ARTICLE IN BRIEF
Stroke educators used hip-hop and other tools to teach children to recognize stroke symptoms.
After participating in a three-day program to learn the signs of stroke and prevention strategies, a sixth-grade boy saw an older woman on a subway platform in Harlem slump to the ground. It was education in motion as he ran for a nearby phone and dialed “911” to do something he knew could save her life or prevent worsening symptoms. The young boy had just memorized the signs of stroke through a unique hip-hop stroke program laced with key medical information set to music and dance.
In a paper published in Stroke, Olajide Williams, MD, and James M. Noble, MD, outlined the educational effort and study they conducted to see if the children learned through the hip-hop song to identify the signs of stoke and take immediate action. The effort seems to have paid off, according to Dr. Williams, associate director of neurology at Harlem Hospital Center, a division of the Columbia University neurology department. Dr. Williams said another boy who participated in the program knew right away that his grandmother was in the throes of a stroke and called immediately for an ambulance. She was able to get to the hospital within the allotted three-hour time period to receive the clot-busting drug tissue plasminogen activator.
The Hip-Hop Stroke program was developed by the National Stroke Association in partnership with Dr. Williams to reach out to Hispanic and African-American communities. Stroke is two to three times more common in African-Americans than in whites, he said, and African-Americans are also twice as likely to die from stroke complications.
The neurologist worked with hip-hop rapper and musician Doug E. Fresh on music and words that would teach children about stroke in a lively way to help them retain the information. Dr. Williams then took the program into local Harlem schools to test whether it works. The program was first introduced in 2005 and it has branched out to seven other cities nationwide. About 15,000 elementary school students have participated in it.
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“The idea is to teach children the cardinal symptoms of stroke and also to identify stroke prevention strategies,” explained Dr. Williams, who is the principal investigator of the study. “We wanted to motivate children to teach their parents and grandparents.” He said that other studies have shown that the best age group to affect behavior change is fourth-to sixth-grade elementary school children.
Dr. Williams has also worked on developing videos, music, and cartoons that are part of the educational strategy. Through a quick-paced rap song, the children learn about the “brain attack” known as stroke. They learn the symptoms by remembering the mnemonic “FAST” — F for facial droop, A for arm weakness, S for slurred speech, and T for time to call 911.
At the end of the program, delivered an hour a day over three consecutive days, the children learned where stroke happens — in the brain — and that the signs of stroke come on suddenly and it is truly an emergency situation. Getting to the hospital quickly could be the difference between complete recovery and a lifetime of disability.
The pre-and post-testing revealed that children retained the information learned and still maintained the knowledge three months later, Dr. Williams said. About 20 percent of the 582 students tested at baseline in the initial study knew that stroke occurred in the brain. After the intervention, 93 percent understood the concept. Three months later, 86 percent of the children answered a number of stroke-related questions correctly. Virtually everyone remembered that it is crucial to call 911 immediately when they witness someone having a stroke.
“Considering that up to 45 percent of public stroke knowledge is derived from family and friends, children may be an underused conduit for stroke education in their homes and communities,” said Dr. Williams. He believes that the hip-hop songs “may have enhanced long-term retention of some stroke concepts such as FAST stroke symptoms, further supporting our initial hypothesis that music and dance likely enhances program objectives through activities perceived as fun rather than uninteresting or primarily educational.” Randomized studies testing the effectiveness of child-to-parent communication are now in the planning stages, Dr. Williams said.
“This is an innovative possibility to teach kids about the warning signs of stroke and help get the message through to their parents,” said Ralph Sacco, MD, chairman of neurology at the Miller School of Medicine at the University of Miami. That the program is geared towards minority populations adds more weight to the need for such a program given the increased risk for stroke. There is some evidence that teaching kids about the signs of strokes pays health dividends, he said.
Lewis B. Morgenstern, MD, director of the Stroke program at the University of Michigan Health System in Ann Arbor, designed and tested a stroke education program with colleagues at the University of Texas in Houston, targeting schools and communities, and they reported a shift in the knowledge about stroke. “They increased the number of people who knew the warning signs and people got medical attention much earlier in those communities,” Dr. Sacco said.
“We need to do a better job at educating patients on the symptoms and the importance of getting immediate treatment,” said Dr. Sacco, who added that the Harlem study provides “an encouraging sign that such a program can be beneficial.” He said it will be important to see whether the children can educate the adults in their lives to recognize the signs and alter behaviors that can increase a risk for stroke.
• Williams O, Noble JM. ‘Hip-hop’ stroke: a stroke educational program for elementary school children living in a high-risk community. Stroke 2008 39(10):2809–2816. E-pub 2008 Jul 17.