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Gait Symmetry and Walking Speed Analysis Following Lower-Extremity Trauma

KR Archer, PT, MS, DPT, is a PhD candidate, Center for Injury Research and Policy, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 545, Baltimore, MD 21205 (USA).
RC Castillo, MS, is Assistant Scientist, Center for Injury Research and Policy, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University
EJ MacKenzie, PhD, is Fred and Julie Soper Professor and Chair, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University
MJ Bosse, MD, is Director and Clinical Research and Orthopaedic Traumatologist, Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC
The LEAP Study Group is: Ellen J MacKenzie, PhD; Michael J Bosse, MD; James F Kellam, MD; Andrew R Burgess, MD; Lawrence X Webb, MD; Marc F Swiontkowski, MD; Roy Sanders, MD; Alan L Jones, MD; Mark P McAndrew, MD; Brendan Patterson, MD; Melissa L McCarthy, ScD; Thomas G Travison, PhD; and Renan C Castillo, MS.

Address all correspondence to Dr Archer at: karcher5{at}comcast.net

Background and Purpose. Gait has been shown to be a major determining factor of function following limb-salvage surgery. However, little is known regarding the measures associated with gait recovery for this patient population. The purpose of this study was to identify clinical measures associated with impaired walking speed and gait asymmetry in patients with lower-extremity reconstruction. Subjects. Study subjects were 381 patients from the Lower Extremity Assessment Project (LEAP) who had undergone reconstruction following severe lower-extremity trauma. Methods. The LEAP study was a longitudinal study of outcomes following lower-extremity reconstruction. The present study used 24-month clinical follow-up data. A combined outcome measure of reduced walking speed and gait deviation was chosen to provide a comprehensive measure of impaired physical mobility. Results. The most significant clinical factors associated with decreased walking speed and gait deviation were impaired ankle plantar-flexion range of motion, knee flexion strength, and a nonreciprocal stair-climbing pattern. Discussion and Conclusion. The findings provide clinicians with specific clinical measures associated with functional recovery in patients with lower-limb reconstruction. These measures, in turn, can be considered to inform treatment decision making and to prioritize interventions.

Key Words: Clinical decision making • Leg injuries • Rehabilitation

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