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
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
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
"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