By Dr. Jennifer Esala, CVT senior evaluator and researcher, Ilona Fricker, CVT clinical advisor for physiotherapy, and former CVT staff members Laura Gueron, physiotherapist, and Dr. Jepkemoi Kibet, physiotherapist
Through decades of work with survivors of torture, CVT has developed a trauma-focused physical therapy approach that integrates physical rehabilitation with mental health and social work services. This interdisciplinary model recognizes the interconnected physical, psychological and social consequences of torture and supports refugees and asylum seekers in recovering from trauma and rebuilding their lives.
CVT physical therapists, also known as physiotherapists, take an integrated approach to care, addressing clients’ mental health needs alongside their physical needs. Among the key considerations in developing physical therapy interventions at CVT is addressing cultural and linguistic needs through appropriate cultural adaptations
Cultural adaptation involves modifying healthcare interventions to better align with clients’ languages, cultural beliefs, experiences and circumstances. For refugees and asylum seekers who have experienced torture and trauma, and who come from diverse cultural backgrounds, these adaptations can be especially important in making healthcare accessible, acceptable and effective.
In physical therapy, cultural differences can influence communication, treatment preferences and clients’ comfort and engagement in care. For example, without appropriate adaptations, clients may struggle to understand home exercises when interpretation is unavailable, feel uncomfortable with educational materials depicting culturally inappropriate clothing, or misinterpret unfamiliar metaphors. Cultural norms surrounding gender and physical touch may also affect clients’ comfort with treatment.
According to Ilona Fricker, clinical advisor for physiotherapy, cultural adaptation is an important process to make physical therapy accessible and effective for diverse populations. “Rehabilitation is more meaningful when it reflects how people understand their bodies, their health and their recovery,” said Fricker. “We bring clinical knowledge, but the people we work with bring knowledge of their lives and culture. Effective rehabilitation needs both.”
We bring clinical knowledge, but the people we work with bring knowledge of their lives and culture. Effective rehabilitation needs both.”
-Ilona Fricker, clinical advisor for physiotherapy
To examine how physical therapy has been culturally adapted for diverse populations, CVT researchers and physical therapists conducted a scoping review. The review identified 37 publications describing approaches such as adapting language, visuals and metaphors; modifying treatment delivery; and responding to cultural norms, religious beliefs and different understandings of health and illness. CVT physical therapists incorporate many of these adaptations into their everyday practice, as illustrated by the following examples.
Language plays a vital role in culturally responsive physical therapy
Beyond interpretation, clinicians’ choice of words and metaphors can shape how clients understand and engage with treatment. For example, CVT physical therapists working with human rights defenders in the Arab world renamed a breathing exercise “freedom bird” instead of “movement breathing.” Because birds symbolize freedom in this community, the name resonated with survivors. The meaningful name also made the exercise easier to remember, potentially encouraging clients to practice at home after treatment.
Metaphors can also make abstract concepts more tangible while reducing reliance on clinical language. Concepts such as grounding, safety and steadiness can be difficult to convey through clinical explanations alone. In northern Ethiopia, the image of a sturdy woven basket (mesob) provides a familiar symbol of stability. Describing the experience as “feeling steady like a mesob” may feel safer and more accessible than discussing trauma or hyperarousal, terms that can evoke shame or fear.
Cultural adaptation can also shape the delivery of treatment and education
In Kenya, physiotherapists adapted a group intervention for participants from a Sudanese ethnic community with a pastoralist heritage. Many participants had limited experience with extended, discussion-based educational sessions. Facilitators observed greater attention and engagement during movement activities, while longer discussions prompted participants to ask when the sessions would end. In response, facilitators interspersed shorter educational discussions with physical exercises. This approach appeared better suited to participants’ experiences and preferences and helped sustain engagement throughout the sessions.
Cultural adaptations can extend beyond treatment sessions
In Jordan, CVT collaborated with clients to develop audiovisual educational materials, including a video explaining trauma-focused physiotherapy that clients could share with their families. The materials aimed to build family understanding and acceptance of physiotherapy and reduce the stigma and criticism some clients faced when practicing exercises at home. This collaboration shows how cultural adaptation can address barriers to engagement and adherence beyond the clinic.
Respect for religious and cultural practices can also shape treatment arrangements
In healing programs for women in Jordan and Kenya, privacy is an important consideration. When clients removed hijabs or outer layers of clothing during sessions, treatment teams ensured privacy by preventing others from looking through windows or entering the room. These measures were particularly important for Oromo and Somali women but were not a concern for some other groups. These differences reflect the diversity of cultural and religious practices in Kenya and the distinct needs of women across communities.
In Jordan, CVT suspended group physiotherapy sessions during Ramadan to accommodate clients who were fasting. This adjustment respected clients’ religious practices while reducing the risk of fatigue or dehydration during physical activity.
Similar cultural and religious considerations guide individualized physiotherapy in Minnesota, United States. When treating clients separated from their husbands, wives or partners, physiotherapists initially focus on restoring continence or pelvic floor function rather than emphasizing potential sexual benefits. For Muslim clients, exercises that restore flexibility and reduce pain when assuming prayer positions can make physiotherapy more relevant and engaging.
Cultural adaptation also means connecting treatment to activities and responsibilities that clients value
For instance, at the CVT clinic in Minnesota, for clients from Southeast Asian countries with backgrounds in agriculture or manual labor, physiotherapists tend to place less emphasis on exercise for its own sake. For some older women from this region, physiotherapists emphasize movements and body mechanics used in gardening and caring for grandchildren, making treatment more relevant to their daily lives. For clients living in multigenerational households, this approach also supports their roles and responsibilities within the family.
Across these examples, clients play a central role in identifying culturally appropriate adaptations
Inviting clients to share their observations and preferences helps ensure that interventions reflect their cultural experiences and needs. “Asking for clients’ observations, preferences and ideas gives clients a voice and a sense of control, which is itself part of healing,” explained physiotherapist Dr. Jepkemoi Kibet. “Setting functional goals around valued roles, for example walking long distances, carrying water, farming, herding, sitting on the ground, ties rehabilitation to what matters in a client’s daily life.”
Setting functional goals around valued roles, for example walking long distances, carrying water, farming, herding, sitting on the ground, ties rehabilitation to what matters in a client’s daily life.”
-Dr. Jepkemoi Kibet, physiotherapist
