Hawaiian Shirts and Hot Pants

Dave Vanderplank seems like the kind of guy who has never met a stranger. He greets everyone — familiar or not — in the Comprehensive Rehabilitation Unit (CRU) gym as he rolls in for his occupational therapy session. In January, Dave sustained a spinal cord injury while diving and has paralysis from the chest down. After about six weeks at UHealth Jackson Memorial in Miami, including two surgeries to stabilize his neck and a month of therapy, Dave transferred to Shepherd Center just a couple of weeks ago.

On this morning, Dave is working with his occupational therapist, Kelsey Taylor, MHS, OTR/L, to learn how to dress himself. Dave’s girlfriend, Amelia Hepner, and his mom, Dana Vanderplank, attend the session with him. They have already learned a lot and look like pros, helping him transfer from his wheelchair to the mat using a lift. Dave jokingly refers to them as his pit crew.

Kelsey has an oversized pair of red shorts for Dave to put on over his own shorts as practice for getting himself dressed. She explains that another patient had the shorts customized as a joke. She holds them up to reveal the words “Hot Pants” emblazoned on the seat.

Kelsey positions a backrest on the mat behind Dave for support in case he needs to take a break. He starts with some stretches for his shoulders and legs.

Amelia pulls Dave’s hair back for him and gives him some fingerless gloves that keep his hands from sliding on the mat. Then Kelsey talks him through how to position himself using his shoulder strength. She demonstrates the process of putting on the shorts, with step-by-step instructions on how to position his arms and legs.

“The goals are to practice coming forward, getting your legs up in order to drag on your pants,” Kelsey explains. “I find that people have the most success, kind of getting a forearm underneath. So, we'll have one arm back behind as a prop. Get your forearm underneath, and then you can just lean back until your foot lands, is the goal.”

“Okay, I love it,” Dave says.

As Dave works through the process of pulling on the shorts, Kelsey offers him different adaptive tools, like a chain of nylon loops he can place around his foot, to try and see what works best.

“This is one of the first times we've really worked on this [putting on shorts], so I'm going to verbally coach him through it and try to physically assist the least amount that I have to, to give him the technique,” Kelsey explains. “But then, next time I'll just help you to the mat and give you some pants.”

Dave’s mom, Dana, says that Dave has always been a problem-solver, evaluating obstacles from many different angles with a curiosity about how things work — a trait that is proving useful as he figures out new ways to complete everyday activities.

She remarks on how the therapists work with Dave and says it’s like parenting in some ways, since parents often have to let their child struggle a bit to learn, but not so much that they get overwhelmed and don’t want to try again.

“I can see that's what the therapists are all doing,” she observes. “Work it out, and then at the right moments, they’ll come and give that little push or tweak, or verbal instruction.”

As Dave works on putting on the shorts, Kelsey talks to him about how he might be able to use spasms to his advantage. For instance, with some experimentation, he may learn how to trigger a spasm to lift his foot into the shorts.

When Dave has wriggled into the shorts, everyone cheers. He’s pleased, but also ready to tackle the next task — putting on a shirt. He has selected a Hawaiian shirt so he can practice buttoning it. When Kelsey starts to demonstrate how to use a tool to button one of the top buttons, Dave protests with a laugh.

“Wait, we can't do that button with a Hawaiian shirt. It’s got to be lower,” he says.

Before the 90-minute session ends, Dave is wearing his Hawaiian shirt and the “hot pants.” He reflects on how all the elements of therapy are coming together to help him meet functional goals.

“It's fun seeing all the goals blend together. So, putting on the shorts … will become more rolling. I've been working on rolling in PT and OT — just how to move and how to forward balance, how to forward sit. I'm seeing a lot of those come together, and then once I can roll to sit myself up, then I could get a slideboard … to slide myself to and from a chair and bed without having to use the lift. So, it's fun seeing all the little goals … all kind of combined together to get dressed, sit up, get to a chair. … It's a lot of things that all build.”

“I like to describe it as a pyramid,” Kelsey says. “We set the foundation, and we're just making these building blocks so that big goal is at the top. And that doesn't stop with inpatient, we just kind of keep adding to the pyramid from there.”

Written by Ruth Underwood