Are working aged adults with aphasia following stroke being ignored?
19 July 2012
Aphasia is a common occurrence following the neurological damage of a stroke. Individuals with aphasia following a stroke and carers are extremely vulnerable and understudied groups. Therefore studies such as the ACT NoW trial are highly welcome (1).
Stroke is mostly seen as a condition of the elderly, however 20-25 % of this patient population is below the age of 65 (2) and being of working age they are presented with a vast challenge when attempting to return to employment (3). The mean age of the study participants in the ACT NoW study was over 70 years of age and unfortunately in the relevant participants no effort was made to measure vocational outcomes such as return to employment (1)
Return to work after stroke should be considered one of the indicators of a successful rehabilitation as it positively influences self-image, well-being and life satisfaction (4). As an outcomes measure return to work is easy to measure, not subject to variability, familiar to non-specialists and highly significant to the patient.
Furthermore Professor Rudd mentions in this Editorial that “Rehabilitation treatments cannot be assumed to be benign and evidence of their cost effectiveness is needed” (5). Therefore the financial implications of returning to work and resuming self provision must also not be ignored.
A review of the literature to date suggests that the rate of return to work for individuals with aphasia following a stroke at 1 year is at best 52.6% and is particularly poor in those with receptive aphasia (6-12). However, in two previous studies it has been suggested that intensive rehabilitation of persons with aphasia can help with return to employment (10, 13).
Further research in this area should focus on the needs of working aged individuals with aphasia following stroke and should include vocational outcome measures such as return to work. Collaboration between units interested in vocational rehabilitation should also be encouraged.
1. BOWEN, A., HESKETH, A., PATCHICK, E., YOUNG, A., DAVIES, L., VAIL, A., et al 2012. Effectiveness of enhanced communication therapy in the first four months after stroke for aphasia and dysarthria: a randomised controlled trial. BMJ 345, e4407
2. DALEMANS, R. J., DE WITTE, L. P., BEURSKENS, A. J., VAN DEN HEUVEL, W. J. & WADE, D. T. 2010. An investigation into the social participation of stroke survivors with aphasia. Disability and Rehabilitation: An International, Multidisciplinary Journal, 32, 1678-1685.
3. PARR, S. 2007. Living with severe aphasia: Tracking social exclusion. Aphasiology, 21, 98-123.
4. TREGER, I., SHAMES, J., GIAQUINTO, S. & RING, H. 2007. Return to work in stroke patients. Disabil Rehabil, 29, 1397-403.
5. RUDD, AG., WOLFE, CDA., 2012. Is early speech and language therapy a waste? BMJ 345, e4870.
6. WOZNIAK, M. A., KITTNER, S. J., PRICE, T. R., HEBEL, J. R., SLOAN, M. A. & GARDNER, J. F. 1999. Stroke location is not associated with return to work after first ischemic stroke. Stroke, 30, 2568-73.
7. HOFGREN, C., BJORKDAHL, A., ESBJORNSSON, E. & SUNNERHAGEN, K. S. 2007b. Recovery after stroke: cognition, ADL function and return to work. Acta Neurologica Scandinavica, 115, 73-80.
8. NAESS, H., HAMMERSVIK, L. & SKEIE, G. O. 2009. Aphasia among young patients with ischemic stroke on long-term follow-up. Journal of Stroke & Cerebrovascular Diseases, 18, 247-50.
9. MCMAHON, R. & CROWN, D. S. 1998. Return to work factors following a stroke. Topics in Stroke Rehabilitation, 5, 54-60.
10. RAMSING, S., BLOMSTRAND, C. & SULLIVAN, M. 1991. Prognostic factors for return to work in stroke patients with aphasia. Aphasiology, 5, 583-588.
11. BLACK-SCHAFFER, R. M. & OSBERG, J. S. 1990a. Return to work after stroke: development of a predictive model. Arch Phys Med Rehabil, 71, 285-90.
12. ANGELERI, F., ANGELERI, V. A., FOSCHI, N., GIAQUINTO, S. & NOLFE, G. 1993. The influence of depression, social activity, and family stress on functional outcome after stroke. Stroke, 24, 1478-1483.
13. HINCKLEY, J. J. 2002. Vocational and social outcomes of adults with chronic aphasia. Journal of Communication Disorders, 35, 543-560.
Competing interests: None declared
Fife Rehabilitation Service, Sir George Sharp Unit, Cameron Hospital, Windygates, Fife, KY8 5RR
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