Medical treatment

High blood pressure. This is the most important risk factor for stroke. Have blood pressure checked regularly. If diagnosed with hypertension, take prescribed medication.

Heart disease. Clots that form in the heart can break away and lead to a brain attack. Management of heart disease reduces the risk of a brain attack. Transient ischemic attacks (TIAs). Proper medical treatment of TIAs, or ministrokes, can reduce the risk of a major stroke. A TIA happens when a blood clot temporarily clogs an artery; treatment usually consists of drugs that help prevent clot formation.

High red blood cell count. Too many red blood cells thicken the blood and make clots more likely. Doctors can treat this problem by prescribing "blood thinners."

Lifestyle. Cigarette smoking. Smoking increases blood pressure, reduces the amount of oxygen in the blood, thickens the blood and makes clots more likely to form. Stopping smoking reduces the risk of brain attack, even in longtime smokers.

Elevated blood cholesterol and lipids. High blood cholesterol increases the buildup of fats in artery walls, increasing the risk of heart disease. A change in your dietary habits can reduce your cholesterol and thus your risk of stroke.

Physical inactivity and obesity. Being inactive, obese or both can increase blood pressure and make the accumulation of cholesterol in artery walls more likely. Devote at least 30 minutes to physical activity three times a week and at least 10 minutes to physical activity daily.

Drinking too much alcohol. More than two drinks a day raises blood pressure. Binge drinking can lead to a stroke.

Drug abuse. Intravenous drug abuse carries a high risk of stroke from cerebral embolisms. Cocaine use also has been linked to stroke, even in first-time users.

Source: American Heart Association and Sentinel research.

No sooner had Joye Schafers settled onto her bed to watch the 6 o'clock news than her left arm fell limp. She tried to shift her body off the numb limb. She couldn't budge.

Minutes passed and Schafers felt control over her body slip away. Maybe 10 minutes later, Nicole happened into room. The 11-year-old scarcely recognized the woman sprawled across her grandmother's bed: The left side of Schafers' face drooped. Pieces of words broke from her lips.

Nicole phoned her grandfather for help. Twenty minutes later, Leo Schafers rushed his wife to the hospital. A CAT scan showed that Joye had suffered a stroke.

A stroke is a cardiovascular disease that affects the arteries of the central nervous system. Burst or clogged vessels cut oxygen to the brain. Nerve cells die, and areas controlled by the damaged region react. That's why a stroke can steal memories and the ability to walk or speak.

Just 20 years ago, doctors were powerless against strokes. But 10 years ago, promising drugs emerged and understanding of stroke grew. Now it is lack of awareness among victims that often renders doctors powerless.

Too few victims seek treatment in time for powerful drugs to do their good -- minutes can make the difference between a future of brisk walks or one of slow turns in a wheelchair.

Recent studies show that Americans are oblivious to the risk factors and symptoms of strokes. Those most at risk, such as the elderly, are the least informed, research shows.

In his recent study on public knowledge of stroke warning signs, however, Arthur Pancioli, an assistant professor of emergency medicine at the University of Cincinnati, found that only 57 percent of the 1,880 polled could name one warning sign.

National and local groups such as the National Stroke Association and Florida Hospital are spearheading campaigns to raise awareness of stroke prevention, treatment, and rehabilitation. Stroke educators now use the term "brain attack" to tie to strokes the same urgency Americans associate with heart attacks.

The American Heart Association estimates that in the United States each year 500,000 people suffer a first stroke; 100,000 endure a second attack. Every year, nearly 160,000 stroke victims die. Stroke ranks as the third leading cause of death in this country behind heart disease and cancer.

Stroke plays no favorites, though the elderly die most often. The older you are, the greater your chance of astroke. That's bad news for baby boomers as they age.

In the next century, Florida could see a marked increase in the number of stroke victims. An aging population already places Florida in the "stroke belt" -- an area consisting of 12 contiguous states and Washington, D.C., where stroke death rates are consistently more than 10 percent higher than the rest of the country.

Strokes have increased in Central Florida. From 1994 to 1996, the number of patients treated at 10 area hospitals for strokes and transient ischemic attacks (ministrokes) inched from 2,627 to 2,840.

If these stats give pause, so should the glacial pace at which many respond to symptoms. Victims try to sleep off the thunderclap headache that can herald a stroke, or they ignore rubbery limbs or slurred speech, figuring, "This too shall pass."

Says Cyrus K. Mody, a neurologist at Cedars-Sinai Medical Center in Los Angeles: "That's the biggest mistake they could make."

Thwarting a killer

The notion of stroke as a marauder to be accepted like fate became etched over the years in the public psyche. Strokes earned their notorious reputation honestly: One instant you're healthy, and the next you're crippled or unable to speak -- if you survive.

That no effective treatment existed to reverse or reduce the effects of a stroke led to what Rashmi Kothari, lead author on a recent study of stroke awareness, calls a "laissez faire" approach. No one spoke of stroke or bothered to learn its symptoms or risk factors.

But a decade ago, powerful medications that thinned the blood and busted clots emerged. Then came neuroprotective drugs designed to shield the brain from damage. Equipped with these tools, doctors stood ready to put up a fight for Joye Schafers.

That Wednesday afternoon in January doctors pumped into her veins a drug called tissue plasminogen activator (TPA). It pulverized the clot starving her brain of oxygen. So powerful was the drug that a scab on Shafers' shoulder dissolved into a crimson puddle. By the time the last drop dripped from the IV line, Schafers says she could move her once limp left leg.

She returned home two days later. Sitting on the floral throw-covered sofa in her home, she spoke of the experience: "The most terrifying thing was when I could not articulate what I was feeling."

Sunlight bounced from the necklace she wears of St. Jude, the patron saint of difficult causes. "As far as I'm concerned, it's a miracle," she said of her recovery. "We are of a generation when a stroke was expected to leave you with a life-altering experience."

Sometimes walking leaves her winded, but Schafers says she feels as fit as any 65-year-old. The notion of a clean bill of health following a stroke is not what comes to the minds of most.

Stroke still strikes as unexpectedly as a thunderstorm but isn't as deadly as it once was. About 4.4 million survivors are alive today, mainly because of drugs like TPA, and improved diagnostic tools such as CAT scans.

And doctors now know of factors that can precipitate stroke. High blood pressure, diabetes, irregular heartbeats, smoking, and drug abuse are among them. Addressing these conditions has helped reduce strokes. No one is immune from stroke, but knowing the symptoms and promptly seeking medical attention can enhance your chances of a good recovery.

Knowledge is your ally. Although stroke educators are linking strokes with heart attacks in terms of urgency, the two conditions operate in dissimilar ways. A stroke can be relatively painless; a heart attack may explode in your chest.

Sometimes strokes are accompanied by an unusually painful headache. Usually there are other symptoms. These include: nausea, dizziness, a flash of blindness, difficulty in speaking, and weakness or numbness on one side of the body.

If you experience these symptoms "get to the hospital," says Michael Gebel, director of the stroke unit at Florida Hospital. "Very few people are crippled from a heart attack. If you have a stroke and your left side is not working or you can't communicate, that could be forever."

Time is at a premium because TPA -- the first drug shown to reduce the effects of a stroke in cases where there is no internal bleeding -- is effective only when given within three hours of the stroke's onset. On average, however, patients reach a hospital five hours after a stroke. Experts believe only 5 percent of stroke victims in the United States are receiving TPA.

Fortune sided with Schafers. She was awake when the stroke hit -- one-third of strokes strike when victims are asleep -- someone noticed her appearance, and she was rushed to a hospital.

"We did not realize the importance of what we'd done" in hurrying to the hospital, Schafers said. She was lucky. But stroke experts are determined to educate the public about strokes so that knowledge, not providence or luck, become Americans' strongest ally in battling the disease.

"We've had this long history of strokes -- that you can do nothing about it. Stroke is a killer, a disabler, but we can now do something about it," says Kothari of the University of Cincinnati College of Medicine. "The biggest thing we have to do is make an attitude change."

From the first months of life, when a simple "ma" brought a smile to your mother's face, you've translated your thoughts into words to communicate with those around you.

But imagine waking up in a world where that's no longer possible. Words that once flowed effortlessly now seem beyond reach. Your mouth doesn't seem to work, turning your sentences into slurred, garbled sounds.

Each year, thousands of Americans who have strokes find themselves in this situation. Strokes can have many debilitating effects, but being unable to talk, read, write or understand those around you can be among the most upsetting.

Fortunately, awareness and understanding of stroke's effect on speech and language are growing. Once, stroke survivors were relegated to silence. Now, improving communication abilities is an important focus of stroke rehabilitation.

Damaged brain cells

When you have a stroke, a clot or rupture in one of your brain's blood vessels damages nearby cells. When this happens in areas of your brain responsible for speech and language, it can affect your ability to communicate--often without impairing your intellect.

About 500,000 Americans have a stroke each year. Of those who survive, between 25 and 40 percent will have impairments in their ability to speak, read, write or understand conversations. Sometimes, a stroke can strip away all of these skills. The three main stroke-related communication disorders are:

Stroke survivors can have a combination of these disorders.

Enhancing skills

Today, the value of speech rehabilitation for stroke survivors is widely acknowledged. That hasn't always been the case. Until the mid-1970s, speech rehabilitation often wasn't offered after a stroke. But many studies have shown that it can help you improve your quality of life. And even when speech can't be restored, rehabilitation can help you communicate in other ways.

Speech rehabilitation may also help prevent depression, a serious condition that affects many stroke survivors. And it may help you regain your independence.

Diagnosing difficulties

Depending on your health, speech rehabilitation may begin very soon after your stroke, maybe even within a day. Time is critical, because speech rehabilitation may stimulate the brain as it heals.

A speech pathologist will typically assist your doctors in determining what speech or language disorders you may have. The speech pathologist may give you a series of tests. For example, you might be asked to say words, follow directions, name objects, repeat sentences, read and write.

Exercise and homework

Based on this testing, the speech pathologist will recommend a speech rehabilitation program for you. A program typically involves regular meetings with a speech pathologist, either individually or in a group, and working at home on exercises.

Speech pathologists tailor rehabilitation sessions individually, but here are some activities and objects you'll likely encounter:

Exercise and practice--Exercising weakened muscles may help you speak more clearly. Your therapist might ask you to say words, smile, lose your mouth or stick out your tongue.

Some stroke survivors with dysarthria or apraxia may benefit from small, hand-held computers that display a message you type. Some computers can provide a mechanical voice output of your message. Prices can range from about $150 to about $500.

Effort required

Therapy sessions usually last 30 minutes to an hour. Although the activities may sound easy, they can be challenging.

When speech rehabilitation begins, you're often still adjusting to the change a stroke has made in your lifestyle. In addition, exercising weakened or paralyzed muscles, even facial ones, requires a lot of effort. Sometimes therapy sessions can feel more tiring than working out in a gym.

Speech rehabilitation can also be mentally exhausting for both stroke survivors and those close to them. Activities and exercises that once would have been easy are now difficult or impossible.

Family members may also find it uncomfortable or painful to watch a loved one struggle to name an object or say a word. Don't take it personally if a stroke survivor becomes emotional or angry. Recovering from a stroke can be very frustrating.

Family roles and activities may also need to be modified. Social workers and other members of the rehabilitation team can help you find the support you need.

Regaining your place

Although stroke-related disabilities can be permanent, many people lead healthy, active lifestyles after a stroke. About two-thirds of stroke survivors are able to resume everyday life and responsibilities.

Medical professionals can't restore all the skills a stroke might have impaired or taken away. What they can do is offer techniques, guidance and support to enhance your recovery.

Speech rehabilitation is one important tool for helping you regain your sense of place in family and community.