600 Section - Physical Therapy–Based Rehabilitation for a Swimmer with Intellectual Disability: A Case Report

Case Diagnosis: The patient was a female competitive swimmer in her 20s with intellectual disability (WISC-IV full-scale IQ 67). She developed right shoulder pain during competition, and evaluation revealed a right glenoid labral injury, limited shoulder range of motion, muscle weakness, postural asymmetry, and pain at rest and during activity. Cognitive characteristics included difficulty understanding verbal explanations and limited self-expression, affecting motor learning. These combined challenges required a tailored rehabilitation program for safe return to competition.

Case Description:

She began competitive swimming at age 10 and had competed nationally for athletes with intellectual disability. Outpatient physical therapy was provided twice weekly for four months, focusing on shoulder function, motor control, and swimming form via video analysis. Non-insurance training continued for 18 months at twice per month, combining land-based conditioning with swimming instruction. Teaching used brief, concrete, visually supported cues. Tasks were practiced on land then transferred to water. Joint sessions fostered autonomy, and home exercises were guided with her mother.

Discussions: Instruction for athletes with intellectual disability must be individualized and delivered in real contexts. Repeated, concrete, contextually grounded cues facilitated comprehension and skill acquisition. Independent design and communication of training tasks enhanced autonomy, concentration, and motivation. Accumulation of successful experiences likely fostered self-efficacy, supporting competitive return. Physical therapists can apply movement analysis expertise to promote participation in parasports, and expanding systems and support structures is essential to broaden access.

Conclusions:

A structured, individualized physical therapy program improved alignment, shoulder range of motion, strength, pain, movement awareness, and self-expression. The athlete returned to competitive swimming without symptom recurrence. This case highlights the importance of tailored instruction, practice in real contexts, autonomy, and self-efficacy in athletes with intellectual disability, and emphasizes the valuable role of physical therapists, including the need for broader access and structured support systems.