A thesis is well organized, thoughtfully written, and free of errors reassures the reader that the conduct of research is creative, important and meaningful. The guidelines of scientific research aid authors in reporting their work in ways that are clear and responsive to the queries of editors and reviewers. The thesis should begin with the research question, then set out design and methods and conclude with a statement of the importance of potential findings of the study. It should be presented in a logical sequence with precision.

This paper is presented to provide the uniform requirements for writing a thesis to be submitted to the Journal Korean Academy of Rehabilitation Medicine.

The purpose of this study was to provide a guideline for early diagnosis comprehensive rehabilitative management including genetic counseling by means of clinical examination. medical and electrodiagnostic record of peroneal muscular atrophy patients and their family reviewed. In addition, nerve conduction study were performed in cooperative family members of patients.

The result of clinical and electrodiagnostic findings was compatible with peroneal muscular atrophy in 4 families out of 8 families: 5 members of 21 family members.

As a conclusion, we strongly recommended the electrodiagnosic evaluation as a diagnostic tool for the members of the patient's family with or without clinical evidence of peroneal muscular atrophy, since it is found to be useful in the early detection of subclinical peroneal muscular atrophy, and hence provide a proper guideline for genetic counseling of the patient's family.

General insults to the nervous system, such as perinatal hypoxia, may be accompanied by pathologic changes in visual evoked potentials (VEPs). Crude correlations have sometimes been identified between the degree of VEP abnormality and long-term neurologic and behavioral outcome.

The aim of the present study was to correlate changes or differences in VEPs with cerebral palsy, The VEPs were analyzed by the latency, amplitude, and interhemispheric symmetry and graded into 4 categories, which were obtained from 25 children with cerebral palsy aged from 15 to 59 months (mean, 29 months).

The results were as follows:

1) By the grade of VEPs, normal response was 24.6%, prolonged latency 45.6%, abnormal wave 15.8%, and no response 2.0%

2) The mean P2 latency of VEPs of normal response group was 98.62±26.07 msec, that of prolonged latency group was 113.27±18.66 msec and that of abnormal wave group 130.28±27.31 msec. The mean N2-P2 amplitude of normal response was 13.02±2.51㎶. that of prolonged latency group 13.29±7.62㎶, and that of abnormal wave group 4.29±0.11㎶.

3) Abnormal wave or no response of the VEPs ware 14.3% in children with spastic diplegia, 18.8% with spastic quadriplegia, and 27.8% with hemiplegia.

4) There was no correlation between the motor development and VEP abnormalities in children with cerebral palsy aged over 15 months.

This study was undertaken to document an association of degenerative lumbar disc disease in patients with thoracolumbar Scheuermann's disease, During a 14-month period, 8.4% of 95 of the persons referred to our center for magnetic resonance imaging of the lumbar spine demonstrated changes of both thoracolumbar Scheuermann's disease and degenerative disc disease in the lower lumbar spine. All investigated patients were younger than 21 years. We theorize that the thoracolumbar Scheuermann's disease and the associated degenerative disc disease of the lower lumbar spine are manifestations of an intrinsic defect of the discs and /or cartilagenous end plates, which results in inadequate nutrition and structural weakness or combination of both, and early degeneration.

Low back pain is major cause of industrial disability and has a significant socioeconomic impact. Risk factors for low back pain are discribed a being either industrial or occupational risk factors. Individual risk factor includes: age, sex, anthropometry, muscle strength, psychosocial factor and previous attack of low back pain. Occupational risk factor includes: lifting, bending, twisting, heavy work and vibration.

Many hospital employees are at risk for work-related low back pain and nursing personnel, when compairing to other occupational groups, have relatively high prevalence rate of back pain.

A cross-sectional questionnaire study was carried out aiming at determining prevalence rates and identifying factors associated with low back pain. The quesionnaire included 37 question items concerning age, height, body weight, job position, physical fittness, job satisfaction and transfer loading score. Transfer loading score was defined as the sum of numbers of lifting weighted by the method of patient handling and by the numbers of participating person.

The results were as follows:

1) Low back pain prevalence rate of the study subjects was 54.6%.

2) In the nurses of intensive care unit and operating room, the prevalence rate of low back pain was significantly higher than in that of general ward nurses.

3) The relationship between the history of previous back pain and present low back pain was found to be significant, with odds ratios of 3.25 The relationship between the transfer loading score of 6 to 10 or 11 to 20 or above 20 and present low back pain was found to be significant, with odds ratios of 2.23, 2.27 and 1.27, respectively.

4)The transfer loading score tended to be lower with increasing age and career of nurses. And it was significantly higher in staff nurses than in head and charge nurses, and in nurses of intensive care unit and operating room than in nurses of general ward.

According to the above results, the transfer loading score is correlated with low back pain. For prevention of low back pain in hospital nursing personnel, the use of portable patient hoist and regular education programe are needed.

When he/she flexes and extends the lumbar spine, the lumbar motion segments rotate and translate in the sagittal plane. This coupled motion can be described as a simple rotation about a fixed center lying in each segment. The location of the center can be determined by plotting images of this vertebra in relation to the underlying vertebra in the motion segment. This center is known as the instantaneous axis of rotation(IAR). It has been suggested that degenerative disease and instability can be diagnosed on the basis of abnormally located instantaneous axes of rotation. This study descirbes a method that determines the IAR using lateral radiographs and reports the results for 17 normal individuals and 17 individuals with intervertebral disc herniation or degeneration who were studied at the L4-L5 and L5-S1 segments for the movement of full flexion form fully extended position. Acetate tracings and contour matching techniques recorded the relative positions of the vertebal bodies on each film. Mean IAR between control group and group with intervertebral disc herniation or degeneration. However, position of IAR of L5-S1 n the Y-axis shifted upward compared with L4-L5 in the group with disc herniation or degeneration.

Walking is the activity that stroke patients themselves think most important. One of the variables often used to describe gait performance after stoke is gait speed because it is well correlated with other measures of performance such as appearance, distance and independence, And it tends to match with functional outcome of stoke. So, we investigated gait speed in 30 stoke patients and 21 normal age matched controls during gait with comfortable and maximum safe gait speeds, And the results are as follows.

1)Stoke patients walked slowly compared with controls(p<0.01) and comfortable gait speed was slower than maximum safe gait speed in each group(p<0.01)

2) In stoke patients, linear ragression equation describing relationship between comfortable and maximum safe gait speed was maximum safe gait speed=0.633+1.375⁓comfortable gait speed.

3) In stoke patients, gait speed was well correlated with Brunnstrom stage, social performance level and preservation of deep sense(position and vibration senses).

4) In stroke patients, 8 patients with ankle foot orthosis walked faster, especially in comfortable gait speed, then the patients without short leg brace(p<0.05).

Above results showed that stoke patients were able to increase their walking speed significantly above the level they found comfortable. And the correlation between comfortable and maximum safe gait speeds indicated that the maximum safe gait speed could be predicted by comfortable gait speed with considerable accurary.

The aim of the study was to evaluate metatarsal arch of foot by the footprint test in patients with or without foot problems.

History, physical examination, X-ray study and the footprint test were done on 870 feet of 435 patients. The cases fall into 5 groups according to depressed metatarsal atch(or transverse arch) by the footprint test.

We considered normal findings as grade 0. which has two pressure marks under the first and fifth metatarsals or a additional relatively large central mark. Grade Ⅰ has only a large central pressure mark. Grade Ⅱ has a relative small pressure points located under the central metatarsal heads, grade Ⅲ has two central pressure points, and grade Ⅳ has three central pressure points respectively.

1) Depressed metatarsal arches were seen in 644 of 870 feet(74.1%) with grade I in 412 feet (47.4%), grade Ⅱ in 138(15.9%), grade Ⅲ in 80(9.2%), and grade Ⅳ in 14(1.6%)

2) The higher grade of hallux valgus, the move significant in grade of depressed metatarsal arch(p<0.001).

3) The more number of involved toe(p<0.001) and of plantar callus(p<0.001), higher grade of depressed metatarsal arch.

4) According to the type of metatarsal bone by X-ray, mean grades of depressed metatarsal arch were 1.46 in the index minus type(28/110), 1.40 in index plus type(55/110), and 1.07 in index plus minus type(27/110). There was significant difference between mean grade of index minus type and that of index plus minus type(p<0.05).

We concluded that our classification of depressed metatarsal arch by the footprint test will be valuable and useful evaluation method for the patients with foot problem.

The purpose of this study was to examine the correlation between foot pain and foot deformity for management of the foot pain by modification of shoe. Subjects included 323 patients with foot pain and 124 control patients without foot pain. These patients were evaluated by history, physical examination, foot printing and X-ray study.

The major results were as follows:

1) Foot pain was more related to younger patients and rheumatoid arthritis than older patients and osteoarthritis(p<0.05).

2) Foot pain was related to many factors such as, hallux valgus angle, toe deformities(i.e.hammer toe, claw toe), callus, bunion, number of invloved toes, varus angle of the 5th toe, depressed metatarsal arch and flat foot.

Aim is to distinguish chracteristics of the pes planus of rheumatoid arthritis from the pes planus of degenerative joint disease.

269 patients with rheumatoid arthritis and 93 patients with degenerative joint disease were evaluated with clinical examination with footprinting for pes planus including calcaneal angle, hallux valgus, range of motion of ankle, loss of metatarsal arch, duration of foot symptom and disease, age and foot pain.

Results were as follows:

1) There was significant increase in the grade of pes planus an increase in the calcaneal valgus, hallux valgus, duration of foot symptom, duration of disease, and patient age in rheumatoid arthritis(p<0.05).

2) There was no significant different of the prevalence between degenerative joint disease and rheumatoid arthritis(p≥0.05).

3) There was no significant correlation between the grade of pes planus and other variables including calcaneal valgus, hallux, valgus, duration of foot symptom, duration of disesae, and patient age in degenerative joint disease(p≥0.05).

Our findings suggest that there are different mechanism in the development of pes planus between rheumatoid arthritis and degenerative joint disease.

The Purpose of this study was to investigate location, the efficacy of diagnostic tools, and risk factors for heterotopic ossification which was a frequent complication in patients with traumatic brain injury(TBI).

Among the fifty-four patients with TBI, heterotopic ossification was developed in twelve patients(22.2%). The most common location was around the hip joint with the incidence of 59.2%. The significant risk factors related to heterotopic ossification were associated long bone fractures and spasticity. The time of diagnosis of heterotopic ossification among six patients was 3.8 months after TBI. Serum alkaline phosphatase levels were elevated in all eight patients with heterotopic ossification within 12 months after injury. All ten patients who took the bone scan reveled increased activity.

In accordance with close clinical observation, serial laboratory tests are needed in patients with TBI at risk of heterotopic ossification. Serial serum alkaline phosphatase measurement, roentgenography and 3 phase bone scan are required for early diagnosis and evaluation of the maturity of heterotopic ossification

The purpose of this study is to determine the acoustic characteristics of dysarthria depending upon the underlying etiology. We used sound spectrography to assess the formant characteristics. phonation time of vowel, and voice onset time of alveolar consonants. With Nasometer, we evaluated nasalance with reflects the ratio of nasal and oral acoustic energy. Visi-Pitch was also used to evaluate pitch perturbation, pitch range, and diadochokinetic rates of the articulatory organ.

Underlying etiology of dysarthria included pseudobulbar palsy in 5 patients, bulbar palsy in 2 patients, language delay in 3 patients, and tonsilar hypertrophy in 3 patients.

In spectrographic evaluation, most dysarthric patients were characterized by loss of specific characteristics of formants of vowel, increased noise in high frequency range, and reduced duration of phonation. Voice onset time was prolonged in alveolar stop consonants in dysarthric patients with pseudobulbar and bulbar palsy.

Nasalance was increased in dysarthric patients with pseudobulbar and bulbar palsy, but decreased in patients with tonsilar hypertrophy.

In Visi-Pitch analysis, voice intensity was normal in all types of dysarthria However, pitch perturbation was increased in dysarthric patients with tonsilar hypertroghy, pseudobulbar and language delay palsy. Diadochokinetic rate was decreased in all dysarthric patients.

Sound spectorgrapy. Nasometer and Visi-pitch were considered to be useful to determine the specific acoustic characteristics of dysarthria in the patients with neurological involvement and structuarl lesion, but were not sensitive to delineate the pathologie region of neurologicl involvements.

The Purpose of this study was to investigate the effects of age and sex on hand strength and dexterity. 158 normal subjects aged 11 to 75 years in 7 age groups were tested on four tests of hand strength: grip, tip pinch, lateral pinch, and palmar pinch and two tests of hand dexterity: purdue pegboard and Pegboard and Pennsylvania bi-manual worksample.

The results showed the average scores of grip and pinch strength increased after 11 to 19 years and were relatively stable from 20 to 59 years, and decreased after 60 years. For grip and pinch strength, males are stronger than females in all age groups but the differences were not significant in 11 to 15 year old group. The scores of purdue pegboard decreased with age over 20 years. with a significant decrease over 60 years. Females performed better than males in general but the differences were not significant in all age groups, The speeds performing to Pennsylvania bi-manual worksample delayed significantly from 60 years in both sexes. , Males were faster than females on the assembly of two subtests from 50 years. But for the speeds of the disassmebly, there were no differences by sex in all age groups.

In modern society, among increased number of traumatic brain injury and survived patients are increased due to improvement of acute medical care and neurosurgical procedure. There are any complications that may be often life threatening and delay rehabilitation program, and requires much attention.

This study evaluated the age and six distribution causes of traumatic brain injury, severity by Glasgow Coma Scale, associated injury, and incidence and days when complications detected, The study was done retrospectively through medical record of 305 patients admitted to Soon Chun Hyang University Chunan Hospital, Chunan, Korea between January, 1991 and April, 1992. The results were as follows.

1) The age incidence was high in the first decade(16.7%), 6the decade(15.7%), 3rd decade(14.4%), and 4th decade(14.4%), in order. Male outnumbered female by almost 2.4 to 1.

2) The common causes were traffic accident(71.6%) and falls(21.6%).

3) The incidence of associated injury was 54%

4) The common complications were subdural hygroma(2.3%), hydrocephalus(2.0%), chronic subdural hematoma(2.0%), upper gastrointestinal bleeding(1.3%), seizure(3.0%), and syndrome of inappropriate secretion of antidiuretic hormone(SIADH, 1.6%)

5) The days when complications detected were 39.0 days for subdural hygroma, 40.0 days for hydrocephalus, 21.3 days for chronic subdural hematoma, 21.5 days for UGI bleeding, 32.7 days for seizure, and 12.6 days for SIADH.

6) There was no significant difference between Glasgow Coma Scale and incidence of complications, such as chronic subdural hematoma, UGI bleeding and SIADH, but there was significant difference between Glasgow Coma Sale and hydrocephalus, seizure and subdural hygroma(p<0.05).

We present a case which was partial median nerve lesion at supracondylar level of humerus that mimicks anterior interosseous syndrome clinically. The lesion was caused by blunt trauma of right arm due to traffic accident 6 months before the examination. It is characterized by weakness of muscles innervated by the anterior interosseous nerve branch of the median nerve as well as other more proximal median nerve innervated muscles, namely, the pronator teres, flexor carpi radialis and flexor digitorum sublimis. But other median nerve innervated distal hand muscles were not involved. Sensibility was intact, Electrodiagnostic study revealed fibrillation potentials and positive sharp waves at rest and absent of reduced recruitment patterns in muscles above mentioned. Routine sensory and motor conduction velocity of upper extremities was within normal limits, except a half amplitude of compound muscle action potential of anterior interosseous nerve picked up at pronator quadratus compared to left side.

We hypothesized neurotopographically this partial median nerve lesion is at supracondylar level, especially posterior portion of the nerve trunk, which contains the bundles to from the anterior interosseous nerve and branches of superficial flexor muscle group at elbow level, It will be discussed along with internal topographic illustrations.

A representative sample of 45 men with spinal cord injury who reside in the community, was studied in terms of sexual activity, concern and interest, Participants reponded to a questionnaire and rating scales and were physically examined to establish their neurologic status, With respect to eleven other area of life, sex life ranked third in terms of importance, and the lowest in terms of satisfaction. Of the sample, 31% reported having had a physical relationship in the past 12 months, Area Of greatest concern were not getting enough personal satisfaction(91.1%). The greatest interest form seven topics related to sexuality were methods and techniques to achieve sexual satisfaction. With the above results, we concluded that the sexual rehabilitation should be included in comprehensive rehabilitation of spinal cord injured men

The authors had studied the clinical follow-up of 47 patients with nerve root symptoms and herniated nucleus pulposus (HNP) who received only a conservative medical treatment. All patients had low back pain with radiation to leg and were diagnosed as HNP by lumber spine MRI and as radiculopathy by electrodiagnostic study. All patients han undergone bed rest, steroid therapy in 5 days and tapered following 2 days, and a physical rehabilitation program.

Clinical follow-up after 17-40 months showed that 37 patients (78.7 percent) had good results, There were no statistically significant difference in outcome in the patients with sensory change and neurologic weakness and the degree, type and severity of HNP in the MRI findings and the presence of low grade of abnormal spontaneous activity in the study of electodiagnosis. But there was a significant positive correlation with symptom improvement during bed rest and the mild physical activities.

As a result, this study demonstrates that herniated nucleus pulposus of a lumbar intervertebral disc with radiculopathy can be treated very successfully with conservative method.

In early or mild carpal tunnel syndrome(CTS), conventional electrodiagnostic studies may show normal responses, In 50 hands from 50 control subjects and 16 hands from 10 CTS patients, mean values for latencies and amplitudes of the median and ulnar nerve were obtained, and then difference(median-ulnar) and ratio(median/ulnar) were calculated.

The difference of distal latencies(median-ulnar) and distal latency ratio(median/ulnar) to ulnar in control and patients group were statistically significant. The amplitude ratios of median ot ulnar sensory action potentials in control and patients group were 1.23 and 0.80, respectively, and the difference between two groups were statistically significant.

Using discriminant analysis, it is suggested that the sensitive diagnostic methods of CTS are the ratio of median sensory latencies stimulated at palm and wrist. the latency of median sensory nerve stimulated at wrist, the latency of median motor nerve stimulated at wrist and the difference between the distal motor latencies of median and ulnar nerve, in order of sensitivity.

Lidocaine and fentany1 are frequently used as analgesic agents or blockers of pathway. To evaluate the influence of lidocaine and/or fentany1 to nerve conduction, we divided 29 wistar rats(200~300gm) into four groups such as 4% lidocaine(2mg/100g) dripping, mixed solution(4% lidocaine and fentany1) dripping, fentany1(2.5ug/100g) dripping, saline solution dripping. Rats were anesthetized with ether and pentothal sodium(2mg/100g) and their sciatic nerves were surgically exposed and were dripped with experimental solution according to groups. Sensory nerve action potentials(SNAP) were examined according to time sequence such as pre-dripping, post-dripping 2 min., 5 min., 10 min., 20 min., 30 min respectively.

The results were as follows:

1) Significantly prolonged latencies and decreased amplitudes were noted in 2 min., 5 min., 10 min., and 20 min. after dripping of lidocaine as compared to that of pre-dripping, respectively (p>0.05)

2) Significantly prolonged latencies were noted in 2 min., 5 min., 10 min., 20 min., and significantly decreased amplitudes were noted in 5 min., 10 min., after dripping of mixed solution as compared to that of pre-dripping, respectively (p<0.05)

3) There was no significant change between pre-and post-dripping of fentany1 or saline solution, respectively (p>0.05).

So we concluded that lidocaine or mixed solution(lidocaine and fentany1) was effective in blocking of nerve conduction, but synergic effects of fentany1 addition was not observed in nerve conduction study.

The polyneuropathy in patients with chronic obstructive pulmonary disease(COPD) were described several years ago, but are not widely recognized neither well documented. To investigate such polyneuropathy, 41 patients(37 males, 4 females) were included in a prospective study. The incidence, type and distribution of polyneuropathy in the patients with COPD were assessed and also analyzed the causative factor of these results.

The resalts were as follows:

1) In a selected group of 41 patients, electrophysiological signs of polyneuropathy were found in 16 patients depending on diagnostic criteria, and when these divided subgroup, as "definite" group 6 patients, "probable" group 5 patients and "possible" group 5 patients.

2) The patients which were found subclinical polyneuropathy(9 patients, 22%) were more than these that were found clinical polyneuropathy(7 patients, 17%)

3) In the patients with polyneuropathy, lesions were predominant axonal degeneration in motor nerve, and combined with demyelination and axonal degeneration in sensory nerve.

4) In the patients with polyneuropathy, the changes were more involved in leg than arm, more frequently affected sensory fibers, and not only more affected common peroneal nerve in motor nerve conduction study, also sural and ulnar nerve in sensory conduction study.

5) There was a significant correlation between FEV1 and the incidence of polyneuropathy, and then lesions which were thought to be due to hypoxia.

The purpose of this study is to demonstrate clinical usefulness of Minnesota Multiphasic Personality Inventory in evaluating the treatment effect in chronic pain patients.

The subjects of this study were 56 patients with chronic pain ; 28 patients with organic pain and 28 patients with functional pain from January 1, 1993 to September 30, 1993.

The goal of treatment is decrement of pain, restoration of function, maintance of muscle power and endurance, and achievement of vocational activity by multidiscriplinary approach(pharmacological treatment, physical therapy, muscles re-education exercise, acupuncture therapy, psychosocial therapy). The average treatment length was 5.2 months.

We had repeated MMPI one time by the patients with above treatment goals.

The results were as follows:

1) The pretreatment mean hypochondriasis, depression, hysteria scores were 65.2⁑10.9, 60.4⁑12.8 and 59.8⁑10.9, respectivly.

2) The posttreatment mean hypochondriasis, depression, hysteria scores were 50.5⁑9.8, 48.3⁑9.6 and 46.3⁑9.6, respectivly.

3) The hysteria score of women was significantly higher than that of men before treatment.

4) The hypochondriasis, hysteria scores of unlabor group of unlabor group was significantly higher than that of labor group.

The pretreatment MMPI characteristic T-score showed decrement markedly in the patients who had showed clinically improvement.

The MMPI study can be easily tested and is an important tool in evaluating the treatment effect in patients with chronic pain.

We described the clinical features and electromyographic findings of one patient who had central core disease, confirmed by music biopsy. This rate type of congenital myopathy is characterized by the formation of "cores" that consist of abnormal arrangement of myofibrils inside the myofibrils. Clinical features include non-progressive music weakness with delayed attainment of motor milestones. Electromyographic findings showed short-duration, polyphasic, low-amplitude motor unit action potentials and normal nerve conduction studies, compatible with primary myopathy. Gastrocnemius muscle biopsy showed definite central cores in sections with NADH-TR stain. Histochemistry revealed deficient or absent mitochondrial enzymes in the cores. Electron microscopy showed both structured and nonstructured cores.

As well known, the original classic triad of features of Klippel-Feil syndrome are a short neck, a low posterior hairline, and a restricted range of motion of the neck, Certain of these patients are prone to associated abnormalities of the central nervous system as well as central stenosis and stenosis of the intervertebral foramen. It is reporting the risks for neurological damage are due to abnormalities other than the fusion pattern of the cervical vertebrae, commonly, However, the possibility of quadriplegia resulting from a minor injury of the neck in a patient with the Klippel-Feil syndrome accompanied with congenital malformation of vertebral artery in the proximal cervical spines. The purpose of this paper is to report a case of quadriplegia occurring in a patient with the Klippel-Feil syndrome having congenital vertebral artery malformation after only minor neck trauma, and to call attention to this particularly dangerous problem in such patients.

POEMS syndrome is an unusual multisystem disorder associated with polyneuropathy, organomegaly, endocrinopathy, M protein(monoclonal protein) in plasma and skin change, The pathogenesis of this syndrome has not been fully explained.

Since 1938, about two hundred cases have been reported in other countries and there were a few reports of polyneuropathy associated with POEMS syndrome in Korea.

We experienced a case with quadriparesis due to polyneuropathy accompanied by nonspecific hepatosplenomeglay, hypothyroidism, skin change such as hyperpigmentation and plasma cell dyscrasia, Clinical syndrome, signs, electrodiagnostic findings, findings of bone marrow biopsy, and histopathologic findings of lymph node and skin in this rare case were reviewed

A "post-postpoliomyelitis syndrome" is characterized by newly developing muscular weakness and decreasing functional abilities as late complications of paralytic poliomyelitis and the clinical features are quite different form those of other neuromuscular disorders.

We recently experienced a 39 year-old man who considered to have postpoliomyelitis syndrome and report this case in view of the necessity of prompting the disease entity and its management.

The clinical presentation include slowly progressive muscular weakness, decreased function, and previous history of poliomyelitis, The electromyographic findings and the pathologic findings are compatible with those of postpoliomyelitis syndrome, We employed the comprehensive rehabilitative management including modification of his environment and life style.

This report reviewed myelopathy following electrical accident. The clinical manifestations of spinal cord involvement are generally divided into two groups: immediate and delayed. The delayed onset of spinal cord injury can happen at anytime from a few days up to two years. Delayed spinal cord injuries are usually incomplete and include motor and sensory components. It can be progressive and full recovery in uncertain, Possible mechanisms for the spinal cord damage are vascular change and direct damage to cord, We experienced three cases with delayed spinal cord injuries during seven year period form 1986 to 1992. There were 268 cases of electrical accidents among 3802 cases of burn patients admitted to Burn Center at Hangang Sacred Heart Hospital.

Etidronate disodium (Didronel^TM) is a synthetic diphosphonate analog of pyrophosphate, a naturally occuring inhibitor of bone metabolism Accepted indications for etidronate disodium therapy are symptomatic Paget's disease, heterotopic ossification and hypercalcemia of malignancy. Etidronate disodium has been extensively studied in heterotopic ossification The mechansim of action of eirdronate disodium in the prevention of heterotopic ossification is not known, Chemical and in vitro studies show that the drug adsorbs to hydroxyapatite crystals, thereby inhibiting their growth and dissolution. But clinical research has not irrefutably proved of disproved the effectiveness of etidronate disodium in prevention on clinical heterotopic ossification

The paper presents two cases of heterotopic bone formation following neurologic insult. A 36-years-old male sustained traumatic brain injury secondary to a traffic accident. Three months post injury, a physical examination revealed limitation of range of motion of Rt elbow joint. The serum alkaline phosphatase was 335 IU/L. Roentgenograms were unremarkable. A bone scan revealed increased uptakes in the region of the Rt elbow and shoulder. Another patient C8 quadriplegic developed limitation of range of motion of Lt hip joint. Etidronate disodium was used in a clinical trial to prevention of heterotopic ossification. Roentgenograms of the joins involved revealed formation of heterotopic bone after the drug was administered for 12 weeks. Further prospective studies will be planned

Phantom sensation and pain are frequently noted problems in patient with loss of extremity due to amputation or any other causes, It can be defined as a remnant sense of losing limb and malpositioned or abnormal sensation with painful episodes. Phantom have some characteristic; 1) pain may persist indefinitely, 2) trigger zone may spread to healthy part of the body and 3) pain may be abolished by either decreasing or increasing the sensory input. The unknown pathophysiology and aetiology of phantom pain and related disorders preclude the possibility of giving unambigous directives for pain treatment in amputees. Authors experienced tow patients with phantom limb pain after amputation, And the were diagnosed as myofascial pain syndrome and successfully managed . So it is recommended to suspect myofascial pain syndrome in patient with phantom pain and its recongnition can greatly aid in patient care.

The great auricular nerve injuries after the rhytidectomy, parotidectomy, mastoidectomy or in inserting the central venous line were previously reported. But great auricular nerve injury after the ventriculoperitoneal shunt operation was rarely reported. We reported one case of great auricular nerve injury after the ventriculoperitoneal shunt in traumatic brain injured patient. A 32 year-old man sufferred from pain on right earlobe following a ventriculoperitoneal shunt operation for obstructive hydrocephalus 4 months before visiting our service. Shock-like paresthesia could be triggered by touching or palpating the distribution of the right great auricular nerve, Nerve conduction study using averaging 30 responses revealed decreasing amplitude(peak to peak) of right great auricular nerve to 12㎶ and slowing latency to 2.8msec compared to 25㎶ and 2.0msec relation on the left side.

The great auricular nerve injury could be frequently occurred because of its anatomical pathway of mid-point of sternocleidomastoid music belly superficially crossing the course of ventriculoperitoneal shunt line. The great auricular nerve conduction study was helpful to identify the involvement in this case. Physicians need to be aware of the risk of injury of great auricular nerve after the ventriculoperitoneal shunt operation.