Stroke case study

Mr Smith had spent many years working full-time in an audit role for a financial services company. He had always been fit and healthy but out of the blue, he suffered a stroke. He spent 10 days in hospital before being discharged, where he started community-based rehabilitation.

As he was now feeling ready to consider returning to work, his employer referred him to our rehabilitation team for advice and guidance to help him plan and implement his return.

What is a stroke?

When someone has a stroke or cerebrovascular accident, the blood supply to a particular area in the brain is restricted or ceases, and some cells within the brain die.

There are two main types of stroke: ischaemic and haemorrhagic. The most common is an ischaemic stroke in which the blood supply stops due to a blood clot. The diagnosis is usually made by an MRI or CT scan, but other investigations may also be needed.

The effects of a stroke can be broad and can include:

• Muscle weakness in the arm and leg and changes in muscle tone
• Impairments in swallowing and speech
• Cognitive impairments (such as difficulties with memory, attention or processing)
• Changes in mood

Treatment usually involves a combination of medication to help dissolve the blood clot, address high blood pressure and reduce cholesterol.

In addition, rehabilitation is often required from different health care professionals, depending on the area of the brain affected and the impact of the stroke on function. This may include speech and language therapy, physiotherapy, occupational therapy and psychology. Rehabilitation begins as soon as someone is medically stable following hospital discharge.

Mr Smith had an ischaemic stroke, so needed physiotherapy support to help address the weakness in his left arm and leg, speech and language therapy to help improve his swallowing and speech, and support from an occupational therapist to help identify adaptations and recommend specialist equipment he might need at home.

Mr Smith’s occupational therapist ran some cognitive tests where he scored well, suggesting he had suffered only a mild memory impairment.

How Zurich was able to help

After being referred to our rehabilitation team, we had some introductory calls with Mr Smith and his employer.

Mr Smith had been advised by his neurologist (who was continuing to review him as an outpatient) that he could start a graded return to work (GRTW). We created and proposed a GRTW plan, taking into account Mr Smith’s current level of functioning and residual symptoms, as well as the demands of his job role, as he was experiencing some fatigue and weakness in his left arm and leg.

The GRTW plan started with Mr Smith working two half-days a week, on non-consecutive days, with a gradual increase of hours and days over a 12-week plan.

Due to the nature of the role and length of his absence, the initial part of Mr Smith’s return to work focused on retraining and updates. This training was carried out in the office but once he was up to speed, he moved to home-based working.

To help him build his confidence, the training was followed by a period of testing with dummy files before once again working on live files. Mr Smith’s training mentor and line manager provided him with support and gave regular feedback on his progress which helped him progress more quickly than had been anticipated.

The GRTW plan included regular calls with Mr Smith and his line manager to review how things were going. As Mr Smith’s case was also a claim that was in payment, regular updates were also provided to his claims case manager at Zurich, so everyone was regularly updated on the situation and his progress.

Dealing with anxiety and returning to full working hours

We noticed that despite his good overall progress, Mr Smith appeared anxious at times during his return-to-work period, and this anxiety seemed to be triggered by minor issues. We discussed it with Mr Smith, and he agreed with our observation. As his employer offered access to an employee assistance programme, he was able to access psychological therapy, and learned some coping strategies to manage his anxiety.

Following discussions with Mr Smith and his line manager, the GRTW plan was amended due to residual fatigue and was extended by four weeks. Mr Smith returned to his full contracted hours and role four months after returning to work and was able to successfully sustain this return.