of the physical consequences of trauma and abuse. Physiotherapists should utilize a biopsychosocial Approach with torture survivors because of the intricate interplay between psychological, bodily, and social aspects. Torture survivors struggle to cope with daily tasks while dealing with the injuries incurred due to the physical attacks and the unpleasant physical signs of trauma. Physiotherapy's overall purpose is to help individuals manage their symptoms so that they can enhance their functional abilities.
The following are the main rehabilitation objectives:
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Treat the immediate consequences of physical abuse or torture.
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Treat the body's physical repercussions of trauma.
The principal effects on their health, as a result, can be summarized as follows:
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Improved functional ability.
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Decreased pain levels.
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Improved management of specific conditions, for example, incontinence, stress, and sleep.
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Improved social participation and functioning.
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Improved coping and outlook.
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Improved body awareness and self-regulation.
What Are the Techniques Physiotherapists Use to Treat Tortured Patients?
Clinical intake data on mobility, pain, function, and special attention to minimize flashbacks during and after intake should be prioritized and ideally completed and informed by other members of the care team, with an emphasis on gender and age concerns.
Some signs that may indicate a therapeutic emphasis include:
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Acute and chronic pain.
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Reduced posture, body awareness, self-regulation, and proprioception.
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Reduced strength.
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Reduced range of motion (ROM).
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Reduced mobility.
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Decreased ability to perform desired activities.
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Specific types of torture affect the neuro-muscular skeletal system.
The physiotherapist must exercise special caution in identifying weaknesses and establishing trust and safety with the patient. In addition to regaining and accompanying functional regain, the recovery of body image, with all of its limitations and possibilities, must be pursued progressively and spread out over the course of treatment. Good group practices, such as focusing on shared thematics like bodily awareness, pain perception, and even the relationship between awareness, body, and lived trauma, should begin to re-connect.
The following are examples of well-known procedures and strategies that have demonstrated their effectiveness and patient satisfaction:
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Recovery of sensory awareness with basic body awareness therapy.
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In the event that a nerve sensation is lost, sensory re-education is used.
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Techniques for relaxation with a focus on respiratory modalities.
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Massage can be used to relax or relieve stress.
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Mobilizations of the motor system, both passive and active, with a focus on connective and soft tissue.
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Reconditioning exercise with a focus on everyday living tasks and an increase in gait perimeter.
Additional treatments and modalities, such as the use of physical agents (heat, cold, vibrations, electrical currents stimulation) for pain relief and relaxation, can be tried with extreme caution in case this causes discomfort due to previous trauma-related experiences. As long as there is no resistance and withdrawal from the patient’s perception or compliance, the use of assistive devices to promote motor stability, pain treatment, or facilitate hindered movements might be offered. Ascertain that these are worn to sustain function rather than to compensate for acquired amyotrophy induced by excessive wear.
Why Is Follow-up Care Important for Survivors of Torture?
While much attention is focused on intake and treatment for torture survivors, it is equally important to give shape to how and when the care process should end or shift towards a status where intensity, frequency, modality, and relevance of treatment should be adapted or ended throughout the care process. They should be able to repeat the abilities and attitudes acquired throughout treatment and transfer them into a method of improved resilience for future participation. Close relatives in the patient's immediate environment should also be included in this process, either by being educated about the patient's background or by providing support. Physiotherapists can train and equip patients with skills like self-care, relaxation, breathing exercises, mobility, and exercise that they can repeat in their own homes.
Conclusion:
Survivors of abuse and torture have a high risk of physical and psychiatric illness, and some people usually flee to another country, where they live in densely packed refugee camps. Doctors rarely find torture histories. Survivors of torture and abuse may be hesitant to speak up because they are unaware that therapy for their physical, psychological, and pain illnesses is accessible. The diagnosis and treatment of torture sequelae are often delayed due to a lack of detection. So it is important to create awareness and guide them to consult a physiotherapist and receive instructions and further guidance.
