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Patients with peripheral artery disease (PAD) often experience leg muscle damage, leading to noticeable walking difficulties. Using ankle foot orthosis (AFO) may enhance gait by supporting weak muscles. This study examined whether wearing AFOs improved the spatiotemporal gait characteristics of patients with PAD to be closer to those of healthy individuals, both from its first use and after a 3-month intervention. Spatiotemporal parameters were calculated from the kinematics of 26 patients with PAD captured in a biomechanics lab. Subjects walked with and without AFOs before and following a 3-month AFO intervention on a crossover basis. The immediate intervention group wore AFOs for 3 months (intervention) before switching to their control shoes (control), while the delayed intervention group followed the reverse sequence. Means and standard deviations (variability) for step width, length, time, and velocity were compared using separate linear repeated measures models. The models included group (immediate vs delayed intervention), time (before vs after intervention or baseline vs 3 mo), and condition (non-AFO vs AFO) as factors of comparison, in addition to interactions, if significant. A 3-month AFO intervention enhanced the temporal gait parameters and reduced gait variability. The mean and variability of temporal gait parameters were sensitive enough to determine whether patients walked more like healthy individuals after a 3-month AFO intervention. This may decrease fall risk and promote more efficient walking patterns in patients with PAD. The long-term benefits and adherence to AFOs and other assistive devices need further study.

Context: Detailed rehabilitation protocols after stem cell treatment are lacking. This case highlights the rehabilitation of a patient treated with human umbilical cord blood-derived mesenchymal stem cell implantation for a large osteochondritis dissecans lesion of the knee. Case presentation: A 17-year-old male adolescent wrestler experienced persistent left knee pain for 1 year, unresponsive to 6 months of conservative treatment. MRI revealed a large osteochondritis dissecans lesion (38 × 18 mm) in the lateral femoral condyle, which was treated with human umbilical cord blood-derived mesenchymal stem cell implantation. Management and outcomes: Rehabilitation was conducted in 4 phases. The protection phase (1–8 wk) emphasized weight-bearing restrictions, continuous passive motion, and early gait training. The gait recovery phase (9–12 wk) incorporated stationary cycling and open kinetic chain exercises. During the maturation phase (13–24 wk), maximal strength and proprioception exercises were introduced with antigravity treadmill running. The final recovery phase (24–52 wk) focused on plyometric drills and sport-specific activities. Team training resumed at 32 weeks, and return to full competitive training occurred at 52 weeks. The limb symmetry index for isokinetic knee-extensor strength and single-leg hop test reached 95.2% and 97.9%, respectively, by 12 months, indicating near-complete functional recovery. The modified MRI of cartilage repair tissue score improved from 40 to 60 points between 1 and 3 years postsurgery. Second-look arthroscopy revealed an International Cartilage Repair Society grade 1 at 35 months. International Knee Documentation Committee scores increased from 17.2 preoperatively to 98.9 at 2 years, while visual analog scale scores decreased from 10 to 2 over 3 years. Conclusions: Accelerated weight bearing, early gait training, and phased strength exercises facilitated substantial improvements in function and cartilage healing in an adolescent wrestler with a large osteochondritis dissecans lesion. Further studies with larger cohorts are recommended to confirm these findings.

A novel phone application (SOBER-EYE) was developed to quantify measures of pupillary light reflex (PLR) that extends beyond traditional PLR dichotomous measurement techniques. Prior to implementation into clinical practice, the test–retest reliability must be evaluated. The primary outcome measure was the intraclass correlation coefficient. Intraclass correlation coefficients for two PLR trials included: constriction amplitude (.825), constriction velocity (.693), initial pupil diameter (.888), latency (.962), and minimum size (.851). Clinical utility was found as all intraclass correlation coefficient values were >.60. The SOBER-EYE phone app has the potential to be used in the clinical environment to assess PLR.

When carrying out a motor task, the direction of the performer’s attentional focus can affect mechanical output and muscle activation. Cortical excitability increases with the observation of motor skills. However, it is unknown if this effect can be additive to that resulting from an internal attentional focus during resistance exercise. A crossover-study design was employed to examine the acute effects of combining mirror self-motor observation (MO) and internally focused verbal instructions on mechanical output and muscle activation during isokinetic concentric knee-extension exercise. Ten participants were tested in 2 different conditions: verbal alone and verbal + MO-mirror. The combination of verbal + MO-mirror attenuated the decrease in torque output in response to 6 sets of 10 isokinetic contractions (P = .043). Interestingly, this effect was paired by a lower-level antagonist/agonist coactivation with the verbal + MO-mirror condition (P = .031). No other differences between conditions were noted. Taken together, these results suggest that the combination of both cueing modalities elicits a more effective contraction strategy during knee-extension exercise. Ultimately, this provides preliminary evidence of better motor performance and heightened fatigue resistance in response to isokinetic exercise.