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May 2005 Issue

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UC Uses Powerful Lesson to Teach Kids Stroke Is "Real"

Published May 2005

As the visitor prepares to speak before a class of Cincinnati middle schoolers, the kids are politely attentive.

This is a health class. They're not expecting surprises.

But when the perfectly normal-looking woman walks to the front of the class and starts to talk, the mood changes quickly.

Her gait is awkward, her speech is slow and slurred, and only one side of her mouth appears to be moving. She sounds ... "different."

The impact on the children is immediate. They glance at each other, then back at the speaker. Now the visitor definitely has their attention.

And a researcher from the UC College of Nursing has made her point--that stroke, the nation's No. 3 killer and a leading cause of severe, long-term disability, can hit anyone, at any time, and at any age.

"Stroke is where all the bad things come together," says Elaine Miller, who holds a doctorate in nursing science. "Both my parents were stroke victims, so I have a very personal interest and want to do everything I can to prevent it.

"We send a very powerful message when we bring a stroke survivor into the school. It really hits home, because it's for real."

The school visits are part of the FAST Stroke Educational Program, the first of its kind for kids in the Tristate area. It combines the standard FAST method for recognizing and responding to stroke with counseling on how to begin changing the behaviors that lead to it.

The acronym FAST is based on the nationally recognized Cincinnati Prehospital Stroke Scale and National Institutes of Health Stroke Scale, which have been used for many years by paramedics, emergency medical services personnel and other health-care professionals.

It stands for the signs and symptoms of stroke or a brain attack, and the appropriate action to take:
F -- Face numbness or weakness, especially on one side
A -- Arm numbness or weakness, especially on one side
S -- Speech slurred or difficulty speaking or understanding
T -- Time to call 911 if these occur suddenly or are accompanied by loss of vision, loss of balance with dizziness, or the worst headache of your life with no known cause, both sudden and severe.

Dr. Miller collaborated with Rosie Miller, RN, and Keith King, PhD, to develop the current FAST educational program as a part of an original Operation Stroke initiative by the American Heart Association (AHA) and the Greater Cincinnati/Northern Kentucky Stroke Team, a UC-based research and public education effort.

Rosie Miller is a senior clinical coordinator for the Stroke Team and a lead committee member on Operation Stroke, and was the creator of some of the initial FAST educational tools. Dr. King, an assistant professor of health promotion in UC's College of Education, is nationally recognized for his work with at-risk children and on the development of school health programs.

"When Operation Stroke assigned us to look at textbooks to see what children were being taught about stroke," says Rosie Miller, "to our surprise, we found very little.

"One text had just a one-liner about stroke," she says, "but a couple of pages about heart disease."

Speedy treatment is key to stroke survival, Dr. Miller emphasizes, which makes recognizing the symptoms of critical importance. Ideally 911 should be called immediately, she says. If the patient can be evaluated and treated with the clot-dissolving drug tPA within three hours, "there's a good chance of full recovery."

According to neurology department chairman Joseph Broderick, MD, director of the Stroke Team and also a lead committee member for Operation Stroke, "Although tPA treatment could be possible for a large number of strokes, it's only used about 4 percent of the time. When treatment is delayed, it's usually because someone didn't recognize the symptoms."

Although stroke disables more people than heart disease, Rosie Miller says, children are not being taught about it.

As a consequence, she says, "People are far more likely to react to the obvious pain accompanying a heart attack, whereas stroke symptoms are so much more subtle.

"We realized that we needed to develop an educational program on the signs, symptoms and risk factors of stroke."

That was the beginning of the middle school program.

"This way we're able to talk to students about what happens if their parents, grandparents or friends are having a stroke," adds Dr. Elaine Miller. "They're not going to get formal training on this in any other way except through our FAST educational program.

"There are many media messages and pamphlets and posters throughout our region," she says, "but it's still not formally taught in schools because the textbooks are so outdated."

"Most adults weren't taught what to look for, and how to react. But if we can help it become a mindset in young people, they're more likely to retain that information."

Stroke occurs at all ages, Dr. Miller explains. Some children are even born with it. Yet despite increased societal emphasis on promoting healthy behaviors, the incidence of diabetes, obesity, smoking, hypertension and other stroke risk factors continues to escalate in the United States.

"If we get to middle school students before they internalize bad health habits, like smoking, lack of physical activity, a poor diet, drinking and drug use," Dr. Miller says, "it will help in the long term for preventing strokes."

And the need is urgent, Dr. Miller says. Every 45 seconds someone in the United States has a stroke, and 60 percent of the children she has worked with--150 so far in three schools--have a family member or friend who had a stroke.

However, prior to participating in Dr. Miller's two-month program, over 95 percent of the children could not confidently identify at least one stroke symptom.

After participating in the FAST program, all of them know the signs and symptoms and when to call 911, and nearly 60 percent say they have made progress in reducing modifiable stroke-risk behaviors.

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