Neurological diseases involve any disorder that affects the central or peripheral nervous system, which is composed of the brain and spinal cord, and all the other nerves in the body.
Neurological diseases are common and can result in an extremely wide range of symptoms, depending on the specific disorder and, especially where the brain is concerned, on the specific areas involved.
Neurological conditions such as Parkinson’s disease, motor neuron disease, and epilepsy result from damage to the brain, spinal column or peripheral nerves. Some neurological conditions are life threatening, with many severely affecting an individual’s quality of life. It is not always easy coping with the pressures of work when a person is affected by a neurological condition, and many employers are unaware of the ways in which their condition
might affect their work.
There are over 600 types of neurological conditions, which are broadly categorized (according also to a recent report of NHS UK) into:
- Sudden onset conditions (e.g. acquired brain injury or spinal cord injury),
- Intermittent and unpredictable conditions (e.g. epilepsy, certain types of headache, or the early stages of multiple sclerosis),
- Progressive conditions (e.g. motor neuron disease, Parkinson’s disease, or later stages of multiple sclerosis),
- Stable neurological conditions (e.g. post-polio syndrome, or cerebral palsy in adults).
In this section, we describe three neurological conditions: migraine, multiple sclerosis and stroke that are very frequent in working age.
The case of stroke
The case of Antoine who suffered for a stroke
A few months ago, Antoine had a stroke that caused him problems with speech and paralysis on the right side of his body. After rehabilitation, he recovered linguistic and motor skills very well but still has problems in moving the right limbs easily. Antoine is afraid that, since he often travels by car to go to customers, he will not be able to go back to his job. He hopes his manager will change his tasks or that the company can find him reallocation in the office but he is afraid, given the current economic crisis, he may be invited to take a disability pension that would mean staying home and leaving the company. This would have serious economic consequences for him and his family; his wife is a housekeeper and they have two children who are still at secondary school. None of his colleagues called him during his rehabilitation period and the human resources department only called him twice just to find out if, and when, he was going back to work.
1 What is it
A stroke occurs when there is an interruption in the flow of blood in the arteries or vessels to the brain, due to narrowing or thinning. Interruptions can come in the form of a burst blood vessel (hemorrhagic stroke / bleeding) or a blockage of a blood vessel, often caused by a clot, which can damage or destroy brain cells, affecting bodily function. The effects of a stroke on the body are immediate, but strokes can be treatable, if action is taken quickly and effectively. Stroke is one of the main forms of cerebrovascular diseases, affecting individuals at any age. 1 in 5 people will have a stroke at some point in their life, with most occurrences in individuals over 65. It is the second most common single cause of death in Europe responsible for 988,000 deaths every year and one of the main causes of disability worldwide. Genetics and lifestyle factors also play a key role in the predisposition for stroke.
People experiencing a stroke have various symptoms, which can also be confused with other unrelated conditions. The combination and duration of symptoms generally increase with the severity of onset, in some cases there are no clear correlations. Signs you may be having a stroke include:
- Numbness, weakness, or paralysis on one side of the body
- Slurred speech, difficulty thinking of words or understanding other people
- Sudden blurred vision or sight loss
- Being unsteady on your feet
- Severe headache
There is a wide variety of simple observational tests that can be done including:
- Facial weakness (can the person smile? Has their mouth or eye drooped?)
- Arm weakness (can the person raise both arms?)
Seeking immediate medical attention can significantly prevent further damage, disability or death.
While much can be done to inform a patient if they are at risk, diagnosis (via physical assessment, blood tests, Echocardiogram, ECG, x-ray/ultrasound/MRI/CAT scan etc.) is conducted following an attack. Determining the type of stroke, the part of the brain affected and the condition of the heart and lungs and circulatory system, will largely determine the course of treatment. Depending on the severity of damage and the timeliness of intervention, treatment therapies may include:
4 Psychosocial issues and impact of the disease on employment
The after-effects of a stroke are unpredictable and depend on the degree of severity and rapidity of intervention thus may vary from case to case depending on the area of brain affected. After a stroke, people may have communication problems and suffer from aphasia (lose the ability to speak or to find the right words, and/or understand others) or severe cognitive deficits and muscle paralysis. In addition to this, people might need the support of a psychologist to help them deal with the mental stress due to the change in their lifestyle, sensory disturbances and memory difficulties.
Rehabilitation aims to help stroke patients gain back their independence and quality of life. However, for some people returning to work, it may be a major concern and might take weeks or months.
To manage workers with stroke and help them continue working or returning to work, employers can promote some interventions
In the workplace, employers and colleagues have an important role in helping and understanding the life change of people affected by stroke:
- Right after the stroke, the level of recovery is individual, but people may need to follow a rehabilitation program, of varying length, in a training center: thus, planning together with the employee and colleagues how to manage absences and cope with the life change and its side effects, such as loss of performance and productivity, is important.
- People experiencing a stroke might need regular psychological support to come to terms with a slow recovery rate and/or the loss of previous abilities, such as mobility and communication. The support of family and friends can help stroke patients, so tele-working might facilitate workers’ reintegration after a stroke. In the longer term, the employer can agree on more flexibility and vocational rehabilitation through an accommodations agreement.
- People affected by stroke might not be able to drive again, especially in presence of hemianopsia (difficulty seeing to the left or the right in one or both eyes). For people who used to drive a commercial or public-service vehicle, this condition may be very disabling. In this case, people should receive training sessions so they can be transferred into a different area and reallocation should/might be provided to allow them to continue to work.
For further information, see:
European Multiple Sclerosis Platform (EMSP) – www.emsp.org/