Rehabilitation Interventions Case Study

Original Editors - Naomi O'Reilly and ReLAB-HS

Top Contributors - Naomi O'Reilly, Tarina van der Stockt, Kim Jackson, Oyemi Sillo and Cindy John-Chu      

History of Presenting Case

Alan is a 28 year old male. He uses a wheelchair for mobility, is independent in all transfers using standing transfers, and drives. Alan was seen by the National Wheelchair Rugby Team physiotherapist prior to full return to National Squad Training sessions, which had been suspended for 16 months as a result of COVID-19 and restrictions on indoor team based sports training. During the time away from National Training Alan had 2 major injuries.

1. Fall from his Wheelchair which resulted in Complex Fractures of the Left Tibia and Fibula in five places including oblique displaced and comminuted fractures, which required removal and replacement of previous IM Nail, Plates and Screws, followed by 12 weeks in cast (8 weeks in full leg cast followed by 4 weeks in below knee cast.
2. Right shoulder injury which occurred while blocking a pass during wheelchair rugby training at his club just at the beginning of the initial COVID-19 lockdown, which remained in place for 3 months. He felt a subluxation at the right shoulder with significant pain and had to stop playing. Rested for 1-2 weeks with ongoing pain prior to going for further assessment and MRI Scan, which showed a right labral tear. As a result of COVID-19 restrictions initial physiotherapist was conducted via telehealth.

Currently Alan was back at club based Wheelchair rugby and basketball training for 6 weeks but has not yet returned to full contact sport or competition. He is doing gym based strength training 3 times per week, cardiovascular training 1-2 times per week on Nordic skier and court based training in his sports chair 2-3 times per week focusing on pushing technique, endurance in chair, agility and just started some speed based training but is now having some intermittent shoulder pain.

Subjective Information

Medical History

Alan has Type 3 Osteogenesis Imperfecta and has had 105 long bone fractures (majority occurred during childhood and adolescents with decreased incidence in adulthood) including femurs, tibia, fibula, humerus, ulna and radius with intramedullary rods in all long bones, and multiple surgeries with plates and screws.

Sport Injuries

Leg Injuries

• Tibial Fracture - Left

Shoulder Injuries

• Rotator Cuff Tendonopathy
• Rotator Cuff Tears
• AC Joint Seperation
• Bursitis

Elbow Injuries

• Recurrent Lateral Epicondyle Tendonopathy - Right
• Bursitis

Wrist Injuries

• Sprains
• De Quervains Tenosynovitis

Fingers

• Sprains- Thumb & Multiple Fingers
• Finger Fractures

Work

Alan works as Strength and Conditioning Coach with a personal training company that promote physical and mental wellbeing and provide an alternative take on health and fitness, integrating quality movement training, professional coaching, and social get togethers as a way to promote physical and mental health, and community spirit. Community is at the heart of the company that he works with, and a big part of that is bringing people together outside of training sessions including regular long table lunch events, monthly book club meetings, and movie nights every now and again.

Sport

Alan plays Wheelchair Basketball at club level and is an Irish International Player for Wheelchair Rugby.

Objective Assessment

Range of Movement and Strength

	Range of Movement		Strength
	Right	Left	Right	Left
Shoulder Flexion	95	110	5-	5
Shoulder Extension	30	45	5-	5
Shoulder Abduction	100	110	5	5
Shoulder External Rotation	50	80	4+	5
Elbow Extension	-45 flexion	-40 flexion	5	5
Knee Flexion	120	135	5	5-
Knee Extension	+5 hyperextension	0	5	5-
Ankle Dorsiflexion	25	10	5	5

Dynamometry

	Personal Best	Current
12 Min Push	52 Laps	41.5 Laps
5m Sprint	2.57 seconds	3.12 seconds
10m Sprint	3.79 seconds	4.9 seconds
Agility	13.96 seconds	15.81 seconds
Throw - Timed 1 min	206	182
Throw - Distance	26.5 meters	21.08 meters

On Court Testing

	Personal Best	Current
12 Min Push	52 Laps	41.5 Laps
5m Sprint	2.57 seconds	3.12 seconds
10m Sprint	3.79 seconds	4.9 seconds
Agility	13.96 seconds	15.81 seconds
Throw - Timed 1 min	206	182
Throw - Distance	26.5 meters	21.08 meters

Goal

1. Return to Full Training including full contact
   • Throw Ball Full Court
   • Decrease Shuttle Test Time
   • Descrease 5 min sprint time
   • Decrease Agility Time
2. Selection for National Team for European Championship in 6 months

References