FAST Signs — Stroke Recognition
The FAST mnemonic is the standard bystander and healthcare provider screening tool:| Letter | Sign | What to Look For |
|---|---|---|
| F | Face drooping | Ask the person to smile — one side of the face droops or is numb; the smile is uneven |
| A | Arm weakness | Ask the person to raise both arms — one arm drifts downward or cannot be raised |
| S | Speech difficulty | Ask the person to repeat a simple sentence — speech is slurred, garbled, or the person cannot speak |
| T | Time to call 911 | If ANY of these signs are present, call 911 immediately — note the time symptoms first appeared |
Additional Warning Signs
- Sudden severe headache with no known cause ("the worst headache of my life" — particularly suggestive of hemorrhagic stroke or subarachnoid hemorrhage)
- Sudden confusion or trouble understanding speech
- Sudden trouble seeing in one or both eyes (visual field loss, double vision)
- Sudden trouble walking, dizziness, or loss of balance and coordination
- Sudden numbness of the face, arm, or leg, especially on one side
What the MT Must Do if Signs Occur During Treatment
- Stop treatment immediately. Do not continue any technique.
- Do not reposition the patient. Leave the patient in whatever position they are in — moving a stroke patient can worsen hemorrhagic bleeding or dislodge a clot.
- Call 911 immediately. State clearly: "I believe my patient is having a stroke."
- Note the time of symptom onset. The exact time symptoms first appeared determines eligibility for thrombolytic therapy (IV tPA window is typically 4.5 hours from onset). This information is critical for the emergency team.
- Stay with the patient. Monitor breathing and consciousness. Do not give food, water, or medication.
- Do not attempt to diagnose the type of stroke. Ischemic and hemorrhagic strokes cannot be distinguished clinically — neuroimaging (CT scan) is required. Treatment differs between types, so clinical guessing is dangerous.
Key Takeaways
- Acute stroke is an absolute medical emergency and an absolute contraindication to massage therapy — the MT role is recognition and emergency activation, not treatment
- The FAST screen (Face drooping, Arm weakness, Speech difficulty, Time to call 911) is the standard recognition tool. Any single positive finding warrants calling 911
- Time of symptom onset is the single most important piece of information the MT can provide to the emergency team — it determines eligibility for clot-dissolving medication
- For the massage therapist's role in post-stroke recovery (spasticity management, ROM preservation, compensatory overload treatment), see Stroke (Cerebrovascular Accident)