Introduction

A stroke is a medical emergency and is potentially life-threatening. If you suspect a person is having a stroke, contact emergency services immediately.

How to recognise if someone is having a stroke

The FAST acronym is the most recognisable system of recognising the most common signs of a stroke:

F – Face weakness. Ask the person to smile and look to see if their mouth or an eye has drooped or looks lopsided.

A – Arm weakness. Can the person raise both arms? Can they keep them there?

S – Speech. Can the person speak clearly and can you understand what they are saying? They may or may not be able to talk at all and have problems understanding you.

T – Time. If any of the above are new or they are worse than normal, suspect a stroke and call for an ambulance.

The above are the most common signs of a stroke, but if a person has any of the following, a stroke should also be suspected:

• Sudden weakness or numbness on one side of the body, including legs, hands or feet.
• Sudden difficulty finding words or speaking in clear sentences.
• Difficulty swallowing.
• Sudden blurred vision or loss of sight in one or both eyes.
• Sudden memory loss or confusion.
• Dizziness, nausea or vomiting, or a sudden unexplained fall.
• A sudden, very severe headache.
• Loss of consciousness.

The key is that these signs and symptoms are new or a deterioration from the ‘norms’ for that person.

The person may have difficulty understanding you if they have severe hearing loss, sight loss, or their first language differs from yours.

What is a stroke?

A stroke occurs when the blood supply to a part of the brain is interrupted, causing damage or death to the affected cells. The long-term impact on the person will depend on many factors. Some people will notice few, if any, effects, whereas for other people it affects every aspect of their life. For more information, read ‘How does a stroke affect an individual?’ below.

There are two main types of stroke:

• Ischaemic – a blood clot blocks the flow of oxygen in a blood vessel in the brain. This is the most common cause of a stroke.
• Haemorrhagic – a blood vessel in the head bursts and bleeds into the brain and surrounding area within the skull. For example, an aneurysm, or high blood pressure.

Another common term associated with strokes is:

• Transient Ischaemic Attack (TIA) or ‘mini stroke’. This is a when a person experiences temporary symptoms of a stroke. The symptoms may last a few minutes or up to about 24 hours. This condition is a warning sign that a full stroke is very likely to happen in the near future and must be treated as a medical emergency. Prompt medical treatment can prevent a full stroke.

How common are strokes?

Anyone can have a stroke at any age, including babies and children.

The World Stroke Organisation produced a report in 2022 with the following global statistics:

• 12.2 million people will have a stroke per year. This equates to one every 3 seconds.
• 101 million people are stroke survivors, nearly double the number 30 years ago.
• One in four people will have a stroke, an increase of 50 per cent in the last 17 years.
• In 2019, 63 per cent of strokes happened in people under the age of 70.
• The estimated global cost of stroke in 2017 was $451 billion.

In the UK, the Stroke Association estimates that:

• Every five minutes someone will have a stroke.
• 100,000 people per year will have a stroke.
• One in four people having a stroke will be of working age.
• There are 1.3 million people in the UK who are stroke survivors.

How does a stroke affect an individual?

The effects of a stroke will vary from person to person and depend on the nature and severity of the stroke. Some people make a very good recovery and have very few residual symptoms, whereas other people will continue to have several symptoms in the longer term.

The common factors that can influence how a person recovers from a stroke include:

• The type of stroke,
• Where in the brain the damage has occurred,
• The extent and severity of the damage,
• Time between the stroke and treatment,
• Access to appropriate treatment and rehabilitation services,
• The general health of the individual prior to the stroke.

Common features and effects of stroke

Physical

• Paralysis on one side of the body.
• Weakness in limbs on affected side and muscle loss.
• Difficulty with co-ordination and balance.
• Difficulty with dexterity.
• Pain.
• Bowels and bladder may be affected.
• Self-care – including the ability to drink and eat.

Vision

This affects about two-thirds of stroke survivors. For example, losing part of the field of vision in one eye, or double vision. If can affect their ability to:

• Read and write.
• Operate machinery.
• Drive.

Fatigue

Mental and physical fatigue is common after a stroke and often remains in the longer term, to varying degrees. These types of fatigue are not related to activity levels and don’t always improve with rest. This means that making adjustments for energy management can be vital in any return to work.

Communication

• Speaking – this can be due to weakness of the facial muscles.
• Understanding what is being said.
• Reading and writing.
• Concentration.

Cognition

• Processing of information (including organising and storing it).
• Concentration.
• Memory, especially short-term memory.
• Problem-solving.

Psychological

A stroke is a traumatic and sudden event which affects every part of a person’s life. In many cases this leads to:

• Depression.
• Anxiety.
• Frustration.
• Anger.
• Feelings of being unable to cope.
• Behavioural changes.
• A lack of confidence while they learn to adjust to their new situation.

Our Mental Health Toolkit has advice on supporting employees’ mental health.

Legal duties

The Equality Act 2010

In the UK, employers have duties to:

• prevent discrimination, and
• provide reasonable adjustments

for their disabled employees. This means that it is unlawful for employers to treat applicants, job candidates and employees unfavourably because of their disability.

The Equality Act also requires employers to make ‘reasonable adjustments’ for their disabled employees.

Suggested adjustments for employees who have had a stroke

Each person’s needs will be unique and will depend on any residual effects from the stroke and the job the person has. Some people will need several adjustments to help them return to work and others will need very few, if any. Just because someone does not have any outward signs of a stroke, does not mean that they have not been affected by it.

• Work with the individual and work to address the individual barriers they are experiencing to facilitate a return to work.
• Stay in touch with the individual when they are off work. Strokes can be traumatic and often leave a person feeling lonely, frustrated and worried about their future. Invite them to social events or coffee with the team if, and when, the person feels ready.
• Remind the employee of any work benefits that they may find useful in their recovery, such as employee assistance, and help for relatives.
• Paid time off for appointments, such as physiotherapy, speech therapy, occupational therapy, dietician, counselling, and doctor appointments, can facilitate recovery.
• Occupational Health review is also advised where redeployment and ill-health retirement are requested. This may be a requirement for larger organisations. More information can be found in our Occupational Health Toolkit.
• Workplace assessment prior to a return to work to assess if any specialist equipment is needed, such as assistive software, equipment and furniture such as chairs, keyboards and larger screens. In the UK, Access to Work may be helpful.
• Flexible working, including working from home if possible and requested.
• Modification of the job description and tasks if necessary.
• Phased return to work – this helps with assessing fatigue and efficacy of adjustments.
• Driving – an individual who has had a stroke may not drive for a minimum period of a month. In the UK, they will need to have met the DVLA criteria before driving. Insurance companies will also have to be informed. If driving for work, they may need to undergo further assessments by Occupational Health. For example, forklift truck driving or HGV.
• Commuting – if the person normally has to drive to work due to where they live or if the workplace is remote, adjustments such as flexible starts, working from home or car share may need to be considered.
• Working with materials, machinery, or in environments that are of higher risk – this will require an Occupational Health assessment prior to a person returning to these. Vision, concentration, dexterity, and mobility can all increase the risk of injury.
• Targets – these may need to be adjusted to fit the new situation.
• Retraining and redeployment – this may be needed if a person cannot do their previous role. For example, if someone can no longer carry out their cleaning role, but can be retrained to work in an administrative role instead. More information can be found in our Redundancy and Redeployment Toolkit.
• Desk position – it may be helpful to move the person’s desk to be nearer places they need access to regularly (such as toilets, kitchens and exits).
• Access and egress – Check if any adjustments are required for access and egress to and from a building are required. A PEEP (Personal Emergency Evacuation Plan) may be required for emergencies and should be in place for a person’s return. Also check accessibility to standard areas such as kitchen areas, toilets, and meeting rooms.

Supporting customers and clients who have had a stroke

• Are your premises accessible for people who have mobility and visual challenges and are they free of trip hazards?
• Ask them if you can help them and how. Don’t assume you know what they need.
• Disability awareness training for staff.
• Static, upright chairs for people to sit and rest while shopping can be very useful for those affected with fatigue. These will also help other customers and clients too. A chair that is too low, soft, or on wheels may be difficult to get up from.
• If someone cannot cut their food up because of their stroke, they may ask for it to be cut up for them. Rather than doing this at the table, arrange for it to be done discreetly, such as in the kitchen. Ask the person if there is anything you can do for them when they are ordering.
• If the customer has difficulty speaking because of their stroke, give them time to finish without interrupting them.

Further information

Business Disability Forum

• Advice Service.
• People Manager Toolkit.
• Occupational Health Toolkit.
• Angela Matthews (BDF Director of Policy and Research) opinion piece – Supporting employees returning to work after a stroke.

Other organisations

• Stroke Association.
• NHS stroke advice.
• Access to Work.