The ‘invisible’ challenges around managing stroke

Employers and managers wanting to support stroke survivors back into work need to be aware that often it is “invisible” impairments such as fatigue, memory loss and poor concentration that are as much an issue as the physical after-effects.

Everyone knows strokes can have sometimes debilitating and extremely serious physical after-effects. But, with May being Action on Stroke Month, timely research has suggested it is often “invisible” side-effects, such as memory loss, concentration problems and fatigue, that can act as barriers to stroke survivors returning to work, or prove difficult for employers to manage.

These invisible impairments can make it hard for stroke survivors to maintain a job, according to a study from the University of Cambridge and Queen Mary University of London.

The findings, published in the journal BMJ Open, make the case that more needs to be done to spread awareness and knowledge among GPs and employers of the common difficulties, challenges and obstacles stroke survivors may face on returning to work.

The study set out to explore the experiences of people who had returned to work after a stroke, with researchers analysing the archives of TalkStroke, a UK-based online forum hosted by the Stroke Association, across a seven-year period, 2004-2011.

The researchers searched more than 20,000 posts for the phrases “return to work” and “back at work”, and ended up identifying 60 people who fitted the bill.


Memory and concentration loss

Almost all of these said they had still experienced a range of invisible impairments, including memory and concentration problems and fatigue. 

One of the challenges of this from the point of view of a manager or employer, of course, is that the employee, the survivor, to all intents and purposes looks “normal”, even if, inside, they’re feeling anything but.

This, in turn, can lead to a sense of frustration from the stroke survivor about their inability to cope, a sense of being somehow “a fraud”, but may also pose problems in the context of a lack of awareness or understanding among co-workers.

And the key?

It’s relatively simple: having a supportive employer. This was found to be hugely important in terms of helping stroke survivors to ease themselves back into work and enabling them to make suitable adjustments, such as perhaps a gradual return to work, reduced hours or working from home.

Conversely, when employers were unsupportive, the survivors said they found things much more distressing and stressful. In fact, some even reported being bullied by colleagues.


Supportive employers

Kate Pieroudis, manager of the Stroke Association’s “Back to Work Project”, said: “Employers can have a vital part to play in helping stroke survivors get back into the workplace and on the road to recovery. Stroke is incredibly complex and affects every person differently. In some cases, the long-term effects of the condition, such as communication problems or memory loss, may only become apparent in a work environment.

“With the right support, many stroke survivors can and do go back to work successfully. Planning with employers is essential so they understand how a stroke has affected an individual, and can put necessary support and adjustments in place. The Stroke Association provides information and practical advice on work and stroke to both employers and stroke survivors,” she added.

Awareness of the effect of strokes is much improved on what it once was, in large part thanks to the example of high-profile survivors of stroke, such as broadcaster and journalist Andrew Marr, as well as the memorable Act F.A.S.T stroke advertisements.

Events such as this month’s Action on Stroke Month from the Stoke Association are also helpful in terms of disseminating knowledge and raising awareness, both among employers and the general public.

More specifically for employers, the Stroke Association has a Complete Guide to Stroke for Employers, which can be downloaded here


Understand the issues

So the BHWA message for employers is, on this occasion, very simple: start by using use the resources that are available (most notably through the Stroke Association) and ensure you understand all the different, and often complex, facets of surviving stroke and returning to work.

But, most of all, understand that perhaps the most important “resource” in this context is you, the employer.

To offer the best support – to be an asset rather than an obstacle – an employer must, first, work to truly understand what an employee is experiencing

For example, as John Picken, MD of CANTAB Corporate Health, a BHWA founder member, makes the point, measuring cognitive function is a key part of rehabilitating stroke sufferers back into work, and there are tools that can readily do this.

“In a wider employment context, cognitive problems such as loss of concentration, struggling to remember or poor decision making can affect us all and for a whole host of reasons. If anyone is concerned, they should have their cognitive health assessed to see if they are performing as expected and rule out any clinically relevant issues,” he explains.

From there, it is question of ensuring the employee (and, to an extent, the manager) is able to access the specialist support they need. Occupational health triage can be helpful in this context in terms of helping to signpost an individual to the most relevant and appropriate specialist support.

Along with the resources already highlighted above, mental health first aid training for your organisation could also be valuable, and you can find resources for this through this website.

Ultimately, it is the attitude, support, understanding and knowledge of you as an employer, both at day-to-day line manager level and throughout your organisation, that is going to make all the difference.


Author: Nic Paton, BHWA blogger and news team. Please send your feedback to

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