1. Determine Current Treatment Methods and Outcome Measures Used in England for Upper Limb Rehabilitation Following Stroke

2. Refresher Objective for WP 1 Gather information on current Treatment methods Outcome measures Indicative costs Over the course of the first year following stroke

3. Refresher Method Phase 1 – advisory group Phase 2 – workshop Phase 3 – pilot Phase 4 – national distribution

4. Where we are at today Phase 1 – Advisory group Created a multidisciplinary advisory group Inaugural meeting held May 21, 2009 Summary of outcome Structure of workshop outlined Need to include patient perspective underscored

5. Where we are at today Phase 2 - workshop Held July 9 th, 2009 at Bournemouth University Participants 30 multidisciplinary specialists from across the Southwest representing Physiotherapists – 40% Occupational therapists – 40% Speech & Language therapist, stroke co-ordinators, educators – 20%

6. ASU Non ASU SRU Neurorehab ward Home OPD Spasticity Clinic Orthotics Community Hospital Social services GP Community Rehab Team Liaison Nurse Private provider Charities Nursing Home Not admitted

7. Phase 2 – Workshop Structure 3 Break-out Sessions, 20 minute feed-back sessions Break-out session What are you doing and why? No clear pathway Amount of treatment dependent on setting No standard guidelines for type/duration of treatment limited focus on upper limb rehabilitation – 30% physio time, 50% OT time. Treatment mainly function-based but dependent on patient status Funding from general budget – minimal for specialist kit

8. Phase 2 – Workshop Structure 3 Break-out Sessions, 20 minute feed-back sessions Break-out session How do you measure change? Feed-back Highlight : no standard protocol for assessing ongoing rehab nor routine measures used.

9. How Do You Measure Change? The Sodring ScaleGoal Attainment ScaleMotor Assessment Scale Some psychological screening Canadian occupational performance measurement (COPM) Functional Assessment Measure Functional Independence Measure Chessington Occupational Therapy Neurological Assessment Battery (COTNAB) Test d'Evaluation de la performance des Membres Supérieurs des Personnes Âgées (TEMPA) Barthel ADL IndexNottingham measuresFrenchay testsAshworth scale Rivermead scalesOxford scaleAction Research Arm Test Goniometer Visual Analogue ScaleFugl MeyerSelf-rating scalesVideos/photos 9 Hole Peg TestTardieu ScaleTape measure for oedame Box & blocks

10. Phase 2 – Workshop Structure Break-out session What will make the survey work? Feed-back Highlight: Short, quick, easy. Electronic and paper Differentiate pathway for mild, moderate and severe stroke Include private sector

11. Workshop 2009 Outcome Draft of the - National Survey of Current Treatment Methods in Rehabilitation of the Upper Limb After Stroke For discussion, review and feedback following presentation

12. Workshop 2009 Outcome Patient Involvement – Prospective study – recruiting cohort of 12 patients from 10 stroke units. Quarterly contact to review treatment received. Retrospective study – recruiting cohort of 12 patients from 10 stroke units. Contact after 12 months to review treatment received.

13. Where we are at today Phase 3 - Pilot Continue to refine drafts of the survey To date invaluable input from David Turner, Lucy Yardley, Paul Strike, and Anand To pilot among - Workshop attendees Salisbury stroke unit Christchurch Hospital

14. Phase 4 – National distribution Need to target the 12 month post stroke for overview of treatment provided for stroke rehabilitation onset Timeframe12mths Stroke Units Outreach services? Community services? Primary Care Trusts? Specialist Rehabilitation Centres?

15. National distribution Who - aim to target team leads Where – still issues on how to reach community services When – in the process of completing the IRAS application and Bournemouth Ethics Review

16. National distribution Support agreed in principle by Royal College of Physicians Stroke Improvement Programme clinical networks

17. TOTAL NUMBER OF ACUTE STROKE UNITS IN ENGLAND 6 3 18 7 18 6 6 13 15 14 116 ASUs

18. TOTAL NUMBER OF REHAB STROKE UNITS IN ENGLAND8 2 9 23 9 8 16 15 16 21 127 RSUs

19. 7 17 17 6 10 8 9 6 7 9 96 CSUs TOTAL NUMBER OF COMBINED STROKE UNITS IN ENGLAND