Rehabilitation Interventions Case Study

Original Editors - Naomi O'Reilly and ReLAB-HS

Top Contributors - Naomi O'Reilly and Tarina van der Stockt      

History of Presenting Case[edit | edit source]

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, 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 physiotherapy was conducted via telehealth. No guidance on return to sport was provided and due to COVID-19 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[edit | edit source]

Medical History[edit | edit source]

Alan has Type 3 Osteogenesis Imperfecta and has had 105 long bone fractures (majority occurred during childhood and adolescents with a 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[edit | edit source]

Leg Injuries

  • Tibial Fracture - Left


Shoulder Injuries

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


Elbow Injuries

  • Recurrent Lateral Epicondyle Tendonopathy - Right
  • Bursitis


Wrist Injuries

  • Sprains
  • De Quervains Tenosynovitis


Fingers

  • Sprains- Thumb & Multiple Fingers
  • Finger Fractures

Work[edit | edit source]

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[edit | edit source]

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

Objective Assessment[edit | edit source]

Transfers[edit | edit source]

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[edit | edit source]

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[edit | edit source]

Personal Best Current
Right Grip Strength 54.7kg 45.2kg
Left Grip Strength 51.3kg 50.1kg

On Court Testing[edit | edit source]

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[edit | edit source]

  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 [edit | edit source]

  1. Aclai. All ages and abilities training at ACLAÍ. Available from: https://youtu.be/K0oGOfxaez0[last accessed 30/10/17]
  2. Aclai. Alan Dineen Training Montage. Available from: https://youtu.be/zXY2_w1ymRM[last accessed 30/10/17]
  3. Paralympic Games. Paralympic Sports A - Z; Wheelchair Rugby. Available from: https://youtu.be/tSzFmlWgVsM [last accessed 30/08/2021]
  4. Irish Wheelchair Association - Sport. Achieving Greatness - Alan's Story. Available from: https://youtu.be/ba9SKRd7uuM[last accessed 30/08/2021]