It is important to know the prognosis of the cerebrovascular disease for plan of the course of rehabilitation program. Up to present, brain computerized tomogram(brain CT) was used in combination with clinical, personal and environmental factors but they are insufficient and have a lot of limitation to expect the neurophysiologic state and the prognosis of the hemiplegic patients. And so we practiced the median nerve somatosensory evoked potentials(SEP) as a prognostic predictor of the cerebrovascular disease on the both upper extremities and evaluated correlation with the clinical findings and brain CT and then correlated with the functional recovery in 40 hemiplegic patients. Results are following.

1) SEP has a good correlation with clinical findings and among them especially strong with vibration and joint position sense.

2) In the lesion of the somatosensory pathway and basal ganglia, loss of the SEP waveform was marked and in the lesion of non-somatosensory area except basal ganglia SEP showed normal or mild change.

3) Changes of the SEP waveform according to the duration of disease were not significant and have no correlation.

4) Motor & sensory improvements in hemiplegic patients had something to do with the improvement implicated still more.

5) We think that it is desirable to exam the SEP as a simple neurodiagnostic study for the appreciation of neurophysiologic state and the prognostic prediction of the functional recovery during acute stage and rehabilitation period in the stroke patients.

The Purpose of this study is to demonstrate the therapeutic effect of a comprehensive rehabilitation approach to cervical radiculopathy including strict bed rest for relief of pain and spasm; instruction for specific activities and posture to prevent aggravation and recurrence; physical therapy such as heating, traction, strengthening exercise; a gradual increase of activities of daily living; and psychotherapy.

The subjects of this study were 146 patients with cervical radiculopathy who were admitted to Yongdong Severance Hospital, Yonsei University, and were managed with a comprehensive rehabilitation approach.

The major results were as follows:

There were abnormal radiographic findings in 78.8% and associated neuromuscular illness in 63% of all patients with cervical radiculopathy.

Patients with psychological factors comprised 24% of all patients and had a significantly longer period of admission(average stay 24.3 days) than those without(average stay 18.9 days). The average hospital stay was 20.8 days. At the time of discharge, 86.3% of all patients showed favorable results and 95.9% showed symptomatic improvement. After discharge, 123 cases out of 146 were followed up for an average of 3 months and showed maintenance of their state at discharge in 71.5%, improvement of symptoms in 16.5% and aggravation of symptoms in 12.2%. According to the above results, a comprehensive approach to cervical radiculopathy is an effective management procedure.

Recently, the early diagnosis and treatment has been emphasized in the management of the cerebral palsy. In Korea, however, the diagnosis has been delayed by many factors. The purpose of this study was to determine these factors. The subjects were 218 cerebral palsied ranged in age between 3 months and 11 years, who visited our department from August of 1985 to August of 1987.

The results were as follows:

1) In 64.2% of the patients, the motor dysfunction was detected by the parents. And, in 58.7% the motor deficit was found within 6 months, in most of the patients(91.8%) it was found within 12 months. The higher educational status of the parents was, the earlier the motor dysfunction could be found.

2) Only 61.8% of the parents visited the medical clinics or hospitals because of the motor deficit. The rest used tranditional methods, such as chinese herb medicine and acupuncture, which was significantly correlative with lower educational status and lack of medical insurance of the parents.

3) The opinions of 62.3% of the physicians who examined the patients for the first time were inappropriate; 25.0%could not find any abnormality, 29.9% recommended to wait for 12 months, and 7.4% of them believed the cerebral palsy as intractable disease.

4) Most of the parents(91.8%) wanted to treat their children successfully as possible, but 46.7% of them had inappropriate ideas about the treatment.

Glasgow coma scale and Glasgow outcome scale are the objective measure to report the degree of brain damage and rehabilitation outcome, respectively.

In an attempt to compare the rehabilitation outcome, a restrospective study of 30 male and 13 female(total; 43) patients, aging from 11 to 75, was undertaken. The causes were traffic accident and stroke and the mean age was 33.0 and 55.8 years, respectively.

Glasgow coma scale was determined from the first neurological examination of the patients and the visual perception, Barthel index and Glasgow outcome scale were evaluated at the time of discharge.

The minor head injured on Glasgow coma scale was 22, The moderate injured was 13 and the severe injured was 8. After the rehabilitation treatment, 61.5% of the severe injured had severs disability and 63.7%, 61.5% of the minor and moderate injured had moderate disability in Glasgow outcome scale. There was correlation between Glasgow coma scale and rehabilitation outcome based on Glasgow outcome scale and Barthel index, but was no correlation between Glasgow coma scale and visual perception.

117 healthy Korean, age ranging between 17-58, were evaluated for H-reflex conduction velocities.

The aim of this study is to find a handy and precise method of H-reflex evaluation. E. Johnson has developed the expected normal latencies for the person with same age and same leg length. If one use this method, his patient's H-reflex latency has to be compared with the expected value every time. We thought this is too complicated and have come to think of more simple one.

Findings were following:

1) The coefficient of variation of the H-reflex latency and H-reflex conduction velocity were 112.3% and 8.0%, respectively. Narrower dispersion was obtained in H-reflex conduction velocity than the difference between observed H-reflex latency and expected H-reflex latency using Braddom & Johnson's formula:

H latency(msec)-9.14+0.46 leg length(cm)+0.1 age(year).

1) The coefficient of variation of the H-reflex latency and H-reflex conduction velocity were 112.3% and 8.0%, respectively. Narrower dispersion was obtained in H-reflex conduction velocity than the difference between observed H-reflex latency and expected H-reflex latency using Braddom & Johnson's formula:

H latency(msec)=9.14+0.46 leg length(cm)+0.1 age(year).

2) A formula was obtained by an analysis of the regression of the H-reflex conduction velocity(HCV) on age: HCV(m/sec)=65.28-0.12 age(year)

3) A formula was obtained by an analysis of the regression of the H-reflex conduction velocity(HCV) on height: HCV(m/sec)=3701+0.15 height(cm)

4) A formula was obtained by an analysis of the regression of the H-reflex latency on height: H latency(m/sec)=14.07+0.08 height(cm)

5) A formula was obtained by an analysis of the regression of the height on age: Height(cm)=177.88-0.30 age(cm)

The younger was taller than the older in this group.

There has been many studies functional outcome and length of stay following rehabilitation with controversial results, especially regarding factors influencing outcome.

Therefore the present study explores the status of rehabilitation of stroke patients in Korea, and factors influencing functional outcome and length of hospitalization.

The study was done retrospectively through a medical record search of 215 stroke patients admitted to Severance Hospital, Seoul, Korea between Jan. 1 and Dec. 31, 1985, excluding 11 cases who expired in hospital.

The major results are as follows:

Ambulatory status at the time of discharge was independent in 19.1% of 97 cases those who received rehabilitative treatment and 0% of 118 cases those who did not. Of these treated, 13.0% were wheelchair ambulatory compare with 34.4% in the nontreated group. Therefore, at discharge, the treated group had a superior ambulatory status(p<10^-6).

Factors influencing ambulation level at discharge were age, severity of weakness of the involved extremities on admission and the interval between stroke onset and rehabilitative treatment in the treated group(p<0.01).

Factors unrelated to ambulation level at discharge were mental status on admission, number of recurrent stroke, duration of rehabilitative treatment and presence of preceding disease such as diabetes mellitus, hypertension, atherosclerotic heart disease(ASHD) or chronic obstructive pulmonary disease(COPD).

Factors influencing length of hospitalization were interval between onset of stroke and rehabilitative treatment, complications and mental status on admission(p<0.1).

Factors unrelated to length of hospitalization were age, number of recurrent stroke, communication problem, severity of weakness of the involved extremities on admission, depression and preceding disease.

Maximal voluntary muscular torque output, total work and endurance ratio of the quadriceps and hamstrings during isokinetic exercise was studied in order to obtain the isokinetic normative data of the knee for clinical use. 160 subjects were tested, from 3rd decade to 6 th decade, 20 men and 20 women in each decade respectively.

The results obtained were as follows:

1) The torque values of males were significantly greater than females at each test speed and in quadriceps and hamstring.

2) The more the age was younger the more the torque values were significantly greater.

3) The quadriceps torque values was significantly greater than the hamstrings at each test speed.

4) The torque values decreased as speed of exercise increased.

5) No significant differences of knee torque values was found between dominant and nondominant limbs.

6) The ratio of hamstring torque values to quardriceps torque values significantly increased as the test speed increased.

7) The total work was significantly decreased in female, old decade and hamstring respectively.

8) The endurance ratio was generally more than 50% except hamstring in 6th decade.

9) The peak torque acceleration energy was significantly decreased in female, old decade and hamstring respectively.

10) The average power was significantly decreased in female, old decade and hamstring respectively.

The increase in the incidence of traumatic head injury in modern populations and the provision of adequate hospital services for them have become major matters of concern.

Increased numbers of victims of traumatic head injury survive due to the improved understanding of the pathophysiology of brain, and better post-traumatic emergency treatment and neurosurgical procedures. The rehabilitation of these patients began only 15 years ago. The problems encountered are numerous, such as motor and sensory deficits, cognitive perceptual deficits, speech/language problems, memory deficits, social adaptation and behavior disturbances, etc.

For these reasons we present the summary of our experiences with 30 cases of traumatic head injury treated during the past 3 years in the Department of Rehabilitation Medicine of the Presbyterian Medical Center in Chonju. The findings are as follows;

1) Seven cases(23.3%) were in their 4 th decade. Twenty-six cases were male, 4 female: the male/female ratio thus being 6.5:1.

2) Mean period of total hospital stay was 108.1 days; mean period of rehabilitation department admission was 47.5 days.

3) Mean follow-up period from the time of head injury was 28 months.

4) The most common cause of injury was traffic accidents(83.4%) and the most common source of hospital payment was motor vehicle accident insurance.

5) Stupor was the most frequent mental status on admission. The patients' level of consciousness improved steadily after transfer to the Rehabilitation department and during the followup period.

6) The most frequent (7 cases, 23.3%) score of the Glasgow Coma Scale on admission was 3~8. After transfer to the Rehabilitation department and at the end of the follow-up period the most frequent score was 13~15.

7) Cerebral contusion was identified in 28 cases, intracranial hematoma in 25, skull fracture in 19.

8) Sixteen cases(53.3%) had associated injuries, fractures being most frequent.

9) The sequelae of traumatic head injury observed included heterotopic ossification(10.7%), frozen shoulder(16.7%), motor weakness(80.0%), speech/language problems(66.7%), bladder incontinence(46.7%), bowel incontinence(33.3%), swallowing difficulty(10.0%), peripheral nerve injury(10.0%), post-traumatic epilepsy(16.7%).

10) Dysrhythmia was noted in 12 cases(54.5%) on EEG.

11) In activities of daily living, most patients(27~29 cases) were independent in eating, dressing, light hygiene, transfer activities and ambulation at the completion of the follow-up period.

12) Thirteen cases(48.1%) had residual perceptual deficits on the Motor Free Visual Perception Test, who had tested.

13) Sixteen cases(33.4%) had a subnormal IQ score.

14) In 5 cases(25%), an organic brain syndrome was suspected on the Bender Gestalt Test.

15) In thirteen cases tested with MMPI, scales of F, hypochondriasis, hysteria, and depression were higher than control group.

16) Follow-up showed that 5 patients held jobs, such as driver, farmer, and officer, although they complained of headache, memory deficits, and speech/language problems. Of the 5 students among the patient population, 1 left school in midcourse.

The SEP test is a valid and repeatable technique which correlates with clinically assessed joint position sense and useful in predicting motor recovery of hemiplegia.

At Kyung Hee Medical Center, we studied 30 cases of Stroke about the motor recovery & SEP patterns. It has been important prognostic index whether the SEP patterns are normal or not. The results were summerrized as follows.

1) 13 patients showed normal SEP patterns. 5 of them showed no weakness and 8 of them showed mild weakness. 4 patients showed abnormal SEP pattern. 1 of them showed mild weakness, 2 of them showed moderate weakness and another one showed severe weakness. 13 patients showed absent SEP patterns. 3 of them showed mild weakness, other three showed moderate weakness and another seven showed severe weakness.

2) The results were statistically significant correlation between the normal and abnormal SEP patterns(p<0.005).

3) The SEP study is useful predicting motor recovery of stroke patients.

Thirteen spinal cord injured men with erectile failure were evaluated for the effect of intracavernosal injection of the papaverine. Findings were as following;

1) Average age was 39.1 years old, the oldest was 52, the youngest was 29.

2) The level of SCI; 10 person(63.5%) had thoracic cord level, 3 person(36.5%) had lumbar cord level.

3) Average penile length was 9.6 cm and circumference was 8.4 cm before injection. After the injection, average penile length and circumference was increased to 10.9 cm and 12.5 cm. The average increase of penile size was 2.8 cm in length and 2.4 cm in circumference.

4) Onset of erection were on 1-3 minutes after injection. The maximal erection were 2-15minutes and the mean was 8.5 minutes. The dosage did not affect the onset of erection or the maximal erection time.

5) The mean duration of erection time was 26 minutes with injection of 7.5 mg, 68 minutes with injection of 15 mg and 143 minutes with injection of 30 mg.

6) There were no effect in 2 person and prolonged erection(priapism) in one person.

7) By increased dosage prolonged duration of the erection time was obtained but no significant change of penile size and maximal erection time was obtained.

Twelve patients with posttraumatic, complete spinal cord injuries consisting of 7 quadriplegics and 5 paraplegics treated at the department of Rehabilitation Medicine, Korea Veterans Hospital were studied clinically and elecrtomyographically to determine the sensory and motor function present below the level of bony injury.

The time since injury ranged from 10 to 55 months(mean 32.0), and the ages of subjects ranged from 22 to 40 years(mean 28.1).

None of the patients had spinal surgery of any kind before or after their spinal cord injury.

Motor function in the ventral rami was preserved only as far as the level of bony injury in quadriplegics.

Pain and light touch extended to similar levels anteriorly in these patients but was found to end at 1 to 2 segments proximal to the bony injury in 3 of the 5 paraplegics.

Electrical activity within the paraspinal musculature was found to be normal as far distal as the bony lesion; or up to 4 vertebrae below this in the quadriplegics and from 1 vertebrae proximal 4 vertebrae distal in the paraplegics.

Electrical activity of less than normal quantity, however, nearly always extended from 1 to 6 vertebrae distal to the bony injury.

Pain and light touch from the posterior rami were preserved in all from 1 to 5 vertebrae below the osseus insult.

A Definitive disparity exists between preservation of anterior and posterior rami level of function.

The level to which reduced electromyographic activity was seen to extend below the lowest injured vertebrae correlated reasonably well with the exact to which pain was appereciated.

Diluted phenol solution has been used to alleviate spasticity and to control pain since 1955. But the mechanism of nerve block with diluted phenol solution has not been established yet. Sciatic nerve of 46 rats were used to produce nerve block with phenol solution.

Nerve conduction studies before and after nerve block were done, and latency and amplitude of evokded potential were compared, Nerve block with pure alcohol and procaine solution were done and compared with those of diluted phenol solution.

The results were as following;

1) Nerve conduction after phenol block resulted in marked decrement of amplitude of the evoked potentials. Increased amount or increased concentration of phenol solution could produce more complete and permanent nerve block.

2) The degree of phenol nerve block was increased by increased concentration, amount of the solution or applying time of the solution to the nerve.

3) Nerve conduction after nerve block with pure alcohol resulted in decrement of amplitude of evoked potentials, while a little change in the conduction velocities. This results were suggestive of axon was affected more.

4) Nerve conduction after nerve block with procaine solution resulted in prolongation of latency and decrement of amplitude of evoked potentials. This results were suggestive of both compotents were affected.

Hemophilia is one of the hereditary coagulation disorders characterized by a deficiency of plasma clotting factors such as factor Ⅷ and Ⅸ. As life long bleeding occurs in hemophiliacs, a continuous multidisciplinary team approach is required for the patient and his family.

This study was performed to determine the various clinical aspects of hemophilia in evidence at the present time as well as to emphasize the effectiveness of a comprehensive rehabilitation management for admitted patients. In spite of the early diagnosis of hemophilia, patients are seldom managed by a multidisciplinary team. AHF(Antihemophilic Factor) infusion, education, early mobilization, and continuous exercise are the most important components of a comprehensive rehabilitation program.

The purpose of this study is to try to quantify the differences in isometric and isotonic exercises of vastus medialis and vastus lateralis of quadriceps, knee extension, and straight leg raising exercises.

In 20 healthy Korean male adults, EMG(rectified mean amplitude) was analyzed quantitatively in vastus medialis vastus lateralis and rectus femoris in various conditions.

The followings are summarized results of the study;

1) The quantitative EMG values in knee extension exercises are higher than in straight leg raising exercises(p<0.001).

2) The quantitative EMG values in isometric exercises are higher than in isotonic exercises. (p<0.05-p<0.001)

3) The activity of the vastus medialis was not limited to the last 15°~20° of extension, but rather took place during all of the knee extension.

4) a. Vastus lateralis and vastus medialis are generally active than rectus femoris.

b. Vastus medialis is more active than vastus lateralis in 5 exercises out of 8(10% isotonic knee extension, 10% istonic straight leg raising, 30% isotonic knee extension, 10% isotonic straight leg raising, 30% isotonic knee extension, 10% isometric knee extension, 30% isometric straight leg raising) and vastus lateralis is more active in remainder.(30% isotonic straight leg raising, 10% isometric knee extension, 30% isometric straight leg raising)

5) As was expected, the quantitative EMG values in 30% repetition maximum weight are higher than in 10% repetition maximum weight.

Common peroneal nerve palsy is one of the most frequently encountered nerve injuries. The reason for this is the superficial portion of the nerve as it curves around the head of the fibula where it is subject to direct trauma, pressure, or other injuries.

In acute stages, when clinical paralysis appears to be complete, electrophysiologic studies are a useful guide to prognosis. They may also indicate an underlying neuropathy and detect early evidence of recovery.

A retrospective analysis of 37 consecutive cases of peroneal nerve palsy seem from January 1985 to July 1987 in the department of Rehabilitation Medicine at Catholic Medical College was carried out. Of the 65 patients. They were selected group confirmed to have peroneal nerve palsy by clinical findings and electrodiagnostic study.

The results of these studies were as follows.

1) The second and the third decades were involved most frequently and the males were most prevalent than the females with the ratio of 6:1.

2) The more frequent site of the lesions was the common peroneal nerve.(81.1%)

3) For the cause of lesions, the fracture was most common.(40.5%) And the other causes are unknown, compression, Laceration, burn, etc.

4) On motor conduction study of common peroneal nerve, 23(62.3%) of the all cases showed abnormalities, 19(5.4%) cases of them showed no conduction, and 4(10.8%) of them showed slowing of conduction or delayed distal latencies.

On needle EMG, all cases showed spontaneus activity in deep peroneal nerve innervated muscles.

In the evaluation of patients for sexual dysfunction, several laboratory methods are being used among which pudendal SEP and Bulbocavernosus reflex study are recently popular. Electrodiagnostic evaluation were performed on 37 healthy males and 111 patients with sexual dysfunction. Following results were obtained.

1) Short latency P₁ SEP stimulating pundendal nerve in healthy males was 38.2±2.2 msec, and the average bulbocavernosus reflex latencies were 32.4±3.6 on the right, 32.5±3.5 msec on the left.

2) Patients showing great abnormality in pudendal SEP were spinal cord injury patients of UMN type and the average P₁ latency was 46.3±7.1 msec which revealed significant difference from the standard value.

Patients group showing one of the most prolonged bulbocavernosus reflex latency was spinal cord injury patients of LMN type with the average value of 48.4±14.6 msec on the right, and 51.8±16.2 msec on the left which also shows significant difference from the standard value.

3) There were no significant difference between normal group and psychogenic, vasculogenic and low back pain patients both in pudendal SEP and bulbocavernosus reflex study. However, significant difference was obtained in the patients of diabetes mellitus, pelvic trauma and spinal cord injury patients of UMN type in the study of pudendal SEP, and there was also a significant difference in the patients with pelvic trauma and spinal cord injury of LMN type in bulbocavernosus reflex study.

4) Electrodiagnostic abnormality rate of the patient group with organic lesion, excluding psychologic group, were 30.6% by pudendal SEP and 21% by bulbocavernosus reflex study. When pudendal sEP study and bulbocavernosus reflex study were done together, 40.3% of abnormality were detected.

From SEP. 1979, 137 cases of myasthenia gravis under the clinical impression at Seoul National University Hospital were analysed by repetitive supramaximal stimulation EMG study.

The results obtained were as follows:

1) Among the 137 cases, 66 cases(48.2%) were positive but 59 cases(43.1%) were negative.

2) The most peak age incidence was the third decade(25.8%) in female.

3) In repetitive supramaximal stimulation test, positive rate in proximal muscles was higher than distal muscles: 92% in proximal muscles, 76% in distal muscles.

4) The slow repetitive supramaximal stimulation was more sensitive than fast repetitive supramaximal stimulation: The decremental ratio of slow and fast repetitive supramaximal stimulation were 30.9% and 23.1% in proximal muscles respectively, and 23.0% and 22.5% in distal muscles respectively.

5) In EMG analysis according to severity of symptoms, the more symptoms were severe the more positive finding were noted and toe more decremental ratio was remarkable.

6) The cases in which the duration of symptoms was more than 1 month showed positive EMG findings in 77.9%, but cases with less than 1 month duration showed positive findings in only 12.5%.

Visual perceptual dysfunctions following stroke cause a high proportion of failures in activities of daily living and difficulty in learning new activities. Because these dysfunctions interfere with an individual's progress in rehabilitation, the diagnosis and remediation of visual perceptual dysfunctions are important.

The authors assessed visual perceptual dysfunctions in 40 adult stroke patients with the Presbyterian Medical Center(PMC) perception test and the Motor-Free Visual Perception Test(MVPT), and investigated the relationship of visual perceptual dysfunctions with site of lesion, side of paralysis, and initial mental state after stroke.

In addition, functional improvements were assessed by the modified Patient Evaluation Conference system(PECS) to see whether the average gain differred according to visual perceptual dysfunctions or side of paralysis. The effect of treatment was assessed also in those who received follow up testing by the MVPT.

The results are summerized as follows:

1) No significant difference was detected in the degree of visual perceptual dysfunction according to the side of paralysis and initial mental state.

2) Perceptual age was significantly lower in the patients who had lesion in the cerebral hemisphere than in those with lesions in other locations.

3) Right hemiplegic patients showed higher average gain in modified PECS scores than left hemiplegics.

4) The patients with severe visual perceptual dysfunction by the PMC perception test showed higher average gain in modified PECS scores than did patients with mild dysfunction.

5) There was improvement in perceptual age of 2.5 years on the average in 5 left hemiplegic patients who received an average of 41.4 days of perceptual treatment.

The psychological consequences of the long-term spinal cord injured and the impact of psychological variables on adjustment to injury have recently got increasing attention.

Thirty-eight persons with spinal cord injury completed the Korean Self-Concept Scale(revised Tennessee Self-Concept Scale) and examined 10 demographic factors including injury level of the spinal cord, severity of the injury, marital status, time after injury bladder condition, residence, education, motivation, pain, and activity.

The results were as follows;

1) Compared to normal controls, significantly lower scores in the Physical Self(t=-4.23), the Family Self(t=-2.44) and the Total Self(t=-2.60) were obtained in the subject group.

2) The Physical Self was significantly related with severity of the injury(f=4.28), marital status(F=2.37), bladder condition(F=10.60), residence(F=5.04), education(F=4.31), and motivation(F=5.60).

3) The Family self was significantly related with the severity of spinal cord injury(F=4.23) and pain(F=3.61).

4) The Total Self was significantly related with the severity of spinal cord injury(F=5.22) and pain(F=10.42).

In the tarsal tunnel syndrome, the posterior tibial nerve is entrapped beneath the flexor retinaculum and deep fascia along the medial border of the foot. This syndrome is not recognized as readily as its counterpart in the upper extremity, the carpal tunnel syndrome. 2 patients with tibial nerve compression were diagnosed by clinical findings and electromyography and had surgical decompression. Besides the tibial compression symptoms, they all complained the symptoms of peroneal compression before operation, In the first case, all the symptoms of tibial and peroneal neuropathies were subsided after surgical decompression, but more aggravated in the 2 nd case.

This paper will reports the clinical & electromyographic findings, and the surgical results.