Is it possible to return to work after a stroke?

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Answered by: Angela, An Expert in the Effects of Having Stroke Category
In October 2011, my life was turned upside down by an ischemic stroke - a clot to the brain. Aged just 44, and considered by many to be "too young for a stroke", my doctor initially mistook it for a kind of migraine. Therefore, I did not receive any proper medical treatment until the following day. I got up expecting to feel well but fell into my bedside table before bouncing downstairs on my backside. There, I found the wreckage of a night I couldn't remember and realising that something was very wrong, dialed 999. The ambulance crew were with me in minutes and as I walked upstairs to dress, falling into the bookcase on the way, I overheard the word 'stroke' behind me.

I was in hospital for one week, having my blood pressure monitored every few hours; blood tests, an ECG, EEG, brain scan, cartoid scan. On release, I was signed off work for 3 months which seemed a very long time but in retrospect was nowhere near enough. My balance was poor, but with physiotherapy, my walking gradually improved although I still drag my left foot. I have very little dexterity in my left hand, although I have regained almost full feeling in it. I avoid bows and buttons as much as possible and struggle to use a knife and fork. Typing is a major challenge!

What I, and many other survivors, struggled with the most was the goddamn awful fatigue. For the first few months, if I wasn't staring into space wondering what the hell had happened to me, I was sleeping. Having always been a light sleeper, now the telephone or even the fire alarm couldn't wake me. The fatigue became much worse on my return to work. I felt exhausted in every fibre of my mind and body and couldn't make anyone understand. I felt frustrated when colleagues told me how well I looked or how much my walking had improved. They couldn't see what was going on in my head. I knew from day one that I couldn’t cope and that it was not what I wanted anymore. I hit a period of deep depression and truly felt it would have been better to have died. I struggled on for a year but was constantly under threat of disciplinary action for time off sick. My medication compromises my immune system and I caught everything going (and in a school everything goes!) The changes in my brain caused me to make mistakes for which I was put ‘under investigation’. The stress and pressure mounted until I couldn’t cope anymore so in March 2013, I quit.

I hear so many stories of stroke survivors been hounded out of their jobs and it makes me furious that some employers refuse to acknowledge or address the psychological effects of stroke. Being put under investigation made me feel criminalised, and the threat of disciplinary for absence made me feel like a malingerer. Colleagues with breast cancer were not treated this way, and were given as much time off for treatment as they needed.

Yet return to work after a stroke can be successful with the understanding, cooperation and willingness to adapt of an employer. A meeting should be set up between the employer, employee and occupational therapist to facilitate this. The therapist can identify obstacles, adaptations that may need to be made and can negotiate a phased return to work, initially with fewer hours or days. The employer has a duty of care to make any 'reasonable adjustments' required. For example, rest periods may need to be built into the working day to combat the fatigue of those who lack stamina.

Stroke kills brain cells and the connections between them and can also change the chemical messengers within the brain. This can lead to changes in physical, cognitive, language and emotional functions. Cognitive problems that are often associated with stroke include, feeling overloaded with information much more quickly, difficulties with concentration and inability to deal with multiple things at once. As a result, the brain has to work much harder to deal with the common everyday cognitive demands. This further leads to fatigue, frustration and anxiety. Strategies need to be put in place to help the survivor learn new ways of compensating to achieve the same result.

A return to work after a stroke is important to many survivors as a key goal in their recovery as well as a means of regaining their social and financial independence. Many have succeeded, but far more education is needed in the workplace and society at large about the effects of a stroke to make this a positive experience.

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