Archives of Physical Medicine and Rehabilitation

journal homepage: www.archives-pmr.org

Archives of Physical Medicine and Rehabilitation 2019;100:379-83

ORGANIZATION NEWS
Information/Education Page
Returning to Work After Mild Stroke
Nearly half of all strokes are considered mild addition, your workload may be part-time or
strokes.1 Even though people with mild stroke full-time.
may have minimal or no difficulty with everyday After a mild stroke, it is important to carefully
tasks like getting dressed or following a morning consider how your abilities have changed since
routine, they may have greater difficulty with the stroke, the type of work you wish to do, your
more complex everyday activities like returning financial needs, and your personal goals.
to work.2 Although mild stroke affects each per- When returning to work, it is important that you
son differently, many people report some changes are able to carry out essential job duties.7 Some
in their ability to: people go to rehabilitation before attempting to
return to work. Other people who have had a mild
 move arms and hands quickly and with good stroke find that gradually returning to work is
coordination helpful. For example, someone may work half days
 move legs and feet quickly and with good 2 times a week until they feel more confident and
coordination comfortable returning to a full workload.
 think quickly and clearly3-5 Health care and community providers who
 see clearly specialize in return to work can support your re-
 speak and/or understand information turn to work goals by collaborating with both you
 maintain physical and mental energy and and your employer to develop an individualized
stamina6 return to work plan.
 manage emotions3,5

This Information/Education Page provides in-

formation to people who have had a mild stroke
Why is it important to return to work?
and are thinking about returning to work. It also Did you know that returning to work may actually
provides information on resources, services, and help you with some of your recovery after a mild
alternatives to returning to work, if resuming stroke? Studies have shown that working can help
your previous job is not possible. you maintain and even improve your brain health
and thinking skills.8
Work also provides structure to your day and
What is return to work? provides opportunities to socialize with other peo-
Return to work can have different meanings to ple. People who return to work after a mild stroke
different people. In this Information/Education often find that they experience health improve-
Page, we describe return to work as (1) returning ments, have better social relationships, and report
to paid employment and/or (2) returning to greater quality of life.3,9 In addition, most people
volunteer work (unpaid). You may be returning to find that getting paid and having employer-provided
a previous position or starting a new position. In benefits like health insurance are necessary.
However, if return to paid employment is not
Disclosure: none an option or a desired goal, remaining active and

Descargado para Anonymous User (n/a) en National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra de ClinicalKey.es por Elsevier en marzo 17, 2020.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2020. Elsevier Inc. Todos los derechos reservados.
380 S.L. Scott et al

Table 1 Common problems after stroke and potential work accommodations

Work-Related Problems Common in Mild Stroke Potential Accommodations
Oversensitivity to external stimuli such as noise or Private office, desk light instead of overhead fluorescent
lights lights
Difficulty concentrating when there is noise and/or Quiet work area, headphones, or ear plugs
distractions
Difficulty resuming tasks if interrupted Uninterrupted hours
Needing longer time to process information and Getting written instructions for all assignments, ability
instructions to record meetings, extended deadlines
Difficulty remembering details Assistive technology such as the use of a notebook or
smartphone to take notes, written checklists
Difficulty completing more than 1 task at a time Organizing tasks into smaller steps, job sharing
Delays in recognizing errors in work and problem Flow charts, regular reviews with assigned colleague or
solving mentor
Difficulty staying organized and meeting deadlines Assistive 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/ Increased breaks, shorter work days, or a gradual return
or physical fatigue to work schedule
Becoming easily stressed and overwhelmed Increased breaks, job restructuring for essential job
functions only
Headaches Quiet work areas, more frequent breaks
Problems with vision Assistive technology such as different glasses or computer
programs
Conflicts with coworkers and colleagues19 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 Hands-free telephone systems, ergonomic workstations,
of the body modified keyboards, voice recognition software
Poor schedule flexibility Consistent work hours that allow you to keep a
consistent sleep schedule and morning and evening
routine
Altered ability to drive Ability to work from home or adjust work hours to allow
for use of public transportation

productive through volunteer work, social activ- to their same employer.12 Waiting longer before
ities, leisure and hobbies, or regular physical returning to work can actually make the transi-
activities can provide many similar physical and tion back to work more difficult.12-14
mental health benefits.10,11
What should I do to return to my
When should I start thinking about previous job?
return to work? The first step when returning to work is contacting
If you were employed at the time of your stroke and your employer. You will need to contact either
think you may want to return to work, it is impor- your direct supervisor or the human resources
tant to start planning early. Although you may feel department. You should find out if you are eligible
the need to return to work right away, most people for short-term disability, long-term disability, or
need a period of rest and rehabilitation first. unpaid medical leave with job protection and
Most people who have had a mild stroke and benefits under the Family and Medical Leave Act.15
decide to return to work return within 3-6 months You must apply to receive these benefits. If you

www.archives-pmr.org

Descargado para Anonymous User (n/a) en National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra de ClinicalKey.es por Elsevier en marzo 17, 2020.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2020. Elsevier Inc. Todos los derechos reservados.
Returning to work after mild stroke 381

Table 2 Additional resources

Organization Description Contact
National Stroke Provides information and resources for those interested www.stroke.org
Association in returning to work, whether paid or unpaid, including
a Return to Work Employment Readiness Assessment
Job Provides free advice and consultation to individuals, https://askjan.org
Accommodation employers, and health care providers on workplace
Network (JAN) accommodations, the Americans with Disabilities Act,
and other work-related policies
Social Security Provides an annual Red Book for understanding https://www.ssa.gov/
Administration employment supports and incentive programs redbook/
O*NET Provides information on job requirements for hundreds https://www.onetonline.
of jobs org/
Vocational Run by the states. Contact information for state VR https://askjan.org/cgi-win/
rehabilitation services can be found on the Job Accommodation TypeQuery.exe?902
services Network website
Office of Personnel Actively recruits individuals with disabilities for https://www.opm.gov/
Management positions across the US federal government policy-data-oversight/
disability-employment/
Getting Hired Recruiting company that works to connect employers http://www.gettinghired.
with individuals with disabilities com/
Volunteer Match Database of volunteer opportunities www.VolunteerMatch.org

have a union, you should consider contacting your mild stroke and some potential accommodations.
union representative. Table 2 shows some additional resources that may
The human resources representative can help you be useful after a mild stroke.
understand and apply for the benefits that match
your circumstances. Early communication with your What services are available to help you
employer will also help you to determine your job
with your return to work decision and
security and understand how supportive your
employer will be of your decision to return to work plan?
and in providing accommodations if needed when Several health care and community providers can
you return.16,17 help you determine how your mild stroke may
Health care and community providers, like voca- affect your ability to return to work. Working with
tional counselors, psychologists, and occupational health care and community providers can support
therapists, can also help work with your employer to your ability to return to work. Given the
create a successful return to work plan for you.17 complexity and diversity of work environments,
there is never a guarantee about return to work
What are reasonable accommodations? and no one can actually predict how successful you
will be if you decide to return to work. Lots of
Some people need reasonable accommodations,
different factors contribute to success with return
supportive services, and a gradual return to work
to work like abilities, emotions, motivation, and
plan. The Americans with Disabilities Act18 pro-
support from other people you work with like su-
tects employees by preventing discrimination on
pervisors or colleagues. Here is a list of providers
the basis of disability and requires employers (with
that might be helpful when returning to work.
15 or more employees) to provide reasonable ac-
commodations. Requests for accommodations  Neuropsychologists and rehabilitation psy-
must be made in writing. Table 1 shows some chologists can screen for and evaluate poten-
common problems experienced by people with tial problems with emotional and thinking

www.archives-pmr.org

Descargado para Anonymous User (n/a) en National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra de ClinicalKey.es por Elsevier en marzo 17, 2020.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2020. Elsevier Inc. Todos los derechos reservados.
382 S.L. Scott et al

skills through in-clinic assessments. They can VR services can assist individuals with aptitude
also provide rehabilitation services and psy- testing, skills training, and job searches.
chotherapy to help you develop strategies and
improve your thinking skills like concentration, What if returning to paid employment is
memory, and mental stamina in preparation for
not an option?
return to work.
 Mental health care providers can provide If you are not able to return to paid employment,
needed psychological support. volunteer work may be an option that provides
 Physical therapists can help create balance and some of the same benefits as paid employment.
endurance programs and/or provide recom- Vocational services can create work trials and
mendations for fitness routines which are help you identify potential volunteer opportu-
helpful for getting through the work day. They nities. Some people may even prefer to volunteer
can also provide recommendations for physical instead of returning to paid employment. Volun-
problems that might affect how you perform teer work may also be the first step of a gradual
your job. return to work plan to help improve skills and
 Social workers or case managers can provide endurance in preparation for return to paid
information on Social Security Disability In- employment if this is important to you.
come and Supplemental Security Income if you
are not able to return to work right away. The importance of advocacy
 Occupational therapists can analyze work-
Because problems related to mild stroke are not
related tasks, requirements of your job, and
always obvious, many adults with mild stroke are
your work environment. Occupational thera-
discharged from the hospital without receiving
pists can collaborate with employers, provide
education about the effect of mild stroke and
recommendations for work accommodations,
about resources and services that can support
and provide training in skills, strategies, and
return to work.3,20 Many people with mild stroke
assistive technology to help you adapt to any
do not receive referrals for continued rehabili-
difficulties (such as those discussed above)
tation services.1 Adults with mild stroke who do
that might affect how you perform at your job.
return to work, whether services are received or
 Speech-language pathologists can help with
not, may still experience challenges.19 Self-
rehabilitation of work-related skills like
advocacy, which is the ability to speak and act
thinking, talking, writing, and understanding
on behalf of one’s own needs, or advocacy by
information. They can provide recommenda-
family members, may be needed to ensure that
tions in these areas that might impact how you
you receive needed services that can support safe
perform your job.
and successful return to work.
 Vocational counselors can provide vocational
evaluations and provide opportunities to
perform tasks similar to real-world job roles, Authorship
which can support decisions to return to work. This page was developed by Shannon L. Scott,
They can also work with employers to help OTD, OTR/L, Ithaca College (e-mail address:
establish return to work plans and can help [email protected]); Suzanne Perea Burns, PhD,
monitor your progress once you return. OTR/L, Medical University of South Carolina;
Jaclyn Schwartz, PhD, OTR/L, Florida Interna-
What if returning to previous employer tional University; and Mark Kovic, OTD, OTR/L,
is not an option? Midwestern University.

For those not able to return to their previous

employment or who are seeking first-time Disclaimer
employment, state vocational rehabilitation This information is not meant to replace the advice
(VR) services can be an important resource. State from a medical professional. You should contact

www.archives-pmr.org

Descargado para Anonymous User (n/a) en National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra de ClinicalKey.es por Elsevier en marzo 17, 2020.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2020. Elsevier Inc. Todos los derechos reservados.
Returning to work after mild stroke 383

your health care provider regarding specific med- 10. Hartman-Maeir A, Soroker N, Ring H, Avni N,
ical concerns and treatment. This Information/ Katz N. Activities, participation and satisfaction
Education Page may be reproduced for noncom- one-year post stroke. Disabil Rehabil 2007;29:
mercial use by health care professionals to share 559-66.
with their patients and caregivers. Any other 11. Billinger SA, Arena R, Bernhardt J, et al.
reproduction is subject to approval by Physical activity and exercise recommendations
the publisher. for stroke survivors: a statement for healthcare
professionals from the American Heart Associa-
tion/American Stroke Association. Stroke 2014;
References 45:2532-53.
1. Wolf TJ, Baum C, Conner LT. Changing face of 12. Culler KH, Wang Y-C, Byers K, Trierweiler R.
stroke: implications for occupational therapy Barriers and facilitators of return to work for in-
practice. Am J Occup Ther 2009;63:621-5. dividuals with strokes: perspectives of the stroke
2. Hu X, Heyn PC, Schwartz J, Roberts P, survivor, vocational specialist, and employer. Top
Johnston M, Gilbody S. What is mild stroke? Arch Stroke Rehabil 2011;18:325-40.
Phys Med Rehabil 2017;15:233-40. 13. Hackett ML, Glozier N, Jan S, et al. Returning
3. Hartke RJ, Trierweiler R. Survey of survivors’ to paid employment after stroke: the Psychoso-
perspective on return to work after stroke. Top cial Outcomes in Strok (POISE) cohort study. PLoS
Stroke Rehabil 2015;22:326-34. One 2012;7:e41795.
4. Kauranen T, Turunen K, Laari S, Mustanoja S, 14. Teasell RW, McRae MP, Finestone HM. Social
Baumann P, Poutiainen E. The severity of cogni- issues in the rehabilitation of younger stroke
tive deficits predicts return to work after a first- patients. Arch Phys Med Rehabil 2000;81:205-9.
ever ischaemic stroke. J Neurol Neurosurg Psy- 15. McDermott EP, Katz MB. The Family and Medical
chiatry 2013;84:316-21. Leave Act of 1993. Labor Law J 1993;44:673-84.
5. Moran GM, Fletcher B, Feltham MG, Calvert M, 16. Donker-Cools BH, Schouten MJE, Wind H,
Sackley C, Marshall T. Fatigue, psychological and Frings-Dresen MHW. Return to work following
cognitive impairment following transient acquired brain injury: the views of patients and
ischaemic attack and minor stroke: a systematic employers. Disabil Rehabil 2018;40:185-91.
review. Eur J Neurol 2014;21:1258-67. 17. Ntsiea MV, van Aswegan H, Lord S. Stroke
6. Hartke RJ, Trierweiler R, Bode R. Critical factors survivors’ and employers’ perceived barriers and
related to return to work after stroke: a qualitative enablers of return to work after stroke [abstract].
study. Top Stroke Rehabil 2011;18:341-51. WCPT Congress 2015/Physiotherapy 2015 2015;
7. Wang Y-C, Kapellusch J, Garg A. Important 101:eS833-1237.
factors influencing the return to work after 18. US Department of Justice. The Americans
stroke. Work 2014;47:553-9. with Disabilities Act of 1990 and Revised ADA
8. Hallevi H, Molad J, Korczyn A, et al. Keep on Regulations Implementing Title II and Title III.
working: occupational status before and after Laws/Regulations 2014;1990:1-51.
stroke protects the brain, general health, and 19. Trygged S. Return to work and wellbeing after
cognitive status. Stroke 2018;49:ATMP92. strokeda success story? Int J Ther Rehabil 2012;
9. Vestling M, Tufvesson B, Iwarsson S. Indicators 19:431-8.
for return to work after stroke and the importance 20. Roth EJ, Lovell L. Employment after stroke:
of work for subjective well-being and life satis- report of a state of the science symposium. Top
faction. J Rehabil Med 2003;35:127-31. Stroke Rehabil 2014;21(Suppl 1):75-86.

www.archives-pmr.org

Descargado para Anonymous User (n/a) en National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra de ClinicalKey.es por Elsevier en marzo 17, 2020.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2020. Elsevier Inc. Todos los derechos reservados.