Page 145 - ประมวลสรุปความรู้เกี่ยวกับพิธีสารอิสตันบูลและพิธีสารมินนิโซตา

ISTANBUL PROTOCOL V. PHYSICAL EVIDENCE OF TORTURE AND ILL-TREATMENT

weeks later, deficiency or reflex loss or decrease is rotation and forearm pronation-supination may be
present, appropriate electrophysiological studies should deficient. Sensory deficiency is noted in the deltoid
be performed by a neurologist experienced in the use region and may extend to the arm and outer parts of
and interpretation of these methodologies; the forearm.

(c) Reflex examination. Reflex loss, a decrease in 4. Other positional torture
reflexes or a difference between the two extremities
may be present. In reverse suspension, even though 448. There are many forms of positional torture, all
both brachial plexuses are subjected to trauma, of which tie or restrain the victim in contorted,
asymmetric plexopathy may develop due to the manner hyperextended or other unnatural positions,
in which the torture victim has been suspended, which cause severe pain and may produce injuries
depending on which arm is placed in a superior to ligaments, tendons, nerves and blood vessels.
position or the method of binding. Although research Characteristically, these forms of torture leave few, if
suggests that brachial plexopathies are usually any, external marks or radiological findings, despite
unilateral (commonly after being catapulted from a subsequent frequently severe chronic disability. Wrist
motorcycle and landing on one shoulder), that is at restraints may cause superficial bruising, abrasions
variance with experience in the context of torture, in and lacerations, particularly over the bony parts
which bilateral injury is common; of the wrist. They may also cause hand oedema,
symptoms of tenosynovitis, fracture of the styloid
447. Among the shoulder region tissues, the brachial plexus process of the radius or ulna or neurological deficit
is the structure most sensitive to traction injury. of variable duration due to nerve compression, most
The incidence and severity of this complication after commonly of a superficial branch of the radial nerve.
suspension will depend on the duration and frequency
of the torture and the degree of musculature – a 449. Positional torture primarily affects tendons, joints
well-muscled individual may well escape such injury. and muscles. Additional positional torture methods
Reverse suspension causes brachial plexus damage include: the “banana stand” or the “banana tie”
due to forced posterior extension of the arms. As over a chair just on the ground, or on a motorcycle;
observed in the classical type of reverse suspension, forced standing; forced standing on a single foot;
when the body is suspended with the arms in posterior prolonged standing with arms and hands stretched
hyperextension, typically the lower plexus and then high on a wall; prolonged forced squatting; and
the middle and upper plexus fibres are damaged forced immobilization in a small cage. In accordance
if the force on the plexus is severe enough. If the with the characteristics of these positions, complaints
suspension is of a “crucifixion” type, but does not are characterized as pain in a region of the body,
include hyperextension, the lower and middle plexuses limitation of joint movement, back pain, pain in the
fibres are likely to be damaged due to hyperabduction. hands or cervical parts of the body and swelling of
Brachial plexus injuries may be categorized as follows: the lower legs. The same principles of neurological
and musculoskeletal examination apply to these forms
(a) Damage to the lower plexus. Deficiencies are of positional torture as apply to suspension. MRI is
localized in the forearm and hand muscles. Sensory the preferred radiologic modality for evaluation of
deficiencies may be observed on the forearm and at the injuries associated with all forms of positional torture.
fourth and fifth fingers of the hand’s medial side in an
ulnar nerve distribution; 5. Electric shock torture

(b) Damage to the middle plexus. Forearm, elbow and 450. In electric shock torture, electric current is transmitted
finger extensor muscles are affected. Pronation of the through electrodes placed on any part of the body.
forearm and radial flexion of the hand may be weak. The most common areas are the hands, feet, fingers,
Sensory deficiency is found on the forearm and on the toes, ears, nipples, mouth, lips and genital area. The
dorsal aspects of the first, second and third fingers of power source may be a hand-cranked or combustion
the hand in a radial nerve distribution. Triceps reflexes generator, wall source, stun gun, cattle prod or other
may be lost; conducted energy device. Electric current follows
the shortest route between the two electrodes. The
(c) Damage to the upper plexus. Shoulder muscles are symptoms that occur when electric current is applied
especially affected. Abduction of the shoulder, axial are characteristic. For example, if electrodes are placed

106