{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T19:00:52Z","timestamp":1762542052107},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,2,1]]},"abstract":"<jats:sec><jats:title>Background and Purpose<\/jats:title><jats:p>Sexual violence has been identified as one of the most common predictors of posttraumatic stress disorder (PTSD). This case report describes the emergence of delayed PTSD symptoms, disclosure of history of sexual trauma, and the influence of re-experiencing, avoidance, and hyperarousal symptoms on physical therapy treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Description<\/jats:title><jats:p>A 60-year-old woman was seen for treatment of low back pain. Discussion of a discord between fear of falling and no balance impairments led to disclosure of sexual assault by a physician at 19 years of age. The patient's PTSD symptoms emerged after 10 weeks of physical therapy. The physical therapists monitored somatic responses and body language closely and modified and planned treatment techniques to avoid PTSD triggers and limit hyperarousal. Collaborative communication approaches included reinforcement of cognitive-behavioral strategies introduced by her psychotherapists.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes<\/jats:title><jats:p>Trauma-cognizant approaches supported the patient's efforts to manage PTSD symptoms sufficiently to tolerate physical therapy and participate in a back care class. Nonlinear psychological healing is illustrated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Symptoms of PTSD may emerge during physical therapy treatment, and patient-sensitive responses to disclosure are important. The trauma-cognizant approach (2-way communication, patient-centered management, and integration of psychological elements into clinical decision making) helped identify and respond to triggers. The physical therapists reinforced cognitive-behavioral strategies introduced by psychotherapists to manage PTSD symptoms. Patient-centered care with further refinement to a trauma-cognizant approach may play an important role in assisting patients with PTSD or a history of sexual trauma to manage symptoms while addressing rehabilitation needs.<\/jats:p><\/jats:sec>","DOI":"10.2522\/ptj.20100344","type":"journal-article","created":{"date-parts":[[2011,12,16]],"date-time":"2011-12-16T06:25:58Z","timestamp":1324016758000},"page":"339-351","source":"Crossref","is-referenced-by-count":25,"title":["Emergence of Delayed Posttraumatic Stress Disorder Symptoms Related to Sexual Trauma: Patient-Centered and Trauma-Cognizant Management by Physical Therapists"],"prefix":"10.1093","volume":"92","author":[{"given":"Kim","family":"Dunleavy","sequence":"first","affiliation":[{"name":"K. Dunleavy, PT, PhD, OCS, Physical Therapy Program, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave, Detroit, MI 48201 (USA)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Kubo Slowik","sequence":"additional","affiliation":[{"name":"A. Kubo Slowik, PT, Detroit Medical Center, Rehabilitation Institute of Michigan, Detroit, Michigan, and Physical Therapy Program, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","reference":[{"key":"2019123009290619300_B1","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1001\/archpsyc.1995.03950240066012","article-title":"Posttraumatic stress disorder in the National Comorbidity Survey","volume":"52","author":"Kessler","year":"1995","journal-title":"Arch Gen Psychiatry"},{"key":"2019123009290619300_B2","volume-title":"The Social Organization of Sexuality: Sexual Practices in the United States","author":"Laumann","year":"1994"},{"key":"2019123009290619300_B3","volume-title":"Handbook on Sensitive Practice for Health Professionals: Lessons from Adult Survivors of Childhood Sexual Abuse","author":"Schachter","year":"2009","edition":"2nd ed."},{"key":"2019123009290619300_B4","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/B978-0-443-07352-6.50008-7","article-title":"Psychological responses to injury and illness","volume-title":"Psychology in the Manual Therapies","author":"Wiese-Bjornstal","year":"2004"},{"key":"2019123009290619300_B5","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1097\/00007611-199103000-00008","article-title":"Long-term medical consequences of incest, rape, and molestation","volume":"84","author":"Felitti","year":"1991","journal-title":"South Med J"},{"key":"2019123009290619300_B6","first-page":"776","article-title":"Physical and sexual abuse in childhood: relationship with post-traumatic stress disorder","volume":"30","author":"Kiser","year":"1991","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"2019123009290619300_B7","doi-asserted-by":"crossref","first-page":"753","DOI":"10.2105\/AJPH.91.5.753","article-title":"Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey","volume":"91","author":"Molnar","year":"2001","journal-title":"Am J Public Health"},{"key":"2019123009290619300_B8","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1192\/bjp.184.5.416","article-title":"Impact of child sexual abuse on mental health: prospective study in males and females","volume":"184","author":"Spatoro","year":"2004","journal-title":"Br J Psychiatry"},{"key":"2019123009290619300_B9","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.chiabu.2003.12.004","article-title":"Psychological sequelae of childhood sexual abuse: abuse-related characteristics, coping strategies, and attributional style","volume":"28","author":"Steel","year":"2004","journal-title":"Child Abuse Negl"},{"key":"2019123009290619300_B10","first-page":"233","article-title":"Stress and development: behavioral and biological consequences","volume":"4","author":"Bremner","year":"2001","journal-title":"Dev Psychopathol"},{"key":"2019123009290619300_B11","volume-title":"Rape in America: A Report to the Nation","author":"Kilpatrick","year":"1992"},{"key":"2019123009290619300_B12","volume-title":"The Post-Traumatic Stress Disorder Sourcebook","author":"Schiraldi","year":"2009"},{"key":"2019123009290619300_B13","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","year":"2000","edition":"4th ed."},{"key":"2019123009290619300_B14","doi-asserted-by":"crossref","first-page":"253","DOI":"10.3109\/10673229409017088","article-title":"The body keeps the score: memory and the evolving psychobiology of posttraumatic stress","volume":"1","author":"van der Kolk","year":"1994","journal-title":"Harv Rev Psychiatry"},{"key":"2019123009290619300_B15","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1002\/jts.20284","article-title":"Neural correlates of re-experiencing, avoidance, and dissociation in PTSD: symptom dimensions and emotion dysregulation in responses to script-driven trauma imagery","volume":"20","author":"Hopper","year":"2007","journal-title":"J Trauma Stress"},{"key":"2019123009290619300_B16","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/j.cpr.2007.10.005","article-title":"The relative efficacy of bona fide psychotherapies for treating post-traumatic stress disorder: a meta-analysis of direct comparisons","volume":"28","author":"Benish","year":"2008","journal-title":"Clin Psychol Rev"},{"key":"2019123009290619300_B17","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1521\/psyc.2008.71.1.13","article-title":"Contributions of psychodynamic approaches to treatment of PTSD and Trauma: a review of the empirical treatment and psychopathology literature","volume":"71","author":"Schottenbauer","year":"2008","journal-title":"Psychiatry"},{"key":"2019123009290619300_B18","doi-asserted-by":"crossref","first-page":"787","DOI":"10.4088\/JCP.v61n1010g","article-title":"Psychodynamic psychotherapy for PTSD","volume":"61","author":"Plakun","year":"2000","journal-title":"J Clin Psychiatry"},{"key":"2019123009290619300_B19","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1146\/annurev.psych.57.102904.190044","article-title":"Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety","volume":"57","author":"Hollon","year":"2006","journal-title":"Annu Rev Psychol"},{"key":"2019123009290619300_B20","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1017\/CBO9780511500008.013","article-title":"Cognitive behavioral treatments for posttraumatic stress disorder","volume-title":"Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives","author":"Yadin","year":"2007"},{"key":"2019123009290619300_B21","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1177\/0145445501251006","article-title":"Treatment of reactivated post-traumatic stress disorder: imaginal exposure in an older adult with multiple traumas","volume":"25","author":"Russo","year":"2001","journal-title":"Behav Modif"},{"key":"2019123009290619300_B22","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD003388.pub2","article-title":"Psychological treatment of post-traumatic stress disorder (PTSD)","volume":"2","author":"Bisson","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"key":"2019123009290619300_B23","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1159\/000112886","article-title":"Treating acute stress disorder and posttraumatic stress disorder with cognitive behavioral therapy or structured writing therapy: a randomized control trial","volume":"77","author":"van Emmerik","year":"2008","journal-title":"Psychother Psychosom"},{"key":"2019123009290619300_B24","volume-title":"Affect Regulation Toolbox: Practical and Effective Hypnotic Interventions for the Over-reactive Client","author":"Daitch","year":"2007"},{"key":"2019123009290619300_B25","first-page":"69","article-title":"Resourcing the trauma client","volume-title":"Trauma: A Practitioner's Guide to Counseling","author":"Turner","year":"2001"},{"key":"2019123009290619300_B26","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1093\/ptj\/79.3.248","article-title":"Towards sensitive practice: issues for physical therapists working with survivors of childhood sexual abuse","volume":"79","author":"Schachter","year":"1999","journal-title":"Phys Ther"},{"key":"2019123009290619300_B27","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1001\/jama.1996.03530260066035","article-title":"Patient-centered medicine: a professional evolution","volume":"275","author":"Laine","year":"1996","journal-title":"JAMA"},{"key":"2019123009290619300_B28","doi-asserted-by":"crossref","first-page":"25","DOI":"10.2522\/ptj.20100061","article-title":"Patient satisfaction with musculoskeletal physical therapy care: a systematic review","volume":"91","author":"Hush","year":"2011","journal-title":"Phys Ther"},{"key":"2019123009290619300_B29","doi-asserted-by":"crossref","first-page":"416","DOI":"10.2522\/ptj.20090226","article-title":"A tool for clinical reasoning and reflection using the International Classification of Functioning, Disability and Health (ICF) framework and patient management model","volume":"91","author":"Atkinson","year":"2011","journal-title":"Phys Ther"},{"key":"2019123009290619300_B30","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1093\/ptj\/83.12.1090","article-title":"Using clinical outcomes to explore the theory of expert practice in physical therapy","volume":"83","author":"Resnik","year":"2003","journal-title":"Phys Ther"},{"key":"2019123009290619300_B31","first-page":"172","volume-title":"Trauma and Recovery","author":"Herman","year":"1992"},{"key":"2019123009290619300_B32","first-page":"57","article-title":"Pearls from the early days of PTSD studies","volume-title":"Clinical Pearls of Wisdom: 21 Leading Therapists Offer Their Key Insights","author":"Rothschild","year":"2010"},{"key":"2019123009290619300_B33","doi-asserted-by":"crossref","first-page":"606","DOI":"10.2522\/ptj.2011.91.5.606","article-title":"A convincing case\u2014for the psychologically informed physical therapist [editorial]","volume":"91","author":"Craik","year":"2011","journal-title":"Phys Ther"},{"key":"2019123009290619300_B34","doi-asserted-by":"crossref","first-page":"609","DOI":"10.2522\/ptj.2011.91.5.609","article-title":"Psychosocial influences on low back pain: why should you care [editorial]?","volume":"91","author":"Main","year":"2011","journal-title":"Phys Ther"},{"key":"2019123009290619300_B35","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1002\/jcop.20189","article-title":"The impact of violence and abuse on women's physical health: can trauma-informed treatment make a difference?","volume":"35","author":"Weissbecker","year":"2007","journal-title":"J Community Psychol"},{"key":"2019123009290619300_B36","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jsat.2005.01.002","article-title":"Women, co-occurring disorders, and violence study: a case for trauma-informed care","volume":"28","author":"Clark","year":"2005","journal-title":"J Subst Abuse Treat"},{"key":"2019123009290619300_B37","first-page":"79","article-title":"Innovations in implementation of trauma-informed care practices in youth residential treatment: a curriculum for organizational change","volume":"89","author":"Hummer","year":"2010","journal-title":"Child Welfare"},{"key":"2019123009290619300_B38","unstructured":"Oregon Department of Human Services, Addictions and Mental Health Division. Trauma Policy. Available at: http:\/\/www.oregon.gov\/OHA\/addiction\/trauma-policy\/trauma-policy.pdf. Published February 14, 2006. Accessed July 28, 2011."},{"key":"2019123009290619300_B39","doi-asserted-by":"crossref","first-page":"737","DOI":"10.2522\/ptj.20100224","article-title":"Early identification and management of psychological risk factors (\u201cyellow flags\u201d) in patients with low back pain: a reappraisal","volume":"91","author":"Nicholas","year":"2011","journal-title":"Phys Ther"},{"key":"2019123009290619300_B40","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1002\/jts.2490060405","article-title":"Reliability and validity of a brief instrument for assessing post-traumatic stress disorder","volume":"6","author":"Foa","year":"1993","journal-title":"J Trauma Stress"},{"key":"2019123009290619300_B41","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1037\/0022-006X.63.6.948","article-title":"Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims","volume":"63","author":"Foa","year":"1995","journal-title":"J Consult Clin Psychol"},{"key":"2019123009290619300_B42","volume-title":"When the Body Says No: Understanding the Stress-Disease Connection","author":"Mate","year":"2003"},{"key":"2019123009290619300_B43","first-page":"101","volume-title":"Trauma Essentials: The Go-To-Guide","author":"Rothschild","year":"2011"},{"key":"2019123009290619300_B44","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/B978-0-443-07352-6.50012-9","article-title":"Recognizing psychopathology","volume-title":"Psychology in the Physical and Manual Therapies","author":"Anderson","year":"2004"},{"key":"2019123009290619300_B45","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1037\/0022-006X.62.2.333","article-title":"Somatic symptoms, social support, and treatment seeking among sexual assault victims","volume":"62","author":"Kimerling","year":"1994","journal-title":"J Consult Clin Psychol"},{"key":"2019123009290619300_B46","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1177\/0886260505285723","article-title":"Taking charge: a pilot curriculum of self-defense and personal safety training for female veterans with PTSD because of military sexual trauma","volume":"21","author":"Teram","year":"2006","journal-title":"J Interpersl Violence"},{"key":"2019123009290619300_B47","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1023\/B:JOTS.0000022620.13209.a0","article-title":"Treatment of posttraumatic stress disorder in postwar Kosovo high school students using mind-body skills groups: a pilot study","volume":"17","author":"Gordon","year":"2004","journal-title":"J Trauma Stress"},{"key":"2019123009290619300_B48","first-page":"133","article-title":"The effects of aerobic exercise on childhood PTSD, anxiety, and depression","volume":"9","author":"Newman","year":"2007","journal-title":"Int J Emerg Ment Health"},{"key":"2019123009290619300_B49","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0304-3959(98)00255-3","article-title":"A 1999 systematic review and meta-analysis of randomized controlled trials of cognitive-behavior therapy and behavior therapy for chronic pain in adults, excluding headache","volume":"80","author":"Morley","year":"1999","journal-title":"Pain"},{"key":"2019123009290619300_B50","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1177\/1534650103259673","article-title":"On \u201cconverting\u201d hand pain into psychological pain","volume":"4","author":"Ciano-Federoff","year":"2005","journal-title":"Clin Case Stud"},{"key":"2019123009290619300_B51","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1521\/psyc.2006.69.4.362","article-title":"The long-term consequences of early childhood trauma: a case study and 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