Returning to Work After Stroke

"Not working is perhaps the truest definition of what it means to be disabled." - T. Louis

A comprehensive evaluation by a rehabilitation team is the key to identifying barriers to working. Physical abilities, communication, and cognitive skills are assessed. Vocational testing to identify job-related aptitudes, interests, and skills may also be performed. A job site analysis may be needed to set up job simulations for therapy sessions, develop modified job duties or identify reasonable accommodations for successful return to work. Early and frequent contact with the employer increases the likelihood of returning to work.

Successful treatment programs are driven by individualized goals that address the specific barriers identified during the evaluation. Several programs are available, depending on the barriers and whether the person has a job to return to or will be training for a new occupation.

Work Hardening: An intensive program (up to 20 hours week) consisting of exercises for strengthening, endurance, and flexibility, and simulations of actual job tasks.

Work Conditioning: A less intensive program (6 to 10 hours a week) that focuses on strength, endurance and mobility. It sometimes leads into Work Hardening, but can also be used to improve general work tolerances when the person does not have a job identified.

Work Adjustment addresses cognitive and behavioral barriers to employability. Areas addressed include interpersonal skills, positive attitude, and appropriate work behaviors (e.g. attendance, timeliness, ability to take instruction from a supervisor, and safety.)

When the treatment goals are met, the return-to-work plan can be implemented. For some workers, it may be as simple as returning to the job site at the scheduled work time. For others, there may be a transitional period to build up specific work tolerances or to work out problems seen only on the job site. The job duties and/or the work schedule may be modified. A job coach may go with the employee to help transfer skills learned in the clinic to the work setting.

Early rehabilitation efforts for stroke survivors are directed at achieving independence in self-care, walking, and communication. Once these skills are mastered the focus changes to community re-entry, including social activities, driving, and return to work. By addressing specific barriers with the employer and treatment team, many stroke survivors are able to reclaim the valued role of worker.

Common Barriers to Return-to-Work after Stroke

Physical
    Weakness
    Paralysis
    Fatigue
    Balance impairment
    Vision changes

Communication
    Impaired reading/writing
    Difficulty speaking
    Difficulty understanding

Cognition
    Decreased memory
    Impaired attention
    Poor safety judgment
    Impaired interpersonal skills

Psychosocial
    Depression
    Decreased confidence
    Lack of knowledge about "The System"
    Not wanting to accept lower position/pay
    Job mentally or physically stressful

Financial disincentives
    Fear of losing government health insurance
    Loss of disability benefits

Other
    Lack of transportation