Returning to Work After a Stroke: A Guide for Survivors and Care Partners

Why Returning to Work Matters After a Stroke

After a stroke, many survivors are eager to return to their daily lives to regain a sense of normalcy and independence. Research shows that stroke survivors who return to work report higher life satisfaction and well-being.¹

Returning to work is a major milestone that supports a survivor’s identity, financial stability, and confidence, but it is not a step to be taken lightly. The transition “back to business” after a stroke requires careful planning, adequate support, and self-compassion.

How Stroke Survivors Can Prepare to Return to Work

While survivors might feel ready to return to work after a stroke, the process requires thoughtful preparation.

The first step is evaluating the individual’s readiness to return to work from a medical and emotional standpoint. Survivors should receive medical clearance from their healthcare providers. This step will likely include tests of thinking skills and physical abilities to make sure the survivor has recovered enough to safely return to work.

Many stroke survivors experience post-stroke fatigue, especially early in their recovery, which could impact their ability to return to work. A fatigue management evaluation may also be a part of the medical clearance assessment. Healthcare providers might recommend a fatigue management plan to help manage this side effect and allow a survivor to return to work after a stroke. 

Survivors and their care partners should consider the physical and logistic details of the work they hope to return to. Depending on how the stroke affected them, survivors may need to think about several important questions before returning to work, including:

• Whether they can work with limited movement or hand use
• Whether working from home is possible, either temporarily or permanently
• What support or changes their workplace can provide
• Whether they can still perform the same job duties they had before the stroke

The answers to these questions will depend on each person’s specific situation and recovery.

Stroke survivors should also honestly assess their own emotional readiness to return to work. Setting clear short-term, medium-term, and long-term goals can help manage expectations and create a realistic timeline.

The American Stroke Association offers several online readiness assessments to help survivors evaluate their personal journey.

We use the term “care partner” to be more inclusive of all types of people who support their loved ones with long-term health conditions, and because it matches our mission of empowering the individual to be in control and in charge of their own health and condition. It also implies that the individual is partnering with their loved one rather than “giving” their loved one a service.

How Vocational Rehabilitation Supports Stroke Survivors Returning to Work

A vocational or career coach might offer evaluations to determine if a survivor can adequately perform certain job functions, and work simulation to practice performing those activities. Research also shows that vocational rehabilitation plays an important role in helping stroke survivors successfully return to work.² Career coaches can also help survivors make a plan for returning to work, including workplace modification planning, understanding reasonable accommodations, and setting realistic goals.

If returning to a previous career isn’t possible, vocational coaches may be able to provide skills retraining for new job roles (or recommend other training options). They can also help with aptitude testing and job searches.

Understanding Workplace Rights and ADA Accommodations

Stroke survivors who hope to return to work should also understand their workplace rights, as outlined by the Americans with Disabilities Act (ADA) in the U.S. The ADA states that a person with a disability can’t be denied employment if they are qualified for and can do the key functions of a job, with or without reasonable accommodations.

Reasonable accommodations for stroke survivors under the ADA might include:

• • Reassignment to a vacant position
  • Providing or modifying equipment or devices
  • Job restructuring
  • Modified or part-time work schedules
  • Adjusting or modifying training materials or policies
  • Providing readers or interpreters

These accommodations must be provided unless they would cause major difficulty or cost too much for the employer. Read more about the ADA on the U.S. Equal Employment Opportunity Commission website.

It’s important to consider when and how to talk about returning to work after a stroke with an employer. In general, the first things a survivor may want to communicate will be:

• The date of the stroke
• The likely date of discharge from the hospital or rehabilitation facility
• A future date to get back in touch to discuss recovery and return to work plans

It’s also recommended that a stroke survivor request a copy of their employer’s policy on returning to work after sick leave. Survivors and their care partners should educate themselves on leave policies and the rights of disabled persons when it comes to returning to work.

Vocational rehabilitation coaches may be able to help survivors and their care partners understand workplace policies, survivors’ rights, and how to approach conversations about accommodations. 

Common Return-to-Work Plans After a Stroke

Stroke survivors will need to set goals and make a return-to-work plan that works for them and for their employer. Here are some example plans a survivor might consider:

• Gradual re-entry: A gradual re-entry plan might include increased breaks, shorter work days, or shorter work weeks with a schedule that slowly increases over time.
• Part-time or hybrid schedules: Returning to a job part-time or on a hybrid schedule that includes a combination of working in the office and telecommuting.
• Modified duties: Changing the duties associated with a job or modifying the duties to accommodate a survivor’s capacity.
• Remote options: Working full time from home or telecommuting.

Vocational rehabilitation coaches, therapists, and other healthcare providers may be able to make additional recommendations for drafting a return-to-work plan that will benefit both the survivor and their employer. 

Common Challenges Stroke Survivors Face at Work

Reasonable accommodations for stroke survivors can be as simple as offering a quiet place to work or as complex as a redesigned workstation.

There are many ways to meet common challenges stroke survivors might encounter:

• Fatigue is one of the biggest challenges stroke survivors face when returning to work.² Longer breaks, shorter workdays, and planned rest times can help manage fatigue at work.
• Memory issues may be helped by asking for written instructions, recording meetings, or using tools like smartphone reminders and checklists.
• Mobility problems can often be improved with special equipment, ergonomic workstations, or the option to work from home.
• Communication may improve with strategies from a speech-language pathologist, such as picture schedules, visual charts, and labeled reminders.

• Headaches and overstimulation may be reduced by providing a quiet workspace and using a desk lamp instead of bright overhead lights and trying to decrease sensory stimulation.

Most accommodations can be considered “reasonable” for stroke survivors in the workplace, depending on the specific job functions. If survivors or employers have specific concerns about a particular challenge, it is helpful to have a list of possible solutions ready to share. 

How Care Partners Support the Return-to-Work Process

Care partners play an essential role in any return-to-work plan. Research on return-to-work outcomes shows that support from care partners, employers, and coworkers plays an important role in helping stroke survivors successfully return to work.²

Care partners can help make and manage appointments, provide transportation, and help mitigate fatigue in day-to-day life. As survivors adjust to going back to work, they may have increased fatigue, irritability or feel uncertain about their employment. Care partners are instrumental in supporting the emotional transitions that naturally follow major changes, such as returning to work after a stroke.

Including care partners in all major decision-making and goal-setting as a survivor creates their return-to-work plan ensures that they receive all the support they need to make their goals a reality.

The Path Back to Work

While every stroke recovery is different, many survivors will include returning to work as a major goal in their recovery process. This milestone is a meaningful step that requires planning, support, and self-compassion. But with the appropriate medical clearance, a clear return-to-work plan, and reasonable accommodations from an employer, survivors can often go back to work and feel a stronger sense of financial and emotional well-being. 

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References:

1. Indicators for return to work after stroke and the importance of work for subjective well-being and life satisfaction, PubMed, https://pubmed.ncbi.nlm.nih.gov/12809195/

2. La Torre G, Lia L, Francavilla F, Chiappetta M, De Sio S, et al. (2022). Factors that facilitate and hinder the return to work after stroke: an overview of systematic reviews. Med Lav 113(3): e2022029. Webpage: https://pmc.ncbi.nlm.nih.gov/articles/PMC9437659/.