Stroke is one of the leading causes of disability in Australia. Each year approximately 56,000 Australians have a stroke and more than 430,000 Australians live with the long-term effects of stroke. For people who are under 65 at the time of their stroke, the NDIS is the primary pathway to accessing disability support funding. The functional consequences of stroke are wide-ranging, highly individual and extend far beyond the physical impairments that are most visible to others. A Functional Capacity Assessment is the cornerstone of NDIS access and planning for stroke survivors.

What is stroke?

A stroke occurs when the blood supply to part of the brain is interrupted, causing brain cells in the affected area to die. The nature and extent of the resulting disability depends on which part of the brain was affected and how much brain tissue was damaged. Stroke is divided into two broad types: ischaemic stroke and haemorrhagic stroke.

The functional consequences of stroke

Stroke can affect almost any area of functioning depending on the location and extent of the brain injury. Two people with the same diagnosis of stroke may have profoundly different functional profiles. The following domains are the most clinically significant for NDIS planning and must each be specifically assessed in the Functional Capacity Assessment.

Motor function: hemiplegia and hemiparesis

Weakness or paralysis affecting one side of the body is the most common motor consequence of stroke. The affected side is opposite to the side of the brain where the stroke occurred. Depending on severity, hemiplegia or hemiparesis affects walking, transfers, balance, upper limb use for daily tasks including dressing, eating, writing and personal care and the ability to use both hands for tasks requiring bilateral manual control.

Spasticity commonly develops after stroke and can cause pain, restricted movement, contracture and difficulty managing the affected limb during personal care, transfers and dressing. In severe cases, spasticity of the hand or arm can interfere significantly with hygiene and self-care.

Communication: aphasia and dysarthria

Aphasia is a language disorder caused by damage to the language areas of the brain, located primarily in the left hemisphere. It affects the ability to speak, understand spoken language, read and write. Aphasia affects approximately one in three people who have a stroke. It is one of the most functionally devastating consequences of stroke for community participation, social relationships, employment and engagement with services including the NDIS.

Aphasia is not a cognitive impairment. A person with aphasia may have intact cognition and full understanding of their situation but be unable to find words, form sentences or comprehend what is said to them. The Functional Capacity Assessment must specifically document the type and severity of aphasia, its functional impact on daily communication, what communication strategies are used effectively and what support is required for the person to participate in service planning and decision-making.

Dysarthria is a motor speech disorder caused by weakness or impaired coordination of the muscles used for speech, resulting in slurred or unclear speech. Unlike aphasia, language processing itself is intact in dysarthria. Both aphasia and dysarthria can occur together or separately and both require specific documentation.

Cognitive impairment

Cognitive impairment is common following stroke and affects a significant proportion of survivors, particularly in the domains of attention and concentration, processing speed, memory, executive functioning and visuospatial processing. Cognitive impairment after stroke is frequently not immediately apparent to others and is consistently underrepresented in NDIS plans focused primarily on physical function.

Visuospatial neglect is the tendency to ignore or fail to perceive information on the side of the body contralateral to the stroke. It is a specific cognitive consequence of right hemisphere strokes and directly affects safety, mobility, daily task performance and rehabilitation participation. A person with significant left-sided neglect may bump into objects on their left, fail to eat from the left side of their plate and dress only the right side of their body.

Anosognosia is a neurological consequence of stroke in which the person genuinely does not recognise the extent of their impairments. This is not denial. It is a direct consequence of the brain injury. Anosognosia has profound implications for safety, for rehabilitation engagement and for NDIS support planning because a person who does not recognise their own limitations may refuse supports they genuinely need.

Post-stroke fatigue

Post-stroke fatigue is present in the majority of stroke survivors and can persist for months or years after the stroke. It is a profound, neurologically based exhaustion disproportionate to physical activity levels and does not resolve fully with rest. Post-stroke fatigue significantly affects the person’s capacity to sustain rehabilitation activities, manage daily routines, engage with services and participate in community life.

A person who appears to be functioning well in the morning may be completely unable to engage in meaningful activity by the afternoon. Planning that does not account for fatigue will result in a schedule the person cannot sustain and supports that cannot be used effectively. The Functional Capacity Assessment must specifically assess the pattern, severity and functional impact of post-stroke fatigue.

Depression and emotional changes

Post-stroke depression affects approximately one in three stroke survivors and is associated with poorer functional recovery, increased disability and reduced quality of life. Depression after stroke is both a psychological response to the experience of stroke and a direct neurobiological consequence of the brain injury. Anxiety, emotional lability and personality changes are also common after stroke and affect relationships, community participation and engagement with support.

Dysphagia

Swallowing difficulty affects approximately half of all stroke survivors in the acute phase and persists in a proportion. Dysphagia creates a risk of aspiration into the airway which can cause aspiration pneumonia: a serious and potentially fatal complication. Where dysphagia is present, modified food and fluid textures are required and eating assistance may be needed. The Functional Capacity Assessment must document swallowing status and the support required for safe eating and drinking, in coordination with the speech pathologist.

Bladder and bowel dysfunction

Urinary incontinence is common in the acute phase of stroke and persists in a proportion of survivors, affecting daily management, community access, personal dignity and the level of personal care support required. Bowel dysfunction including constipation is also common. These symptoms and their functional implications must be documented in the Functional Capacity Assessment.

Pain

Pain after stroke includes central post-stroke pain: a neuropathic pain syndrome caused by damage to the sensory pathways of the brain, characterised by burning or aching pain in the affected limbs. Shoulder pain from subluxation of the shoulder joint in a hemiplegic arm is also common and directly affects function, transfers and management of the affected upper limb. Pain must be documented as a functional impairment in its own right.

The recovery trajectory and its implications for NDIS planning

Why the timing of assessment matters for stroke?

Natural recovery: the greatest degree of natural neurological recovery typically occurs in the first three to six months after stroke, with further gains possible over the first one to two years. An assessment completed in the weeks immediately following stroke reflects the acute functional picture, not the long-term stable picture.

Hospital and rehabilitation versus home: functional capacity in a structured rehabilitation environment does not reflect the functional capacity in the home environment. An in-home assessment following discharge provides a substantially more accurate and more relevant picture of the support needed for daily life.

Plateau and residual disability: after the initial recovery period, residual neurological impairments generally stabilise. An assessment completed after the natural recovery plateau provides the most stable and most accurate picture of long-term support needs.

Plan review timing: for participants whose stroke occurred recently, a plan review assessment at 12 to 18 months post-stroke may reflect a substantially different functional picture from the initial assessment.

Younger onset stroke: for people in their 30s, 40s or 50s when they have a stroke, the life circumstances and support needs are different from those of older stroke survivors. Employment, family roles, parenting responsibilities and community participation goals require specific consideration in the Functional Capacity Assessment.

Aphasia and the Functional Capacity Assessment

Conducting a Functional Capacity Assessment for a person with aphasia requires specific clinical adaptations. Standard assessment approaches relying on verbal interview and self-report cannot be used without modification for a person with significant expressive or receptive aphasia. The assessment must be adapted to use the person’s most effective communication channel: written communication, picture-based communication, gesture, yes or no responses or supported communication strategies with a familiar communication partner.

The functional impact of aphasia itself must be comprehensively documented, including its impact on the ability to access services, engage with healthcare and NDIS planning, maintain social relationships, manage safety in the community and pursue employment or other meaningful activities.

Stroke and NDIS eligibility

Stroke is included in NDIS Condition List B. A confirmed diagnosis of stroke does not automatically establish NDIS eligibility. The person must demonstrate that the stroke has resulted in substantially reduced functional capacity across one or more NDIS functional domains. For people who are under 65 at the time of their stroke, the NDIS is the primary disability funding pathway. People over 65 at the time of stroke access support through the aged care system rather than the NDIS.

What a Functional Capacity Assessment covers for stroke survivors

The Functional Capacity Assessment completed by an Occupational Therapist focuses on the functional impact of stroke on the person’s daily life in their home and community environment. Formal assessment of specific cognitive domains is conducted by neuropsychologists. Formal communication and swallowing assessment is conducted by speech pathologists. Specialist on-road driving assessment following stroke is conducted by accredited driving assessors. The OT Functional Capacity Assessment draws on reports from these clinicians and directly observes how the combined effects of the stroke present in the person’s daily functioning.

• Assessment of motor function in the home and community: how hemiplegia, hemiparesis, spasticity, balance difficulties and upper limb impairment affect the person’s capacity to perform daily tasks independently and safely
• Functional observation of communication in daily tasks: how aphasia or dysarthria affects the person’s capacity to participate in daily life, access services and engage with NDIS planning. The FCA does not replace speech pathology assessment but documents the functional consequences in daily life and the communication supports required
• Functional observation of how cognitive impairment affects daily task performance: how difficulties with attention, memory, neglect and executive functioning present when the person attempts real daily activities. The FCA does not replace neuropsychological assessment but documents the functional consequences visible in daily life
• Assessment of anosognosia where present and its implications for safety and support planning
• Assessment of post-stroke fatigue: its pattern across the day and its functional impact on the capacity to sustain daily activities
• Assessment of depression, anxiety and emotional changes and their functional impact on daily functioning and community participation
• Assessment of bladder and bowel management and the support required. Where swallowing concerns are identified, the FCA notes these and recommends referral to a speech pathologist
• Assessment of pain and its functional impact on daily activities and sleep
• Assessment of the home environment and the modifications and assistive technology required to support safe and functional daily living
• Documentation of where the person is in their recovery trajectory and clinical reasoning about the expected stability of the functional picture
• Integration of findings from treating clinicians including rehabilitation reports, neuropsychological assessments and speech pathology reports to build a complete functional picture

The 2026 NDIS context

The Securing the NDIS for Future Generations Bill 2026, introduced to Parliament on 14 May 2026, strengthens the requirement that NDIS supports must have a direct causal connection to the eligible impairment. For stroke survivors this means the Functional Capacity Assessment must clearly document how the specific neurological consequences of the stroke cause the functional impairments documented and justify each support recommendation made. The causal link between the stroke and each area of functional limitation must be explicit and not assumed.

Who can refer?

Referrals are accepted from participants and families, support coordinators, stroke rehabilitation teams, neurologists, GPs and legal representatives involved in NDIS appeals. Sina OT has completed Functional Capacity Assessments for individuals following stroke across a range of presentations and stages of recovery across Adelaide, Melbourne and Sydney. All assessments are completed in person in the participant’s home and community environment.