Dr. Kimberly Erler is the inaugural director of the Tedy’s Team Center of Excellence in Stroke Recovery and an associate professor of occupational therapy at the MGH Institute. Erler discussed Stroke Awareness Month that occurs each May.

Q: Why is stroke awareness so important?

Almost 800,000 people a year, just in the United States, have a stroke. That’s one every 40 seconds. It’s the leading cause of serious long-term disability. Stroke awareness is crucial for several reasons, primarily because it significantly impacts early detection, timely treatment, and overall outcomes. Stroke treatments are highly time-sensitive so awareness and quick recognition of stroke symptoms can lead to faster medical intervention and better outcomes.

Q: What exactly is a stroke?

A stroke happens when the blood flow to a part of the brain is interrupted or reduced, preventing brain tissue from getting enough oxygen and nutrients. There are two main types of strokes. The most common type is an ischemic stroke which occurs when the blood flow to the brain is blocked. There's also a hemorrhagic stroke, and that occurs when a blood vessel ruptures causing bleeding in the brain.

There is another condition called a transient ischemic attack, also known as a TIA that’s sometimes called a mini-stroke or brain attack even though it’s not technically a stroke. With a TIA, the blood flow to the brain is temporarily blocked, the damage to the brain isn't permanent and the symptoms resolve on their own. So, a person might have some facial numbness that comes on suddenly and then resolves on its own without any medical attention. 

However, once you have a TIA, your risk for having a full ischemic stroke is much higher so we want people to understand that if you do have these symptoms, even if they go away on their own, it's critical that you seek medical attention so that you can get a full workup and help prevent a full stroke from happening.

Strokes don't discriminate. While they are more common in older adults, they do occur in young adults, children, and even infants, making proactive management of stroke risk factors and spreading awareness of signs of stroke important across all demographics. 

Q: How can a person reduce their risk of having a stroke?

There are several things people can do to reduce their risk of stroke. A big one is managing blood pressure, both through lifestyle changes and potentially medication if your medical team deems that necessary. Another is maintaining or changing to a healthy diet. Exercise has been shown to prevent or to reduce a person's risk of stroke and limiting smoking and alcohol consumption also are important. If you have diabetes, managing blood sugar levels is necessary, and treating other conditions that are known to increase your risk of stroke like atrial fibrillation. Preventive care ensures that individuals receive timely screenings and follow-up care.

Q: What are the warning signs of a stroke?

It really depends on the area of the brain that the stroke occurred, and the extent of the damage. So, a person who has a stroke on the right side of their brain will have very different impairments or challenges than a person who had a stroke on the left side of their brain. 

A primary part of stroke awareness is familiarizing people with the BE FAST acronym. BE FAST stands for Balance difficulties, Eyesight changes, Face drooping, Arm weakness, Speech difficulties, and Time to call 911. 

If someone shows all of these symptoms, or even just one of them, or if you’re not sure but there’s a concern that something is off, call 911 immediately so the person can access medical care as soon as possible. Early treatment can minimize brain damage and improve the likelihood of recovery. Delays in treatment can result in more severe disability or even death.

In my clinical practice, I’ve seen stroke survivors whose loved ones recognized they were having a stroke and activated the emergency response system allowing the person experiencing the stroke to access clot busting medications because they got to the hospital right away. And by the time I completed the occupational therapy evaluation 24 hours later, you would have never known that they had any paralysis or language impairments because their symptoms had fully resolved and they were back to their original baseline.

Educating people on BE FAST saves lives and quality of life. 

Q: For someone who has had a stroke and is experiencing difficulties functioning, what does rehabilitation look like?

Stroke rehabilitation is a comprehensive, multifaceted process designed to help stroke survivors regain as much independence and function as possible. Because stroke can impact movement, strength, sensation, mobility, daily tasks, cognition, psychological well-being, and community integration, stroke rehabilitation requires an interprofessional approach. 

Here at the IHP, our students work alongside expert faculty in the Sanders IMPACT Practice Center [IPC] to provide this type of personalized rehabilitation care to stroke survivors. In recent years, there has been a shift to recognizing that the needs of stroke survivors go beyond just those first few months but our insurance and reimbursement system doesn’t always allow for this ongoing rehabilitation. The IPC allows stroke survivors to be able to get the therapy they need in the chronic stage of stroke while also providing our students the opportunities to get hands-on experience and to learn the skills that they will need for future clinical practice.

Q: So, what’s the Tedy’s Team Center doing to raise awareness?

Since the Center launched in 2023, our team has been going into underserved communities such as Charlestown, Chelsea, Winthrop, and South Boston to raise awareness about stroke and BE FAST. We talk with people about confusion around stroke, hesitations related to calling 911, and explaining the rationale for why getting help is time sensitive. We're trying to meet people where they're at and where they're comfortable in places like senior centers and food pantry lines and having those conversations there. 

While we raise awareness of stroke prevention through BE FAST, we also are committed to supporting stroke survivors and their care partners. In addition to supporting the great therapy that's already happening in the IPC, we’ve been able to add programming that promotes social participation and community integration – areas that are often overlooked and neglected in stroke rehabilitation despite the evidence that suggests their association with better quality of life, better physical outcomes, and better mental health for people with stroke.

We hosted a Waterfront Wellness Walk in July 2023 at the New England Aquarium in partnership with Coalition for Resilient and Inclusive Waterfront. This event not only promoted exercise post stroke but also social participation. We’ll be hosting the waterfront walk again this fall. We held a seasonal social in November 2023 celebrating the stroke survivors involved in the center and their progress toward their goals. This past spring semester, we piloted two group therapy programs, one group aimed to support caregivers of stroke survivors while the other focused on helping stroke survivors themselves rebuild their identity.

Tedy’s Team Center supports novel research efforts, and we’re currently funding three teams of research fellows to collect pilot data that will enable them to apply to external funding and advance the scientific understanding of stroke recovery and effective interventions. 

The Tedy’s Team Center of Excellence in Stroke Recovery is uniquely positioned to raise awareness of stroke prevention and meet the needs of stroke survivors. We are excited to continue to build upon what we’ve accomplished and influence the future of stroke recovery. 

Do you have a story the Office of Strategic Communications should know about? If so, let us know.