Nintendo WiiTM versus Xbox KinectTM for functional locomotion in people with Parkinson's disease: a systematic review and network meta-analysis.

PURPOSE: To investigate the effectiveness of commercial exergames treatments on people with Parkinson's disease (PD), a systematic review and network meta-analysis (NMA) of randomised controlled trials (RCT) was performed to evaluate functional locomotion effects in patients with PD. METHODS: A comprehensive search on PubMed, Embase, Cochrane Controlled Trials Register, the Cochrane, and other databases without language restrictions was conducted. References and reviews were cross-checked for possible studies. RCTs from 2012 were included. Seven studies with 236 participants were included in the NMA that used a random-effect Frequentist model to investigate the standard mean difference of pooled effect sizes change in functional locomotion between baseline and delayed retention tests on six comparisons. RESULTS: The direct comparisons Kinect: Control (n = 4), Wii: Control (n = 5) and the indirect-network comparison Kinect: Wii (n = 1) determine that Nintendo Wii™ may be the best choice in functional locomotion improvements. CONCLUSIONS: These network meta-analytic findings show that Kinect and Wii show immediate positive effects on functional locomotion in people with PD. Compared with Kinect RCTs, Wii may be considered the best therapy for providing functional recovery in PD.Implications for rehabilitationExergames rehabilitation reveals intervention benefits for functional locomotion in people with PD.In patients with cognitive disorders, Wii's platform can be considered a visual reference and a cue to facilitate patients with freezing.Nintendo Wii seems to be a better device for locomotion rehabilitation in people with PD than Xbox Kinect.

Synergic use of botulinum toxin injection and radial extracorporeal shockwave therapy in Multiple Sclerosis spasticity.

BACKGROUND AND AIM: In Multiple Sclerosis (MS) spasticity worsen patient's quality of life. Botulinum NeuroToxin TypeA (BoNT-A) is extensively used in focal spasticity, frequently combined with physical therapies. Radial extracorporeal shock waves (rESW) were already used in association with BoNT-A.  Considering that loss of efficacy and adverse events are determinants of BoNT-A treatment interruption, this study aimed to evaluate the possibility to prolong BoNT-A's effect by using rESW in MS focal spasticity. METHODS: Sixteen MS patients with spasticity of triceps surae muscles were first subjected to BoNT-A therapy and, four months later, to 4 sections of rESWT. Patients were evaluated before, 30, 90 days after the end of the treatments, by using Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS) and kinematic analysis of passive and active ankle ROM.   Results: BoNT-A determined a significant reduction of spasticity evaluated by MAS with a reduction of positive effects after 4months (p<0.05); MTS highlighted the efficacy only 90 days after injection (p<0.05). rESWT decreased MAS values at the end and 30 days later the treatment (p<0.01); MTS values showed instead a prolonged effect (p<0.01). BoNT-A determined a gain of passive and active ankle ROM, persisting along with treatment and peaking the maximum value after rESWT (p<0.05).  Conclusions: rESWT can prolong BoNT-A effect inducing significant reduction of spasticity and improvement in passive and active ankle ROM in MS patients. The use of rESWT following BoNT-A injection is useful to avoid some limitations and to prolong the therapeutic effects of BoNT-A therapy.

Late Activation of the Vastus Medialis in Determining the Risk of Anterior Cruciate Ligament Injury in Soccer Players.

CONTEXT: Activation time of the quadriceps is important in determining injury risk in professional soccer players. OBJECTIVE: To compare the activation time of the quadriceps and hamstrings muscles during a movement that puts stress on anterior cruciate ligament (ACL) to assess the risk of ACL injury. DESIGN: Case series. SETTING: University laboratory for movement analysis. PATIENTS OR OTHER PARTICIPANTS: Twenty (10 males and 10 females) professional soccer players. INTERVENTION(S): An inertial sensor and 4 electrodes positioned on the quadriceps and hamstrings muscles were used for the surface electromyography. The athlete resting on 1 leg dropped, from a 32-cm-high platform, on the suspended foot (testing leg), without jumping or lowering his center of gravity and maintaining single-leg landing for 5 seconds. Using a software, it is possible to calculate the activation time of the rectus femoris, vastus medialis (VM), biceps femoris, and semimembranosus muscles before ground contact. MAIN OUTCOME MEASURES: To evaluate the activation times of the rectus femoris, VM, biceps femoris, and semitendinosus muscles before ground contact in comparison with the range of normality calculated by the manufacturer. RESULTS: All male soccer players demonstrated a low risk related to the correct activation of all the examined muscles, while female soccer players demonstrated delayed activation of the VM. CONCLUSIONS: Delayed activation of the VM registered in females determines an increase in anterior shear force, which is an important risk factor for incurring an ACL injury. This testing protocol becomes adequate for the screening of high-risk athletes and for targeting interventions to specific imbalances that may increase injury risk.