Bridging: The foundation for recovering arm and hand use

This simple, sometimes painful,sometimes frightening, sometimes frustrating exercise was for me a "break-through" therapy that pushed me, pulled me, and marked the mile-posts of recovering the function of my affected arm and hand.

How this works: Although there are many variations, the core of the exercise involves moving from a seated position, to a position in which weight is supported--first by both arms-- then through a sequence of adjusting position of legs to increase the amount of weight on and support provided by the weaker affected arm until most or all of the weight is supported by only one arm - the weaker affected arm. The therapist provides a sequence of instructions and (when appropriate) physical assistance that will gradually and safely help you to shift an increasing amount of weight onto your weaker affected arm.The therapist might, for example, provide support at the shoulder, the elbow, or the wrist - to make sure those joints are in optimal position to support the increasing amounts of weight induced by each adjustment of position in the sequence. Over time, your therapist might propose increasingly complex instructions for positioning your feet: moving feet farther from the chair or platform on which you're seated or upward onto steps or other objects- chairs perhaps even the steps of a ladder!

Why this works:The technique involves Constraint-Induced Movement Therapy (CIMT), also known as forced use movement therapy-- a therapy that aims to retrain the brain by constraining the unaffected arm and forcing the use of the weakened arm. The exercise helps to overcome the body's "guarding instinct" that detects the weakness of the impaired arm. Arm-bridging also works by providing bio-feedback and positive re-enforcement in the form of the "little victories" achieved by successfully and safely mastering each increasingly difficult bridging position. The benefits acquired include the obvious strengthening of the muscles required to support the weight of the torso. More subtle benefits include the gradual recovery of "voluntary --as opposed to "reflexive" control of the arm and hand. As you learn and re-learn how to manage moving from one position to the next with less assistance from your therapist, you are engaging and becoming increasingly conscious of your capacity to invoke and control dozens of muscles in the torso, shoulder, arm, and handto shift and then hold each position in the sequence. Over time, this and other therapies that assert conscious or voluntary muscle control will allow you to progress to higher levels of learned or "seemingly reflexive" movements so that you can execute your daily activities without the extraordinary levels of concentration required to execute the movements involved in therapies such as arm-bridging exercises. For example, as you re-acquire movement and strength of your arm and hand, you will notice that it is the more subtle skills and nuanced control that enables or inhibits smooth or "effortless" shaping of your hand for tasks such dressing or food preparation. The term "shaping" describes the skill of correctly positioning the hands and fingers to optimize leverage and application of pressure to perform tasks such as turning a door knob, picking up and holding a coffee cup (with crushing the cup and burning the hand with hot cofee.) For me, arm-bridging was instrumental to the awakening and development of the muscular and neurological network that enabled higher-level functions such as shaping.

The strategies and benefits of bridging illustrates several core principals about the recovery process:

• motor function recovers in a sequence of proximal to distal (near to the spine, then outward to the extremities away from the spine)
• my personal recovery folowed the sequence of:
• ability to bear body's weight with limb,
• ability to bear limb's weight with base and surrounding muscle groups
• ability to gain isolated control of individual muscle or muscle groups at and along the limb,
• ability to re-acquire full range of motion of limb and extremity (involves strength and flexibility)
• ability to re-acquire coordinated movement--getting the right amount of signal to the right muscles in the right sequence to execute correctly.