Stroke(CVA), the most common disorder of the central nervous system(CNS), exhibits various clinical symptoms according to the location and the size of the lesion. The major manifestations include muscle weakness of the affected side(hemiparesis), sensory dysfunction, and speech impairment. Among them, hemiparesis is the most debilitating component of stroke for many patients, which results in serious limitations to successful carrying on independent activities of daily living(ADL) and social living. One potentially critical area of stroke research, the abnormality of the energy metabolism in the hemiparetic muscle secondary to stroke, has been largely neglected.

Thus, the object of this investigation was to measure and observe the metabolic changes of the hemiparetic limb muscle in stroke patients using 31P magnetic resonance spectroscopy. Spectrum data were obtained from the flexor digitorum superficialis muscles of both, affected and unaffected, sides and analyzed statistically. For this study, 16 male stroke patients were selected as test subjects.

The results showed that the intracellar Pi/PCr ratio was 0.18±0.01 on the affected side compared to 0.14±0.01 on the unaffected side, resulting in a statistically significant increase(p<0.05). Intracellular pH level(7.00±01) was found to be significantly higher(p<0.05) on the affected side compared to the unaffected side(6.98±0.01). Although the hemiparetic conditions of the affected muscles, such as muscle atrophy and motor recovery were not reflected by the intracell-ular Pi/PCr ratio or the pH level, it was evident that the longer duration of the stroke in patients corresponded to a significant increase(p<0.05) of the Pi/PCr ratio. Also, signal density of phosphodiester was detected in the affected side in 8 out of the 16 tested patients.

From these results, the author was able to confirm the decreases in energy storage capacity(due to reduced mitochondria activity) of the cell and the possibility of an injured cell membrane in a hemiparetic muscle cell found in stroke patients.

The motor unit action potentials(MUAP) of the needle EMG are analyzed morphologically in time domain generally. The limitations of the morphological analysis of the MUAP make the electromyographer to hesitate making the diagnosis in clinic, because of its complexity. We introduced the power spectrum to the analysis of the MUAP in this study, and its clinical values were evaluated.

42 Sprang-Dawley rats were grouped according to the duration of the nerve injury(normal, n=10; post-operative 3rd week, n=10; post-operative 4th week, n=11; post-operative 8th week, n=11). Crushing nerve injury was applied to the left sciatic nerve between the sciatic notch and the knee. Sciatic motor nerve conduction study, turn/amplitude analysis, and power spectral analysis of the MUAP in the M. Tibialis anterior were evaluated on both sides in all groups.

Results were as followings.

1) The amplitudes of the sciatic motor nerve conduction got to the normal range at 8th week after the nerve injury.

2) The turn/amplitude analysis had no statistical significance to differentiate the MUAP of the unaffected from the affected muscles at the 8th week after the nerve injury in this study(P>0.1).

3) The power spectral analysis had no ability to discriminate the MUAP among the affected and the unaffected muscles at the 8th week after the nerve injury in terms of the total power and the frequency range(P>0.1). But the changes in the ratio of the power in each range (high to total, middle to total, low to total) were significant to differentiate the nerve-injured from the control rat. Increment of the ratio of the middle(151~300Hz) and low(51~300) frequency power was noticed in both of the affected and unaffected muscles in the nerve-injured rats(P<0.05).

4) In terms of the MUAP according to the interference and amplitudes, the proportional ratios of the power spectrum were different between the affected and the unaffected muscles of the nerve-injured rat at 8th week after the crushing.

In conclusion, the power spectral analysis of the MUAP could contribute to improve the range of diagnosis of the MUAP abnormality.

The relationship between myoelectric signal and force was investigated. 16 healthy male volunteers performed isometric contraction of elbow flexor and extensor at 90 angle from the horizontal plane. The contracting force was measured at 20% maximal voluntary contraction(MVC), 40%MVC, 60%MVC, 80%MVC and 100%MVC. The myoelectric signal was detected from elbow flexor and extensor using monopolar surface electrodes at each force level. The recorded myoelectric amplitude, turns/mean amplitude, root mean square voltage and power. The relationship between contraction force and myoelectric signal parameters was analysed.

1) The frequency sensitive parameters, zero crossings and turns were increased abruptly with force form 0 to 20%MVC and increased gradually with force from 20 to 60%MVC, but decreased slightly with force from 60 to 100%MVC.

2) The amplitude sensitive parameters, mean amplitude and root mean square voltage were increased linearly with force from 0 to 100%MVC, and power value was increased curvilinearly with force from 0 to 100%MVC.

On the basis of this study, mean amplitude and root mean square voltage were superior to other parameters when used as descripters of contracting force in elbow flexor and extensor, and can be used as an indirect parameter of measuring force in the future.

The F wave has been thought to be useful for diagnosis of proximal neuropathy such as radiculopathy. But its diagnostic sensitivity is not satisfactory so far, and many techniques were designed to improve the sensitivity. Among these, electronic averaging of F waves were introduced as a simple and useful methods that allow one to quickly summate a large number of F waves, yielding a stable and easily reproducible waveform of shortest latency. We studied the significance of F wave in the diagnosis of lumbosacral radiculo-pathy using both conventional and averaging techniques, and compared their sensitivity. 88 patients were studied who had been diagnosed as lumbosacral radiculopathy by clinical, radiological, and electromyographic findings. The results showed that both conventional and averaging F wave study are not sensitive techniques in the diagnosis of lumbosacral radiculopathy.

This study was planned to evaluate the Magnetic Resonance Imaging(MRI) findings in assessment of the CP patients with periventricular leukomalacia(PVL) on brain MRI and to analyze the neurodevelopmental outcome in those patients in comparison with the extent of PVL on brain MRI findings.

Brain MRI study was performed in 50 children with CP evaluated at Department of Rehabilitation Medicine, St. Mary's Hospital, Catholic University Medical College, between March 1991 and July 1994.

Of the 50 children, 20 children showed PVL on brain MRI.

Besides brain MRI, evaluation consisted of patients; ① medical, developmental, family and pregnancy histories, ② physical examination including assessment of spontaneous motility from the standardized tests by Vojta and Bobath, primitive reflexes and Vojta's Postural Reactions, ③ developmental assessment (MFED: Münchener Functionelle Entwichlungs Diagnostik).

Motor age and motor quotient(M.Q.) was estimated from the standardized test by Vojta and Bobath. Developmental quotient(D.Q.) was also estimated from MFED in perceptual, speech, social and selfhelp areas. And the mean of D.Q. in above 4 areas was also estimated.

To analyze the brain MRI findings of PVL, abnormalities on the MRI were divided into 4 categories: ① distribution of highsignalintensity areas on T2 images within the cerebral white matter, ② degree of ventriculomegaly, ③ degree of brain atrophy, ④ extent of myelination.

From the distribution of high-signal-intensity areas on T2 images within the cerebral white matter, localized or extensive PVL was defined. Localized PVL refers to lesions involving 1 lobe or 2 lobes and extensive PVL refers to lesions involving 3 lobes.

Range and mean±standard deviation(S.D.) of M.Q. and D.Q. were obtained in localized and extensive PVL lesions.

The results were as follows:

1) The number of the distribution of high-signal intensity areas on T2 images within the cerebral white matter was 19 cases(46.3%) in occipital lobe, 10 cases(24.4%) in frontal lobe, 8 cases(19.5%) in parietal lobe, 4 cases(9.8%) in temporal lobe.

2) The number of the cases was 11 cases(55%) in localized PVL lesion, and 9 cases(45%) in extensive PVL lesion.

3) The number of the cases was 9 cases(45%) in no dilatation of ventricle, 11 cases(55%) in mild to moderate dilatation of ventricle.

4) The number of the cases was 7 cases(35%) in no brain atrophy, 9 cases(45%) in mild brain atrophy, 3 cases(15%) in moderate brain atrophy, 1 cases(5%) in severe brain atrophy.

5) The number of the cases was 12 cases(60%) in no delay in myelination, and 8 cases(40%) in delayed myelination.

6) Range and mean±S.D. of M.Q. were 11 80(43.2±21.1) in localized PVL and 10~67(35.5±16.0) in extensive PVL.

7) Range and mean±S.D. of the mean of D.Q. in perceptual, speech and social areas by MFED for 1-year-old children were 59~87(78.1±11.0) in localized PVL and 30~93(60.5±25.7) in extensive PVL. Range and mean±S.D. of the mean of D.Q. in perceptual, speech, social and self-help areas by MFED for 2-year-old children were 76~102(83±9.5) in localized PVL and 65~87(77.4±11.6) in extensive PVL.

In summary, the data obtained in this study would be helpful for estimating neurodevelopmental prognosis of the CP patients with PVL on brain MRI.

Since F responses involve conduction in motor fibers to and from the spinal cord as well as discharge of anterior horn cells, F waves are dependent on the state of both the peripheral and central nervous system. The ratios of F to M amplitudes, determined by dividing the mean amplitude of 20 F waves by the amplitude of maximum evoked compound muscle action potential recording from the abductor pollicis brevis and abductor hallucis, were compared from age matched control subjects and patients with polyneuropathies or spastic hyperreflexia.

Compared with controls, F/M ratios were increased at statistically significant levels in all patients with either peripheral or central lesions.

Even if the mechanisms differ, the results indicate a similar physiological response in situations where muscle tension might be abnormal whether the injury is peripheral or central.

The electromyographic interference pattern, usually assessed by its appearance on a screen and its sound on a speaker, is known to be a difficult tool to make an accurate and objective assessment of the interference pattern. To overcome this problem, several methods to quantify the interference pattern such as mean ratio, peak ratio and Nandedkar's cloud method have been developed. So, we used all three of these interference pattern analysis methods simultaneously in 46 normal subjects, 12 neuropathies and 8 myopathies, to investigate which of these methods represent the characteristics of the motor unit action potential(MUAP) in neuropathy and myopathy most accurately. The interference pattern were measured at the biceps brachii muscle with concentric needle electrode while the subject contracted the muscle at various degree, and the turn, mean amplitude, complexity, upper centile amplitude and activity were analyzed. The results were as follows;

1) All 12 patients with neuropathy(100%) and 6 out of 8 patients with myopathy(75%) had mean ratio above and below the control group range.

2) 11 out of 12 patients with neuropathy(91.7%) and 7 out of 8 patients with myopathy(87.5%) had peak ratio below and above the control group range.

3) All 12 neuropathy(100%) and all 8 myopathy(100%) patients showed abnormal findings in the cloud method.

4) These three analysis methods were very useful in chidren who could not cooperate in the conventional subjective electromyography.

On the basis of this study, mean ratio and peak ratio methods were found to be a relatively sensitive tools in the evaluation of neuropathic or myopathic disease activity and that they could be done with ease. The Nandedkar's cloud method was most sensitive and represented the characteristics of the MUAP of neuropathy and myopathy most accurately and objectively. Further studies are recommended for the evaluation of monitoring the various neuropathic and myopathic disease activity and its progression.

The Modified Barthel Index(MBI), a weighted scale for measuring basic ADL(Activities of daily living), and the Functional Independence Measure(FIM), a singlescore instrument used to measure independent functioning in six areas of basic selfcare skills, were used to evaluate 36 patients following CVA.

Patients on rehabilitation therapy in the department of rehabilitation, KyungHee medical center were assessed with MBI and FIM at start for the rehabilitation therapy(RS) and on discharge(DC) respectively.

1)MBI and FIM scores averaged 46.9, 73.3 at RS and 76.9, 106.4 on DC respectively.

2)The item with the highest score among subscales of FIM at RS was `SPHINCTER CONTROL', and the lowest one `STAIRS CLIMBING'. On discharge, the highest scale was `SPHINCTER CONTROL', and the lowest one `STAIRS' and `BATHING'.

3)On assessment at every 2 weeks, the increment of FIM scores was the largest in a first two weeks.

4)On Chi-square test between MBI and FIM%, Chisquare values are 336.12 and 260.12, and Pearson's R scores were 0.92 and 0.83 at RS and on DC respectively. Therefore there was a very high correlation between MBI and FIM.

5)On regression analysis of the factors predicting the prognosis of CVA, in order, FIM scores at RS, the cognitive scores of FIM at RS, the motor scores on FIM at RS, the duration between onset and RS, and MBI score at RS were found significant statistically. But the variables such as site of lesion, type of paresis, cormodity, sex, and type of CVA were of no significance.

In conclusion, FIM was found to be the useful scale to assess the disability of patients at present, to evaluate outcomes of the rehabilitation therapy, and to predict the prognosis of a patient of CVA.

We studied the correlation between the neck muscle strength and the degree of pain in 31 women with chronic neck pain and 25 healthy women. The neck isometric flexor and extensor muscle strength were measured using FARO Axis muscle tester and Pain Disability Index(PDI) was scored in the chronic neck pain patients at the beginning and at the end of the 4-week rehabilitation training including neck isometric exercise(NIE), electrical theraphy, heat therapy and traction. At the beginning of training, there was significant decrement of the neck muscle strength in the patient group compared with the control group and the PDI was correlated with the neck muscle strength significantly. After the 4-week training, significant increment of the neck muscle strength and decrement of the PDI were noticed. there were significant correlations between the increment of neck muscle strength and the reduction of PDI. This study was concluded that neck muscle strength measurement is useful in diagnosis and follow up of the chronic neck pain patients and neck isometric exercise is effective in strengthening of neck muscle and pain reduction.

Peak pressure, force-time integral and relative impulse of feet were measured from 14 young normal adults by a F-scan system.

The measurements were recorded from the subjects while walking on their comfortable speed with soft shoes and ordinary shoes respectively(2cm heel for men and 4cm heel for women). The mean peak pressure measurements of middle forefoot are a were higher than of hallux area and of medial forefoot area while pushing off. The force tended to deviate on heel area while walking. The weight shifting from calcaneal area and lateral forefoot area to medial forefoot area was prominent with the high heel shoes than with the soft shoes.

In diabetic neuropathy, assessment of distal autonomic nerve function is important for the dysfunction of peripheral unmyelinated fibers acts as a factor for development of diabetic foot ulcer and Charcot joints. The sympathetic skin response is known to be an useful electrophysiologic technique to evaluate autonomic funtion in diabetic autonomic neuropathy, but little has been known about the site of excitation and the useful parameters for diagnosis. Our purpose is to find out the proper stimulation site and appropriate electrodiagnostic parameters and diagnostic criteria.

36 patients with history of diabetes mellitus and 16 age and sex matching normal subjects were included and the results of sympathetic skin response were compared. Of the various parameters, onset latency was proven to be the most useful parameters and the proper stimulation site was Median nerve at wrist. There was no correlation between the results of sympathetic skin response and the level of fasting blood glucose, duration of disease, HbA1C, method of treatment or systemic complications. Also there was no correlation between the results of sympathetic skin response and the results of sensory nerve conduction studies.

Our conclusion was that

1) The proper site of stimulation is Median nerve at wrist.

2) The most useful parameter is onset latency.

3) The diagnostic criteria of sympathetic skin response is 1.64sec at ipsilateral palm, 1.57sec at contralateral palm, 2.18sec at ipsilateral sole, 2.17sec at contralateral sole.

Knee joint is one of the important determinants that determine gait pattern. There are few studies on the normal and pathologic gait pattern using 3-dimentional motion analyzer in Korea. The authors measured the extent of gait deviation of 20 anterior cruciate ligament injured patients compared to 20 normal men through the kinematic analysis.

The stride length was shortened 100.2cm in the patient group compared to 128.3cm in the normal group. After the application of Donjoy knee brace the stride length of the patient group was increased.

The gait speed was decreased significantly in the patient group. The motion angle of maximal knee flexion in the swing phase was greately decreased in the patient group and that of minimal knee flexion in the stance phase was decreased in the patient group. There is no statistical difference between the patient group and the normal group in measurements of the ankle motion angle throughout the gait cycle. The angular velocity of the knee and ankle joint was significantly slow in the patient group but that of hip was fast in the patient group compared to normal group.

We concluded that pathologic gait pattern in the anterior cruciate ligament injured patients is influenced by insufficient knee flexibility, restriction of range of motion and pain. Therefore early rehabilitative program to correct pathologic gait pattern after reconstruction surgery of the anterior cruciate ligament injured patients is highly recommended.

For evaluating the significance of intraoperative electrophysiologic monitoring and observing the change of clinical and electrophysiologic results after Microvascular Decompression(MVD), we did follow-up 227 cases with hemifacial spasm, who had been operated at Bong Seng Memorial Hospital and Dong Rae Bong Seng Hospital, for more than 2 months. For comparing, we divided patients into Monitoring group(n=134) and Non-monitoring group(n=93). The success rate of MVD was 89.5% at POD 7 and 92.3% at follow-up, respectvely, and there was no statistical difference between Monitoring and Nonmonitoring group. But the distribution of offenders was only statistically different from each other. During follow-up, the clinical results changed at 59 cases of 142(41.5%), and hemifacial spasm in 32 cases gradually disappeared. In the 57 cases, which were able to test follow-up electrophysiologic study, 73.7% electrophysiologically changed, and the ratio of completely disappeared Abnormal Muscle Response was statistically increased from 35.1% at POD 7 to 70.2% at follow-up study. In the 85 cases, which were able to followup at Monitoring group, the results of electrophysiologic study at POD 7 were statistically correlated with clinical results at follow-up.

According to the above results, electrophysiologic study is helpful for identifying the offenders and determining the adequacy of vascular decompression, clinical and electrophysiologic status of hemifacial spasm after MVD has continuously changed, and the results of electrophysiologic study at POD 7 are useful for predicting the clinical results at follow-up.

The demand for objective and quantitative assessment of muscle power which can replaces the manual muscle test is increasing. The purpose of this study is to determine the usefulness of total spectral power(P_EMG) of individual muscle as one of the objective spectral parameters, in quantitification of muscle power. From 17 normal male without neuromuscular dysfunction, motor unit action potentials(MUAPs) of flexor muscle group of the thumb of the dominant hand were obtained. The surface electrode was used in 11 subjects and the needle electrode was in 6 subjects. The changes of P_EMG and spectral power according to frequency components were calculated during increasing force of isometric muscle contraction by power spectral analysis of MUAPs signal. The following results were obtained.

1) There was a linear relationship between P_EMG and isometric ramp muscle contraction with surface(F-ratio=363.8, P<0.01) and with needle(F-ratio=12.83, P< 0.01) electrodes. And also a quadratic relationship was noted with surface(F-ratio=6.62, P<0.05) electrode.

2) There was a linear relationship between 20-80 Hz frequency spectral power and isometric muscle contraction with surface(F-ratio=196.9, P<0.01) and with needle(F-ratio=13.42, P<0.01) electrodes. And also a quadratic relationship was noted with surface(F-ratio=5.20, P<0.05) electrode.

3) There was a linear relationship between 81-200 Hz frequency spectral power and isometric muscle contraction with surface(F-ratio=148.43, P<0.01) and with needle(F-ratio=10.55, P<0.01) electrodes.

4) There was no significant correlation between pinch power in MVC(maximal voluntary contraction) and total spectral power in 87.5-100% of MVC with surface(r=-0.215) and needle(r=0.384) electrodes. Above results suggest that the P_EMG, especially when measured with surface electrode, will be useful in quantitification of muscle power.

The purpose of this study was to investigate the influence of tension, contraction time, and joint angle on the cardiovascular responses of isometric exercise.

Twenty-six normotensive male subjects performed isometric contractions of knee extensors at 60%, 80%, 100% maximal voluntary contraction(MVC) for 10 seconds, 80% MVC at three knee joint positions(30°, 45°, 90°) for 10 seconds and 80% MVC for 10 seconds and 20 seconds. Peak torques were measured for each contraction. In addition, blood pressure and heart rate were recorded simultaneously at rest and immediately following each contraction.

The mean isometric peak torques of young age group were significantly higher than those of old age group at all examined joint angles(p<0.05). Blood pressure and heart rate rise were proportional to the percentage of MVC rather than to the absolute amount of force produced, but blood pressure and heart rate of the group exercising at 100% of MVC were not significantly higher than those of the group exercising at 80% of MVC(p>0.05).

Blood pressure and heart rate of the group exercising at 20 seconds were significantly higher than those exercising at 10 seconds(p<0.05).

It was concluded that the blood pressure and heart rate changes to isometric exercise were influenced by the percentage of MVC and contraction time, but not by the joint angle.

An investigation was designed to assess and compare the effects of therapeutic forms of heat and cold on the pain threshold in the normal adults. The volunteers of this study were 34 healthy adults. We used hot-packs for heat and criojet air c 100E(medizintechnik GMBH, Germany) for cold. The pain threshold was quantatively measured by means of an electrical stimulation and distance of two-point discrimination by compass according to skin temperature. And then we assessed their relation to BMI(body mass index).

The results were as follows:

1) heat and cold were both found to raise the normal pain threshold and distance of two-point discrimination significantly and cryotherapy was significantly more effective than heat.

2) In higher BMI, the distance of two-point discrimination was significantly increased at each skin temperature.

Myotonic dystrophy is a neuromuscular disorder characterized by muscle weakness and myotonia. Myotonia manifest as abnormally slow relaxation after strong voluntary contraction. So patients with myotonic dystrophy are difficult to perform activities of daily living. The purpose of this study was to assess the degree of muscle weakness and myotonia in 10 patients with myotonic dystrophy, and to determine the effect of a four-week therapeutic trial of quinine sulfate quantitatively. The patients didn't recieved any rehabilitative treatment including muscle strengthening exercise during medication. Muscle strength was quantified by comparing threesecond maximum voluntary contraction of 10 patients with that of 20 healthy subjects. First dorsal interosseous, elbow flexor, and knee extensor were compared. Myotonia was quantified by measuring relaxation times at the end of three-second maximum voluntary contraction produced by First dorsal interosseous, elbow flexor, and knee extensor as the time taken from the maximum voluntary contraction to decrease by 100%. The change of amplitude of the evoked muscle action potentials between before and after ten-second maximum voluntary contraction were assessed from the first dorsal interosseous and abductor digit quinti muscles. The results were as follows:(1) The mean muscle strength of each of the three muscles of the patients was significantly reduced compared with healthy subjects; and (2) Relaxation times of the three muscles of the patients were significantly prolonged compared with healthy subjects. Seven of the ten patients participated in a therapeutic trial of quinine sulfate. Therapeutic effects were also assessed by measuring muscle strength, and relaxation time. Relaxation times were reduced significantly in all three muscles after medicaton with quinine sulfate. However, there were no significant improvement of muscle strength of all the three muscles. We concluded that quinine sulfate may provide therapeutic benifit to myotonia but not muscle weakness. So for improvement of muscle strength, comprehensive rehabilitative treatment based on muscle strengthening exercise should be combined.

To evaluate the effects of decreased physical activities on serum lipids, we measured serum lipids level in 25 patients with cervical cord injured and 17 normal controls.

The patients with cervical cord injured were divided into 2 groups, SCI athletes and SCI non-athletes, and the serum levels of concentration of lipoproteins were observed and compared with these groups each other. The results were as follows:

1) The serum HDL-cholestrol levels of nonathletes group were significantly lower than those of SCI athlete group, and those of athletes group were significantly lower than those of normal controls.

2) The serum total cholestrol, LDL-cholesterol, and triglyceride levels of SCI athletes group showed no significant differences, compared with those of normal control and SCI athlete group.

3) The ratios of total cholesterol to HDL-cholesterol, commonly used ratio for the risk of coronary heart disease, were highest in non-athletes group.

Therefore, we conclude that serum lipid levels of cervical cord injured are influenced by decreased physical activities primarily, and the serum HDL-cholesterol level can be affected by physical activities positively.

A group of 47 out-patients with low back pain who examined especially pain at lateral bending, flexion, extension of low back and showed radiologic degenerative change of facet joints were randomised to receive one of four types of injection treatment Group A: Triamcinolone and lidocaine, 20 patients; Group B: Triamcinolone only, 10 patients; Group C: Physiologic saline, 7 patients; Group D: Lidocaine only, 10 patients- into both facet joints of L4-5 and L5-S1.

The effect of therapeutic drug for facet block was evaluated each group of drugs change of physical datas, characteristics of radiologic findings and activities of daily living, age and sex with physical accessment and visual analogue scale.

A significant improvement of pain relief was observed in group A and B at one hour after facet injection, and group A, B and D at one week after. Also patients with severe degenerative change of facet joints were significantly improvement of pain relief after treatment. Although female and older improved subjective pain scales compared with male and younger but there were no important difference between the groups with respect to change of physical accessments, sex and age.

We concluded the degree of degenerative change of facet joint is a one of important diagnostic values, and the physical accessments itself are non-specificity for follow up of improvement of facet syndrome.

The purpose of this study was to determine the incidence of deep vein thrombosis in stroke patients and to identify factors that alter its risk.

Among 5,703 cases of stroke, eight cases(0.14%) were diagnosed as deep vein thrombosis. The sites of deep vein thrombosis were superficial femoral veins(4 cases) and common femoral veins(4 cases). Deep vein thrombosis developed on the paretic leg alone and all patients were able to walk independently. There was no significant risk factors in these patients.

The results of this study showed that very low incidence of deep vein thrombosis in stroke patients compared with that of the other studies. The risk of deep vein thrombosis was high in paretic leg of bedridden patients.

If a patient has a trigger point at shoulder or upper back area, his function of shoulder is influenced by that. We may assess the severity of myofascial pain syndrome or the effect of treatment by shoulder function test.

The purpose of this study was to compare shoulder function test between persons with and without trigger point and to assess the correlation of shoulder function test with the duration of disease or the number of affected muscles.

We examined 40 myofascial pain syndrome patients and 27 normal control subjects and concluded the following,

1) The patients with trigger point revealed significantly lower score in shoulder function test than the one without trigger point.

2) All the items in shoulder function test except position and power are affected in myofascial pain syndrome.

3) There is no correlation between shoulder function test with duration of myofascial pain syndrome.

4) There is a tendency the increasing number of trigger points are the lower score of shoulder function test, but not significant.

Discriminant analysis is a useful analytic method in maximal seperation of group means, finding more meaningful factors on group discrimination and group seperation by discriminant function. This analysis can be applied to multiple electrodiagnostic parameters fordiabetic and nondiabetic subjects to reveal the essential dimension along which key neuropathic differences occur between these groups.

In this study electrodiagnostic data of 121 diabetics and 30 controls was obtained and 25 electrodiagnostic parameters including distal latency, amplitude, velocity, F-wave minimal latency and H-latency were used in a stepwise discriminant analysis. At first, discriminant analysis between control and diabetic group was used to reveal a few meaningful parameters and produce a discriminant function seperating two groups. And then, discriminant analysis between control and non-neuropathic diabetic(I) group was performed to find parameters reflecting early change of polyneuropathy.

The discriminant analysis between controls and diabetics revealed 6 meaningful parameters( eigen value=0.5559, p=0.00) and analysis between control and non-neuropathic diabetic group(I) reveals 9 parameters(eigen value=0.7196, p=0.0003). The H-latency was the most significant parameter. H-latency, median motor conduction velocity and ulnar F-latency are reproducible parameters in two analyses. The sensitivity and specificity of the discriminant function seperating the control and the diabetic group were 78.5% and 96.7%, respectively, and between the control and the non-neuropathic diabetic group(I) were 82.5% and 76.7%, respectively. Though the statistical complexity is recognized, we belive discriminant analysis is useful in the detection of diabetic neuropathy and is needed for classification of many diabetics into neuropathic and non-neuropathic categories with a few electrophysiological parameters.

The isokinetic machine generally allows a relatively safe application of maximal loading to a specific muscle group as well as an accurate and objective evaluation of muscle strength and endurance. However, still there is not enough scientific background in establishing the optimal number of repetitions of each set, optimal number of sets per day, and frequency and rest interval between each set of exercises for most effective isokinetic training. The purpose of this study is to determine the optimal number of repetitions for ideal isokinetic training to improve muscle strength.

Twenty three male volunteers were randomly assigned to three training groups. All groups were trained for isokinetic knee flexors and extensors using the Cybex 340 isokinetic dynamometer three times a week for 6 weeks at 1800/sec. 5 repetitions for group 1, 10 repetitions for group 2 and 15 repetitions for group 3 were used for training and all subjects were tested before and after training at 60, 120, 180, 240, 3000/sec for peak torque improvement of quadriceps.

All three groups showed improvements in peak torque after training. However, 10 and 15 repetition groups showed higher incremental ratio of peak torque than the 5 repetition group. The incremental ratio between 10 and 15 repetition groups was not significant. It was concluded that isokinetic training is repetition-specific in peak torque improvement and 10 repetition is the optimal number of repetitions for isokinetic training according to this study.

The aims of this study were to identify the critical value of relaxation index of pendulum test according to the Modified Ashworth Scale and to create new measurement scale for evaluation of spasticity using pendulum test in the 127 hemiplegic patients with varing degrees of spasticity.

The results were :

1) Modified Ashworth Scale was reversely correlated with the relaxation indices of the isokinetic dynamometer pendulum test and the electrogoniometric ones, but correlation coefficients were not so high.

2) The relaxation indices of the pendulum test were not significantly different among the Brunnstrom stages.

3) The relaxation indices of the isokinetic dynamometer pendulum test were gene rally higher than those of the electrogoniometric ones according to Modified Ashworth Scale and Brunnstrom Stage, but statistically not significant.

4) When Modified Ashworth Scale was grade 1, the distribution of relaxation indices was mostly distributed above 1.0. But we could not identify the ranges of the relaxation indices when Modified Ashworth Scale was 2 and 3 because the distribution of those relaxation indices was greatly wide.

5) Concordance rates of relaxation indices and Modified Ashworth Scale in 17 follow up patients were also so low (24%).

In the above study, when Modified Ashworth Scale was grade 1, the distribution of relaxation indices was mostly distributed above 1.0, but we could not identify the ranges of the relaxation indices when Modified Ashworth Scale was 2 and 3 because the distribution of those relaxation indices was greatly wide. Also we could not create new measurement scale for evaluation of spasticity using pendulum test.

So, when measuring spasticity using pendulum test - especially Modified Ashworth Scale is high grade (ie, 2 or 3) - we would better be cautious about other patient's clinical status (synergic pattern, etc), but further study for contributing factors to pendulum test was also needed.

Access to the pudendal nerve is exceedingly limited and measurement of its conduction velocity has proved difficult. Work at St. Mark's Hospital, London, resulted in the development of an easier method for measuring the distal motor latency in the pudendal nerve. The purpose of this study is to help diagnosis of fecal or urinary incontinence with pudendal nerve injury. We stimulated rectal mucosa using St. Mark's pudendal electrode and recording from external anal sphincter, and we got the distal latency of pudendal nerve, 2.03 ms. The mean latencies of responses from anal sphincter are 2.05 ms in men, 2.01 ms in women and 2.04 ms on the right, 2.03 ms on the left. There is no difference of latencies between the men and women, right and left. We got the greately prolonged distal latency of patients with fecal incontinence, 3.53ms.

The purpose of this study was to evaluate functional outcomes for cauda equina injured patients who participated in rehabilitation program. The subjects were twenty cases of cauda equina injured patients who were diagnosed by neurological examinations and electrodiagnostic studies.

We evaluated functional outcomes of voiding status, motor index score(MIS), use of orthosis and ambulation status.

The results were as follows;

1) Indwelling catheterization at admission and Valsalva & Percussion/Crede maneuver at discharge were the most common method for voiding.

2) There was statistically significant difference in the MIS of both hip flexors and knee extensors between admission and discharge.

3) At discharge, there were three Hip-Knee-Ankle-Foot Orthosis(HKAFO), four bilateral Knee-Ankle-Foot Orthosis(KAFO), one unilateral KAFO and three no bracing in T10-L1 injury(11 cases).

4) At discharge, there were three bilateral Ankle-Foot Orthosis(AFO) and six no bracing in L2-S1 injury(9 cases).

5) At admission, there were one standing only and ten non-ambulators, and at discharge, there were three standing only, five therapeutic ambulator, seven indoor/functional ambulators and one non-ambulator, and at discharge, there were seven community ambulators, one therapeutic ambulator and one indoor/functional ambulator in L2-S1 injury.

Urinary tract infection(UTI) is one of the most common complications in the patients who have neurogenic bladder, and if proper management were not given, there could be serious complication, such as vesicoureteral reflux, hydronephrosis, urinary stone, and renal failure. An early and appropriate antibiotic treatment is crucial to avoid these cmplications, and the guidelines of antibiotic choice depend on the type of causative microorganisms and results of sensitivity test to various antibiotics. But the incidence of causative microorganism of UTI and their antibiotic sensitivity may change over time. So I retrospectively analysed the change of causative microorganism and antibiotic sensitivity pattern during 5 years(1990-1994 year). The results are as followed:

1) The incidence of Gram(-) rods was gradually decreased, and Gram(+) cocci increased.

2) Pseudomonas aeruginosa and Escherichia coli were still one of the most common causative microorganisms but their incidence was decreased, and the incidence of Enterococcus, Staphylococcus increased.

3) Antibiotic sensitivity of causative microorganism had not changed statistically over 5 years.

The overall compositions and yearly trend of contents of 559 articles in the Journals of Korean Academy of Rehabilitation Medicine(KARM) for calender years 1977 through 1993 was to studied to develop a baseline for demonstraitng academic productivity from the Journal of Korean Academy of Rehabilitation Medicine and was compared with those of Archives of Physical Medicine and Rehabilitation(Arch Phys Med Rehabil).

Digital Infrared Thermal Imaging(DITI) is a study measuring the surface temperature of the skin which could be controlled by the vasomotor activity of the sympathetic nervous system. DITI is useful in diagnosis of many disease entities, such as the peripheral neuropathy, the cardiovascular diseases, the musculoskeletal diseases, and so on. This study aims to identify the distribution of the absolute skin temperature in normal healthy subjects by repeating DITI four times. DITI was taken on 25 normal healthy males who do not have any neuromuscular or cardiovascular diseases. The distribution of the absolute temperature of the skin surface was between 29.5°C and 31.9°C. The Rt-to-Lt side difference of the surface temperature was 0.1±0.1°C on the whole areas of the skin surface, except lateral sole and heel of which difference of interside temperature were 0.2±0.1°C and 0.2±0.2°C, respectively.

The maximal difference of the skin temperature in same individual was maximal at dorsal elbow(1.7±1.2°C) and minimal at dorsal hand(1.1±0.3°C) in upper extremity, and maximal at heel(1.8±0.5°C) and minimal at dorsal foot(1.4±0.9°C) in lower extremity. The Rt-to-Lt side difference in this study may become a control data to be used in the further studies using DITI.