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Returning to Work After Mild Stroke

      Nearly half of all strokes are considered mild strokes.
      • Wolf T.J.
      • Baum C.
      • Conner L.T.
      Changing face of stroke: implications for occupational therapy practice.
      Even though people with mild stroke may have minimal or no difficulty with everyday tasks like getting dressed or following a morning routine, they may have greater difficulty with more complex everyday activities like returning to work.
      • Hu X.
      • Heyn P.C.
      • Schwartz J.
      • Roberts P.
      • Johnston M.
      • Gilbody S.
      What is mild stroke?.
      Although mild stroke affects each person differently, many people report some changes in their ability to:
      • move arms and hands quickly and with good coordination
      • move legs and feet quickly and with good coordination
      • think quickly and clearly
        • Hartke R.J.
        • Trierweiler R.
        Survey of survivors’ perspective on return to work after stroke.
        • Kauranen T.
        • Turunen K.
        • Laari S.
        • Mustanoja S.
        • Baumann P.
        • Poutiainen E.
        The severity of cognitive deficits predicts return to work after a first-ever ischaemic stroke.
        • Moran G.M.
        • Fletcher B.
        • Feltham M.G.
        • Calvert M.
        • Sackley C.
        • Marshall T.
        Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review.
      • see clearly
      • speak and/or understand information
      • maintain physical and mental energy and stamina
        • Hartke R.J.
        • Trierweiler R.
        • Bode R.
        Critical factors related to return to work after stroke: a qualitative study.
      • manage emotions
        • Hartke R.J.
        • Trierweiler R.
        Survey of survivors’ perspective on return to work after stroke.
        • Moran G.M.
        • Fletcher B.
        • Feltham M.G.
        • Calvert M.
        • Sackley C.
        • Marshall T.
        Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review.
      This Information/Education Page provides information to people who have had a mild stroke and are thinking about returning to work. It also provides information on resources, services, and alternatives to returning to work, if resuming your previous job is not possible.

      What is return to work?

      Return to work can have different meanings to different people. In this Information/Education Page, we describe return to work as (1) returning to paid employment and/or (2) returning to volunteer work (unpaid). You may be returning to a previous position or starting a new position. In addition, your workload may be part-time or full-time.
      After a mild stroke, it is important to carefully consider how your abilities have changed since the stroke, the type of work you wish to do, your financial needs, and your personal goals.
      When returning to work, it is important that you are able to carry out essential job duties.
      • Wang Y.-C.
      • Kapellusch J.
      • Garg A.
      Important factors influencing the return to work after stroke.
      Some people go to rehabilitation before attempting to return to work. Other people who have had a mild stroke find that gradually returning to work is helpful. For example, someone may work half days 2 times a week until they feel more confident and comfortable returning to a full workload.
      Health care and community providers who specialize in return to work can support your return to work goals by collaborating with both you and your employer to develop an individualized return to work plan.

      Why is it important to return to work?

      Did you know that returning to work may actually help you with some of your recovery after a mild stroke? Studies have shown that working can help you maintain and even improve your brain health and thinking skills.
      • Hallevi H.
      • Molad J.
      • Korczyn A.
      • et al.
      Keep on working: occupational status before and after stroke protects the brain, general health, and cognitive status.
      Work also provides structure to your day and provides opportunities to socialize with other people. People who return to work after a mild stroke often find that they experience health improvements, have better social relationships, and report greater quality of life.
      • Hartke R.J.
      • Trierweiler R.
      Survey of survivors’ perspective on return to work after stroke.
      • Vestling M.
      • Tufvesson B.
      • Iwarsson S.
      Indicators for return to work after stroke and the importance of work for subjective well-being and life satisfaction.
      In addition, most people find that getting paid and having employer-provided benefits like health insurance are necessary.
      However, if return to paid employment is not an option or a desired goal, remaining active and productive through volunteer work, social activities, leisure and hobbies, or regular physical activities can provide many similar physical and mental health benefits.
      • Hartman-Maeir A.
      • Soroker N.
      • Ring H.
      • Avni N.
      • Katz N.
      Activities, participation and satisfaction one-year post stroke.
      • Billinger S.A.
      • Arena R.
      • Bernhardt J.
      • et al.
      Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

      When should I start thinking about return to work?

      If you were employed at the time of your stroke and think you may want to return to work, it is important to start planning early. Although you may feel the need to return to work right away, most people need a period of rest and rehabilitation first.
      Most people who have had a mild stroke and decide to return to work return within 3-6 months to their same employer.
      • Culler K.H.
      • Wang Y.-C.
      • Byers K.
      • Trierweiler R.
      Barriers and facilitators of return to work for individuals with strokes: perspectives of the stroke survivor, vocational specialist, and employer.
      Waiting longer before returning to work can actually make the transition back to work more difficult.
      • Culler K.H.
      • Wang Y.-C.
      • Byers K.
      • Trierweiler R.
      Barriers and facilitators of return to work for individuals with strokes: perspectives of the stroke survivor, vocational specialist, and employer.
      • Hackett M.L.
      • Glozier N.
      • Jan S.
      • et al.
      Returning to paid employment after stroke: the Psychosocial Outcomes in Strok (POISE) cohort study.
      • Teasell R.W.
      • McRae M.P.
      • Finestone H.M.
      Social issues in the rehabilitation of younger stroke patients.

      What should I do to return to my previous job?

      The first step when returning to work is contacting your employer. You will need to contact either your direct supervisor or the human resources department. You should find out if you are eligible for short-term disability, long-term disability, or unpaid medical leave with job protection and benefits under the Family and Medical Leave Act.
      • McDermott E.P.
      • Katz M.B.
      The Family and Medical Leave Act of 1993.
      You must apply to receive these benefits. If you have a union, you should consider contacting your union representative.
      The human resources representative can help you understand and apply for the benefits that match your circumstances. Early communication with your employer will also help you to determine your job security and understand how supportive your employer will be of your decision to return to work and in providing accommodations if needed when you return.
      • Donker-Cools B.H.
      • Schouten M.J.E.
      • Wind H.
      • Frings-Dresen M.H.W.
      Return to work following acquired brain injury: the views of patients and employers.
      • Ntsiea M.V.
      • van Aswegan H.
      • Lord S.
      Stroke survivors’ and employers’ perceived barriers and enablers of return to work after stroke.
      Health care and community providers, like vocational counselors, psychologists, and occupational therapists, can also help work with your employer to create a successful return to work plan for you.
      • Ntsiea M.V.
      • van Aswegan H.
      • Lord S.
      Stroke survivors’ and employers’ perceived barriers and enablers of return to work after stroke.

      What are reasonable accommodations?

      Some people need reasonable accommodations, supportive services, and a gradual return to work plan. The Americans with Disabilities Act
      US Department of Justice
      The Americans with Disabilities Act of 1990 and Revised ADA Regulations Implementing Title II and Title III.
      protects employees by preventing discrimination on the basis of disability and requires employers (with 15 or more employees) to provide reasonable accommodations. Requests for accommodations must be made in writing. Table 1 shows some common problems experienced by people with mild stroke and some potential accommodations. Table 2 shows some additional resources that may be useful after a mild stroke.
      Table 1Common problems after stroke and potential work accommodations
      Work-Related Problems Common in Mild StrokePotential Accommodations
      Oversensitivity to external stimuli such as noise or lightsPrivate office, desk light instead of overhead fluorescent lights
      Difficulty concentrating when there is noise and/or distractionsQuiet work area, headphones, or ear plugs
      Difficulty resuming tasks if interruptedUninterrupted hours
      Needing longer time to process information and instructionsGetting written instructions for all assignments, ability to record meetings, extended deadlines
      Difficulty remembering detailsAssistive technology such as the use of a notebook or smartphone to take notes, written checklists
      Difficulty completing more than 1 task at a timeOrganizing tasks into smaller steps, job sharing
      Delays in recognizing errors in work and problem solvingFlow charts, regular reviews with assigned colleague or mentor
      Difficulty staying organized and meeting deadlinesAssistive technology such as the use of a smartphone at work to remind you of deadlines and meetings
      Not being able to work as long due to mental and/or physical fatigueIncreased breaks, shorter work days, or a gradual return to work schedule
      Becoming easily stressed and overwhelmedIncreased breaks, job restructuring for essential job functions only
      HeadachesQuiet work areas, more frequent breaks
      Problems with visionAssistive technology such as different glasses or computer programs
      Conflicts with coworkers and colleagues
      • Trygged S.
      Return to work and wellbeing after stroke—a success story?.
      Sensitivity training for supervisors and staff, approved breaks for stress management, allotted time for calls to counselors, individual or group psychotherapy for skill training in areas of communication and emotional regulation
      Weakness and/or decreased coordination on 1 side of the bodyHands-free telephone systems, ergonomic workstations, modified keyboards, voice recognition software
      Poor schedule flexibilityConsistent work hours that allow you to keep a consistent sleep schedule and morning and evening routine
      Altered ability to driveAbility to work from home or adjust work hours to allow for use of public transportation
      Table 2Additional resources
      OrganizationDescriptionContact
      National Stroke AssociationProvides information and resources for those interested in returning to work, whether paid or unpaid, including a Return to Work Employment Readiness Assessmentwww.stroke.org
      Job Accommodation Network (JAN)Provides free advice and consultation to individuals, employers, and health care providers on workplace accommodations, the Americans with Disabilities Act, and other work-related policieshttps://askjan.org
      Social Security AdministrationProvides an annual Red Book for understanding employment supports and incentive programshttps://www.ssa.gov/redbook/
      O*NETProvides information on job requirements for hundreds of jobshttps://www.onetonline.org/
      Vocational rehabilitation servicesRun by the states. Contact information for state VR services can be found on the Job Accommodation Network websitehttps://askjan.org/cgi-win/TypeQuery.exe?902
      Office of Personnel ManagementActively recruits individuals with disabilities for positions across the US federal governmenthttps://www.opm.gov/policy-data-oversight/disability-employment/
      Getting HiredRecruiting company that works to connect employers with individuals with disabilitieshttp://www.gettinghired.com/
      Volunteer MatchDatabase of volunteer opportunitieswww.VolunteerMatch.org

      What services are available to help you with your return to work decision and plan?

      Several health care and community providers can help you determine how your mild stroke may affect your ability to return to work. Working with health care and community providers can support your ability to return to work. Given the complexity and diversity of work environments, there is never a guarantee about return to work and no one can actually predict how successful you will be if you decide to return to work. Lots of different factors contribute to success with return to work like abilities, emotions, motivation, and support from other people you work with like supervisors or colleagues. Here is a list of providers that might be helpful when returning to work.
      • Neuropsychologists and rehabilitation psychologists can screen for and evaluate potential problems with emotional and thinking skills through in-clinic assessments. They can also provide rehabilitation services and psychotherapy to help you develop strategies and improve your thinking skills like concentration, memory, and mental stamina in preparation for return to work.
      • Mental health care providers can provide needed psychological support.
      • Physical therapists can help create balance and endurance programs and/or provide recommendations for fitness routines which are helpful for getting through the work day. They can also provide recommendations for physical problems that might affect how you perform your job.
      • Social workers or case managers can provide information on Social Security Disability Income and Supplemental Security Income if you are not able to return to work right away.
      • Occupational therapists can analyze work-related tasks, requirements of your job, and your work environment. Occupational therapists can collaborate with employers, provide recommendations for work accommodations, and provide training in skills, strategies, and assistive technology to help you adapt to any difficulties (such as those discussed above) that might affect how you perform at your job.
      • Speech-language pathologists can help with rehabilitation of work-related skills like thinking, talking, writing, and understanding information. They can provide recommendations in these areas that might impact how you perform your job.
      • Vocational counselors can provide vocational evaluations and provide opportunities to perform tasks similar to real-world job roles, which can support decisions to return to work. They can also work with employers to help establish return to work plans and can help monitor your progress once you return.

      What if returning to previous employer is not an option?

      For those not able to return to their previous employment or who are seeking first-time employment, state vocational rehabilitation (VR) services can be an important resource. State VR services can assist individuals with aptitude testing, skills training, and job searches.

      What if returning to paid employment is not an option?

      If you are not able to return to paid employment, volunteer work may be an option that provides some of the same benefits as paid employment. Vocational services can create work trials and help you identify potential volunteer opportunities. Some people may even prefer to volunteer instead of returning to paid employment. Volunteer work may also be the first step of a gradual return to work plan to help improve skills and endurance in preparation for return to paid employment if this is important to you.

      The importance of advocacy

      Because problems related to mild stroke are not always obvious, many adults with mild stroke are discharged from the hospital without receiving education about the effect of mild stroke and about resources and services that can support return to work.
      • Hartke R.J.
      • Trierweiler R.
      Survey of survivors’ perspective on return to work after stroke.
      • Roth E.J.
      • Lovell L.
      Employment after stroke: report of a state of the science symposium.
      Many people with mild stroke do not receive referrals for continued rehabilitation services.
      • Wolf T.J.
      • Baum C.
      • Conner L.T.
      Changing face of stroke: implications for occupational therapy practice.
      Adults with mild stroke who do return to work, whether services are received or not, may still experience challenges.
      • Trygged S.
      Return to work and wellbeing after stroke—a success story?.
      Self-advocacy, which is the ability to speak and act on behalf of one’s own needs, or advocacy by family members, may be needed to ensure that you receive needed services that can support safe and successful return to work.

      Authorship

      This page was developed by Shannon L. Scott, OTD, OTR/L, Ithaca College (e-mail address: [email protected] ); Suzanne Perea Burns, PhD, OTR/L, Medical University of South Carolina; Jaclyn Schwartz, PhD, OTR/L, Florida International University; and Mark Kovic, OTD, OTR/L, Midwestern University.

      Disclaimer

      This information is not meant to replace the advice from a medical professional. You should contact your health care provider regarding specific medical concerns and treatment. This Information/Education Page may be reproduced for noncommercial use by health care professionals to share with their patients and caregivers. Any other reproduction is subject to approval by the publisher.

      References

        • Wolf T.J.
        • Baum C.
        • Conner L.T.
        Changing face of stroke: implications for occupational therapy practice.
        Am J Occup Ther. 2009; 63: 621-625
        • Hu X.
        • Heyn P.C.
        • Schwartz J.
        • Roberts P.
        • Johnston M.
        • Gilbody S.
        What is mild stroke?.
        Arch Phys Med Rehabil. 2017; 15: 233-240
        • Hartke R.J.
        • Trierweiler R.
        Survey of survivors’ perspective on return to work after stroke.
        Top Stroke Rehabil. 2015; 22: 326-334
        • Kauranen T.
        • Turunen K.
        • Laari S.
        • Mustanoja S.
        • Baumann P.
        • Poutiainen E.
        The severity of cognitive deficits predicts return to work after a first-ever ischaemic stroke.
        J Neurol Neurosurg Psychiatry. 2013; 84: 316-321
        • Moran G.M.
        • Fletcher B.
        • Feltham M.G.
        • Calvert M.
        • Sackley C.
        • Marshall T.
        Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review.
        Eur J Neurol. 2014; 21: 1258-1267
        • Hartke R.J.
        • Trierweiler R.
        • Bode R.
        Critical factors related to return to work after stroke: a qualitative study.
        Top Stroke Rehabil. 2011; 18: 341-351
        • Wang Y.-C.
        • Kapellusch J.
        • Garg A.
        Important factors influencing the return to work after stroke.
        Work. 2014; 47: 553-559
        • Hallevi H.
        • Molad J.
        • Korczyn A.
        • et al.
        Keep on working: occupational status before and after stroke protects the brain, general health, and cognitive status.
        Stroke. 2018; 49: ATMP92
        • Vestling M.
        • Tufvesson B.
        • Iwarsson S.
        Indicators for return to work after stroke and the importance of work for subjective well-being and life satisfaction.
        J Rehabil Med. 2003; 35: 127-131
        • Hartman-Maeir A.
        • Soroker N.
        • Ring H.
        • Avni N.
        • Katz N.
        Activities, participation and satisfaction one-year post stroke.
        Disabil Rehabil. 2007; 29: 559-566
        • Billinger S.A.
        • Arena R.
        • Bernhardt J.
        • et al.
        Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2014; 45: 2532-2553
        • Culler K.H.
        • Wang Y.-C.
        • Byers K.
        • Trierweiler R.
        Barriers and facilitators of return to work for individuals with strokes: perspectives of the stroke survivor, vocational specialist, and employer.
        Top Stroke Rehabil. 2011; 18: 325-340
        • Hackett M.L.
        • Glozier N.
        • Jan S.
        • et al.
        Returning to paid employment after stroke: the Psychosocial Outcomes in Strok (POISE) cohort study.
        PLoS One. 2012; 7: e41795
        • Teasell R.W.
        • McRae M.P.
        • Finestone H.M.
        Social issues in the rehabilitation of younger stroke patients.
        Arch Phys Med Rehabil. 2000; 81: 205-209
        • McDermott E.P.
        • Katz M.B.
        The Family and Medical Leave Act of 1993.
        Labor Law J. 1993; 44: 673-684
        • Donker-Cools B.H.
        • Schouten M.J.E.
        • Wind H.
        • Frings-Dresen M.H.W.
        Return to work following acquired brain injury: the views of patients and employers.
        Disabil Rehabil. 2018; 40: 185-191
        • Ntsiea M.V.
        • van Aswegan H.
        • Lord S.
        Stroke survivors’ and employers’ perceived barriers and enablers of return to work after stroke.
        WCPT Congress 2015/Physiotherapy 2015. 2015; 101 ([abstract]): eS833-eS1237
        • US Department of Justice
        The Americans with Disabilities Act of 1990 and Revised ADA Regulations Implementing Title II and Title III.
        Laws/Regulations. 2014; 1990: 1-51
        • Trygged S.
        Return to work and wellbeing after stroke—a success story?.
        Int J Ther Rehabil. 2012; 19: 431-438
        • Roth E.J.
        • Lovell L.
        Employment after stroke: report of a state of the science symposium.
        Top Stroke Rehabil. 2014; 21: 75-86