For most of us, work forms a large part of who we are. When a stroke or head injury happens, it can drastically change a person’s ability to meet all the requirements of their job role.
VocationaL rehabilitation (VR) is a means of supporting people to work towards a return to work-related activity.
How can Vocational Rehabilitation help?
The aim of Speech and Language Therapists (SLTs) involved in VR (based on The Healthcare Professionals’ Consensus Statement on Health and Work) is to:
- Promote a culture where work is seen in a positive light
- Encourage stroke/brain injury survivors to strive towards returning to work
- Promote healthy lifestyles
- Determine appropriate adaptations for the workplace, considering any health risks or hazards
- Give specialist support for stroke/brain injury survivors to enter work, remain in work or return to work when they are ready and able to
- Reduce discrimination associated with ill health or disability
The NHS Vocational Rehabilitation Toolkit recommends that VR services are structured in 3 levels (see image below), with level 1 support being reserved for those with the most significant difficulties. Speech and Language Therapists are involved in all levels for stroke/brain injury survivors who are experiencing communication and/or swallowing difficulties.
A Collaborative, multi-disciplinary approach
Therapists working with stroke/brain injury survivors should ensure that they:
- Discuss their clients’ pre-stroke/injury work as soon as possible, regardless of whether they plan to return.
- Support their clients to understand how their stroke/injury might impact on their work.
- Support their clients to engage in conversations with their employer about returning to work, when appropriate.
- Help their clients to explore what support is available to access their job role.
- Do not explore plans for their client to return to work too early or without the required support.
This approach is only effective when Therapists work collaboratively, with each member bringing their specialist skills to the team. Professionals forming part of the team include (among others) Speech and Language Therapists, Physiotherapists, Occupational Therapists and Psychologists.
What do Speech and Language Therapists do to support Vocational Rehabilitation?
As we have covered in previous blog posts, Aphasia affects an estimated 350,000 people in the UK. It is the second most common major impairment after stroke. Aphasia is often associated with social withdrawal, low mood and reduced quality of life.
Many people with Aphasia struggle to return to their pre-stroke/injury work. Given that 10% of working age stroke survivors have Aphasia, this is especially problematic. Studies have shown that younger survivors with aphasia are less likely to return to work following a stroke than those without aphasia.
Speech and Language Therapists can support you (or your loved one) by:
- Conducting specialist assessment to determine the degree of difficulty and appropriate therapy and strategies to manage it.
- Discussing your working role prior to stroke/injury to find out the language and numeracy skills which may be required.
- Planning therapy activities around work-related tasks
- Helping you to engage with your employer.
- Helping you to receive appropriate support at work.
- Staying involved in the longer term, even after a return to work to prevent you from dropping out of employment.
- Working with other Therapists to consider other difficulties you may have e.g. changes in thinking skills, mobility, mood (to name a few), and making a therapy plan together.
What support can you get to make work more accessible?
Under the terms of the Equality Act (2010), employers should support people with disabilities to enable them to continue to work through the use of ‘reasonable adjustments’.
Examples of reasonable adjustments might include:
- Extra time to complete tasks
- Help from a support worker
- Changing working hours e.g. working reduced hours or different start and finish times
- Changing the working environment e.g. working in a quieter office, or from home
- Specialist equipment being provided e.g. seating, computer software
- Changing tasks to suit what you can do
- Changing targets or getting support from other colleagues to meet targets
- Time off to attend hospital appointments
- Regular meetings with the manager to review if any reasonable adjustments are effective
- Having help from an occupational health team
Schemes such as Access to Work can offer practical and financial support to help you get back to work. This might include help with writing job applications and CVs, advice on courses to help you to gain new skills or further develop existing skills. They may also be able to assign a work coach (or disability employment advisor) who is trained to help you to find work or to gain new skills for a job. Work coaches can help with preparing to enter work, the application and interview process and in confidence building. You might also be able to access work experience or work trials, to see if a job is the right fit for you before you enter into permanent employment.
Speech and Language Therapists and Advocacy
Speech and Language Therapists place person-centred care at the forefront of everything they do. A large part of this is ensuring that we understand your wants and needs to be able to act as your advocate.
As part of VR, SLTs will strive to find out more about your job role and routines including:
- What you do as part of your job
- Whether you are employed or self-employed
- What type of contract you have e.g. permanent, paid or voluntary
- Whether you plan to return to work
We want to empower you to feel confident to engage in discussions with your employer by helping you to access the right information and support. The final decision as to whether you will return to work or not will be between you and your employer. SLTs, and the wider VR team, can support you to produce an action plan regarding return to work, factoring in what adjustments could be needed and how barriers may be overcome.
What if returning to prior work is not possible?
We understand that for some stroke/brain injury survivors, a return to their prior job role may not be possible. Many factors might influence this including the amount of written/spoken communication required or the physical and/or cognitive demands of the role.
If you and your employer decide that returning to your prior job role is not possible, VR programmes can support you to explore alternative employment options. Many stroke/brain injury survivors decide that volunteering is a gentle transition to work-related activity. Volunteering can help people to gain confidence, meet people, learn new skills and make a difference. SLTs can support you to find volunteering opportunities which align with your interests and review how you are progressing when you start your volunteer role.
Why choose private Speech and Language Therapy to help with returning to work?
While the NHS has established guidelines for vocational rehabilitation, dedicated VR services are not yet established in all areas. Therefore, accessing this specialist support from the NHS in your area may not be possible. Independent SLTs have considerable experience in their field and can work with their clients in the longer term. This is in contrast to many NHS services, as we have discussed in previous blog posts. With the benefit of time and experience, we can understand your communication difficulties in the context of your daily life and plan activities to support you to work towards a return to work. Private SLTs can encourage therapy activity in real life settings and are well versed in working as part of a wider therapy team. If there are other professionals involved in your care, the VISTA SLT team would be keen to collaborate with them. Our experience shows us that working towards a shared goal is the best way to get the most out of your therapy.
If you, or a loved one, is in need of specialist support around returning to work, please do not hesitate to contact VISTA SLT for a no-obligation initial consultation.
Useful links and references
Academy of Medical Royal Colleges. 2019 Healthcare Professionals’ Consensus Statement for Action Statement for Health and Work. https://www.aomrc.org.uk/wp-content/uploads/2019/04/Health-Work_Consensus_Statement_090419.pdf
Brown C et al. Social Activity and Cognitive Functioning Over Time: A Coordinated Analysis of Four Longitudinal Studies. September 2012 Journal of Aging Research: https://pubmed.ncbi.nlm.nih.gov/22991665/
Brown K, Worrall L, Davidson B et al. Snapshots of success: An insider perspective on living successfully with aphasia. Aphasiology. June 2010; 24:10, 1267-1295.: https://www.tandfonline.com/doi/abs/10.1080/02687031003755429
Gov.uk ‘Access to work’: https://www.gov.uk/access-to-work
Government Equalities Office and Equality and Human Rights Commission. The Equality Act 2010. London: HMSO, June 2015: https://www.legislation.gov.uk/ukpga/2010/15/contents
Headway ‘Returning to work after brain injury’: https://www.headway.org.uk/about-brain-injury/individuals/practical-issues/returning-to-work-after-brain-injury/
Headway ‘Volunteering after brain injury’: https://www.headway.org.uk/media/11981/volunteering-after-brain-injury-publication.pdf
Manning M, MacFarlane A, Hickey A et al. Perspectives of people with aphasia post-stroke towards personal recovery and living successfully: A systematic review and thematic synthesis. PubMed. March 2019;14(3): https://pubmed.ncbi.nlm.nih.gov/30901359/
NHS England. National Stroke Service Model. May 2021; London: NHSE. https://www.england.nhs.uk/wp-content/uploads/2021/05/stroke-service-model-may-2021.pdf
NHS England. Vocational Rehabilitation Toolkit for professionals: https://www.e-lfh.org.uk/programmes/strokevrtoolkit/
Ross-Graham J, Pereira S, Teasell R. Aphasia and return to work in younger stroke survivors. May 2011. Aphasiology: Vol 25, No 8: https://www.tandfonline.com/doi/full/10.1080/02687038.2011.563861
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