The management of muscular disorders has not been actively offered and generally limited in diagnostic studies in our clinics. Any disability from weakness and atrophy can be managed with balanced nutrition and a daily exercise program that emphasizes stretching. In additin to this, bracing, surgical correction of deformities and adoptive aids and respiratory therapy are necessary to prevent and correct the deformity, contractures, and life-threatening complications. A brief summary of clinical features found in specific muscle diseases particulary with progressive muscular dystrophy and the rehabilitation program wish to offer hospital facilities and home care basis are introduced in this article.

Electrophysiologic examinations including electromyography (EMG), late responses and somatosensory evoked potentials (SSEP) were performed on the L4, L5 and S1 roots distributed regione on the 34 cases of low back pain with had already studies of myelography and computerized tomography (CT) scan. The SSEP findings were compared to the EMG, myelography and CT scan findings with the sensitivity and speciticity between them.

The results were as follows.

1) Among the thirty four cases who had done either a myelogram, CT scan, or both, twenty two cases (64.7%) showed evidence of nerve root compression sign on EMG study and 23 cases (67.6%) showed to be positive in SEP findings.

2) The sensitivity was 59.1% and the specificity was 41.7% when the EMG findings were compared to myelgram and CT scan findings, and the sensitivity was 83.6% and the specificity was 25.0% when the SSEP findings were compared to myelogram and CT scan findings. There was no statistical significance between the EMG and SSEP.

3) Ten cases out of eleven who showed on EMG positive findings revealed that positive findings in SSEP studies and 5 cases free from EMG, myelogram and CT scan findings showed positive findings in SSEP studies.

The objective of this study was to standardize the technique, increasing the clinical significance of the nerve conduction study in medial and lateral planter motor and sensory nerves.

At first we found the stimulating point that the muscle action potentials or nerve action potentials are most definitely elicited after stimulating to the medial and lateral planter motor nerves at the ankle and stimulating to the sensory nerves at the toe in 35 healthy Korean adults aged from 22 to 53 years. And then we measured the conduction distance from the stimulating cathode to the active recording electrode in the foot with a flexible tape and a caliper. The mean values of the conduction distance in medial and lateral plantar motor nerves were 7.75±0.85 cm and 8.06±0.97 cm respectively. The mean value of that in medial plantar sensory nerve was 18.3±1.77 cm, too.

The mean value of the distal motor latency was 3.93±0.49 msec for the medial planter nerve and 4.29±0.55 msec for the lateral planter nerve. The mean value of distal sensory latency was 4.30±0.53 msec for the medial plantar nerve and 4.61±0.49 msec for the lateral planter nerve. There was significant difference in the distal latency and amplitude between the medial and lateral plantar motor and sensory nerves.

Spasticity, as one component of the upper motorneuron syndrome has been one of the most troublesome obstacles to the successive rehabilitation of motor function. Moreover, the objective diagnosis and the quantification of the extent of spasticity have been the interesting issues to be solved.

In the present study, to control spasticity systemically, we used a GABA derivative (i.e baclofen) to ten subjects who had symptomatic spasticity due to spinal or cerebral lesion fir 4 weeks. And then we examined H/M ratio weekly to observe the effect. The result obtained as follows:

1) The basal H/M ratio of the spastic, 16 limbs of 10 subjects, was 0.476±0.161, significantly larger than the standard normal value.

2) The percentile changes of the H/M ratio after 1,2,3 and 2 weeks during the medication, were accordingly -20.1±26.2, -21.0±25.4%, -23.4±23.8% and -32.8±19.6%, so the significant serial decrement of the H/M ratio with clinical improvement of spasticity could be observed.

3) The H/M ratio change of the spinal spasticity was not significantly larger than that of the cortical spasticity.

4) The H/M ratio change in spastic hemiplegia showed the decrement in affected side as well as in unaffected side.

5) Of the spastic symptoms, resistance to the passive movement showed improvement in 80%, in contrast to the ankle clonus, which had the improvement only in 40%.

The purpose of this study is to help the severely handicapped persons who are in the state of quadriplegia due to high cervical spinal cord injury, head injury, myopathy, etc. by developing pneumatically-operated Environmental Control System (ECS) for operating an interphone, a TV, a radio, a ceiling lamp, a table lamp, a fan, an electric curtain and an electric bed.

The ECS used in this study were designed in cooperation with Department of Rehabilitation Medicine and Department of Physics, Catholic University Medical College (1986. 3-1987. 8.).

The authors used an ECS which performed 10 different functions in a case of C5 quadriplegic patient who is 60 years old.

From August 1987 to May 1988, the authors studied for the efficacy of the ECS.

After the use of the ECS (1988.3.14-5.13), via the adaptational period for about 20 weeks, the quadriplegic patient had many psychological benefits such as a heightened sense of independency, a reduction of frustration and practically the numbers of help demands was reduced, compared with before the use of the ECS (1987. 8. 21-10.20), from 87.1 times a day to 42.0 times a day (48.2%).

The problem of depression after a stroke has received very little attention from the medical profession until recently. Even the frequency of depression after stroke is uncertain, and there has been very little research.

The author studied depression, using BDI (Beck Depression Inventory) in 30 CVA patients who were inpatient at Kyung Hee University Hospital and 30 normal subjects, during the period from the beginning of Feb 1988 until the end of April 1988.

The summary of the results is as fallows;

1) The BDI mean score were 22.63±10.9 in the CVA patients and 12.87±7.58 in the normal subjects.

2) Depression status was not significantly related to age, sex, side of brain involuement, duration of illness, or independence in ADL.

3) Depression status was significantly related to limited social function, guilty conscience, helplessness, and damage of self-image.

Somatosensory evoked potentials (SEPs) are of value in evaluating the somatosensory pathway from peripheral sensory receptor to cerebral cortex. Scalp-recorded SEPs recorded by median nerve stimulation were investigated in one group (total 23, male 19, female 4) of healthy Korean, and tibial nerve stimulation were studied in another group (total 40, male 34, female 6) of healthy Korean.

1) The Mean latency of the N1, P1, N2, P2, were 14.7±1.32 msec, 18.4±1.24 msec, 23.1±1.62 msec, 31.1±1.9 msec by the right median nerve, and 36.2±2.29 msec, 44.4±2.30 msec, 55.4±3.08 msec, 67.2±3.47 msec by the right tibial nerve.

2) There was no significant difference between right and left sides in the mean latency or amplitude of the median or tibial nerve SPEs.

3) The mean latency of the median or tibial nerve SEPs was increased significantly as the age of subjects was increased. The mean latency of the median or tibial nerve SEPs was increased significantly as the height of subjects was increased.

4) The coefficient of variation of the mean latency of SEPs of all cases were range from 5.16 to 6.32. The coefficient of variation of the mean amplitude of SEPs of all cases were range from 45.69 to 65.16. Narrower dispersion was obtained in the mean latency than amplitude of the median or tibial nerve SEPs.

5) There was no significant correlation between the amplitude of the median or tibial nerve SEPs and the age or height of subjects.

In a 8-month period, 39 selected patients with cerebrovascular accidents were studied utilizing computerized tomography of the brain and the Barthel index in an attemt to correlated findings with final functional outcome.

Parameters that were studied included age, sex, lesion size and location and their functional status.

The results of the CT scan were divided into the following major group; deep (involving the basal ganglia, internal capsule and thalamus), superficial large and superficial small (involving the cerebral hemisphere up to and including the external capsule) and normal.

Functional recovery measured by modified Barthel index appeared to be mostly found in those patients with CT scans showing no abnormalities or only small superficial lesions, whereas the patients with large, deep lesions showed poorer outcome.

Thus, results of CT scanning appear to be associated with degree of unctional outcome.

Affecting factors and degree of recovery were analysed among 101 brachilal plexus injury patients who were followed up for at least 6 months after being referred to this department's Electrodiagnostic Laboratory from January 1, 1980 to December 31, 1986. The patients were classified as preganglionic lesion, postganglionic lesion and combined pre and postganglionic lesion after paracervical muscle electromyography and sensory nerve conduction study. The results showed satisfactory functional recovery in 18.2% of preganglionic lesion patients, 64.9% of postganglionic lesion patients and 6.2% combined lesion patients. According to the types of brachial plexus injury, satisfactory functional recovery was found in 80.5% of Erb's type and in 38.0% of Klumpke type. According to the causes of the injury, satisfactory functional recovery was found in 60.9% of birth palsy patients and in 46.1% of other causes.

It is obvious that the examination of nerve conduction as a diagnostic aid is a field of interest with the state undergoing evaluation and improvement. This is true particularly in sensory action potential recording.

Conduction study of dorsal ulnar cutaneous nerve was performed with an antidromic technique. Surface recording electrode was placed at the apex of the "V" between the fourth and fifth metacarpal bone, and nerve is stimulated using surface electrodes 9.5 cm above the recording electrode between the flexor carpi ulnaris and the ulnar bone.

90 nerves in 45 normal person were examined. The results were summarized as follows:

1) The sensory conduction velocity of dorsal ulnar cutaneous nerve was 48.11±3.90 meters/sec.

2) The mean value of the latency to the peak of the negative phase was 1.98±0.16 msec.

3) The amplitude of the action potential was 42.96±15.30 uV.

4) NO statistical variation was noted with advancing age in sensory conduction velocity, latency and amplitude of the evoked potential.

5) There were no significant differences related to the dominance of the extremities.

The 1232 cases of traumatic peripheral Neuropathy was studied retrospectively and the result was discussed with other previous studies.

The subjects of this study were selected among those who were diagnosed as peripheral neuropathy in the EMG laboratory of Seoul National University Hospital from Jan. 1979 to dec. 1987. Facial neuropathy and radiculopathy were excluded in this study.

The results were as followed:

1) The total 1232 cases were composed of 1028 males(83.4%) and 204 females(16.4%) with the male to female ratio of about 5 to 1.

By age distribution, the largest composition, 30%(406 cases) of total cases falled in 3rd decade, followed by 21.2% of 4th decade, 12.9% of 1st decade and 12.7% of 5th decade.

2) The four main causes of trauma were traffic accidents(29%), glass & knife injury(20.7%), iatrogenic causes(13.3%), and fall-downs(9.9%).

The four types of the traffic accident were pedestrian injury(58.5%), autobicycle accident(23%), car-collison accident(15.7%) and bicycle accident.

3) The recent trends of causes of trauma was that the traffic accident, iatrogenic causes and fall downs had shown increasing tendency with 10%, 25% and 10% respectively, but the glass and knife injury had shown decreasing tendency with 18.7%.

4) The nerves most frequently damaged was ulnar nerve followed by median nerve, brachial plexus and peroneal nerve.

5) The percentage of injured nerve showed increasing tendency in peroneal nerve(23%) brachial plexus(16.3%) sciatic nerve(12.7%) and ulnar nerve(8.3%): decreasing tendency in radial nerve(19.5%) and median nerve(6.5%)

6) The degree of peripheral nerve injury was more severe in glass & knife injury and Iatrogenic causes associated with operations.

The degree of the injury due to autobicycle was less severe than injury due to car-collison injury. The brachial plexus was injured mostly due to autobicycle accident.

Early prognostication of motor function in cases of cerebral palsy is complicated by a variety of motor and other neurogical deficits. An accurate prediction of the eventual outcome of motor function in cerebral palsy is not an easy task within the first few years of life.

My interest was to predict the potentials for ambulation at an early age based on the scoring for prognosis with 7 signs of postural and tonic reflex; asymmetrical tonic neck reflex, symmetrical tonic neck reflex, Moro reflex, neck righting reflex, foot placement reaction, parachute reaction, and the extensor thrust.

Fifty-two children with cerebral palsy, aged 3 to 15 years were included in the study completed in 1986 and the duration of follow up was 6 months to 7 years 8 months.

Of the total population, 55.8% achieved some degree of functional walking. Among the 24 children who were scored having a good prognosis, 16(67%) could walk at the mean age of 5 years 2 months and 8(33%) could not walk at the mean age of 6 years 2 months. Among the 15 who were scored having a guarded prognosis, 9(60%) could walk at the age of 8 years 5 months and 6(40%) could not at the age of 8 years 7 months. Among 13 who were scored having a poor prognosis, 4(31%) could walk at 9 years 9 months and 9(69%) could not at the age of 8 years 1 month.

These observation suggested that if the infantile reflex test were done at an earlier age and more regularly the accuracy for prognosis would be higher.

Ambulatory functional data from eighty one stroke patients who were admitted for comprehensive rehabilitation treatment between 1983 and 1987 were used to determine the relationship between early initiation of rehabilitation treatment and independent ambulation. Descriptive material for the group includes analysis of such factors as duration between onset of stroke and beginning of rehabilitation treatment, age, side of paralysis, cognitive, function, position sense of involved lower extremity and family support. Comparative study on each group of patients showed significantly poor prognosis for achieving functional independence in the patient group who received rehabilitation program 6 months after onset of disease, who were over 65 years of age and who had cognitive deficits.

Sciatic nerve palsy is usually related to trauma. Hip fracture is the most common cause frequently associated with fracture of the posterior acetabulum, and posterior displacement of the femoral head.

Intramuscular injections in the gluteal region can cause sciatic damage, especially in newborns and debilitated patients, probably more because of chemical irritation than mechanical needling.

Diagnosis of sciatic nerve palsy is made on the basis of history, neurogic test, nerve conduction studies and electromyography. Electrophysiologic studies are simple, relatively quick, and accurate method for the diagnosis of peripheral nerve lesion. And so, electrophysiologic studies are a very useful to the measure of severity, detection of location, and differential diagnosis of sciatic nerve palsy.

A retrospective analysis of 24 consecutive cases of sciatic nerve palsy seen from June of 1986 to December of 1987 in the department of Rehabilitation Medicine at Catholic University Medical College was carried out. They were confirmed to have sciatic nerve palsy by clinical finding and electrodiagnostic studies.

The results of this were as follows.

1) Of a total 24 cases, 22 were males and 2 were females. The most them were in their twenties and thirties (52.4%).

2) The major causes for lesions were fracture of pelvis and femur (45.8%).

3) The most frequent site of the lesions was the peroneal division of sciatic nerve (50.0%). The type of injuries was an incomplete injury in 20 cases, and a complete injury in 4 cases.

4) The symptoms observed were a motor weakness (87.4%), sensory change (83.3%) and muscle atrophy (45.8%).

5) 20 cases showed abnormalities in conduction study and needle EMG study, and only 4 cases showed abnormalities in the needle EMG study.

6) The 4 cases with out sensory change showed abnormalities in sensory nerve conduction study.

7) On sensory conduction studies of sural and superficial peroneal nerves, the two cases were 70.8% and 87.5% respectively, showing abnormal conductions.

8) On motor conduction studies of peroneal and tibial nerves, the two cases were 70.8% and 41.7% respectively, showing abnormal conductions.

9) On needle EMG study, all cases showed spontaneous activity in sciatic nerve innervated muscles.

A 11-year-old female with severe multiple joint contractures was evaluated for Arthrogryposis multiplex congenita. She could noe ambulate with 40 degree flexion contracture of hips and knees. E.M.G. and muscle biopsy revealed myopathic findings.

Soutter procedure was done to the both hip joint and Yount Procedure and tenotomy of medial and lateral head of gastrocnemius was done for tendon lengthening of both knee joint.

After the surgeries, she could stand and ambulate with bilateral long leg braces.

Since isokinetic exercise equipment can give an evaluation of muscle strength with great accuracy and objectively, it is widely used as the one of the important methods for evaluation of muscle performance.

In order to determine the changes of muscle strength while aging, we examined the main muscles in both lower extremities; hip flexor, hip abductor and adductor, knee extensor and flexor, tibial internal and external rotator, and ankle plantar-flexor and dorsiflexor by using the Cybex Ⅱ⁺ Dynamometer.

120 subjects were tested, from 3rd to 8th decade, 10 men and 10 women in each decade respectively.

The results were as follows;

1) The mean values of hip flexor peak torque (strength) were 106.30±24.92 ft-lbs in male and 52.21±11.50 ft-lbs in female, and the angle of occurrence were 20.8° and 20.6° flexion in male and female, respectively. Those of hip abductor were 80.64±18.56 ft-lbs at 4.4° abduction in male and 50.01±12.96 ft-lbs at 3.5° abduction in female. Those of hip adductor were 63.02±14.20 ft-lbs at 16.2° adduction in male and 39.17±12.11 ft-lbs at 15.7° adduction in female.

2) The mean values of knee extensor peak torque were 81.08±27.01 ft-lbs in male and 61.81±18.54 ft-lbs in female, and the angle of occurrence were 48.3° and 48.1° flexion in male and female, respectively. Those of flexor were 65.29±21.83 ft-lbs at 41.3° flexion in male, 47.77±15.07 ft-lbs at 40.7° flexion in female. Those of external rotator were 19.58±4.94 ft-lbs in male and 15.23±4.85 ft-lbs in female, and those of internal rotator were 16.23±3.7 ft-lbs and 11.44±4.23 ft-lbs in male and female, respectively.

3) The mean values of ankle plantarflexor peak torque were 62.36±14.35 ft-lbs in male and 38.75±8.5 ft-lbs in female, and the angle of occurrence were 6.5° and 2.1° dorsiflexion in male and female, respectively. Those of dorsiflexor were 20.31±3.88 ft-lbs at 13.9° plantarflexion in male and 14.48±2.87 ft-lbs at 15.6° plantarflexion in female.

4) The peak torque ratio between male and female were about 50% in hip flexor, and more than 60% in others. The peak torque to body weight ratio in female were more than 70% of those in male in all sampling muscles except hip flexor.

5) The peak torque of hip and knee joint muscles decreased as the age increases. Those of hip flexor were on statistically significant decrease from 6th decade, and others from 5th decade and especialy those of knee extensor showed a severe decrease.

6) The peak torque of ankle joint muscles did not changer with the age, and were affected by body weight.

7) The mean±2SD values of the peak torque difference between dominant and nondominant sides were about 10% in hip flexor, knee extensor and flexor and about 15% in hip abductor and adductor and adductor and about 12% in ankle joint muscles.

From these results we conclude a proper exercise program is needed before 5th decade to preserve the muscle strength of the lower extremities, and especially the exercise of knee joint muscles.

The length of the lower limb prosthesis was compared with the length of the contralateral lower extremity in 44 Korea war or Vetnam was disabled amputees by a radiological weight bearing method developed by O. Friberg.

Considering a shortening of 10mm for above-knee prostheses and of 5 mm for below-knee prostheses as tolerance limit, the length of the prosthesis was acceptable in 25 cases (56.8% of the total group).

In 16 cases (36.4%) the prosthesis was up to 27.0 mm too short and in 3 cases (6.8%) up to 20.0 mm too long.

Chronic pain symptoms of low back and hip correlated significantly with the lateral asymmetry caused by incorrect length of the prosthesis.

Independently of the side of amputation, the unilateral hip pain occured mainly on the long leg side.

The purpose of amputee rehabilitation is to enable them to function again in their own environment and reintegration into their society as well as possible.

A questionnaire was used to evaluate the state of prosthetic use in 268 adult upper limb amputees.

The major results are as follows

1) Considerable number of amputees still suffered from residual sequelae, such as neuroma, phantom pain, etc.

2) For the majority of the amputees, the cosmetic function of the prosthesis is more important than its functional use in their job and ADL.

3) Overall independent performance of ADL in upper limb amputee is above 50% in this study, though users of functional prosthesis achieved especially high degree successful performance.

The information thus obtained provide us variable recommendations and reattention about a desire for prosthesis training which is more in accordance with the specific needs of the individual amputee and successful rehabilitation eventually.