The Role of Hand Therapy in Facilitating Participation in Rock Wall Climbing: A Case Report of a Woman with Cerebral Palsy

Abstract Introduction 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 employed 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. Conclusion 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.