From Our 2011 Archives
Crossing Legs May Be Sign of Stroke Recovery
Study Shows Patients Who Cross Their Legs Soon After a Stroke Have Better Chance of Recovery
By Jennifer Warner
Reviewed by Laura J. Martin, MD
Oct. 10, 2011 -- People who can cross their legs soon after a major stroke may have much better odds of a good recovery than those who cannot.
A new study shows people who crossed their legs within 15 days of a severe stroke were less likely to die and more likely to be walking and independent compared to those who did not.
For example, only one of the 34 people (9%) who crossed their legs died within one year of leaving the hospital compared with 18 of the 34 (53%) who did not cross their legs.
Researchers say they were astonished with the results.
"We were in the ICU doing our rounds and would notice, 'Oh look, he is crossing his legs, doesn't he look comfortable. He might have a good outcome,'" says researcher Berend Feddersen, MD, PhD, assistant professor of neurology at the University of Munich, in Germany. "It was really surprising that it was in fact such a good marker, especially one year after the stroke."
They say if further studies confirm the results of this small study, leg crossing may become a valuable indicator of future stroke recovery among those with severe strokes.
The study is published in Neurology.
Signs of Recovery From Stroke
The researchers followed 34 people who had suffered a severe stroke and crossed their legs during their stay at a German hospital. They matched the leg crossers to 34 randomly selected people who did not cross their leg following a severe stroke.
All of the participants were evaluated when they were admitted to the hospital, on the day of leg crossing, when they were discharged from the hospital, and one year after discharge.
At the time of admission, researchers say there were no significant differences between the two groups in terms of level of neurological impairment, independence, and disability.
But researchers found people who crossed their legs within 15 days of their stroke had fewer neurological problems when they were discharged from the hospital than those who did not cross their legs.
Leg crossers scored an average of 6.5 on the National Institutes of Health (NIH) stroke scale, a measure of stroke severity and impairment, compared with an average score of 10.6 for non-leg-crossers.
A year after leaving the hospital, more differences in stroke recovery emerged:
One person in the leg-crossing group vs. 18 in the non-leg-crossing group died.
People who were able to cross their legs had lower levels of disability, were more likely to be able to walk unassisted, and were only moderately disabled. Non-leg-crossers were more likely to have severe disability requiring constant attention.
Leg crossers had significantly higher levels of independence compared with the non-leg-crossers. Feddersen says all of the leg crossers were lying down and most were unconscious when they crossed their legs in the first few days after a stroke while in the intensive care unit.
He says leg crossing may mark the first noticeable return of ability to move your limbs, which is often the first step in stroke recovery. Other types of movement, like crossing arms, may also be equally predictive of good stroke recovery but may happen too fast for doctors or nurses to notice.
Predicting Stroke Recovery
Researchers say the next step will be to compare the accuracy of leg crossing in predicting stroke recovery vs. established methods in a larger, prospective study.
The most commonly used method to predict stroke recovery following a stroke is the NIH stroke scale, which requires extensive evaluation by a health care professional.
"We know this is not sufficient to give us a very accurate predictor of prognosis," says Pierre Fayad, MD, director of the Stroke Center at the Nebraska Medical Center.
For example, the people in this study all had similar NIH stroke scale scores on admission to the hospital, but leg crossers went on to have much better recovery rates.
Fayad says if further studies confirm the results of this study, leg crossing may offer a simple tool that goes beyond NIH scores to predict stroke recovery.
"It is quite intriguing and something that has not come up on the radar screen before," says Fayad, who is also the Reynolds Centennial Professor of Neurology at the University of Nebraska Medical Center. "It's a brand new concept. It is something simple everyone can notice and doesn't need specialized training to recognize."
"But we need to be sure that it is a reliable sign before we start acting upon it and making decisions based on it that may impact a patient's long-term treatment or care," says Fayad.
SOURCES: Remi, J. Neurology, published online Oct. 11, 2011.Berend Feddersen, MD, PhD, assistant professor of neurology, Univeristy of Munich, Germany.Pierre Fayad, MD, Reynolds Centennial Professor of Neurology, University of Nebraska Medical Center; director, Stroke Center, Nebraska Medical Center.News release, American Academy of Neurology.