Returning to Work After Aphasia: Reframing Work
Re-entry
by
Marlene Schoenberg
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.
