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Among the many contributions of Leon Thal to the field of Alzheimer’s disease (AD) research was his leadership in developing the clinical trial network required for accelerating the testing of new potential therapies. He co-founded the Alzheimer’s Disease Cooperative Study to serve the public need for promising new treatments for AD [1]. The Leon Thal Symposium, held in December 2008, was structured around five major public policy initiatives designed to advance the study of new therapeutics for AD. Participants in the symposium were charged with formulating specific recommendations for an action plan for the Alzheimer’s Study Group (ASG). The final recommendations will be used by the ASG as part of the National Strategic Plan for Alzheimer’s, which will be forwarded to the 111th U.S. Congress [2]. We propose in this commentary that recommendations for the strategic plan include the Medicare program to increase public awareness of AD clinical trials and provide information on how potential study participants can enter AD clinical trials. (Medicare is the largest U.S. health insurance program and covers nearly 40 million Americans. It is for people aged 65 years or older, some disabled people younger than age 65, and people with end-stage renal disease.)

It has been proposed that the restraining structures of an individual lumbar segment may become weakened during the early stages of degeneration. The process results in a loss of stiffness in the restraints, compromising their constraining and restoring forces. The effected level would offer less resistance to an applied load and it may displace through excessive range or display abnormal movement patterns. Erratic centrode patterns have been found in cadaveric segments with early disc degeneration. Abnormal ratios between segment translation and rotation have been detected in a group of ten patients with degenerative disc disease. Early attempts to detect abnormal motion radiologically have proved unreliable. Two new techniques are being researched. Some clinicians consider that an unstable lumbar segment can be detected by perceiving abnormal compliance during manual passive accessory tests. These perceptions have been defined biomechanically in terms of an increased neutral zone in the segments...

I congratulate and express appreciation to Mann and Refshauge for their comprehensive analysis of the causes of complications from cervical spine manipulation (Mann and Refshauge 2001).

Joining the discussion on whether our profession is meeting its full responsibilities to provide optimum care (Refshauge et al 2002) for patients receiving cervical manipulation, I offer these personal observations.

When shoulder movements become restricted in all directions, the literature reports that contracture of the joint capsule is not present in every case. These findings suggest a different underlying pathology in some cases, which restricts shoulder movements in a manner resembling contracture. In order to investigate the concept of another mechanism, fourteen patients were selected with a specific pattern of shoulder stiffness: a gross restriction of lateral rotation associated with only moderate restrictions of abduction and medial rotation. The patients were treated with mobilization of the lower cervical spine, which resulted in an improvement in the range of lateral rotation of the shoulder, the most restricted movement. These results suggest a correlation between the cervical spine and shoulders with this pattern of movement restrictions.