Functional therapy is at the bedrock of recovery from injury. An extension of what can be done in a therapy gym, the functional side asks whether these skills are indeed applicable in a community or “real-world” setting. It is one thing to hone one’s arm and hand strength, yet it is another to see if those skills
can help pour a glass of water and lift it to drink. A part of the cutting edge and philosophy at QLI is a renewed endeavor to harness functional results in an unsimulated environment, such as the client houses on QLI’s campus, and this can be first seen through the implementation of the Xcite devices. The effort is led by occupational therapist Sara Waid, and the devices, created by Restorative Health, provide electro-stimulation to the hand, wrist, and arm muscles, providing a chime as a cue as the nodes fire.
A client’s program with Xcite begins with identifying major goals about activities of daily living (ADLs). “For some of our clients,” says Sara, “they want to return to using their hands functionally, whether that be cooking for the family, feeding themselves, or managing toileting needs. We can assess where clients are at with those routines and skills and then introduce the Xcite, which can bridge the gap and put them on the road towards learning the skills they need to accomplish those tasks independently.”
It isn’t just a firing of electrodes—the Xcite has preset and designed patterns that a user can implement and follow, while elements such as the speed of the chimes and firing can be controlled (though it must be changed as a whole and not simply in part). Additionally, various levels of the Xcite’s firing and support can also be controlled. For example, a seated individual wanting to practice grabbing a cup of water and bringing it to their mouth might first have a chime that fires muscles in the hand, opening the
fingers, and then the client can move these around the cup, which in turn can lead to the next firing that secures the grip of the fingers around the cup. After a pause (which can be programmed in), the next would fire the wrist muscles tilting the cup up, and the other to follow behind and bring the cup fully to the mouth.
The technology still presents some inherent barriers, such as the structure of preset eating patterns. An individual may not complete forking their food, and as they’re trying again the Xcite will move on to the next phase of the exercise (bringing the fork to the mouth). Ideally, the Xcite devices will find a place in every QLI campus home with direct care team members trained, but the barrier to entry and the learning curve is significant. Fortunately, the process is evolving, and clinicians are committed to this future ideal.
Not only are clients’ goals actively worked towards in these sessions, but they also provide a clearer picture for the clients. “The correlation between what we work on formally and what someone can do functionally is apparent to our clients,” notes Sara. “For one client I’ve worked with, she can see the 
good range of motion she gets. The stimulation from the Xcite feels good on her hands and arms. When we use the Xcite in the house and work on grasping and lifting household items, its applicability has clicked for her. Before work with Xcite, it was difficult to grasp a coffee mug with two hands let alone one.” Through repetitions, the pattern provided becomes evident in daily life. With this focus on functionality, the possibilities for client recovery at QLI will increase tenfold.
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Categories: Functional Rehab, Neuroscience, Skill Acquisition, Spinal Cord Injury, Stroke