Clerkship course enables DPT students to gain empathy for, experience with victims of torture
Second-year Doctor of Physical Therapy (DPT) students participate in a semester-long Clerkship Course each Fall Semester titled, The Physical Therapist in Today’s Society. For the past 13 years, the Center for Victims of Torture (CVT) in St. Paul, MN, has been among those organizations with which they can choose to work. Those who do work with the Kenya Program Clinical Advisor for Physiotherapy Laura Pizer Gueron, PT, MPH, DPT, who has been with the Center since 1992 (she started volunteering in 1992 and was employed in 2013).
One of the important things the students learn during their work with CVT is that, with such high populations of refugees in the United States, meta-analyses indicate that up to 44 percent of them are survivors of torture, according to Gueron (pictured at left). “As physical therapists, we will, at some point, work with people who have survived torture, even if we don’t always know it,” she said. “The principles of trauma-informed physical therapy that the DPT students learn with us also apply to patients who have been exposed to gender-based violence, those with PTSD, and those who have survived natural disasters or accidents. It’s about providing care for traumatized people in ways most likely to create a supportive environment for healing.”
Gueron gives the DPT students resources to not only use for their projects with the Center but also for their future practice. “Trauma-informed care is something that is really important in
physical therapy right now and being able to learn from someone who is an expert was an experience that I will keep with me throughout my career,” said Lizzie Smith (pictured at right), a DPT student who completed her experience with CVT in the fall of 2020.
During the semester, students attend a two-hour panel discussion that includes those working with patients from various underserved communities (from an access to medical care perspective). They also complete recommended reading on their own. “We teach the students that these patients have chronic pain in many different locations that might not fit into a clear pattern,” Gueron said. “The patient might be very anxious and guarded. Or they might seem depressed. Some might not appear different from any other patient.”
Katie Larson (pictured at left), another participant, noted that the knowledge Gueron provided through stories and literature about the widespread effects of torture is critical to understanding how physical therapists can support their patients in the future. “We have a unique responsibility to help victims of torture reconcile their relationship with their bodies through movement and education,” she said.
How can physical therapists help victims of torture? “For those who have chronic pain, the physical therapist can slowly and gently guide them through breathing and movement to the point where they once again believe they can move with pleasure,” said Gueron. “It can help them get back to their favorite activities.”
Torture’s long-term impact
Getting physical therapy helps these individuals heal what might be long-term injuries. “After people have been tortured, they are often left with PTSD, depression, and anxiety,” said Gueron. “They may have chronic pain and mobility issues. There can be an assumption made that these symptoms are purely psychological. Full healing is difficult without paying attention to both the mind and the body. We have so much to offer these people – we help them reconnect with their body as a safe place.”
Larson agrees, adding, “I think that it was important for us to look into these stories to challenge our own narratives, breach our biases, and learn to help others cope with the impact of their experience more effectively. With increased awareness, I feel more confident in working with and advocating for patients who are victims of torture.”
Helping in many ways
Because of the unique needs of CVT clients, students who participate in the Clerkship experience don’t interact directly with them. They do, however, work on projects that have helped the clients and the Center. “They created an international Facebook group for physical therapists working with survivors of torture that has 230 followers from 35 countries,” Gueron explained. “They have created handouts about posture and body mechanics and developed an international survey for treatment centers to gauge their use of physical therapy. The students also created handouts for physical therapists and clients about the impact of gender-based violence and they have done article reviews for the Heal Torture website. They’ve done and learned so much.”
Smith noted that her subsection of the Clerkship group made handouts about audio-only telehealth for physiotherapists in Kenya. “The need was prompted by the ongoing COVID-19 pandemic and limited technology resources in that country,” she said.
Trauma comes in all shapes and sizes
Gueron’s experiences with the Center have informed how she works with her patients at the Gillette Children’s Specialty Healthcare clinic for teens and adults with disabilities. “I’ve come to realize that many people with cerebral palsy or spina bifida have been through numerous surgeries — that can create a lot of trauma, a feeling of invasion of their bodies,” she said. “Many of our patients have issues with anxiety, depression or PTSD. Thanks to CVT, I’ve learned how to be a physical therapist who is sensitive to mind-body connections and how grounding, mindfulness, breathing, deep pressure, heat, TENS [transcutaneous electrical nerve stimulation], and many types of exercise create a menu of treatments that can calm my patients’ nervous systems and help them have a fuller recovery.”
Increasing awareness of the challenges that accompany a victim of torture – or of any kind of trauma – is an important first step in developing the empathy needed to navigate a relationship that will make or break a rehabilitation experience, according to Larson. “It’s important that others are aware that torture isn’t only a physical or even psychological one-time experience — the effects can be longstanding and have immense consequences,” she said.
The Journal on Rehabilitation of Torture Victims and Prevention recently published an article co-written by Gueron about the work done on the international survey by the 2014 DPT Clerkship participants.