de Visser E, Veth RPH, Schreuder HWB, Duysens J, Mulder T: Reorganization of gait after limb-saving surgery of the lower limb. Am J Phys Med Rehabil 2003;82:825–831.
In this study, the concept of a cognitive dual-task performance and visual restriction during walking has been used to study the recovery of gait after limb-saving surgery in ten patients.
All patients were recovering from some form of treatment to tumors of the lower limbs. Patients had to walk on a treadmill at their preferred speed. During the course of recovery, we measured normal walking, walking while performing an attention-demanding dual task, and walking during restricted vision, starting 5 mo postoperatively.
Patients are able to reach an acceptable level of gait within 15 mo, especially when the basic locomotor activity (i.e., step-cycle duration, walking speed, gait symmetry) is taken into account. Nevertheless, the results showed that during the recovery, the patients were still hindered by the dual task and visual restriction while walking because they exhibited a decrease in step-cycle duration under these conditions.
In general, an improvement in walking speed and a decrease in asymmetry was seen. On the other hand, patients still had a basically reduced control of gait after the 15-mo recovery period. This can be attributed to a lack of gait automatism caused by an irreversible loss of somatosensory input.
From the Departments of Orthopaedics (EDV, RPHV, HWBS) and Biophysics (EDV, JD), Nijmegen University Medical Centre, Nijmegen, The Netherlands; Sintmaartens Kliniek-research, Nijmegen, The Netherlands (JD); and the Department of Human Movement Science, University of Groningen, The Netherlands (TM).
All correspondence and requests for reprints should be addressed to Rene P. H. Veth, MD, Department of Orthopaedic Surgery, Nijmegen University Medical Centre, P.O. Box 9101, NL-6500 HB Nijmegen, The Netherlands.