POST STROKE

[debra21784]

What measures are used in making decisions about return to work post Stroke .Is there a defenitive guideline.My stroke was 2 years ago(massive)but treated with TPA and can walk independently but I am very slow N left hand use including fine motor .My spirit wants to return to work but I am fearful and wondering when that time comes how will I know.Also I am searching for any published articles or scholarly papers on this topic as well as cognitive changes post stroke when MCA  with speech loss was the area of ischemic attack.Can you point me in the correct direction? I am a master's prepared RN so I am looking for non-patient centered publications

[JodiB]

For those wondering whether returning to work is a viable option, might I suggest having some neuropsychological testing?  

Going through neuropsych testing and interpretation with a Ph.D. familiar with brain injury (a stroke IS an acquired brain injury, according to BIAUSA) is worth the effort:  It can then isolate any cognitive changes which have occurred.  

From there, one can begin some cognitive retraining to help develop strategies and compensations -- if needed.  Some very good CR programs exist which can help those stroke survivors function at an improved level.

I wish you well.

JodiB

[CCF-Neuro-M.D.-JT]

Understandable that you are concerned about returning to work after a stroke. As your "spirits" are ready, consider easing back into thing slowly. Start with a desk job just for a few hours a week. Use your comfort level (both physical and mental) to judge if you're working too hard or can do more. Don't push yourself especially when you're just starting. As no two strokes or patients are exactly alike, there's no real set guideline as to when someone is allowed to go back to work. We use the clinical exam (good that you're ambulatory) and cognitive status to help decide when the person can try. In one study, 58% of patients who had a stroke (all different kinds) were able to work after a year. There have been a few studies looking at which prognostic factors are most important in determining this:
1.memory deficit at 3 mos
2.impaired intelligence (how much?)
3.side of the stroke, dominant side less favorable
4.degree of weakness, meaning patients with normal strength had abetter prognosis
5.white collar job

THe studies don't all agree with each other and there are no hard and fast rules. For more academic info, here are some good articles

Stroke journal Dec 99, pp2568-73 by Wozniak et al
Stroke journal Mar 95, pp399-401 by Saeki et al
Disability and Rehab Sept 2000, pp578-82 by Saeki et al

If you're near an academic medical library, you can do a literature search using the key words "return to work" and "stroke."
HOpe that helps