{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T22:11:03Z","timestamp":1774476663903,"version":"3.50.1"},"reference-count":48,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,8,24]],"date-time":"2024-08-24T00:00:00Z","timestamp":1724457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp;amp; Comm Disor"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>People with communication disability after stroke experience low rates of return to vocational roles. Vocational rehabilitation is recommended; however, there are no clear guidelines informing vocational rehabilitation for people with communication disability. Understanding the needs and experiences of this population is critical to improving vocational stroke rehabilitation outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>This study aimed to: (1) investigate the experience of vocational rehabilitation for people with communication disability after stroke, (2) identify gaps and, (3) provide preliminary recommendations for tailored service delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Seven participants with an identified communication impairment following stroke were recruited from a larger clinical trial of early vocational rehabilitation (20% of total sample, <jats:italic>n<\/jats:italic> = 34). To address the study aims, a qualitative design was employed. Semi\u2010structured, in\u2010depth interviews were conducted and analysed using thematic analysis. Data were integrated with demographic and intervention audit data to contextualise participant experiences, identify vocational rehabilitation gaps and inform preliminary recommendations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Participants were five men and two women aged 24\u201369 years whose communication profiles included difficulties with auditory comprehension and information processing, reading comprehension, thinking, executive function and self\u2010regulation, as well as difficulties with verbal and written expression. Vocational rehabilitation was perceived as beneficial but participants identified gaps including limited access to psychological and peer\u2010based support during early rehabilitation, limitations to accessing specialist vocational rehabilitation programs, barriers to accessing ongoing rehabilitation after resumption of vocational activity, and limited preparedness for the degree of impact that their communication changes had on execution of vocational roles and responsibilities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Vocational environments are communicatively demanding and people living with acquired communication difficulties face a range of vocation\u2010related participation barriers even when communication difficulties are mild. Greater emphasis on evaluating the vocational communication environment and targeted communication training and preparation for colleagues within the workplace is recommended to reduce barriers faced. Interdisciplinary rehabilitation, inclusive of psychological care, may support working\u2010age stroke survivors to recognise and acknowledge changes in their communication function, lead to improved engagement in the rehabilitation process, and ensure early identification of factors likely to influence successful return\u2010to\u2010vocational activity.<\/jats:p><\/jats:sec><jats:sec><jats:title>WHAT THIS PAPER ADDS<\/jats:title><jats:sec><jats:title>What is already known on the subject<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Stroke is common amongst people of working age yet fewer than half of stroke survivors will return to pre\u2010stroke vocational roles. Communication difficulties affect anywhere between 24% and 45% of people after stroke and include changes to language abilities, motor speech, vision, hearing and cognition. This group experiences much lower rates of return to vocational roles when compared to people with stroke who do not have a concomitant communication difficulty. Vocational rehabilitation is recommended. However, currently there is limited evidence to inform vocational rehabilitation guidelines for people with stroke and communication difficulties. Achieving a successful return to vocational activity is associated with improved life satisfaction for people with communication difficulties after stroke and is a key research priority for this population.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What this study adds<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>This study investigated the experiences of people with communication difficulty after stroke who reported a goal of returning to pre\u2010stroke vocational activity. Data associated with types of interventions received, the experiences and perceptions of vocational rehabilitation, and experiences of returning to vocational activity were analysed to identify core rehabilitation needs and develop preliminary recommendations to inform future vocational rehabilitation guidelines for this population.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What are the clinical implications of this work?<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>The present study provides preliminary evidence that people experiencing communication difficulties after stroke require a more integrated rehabilitation pathway. During early stages of vocational rehabilitation psychological and peer\u2010based support is indicated to support adjustment to changed communication function and to enable productive goal setting and engagement in rehabilitation. Clinicians need to complete a detailed analysis of the vocational communication environment and consider the communication activities involved in the individual's future vocational duties in order to plan meaningful rehabilitation. A multidisciplinary approach is required and additional training for clinicians is indicated to support clinicians to work collaboratively within the vocational setting.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><\/jats:sec>","DOI":"10.1111\/1460-6984.13106","type":"journal-article","created":{"date-parts":[[2024,8,24]],"date-time":"2024-08-24T10:38:18Z","timestamp":1724495898000},"page":"2655-2670","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["\u201bUntil you're in the chair and executing your role, you don't know\u2019: A qualitative study of the needs and perspectives of people with stroke\u2010related communication disabilities when returning to vocational activity"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8571-4453","authenticated-orcid":false,"given":"Lucette","family":"Lanyon","sequence":"first","affiliation":[{"name":"Discipline of Speech Pathology, School of Allied Health, Human Services and Sport La Trobe University Melbourne Victoria Australia"},{"name":"Centre of Research Excellence in Aphasia Recovery and Rehabilitation Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3263-5038","authenticated-orcid":false,"given":"Ciara","family":"Shiggins","sequence":"additional","affiliation":[{"name":"Centre of Research Excellence in Aphasia Recovery and Rehabilitation Melbourne Australia"},{"name":"Queensland Aphasia Research Centre the University of Queensland Brisbane Australia"},{"name":"Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance The University of Queensland and Metro North Health Queensland Australia"},{"name":"School of Health Sciences The University of East Anglia Norwich Norfolk UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8605-5181","authenticated-orcid":false,"given":"Caroline","family":"Baker","sequence":"additional","affiliation":[{"name":"Centre of Research Excellence in Aphasia Recovery and Rehabilitation Melbourne Australia"},{"name":"Speech Pathology Department Monash Health Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3457-4438","authenticated-orcid":false,"given":"Serena Alves","family":"Stein","sequence":"additional","affiliation":[{"name":"Alfred Health Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7313-9909","authenticated-orcid":false,"given":"Sophie","family":"O'Keefe","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy Monash University Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9645-5429","authenticated-orcid":false,"given":"Emma J.","family":"Schneider","sequence":"additional","affiliation":[{"name":"Alfred Health Melbourne Australia"},{"name":"Department of Nursing &amp; 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