Challenges in severe lower limb injury rehabilitation.

Restoration of lower limb function following severe injury is a challenge. Rehabilitation must take into account psychosocial factors and patient self-efficacy as well as functional goals. The Return to Run clinical pathway, an integrated orthotic and rehabilitation initiative, is an example of goal-oriented rehabilitation with periodic assessment aimed at restoring wounded warriors to high-level performance following severe lower extremity trauma. Objective assessment measures of surgical and rehabilitation interventions are lacking for persons with high-level performance demands, such as those required by service members. Thus, the Military Performance Laboratory at the Center for the Intrepid has established normative data for several physical performance measures, some of which are now routinely used to assess service members with severe lower extremity trauma. Patient expectations of treatment and rehabilitation are high and must be met to avoid poor outcomes attributed to nonanatomic factors.