Shoulder-hand syndrome is characterized by pain, vasomotor instability, and tenderness, mainly in the distal upper extremity. The pathophysiologic mechanism of this syndrome is not yet proven. The purpose of this study is to determine the usefulness of digital infrared thermographic imaging for the early and objective diagnosis of shoulder-hand syndrome. Prospectively seventy seven patients of post cerebrovascular accident were analyzed. In this study the subjects were divided into the control group and the study group. The control group consisted of 49 hemiplegic patients without clinical symptom of shoulder-hand syndrome. The study group consisted of 28 hemiplegic patients who had the clinical symptom and showed diffuse uptake in the hand and wrist on delayed image of radionuclide scan.

In the control group, digital infrared thermographic imaging study revealed hypothermia on the involved upper extremity, compared with the opposite intact side (p<0.01). In the study group, it revealed hyperthermia on the dorsal hand and distal forearm of involved upper extremity (p<0.001), compared with the opposite intact side. In patients with stroke onset within 3 months, the sensitivity of digital infrared thermographic imaging for the diagnosis of shoulder-hand syndrome was 86.7% and the specificity was 100% in the dorsal hand. Digital infrared thermographic imaging is considered to be very sensitive to the changes of skin temperature in shoulder-hand syndrome and can be applied as a useful diagnostic modality for the early detection.

Spasticity is one type of hypertonus, which increases with the velocity of joint movement. It is attributed to hyperactive stretch reflexes mediated by muscle spindle stretch receptor. Mechanisms underlying the development of spasticity after spinal cord injury are not understood. One spinal interneuron likely to be affected is Renshaw cell, which acts to produce recurrent inhibition in motor neurons as well as inhibiting Ia interneuron.

The Renshaw cell activity was evaluated in 20 normal subjects as control and in 5 patients with spasticity after spinal cord injury using the conditioned H-reflex technique of Pierrot-Deseilligny and Bussel to investigate the role of Renshaw cell activity in the development of spasticity after spinal cord injury. The H/M ratio was increased (p<0.1) and H'/H ratio was decreased (p<0.05) in spinal cord injured patients and correlates well with clinical measurements of spasticity although the absolute values of amplitude of M response, H reflex and the conditioned H-reflex were not significantly different between two groups. These results suggest that the recurrent inhibition via Renshaw cell activity is increased in spinal cord injured patients and recurrent inhibition can be measured using the conditioned H reflex technique.

Diabetic neuropathy is one of the most common complications of diabetes mellitus. Hence the early detection and treatment is important. It is known that the electrophysiologic study is one of the most sensitive tests in the diagnosis of diabetic neuropathy. The purpose of this study was to find out whether the somatosensory evoked potential (SEP) study of median and posterior tibial nerve can give additional information to conventional nerve conduction study and in which conditions the SEP study is useful in diabetic neuropathy.

The medical and electromyographic records of 57 patients referred to the electromyographic laboratory of Seoul National University Hospital were reviewed. Inclusion criteria were patients 1) who had history of diabetes mellitus, 2) who had no other systemic diseases that may cause polyneuropathy, 3) who had undertaken the motor and sensory nerve conduction study of median, ulnar and tibial nerve of both sides, 4) who had undertaken the SEP study of median and posterior nerve of both sides. The number of patients with abnormal median nerve SEP response was 29.8% (17/57), and the number of patients with abnormal posterior tibial nerve SEP was 70.2% (40/57). All the patients with abnormal SEP response in median nerve showed abnormal SEP response in posterior tibial nerve. The more severe the results of the nerve conduction study, the higher the percentage of abnormality in posterior tibial SEP response. Among various electrodiagnostic parameters, the percentage of abnormality of posterior tibial nerve SEP ranked second (70.2%), next to tibial nerve conduction study (77.2%). But considering the combinations of various electrodiagnostic parameters, the posterior tibial nerve SEP study had little benefit to nerve conduction study. Of 7 patients with normal nerve conduction study results, only one patient showed abnormal SEP response. Of 17 patients with normal SEP response, 11 patients showed abnormal nerve conduction study results. The conclusion was that the SEP study does not give additional information to nerve conduction study.

Injury of the spinal accessory nerve in posterior cervical triangle may result from a variety of causes. These include direct trauma, compression by lymph node or tumor, spontaneous accessory nerve palsy, and complication from surgical procedures. One of the most valuable method for diagnosis of spinal accessory nerve injury is measurement of its latencies. But we could scarcely find the useful electrodiagnostic data about spinal accessory nerve which was measured in normal subjects in Korea. We measured normal values of spinal accessory nerve latency in 71 volunteers, and clarified the correlation of latency with age, and of latency with conduction distance. Mean latencies of 142 spinal accessory nerves to the upper, middle, and lower trapezius muscles are 2.01±0.31 msec, 3.08±0.46 msec, and 4.54±0.74 msec, respectively. There is no significant correlation of latency with age, and of latency with conduction distance to the upper trapezius. Those are measured and analyzed as a preliminary conduction study for diagnosis of neck dissection patient.

Neurologic level and change of neurologic function in spinal cord injury patient is valuable in predicting improvement of function and developing a comprehensive rehabilitation plan. Previous studies have grouped spinal cord injury patients according to Frankel's classification system and have reported recovery in terms of changes in their grades.

The purpose of this study is to investigate the neurologic recovery in terms of neurologic levels and to compare the recovery among the conservative care group, the early operation group, and the late operation group.

Fifty two traumatic cervical spinal cord injury patients who were admitted to Severance Hospital and Youngdong Severance Hospital, Yonsei University College of Medicine, between January, 1983, and December, 1993, were studied retrospectively dividing them into 3 groups. Twenty four patients were grouped into the conservative care group and 11 and 17 patients were grouped into the early and the late operated groups, respectively.

The results were as follows:

1) In motor level recovery, 45.8% of patients in group 1, 45.5% of patients in group 2, and 47.1% of patients in group 3 recovered more than 1 root level. There were no statistical difference among 3 groups.

2) In sensory level recovery, 45.8% of patients in group 1, 27.3% of patients in group 2, and 35.3% of patients in group 3 recovered more than 1 root level. There were no statistical difference among 3 groups. But the recovery rate was the lowest in group 2 patients.

3) In 8 cases in operated group, neurologic level became higher immediately after operation. However with exception of 3 cases, all patients recovered to preoperative levels.

In this study, regardless of treatment methods, 46% of cervical spinal cord injury patients improved more than 1 motor root level. The group 2 patients showed the lowest neurologic recovery rate. But the cases were too small to be statistically significant. Prospective study weth large spinal cord injury population is in need.

Because of the complex 3 dimensional structure of the femur, the conventional methods that use cross sectional computerized tomograph (CT) images to measure anteversion have several problems. These are 1) the ambiguity of defining the femoral neck axis and condylar line, 2) the dependence of patient positioning. Especially, the femoral neck axis which is known as a major source of error is hard to determine from single or several 2 dimensional transverse CT images. The present study has devised a new method for the measurement of anteversion utilizing the 3 dimensional imaging technique. First, the CT scan was taken into two parts include from the head to lesser trochanter (proximal part) and the condylar part (distal part) of femur. The two parts of cross-sectional images were position-corrected by adjusting the centroid of the neck base and the supra-condylar cross-sections. Then the slice images of proximal part are rearranged to antero-posterior view parallel to the condylar axis and bisected obliquely along the line of the inclination of the neck for a better definition of the neck axis. Then the bisected proximal part and the distal part of femur were 3 dimensionally reconstructed and rotated to make a cranio-caudal view for a final measurement. The direct measurement was performed on computer screen with the aide of specially designed caliper tool software. This method provides the most accurate measurement of anteversion because it is virtually equivalent to the direct measurement of bisected dried femur in vitro.

The functional assessment scales are important to express the sevenity of the disability and to evaluate the results of the management in the rehabilitation medicine. Many kinds of functional assessment scales were suggested. But Modified Barthel Index (MBI) and PULSES profile have been used commonly in Korea. Both scales are useful for measuring functional levels of self-care and mobility in physically impaired, however these indicls are not adjustable to evaluation of disability in severely handicapped individuals. So Functional Indepandence Measure (FIM) and Edinburgh Rehabilitation Status Scale (ERSS) were developed and published recently each in United States and New Zealand.

The number of patients were 14 inpatients and 24 outpatients who performed the rehabilitation program in the department of rehabilitation medicine. Fifteen of them had brain damage and twenty-three had spinal card injury. Four kinds of the scales were applied in each patients at the same time. Four scales were MBI, PULSES profile, FIM and ERSS.

Four scales evaluated their canacity and the characteristics of functional assesment.

The following results were obtained.

1) MBI and FIM are considered as concordant funocional scaie to follow the change of the disability in the same disease categary. This is statistically significant (P<0.01).

2) MBI is more useful in the patien of spinal cord injury and FIM in the patients of brain damage respectively because of saving the time are checking the mental function.

3) PULSES profile, that inciudes the function to assess the impairment, had the high correlation with the MBI and FIM but no discrimination function between them statistically.

4) ERSS is useful in measuring the hadicaps as well as the ability to assess the functional activity and the sensitivity to discriminate the disability is weak relatively.

In, conclusion, the measurement of both ERSS and other one of MBI and FIM was known to satisfy the functional measuring of generally disabied patients.

The purpose of this study is to evaluate the reliability of motor nerve conduction velocity (MNCV) in the assessment of uremic neuropathy. Ulnar and peroneal MNCVs were measured by Hopf technique as well as conventional method in 19 patients with renal failure in conservative therapy (Group I), 15 patients with renal failure in dialysis therapy (Group II) and 32 healthy volunteers (Control). The results were as follows:

1) Most of the cases showed normal range values of motor conduction velocity by conventional method, but the patients with renal failure in conservative therapy showed negative relationship between the serum creatinine level and conduction velocity of ulnar nerve.

2) The mean maximal and minimal conduction velocity of ulnar nerve were 60.74±9.65 m/sec 43.15±7.94 m/sec in group I, 54.87±9.66 m/sec 38.17±7.45 m/sec in group II and 64.88±7.17 m/sec 49.65±4.89 m/sec in control group, respectively.

3) The mean maximal and minimal conduction velocity of peroneal nerve were 48.51±3.73 m/sec 37.40±4.58 m/sec in group I, 47.93±7.78 m/sec 34.43±6.96 m/sec in group II and 56.27±7.18 m/sec 42.11±5.88 m/sec in control group, respectively.

4) By comparing conventional method with Hopf collision method, the measurement of minimal conduction velocity using Hopf's technique (collision method) is more precise estimate in detecting of polyneuropathies which is not detected by conventional nerve conduction study.

5) The maximum likelihood estimate between renal failure groups and control group was noted when the minimal conduction velocity of 5.05 m/sec cutpoint was used for ulnar nerve (odds ratio 14.12, sensitivity 94%, specificity 47%, concordance rate 71%) and 43.0 m/sec for peroneal nerve (odds ratio 11.00, sensitivity 97%, specificity 25%, concordance rate 62%).

The spontaneous posterior interosseous neuropathy is a relatively rare neuropathy and its etiologic mechanism is not clearly understood yet. The present study was based on a retrospective review of the electrodiagnostic records of 13 patients with spontaneous posterior interosseous neuropathy diagnosed at the EMG laboratory of Seoul National University Hospital from 1978 to 1992. Clinical and electromyographic features, occupational factors, and relationships between dominant hand and involved side were analyzed for the purpose of investigating the etiologic mechanism of spontaneous posterior interosseous neuropathy.

The results of our study indicate that spontaneous posterior interosseous neuropathy is very rare neuropathy (0.34% of peripheral neuropathy) and repeated forearm movement is not so significantly associated with the development of spontaneous posterior interosseous neuropathy. We suggest some etiologic mechanisms of spontaneous posterior interosseous neuropathy as follows: 1) compression by tumor, 2) acute compressive injury by external compression, 3) acute compressive injury by increased internal pressure, 4) entrapment neuropathy by fibrotic arcade fo Frohse.

This study was disigned to evaluate neurologic recovery in patients with spinal cord injury.

All 34 patients were neurologically evaluated and classified according to the Frankel classification system.

And neurologic function was reassessed at an average of 13 months postinjury.

Patients were evaluated for muscle power, sensation, simple x-ray, computed tomography, magnetic resornance imaging (MRI), somatosensory evoked potential (SEP) in acute stage.

Functional recovery (D.E) was obtained 100% in the initial Frankel's classification B and C, while only 14.3% in the initial Frankel's classification A.

Patients with combined fracture and dislocation were difficult to obtain the functional recovery (23.1%).

MRI signal patterns were divided into 3 patterns. The patients with hemorrhagic pattern have lowest recovery rate to functional state (14.3%).

Evocability of somatosensory evoked potential was well correlated with good functional recovery (69.2%).

Time duration to functional recovery was 6.5, 5.3, 1.8 months for initial Frankel's classification A, B, C.

As a result, incompleteness of motor and sensory loss, absence of cord hemorrhage, absence of combined fracture and dislocation and evocability of somatosensory evoked potential were important good prognostic factors.

This study was performed to investigate the Life Satisfaction (LS) of individuals with disabling conditions, especially focusing the relationship among LS, physical and functional limitations, economic circumstances, and psychosocial factors. Data were collected by a personal or telephone interview and a letter from 164 individuals of working age who had visited the department of Rehabilitation Medicine, Guro Hospital for registration of disability to Ministry of Health and Welfare, Korea.

Life satisfaction was studied by 5-score Likert scale and Reintegration to Normal Living (RNL) index of 11 questions, 8 functional and 3 perceptual items.

The mean score of Likert scale about LS was 3.67±1.17 before disabled and 2.21±1.02 in current state. Life Satisfaction and quality of life were found to be related to the age of respondants, onset age of disability, marital status, education level, severity of condition, and employment status. Life satisfaction was also dependent upon perceived health status by self, number of combined diseases, and self esteem. And Likert score was correlated significantly with RNL index and Beck Depression Inventory score.

Carpal tunnel syndrome, a median neuropathy at the wrist is the most common entrapment neuropathy. There are many methods to diagnose carpal tunnel syndrome, but each study has some limitations.

In carpal tunnel syndrome, the median motor distal latency is normal from 35% to 50% of patients. This lack of sensitivity of distal motor latency may be due either to spairing of motor as compaired to sensory fibers or to inability of standard median motor studies to detect abnormality.

We performed the conventional nerve conduction studies 50 controls and in 20 patients with clinically suspected carpal tunnel syndrome and compared with Preston and Logigian's method that used the same active electrode lateral to the third metacarpal bone, to record the second lumbrical or the deeper interossei responses by stimulating at median and ulnar nerves, respectively.

In control group, the mean distal motor latency of median nerve on lumbrical recording was 3.09±0.21 msec, and that of ulnar on interossei recording was 3.00±0.21 msec and the mean lumbrical-interossei difference was 0.10±0.15 msec. In carpal tunnel syndrome group, the mean distal motor latency of median nerve on lumbrical recording was 4.11±1.24 msec, and that of ulnar on interossei recording was 3.08±0.42 msec and the mean lumbrical-interossei difference was 0.91±0.70 msec, The abnormal lumbrical-interossei latency difference was set at greater than 0.4 msec as the mean±2SD. there was no significant correlation between age and lumbrical-interossei latency difference (r=-0.09). the sensitivity of lumbrical-interossei latency difference was 90.9%.

The lumbrical-interossei latency difference is a more sensitive test than conventional median motor nerve conduction study recording at abductor pollicis brevis in patient with carpal tunnel syndrome.

Between August 1993 and March 1994, electrodiagnostic studies were performed on 42 patients with spinal cord injuries who were admitted to Severance Hospital, Yonsei University College of Medicine. The patients were classified into two groups: complete spinal cord injury group and incomplete spinal cord injury group. The changes of abnormal spontaneous activities and nerve conduction study findings were evaluated according to time along with spasticity grade.

In this study, it was found that both abnormal spontaneous activity occuring frequency and compound muscle action potential amplitude decreased according to time after complete spinal cord injury. For both complete and incomplete spinal cord injury, occurrence of abnormal spontaneous activity was found to be decreasing as spasticity increased.

According to this study it was found that abnormal spontaneous activities to be present in most patients with spinal cord injury even without peripheral nerve lesions, and their occurance decreased proportionally as the time after injury and the spasticity increased.

The ability to maintain balance underlies the successful performance of most physical activities and daily life task. When balance is insuffient, rehabilitational outcomes may be much impaired. Assessment of balance is essential to the rehabilitation course.

The development of clinical technique for evaluating balance is dependent on a thorough understanding of sensory and motor process underlying normal balance control. Many measures used for describing balance were all with important limitations.

The primary objective of this study was to develop a quantitative measure of balance suitable for effective approach for clinical measurement. One approach to systematic evaluation of balance is accomplished when sensory input were altered among somatosensory, visual and vestibular for postural orientation and when divided into static and dynamic state. To provide this conditions, we designed a method 'balance index' which was tested under several different conditions that restrict visual, surface sensory input and produce inaccurate postural reaction by tilting, moving on wheel chair, standing on one leg. Timed performances for assessment criteria under each conditions were then observed in amount of sway or postural reactions for a period of 10 seconds. Quantifying include a numeric ranking of six scales for each unit test. Total score is maximally 40 ratings both in the sitting and standing balance index.

The analyzed results from examining 50 healthy adults and 20 stroke patients were that the normal range of scoring represented 38.3±0.8 in sitting, 34.5±2.7 in standing, balance index, but these values were significantly dropped in stroke patients to 27.8±13.9 in sitting, 21.0±6.9 in standing position. And a decrease in index of normal adults was first found in the aged from 50∼59 years in sitting and 40∼49 years in standing, and no difference were apparent when comparing the two sexes. Both intra- and interrater test reliabilities were high, which indicates that index seems to be a fairly constant parameters.

We suggest that this test is a useful screening tool not only offering quantitative, objective data about balance but also inexpensive, easily administered for examining sitting and standing balance in clinics.

Recently, the lifespan has been prolonged in the patients with spinal cord injury, which has resulted in change to the cause of death of them.

This study intended to inspect the cause of death and the survival length of spinal cord injured patients, and to help prevent and manage fatal complications, so the life expectancies increase much further.

There were total 42 patients with deceased chronic, traumatic spinal cord injury including 11 quadriplegics and 31 paraplegics.

The average length of survival of the deceased spinal cord injured patients was 23.6 years, in which that of quadriplegics was 18.9 years, and paraplegics was 25.3 years. but the paraplegics has a longer survival length than quadriplegics, but showing no statistically significant difference (p>0.05).

The respiratory disease and kidney and urinary tract disease is the leading cause of death followed by cardiovascular disease and sepsis, and other cause such as malignancy, unknown origin digestive diseases, suicide, and accident in order of the frequency in deceased spinal cord injured patients.

And the urinary tract disease was the major cause of death among paraplegics, whereas respiratory disease was the leading cause of death among quadriplegics, but it was no significant correlation between neurologic level and cause of death in spinal cord injury.

The utility of the dexamethasone suppression test (DST) in the diagnosis of depression were examined in 38 stroke inpatients. The depressive symptoms were assessed by the modified Hamilton depression rating scales.

The results were as follows:

1) The patients with abnormal DST had significantly higher Hamilton scales (13∼15) than those with normal DST (8∼9).

2) Defining the depression as above 14 points of Hamilton scales, the sensitivity, specificity and positive predictive value (PPV) of the DST were in the following order: 69.2∼78.6%, 79.2∼87.5% and 66.7∼76.9%.

3) Three patients with false positive DST were all within one month after the stroke,

4) The specificity and PPV of the DST were in the following order: DSTL (DST in which the lower cortisol value between the 8AM and 4PM cortisol, value was selected)- 87.5%, 76.9%; DST8AM (DST in which the 8AM and 4AM cortisol value was selected(- 87.0%, 75.0%; DST4AM (DST in which the 4AM cortisol value was selected)- 82.6%, 66.7%.

5) Abnormal DST or Hamilton scales representing depression were not correlated with the nature, site or size of the brain lesion.

The results demonstrate that the DST is a useful specific indicator of depression in patients with stroke, and it is necessary to rule out the false positivity, especially in acute phase.

We undertook this study to evaluate chracteristics of hallux valgus in rheumatoid arthritis.

137 patients with rheumatoid arthritis were evaluated with clinical examination and radiological study for hallux valgue. 86 patients with degenerative joint disease were evaluated for control study.

Results were as follows:

1) There were significant increase of hallux valgus angle as increase age, duration of disease, calcaneal valgus, grade of pes planus and 1st intermetatarsal angle (p<0.05).

2) There were significant correlation between hallux valgus angle between physical examination and radiological study (p<0.05).

3) There were no significant difference in hallux valgus angle between physical examination and radiological study (p≥0.05).

4) Hallux valgus was more frequent in degenerative joint disease than rheumatoid arthritis significantly (p<0.05).

This study suggested that hallux valgus tends to increase severity and frequency as aging, duration of joint disease, calcaneal valgus, grade of pes planus and 1st intermetatarsal angle, throughout long time. Rheumatoid arthritis is not unique disease to have hallux valgus.

F-wave minimal latency, mean latency, persistence, chronodispersion and tacheodispersion were studied to evaluate the diagnostic sensitivity of various F-wave parameters in the ulnar and peroneal nerves in subjects with diabetic polyneuropathy. The minimal & mean latencies were corrected by height and age, 35 diabetic patients were divided into two groups according to the conventional electrophysiologic study: no evidence of polyneuropathy (group 1) and polyneuropathy (group 2).

F mean latency of ulnar nerve and F minimal latency, mean latency of peroneal nerve showed the highest sensitivity. The F conduction velocity and tacheodispersion showed gradual decline from control to group 2 in ulnar & peroneal nerves.

Therefore height and age corrected F mean and minimal latency or F tacheodispersion are sensitive methods in early diagnosis of diabetic neuropathy.

In 26 amputees, the results after application of digital infrared thermographic imaging and Minnesota Multiphasic Personality Inventory test were evaluated.

There was no correlation between cause of amputation and phantom pain. In patients with phantom pain or stump pain, there was significant hypothermia at amputated site (p<0.05, Fischer's exact test). The pattern of hypothermia was regional in the patients with phantom pain, and localized in the patients with stump pain only(p<0.05, Fischer's exact test).

There was no specific psychological characteristics in the amputees with phantom pain as a result of Minnesota Multiphasic Personality Inventory test(p>0.05) but in the counselings, depression, denial, anxiety, and paranoia components were found in 15, 9, 14, and 2 cases respectively.

We assessed shoulder function in 62 frozen shoulder patients with shoulder function assessment method which devised by Constant for the purpose of evaluating the usefulness of this method. The basis of this method is a 100-point score, composed of individual parameters (pain, ADL, ROM, and power). We found that this method is easy to perform and provides relatively exact overall functional assessment in frozen shoulder patients. So, it will be used for evaluation of treatment results and documentation of disease progression in frozen shoulder. The total score of frozen shoulder patients showed normal distribution and average score was 64.2±15.4. So, we suggest the severity grading of frozen shoulder by total score with this method as follows; 1) total score below 50 point : severe, 2) 51-60 : moderate to severe, 3) 61-70 : moderate, 4) 71-80 : moderate to mild, 5) above 80 point : mild.

A method for quantitative analysis of the electromyographic interference pattern (IP) was carried out before and after phenol motor point blocks. Clinical evaluation for the spasticity was based on Ashworth scale before and after the blocks. Eight children with cerebral palsy and two children with traumatic brain injury were studied. The number of turns per second (NT) and the mean amplitude change between successive turns (MA) were obtained with recordings from the gastrocnemius muscle with surface electrodes at constant level of voluntary contraction for 10 times. The mean percentage differences in mean NT and mean MA between blocked and pre-blocked muscle were 59.2% (P<0.01) and 22.8% (p<0.01), respectively. The mean difference in Ashworth scale was grade II (p<0.01). A better correlation was noted between the differences of NT and the differences of Ashworth scale, than between differences of mean MA and differences of Ashworth scale. The mean NT correlated well to the Ashworth scale, indicating a close correlation between the mean NT and spasticity. All of the patients after motor point block revealed decreased mean NT and Ashworth scale. We concluded that quantitative EMG analysis helps evaluation of clinical status after treatment of phenol motor point block for the spasticity.

Clinical results and data were obtained by phone calls and chart reviews from 69 patients who were conservatively treated and diagnosed as herniated intervertebral lumbar disc (HIVD) by Magnetic resonance imaging (MRI) from Aug. 1989 to June 1992.

Clinical results were evaluated by Stauffer's criteria for clinical result. The purpose of this investigation is to determine the clinical factors that influence clinical results and effectiveness of conservative treatment for lumbar HIVD. The results were as follows:

The clinical result of 69 patients treated conservatively was excellent 14 cases (20.3%), good 45 cases (65%), fair 6 cases (8.7%) and poor 4 cases (5.8%) respectively. MRI classification of HIVD by severity was bulging disc 16 cases (23.2%), protruded disc 28 cases (40.6%), extruded disc 17 cases (24.6%) and sequestered disc 8 cases (11.6%) respectively. This study showed the favorable outcome of back exercise group (85.3%). There was correlation between the clinical result and occupation. The cause and severity of HIVD, the number herniated discs and degenerated discs were not showed any correlation with the clinical result of HIVD. There was no correlation between the clinical result and life style factors (smoking, obesity and driving). Education, economic status were not showed any correlation with the clinical result of HIVD.

The experimental study was conducted in order to observe the change and degree of the sciatic nerve damage following direct injection and dripping of physiological normal saline solution, sulpyrine and gentamysin sciatic nerve.

Twenty-four normal adult Wistar rats were divided into three groups depending on the injected materials. The sciatic nerves of the rat were surgically exposed and injected into the right sciatic nerve intraneurally and dripped around the left sciatic nerve perineurally.

The nerve conduction study, needle electromyography were performed before experimental injury and were performed at 3, 7, 10, 14 days after experimental injury and the pathologic study was also performed at 7, 14 days after experimental injury.

In the nerve conduction study, there was no decrement of the amplitude of compound muscle action potentials after injection and dripping in normal saline group. There was significant decrement (P<0.05) of the amplitude at 3 days after injection and remained same at 7, 10, 14 days after injection but no significant decrement of the amplitude after dripping in sulpyrine and gentamycin group.

In the needle EMG, the abnormal spontaneous acitivies (ASA) were noted at 3 days after injection and the amount of ASA remained same at 7, 10, 14 days after injection and no ASA was observed after dripping in normal saline group. The ASA were noted at 3 days after injection and the amount of ASA were increased at 7, 10, 14 days after injection in sulpyrine and gentamycin group.

Histologic studies showed splitting of myelin sheath at 14 days after saline injection and showed decreased numbers of myelinated fibers, hydropic change of axon, disruption and collapse of myelin sheath at 14 days after sulpyrine and gentamycin injection.

With the above findings, it is suggested that the main cause of the injection injury of the peripheral nerve is chemical reaction rather than mechanical problem.

Swallowing is a brief but intricate process. When this process in disrupted as in patients with neurogenic disorders aspiration or malnutrition can occur.

A retrospective study was conducted to determine the treat outcome of neurogenic dysphagia. Seventeen (55%) out of thirty-one dysphagic patients entered in this study became successful oral feeders and the average time needed for the successful treatment process was about five weeks. Cough reflex, swallowing reflex, disability rate, and cognitive function were associated with the outcome of dysphagia.

Phrenic nerve conduction studies are clinically helpful in the evaluation of the disease of peripheral nerves and therapeutic applications.

The purpose of this study is to determine the normal value of the phrenic nerve conduction using magnetic stimulation in 30 healthy Korean male adults, in addition compared to one from the electrical stimulation.

In the present study, phrenic nerve function was evaluated by transcutaneous magnetic stimulation at the posterior border of the sternocleidomastoid muscle on the thyroid cartilage level and recording the diaphragmatic action potential with surface electrode placed at the ipsilateral eighth-ninth intercostal space of 8-10th rib.

The results were as follows:

1) The mean latency was 7.00±0.72 msec at right, 7.00±0.76 msec at left, there was no significant differences between sides.

2) The mean amplitude was 647.3±262.3 uV at right, 663.6±278.8 uV at left, there was no significant differences between sides.

3) There was no significant differences in the latency and amplitude of compound motor action potential of phrenic nerve between magnetic and electrical stimulation.

4) There was no significant differences between the latency and the age, and sitting height and the chest circumference.

In conclusion, the use of magnetic stimulation may be used as the method of phrenic nerve conduction study like the electrical stimulation.

Cauda equina syndrome and spinal cord injuries are ensued as a sequele of back trauma which is major part in industrial accidents.

In cauda equina syndrome, it is very difficult to evaluate and diagnose because of subjectivity, especially in mild and moderate cases.

76 cases of cauda equina syndrome were reviewed from 423 cases studied electrophysiologically in 669 back trauma patients.

The cases were evaluated with causes, symptoms, and clinical signs.

The results were as follows.

1) The causes of cauda equina syndrome were compression fracture (61.8%), herniated disc (32.9%), spinal stenosis (9.2%) and so forth. Operative managements were performed in 73.7% of patients with cauda equina syndrome.

2) 40.8% of patients could ambulate by the use of orthosis or assistive devices.

3) The degree of pain were severe (40.8%), moderate (55.3%), mild (3.9%).

The results demonstrate that the major clinical feature of cauda equina syndrome, which is noted in 11.4% of patients with back trauma, is rather pain than weakness or sphincter problems.

The purpose of this study were to know the correlation between kinetic and kinematic parameters in jump activity and to know the difference between the function of biarticular muscles and uniarticular muscles in jumping. For these purposes, isokinetic testings of ankle muscles of 20 non-athlete males were compared with the kinematic parameter, jump height and anthropometric measurements. The Cybex isokinetic dynamometer for kinetic parameters and Sargent Jump Meter for kinematic jump parameter were used. And the results were as follows:

1) The mean age of 20 subjects was 24.8 years, mean height was 172.5 cm, mean weight was 68.0 kg and the mean jump height was 51.5 cm.

2) There was no meaningful correlation between jump height and peak torque among muscles around ankle joint. But there were meaningful correlation between jump height and peak torque % body weight and average power even though the correlation coefficient was low.

3) The plantar flexor activity during knee flexion was more correlated with jump height than that during knee extension but there was no statistical meaning.

4) The weight was highly reversely correlated with jump height and was linearlly correlated with peak torque and other isokinetic parameters.

And the authors concluded as follows: firstly, isokinetic parameters should be cautiously used in sports medicine for evaluations, secondly, the soleus muscle activity was important for jumping activity as much important as biarticular gastrocnemius muscle and finally, weight factor during high competitive sports activity and sports medicine is very important and should be considered.

The spondyloepimetaphyseal dysplasia are subclassifications of chondrodystrophies with selective and combined involvement of the vertebrae and long bone epiphyses and metaphyses.

The clinical findings include short-trunk dwarfism, platyspondyly, coxa vara, kyphoscoliosis, lumbar lordosis, barrel-shaped thorax and odontoid hypoplasia.

Kozlowski, in 1974, described the micromelic type of spondyloepimetaphyseal dysplasia, presumed to be of autosomal recessive inheritance, with greatest shortening in the proximal portion of the limbs.

We experienced two cases of spondyloepimetaphyseal dysplasia in sibbling and reported the cases with physical examination, radiologic findings, chromosomal analysis and various clinical evaluation.

Clonidine, centrally acting α₂ agonist, has been used as an antihypertensive agent. Although antispastic action of clonidine has been known, the clinical use of oral clonidine on spinal spasticity has been limited due to side effects, mainly postural hypotension. Two cases are presented of patients with spasticity as the result of cervical spinal cord injury, inadequately managed by oral baclofen & other conservative treatment, in whom transdermal clonidine was administered. Dramatic relief in spasticity and increment in functional level were achieved in both of 2 cases with side effect limited to dryness of the mouth in one case. In addition to improvement in spasticity, there was amelioration of paresthesia in one case.

Guillain-Barré syndrome, acute inflammatory demyelinating polyradiculoneuropathy, is acutely or subacutely evolving paralytic disease caused by unestablished etiology. It's antecedent events are upper respiratory infection, unexplained fever, vomiting, diarrhea, vaccination, viral and bacterial infection, and surgical procedure, in order of frequency. Measles infection is known as the rare antecedent event of Guillain-Barré syndrome. The acute axonal form of Guillain-Barré syndrome is characterized by rapid progression to severe widespread paralysis and show respiratory dependence within 2-5 days of the onset of weakness with very poor and delayed recovery. But in this presented case, axonal Guillain-Barré syndrome and combined encephalitis caused by measles infection, 14 year-old girl showed rapid and good recovery though suffered from severe clinical course. This case illustrates prognostic indicator in adult can't apply to child. So more study about causative agents, classification, and prognostic indicator is necessary.