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 presented to the National Wheelchair Rugby Team physiotherapist prior to a 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 a cast (8 weeks in full leg cast followed by 4 weeks in a below-knee cast. Initially, the physiotherapist focused on ankle and knee range of movement. Occupational Therapy provided an adaption for his wheelchair to elevate his leg and a sliding board for transfers.
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, that 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 physiotherapy was conducted via telehealth. No guidance on return to sport was provided and due to COVID-19, there was no face to face National Team training, Physiotherapy or Strength and Conditioning support during initial Injury. Alan returned to gym-based training to work on range of movement and strength with guidance from the National Team physiotherapist.

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 a 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 adolescence with a decreased incidence in adulthood) including femur, 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 Tendinopathy
• Rotator Cuff Tears
• AC Joint Separation
• Bursitis

Elbow Injuries

• Recurrent Lateral Epicondyle Tendinopathy - Right
• Bursitis

Wrist Injuries

• Sprains
• De Quervains Tenosynovitis

Fingers

• Sprains- Thumb & Multiple Fingers
• Finger Fractures

Work

Alan works as a 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

Transfers

Day Chair Level Surface

• Baseline - Independent Standing Transfer

• Current - At Baseline

Day Chair into Sports Chair

• Baseline - Independent Tricep Lift Transfer
• Current - Stand by Assistance x 1 to support Chair

Sports Chair into Day Chair

• Baseline - Independent Tricep Lift
• Current - Assistance x 1 to support weight to decrease like ad on the shoulder (as his sports chair lower than day Chair)

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
Right Grip Strength	54.7kg	45.2kg
Left Grip Strength	51.3kg	50.1kg

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. Transfers
   • Independant Transfer Day Chair to Sports Chair
2. Return to Full Work including:
   • Assist clients with transfers
   • Demonstrate Ring Based Exercises
   • Demonstrate Overhead Barbell & Kettle Bell Lifts
3. Return to Full Training including full contact:
   • Throw Ball 28 meters (Full Court) in 8 weeks
   • Increase 12 Minute Endurance Distance to 50 Laps in 12 weeks
   • Decrease 5 meter sprint time to 3 seconds in 6 weeks
   • Decrease Agility Time to 14.5 in 6 weeks
   • Selection for National Team in Wheelchair Rugby for European Championship in 6 months

References