The distribution of positive work and power generation amongst the lower-limb joints during walking normalises following recovery from traumatic brain injury

•Proximal compensatory pattern normalises during rehabilitation following TBI.•Initial ankle power generation reductions significantly improved over six months.•Improved distribution of lower-limb power generation was associated with higher walking speeds.•Strong inverse relationship between increased ankle and reduced hip power generation.

ObjectiveTo determine whether better walking performance following recovery from traumatic brain injury (TBI) is attributable to an accentuation of compensatory strategies or an improvement in the way positive work is done and power is generated by the lower-limb joints. Setting: A large metropolitan rehabilitation hospital. Participants: Thirty-five ambulant people with extremely-severe TBI who were attending physiotherapy for mobility limitations, and a comparative sample of 25 healthy controls (HC). Design: Cross-sectional cohort study with six month follow-up. Main Measures: Positive work done and average power (i.e. over time) generation by the hip, knee and ankle during stance as well as self-selected gait velocity. Results: In comparison to HCs, TBI participants walked at baseline with a significantly (p < .01) reduced contribution from the ankle to total lower-limb average power generation (and positive work done) during stance, and a significantly (p = .03) greater contribution from the hip. However, this compensatory strategy resolved over time such that at six month follow-up no significant differences in the relative contributions from the ankle and hip were identified for the TBI participants when compared to HCs. Conclusion: Better walking performance following recovery from TBI is attributable to an improvement in the way positive work is done and power is generated by the lower-limb joints rather than an accentuation of compensatory strategies.