Returning to Work After Aphasia: Reframing Work Re-entry

This is the first in a series of articles on speech issues in the workplace. Future articles will expand upon hidden speech disabilities, as well as differential diagnosis between a speech disability and ESL (English as a second language).

Daniel Webster, the famous orator, once said, “If my possessions were taken from me, with one exception, I would choose to keep the power of communication. For by it, I would soon regain all the rest.” Individuals whose speech and language skills are stolen by a stroke deeply understand the effects of aphasia on their careers and social lives.

What is Aphasia?

Aphasia is a loss of language after a stroke. It could affect comprehension, reading speech or writing, depending on where the brain lesion is located. Aphasia might occur in isolation or it can be accompanied by dysarthria (a motor weakness or incoordination), apraxia (a sound sequencing disorder) or loss of executive functions (high-level cognitive skill organization and integration). Aphasia can be mild, moderate or severe. It could affect grammar, articulation, fluency and word finding.

This speech/language disorder tends to look worse in the acute phase but usually much recovery does occur in the first three months after the stroke. Recent research has indicated that brain cells can continue to recover after a year or more. What happens in that time between termination of therapy in the hospital or rehab center and getting back to work?

About 20 years ago, I helped a client return to work as a veterinary technician many months after her brain tumor was removed. She developed a dyslexia type syndrome reversing letters and had difficulty reading non-phonetic words (e.g., aisle or clothes). With therapy, she made a remarkable recovery and was able to return to her job.

Other people are not as lucky. The ability to return to work after aphasia so often depends on the location and the extent of the client’s specific brain damage, their education and personality, the support system they have, as well as the nature of their jobs.

A janitor’s position may not involve a lot of verbal communication, however, if he or she cannot read the chemicals on cleaning products, the neurological impairment might affect the job. The loss of the tip of a pinky can be a traumatic occupational adjustment for a concert pianist.

After a stroke, a high school teacher might still be able to teach, but have a difficult time planning. A lawyer might be able to do public speaking, but might not be able to remember conversations. A pharmacist may be able to count pills and use a computer with assistance, but may not be able to use the computer independently or direct assistants. A psychologist might be able to continue to counsel clients, but might not be able to write reports or organize files.

An Inspiring Professional with Aphasia

Rita M. was a successful nurse manager and an expert in her field at a major health care provider. She was at the top of her game and well respected by colleagues. Initially, when she had her stroke, she completely lost her speech.

After intensive speech therapy and a lot of hard work, Rita regained much of her speech. Early on, she pushed herself to make phone calls and meet people. She sought out the help she needed at every stage of the recovery process. Her indefatigable spirit and her ability to mobilize a community of supporters assisted her recovery. She found many volunteer opportunities where she could give back to others, such as helping refugee families and working for the Stroke Association.

Rita realized that she could not go back to nursing so she explored other career options. She still has some residuals of her speech disability, which include word finding problems and difficulty sequencing numbers. Although her speech recovery indicates that she might be able to return to a professional position, she tires too easily to work even part time. Nevertheless, because of Rita’s relentless spirit and inspiring drive to succeed, she was chosen as the recipient of the Levine-Cohen Jewish War Veterans Speech Therapy Scholarship in 2004.

For individuals like Rita who want to prepare for re-entry into the workforce, I would suggest the following:

• Find Ways to Feel Productive while Recovering Language Skills – Volunteer

After outpatient or home care speech therapy, there is a twilight time between waiting for more recovery and returning to gainful employment. This is a good time to volunteer as Rita did. Helping people less fortunate provides an incredible boost to self-esteem. It’s a natural way to practice language skills.

• Seek Vocational Rehabilitation

Vocational Rehabilitation plays an important role in the transition to work. Finding out what you can and cannot do is important. It is essential to figure out how speech and language play a part at work. In addition, other factors such as fatigue, stress, transportation, and motor coordination must be considered.

• Keep Time on Your Side

Don’t go back to work until you are ready. Give yourself as much time as you need. Accept the advice of your physicians and rehab counselors, although it may be a bitter pill to swallow. Then set new goals within your reach.

For anyone who deals with aphasia, also consider the social side of returning to work:

• Coworkers’ Reactions

It is challenging dealing with co-workers. Initial interactions may be awkward at first. It’s up to you to reach out and define interactions. Develop a brief, to the point way to explain your deficits. Know what information to keep to yourself, and what to share.

• Know Whom You Can Trust

Keep in touch with close colleagues who are supportive and enjoy being with you.

• Carefully Structure Social Activities in Your Favor

Noisy restaurants can be overwhelrning. Find a quiet place to talk.

For companies that want to help their employees transition back to work after a stroke, defining the occupational requirements for the speech and language of each job can provide a useful tool for determining whether an employee with aphasia can still perform the job successfully. Some questions employers can ask while developing this tool are:

(1) What are the bona fide occupational requirements for speech and language of any job?

(2) Can employees still do their jobs with limited speech/language skills?

(3) Is verbal communication a major component of the work?

(4) What accommodations can be made?

People recovering from a brain injury might be able to do each aspect of their jobs but not with time pressures, stress, or while multi-tasking. Every job needs to have specific speech and language requirements with levels spelled out in the job description, similar to ADA regulations for lifting.

Marlene Schoenberg is a speech/language pathologist. She can be reached at Ethnic Communication Arts, 651-699-9233.