Working with survivors of sexual violence has been the most challenging and rewarding aspect of my pelvic rehabilitative work. I am fortunate to have been trained as a legal and medical advocate for sexual assault survivors and worked in mental health before becoming a physical therapist. I hope to give everything I know about being a patient-centered trauma-aware practitioner.

Can we talk about how common sexual violence is within our society and our work? I can spout the statistics: 1 in 4 women and about 1 in 26 men have experienced completed or attempted rape. About 1 in 9 men were made to penetrate someone during his lifetime. Additionally, 1 in 3 women and about 1 in 9 men experienced sexual harassment in a public place.¹ But in our rooms, sexual violence is pandemic.

Please feel empowered to provide appropriate, trauma-informed support to these patients. It starts with our wellness and self-care. We cannot empower others if we have not empowered ourselves. We don’t have to be perfect. Practice self-forgiveness. Know your triggers. Commit to impeccable self-care. Be well. Keep ourselves safe by practicing empowered choice. If you have empowered choice, you can provide and teach empowered choice to your patients. What is empowered choice? Empowered choice is saying: we don’t do anything you don’t want to do, or I don’t do anything I don’t want to do. Ever. Give your patient the power to direct their healing while providing extensive physiology and anatomy education with trauma-focused, patient-centered care. With information, patients choose what they want to be treated and when. And with empowered choice, they tend to choose higher-level treatment quicker.

In the realm of rehabilitation, where innovative methods continuously emerge, one particular approach stands out for its unique blend of traditional wisdom and modern science: hippotherapy improves function for people who have experienced trauma. This unconventional form of therapy harnesses the healing power of horses to aid individuals in overcoming physical and emotional trauma while working on their rehabilitation goals. From veterans grappling with post-traumatic stress disorder (PTSD) to survivors of abuse or accidents, hippotherapy has shown remarkable efficacy in promoting function, healing, and resilience.

Understanding Equine-Assisted Therapy Versus Hippotherapy:
Equine-assisted therapy involves interaction with horses in a structured environment under the guidance of trained mental health therapists. Unlike traditional therapy settings, the presence of horses creates a dynamic and immersive experience that facilitates emotional expression within the mental health realm. Hippotherapy is a treatment tool used by physical therapists, occupational therapists, and speech-language therapists to address impairments, functional limitations, and disabilities in clients with neuromusculoskeletal dysfunction (AHA). Unlike equine-assisted therapy focused on mental health, hippotherapy is a tool that uses evidence-based practice and clinical reasoning in the purposeful manipulation of equine movement as a therapy tool to engage sensory, neuromotor, and cognitive systems to promote functional outcomes.

The Bond Between Humans and Horses:
Horses, known for their sensitivity and intuition, possess a remarkable ability to mirror human emotions and respond to nonverbal cues. This unique quality forms the foundation of equine-assisted therapy and hippotherapy, where the therapeutic relationship between humans and horses serves as a catalyst for healing.

Last week- on May 6 amid a pandemic- the Department of Education released changes to Title IX. Title IX is a 1972 Civil Rights Act that bans sexual discrimination within the educational system. Sadly, the new provisions within the 2,033 page document include the following changes:

• Narrows the definition of sexual harassment
• Reduces options to survivors of sexual assault, dating violence and stalking
• Reduces liability of colleges and universities
• Reduces mandated reporting of sexual violence
• Deregulates federal guidelines to protect sexual violence survivors
• Changes the ‘standard of proof’ from ‘preponderance’ to ‘clear and convincing’
• Bolsters protections for perpetrators
• Allows for live hearings and cross examinations of the assault survivor
• Only investigates if assault reported to ‘certain people’

23% of undergraduates and 11% of graduate students report having experienced sexual violence, AND we know survivors under-report assaults. We talk extensively about medical and legal considerations for sexual violence survivors in my "Empowering the Sexual Assault Survivor" course. Participants who took my course will need to know those protections we discussed just a few days ago are slated to be rolled back. Today, in my remote course "Trauma Informed Care", we lay the physiological and neurobiological framework for empowering the sexual assault survivor. Following that, in addition to how to continue empowering for survivors, we elaborated on the legal changes listed above.

Outrageously, these Title IX deregulating provisions are to go into effect August 14, 2020 while schools are struggling to keep students safe amid coronavirus pandemic.  Again, let us look at these percentages (23% of undergraduates, and 11% of graduate students) and think about who needs safety and protection.

It’s OK to be feeling (insert feeling) right now. (maybe: sad, fearful, angry, denial, numb, anxious, avoidant, bored?)

It’s OK to acknowledge those feelings.

It’s also OK to create a plan and direction about what we may do about our feelings, thoughts, and actions.

I work at University of Chicago and we are in the throes of preparing for a (big T) Trauma Center. But I am physical therapist who works with (little t) traumatized patients- as I treat only pelvic or oncology patients (and usually both).

From the online dictionary: Trauma is 1. A deeply distressing or disturbing experience (little t trauma) or 2. Physical injury (injury, damage, wound) yes- big T Trauma. In my experience, the Trauma creates the trauma and the body responds in characteristically uncharacteristic ways (more on this later).

People in distress/trauma-affected do not respond rationally or characteristically, so I have learned to respond to distress/trauma in a rational, ethical, legal and caring manner. Always. Every time. To the best of my ability, and without shame or blame.