The aim of this study was to evaluate the relationship between severity of dementia and hand dexterity in patients with Alzheimer's disease (AD) using the Purdue Pegboard test including both simple and complex dexterity tasks. Eighty-four patients with AD and 32 non-demented subjects (controls) who were registered in a senior day-care center participated in this study. All of the subjects in this study were right-handed. The AD group consisted of 36 patients with a Clinical Dementia Rating of 1 (CDR 1), 35 with a CDR of 2 (CDR 2), and 13 with the CDR of 3 (CDR 3). For the simple task, right hand scores in the CDR 1, CDR 2, and CDR 3 groups were significantly lower than those of the controls whereas left hand scores were not lower than the controls. While the right hand scores were higher than the left hand scores in the controls and the CDR 1 group, no significant difference was observed between the right and left hand scores in the CDR 2 and 3 groups. Moreover, left hand scores were higher than right hand scores in 19 % of the CDR 1 group, 34% of the CDR 2 group, and 23 % of the CDR 3 group. Differences between right and left hand scores, which is a measure of handedness superiority, were decreased in order from the control group to the CDR 1 group and to the CDR 2 group. There was a relationship between “memory” subscale in the CDR and the differences in right and left hand scores. These results indicated that handedness superiority became unclear or disappeared as memory impairment progressed.

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Botulinum toxin A (BTX-A) was used in adult cerebral palsy patients for chronic pain treatment. Five patients (quadriplegia 3, diplegia 1, and athetosis 1 with an average age of 47) were all classified as GMFCS level IV. As a treatment for neck and trunk muscle pain, BTX-A injections were administered with a total dose below 6 units per kilogram of body weight. To investigate the efficacy of BTX-A, the Visual Analogue Scale and Modified Tsui Scale were used to evaluate the patients before and at regular monthly follow-ups after their injections. We found significant improvement in the Visual Analogue Scale scores at 1 month after initial injection and also found the same difference at the second injection. Also, although we found improvement in the Modified Tsui Scale scores at 1 month after injection, these improvements did not last as long as the Visual Analogue Scale improvements. BTX-A has been used in a growing number of indications for the treatment of muscle spasticity including blepharospasm, facial spasm and spasmodic torticollis. We found that BTX-A may also be useful in treating patients with cerebral palsy suffering from chronic pain.

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Electrical stimulation (ES) is an established method for providing muscle activity. Moreover, there are some reports that ES induces angiogenesis. It was thought that the angiogenesis from ES is induced by physical phenomenon such as calculated shear stress, capillary wall tension, and stretch. However, there is a report that the electrical field itself might play a role in angiogenesis by stimulating the vascular endothelial growth factor (VEGF) receptor signaling pathway. Therefore, there is a possibility that ES might be used as a new therapy for ischemic diseases such as arteriosclerosis obliterans (ASO). The limited physical performance of chronic heart failure (CHF) patients may not only be entirely due to impairment of cardiac and lung function but may also result from peripheral hemodynamic variables and abnormalities in skeletal muscle metabolism and structure, such as a decrease in capillary density, mitochondrial content etc. There are some studies showing the positive effect of low frequency electrical stimulation on muscle strength and blood flow in patients who have advanced CHF and can not achieve conventional exercise training. Thus, ES could be recommended for the treatment of patients with severe CHF. Furthermore, cardiac-resynchronization therapy in the form of biventricular stimulation with a pacemaker would reduce the risk of death and hospitalization among patients with advanced CHF. Further studies are required to precisely define the underlying mechanism and determine the most effective mode of application.

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