After Stroke, Crossed Legs a Welcome Sign

Patients who crossed their legs within 15 days functioned better a year later, study shows

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_117374.html
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Stroke

MONDAY, Oct. 10 (HealthDay News) -- The sooner people can cross their legs after having a stroke, the better their chances for recovery, new research suggests.
This complicated movement, occurring within two weeks of a stroke, is a good sign that the brain is processing again, researchers said.

"It looks simple, but it's very complex," said Dr. Naveen Goyal, director of the Stroke Center at the Brooklyn Hospital Center in New York City. "It requires a good amount of strength because the leg is such a heavy part of the body. Also, coordination is required. Then there's the ability to tell one side of the body from the other side."

Goyal was not involved with the study, which appears in the Oct. 11 issue of Neurology.

Using leg crossing to assess patients would be simple for clinicians, much simpler than standard tests to gauge disability, said the study authors.

And it could quickly help direct patients into the right treatment, they said.

"Of course, every survivor after severe stroke should get the maximal intensive rehab, but when we know that leg movement is possible we could switch to more specific training programs," said study senior author Dr. Berend Feddersen, assistant professor of neurology at the University of Munich in Germany.

Stroke occurs when blood flow to the brain stops because of a blocked or ruptured blood vessel. It is the third leading cause of death and the leading cause of disability in developed countries.

Several scales have been developed to predict recovery, but these usually are administered by trained professionals and may only provide information up to three months' post-stroke.

For this study, the researchers followed 34 patients who crossed their legs within 15 days of a stroke and 34 who did not cross their legs in that critical time frame.

All participants had had severe stroke and were in intensive care units (ICUs), some with ventilators.

Over the course of a year, 20 patients crossed their right leg over their left, while 13 crossed the left over the right. One patient crossed both legs, and six were able to cross the leg that had been paralyzed or partially paralyzed by the stroke over the "good" leg.

"Nobody was instructed to cross the legs, and maybe we missed short crossings, but in the ICU, the nurses are very vigilant and good observers," said Feddersen.

Following instructions would have required even more brain power.

The leg crossers had fewer neurological impairments and were able to walk independently. The non-leg crossers were "severely disabled and required constant attention," the study reported.

The most dramatic differences were seen in death rates: Only one patient in the leg crossing group died in that one year compared with 18 in the other group.

"Crossing of the leg is a very simple test and can be done by anyone. Family members can do it," Goyal said.
Larger studies should be undertaken to confirm the test's reliability, the researchers said. This inexpensive tool might also be used with other conditions treated in the ICU, they added.

SOURCES: Berend Feddersen, M.D., Ph.D., assistant professor of neurology, University of Munich, Germany; Naveen Goyal, M.D., director, Stroke Center, Brooklyn Hospital Center, New York City; Oct. 11, 2011, Neurology

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