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About Stroke
Many individuals who have had strokes recover without limitations. Some individuals have temporary limitations while others have more long-term issues. Strokes can occur at any age, but are more common in people 65 years or older. Individuals who have had strokes can have short or long-term limitations that are cognitive or motor related.
Accommodations for individuals who have had a stroke vary, but for those with vision loss, technologies are available to help them overcome these limitations. These technologies may help with reading printed material, accessing computer information, writing notes and completing forms, accessing a telephone, working with money, reading from an instrument, assembling parts, driving, working with light sensitivity, distinguishing colors, and being mobile.
Hemiparesis, which is a weakness of one side of the body, is one of many residual effects of having a stroke that limit physical or motor functioning. Depending on the area of the brain where the stroke occurred, either the left or the right side of the body may experience a reduction in muscle strength. The degree to which motor functioning is limited depends on the individual and improvement in physical ability can be seen as a result of therapy and various forms of treatment. Hemiparesis can also limit an individual’s ability to perform a job or parts of a job, and those planning or preparing to return to work following a stroke may need to explore accommodation options. An individual experiencing hemiparesis may have difficulty walking, standing, balancing, climbing, grasping, or gripping objects for precision or detailed work tasks, and could experience general muscle fatigue or a lack of coordination. Depending on the type of job and the essential functions of the position, one or more accommodations may be needed to ensure that a return to work is successful for an individual with hemiparesis.
Strokes can also impact communication in a variety of ways depending on the part of the brain affected. Three typical speech and language impairments arising from stroke include dysarthria and apraxia, which impact one’s control over the movements of the muscles used in speaking; and aphasia, which causes difficulty understanding and using language. Some individuals who are recovering from stroke may have undergone evaluations to determine whether they would be helped by assistive technology such as augmentative and alternative communication (AAC) devices. This may be more likely for individuals with severe apraxia of speech that is not responding well to other treatments. They may also have learned or be in the process of learning compensatory techniques such as using a slower rate of speech or using other communication methods like typing, writing, drawing, or gesturing to support and enhance communication.
A stroke is a life-changing event that can affect an individual’s emotional well-being as much as his/her physical function. Many of us know and understand the physical (weakness, paralysis), cognitive (memory, processing), and communication (speech, language) challenges stoke survivors face, but we may not be aware of the challenges faced when mood disorders occur as result of a stroke. Although stroke effects are unpredictable, mood disorders such as depression, anxiety, and pseudo-bulbar affect (PBA) are common.
In general, accommodations could include the purchasing of equipment or assistive technology for an individual who uses a computer or performs detail-oriented assembly work. If an individual uses a mobility aid such as a scooter or wheelchair, worksite and/or workstation modifications may need to be made. A restructuring of a job, either to perform essential functions in a different way or reallocate marginal functions, flexibility in breaks, and leave to seek treatment may be potential accommodations to explore. Reassignment to a vacant position may be necessary if accommodations cannot be made in the current job or if an accommodation would pose an undue hardship.
JAN's Accommodation Solutions: Executive Functioning Deficits is a publication detailing accommodations for individuals with limitations related to executive functioning. These ideas may be helpful in determining accommodations.
Stroke and the Americans with Disabilities Act
The ADA does not contain a definitive list of medical conditions that constitute disabilities. Instead, the ADA defines a person with a disability as someone who (1) has a physical or mental impairment that substantially limits one or more "major life activities," (2) has a record of such an impairment, or (3) is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA).
Accommodating Employees with Stroke
People with stroke-related limitations may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people who are aging will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations is the employee experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training?
Accommodation Ideas:
Situations and Solutions:
The following situations and solutions are real-life examples of accommodations that were made by JAN customers. Because accommodations are made on a case-by-case basis, these examples may not be effective for every workplace but give you an idea about the types of accommodations that are possible.
A court employee was having difficulty with emotions after returning to work following an acquired brain injury due to a stroke.
She was diagnosed with pseudo-bulbar affect (PBA) that caused outbursts of uncontrollable laughter at seemingly inappropriate times. The employee asked that her co-workers be educated on PBA so they would better understand what could be viewed as inappropriate behavior. The employee agreed to talk to her neurologist about the training. She was also accommodated with extra breaks to help manage her stress, a temporary lightening of her workload, and a flexible schedule to allow her time for counseling and doctor appointments.
A customer service representative for a financial institution had long-term blurry vision from a stroke and could no longer read his computer screen.
The employer provided screen reading software for his computer so that information present on the screen and information inputted into the system would be read back to him.
A teacher had been released to return to work following a stroke resulting in hemiparesis of her dominant left side.
The individual had undergone treatment and rehabilitation, but had trouble balancing, standing, walking, and grasping small items, such as a pen. Accommodations provided included a stand/lean stool, a height-adjustable laptop tray with a laptop connected to the classroom smart board, low-tech grip aids for writing, and grab bars placed along the walls of the class and in the hallways for assistance with balancing.
An assistant manager for a nonprofit had complete loss of vision in one eye and low vision in the other due to a stroke.
The individual was having problems reading printed paper copies and emails. A portable magnifier, stand magnifier, and a closed-circuit television (CCTV) were used to magnify materials.
An automobile parts assembler had hoped to regain strength in his dominant right side following a stroke resulting in hemiparesis.
He had exhausted FMLA leave and decided to request reassignment. He was placed in a vacant stock clerk position that was less physically demanding. He was also provided a scooter to access the facility and a tablet device was mounted to the handlebars, which allowed him to access purchasing and receiving documents with one hand.
A medical receptionist was returning to work following a stroke resulting in hemiparesis of her non-dominant left side.
She had difficulty holding the phone while taking notes and typing information into a computer. Her employer provided a wireless headset and a one-handed keyboard as accommodations.
An employee returning to work after a stroke was dealing with depression.
As a result, the employee’s performance was impaired and the previous supervisory method was no longer effective. The supervisor agreed to meet with the employee weekly to discuss performance and conduct issues that were becoming problematic, as well as put accommodations into place. Among the accommodations: a flexible schedule for health care appointments, a diagram to help with the flow of duties, templates to assist in report writing, and a move to an area with more natural lighting.