1. Bridges at Kingston Stroke Unit Olivia Kemsley Physiotherapy team leader Kingston Stroke Unit

2.  20 bedded stroke unit, set up in November 2009  Cover 5 boroughs including Kingston  Majority of teams we refer to have had Bridges training  MDT including physio, OT, SLT and nurses completed Bridges training Feb 2011

3.  Given out 25 workbooks in past year  Mostly given just before discharge or awaiting rehabilitation  Have given workbooks to patients with cognitive and communication problems by involving family members

4.  Workbook introduced to patient and family by keyworker  Time taken at introductory session to go through work book and discuss patients goals  Not frequently followed up as therapists priorities are organising discharge

5.  Stroke Co-ordinator Chris Jones – unfortunately temporary post, now finished  Tolworth Cedars Unit  Kingston ICT  Richmond Community Neuro Rehab Team  Reablement

6.  Not enough time ◦ Incorporate into treatment session ◦ Base treatment session around workbook Wrong environment/Too early ◦ Introduce workbook prior to discharge home or to rehab ◦ Patients with low mood have benefited from workbook

7.  52 year old lady  Very low mood  Unable to identify achievements so far  Unable to break down future goal of Walking into smaller stages.  Introduced Bridges workbook  Therapist and family came up with achievements so far, then left with patient to think about future goals

8.  Goal setting more patient centred  Move away from SMART goals with terminology  Developed role of keyworker  Improved communication in MDT and along pathway  More positive approach, giving hope to patients

9.  Broaden range of patients we give it to and try at an earlier stage  Follow up more within acute setting rather than just giving prior to discharge  Continue to implement self management approach not just through workbook  Gain patient feedback at Kingston stroke forum

10. Thankyou Any Questions?