Returning To Work Post-Stroke: What You Need To Know

Returning to work after a stroke is a common concern for patients and their loved ones. While the recovery time after a stroke varies from person to person, the first three months are typically the most crucial for recovering from long-term cognitive impairments. After six months, many stroke patients experience significant improvement and can consider returning to work. However, this process can be slower for some, taking several years depending on the severity of the stroke and the intensity of treatment. During this time, stroke survivors often still experience invisible impairments, such as fatigue and concentration issues, which can impact their ability to work effectively. To support employees returning to work after a stroke, employers should understand these impairments and make reasonable adjustments, such as shorter hours and a gradual return to duties.

Gradual return to work, starting part-time and building up to full-time hours

Returning to work after a stroke is a common concern for many patients and their loved ones. While a stroke can affect many aspects of your everyday routine, it can also have a severe impact on speech and language, which are crucial in a work-related environment. The good news is that improvement following a stroke can be achieved years after the event, and returning to work is a goal for many patients.

A gradual return to work, starting part-time and building up to full-time hours, is often recommended as part of a patient's recovery. This approach, known as a phased return, can help stroke survivors ease back into work gently and is supported by occupational therapists and healthcare professionals.

• Timing: The first three months following a stroke are critical for recovering from long-term effects. However, it may take longer for some individuals, and improvement can be achieved even years after the stroke. Typically, at the six-month mark, individuals can begin to assess the feasibility of returning to work.
• Communication: It is essential to maintain open and regular communication with your employer during this process. Discuss your needs, adjustments that can be made, and work together to create a return-to-work plan.
• Support: Access support services, such as occupational therapists, who can help assess your readiness for returning to work and advise on any necessary aids or equipment. You can also seek support from organisations like the Stroke Association, which offers resources and guidance for returning to work.
• Adjustments: Be aware of the potential for "invisible impairments," such as fatigue, concentration issues, and changes in personality. These may not be immediately obvious to employers or even the stroke survivor themselves. Adjustments such as shorter hours and working from home may be necessary to facilitate a successful return to work.
• Travel: Travelling to work can be tiring, especially if you have a physical disability or sight loss. Consider trying out the journey on a non-work day to assess your needs. Working from home, even part of the time, can be a reasonable adjustment.
• Driving: After a stroke, there is a minimum one-month period during which you are not allowed to drive. Depending on your situation, this period may be longer, and you may need to explore alternative transportation options or career changes.
• Workload: When planning your return to work, it is essential to consider your tasks and workload. Be realistic about what you can and cannot do, and work with your employer to make any necessary adjustments. Prioritise your workload and consider what tasks you can start with and what you can work up to later.
• Reviews: Regular reviews with your employer are essential to assess your progress and make any necessary adjustments. These can be informal, such as weekly 20-minute check-ins with your line manager, but it is helpful to keep brief notes of each meeting.

Remember, returning to work after a stroke is an individual process, and the timeline and adjustments will vary depending on your specific circumstances. It is crucial to seek professional advice and support throughout this journey.

Adjustments in the workplace, such as long-handled tools or special gloves

Returning to work after a stroke is part of the recovery process. When you feel ready to return to work, your employer should work with you to identify your needs and the adjustments they can make to help you.

Long-Handled Tools

Long-handled tools can assist individuals who have limited range of motion, strength, or balance after a stroke. These tools can help with various tasks, such as:

• Reaching and Gripping: Long-handled tools, such as reachers, can assist individuals who have difficulty bending, reaching, or gripping items. These tools extend an individual's reach and enable them to grasp items without straining.
• Hygiene and Self-Care: Long-handled shower brushes and hip kits, which include long-handled shoe horns, can aid in bathing and dressing, especially for those with limited mobility.
• Mobility Aids: Some long-handled tools, like walking sticks or canes, can provide support and balance for individuals who need assistance with walking or standing.

Special Gloves

Specialised gloves can be incredibly beneficial for stroke survivors experiencing hand weakness, paralysis, or limited mobility. Here are some types of gloves that can help in the workplace:

• Static Hand Braces: These braces hold the hand and fingers in a stretched-out position, preventing contractures (stiff, tight, and often painful joints) from developing. They are ideal for individuals with clenched or immobile hands.
• Edema Gloves: These tight-fitting gloves help reduce and prevent swelling in the hand and wrist. They can improve hand mobility by reducing excess fluid build-up.
• Dynamic Braces: These gloves place the fingers in a stretched position while allowing some flexibility for finger movement. They promote hand movement and protect the joints.
• Assistive Robotic Gloves: These gloves use technology to power finger movement. They enable individuals to use their hands more easily during daily activities and encourage small movements, providing stimulation to the brain.
• Hand Therapy Exercise Gloves: These gloves contain sensors that track hand movements during therapy exercises. They help rewire the brain and restore hand function. An example is the MusicGlove, which has been clinically proven to improve hand function.

Speech therapy and recovery

The impact of a stroke on an individual's speech and communication capabilities can be severe, and often frightening. However, speech therapy can help patients recover their ability to express thoughts and emotions and understand others.

Aphasia

The medical term for communication problems caused by a stroke is "aphasia". This is the most common language disorder caused by a stroke and can affect how someone speaks, their ability to understand what is being said, and their reading and writing skills. There are three types of aphasia: receptive, expressive, and mixed. Receptive aphasia involves problems understanding what is being said, while expressive aphasia makes it difficult to express oneself, and mixed aphasia is a combination of the two. Aphasia does not affect intelligence, but it can sometimes appear that way.

Dysarthria and Dyspraxia

Following a stroke, a patient may suffer from dysarthria, which causes weakness in the muscles used to speak, including the mouth, lips, tongue, and those that regulate breathing while speaking. This can make speech sound different or less clear. Dyspraxia is similar, in that it affects the movement and coordination of muscles, but in this case, the muscles used to produce the voice remain functional. However, the patient may be unable to move those muscles in the correct order or sequence to make the necessary sounds for clear speech.

Speech Therapy

Speech therapy can help to reduce the effects of aphasia and improve everyday activities like joining in conversations, reading, and writing. Speech-language pathologists (SLPs) assess, diagnose, and treat disorders related to speech, voice, language, and cognitive communication. They work with the patient and their caregiving team to create an individualized treatment plan, tailored to the patient's needs, with the goal of helping them achieve the highest level of communication and language function possible. Treatment may include neuromuscular re-education of the voice and swallowing muscles, cognitive language exercises, and activities to adjust communication ability. SLPs also work with the healthy areas of the brain, stimulating them to take over the function of language through neuroplasticity.

SLPs also direct patients to resources outside of therapy sessions, such as computer programs and mobile apps that aid in relearning words and sounds. Props and communication aids, such as pictures, notecards with common phrases, and pen and paper, are also often encouraged. Family and friends can help by consistently including the patient in conversations, giving them plenty of time to talk, and keeping distractions to a minimum.

Singing Therapy

For patients who have sustained major damage to the brain's language centre, it may take some time before they are able to talk again. However, singing therapy can be a highly effective strategy for helping stroke patients regain their ability to speak conversationally. This is because speech is a left-brain function, while singing is a right-brain function, so the undamaged right side of the brain can be trained to speak through singing.

Understanding invisible impairments like fatigue and concentration issues

Returning to work after a stroke is a challenging process that requires careful planning and support from employers and colleagues. A stroke survivor may face various invisible impairments, such as fatigue and concentration issues, which can impact their ability to perform their job effectively. These issues are not always obvious, and they can put individuals at risk of losing their jobs if not properly addressed. Here are some ways to understand and manage these invisible impairments:

Recognise the Impact of Fatigue

Fatigue is a common issue after a stroke and can affect an individual's ability to perform their job. It is important to understand that fatigue is not just physical tiredness but also includes mental and emotional exhaustion. Stroke survivors may need longer breaks, reduced hours, or flexible work arrangements to manage their energy levels throughout the day.

Address Concentration and Memory Issues

Concentration and memory issues can make it difficult for stroke survivors to focus on tasks, retain information, and make decisions. To help with this, employers can provide additional training, clear instructions, and structured routines. Breaking down complex tasks into smaller steps and providing visual aids or checklists can also improve concentration and memory retention.

Implement Gradual Return-to-Work Programs

A gradual return to work can help stroke survivors adjust to their new reality and manage their energy levels. Starting with reduced hours and gradually increasing them over time allows individuals to ease back into their work responsibilities. This approach can also help employers and colleagues understand the challenges faced by the returning employee and make any necessary adjustments.

Provide Flexible Work Arrangements

Flexible work arrangements, such as working from home or having a hybrid work model, can benefit stroke survivors by reducing the stress of commuting and providing a more comfortable and familiar environment. Additionally, flexible hours can help individuals manage their energy levels and medical appointments more effectively.

Offer Emotional Support and Understanding

Returning to work after a stroke can be emotionally challenging, and individuals may struggle with feelings of anxiety, depression, or a lack of confidence. Employers and colleagues can provide emotional support by being patient, offering encouragement, and creating a positive work environment. It is important to remember that each stroke survivor's experience is unique, and their needs may change over time.

By understanding and addressing invisible impairments like fatigue and concentration issues, employers can play a pivotal role in helping stroke survivors successfully return to work and thrive in their roles. It is essential to maintain open communication, make reasonable accommodations, and provide the necessary support to facilitate a smooth transition back to the workplace.

Support from employers, including accommodating new working patterns

Returning to work after a stroke can be challenging, but it is possible with careful planning, support, and adjustments. Here are some ways employers can support stroke survivors during their return to work and accommodate new working patterns:

Flexible Work Hours

Employers can allow survivors to adjust their working hours to match their energy levels. This may include starting work later in the day, taking more frequent breaks, or working from home. This flexibility can help survivors manage their energy and gradually ease back into work.

Phased Return to Work

Employers can facilitate a gradual return to work, starting with part-time hours or lighter duties. As the survivor builds stamina and confidence, their workload can be gradually increased until they are back to full-time hours and responsibilities.

Assistive Technology and Workspace Adjustments

The use of assistive devices or software can aid survivors with physical or cognitive challenges. This may include speech-to-text programs, screen readers, or ergonomic office equipment. Additionally, modifications to the physical workspace can be made to accommodate any physical limitations, such as changing the layout, using adaptive equipment, or ensuring easy access to necessary resources.

Vocational Rehabilitation Services

Vocational rehabilitation specialists can provide professional support to stroke survivors during their return to work. They can assess the survivor's skills, interests, and limitations to create a personalized return-to-work plan. This may include skill training, job placement assistance, and ongoing job coaching or mentoring.

Open Communication

Employers should encourage open and honest communication with employees who have experienced a stroke. It is important to discuss their condition, limitations, and any accommodations they may need. This can help employers make necessary modifications and provide the required support to facilitate a successful return to work.

Frequently asked questions