On four successive Mondays in April 2016 I helped with on a research project into whether the step process method in stroke rehabilitation as pioneered by Bridges Self-Management can be made to work in a group setting. The more interesting details of the study, by University College London's (UCL) Ella Clark, will I’m sure appear in more scholarly quarters, but what I can report is that about half way through the trial, which brought together seven stroke survivors and Lucinda Brimicombe, Bridges Director of Training and Innovation, raised question as to what was uniquely "Bridges" about this project? How was it different from other stroke rehab groups? In what ways and to what extent were Bridges methods working successfully? It was at this point that images of bridges started to pop into my head.
I have come to know several bridges, starting with my earliest memories as a child in the back seat of a car crossing the Runcorn Bridge over the River Mersey. It seemed so big with its hard iron frame studded with rivets the size of your fist. It was scary. And more recently I enjoyed the Scandinavian TV crime series The Bridge, which features the Øresund Bridge that connects Sweden and Denmark. It is 16km long, and it is scary. The drama begins with the discovery of a body exactly half way along the bridge. Is this in Sweden or Denmark? Which police force will investigate the crime? The Swedes? The Danes? The story is later complicated when the body is found to have been cut into two equal parts. Scary.
Travelling the Øresund Bridge via Google Earth is an eye-opener. It seems to go on forever, and you can easily get lost in thought along the way. You begin to run your imagination over the symbolism of the bridge as a connector, how a structure can unite two very separate things, what kind of loads will that structure carry, what is the importance of traffic volume, foundations, etc, etc, blah, blah?
I have noticed that motivation is where rehabilitation often stands or falls. I am a very focused and determined person. Most people are not, and I have seen progress in others falter simply because the will to action is simply not there. And in the group work we did at UCL, what surprised me most was the drive shown by some of the group members to help others. They had found a role, a mission, a sense of purpose. They found their motivation, their post-stoke mojo, a reason for doing something.
Back on dry land and stroke self-management, in 'Bridges World', small steps to big things is the mantra. I call them 'baby steps'. What I have found from experience is that in setting yourself small goals (for me that means easily achievable) and then exploring ways to hit your tiny targets, you reflect on and modify them along the way. For example, what a year ago for me was the stated desire to complete a walk of the famous Seven Sisters along the white cliffs of the Sussex coast from Eastbourne to Cuckmere Haven, has mutated into a daily patrol of my neighbourhood on foot, stopping to chat with the locals, telling children to stop being naughty and checking the ever changing world of an inner-city wildlife garden. The dream of walking the Seven Sisters has not disappeared, but it is much less urgent than it was a year ago (I have even done the walk, on a treadmill with Google Earth on my iPad). In this way, by embracing the small steps as an end in themselves, I learn more about myself and can therefore make better decisions about those big juicy goals.
The approach is even appropriate to activities not remotely related to stroke rehab. Not long ago I used a piecemeal step method to 'build' from visual components a picture of Hammersmith Bridge for my wife's godmother. And she thought I sat around in the cold with a box of paints for several days. Not likely! It's a fake.
So how might these 'baby steps' work in a group situation? That is still a work in progress, but I do have one observation from the UCL meetings. I have noticed that motivation is where rehabilitation often stands or falls. I am a very focused and determined person. Most people are not, and I have seen progress in others falter simply because the will to action is simply not there. And in the group work we did at UCL, what surprised me most was the drive shown by some of the group members to help others. They had found a role, a mission, a sense of purpose. They found their motivation, their post-stoke mojo, a reason for doing something. It is as simple as the slogan 'Help others to help yourself'.
It doesn't take a mammoth leap of the imagination to see that this is potentially very powerful. How systems and structures (the bridge?) can be built to support such a self-sustaining programme of mutual enablement is the question. Making it work is the challenge.
Billy Mann was not killed by the haemorrhagic stroke he experienced, age 53, in October 2012. He spent four months in London’s National Hospital for Neurology and Neurosurgery, where he learned how to build a new life. Before the stroke he had, for 20 years, worked as a production journalist at the Guardian. Prior to that he was a writer and editor in the rock music press.
In the years since his stroke, Billy has engaged in a number of strategic paths to improve his quality of life, mainly following what he calls ‘baby steps’. He receives continuing therapy at Headway East London - for whom he also helps in member-led training - does voluntary work in teaching, and contributes to neuro research studies. He recently took part in a ‘Bridges in a Group’ pilot project. He still considers himself a journalist. http://neurobilly247.blogspot.co.uk/
Bridges is a social enterprise that exists to make a difference to the lives of people who live with acute and long-term conditions, by working with teams from health, social care and the third sector, to define and deliver best practice in self-management support.