Crossed Leg Sign Is Associated With Severity of Unilateral Spatial Neglect After Stroke

I don't understand but that is simply because I had to look up what crossed leg sign is in stroke. Nothing in the article clarified it for me. So this article is useless for stroke survivors.
As compared to this:

The crossed leg sign indicates a favorable outcome after severe stroke  Oct. 2011 

Gustavo José Luvizutto¹*, Eduardo de Moura Neto², Luiz Antônio de Lima Resende³, Hélio Rubens de Carvalho Nunes⁴, Luiz Eduardo Gomes Garcia Betting³ and Rodrigo Bazan³

• ¹Department of Applied Physical Therapy, Institute of Health Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
• ²Department of Physical Therapy, Faculty of Human Talent (FACTHUS), Uberaba, Brazil
• ³Department of Neurology, Psychology and Psychiatry, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho (UNESP), Botucatu, Brazil
• ⁴Department of Public Health, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho (UNESP), Botucatu, Brazil

Background: The crossed leg sign in patients with right hemisphere stroke is thought to be associated with perceptual disorders, such as unilateral spatial neglect (USN). The aim of this study was to compare the crossed leg sign with the severity of USN during the acute phase of stroke.

Experimental procedures: This was an observational and prospective clinical study of individuals with a diagnosis of right parietal stroke, as confirmed by neuroimaging. The occurrence of the crossed leg sign, the time at which this occurred after the stroke, and a clinical diagnosis of USN were measured and recorded. The patients’ age, sex, and lesion severity, as determined by the National Institutes of Health Stroke Scale and Glasgow coma scale, were included in the analyses as confounding variables. The outcome of interest was the degree of USN, as measured by the cancellation and bisection tests. Binary logistic regression was used to analyze the effect of crossed leg syndrome on the severity of USN. In the adjusted multiple regression model, a p-value of <0.05 was considered statistically significant.

Results: Overall, 60 patients were included in this study. There were no associations between patient demographics and the presence of the crossed leg sign. There was, however, an association between the crossed leg sign and the absolute value of the deviation in the line bisection test (B = −0.234; p = 0.039). The crossed leg sign was not associated with other measures of USN.

Conclusion: Based on the results of our study, we can conclude that a crossed leg sign in the acute phase of stroke is associated with USN severity, specifically the misinterpretation of the midline.

Introduction

Unilateral spatial neglect (USN) is a perceptual disorder that is characterized by an inability to respond to people or objects that are presented contralateral to the lesioned side of the brain when these symptoms cannot be attributed to either motor or sensory deficits (1–3). USN is frequently demonstrated in the clinic as misinterpretation of the midline, which may include head and eye deviations on the side contralateral to hemiplegia as well as the crossed leg sign (4–6).

The crossed leg sign was first described in patients with right hemisphere stroke who presented with USN, including cases in which there were associated changes in consciousness (7). It is impossible to detect USN during coma, but frequent rubbing movements of the right leg over the left observed in the first days of clinical evolution may differentiate between patients with torpor and coma. This sign is characterized by an overlap of the right leg over the left as the patient attempts to orient to the midline because there is a loss of spatial orientation of the left space. If the left leg is not perceived or felt to be one’s own limb, then abnormal rubbing movements may appear, which may be of predictive value in the development of USN (7).

Our hypothesis is that patients with the crossed leg sign may have a perceptual disorder that causes severe USN after stroke. The aim of this study was to compare the crossed leg sign with the severity of USN in the acute phase of stroke.

Materials and Methods

Study Design, Setting, and Participants

This was a prospective clinical study in individuals with a diagnosis of stroke that had been confirmed by computed tomography or magnetic resonance imaging. Patients hospitalized in the Emergency Room at the Stroke Unit at the Botucatu Medical School in Botucatu, Brazil were included in this study and were followed from January to December 2016. Stroke diagnoses were established according to the routine guidelines of the hospital. In the hyperacute phase (up to 8 h following the stroke), the CT scan is performed without contrast and extra and intracranial angiotomography, in addition to perfusion CT. In patients in the acute phase (after 8 h following the stroke), the CT scan is performed without contrast and extra and intracranial angiotomography. In all subjects, unconfined CT is repeated to obtain a control. Contrast magnetic resonance imaging (T1, T2, flair, and diffusion) is only performed to exclude stroke mimics, neuroinfections, and tumors.

Inclusion and Exclusion Criteria

Male and female subjects aged 18–85 years with right parietal ischemic stroke confirmed by a CT scan or MRI in the acute phase were included in this study. Individuals with a prior modified Rankin Scale >1, aphasia, preexisting dementia, previous visual changes, associated hemianopsia, mechanical orthopedic changes that impair the movement of the lower limb, or other neurological diseases were excluded.

Variables

Exposures

The occurrence of the crossed leg sign, the time at which the sign occurred after the stroke, and a clinical diagnosis of USN were measured and recorded.

Potential Confounding Variables

The main confounding variables that could potentially be associated with the outcome included age (older individuals have higher severity of USN after stroke), sex (women have worse outcomes of USN in some studies), severity of stroke according to the National Institutes of Health Stroke Scale (NIHSS) (the severity of stroke was associated with higher degree of USN), and the level of consciousness, as measured by the Glasgow coma scale (GCS) (greater degree of USN is expected in individuals with a lower degree of GCS).

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