We surveyed the patient's characteristics and the changes of functional and neurologic state in 39 numbers of non-traumatic spinal cord dysfunctioned patients who were received the rehabilitation management during two and half years. (From 1986 March to 1988 June) In above descriptive research, the results are

1) Etiologies: Tumor (11 cases), spinal AVM (6 cases), Transverse myelitis (6 cases), Idiopathic myelopathy (3 cases), Ruptured intervertebral disc (2 cases), Multiple sclerosis (1 case), Epidural abscess (1 case), Anterior spinal artery syndrome (1 case).

2) Age distrinbution: Even distribution over whole range of age. From the age of 8 to sixth decade.

3) Sex distribution: The male to female ratio is 22:17. No significant differences between two sexes.

4) Distribution of the most proximal dysfunctioned level: even distribution from C4 to L3.

5) In functional stae, there is more significant improvement than traumacic cases, and no significant difference to between complete paralysis and incomplete paresis; PULSES score change in non-traumatic caes. (From 14.6±3.6 at admission to 10.3±2.7 at discharge); Modified Barthel Index change in non-traumatic cases (From 65.6±21.1 at admission to 76.5±15.3 at discharge)

6) In neurologic state, there is more significant improvement than traumatic cases.; Cord Motor Index change in non-traumatic cases (From 44.8±26.1 at admission to 78.6±22.6 at discharge)

Brainstem auditory evoked potentials are the far field reflections of electrical events generated within the auditory pathway in its course through the brain. The latency of the evoked potential is affected by test subjects and techniques. The purpose of this study is to demonstrate the effects of age, sex, and intensity of stimuli in auditory evoked potentials.

The subjects of this study were 120 nomal volunteers between 12 to 72 years of age. Tests were done at 90, 70 and 50 dB on both sides.

The major results were as follows:

In all 720 BAEP study, the mean latencies of wave I, III, and V were 1.57±0.19 msec, 3.72±0.21msec, and 5.68±0.20 msec; and the mean interpeak latencies of I-III, I-V, and III-V were 2.15±0.09 msec, 4.10±0.09 msec, and 2.00±0.08 msec, respectively.

The men latencies of wave I, III, and V became significantly shorter, while the mean interpeak latency of I-V became progressively longer with increment of stimulus intensity (p<0.01).

The mean latencies of wave I, III, and V were significantly shorter in females than in males (p<0.01), however, there was no sexual difference in all mterpeak latencies.

With incrment of age, the mean latencies of wave I, III, and V became significantly prolonged with high correlation (p<0.001), but all interpeak latencies showed no change.

At 90 dB of stimulus intensity, the age influence to the mean latencies of wave I, III, and V was greater in males than in females.

The detection rates of wave II, IV, and, VII were 69%, 69%, 62%, and 52%, respectively; and these rtes were not affected by sex, age or stimulus intensity.

The syndrome of acute transverse myelopathy (ATM) has been described in the medical literatures for decades. ATM is a well known clinical entity, but little is known about it's etiology and epidemiological characteristics. Presently, the literature postulates viral infections, vascular disease, multiple sclerosis and malignancy as possible etiologic factors.

We have seen three cases of ATM since 1986. All three patients described unusual stressuful body posturing immediately preceding the onset of neurologic deficit. In our presentation we wish to focus on vascular compromise associated with stressful body positioning as another possible etiology for ATM.

Many useful diagnostic methods such as needle EMG, motor and sensory nerve conduction velocity, F-wave, H-reflex, somatosensory evoked potential and blink reflex were used in diabetic neuropathy.

The purpose of this study was to observe the cranial nerve involvement in diabetes mellitus by using blink reflex and facial nerve conduction time. The subject was composed of 41 diabetic patients who had been admitted to Seoul National University Hospital and diagnosed to have diabetic neuropathy.

The result were as follows:

1) Total 41 cases were composed of 23 males (56%) and 18 females (44%) with mean age of 56.6 years. The mean duration of the diabetes mellitus was 11.22 years and the mean fasting blood sugar level was 186 mg/100 ml.

2) The mean latency of the blink reflex was delayed in diabetic neuropathy with statistical significance and there was cranial nerve involvement in 22 cases (54%) of total 41 diabetic neuropathies.

3) The R/D ratio in diabetic neuropathy was decreased with statistical significance, which means that the distal involvement was more severe in diabetic neuropathy.

4) There was no correlation between the blink reflex latency and the fasting blood sugar or the duration of the diabetes mellitus.

5) The abnormality of the blink reflex was correlated mostly with the abnormal motor nerve conduction velocity, followed by sensory nerve conduction velocity and somatosensory evoked potential with statistical significance.

6) The most sensitive test to diagnose the diabetic neuropathy was sensory nerve conduction velocity, follwed by motor nerve conduction velocity, somatosensory evoked potential and blink reflex.

Somatosensory evoked potentials (SEPs) stimulating tibial nerve were monitored in ll patients receiving isoflurane anesthesia during operation. We found that reproducible SEPs were obtained throughout the surgical procedure in 100% of the cases we monitored while using isflurane at concentrations of 0.5-1.1%

Our data demonstrated 3 major effects of isofurane on SEP:

(a) occasional obliteration of components of N1, N2, P2, and N3 latencies, but never of P1,

(b) slight and insignificant prolongation of the average latencies of the 5 components,

(c) a significant increase in average amplitude of first component (N1-P1) (p<0.05)

In summary, our results suggested that in many instances the use of isoflurane anesthesia could be administered safely and successfully during intraoperative SEP monitoring without much influence on SEP early potentials on tibial never stimulation

Peak torque, peak torque, to body weight ratio, peak torque acceleration energy, average work during isokinetic exercise were studied in order to obtain the normal data of the shoulder.

118 subjects were tested, from 3rd to 6th decade.

1) All the values tested in males were greater than those of females.

2) The longer the arm length, the higher the values of peak torque, peak torque acceleration energy, average work.

3) The values of peak torque acceleration energy were declined beyond 5th decade.

4) No significant difference was observed between decades.

5) The ratio of peak torque in antagonists showed no significant difference between decades or sides.

6) There were significant correlation between all items each other measured in this study.

The aim of the management of neurogenic bladder in spinal cord injury patients is to achieve balanced voiding without any deleterious effects on the upper urinary tract. In establishing balanced bladder, functional evaluation and comprehensive management of neurogenic bladder is important.

The purpose of this study was to review the results of bladder training in spinal cord injury patients who received urodynamic study.

The subjects of this study were 48 spinal cord injury patients with neurogenic bladder dysfunction who were admitted to Severance Hospital, Yonsei University, and received urodynamic study between July 1, 1987 and June 30, 1988.

The results are as follows:

1) The subjects were 38 male and 10 female patients and age ranged form 4 to 66 years old.

2) The types of neurogenic bladder according to the urodynamic study did not always correlate with the spinal cord injury level.

3) Detrusor sphincter dyssynergia was found in 24 of 28 patients (85.7%) with detrusor hyperreflexia.

4) Regardless of types of neurogenic bladder, the bladder capacity and compliance were smaller, and maximum bladder capacity was higher in the late group compared to the early group (p<0.05).

5) Balanced bladder was achieved in all patients of the early group and 80% of the late group by conservative management. However with inclusion of the patients who received transurethral sphincterotomy, all patients reached balanced bladder.

6) The period of intermittent catheterization was 65 days in the early group and 16 days in the late group.

7) In the early group, the period between injury and establishment of balanced bladder was 113 days in the complete spinal cord injury patients and 85 days in the incomplete spinal cord injury patients.

Blink reflex was the helpful electrodiagnostic study that found out the lesions of trigeminal nerve, brain stem and facial nerve. This study has been undertaken to obtain normal values of the reflex response with Cadwell 7400 EMG system, and to determine whether the height or head circumference affect on the latencies of blink reflex. Since March 1987 to May 1988, this study was performed in 56 healthy adults ranging in age from 21 to 30 years.

The results were as follows;

1) Latencies of R1, ipsilateral R2 and contralateral R2 were 9.78±0.75 msec, 26.81±2.60 msec and 27.15±2.70 msec.

2) Upper limit of the difference between two sides in R1 latency was 1.3 msec.

3) Upper limit of the difference between two sides in ipsilateral R2 latency was 7 msec.

4) There was no correlation between height and latency of blink reflex.

5) There was no correlation between head circumference and latency of blink reflex.

Hand injury causes not only loss of hand function but also threaten the economic security of the patient and family.

Goals of rehabilitation are to promote optimal function of the surgically repaired hand, and psychological adjustment and vocational adaptation are also important additional therapeutic concerns.

This study attempted to assess the influences of the functional, psychological and socioeconomic factors on the return to work status following hand injury.

Sixty five patients (63 males and 2 females) with an age range of 17 to 54 years were studied retrospectively. Among the hand injuries, 92.3% were caused by industrial machinery, and 83.0% of them were crushing and amputation injuries. The return to work status of the subjects fall into four groupings: Returned to original work in 40.0%, returned to some suitable work at the same company in 23.1%, returned to some suitable work at the another company 24.6% and had not returned to work in 12.3%. The factors related to the return to work status were active range of motion of the fingers, grasping and pinch strength, level of activities of daily living, injuries affecting the thumb, monthly wage, time on the job, and the cosmesis of the injured hand. But the laterality of the side of injury, the results of Jebsen hand function test, level of education, marital status, and the patient's satisfaction of the result were not associated with the return to work status.

We reviewed our electrodiagnostic studies of thirty three patients with clinical diagnosis of Guillain-Barr syndrome during the first one month of onset.

1) Positive findings in electrodiagnostic study were more frequent in a group of patients with severe clinical symptoms (p＜0.025).

2) Positive findings were more frequent in tibial F-wave study than conventional tibial nerve conduction study (p＜0.05).

3) Positive findings were more frequent in conduction study of sensory nerves than that of motor nerves (p＜0.05).

4) Positive electrodiagnostic study showing abnormalities in more than one parameter was noted in 87.9% of patients.

We have seen a 47-year-old male patient who complained of right lower extremity weakness and gait disturbance after intramuscular injection on gluteal region.

The physical examination and electrodiagnostic procedure revealed that the patient has a peripheral neuropathy of terminal branch of superior gluteal nerve to tensor fascia lata which has not been reported before.

Motor and sensory latencies of the median nerve using conventional techniques in normal subjects and patients with a history compatible with carpal tunnel syndrome are measured.

In addition, measurement of sensory latency of ulnar nerve using conventional technique, and difference of median-ulnar distal sensory latencies are described. It is concluded that the use of measurement of median palmar sensory latency adds to the sensitivity of the nerve conduction studies in the diagnosis of carpal tunnel syndrome.

So, in patients with suspected carpal tunnel syndrome in whom conventional nerve conduction studies are normal, the measurement of palmar sensory latency are very useful in the diagnosis of carpal tunnel syndrome.

For the preliminary data to the relaxation training of spasmodic paravertebral muscle in the low back pain sufferers with myofeedback, integrated EMG (full wave rectified and averaged values of the signal amplitudes) of the paravertebral muscles, L₅ & S₁, was done in the low back pain patients (6 persons) and the healthy men (10 persons) at the prone, Taylor's posture and the standing postures.

The results obtained were as follows;

1) In the control group, the intgrated EMG value (iEMG) of the paravertebral muscles, was significantly increased at the standing posture, but at the Taylor's posture there was no significant difference to the prone posture.

2) In the back pain group, iEMG of the paravertebrl muscles, at the site of radiating pain occurred, had no significant difference to the opposite site.

3) In the back pain group, iEMG of the paravertebral muscles was significantly increased at the Taylor's posture as well as standing posture. There was no significant difference between the Taylor's and standing posture.

4) In the back pain group, iEMG of the paravertebral muscles was significantly higher than those in the control group at the Taylor's posture but at the other potures, were there no significant differences to the control group.

To study the effectiveness of human plasma, cold-quartz ultraviolet and low-energy GaAlAs laser in the treatment of full thickness skin wounds, five rabbits were used. The control group was treated using povidone iodine and hydrogen peroxide.

The wound sizes (the longest diameter) were measured every 3 days until completely healed. And statistically, wound healing time and healing rate were studied. The human plasma treated wounds healed fastest among the groups, but no statistically significant difference.

Hereditary Motor & Sensory Neuropathies (HMSN) are autosomal inherited disorders with clinical features of peroneal muscular atrophy. The disorder of peroneal muscular atrophy with pyramidal features has been referred to as HMSN Type V by Dyck. We have seen a 44 year-old male patient who complained of hypesthesia below the lovel of umbilicus and gait disturbance. Physical examination reveals increased knee jerk with extensor plantar reflex, pretibial muscle atrophy and weakness and hypesthesia below the level of T₁₀. He was diagnosed as HMSN Type V by clinical manifestation, electrodiagnostic study and sural nerve biopsy.

There are only a few limited situations in which the spinal cord injured patients are able to live an active and independent life as members of society. At present it is also possible that many spinal cord injured patients in Korea are able to perform independent activities of daily living at wheel chair level through early and active rehabilitation program. Actually in Korea it is very difficult for them to use public transportation in outdoor activities.

We have experienced driver training of complete T3 spinal cord injured patient who could lead an active life independently with driving a car after going through comprehensive rehabilitation by team approach during hospital admission.

Thus we hereby strongly suggest that driver training for spinal cord injured patients is essential for them to return to vocation as active members of society and that dirver training program should be included in comprehensive rehabilitation program during admission period in Korea, if it is possible.

Detrusor-external sphincter dyssynergia (DSD) has been known as a most common cause of unbalanced neurogenic bladder in spinal cord injured. DSD can be controlled or treated by antispastic drugs or muscle relaxants and external urethral sphincterotomy.

But antispastic drug or muscle relaxant treatment may bt impractical because of too large dose and side effects of the drugs, or long-term treatment.

We experienced an excellent effect of bilateral pudendal nerve block using small amount of 7% phenol solution on DSD of neurogenic bladder in a 52 years old paraplegic.