The role of hand therapy in facilitating participation in rock wall climbing: A case report of a woman with cerebral palsy

Abstract

Study DesignThis is a case report. BackgroundA woman with hemiplegic cerebral palsy and limited right upper extremity motion, strength, and control was referred to hand therapy to enable participation in adaptive climbing. PurposeThe purpose of this case is to describe the role of hand therapy in identifying and addressing barriers to participation in adaptive climbing. Description of the patient’s wrist flexion/extension, grip strength, and functional use over the course of eleven months is also included. MethodsActivity analysis, iterative problem solving, activity simulation, activity modification, and targeted therapeutic exercises were used over the course of eleven sessions. ResultsThe patient conveyed successful participation in adaptive climbing with reported improvements in overall strength, motion, ability to shift weight, ability to manage digit spasticity, spontaneous right upper extremity use, and body awareness. Active right wrist flexion, wrist extension, and grip strength improved by 33 degrees, eight degrees, and 35 lbs, respectively. ConclusionsThis case highlights an unconventional treatment scenario where outpatient hand therapy was entirely focused on targeting and facilitating the patient’s participation in a specific activity—adaptive climbing. Rehabilitation professionals, uniquely suited to helping individuals explore interests, determine “good fit”, identify barriers, and navigate obstacles, can advance the promotion of participation in activities that are both meaningful and physically engaging.