Anodal block, a local block of nerve conduction caused by hyperpolarization of the nerve cell membrane under the anode, has been described when the anode is inadvertently placed between the cathode and recording electrode. This phenomenon has been documented in animal studies but not in humans.

In this investigation, the measured latencies and amplitudes in median nerve motor and sensory conduction, and the H-reflex studies were not significantly different when the anode placed proximally or distally to the cathode. However, when orthodromic sensory conduction studies were performed with anode-active recording electrode and gradually increasing intensities of stimulation, prolonged latencies were observed with low intensities. Furthermore, moderate stimuli intensities led to double peak potentials, most prominently displayed with a 4 cm anode-cathode separation. With further increases in intensity of the stimulation, the double peak potentials disappeared and the latencies shorten.

Hemiplegic patients have limitations in carrying out activities of daily living because of weakness, spasticity, and abnormal synergy patterns of movement. Even though there is common agreement on the importance of muscle strength, sufficiently objective information on muscle strength and patterns of weakness in hemiplegic patients, elbow flexors and extensors in particular, is still relatively lacking. Therefore, the purpose of this study was to determine the strength and the strength ratio for elbow extensors and flexors of hemiplegia to provide a guideline for rehabilitation of hemiplegic patients.

Isometric test was performed at a joint angle of 90o, and isokinetic test at an angular velocity of 60o/sec, using an isokinetic dynamometer, Cybex 340. Thirty normal subjects (control group) and sixteen hemiplegic subjects (patient group) were participated in this study.

The results are as follows:

1) In the control group, there was a significant difference in isometric and isokinetic strengths at the elbow joint by sex (p＜0.01), but, no significant difference in extensor to flexor strength ratio by sex.

2) In the patient group, the isometric and isokinetic torque values for flexors and extensors were significantly lower than in the control group (p＜0.01). The extensor to flexor strength ratio in the isometric mode was 135.3% in the patient group compared with 82.9% in the control group, a significant difference (p＜0.01). There was also a significant difference in isokinetic test, with the patient group strength ratio showing 141.5% compared with 95.7% in the control group.

According to the above results, the strength ratio is a useful parameter for evaluating joint function and guiding treatment of hemiplegia.

Consensual reaction of the heat refers to the fact that heating the skin of one extremity reflexively increases the blood flow in the contralateral extremity.

The mechanism of consensual reaction is thought to be the neural reflex mediated by sympathetic nervous system, which has reflex centers above C5 cord. To find out the effects of consensual reaction of the heat on cardiovagal response, sudomotor response and nerve conduction, we applied infrared therapy on one upper extremity in normal 27 men and compared with the changes of oral temperature, pulse rates, skin temperature, sensory nerve conduction and sympathetic skin response.

The results showed no change in oral temperature and pulse rate. However, increases in skin temperature and nerve conduction velocity in contralateral upper extremity were observed, which suggested the effects of consensual reaction of the heat on contralateral nerve conduction. In sympathetic skin response, the decrease of minimum latency in the contralateral upper extremity was observed and it also suggested the increase of nerve conduction velocity of sudomotor fiber by the effects of consensual reaction of the heat.

The value of nerve conduction studies in the assessment of carpal tunnel syndrome (CTS) has been established. There are many criterias for early diagnosis, but most of them use sensory abnormalities of median nerve. There is some limitation to diagnose the carpal tunnel syndrome in the cases of polyneuropathy such as diabetic polyneuropathy.

This study was done to assess the diagnostic value of median-ulnar motor difference recorded on lumbrical and interosseous in carpal tunnel syndrome, especially in the cases associated with polyneuropathy. And we also compared the sensitivity and the specificity of the new cirteria with those of other diagnostic criterias.

Fifty hands with clinical symptoms and signs suggestive of CTS and forty healthy volunteer's hands as control were studied.

In control group, the mean distal motor latency of median nerve on lumbrical recording was 2.67±0.29 msec, and that of ulnar on interosseous recording was 2.66±0.30 msec and the mean lumbrical-interosseous difference was 0.09±0.11 msec. The mean amplitude of the interosseous was higher as 7.05±2.12 mV than that of the lumbrical as 3.18±1.53 mV (p<0.01). In CTS group, the mean value of median motor distal latency on lumbrical recording was 4.30±1.67 msec, and that of ulnar on interosseous was 2.19±0.41 msec. The mean lumbrical-interosseous latency difference was 1.50±1.24 msec, which was statistically different from control group (p<0.01). The amplitude on lumbrical and interosseous recording were 1.76±0.91 mV, 5.97±1.56 mV, respectively. The abnormal lumbrical-interosseous difference criteria was set at greater than 0.42 msec as the mean±3 S.D. of lumbrical-interosseous latency difference. The sensitivity and specificity of the lumbrical-interosseous difference were 84%, 100%, respectively, and were comparable to those of other previously used sensory critierias.

The lumbrical-interosseous latency difference is a new and sensitive measurement in the eletrophysiologic diagnosis of carpal tunnel syndrome and a helpful criteria in patients with coexistent polyneuropathy.

One hundred and sixty two patients with traumatic brain injury (TBI) were evaluated for associated injuries and medical problems.

1) Associated injuries in the TBI were as follows: facial bone fractures were 24.7%, limb fractures 15.4%, rib fractures 10.5%, vertebral fractures 6.8%, visceral injuries 3.1%, and genitourinary injuries 1.9%.

2) Medical problems in the TBI were noted: neurogenic (32.1%), gastrointestinal (25.3%), respiratory (21.0%), musculoskeletal (21.0%), genitourinary (17.3%) and cardiovascular (3.7%) problems were encountered frequently.

3) The case were that Glasgow Coma Scale (GCS) score was 60.4%, 9∼12 was 13% and 3∼8 was 26.5%. There were a significant difference of the mean hospital days among three groups as each 42.6 days, 106.8 days and 291.2 days (p<0.05).

4) The mean hospital days was 28.6 days accompanying of complication when the group having GCS score's 13∼15, 28.6 days when no complication 173.6 days accompanying of complication when the group being on 9∼12, 49 days when no complication, and 302.4 days accompanying of complication when the score of group having 3∼8, 223.3 days when no complication. But it showed significant difference on the group that the score was 9∼12 dependent on existence of complication (p<0.05).

5) It showed a good recovery at 93.8% of group that GCS score's 13∼15 and a death at 39.5% of group that 3∼8 score. The group which had the higher GCS score will have the better prognosis.

Pneumonia is a frequent medical complication that is mostly caused by aspiration and a major cause of death in patients with stroke. Clinical diagnosis of aspiration pneumonia, however, is so difficult that the study about the incidence in stroke os rare.

To study the incidence and clinical findings of aspiration pneumonia in the stroke patients, we reviewed medical records of 167 stroke patients in Dept. of Rehabilitation Medicine of Asan Medical Center.

The results are as follows:

1) The incidence of aspiration pneumonia in 167 stroke patients was 16.8 percent (8.7 percent in ischemic insult and 19.8 percent in hemorrhagic patients, but showed no statistical difference).

2) Pseudomonas aeruginosa was the most common etiologic microorganism, and combination therapy of cephalosporin and aminoglycoside was preferred.

3) One case was died because of septic shock secondary to aspiration pneumonia, but others were recovered from aspiration pneumonia completely.

Somatosensory evoked potential (SEP) waveforms were recorded over the scalp in response to tibial nerve stimulation at the ankle of 47 normal subjects. The SEP data was analyzed with the correlation coefficient and delay time, by using the program in a Cadwell Quantum 84 EMG system, to determine the reproducibility of the waveforms, and to identify side-to-side symmetry.

The purpose of this study was to find out the mean and standard deviation (SD) of the correlation coefficient and its differences between the sides of extremities, and between the raw and windowed data in normal subjects.

The results were as follows:

1) There were no significant differences between right and left sides in correlation coefficient and delay time, that were taken from raw and windowed data.

2) In raw and windowed data, the correlation coefficient compared with the ipsilateral side showed higher values than the contralateral side.

3) There was a significantly higher correlation coefficient from windowed data than raw data.

4) In the comparison between ipsilateral and contralateral sides of correlation coefficient and delay time, the more correlation coefficients were increased, the more delay times were decreased significantly.

Therefore, we conclude that the correlation coefficient analyzed by the computerized program can provide objective and quantitative waveform data that complements latency and amplitude measurement in the clinical interpretation of somatosensory evoked potential waveforms.

The aims of this study were to compare the normal values of the isokinetic dynamometer pendulum test and those of the electrogoniometric one, to compare the relaxation indices of the isokinetic dynamometer pendulum test and those of the electrogoniometric one according to modified Ashworth scale, to identify the critical value of the relaxation index of the isokinetic dynamometer pendulum test according to modified Ashworth scale, to identify the correlation of modified Ashworth scale with the pendulum test, and to identify the correlation of Brunnstrom stage with the pendulum test in the 77 hemiplegic patients with varing degrees of spasticity.

The results were:

1) The relaxation index, amplitude ratio, swing number, and swing time of the isokinetic dynamometer pendulum test were significantly lower than those of the electrogoniometric one in the control group.

2) The relaxation indices of the isokinetic dynamometer pendulum test were generally higher than those of the electrogoniometric one according to modified Ashworth scale and Brunnstrom stage.

3) If the relaxation index was over 1.20, that modified Ashworth scale was considered as grade 1. But we could not estimate the range of the relaxation index of modified Ashworth scale 2 and 3.

4) Modified Ashworth scale was reversely correlated with the relaxation index of the isokinetic dynamometer pendulum test and the electrogoniometric one, but correlation coefficients were not so high.

5) The relaxation index of the pendulum test was not significantly different among the Brunnstrom stages.

In the above study, modified Ashworth scale was reversely correlated with the relaxation index of the isokinetic dynamometer pendulum test, but correlation coefficients were not so high and the ranges of relaxation index were not clearly defined according to modified Ashworth scale. So, we thought that new measurement scale for evaluation of spasticity using pendulum test (especially, electrogoniometric pendulum test) was needed, but further study was also needed after collection of more samples.

The purpose of this study was to standardize an easy and convenient method of studying the deep peroneal sensory nerve for clinical purpose of differential diagnosis of ankle and foot pain. We studied the deep peroneal sensory nerve in 40 neurologically healthy adult subjects. The latency to onset of sensory action potential was 2.95±0.23 msec. The latency to peak of sensory action potential was 3.66±0.28 msec. The conduction velocity measured by onset latency was 40.89±3.36 m/sec. The amplitude was 5.75±1.89uV.

We also presented a case of partial peripheral neuropathy of left common peroneal nerve which revealed no evoked potential in deep peroneal sensory nerve.

We concluded that the electrophysiologic evaluation of the deep peroneal sensory nerve may be helpful in the diagnosis of deep peroneal neuropathies in the anterior tarsal tunnel or local deep peroneal nerve injury and also helpful in early detection of peripheral neuropathies.

Ankylosing spondylitis starts from sacroilitis and the inflammation gradually spreads throughout the entire spine. Bony ankylosis may occur in the numerous joints around the thorax in late stage. Ankylosing spondylitis leads to limitation of movement of the spine and thorax. Then these can cause alterations in pulmonary function.

So, we undertook this study to evaluate whether limitation of spinal movement and chest expansion affected pulmonary function and to obtain basic information for chest physical therapy.

71 patients with ankylosing spondylitis were evaluated with mobility of the thoracic cage (chest expansion) and mobility of the spine (Modified Schober test, lateral spinal bending), and pulmonary function test (maximal vital capacity, tidal volume, forced vital capacity: FVC, forced expiratory volume at one second: FEV1.0, forced expiratory volume at one second per forced vital capacity, diffusion capacity).

Results were as follows:

1) There was a significant correlation between the mobility of the thoracic cage and the mobility of the spine (p<0.05).

2) There were significant correlations between pulmonary function (FVC and FEV1.0) and mobilities of the thoracic cage and the spine (p<0.05).

3) There was a significant correlation between tidal volume (VT) and the mobility of the spine (p<0.05), but no significant correlation between thoracic mobility and VT (p≥0.05).

4) There was no significant correlation between the duration of the illness and pulmonary function (p≥0.05).

Therefore spinal mobility and thoracic mobility seem to contribute in improvement of pulmonary function.

Deformities of the hip in cerebral palsy were second most common deformities encountered. They were caused by an imbalance of muscle power, retained primitive reflexes, habitually faulty posture, an absence of weight bearing stimulation on the bones, and growth.

During the period of March 1990 through June 1993, we evaluated 123 cerebral palsied children about their neuromotor type, topography, severity, and hip and pelvic deformities by physical examination and pelvic X-ray study in an institutionalized center for severely disabled children.

The results were as follows:

1) The neuromotor type distribution was spastic in 54.5% (67/123), athetoid in 26.0% (32/123), mixed in 14.6% (18/123), and hypotonia in 4.9% (6/123). The severity was to a mild degree in 3.3% (4/123), a moderate degree in 21.1% (26/123), and a severe degree in 75.6% (93/123). The topographic distribution of spastic type was hemiplegia in 16.4% (11/67), triplegia in 4.5% (3/67), quadriplegia in 58.2% (39/67), and diplegia in 20.9% (14/67).

2) Among 246 hips of 123 children, the frequencies of hip and pelvic deformities were; hip subluxation or dislocation in 27.6% (34/123) with 28 hip subluxation (13 right, 15 left, & 5 bilateral) and with 13 hip dislocations (9 right & 4 left); acetabular dysplasia in 36.6% (45/123) with 59 hips (30 right, 29 left, & 14 bilateral); pelvic obliquity in 16.3% (20/123) with 20 pelvis (11 right & 9 left); and increased femoral anteversion in 46.3% (57/123) with 95 femurs (45 right, 50 left, & 38 bilateral).

3) The mean of acetabular indexes were 18.8±7.7^o in right and 19.5±8.3^o in left.

4) Among 45 children (36.6%) with acetabular dysplasia, right hips were 30 cases and left hips were 29 cases, 30 right acetabular dysplasias were normal in 8.9% (9/101), had subluxation in 100.0% (13/13), and had dislocation in 89.9% (8/9), with 29 left acetabular dysplasias were normal in 9.6% (10/104), had subluxation in 100.0% (15/15), and had dislocation in 100.0% (4/4). Then, a high frequency of hip subluxation or dislocation in cerebral palsy with acetabular dysplasia was significant, when compared to cerebral palsy without acetabular dysplasia (p=0.000).

5) Among 34 children with hip subluxation or dislocation, the frequencies of neuromotor type in cerebral palsy were spastic (include mixed) in 82.4% (28/34) and nonspastic (include athetoid & hypotonia) in 17.6% (6/34). The frequency of spastic types in cerebral palsy with acetabular dysplasia was significantly high, when compared with nonspastic types (p=0.04938).

6) The incidence of hip subluxation or dislocation among 45 children with acetabular dysplasia was 71.1% (32/45). They were spastic in 65.6% (21/32), athetoid in 15.6% (5/32), mixed in 18.8% (6/32), and hypotonia in 0%. Then, a high frequency of hip subluxation or dislocation in cerebral palsy with acetabular dysplasia was more significant in spastic types than with other types (p=0.005).

7) The children with increased femoral anteversion were 59.7% (40/67) in spastic, 31.3% (10/32) in athetoid, 22.2% (4/18) in mixed, and 50.0% (3/6) in hypotonia. Then, a high frequency of increased femoral anteversion was more significant in spastic & hypotonia than in other types (p=0.00744).

8) The 19 children (15.4%) with above 26^o of right acetabular indexes were 66.7% (6/9) in dislocation, 53.8% (7/13) in subluxation, 15.6% (6/101) in normal hips, and the 24 children (19.5%) with above 26^o of left acetabular indexes were 100.0% (4/4) in dislocation, 60.0% (10/15) in subluxation, 20.3% (10/104) in normal hips. Then, a high frequency of dislocation or subluxation was more significant in above 26^o of acetabular index than in below 25^o of acetabular index (p=0.000).

We recommand regular physical examination and pelvic X-ray study every 3-6 months for early detection and treatment of the hip and pelvic problems in cerebral palsy.

We reviewed the electrophysiologic findings and the relationship of diabetic polyneuropathy (DMPN) with the age of the patients, the duration of diabetes mellitus, and the blood glucose level in 143 patients with diabetes mellitus. In this study, motor and sensory nerve conduction studies, needle electromyography, brainstem evoked potentials (BSEP), pattern-shift visual evoked potentials (VEP) were recorded in the subjects, and metabolic control was evaluated in terms of glycemia and glycosylated hemoglobin (HbA1C).

The purpose of the present study was to evaluate the diagnostic value of the electrophysiologic procedures and to find the clinical correlations of them in diabetic polyneuropathy.

The results were as follows:

1) The age distribution was from 10 to 83 years of age (mean 52.3 years).

2) The nerve conduction study revealed diabetic polyneuropathy in 92 of 143 subjects (64.3%) with significantly increased frequency in accordance with the age of the subjects and the duration of diabetes mellitus (p<0.05).

3) The levels of blood glucose and glycosylated hemoglobin were significantly high in the dibetic polyneuropathy group as compared with the normal group (p<0.05).

4) The electrophysiologic study revealed abnormality in H-reflex (91.3%), F-wave (peroneal; 86.8%, tibial; 83.7%, ulnar; 76.1%), motor and sensory nerve conduction study, and electromyography (87.0%). The most frequently involved sensory nerve was superficial peroneal nerve (76.1%), and as for the motor nerve, deep peroneal nerve (72.8%) was involved most frequently. But these findings had no significant correlations with the blood glucose level in the subjects with dibetes mellitus (p>0.05).

5) The BSEP study revealed abnormal findings in 93 of 128 subjects (72.7%) with significantly increased frequency in accordance with the duration of diabetes mellitus (p<0.05), and the latenies of peak III and V and the interpeak laterpeak latencies of I-III and I-V were prolonged significantly (p<0.05).

6) The VEP study revealed abnormal findings in 80 of 125 subjects (64.0%) with the tendency of increased frequency in accordance with the duration of diabetes mellitus (p>0.05), and the P100 latencies were significantly prolonged in the abnormal group as compared with the normal group (p<0.05).

Presence of coronary artery disease (CAD) in stroke patients may result in poor prognosis and functional outcome in rehabilitation. However, studies on diagnostic and functional evaluation of such patients are scarce. In this perspective, authors explored the usefulness of bicycle ergometer in CAD diagnosis of hemiparetic patients and its implication in their rehabilitation. Among 20 hemiparetic patients, 2 were found to have ST segment depression during bicycle ergometer stress test. The rate pressure products (RPP) measured during various rehabilitation activities did not exceed those obtained during the stress test in most subjects, disputing against common reluctance in active rehabilitation treatment of hemiparetic patients with CAD.

In conclusion, stress test with bicycle ergometer can be effectively used in selective group of hemiparetic patients with coronary artery disease for both diagnostic and functional purposes.

The purpose of this study is to compare the radiological corrective effect for shoulder subluxation among four different types of arm sling. Three radiologic parameters were measured on plain A-P view: Vertical Distance (VD), Horizontal Distance (HD), Joint Distance (JD). The types of arm sling used in this study were cuff, Kenny-Howard, extension, modified Bobath. We investigated the statistical difference of corrective effect among the types of sling.

The mean value of the VD without sling application was 19.6 mm which was corrected to 13.5 mm by the cuff type, 13.1 mm by the Kenny-Howard, 17.6 mm by the extension type and 14.9 mm by the modified Bobath type. These four values were all significantly different from the value of without sling, which means that all types of sling were effective for VD, and the Kenny-Howard sling was the most effective. The HD of without arm sling application was 24.4 mm, and this was corrected to 22.6, 21.0, 22.4, 26.3 mm respectively by four types of sling. And all these differences had statistical significance. The Kenny-Howard sling showed the lowest value, and the modified-Bobath type showed increased HD reversely. The mean value of JD was 9.6 mm in subluxed shoulder, but this was corrected significantly by four different types of sling. And the Kenny-Howard type was the most effective and cuff type was the second.

The results support that the Kenny-Howard type is the most effective sling for the correction of three distances and the cuff type may be considered as the relatively more effective than the other two slings in VD and JD, but the modified Bobath sling increase HD reversely. This study is limited to the temporary radiologic effect of arm sling, but this conclusion may give very useful and practical suggestion for the sling prescription for subluxed shoulder patients.

It is a well known fact that osteoporosis is an inevitable complication in patients with spinal cord injuries. This study focused on the degree of bone density of the femur in complete paraplegics and quadriplegics after their injuries and effect of the weight bearing exercises on bone density in spinal cord injury (SCI) patients.

The subjects were 29 complete SCI patients (8 quadriplegics, 21 paraplegics) and 29 healthy volunteers as the control.

Using the DP4-dual photon absorptiometry (44 keV, 100 keV) from Lunar, the bone mineral density (BMD) of the right femoral neck, Ward triangle and the femoral trochanter were measured. 13 fo 21 complete paraplegics had walking exercies with leg braces on for at least 45 minutes a day, 6 times a week and 5.5 months average. 3 of 8 complete quadriplegics were put on the tilt table for 30 minutes each twice daily and 4 months average. The BMD was measured before the weight bearing exercises and compared to those afterwards. To compare the changes in bone density in relation to the time after the injury and the changes after the weight bearing exercises, the age-matched percent of BMD of the patients was obtained from the normal femoral BMD.

The results of the study were as follows.

1) The bone density of the femoral neck, Ward triangle and femoral trochanter in the control group were 0.98 g/cm², 0.88 g/cm² and 0.84 g/cm² respectively, and 0.82 g/cm², 0.72 g/cm², 0.66 g/cm² in the patients. Comparing with the control group, the patient group significantly decreased (p<0.001) The age-matched percent of BMD of the femoral neck, Ward triangle and femoral trochanter in the patients were 91.1%, 87.3% and 89.4%.

2) The period after the spinal cord injury was an average 9.6 months. The change in bone density in relation to the period after the spinal cord injury was found to be inconsistent in the femoral neck and Ward triangle (p>0.05), but showed a decrease of 1.3% a month in the femoral trochanter (r=-0.367, p=0.05).

3) The average bone density and age-matched percent of BMD of the femoral neck, Ward triangle and femoral trochanter in paraplegics before starting the weight bearing exercises were 0.86 g/cm², 95.3%. 0.76 g/cm², 90.7% and 0.72 g/cm², 97.5%. Even after weight bearing exercises for an average of 5.5 months, the bone density and percent in paraplegics decreased significantly (p<0.05) as 0.82 g/cm², 91.4%, 0.73 g/cm², 86.6%, and 0.65 g/cm², 88.1% respectively. There was no significant difference between the average femoral bone density and average femoral percent of BMD in quadraplegics before and after the exercises (p>0.05).

These results indicate that osteoporosis related to spinal cord injuries may not be prevented or treated by weight bearing exercises alone.

This study was performed to figure out mechanical load on the lower back during lifting objects by measuring the mean amplitudes and durations of compound muscle action potentials of the lumbar extensor muscles in eight postures from 30 healthy male adults.

As follows:

1) The highest value of mean amplitude of lumbar extensor muscle activities was 485.0±250.7 uV which was in the posture of extending both upper extremities forwardly and upright position.

2) The lowest value of mean amplitude of lumbar extensor muscle activities was 107.1±54.6 uV in the posture of both wrist joints to anterior axillary fold and partially flexing and leaning of both knees to fixed wall.

3) There was no significant differences of mean duration of compound muscle action potentials of lumbar extensors in 8 postures.

In conclusion, to reduce mechanical load on the lumbar spine during lifting objects was lowest with the posture that the object is close to trunk lowering the body posture with flexing knee joints and leaning to fixed wall.

Hemifacial spasm is characterized by involuntary, tonic, and clonic contraction of muscles on one side of the face with synkinesis, which typically begins in the inferior orbicularis oculi muscle.

Routine electrodiagnostic study, simultaneous monitoring of motor unit activities in 2 facial muscles, and recordings of the late response in orbicularis oculi and mentalis were performed before operation for patients with hemifacial spasm. In 85 patients, consecutive intraoperative recordings of late response were made from the mentalis muscles during microvascular decompression for hemifacial spasm. The major results of this study were as follows:

1) The ages of the 85 patients with hemifacial spasm (15 men, and 70 women) ranged from 28 to 66 years, with a mean of 47 years.

2) The duration of symptoms before surgery was 6 months to 25 years, with mean 8.2 years.

3) In all of the patients studied, antidromic stimulation of the zygomatic branch produced a late response of mean 8.96±0.72 msec latency in the mentalis, and intraoperative EMG monitoring observing this late response was performed.

5) The amplitude of late response diminished significantly after the dura incised in 11 cases.

6) When the offending vessel was held away from root exit zone of the facial nerve, the late response disappeared totally in 32 patients, and much reduced in 41 patients.

7) At the end of operation, the late response disappeared totally in 34 patients, and much reduced in 44 patients.

8) In the clinical results of the 85 patients treated with microvascular decompression for HFS at 7 days after the operation, 47 were free from spasm, 32 had occasional minimal spasm, and 6 were slightly improved.

Rehabilition after spinal cord injury (SCI) is a complex process involving as array of adaptation to changes in both physical and psychosocial functioning. In this study, we examined the correspondence between staff ratings and patient ratings about depressed mood for 32 spinal cord injured persons admitted to rehabilitation center. Patients rated their mood by using the Self-rating Depression Scale (SDS), Staffs estimated patient's mood by using the Depression Status Inventory (DSI).

The purposes of this study are to investigate 1) staff-patient congruence with regard to appraisals of patients' affective state, 2) intrastaff-patient congruence with regard to appraisals of patients' affective state.

The purposes of this study are to investigate 1) staff-patient congruence with regard to appraisals of patients' affective state, 2) intrastaff-patient congruence with regard to appraisals of patients' affective state.

The results were as follows:

1) Staffs underestimated patient's depression.

2) The highest correlation was between patients and occupational therapists, followed by physical therapists.

3) Clinical manifestations of depressive symptoms were in the following orders: dissatisfaction, psychomotor retardation, confusion, and personal devaluation.

This study reported discrepancies between patient's descriptions and staff's perceptions. We hope that the findings of this study would have clinical relevance to the psychosocial adjustment and total rehabilitation of spinal cord injured persons.

Hyperglycemia after a stroke probably reflects the intensity of the stress hormone response. Many experimental studies have reported that elevated blood glucose concentration greatly enhances the extent and the degree of subsequent brain damage. The purpose of out study was to find out whether the blood glucose level in the first day after stroke correlated with the neurological outcome or not.

We found that blood glucose level in the first twenty-four hours showed a significant correlation with neurological outcome measured by modified Barthel index, but no correlation to cognitive capacity screening examination.

The neurological outcome of reattack cases was worse than the first attack cases. We concluded that hyperglycemia after stroke reflects a stress response to more severe brain lesions.

The peripheral polyneuropathy has rarely been reported following carbon monoxide intoxication, and the precise pathogenesis remains in doubt. This report concerns a man who suffered from severe carbon monoxide intoxication, and resulting in the development of a peripheral polyneuropathy with polyradiculopathy.

The electrodiagnostic study showed abnormal resting potentials on electromyogram, normal to subnormal range of nerve conduction velocity with reduced amplitude, and evidence of polyradiculopathy.

Dysarthria is a group of motor speech disorder resulting from a disturbance of motor control of the speech mechanism. In the approach of dysarthric speech, most study was based on perceptural analysis by subjective judgement. However, objective assessment of the acoustic features of distored articulation is necessary for quantitative evaluation of the motor control disturbance and estimate the effect of treatment in dysarthric patients. Computerized speech analysis systems such as sound spectrograph and Nasometer^Ⱂ are recently developed for that purpose and can be applicated in clinical setting. We report a patient with dysarthria and athetoid type cerebral palsy who was evaluated by computerized sound spectrograph and Nasometer^Ⱂ before and after speech therapy. We concluded that computerized sound spectrograph and Nasometer^Ⱂ were considered as a useful tool of quantitative assessment of dysarthria and the effect of speech therapy.

The Brown-Séquard syndrome is a special type of unilateral spinal cord injury which characteristic symptoms are ipsilateral spastic hemiparesis, contralateral impairment of pain and temperature sensation, ipsilateral impairment of vibration and position sense, and ipsilateral flaccid paralysis with hypesthesia at the level of involved segment.

We present a case of cervical spinal cord injury by C6 and C7 vertebral fractures which was thought as Brown-Séquard syndrome accompanied with cervical roots injury. The temporal course of motor recovery was observed retrospectively and the mechanisms of recovery as well as possible sites of injury were also reviewed.

We report a patient who had childhood onset medium-chain acyl Co-A dehydrogenase deficiency, confirmed by gas chromatography-mass spectrometry (Gc-Ms). A 9 year 3 month old girl had suffered from generalized weakness and hypotonia, including vomiting, lethargy and comatous consciousness.

The autosomal-recessively inherited myopathy is characterized by organic aciduria that distinguishes from Reye syndrome and other masqueraders characterized by dicarboxylic aciduria.

The key metabolities, subglycine and hexanoylglycine, are excreted in high concentration only when the patients are acutely ill. More significantly, using novel technique in Gc-Ms, the medium-chain acylcarnitines, mostly octanoylcarbnitine are excreted without significant excretion of a normal metabolite when the patients are not ill. EMG findings usually show "myopathic" features.

In view of the carnitine deficiency and the demonstration of excretion of the toxic medium-chain acyl Co-A compounds as acylcarnitines, a combined therapy of reduced dietary fat, 50∼150 mg/day of riboflavin and L-carnitine supplementation (25 mg/kg/6h) has been devised and applied with positive outcome in our patient.