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

STUDY DESIGN: This is a case report. BACKGROUND: A 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. PURPOSE: The 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. METHODS: Activity analysis, iterative problem solving, activity simulation, activity modification, and targeted therapeutic exercises were used over the course of eleven sessions. RESULTS: The 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. CONCLUSIONS: This 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.

Long-term results following surgical treatment of elbow deformity in patients with cerebral palsy.

PURPOSE: To evaluate the long-term results of surgical intervention for elbow flexion deformity in cerebral palsy. We hypothesized that improvements in elbow extension and flexion posture angle at ambulation would be maintained over time with preservation of active flexion. METHODS: A total of 23 patients (23 elbows) were available for long-term follow-up. Patients had fixed elbow contractures less than 45° and were treated with partial elbow muscle lengthening. Active and passive range of motion and elbow flexion posture during ambulation were measured at each follow-up, and longitudinal results were compared. RESULTS: Active extension and flexion posture angle during ambulation improved 12° and 63°, respectively, with an 8° loss of active flexion. CONCLUSIONS: Soft tissue lengthening of the anterior elbow can provide statistically significant lasting improvements in active extension and flexion posture during ambulation in patients with cerebral palsy. Our long-term findings substantiate previously reported short-term results. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.