Trauma Informed Practice: A Physiotherapy Perspective

Physiotherapy and trauma informed practice

The primary elements of a trauma-informed approach
(1) Realizing the widespread impact of trauma exposure
(2) Identifying how ant type of trauma may impact patients, families, and staff
(3) Responding by applying this knowledge into practice
(4) Preventing re-traumatization of patients

What does trauma informed practice mean?

This form of practice is a mind set. It is the knowledge and realization that many our patients come to us with varying traumatic experiences. Past traumas can include physical, emotional, psychological, sexual and many others. Trauma can have a great effect on each person and may even impact a patients ability for successful rehabilitation. Trauma can impact our patients in a variety of different ways, including:
  • Cognitively
  • Emotionally
  • Physically
  • Socially
  • Academically
  • Professionally

Importance of trauma informed care?

Many of our patients will come to us with previous trauma experiences. A trauma-informed practice allows practitioners to shift their focus from a persons problem or pain to more of a holistic approach. Taking into account a patients unique situation and experiences. This lens requires physiotherapists to shift the questions from, “what happened to you?” instead of “what is wrong with you?”

This engaging and respectful approach is important for therapists working with a variety of patents. Especially when assessing and treating a person who already may feel broken, unwanted, or unlovable.

Trauma-informed care is viewed as a paradigm shift, and it could be vital for all physiotherapists in practice. The trauma-informed care approach asks that physiotherapists use compassion and empathy and to be aware of the likelihood of trauma in their clients’ past. This is an important step in helping prevent re-traumatization of our patients and working towards our patients' goals and aspirations.

Trauma informed practice for health care professionals

Trauma informed practice introduces best practice initiatives and assists health care professionals in gaining insight into the theories around trauma.

Organizations that provide this services are also conscious that their services can retraumatize patients.

A Trauma-Informed Care Environment

Environment of Care

  • Clean, well maintained and neutral
  • Overall quiet, unobtrusive
  • Neutral aroma
  • Soothing colors for decor and paint
  • Individual bathroom option
  • Individual chairs with discrete seating and treatment areas
  • Clear welcome sign and area

Staff Appearance

  • Good general hygiene practices
  • Easy to identify staff members
  • Professionalism attire
  • Clothing not sexually provocative
  • No religious icons
  • Discreet jewelry options

Staff Behavior

  • Professional manners, and respectful to all patients
  • Immediate response to help requests
  • Speak clear with good eye contact
  • Smile and demonstrate a pleasant attitude
  • Initiate greetings
  • Avoid drink or eat in front of patients

Organizational Understanding

  • Trauma policy/philosophy in place
  • Commitment to trauma-informed care
  • Staff education on trauma and its impact
  • Behavioural crisis protocol or mental health first aid

Treatment Considerations

  • Patient centred goals
  • Informed consent explained with patients
  • Common language used when treating and assessing patients
  • Sensitivity to seating configuration and proximity of seating options
  • Culture of origin respected
  • Recognize the importance of physical boundaries and aware that touch—sometimes even a handshake—could trigger trauma
  • Recognize importance of social boundaries. Jokes, story telling, and speaking vaguely can potentially convey risk or threat

Patient engagement

Patient engagement correlates with creating a safe environment. According to Delaney and Johnson (2014), meaningful patient engagement forges a connection that conveys a sense and appreciation of an individual’s human struggle. This sense of empathy is a powerful way to let the patient know that you hear them.

When patients feel connected, they are more likely to respond or seek assistance individuals in moments of distress. This can can prevent or deescalate a personal crisis.

How to reduce triggering past trauma

  • Avoid asking the patient to reproduce the story or event.
  • Create a comfortable, supportive and relaxed environment
  • Acknowledging patient's stories and show empathy by normalizing and validating feelings
  • Paraphrasing patients experience to let them know you are listening
  • Encourage self care and mindfulness
  • Referring to proper support systems

Barriers to Trauma informed care?

  • Time constraints
  • Need of training
  • Confusing information and evidence on trauma-informed practices
  • Worry about further upsetting or retraumatizing patients.
When asked, many health care providers held favorable views to integrating TIC into their practice and had some prior awareness about how traumatic experiences may affect patients emotionally and behaviorally.

What is an Adverse Childhood Experience and ACE Score?

Adverse childhood experience (ACE) can cause physiological changes in the brain, leading to antisocial and risky behaviors, which may result in head injuries, spinal cord injuries, amputations, and multiple traumas with subsequent rehabilitation admissions, as well as obesity, and chronic illnesses.

 Although the association between adverse childhood experiences (ACEs) and adult mental health is becoming well established, less is known about the complex and multiple pathways through which ACEs exert their influence. Growing evidence suggests that adversity early in life conveys not only early impacts, but also augments risk of stress-related life course cascades that continue to undermine health.

Resources for referrals

Physiotherapy alone may not be enough for our patients. We must ensure that we refer to appropriate resources that have the knowledge and expertise to help work with these individuals to overcome any challenges they may be having.

Thanks for reading,