Return to work after stroke: how to guide your client

Employment is an essential aspect of life- impacting how we view ourselves, our contributions to society at large, and self-esteem; not to mention the very necessary paycheck and health insurance coverage that most people will rely on. If you are a clinician working with someone who has sustained a cerebrovascular accident (CVA), especially someone who was working up to the point of injury, the question ‘will I be able to return to work after having a stroke?’ is likely on their minds.

Returning to work could also have long term, positive impacts on your clients wellbeing. Recent research shows that adults who return to work after their first stroke are more likely to have improved cognition than their counterparts, after 2 years.

For a younger person, employment is a state they likely had anticipated for many years to come. The prospect of suddenly being unemployed or even unemployable can be devastating. Occupational therapists study the various roles that a person holds in their life- and gainful occupation (paid or unpaid) is a major aspect of feeling productive and valuable to self and to society.

As a clinician working with people post-CVA, especially the younger population, return to work after a stroke is an area that you can expect to be asked about. The answer to this question, of course, will depend. The severity of their stroke, their specific area of employment, the modifications that their employer may be able to make to enable their continued employment, and other considerations must be taken into account.

Let’s have a look at what could impact this question, and some considerations to bear in mind when working with this population on this thorny issue.

Firstly, consider their level of ability.

Depending on the severity of the stroke, your client may/may return to their previously held employment. For those at a lower level of function, or facing profound health issues, employment will not be the immediate priority. However, for those who have had a moderate or mild CVA, return to work is a more realistic concern.

return to work wheelchair stroke

Depending on the area of the brain affected by their CVA, the varying difficulties and impairments they have, etc., your client may be able to consider returning to their previous jobs. Analyzing the demands of the specific job and how their current skills/challenges translates to the work is key to success. Your client may benefit from working with an occupational or vocational therapist to help break down the work demands and make specific adaptations and workplace modifications if necessary. An open line of communication with the employer is crucial in terms of making workplace expectations clear on both sides. The employer may not understand the specifics of the situation, or the persons remaining level of function, and so the tasks that will be part of employment should be clearly and unambiguously delineated.

Interested in becoming a Certified Brain Injury Specialist (CBIS)? Check out this article!

Analyze the job demands.

Even for a person with very good stroke recovery, it is worth scrutinizing the job tasks to see if modifications can be made to help make the transition back to work, and ongoing, an easier one. The employer may be able to reduce or offload certain tasks. They may provide physical accommodations, or even create a new position for the employee that will use their skills in the most effective way.

To learn more about accommodations such as assistive devices, technology, and worksite modifications; job restructuring and flexibility in time that may be made by the employer of a previously held position, read this publication.

For a person who has been more seriously impacted, or with a lower level of function, return to their previously held work after stroke may not be possible. In this scenario, it is still important to consider other avenues of employment. The benefits of working outweigh not working; and knowing that you can still function and contribute to your community is powerful!

Figure out what might work.

Help your client identify what work they’re suited to, based on their remaining skills and abilities. Help them identify their skills and the areas that they enjoy: be it interpersonal relations; working as a team; outdoors vs indoors; working with technology (or without); physical tasks versus more cognitive work; and so on. Whatever their previously held position, you can be sure that there were aspects that they enjoyed more than others. Leveraging on these preferences and skills will help re-frame returning to the workforce in a different job than before.

Volunteer positions may be a good jumping-off point to gain experience and confidence with return to work. This may also have the benefit of support from volunteer coordinators, shorter hours, and accessibility options.

Advocacy services, vocational counselors, and occupational therapists are fantastic resources to assist in the return to work process. Visit for more details on return to work resources in the USA.

Returning to work is a conversation that is worth having with your client, post-stroke. There are many fulfilling and productive roles that your client post-stroke can play in the community. By empowering them and collecting resources, we can be advocates and allies in the process of returning to work.

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