Recovery and Return to Work after Stroke: A Case Study of a Commercial Baker Enrolled in the Accelerated Skill Acquisition Program of the ICARE Randomized Controlled Trial.

Case Study Report
Population: Adult

Oscar Gabriel Gallardo, PT, DPT, NCS, Site Study Coordinator/ASAP Therapist, Rancho Los Amigos National Rehabilitation Center

Rebecca Lewthwaite, PhD, Sub-Investigator, Rancho Los Amigos National Rehabiliation Center/University of Southern California

Carolee Winstein, PT, PhD, FAPTA, Principal Investigator, University of Southern California

Keywords: Participation, Return to Work, Recovery, Stroke


Stroke is the leading cause of adult disability in the United States, impacting approximately 6.8 million individuals and their families, with approximately 795,000 people experiencing a new or recurring stroke annually.  Approximately a quarter of these individuals are of working age; thus stroke survivors and their families, as well as society in general, experience substantial economic impacts. The Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) Stroke Initiative was an NIH-funded Phase III clinical trial designed to evaluate an investigational task-focused therapy (Accelerated Skill Acquisition Program, ASAP) and usual care occupational therapy in the outpatient setting for arm recovery after stroke.  ASAP is a structured, principle-based program consisting of 30, 1-hour sessions delivered over 16 weeks. Participants collaborate with their ASAP therapists to choose a set of upper extremity tasks involving strength, dexterity, and bimanual activity that are systematically pursued throughout their therapy visits.


The participant in this case study is a 61 yr old woman who experienced a left ischemic stroke.  She was randomized to the ASAP intervention 61 days after her stroke.  Prior to her stroke, she was employed full-time as a commercial baker working 6-7 days/week. Her daily tasks included fast-paced mixing, forming, and rolling out of dough, as well as carrying and shelving heavy trays of bread and pastries. At baseline, her Fugl-Meyer Assessment Upper Extremity Motor Score was 43/66.  Her Confidence in Arm and Hand Movement (CAHM) score was 28.5/100, and her Satisfaction with Life Scale (SWLS) score was 2.6/7.  Six out of the initial nine primary ASAP goals identified by the participant were related to tasks required for her return to work.

OUTCOMES:  The participant returned to her work at the bakery part-time with restricted duties for 4 hours/day by her 4th session of ASAP therapy, and to full-time employment without restrictions by her 12th therapy session, remaining in that status through the end of the study (12 months after randomization; 14 months post-stroke). She reported an end-of-study CAHM score increase to 60.5/100 and SWLS to 7/7.  She perceived that her study therapy had improved her ability to return to work and meaningful activities to a great extent: 7/7.

DISCUSSION: Return to work following stroke can contribute to greater subjective well-being and life satisfaction for patients and their families.  For the many stroke survivors who wish to pursue their participation and work roles following stroke, patient-centered rehabilitation strategies can be beneficial. In combination with other patient and stroke characteristics, recovery to the point of reintegration into work roles can be feasible.

Gallardo, Oscar Gabriel, PT, DPT, NCS; Lewthwaite, Rebecca , PhD; Winstein, Carolee J, PT, PhD, FAPTA. Recovery and Return to Work after Stroke: A Case Study of a Commercial Baker Enrolled in the Accelerated Skill Acquisition Program of the ICARE Randomized Controlled Trial.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online.