Impairments resulting from ever increasing head injuries are affecting the injured individuals greatly with significant physical and functional limitations in their activities of daily living. Not only physical deficits but also psychological and cognitive deficits are affecting their functional independence as an individual.

It is widely known that there are significantly more young aged patients who suffer from head injuries than the aged, and there are more males involved than females in head injury cases. About 50 % of all head injuries occur in the age group of 15 to 34 years according to a report.

Many of the head injured patients will demonstrate cognitive impairments, greater or lesser degree.

Modern, advanced medical technologies made it possible to detect easily the extent and location of the lesions and also made useful in predicting the outcome. GCS(Glasgow Coma Scale) and PTA(Postraumatic Amnesia), VIQ(verbal IQ), PIQ(performance IQ) are also being utilized in predicting the outcome. However one needs to consider cognitive therapy as a possible therapeutic tool for the head injured patients beside the behavioral modification, psychological for neuropharmacologic remedies.

Although there have been many studies on regeneration of the articular cartilage, mechanism of regeneration has not been clarified. Some studies showed that maturity was one of the factors of successful articular cartilage regeneration.

In this study, articular cartilages in immature and mature rats were injured by the intra-articular H₂O₂ injection, and the differnece of the regeneration processes of articular cartilages in both groups was compared. For this study, 4 week-old 28 Sprague-Dawley rats(immature group), weighing 100g on an average and one year-old 28 Sprague-Dawley rats(mature group), weighing 350g on an average were used. For all rats, 0.05ml of 2% H₂O₂ was injected into the left knees four times with one week interval. In each experimental group, 4 rats were sacrificed at 1, 2, 3, 4, 6 and 7 weeks after first intra-articular injection, and tibial sides of the joints were taken for the histopathological and histochemical studies of articular cartilage.

The results were as follows:

1) In both groups, the severity of articular cartilage damage depended upon the numbers of injection.

2) Articular cartilage damage was less severe in the immature group than the mature group at 1, 2 and 3 weeks but at 4 weeks, severe destruction of articular cartilage was noted in both groups and there was no difference between two groups.

3) After 4 weeks, there were cartilage regeneration of fibrous nature and focal hyaline cartilage in immature group, but only fibrocartilaginous regeneration were observed in the mature group and there was repair process of the proteoglycans only in the immature group.

Through this study, it is concluded that the immature rats have the regeneration potentiality of damaged hyaline cartilage, while the mature rats do not have it.

Partial peripheral nerve injuries often result in neuropathic pain such as causalgia. The pain is characterized by spontaneous burning pain combined with hyperalgesia and allodynia. There have been many attempts to find the pathogenesis. However, even though the disease has been known over a century, we have little knowledge about not only its pathogenesis, but also its treatment. Recently, a neuropathic animal model, produced by incomplete injury of the nerve innervating the rat tail, has been developed. This model elicits behavioral signs of neuropathic pains mechanical, cold and warm allodynia) that are localized in the tail.

In the present study, using this model, we assessed the effects of several drugs (acetaminophen, diclofenac sodium, amitriptyline, carbamazepine, baclofen, clonidine, and morphine) on the manifestations of the neuropathic signs. To test for mechanical allodynia, mechanical sensitivity of the tail was quantified by the tail-withdrawal frequency occurred by the application a von Frey hair(19.6mN; 2gm). Tests for cold and warm sensitivity of the tail were performed using the method of immersing the tail in 4°C and 40°C water with a cut-off time of 15 sec, respectively. Of injected drugs, amitriptyline, carbamazepine, baclofen and morphine alleviated the signs of neuropathic pains, whereas acetaminophen, diclofenac sodium and clonidine didn't. These results suggest that the supraspinal changes take part in the development of the neuropathic pains.

Low-Energy laser is a newly developed therapeutic modality that is widely used in medical practice. It is indicated in wound healing, soft tissue injury, pain relief, arthritic condition, and so on. But, its mechanism of action is not known so far and its effect is controversial. Recently, some investigators reported that low-energy laser promoted regeneration of injured peripheral nerves in animal studies. However, some reported that they could not prove such results. We made crushing injury on sciatic nerves of 20 rats artificially and investigate effect of low-energy laser on their regeneration. The results showed no significant difference between laser irradiated rats and control rats. We could not prove beneficial effect of low-energy laser on the regeneration of injured peripheral nerves.

Myotonic dystrophy is a muscular disorder characterized by muscle weakness and myotonia. Myotonia menifest as abnormally slow relaxation after strong voluntary contraction. So patients with myotonic dystrophy are difficult to perform activities of daily living. In our previous study we reported that quinine sulfate therapy not combined with muscle strengthening exercise provided therapeutic benifit to myotonia but not muscle weakness. The purpose of this study was to determine the effect of six-month home exercise program based on muscle strengthening exercise. Seven patients with myotonic dystrophy trained daily for six months at home with weights adapted to their force or without any tools and received one gram of quinine sulfate daily for six months. The changes of muscle strength and relaxation times between pretherapy and post-quinine sulfate therapy and post-six-month home exercise program combined with quinine sulfate therapy were assessed from the first dorsal interossei, elbow flexors, and knee extensors. The results were as follows: ① The improvement of the mean muscle strengh of the elbow flexors, and knee extensors was significant compared with pretherapy and post-quinine sulfate therpay. ② The improvement of the mean muscle strength of the first dorsal interossei was slight but not significant compared with pretherapy and post-quinine sulfate therapy. ③ The shortening of relaxation times of the three muscles was significant compared with pretherapy. ④ The shortening of relaxation times of the three muscles was slight but not significant compared with post-quinine sulfate therapy. In conclusion, home exercise program based on muscle strenghening exercise combined with quinine sulfate therapy showed significant improvement of the muscle strength and shortening of relaxation times for the patients with myotonic dystrophy.

The purpose of this study was to investigate usefulness of physiological cost index(PCI) with correlation to the heart rate, walking speed, O₂ rate and O₂ cost responses of individuals with hemiplegia to resting and comfortable walking. We measured the physiological energy expenditure using the portable oxygen consumption monitor(K2, COSMED, Rome, Italy).

Twenty hemiplegic patients and twenty able-bodied control subjects participated. Results showed that the hemiplegic group required significantly high O₂ cost and PCI during comfortable walking. In the hemiplegic group, there was statistically positive correlation between O₂ rate and heart rate, O₂ cost and PCI and negative correlation between walking speed and PCI, and O₂ cost and walking speed. In the control group, there was statistically positive correlation between O₂ rate and heart rate, O₂ rate and PCI, and heart rate and PCI. According to the above results, it could be concluded that hemiplegic group required higher energy consumption during comfortable walking compared to the control group, and PCI is an easy and comfortable index to estimate energy expenditure during ambulation.

This study was designed to estimate the chronologic difference of the pharyngeal transit time (PTT) between aspirating hemiplegics and non-aspirating ones, and to find out the most effective tool and the condition (position, diet) in the measurement of PTT, and lastly, to evaluate diagnostic validity of each tool in detection of aspiration. We measured PTT of 36 hemiplegics by videofluoroscopy, scintigraphy and swallowing electromyography. PTT was measured in three kinds of chin position (neutral, chin up, chin down) and two kinds of diet (fluid, soft blend diet), and the presence of aspiration to trachea was monitored through fluoroscopic images. The results were as follows; PTT was longer in aspirating group than non-aspirating group(p<0.05). Videofluoroscopy perfomed with fluid and scintigraphy performed with soft blend diet in chin-neutral position were most effective in the measurement of PTT (p<0.01), and these tools were more sensitive than conventional fluoroscopy in detection of aspiration in hemiplegics (p<0.05).

Degeneration of the myelin sheath and axon distal to the most proximal site of axonal interruption secondary to axonal disease has been called Wallerian degeneration. On MR imaging, Wallerian degeneration of the pyramidal tract can be observed as an abnormal signal intensity, showing prolonged T1 and T2 relaxation times that correspond to the corticospinal tract, with or without shrinkage of the ipsilateral cerebral peduncle and pons.

Thirty-one patients with Wallerian degeneration seen on MR imaging after CVA were studied. The purposes of this study were to identify the somatotopic localization of the descending cortical tract, to demonstrate their relationship with the severity of motor deficit.

With small lesion confined to the precentral gyrus, corona radiata, or the posterior limb of the internal capsule there was an abnormal signal at the centre of the peduncle, suggesting degeneration of the corticospinal tract. Patients with a lesion of the parietal, temporal or occipital lobes, not including the paracental or precentral gyri, corona radiata, or the posterior limb of the internal capsule, had an abnormal area laterally in the peduncle, suggesting degeneration of the parietopontine, temporopontine or occipitopontine tract. A lesion in the involving frontal lobe, not including the precentral gyri, showed an abnormal area medially in the peduncle, suggesting degeneration of the frontopotine tract.

The maximum extent of shrinkage of the ipsilateral cerebral peduncle was measured on T2W imaging. The width of shrinkage of cerebral peduncle was closely related to the severity of motor deficit.

Spasticity, as one component of the upper motor neuron syndrome has been one of the most trouble some obstacle to the successive rehabiliation of the motor function.

The goal of this study was to determine if electroaupuncture therapy would temporalily reduced muslces spasticity.

6 traumatically brain injured(TBI), 7 spinal cord injured(SCI), and 8 stroke(CVA) subjects, all clinically evident spasticity received electracupuncture on couples of acupoint on lower extremity unilaterallly.

Using the spasticity measurement methods(Modified Ashworth scale, Beats of ankle clonus, H/Mratio) was measured before, immediately, 24 hours, and 36 hours after.

Low frequency electroacupuncture(4Hz), short time application(15min/time) produced on antispatic effecs.

We conclue that 1) electroacupuncture therapy transiently decreases both brain and SCI related spasticity but is most effective to the SCI population, 2) electracupuncture therpy will decreased spasticity for 24 hours or more hours in SCI subjects, 6 hours in SCI or less in brain injured subjects.

Laterality is the tendency of the cerebral hemisphere to specialize in function.

To confirm the prediction of lateralized motor ability we tested grip strength and finger tapping rate in 21 right-handed hemiparetic patients due to cerebro-vascular disease and 21 right-handed age and gender matched controls. GRIP and TAP tests are common measures of motor function selected to distinguish rapid repetitive vs sustained performance.

Right hemispheric cerebrovascular accident(R-CVA) patients exhibited lower grip power than controls in right hand and left hemispheric cerebrovascular accident(L-CVA) patients exhibited lower finger tapping rate than controls in left hand.

In addition, L-CVA male patients had the enhanced abilities in left hand grip power compared to contols.

It was concluded that individuals behave differently depending on hemisphere of stroke, and some implications for the poststroke motor rehabilitation program were discussed.

External urethral sphincter hypertonicity(EUSH) with or without detrusor hyperreflexia has been known as the most common cause of unbalanced neurogenic bladder in patients with spinal cord injury. Antispastic drugs or muscle relaxants have been tried to treat EUSH. However, the drugs to treat EUSH required too large dose and long-term treatment, with side effects. We performed 15 pudendal nerve blocks using 7% phenol solution in 8 patients who were not effective on relaxation of external urethral sphincter with large residual urine(150ml to 600ml) despite of 80 mg baclofen and 20 mg diazepam a day and intermittent catheterization over minimal 3 weeks. Drugs were discontinued at least for 48 hours. The neurological deficit was complete in 3 paraplegics and incomplete in 5 (2 paraplegics and 3 quadriplegics). Patient age ranged from 24 to 58 years, with mean age of 42.6 years. The recording of residual urine were done before and after pudendal nerve blocks. A pudendal block was produced by injecting 7% phenol solution with specific localization of the nerve by electrical stimulation into the area medial to the ischial tuberosity. Voiding patterns have been markedly improved and the residual urine had dropped. Of the 8 patients who underwent pudendal block, 5 had excellent results, and 1 good and 1 fair result. There has been no impairment to urinary continence. The mean difference of 255.7ml of the residual urine before and after pudendal nerve block in 7 patients, with exclusion of one patient having urethral stricture, was highly significant statistically(p<0.001).

47 unilateral lower extremity amputees who visited Seoul National University Hospital were studied to evaluate the outcome of prosthetic use of lower extremity amputees and determine the factors which affect successful long term prosthetic use.

In follow up via chart review and telephone survey, the mean age of amputees was 43 years, 76% were males. Vascular insufficiency(36%) was the main reason for amputation, below-knee amputation(42%) was the most common level of amputation. Among the follow-up cases, 11 cases were in death and 2 cases were in bed-ridden. 30 cases capable of prosthetic ambulation were selected for concrete questionnaire related to the actual use of prosthesis and modified from Prosthetic Profile of the Amputees(PPA) designed by Gris . They fitted prosthesis for ambulation daily(6.7 days/week) and mean fitting time a day was 9.5 hours. Most amputees could do independent prosthetic ambulation but they were relatively low in degree of satisfaction with prosthesis. According to the supervision by physiatrist or not, a comparison between two groups was made about satisfaction and ambulatory status. A group supervised by physiatrist showed the higher degree of satisfaction, more frequent indoor prosthetic use, and longer walking distance than non-supervised. Supervised above-knee amputees were in use of walking aids less frequently than non-supervised above-knee amputees. The most probable factor affecting prosthetic ambulation was the additional medical problems. Below-knee amputees could do more independent donning and doffing and stair walking than above-knee amputees.

Tip toe gait is one of the most common abnormalities in cerebral palsy and caused by spasticity in calf muscles or contracture of the triceps surae. The result is clumsy and inefficient. Also, it may wear out shoes too much. Six cerebral palsy patients with tip toe gait were managed by long leg cast. The management had covered a period of 3 to 5 days. The casts provided decreasing of spasticity, increasing of ankle joint range of motion and improving of active ankle dorsiflexion. These results had facilitated the development of the normal gait pattern in these children. Pressure sore had been developed after casting. But it was healed within several days, because it only involved epidermis. Long leg casting was considered as an effective method of the treatment for the tip toe gait caused by cerebral palsy.

The purpose of this study was to evaluate the efficiency of wheelchair ambulation by

the paraplegics in the community. Energy expenditure was evaluated in the individuals with paraplegia during quiet sitting in a personal wheelchair, and during wheelchair propulsion on level surface and 5 degree ramp by measuring speed, heart rate, oxygen rate and oxygen cost.

Twenty traumatic paraplegic men for longer than one year and 16 able-bodied men participated in this study. The paraplegic group showed increased heart rate and oxygen rate at rest(P<0.05), increased propelling speed on level surface with out increased energy expenditure and increased heart rate and oxygen rate during wheelchair propelling up on 5 degree ramp(p<0.05) compared to the control group.

With the results above, wheelchair is thought to be an energy efficient method of mobility for the paraplegics on the level surface. However, more attention needs to be paid to the increased metabolic demand on the surfaces which are not level.

We performed facet joint injection to thirty two patients who had chronic low back pain. The mean age of the subjects was 52.8 years. All patients had other mechanical lumbar problems such as herniated intervetebral disc, degenerative spondylosis, spondylo-listhesis, old L1 compression fracture and all had been refractory to the usual conservative treatment at least for 6 weeks.

Facet joint injection was done under fluoroscopic guide. Lidocane 1 mL, Depomedrol 1mL, and contrast media(Ultravist^Ⱂ) 1mL were injected into the facet joint cavity and were extravaginated into the extracapsular tissue.

Pain assessment was carried out with 10cm visual analog scale(VAS) before the injection, and the presence or absence of immediate pain relief after the injection. Twenty patients followed-up for 3 months and the severity of pain was asked(A: completely relieved, B: improved, C: not changed, D: aggravated).

Immediate pain relief was present in 22(68.7%) out of 32 patients. 3 months later, pain was relieved completely or improved in 10 patients(50%). The similar good result was shown in 9 patients who had confirmed the lumbar herniated intervetebral disc.

We assumed the facet joints were responsible for 20∼25% of chronic low back pain. Facet joint injection is easy to perform and a safe procedure. We could expect good results in 50% of subjects regardless of combined lumbar problems.

This study was designed to evaluate the clinical value of ^99mTc HMPAO (Hexamethyl Propylene Amine Oxyme) brain SPECT (Single Photon Emission Computed Tomography) in visualization of topographical involvement of cerebral palsy. Ten children with cerebral palsy (4: spastic diplegia, 2: spastic quadriplegia, 2: athetoid quadriplegia, 2: hemiplegia) were studied. The results showed that SPECT abnormalities were congruent in most cases with their to pographical involvement of disabilities, despite of no correlative abnormality demonstrated by conventional radiological studies including CT or MRI. These results indicated that ^99mTc HMPAO brain SPECT might have a potential clinical value in visualization of related site and extent with topographical disabilities.

As we proposed the shoulder function assessment would be very useful in evaluating functional and disease status of frozen shoulder patients, To know the clinical utility of shoulder function assessment through patient follow-up and to analyze the clinical features and treatment result of patient follow-up and to the factors that correlate with treatment outcome and total treatment duration ,We analyzed 61 patients who finished treatment and had adequate follow-up from 128 patient who referred from complaints shoulder pain and limitation of motion. All patient were evaluated at the initial visit and during subsequent visits by physicians. The effect of variables on clinical outcome and treatment duration were analyzed The conclusions were as following;

1) Longer treatment duration could be estimated with the patients who had bilateral involvement, longer pretreatment symptom duration , low initial score but after excluding the effect of other variables, Severity grouping of shoulder function assessment and history of Diabetes Mellitus were most independently correlated with treatment duration.

2) Poor treatment outcome was correlated with lower patient's range of motion, longer pretreatment symptom duration, bilateral involvement and lower power but most independently correlated with significant degenerative change in X-ray findings in multi-variate analysis.

3) Above findings show shoulder function assessment score in initial visit and severity grading was correlated with treatment duration and outcome, so it was useful in initial evaluation of disease status and documentation of function as well as estimation of treatment result.

Subcalcaneal pain, a clinical syndrome is the common foot problem in middle-aged persons. Many possible causes and treatment have been discussed. However it is not clean exact cause of the pain because of complexity of mechanism of subcalcaneal pain. Some authors suggest that the certain abnormal plantar fascial tension created by biomechanical factors(such as flat foot, limited subtalar motion, tight Achilles tendon etc.) may be occurring symptoms.

The calcaneal pitch is the simple method to measure the flat foot(reduction of medial longitudinal arch). Comparison the mean calcaneal pitch in 12 subcalcaneal pain patients with 20 normal subjects revealed no statistical differences. And also body weight using body mass index(BMI) compared in this two groups. There was significant statistical differences in subcalcaneal pain patients. The incidence of calcaneal spur and overweight were significantly higher in subcalcaneal pain patients than in normal subjects.

As a conclusion, there is no direct relationship of subcalcaneal pain and reduced calcaneal pitch, however body weight may be important factors to develop subcalcaneal pain and heel spur formation. I think that a correct evaluation of subcalcaneal pain must be based on the anatomic and mechanical factors that produce the abnormality.

Urinary tract infection is a common problem among acute spinal cord-injuried patients who require intermittent catheterization of the bladder. A standard microwave oven has been used to sterilize catheters used for intermittent catheterization. The purpose of this study was to assess a method for sterilization of urinary catheters by microwave irradiation by comparing to soap washing, or betadine soaking. Representative urinary isolates of Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumonia, and Streptococcus fecaelis species were tested. Sterilization by microwave irradiation was more effective than conventional soap washing or betadine soaking. And all strains were sterilized 10 minutes after microwave irradiation. Sterilization in the microwave oven did not affect the integrity of the catheter. According to the results, microwave irradiation can be a practical, efficient, and cost-effective method of home catheter sterilization.

Locomotion is a complex mechanism of propulsion and equilibrium control, and the analysis of ground reaction force(GRF) during locomotion can therefore give valuable information about basic mechanism of locomotion. Fourteen men with no history of neuro-musculoskeletal disorder were studied during walking with 5 different walking speeds(57.11∼99.09m/min). Vertical, anteroposterior and mediolateral force components were recorded with 2 force platforms. Elite DMA acquisition program(B.T.S., Italy) was used to calculate amplitude and duration of GRF.

The result was as follows;

1) Increased walking speed was accompanied by shorter stance and double support time with constant ratio of double support to stance time.

2) Timing of different events of GRF were earlier with increased walking speed without changing the ratio of each events to stance time at all walking speeds.

3) All peak forces were larger with increased speed except lateral force in late stance phase(Fx3).

4) The complex interactions between vertical, anteroposterior and mediolateral forces needed for propulsion and equilibrium during locomotion were different at different speeds.

The aim of this study is to find out the relationship between distance from joint axis to the hand-held dynamometer placing site and calculated force during isometric shoulder adductor strength examination using a hand-held dynamometer.

The subjects of this study were 20 normal male volunteers between 24 to 38 years of age, who were students at chungbuk national university college of medicine.

The results were as follows;

1) The calculated muscle force were different at 3 different placing sites.

2) But, the values of Torque were no significant difference at 3 different sites(p=0.8421).

3) There was significant correlation between force and distance(p<0.001).

4) The relationship between force(F) and distance(D) in shoulder adductor strength examination was

F(kg)=-0.47 D(cm)+37.94(r=-00.83, p<0.001)

Therefore, when examiner calculating the muscle force using a hand-held dynamometer, determination of correct and same placing site is very important in standard testing positions and procedures.

To evaluate the intrasubject repeatability of kinematic data in computerized three dimensional gait analysis and to know whether a significant clinical decision could be made on the basis of a single gait evaluation, repeated gait analysis was done with three-dimensional motion analyzer in 10 healthy young men.

Each subject was evaluated in ten runs in a single session on a test day. Time gait parameters, distance parameters, and angle values of hip, knee, ankle and pelvis on the specific gait event in a gait cycle in the sagittal, coronal and transverse planes were measured. Coefficient of variation was used to evaluate the repeatability.

Intrasubject repeatability was excellent for kinematic data in sagittal plane. In contrast, kinematic data in transverse plane showed relatively poor repeatability.

We concluded that it might be reasonable to base significant clinical decisions on the results of a single gait evaluation and it is necessary to improve algorithm to measure the rotational axis of joint to increase the repeatability of kinematic data in transverse plane.

The neurobehavioral cognitive status examination(NCSE), a screening examination that assesses cognition in a brief but quantitative fashion, uses as an independent test to evaluate cognitive function within five major areas: language, constructions, memory, calculation, and reasoning. And the examination separately assesses levels of consciousness, orientation, and attention. This instrument quickly identifies intact areas of functioning, yet provides more detailed assessment in areas of dysfunction. The level of cognition is classified as unimpaired and mild, moderate, severe impaired. Standardization data are provided for 61 healthy adults, age ranged from 40 to 88 years and for 30 patients with documented brain lesions, age ranged from 16 to 78 years. The mean scores of the healthy eldest group, age ranged from 80 to 88 years, showed moderate impaired in construction and mild impaired in memory, calculation, similarity. The other groups showed unimpaired in all 5 areas, but the mean score of memory was in low normal value in 60 to 69 and 70 to 79 years group. The mean score of patients were significantly lower than those of the healthy group in orientaion, attention, construction, memory, and judgement (P<0.05). The sensitivity was 86.7 % for NCSE. We concluded that NCSE was a brief but sensitive test for the detection of cognitive dysfunction of the patients with brain lesion.

The sequelae of neonatal hyperbilirubinemia include hearing loss as well as other central nervous system deficits. It is generally accepted that the most sensitive test for hearing loss in neonates is the brainstem auditory evoked potential(BAEP). The purpose of this study is to demonstrate the changes of BAEP in neonatal hyperbilirubinemia in order to evaluate the cochlear damage and the prognostic value of brainstem lesion.

The waves of BAEP in 25 of 33 neonates were absent or prolongation of the latencies of wave I, the interpeak latencies of wave I-III and I-V, and the difference latency of wave I between Rt and Lt side were significant statistically. Our results indicate latencies appear to be more sensitive than amplitudes of BAEP.

We may conclude that BAEP testing can be used to screen hyperbilirubinemic fullterm and premature infants for cochlear damage. The question of a safe level of bilirubin concentration, and safe duration of exposure relative to long-term minor or soft neurodevelopmental handicaps remains unanswered. Large, controlled, prospective, epidemiologic studies are needed to provide these answers.

Brainstem evoked potentials(BSEP) in newborn infants are altered by elevated serum bilirubin levels and may be used as an indicator of bilirubin toxicity. The purpose of this study is to evaluate the effects of serum bilirubin on brainstem evoked potentials in full-term neonates. We examined altered responses of brainstem evoked potentials by studying 81 full erm neonates divided into three gruops: group 1(n=33), peak serum bilirubin(PB) level<5mg/dl; group2(n=22), 5mg/dl<PB level<10mg/dl; group 3(n=26), PB level>10mg/dl. The rate of appearance of peak waves reduced significantly in peak I, II, III, & V of group 2 and all peak waves of group 3 as compared with group 1, respectively. The increased serum bilirubin levels were associated with significant amplitude reduction of peak waves, but had no effect on absolute latencies and interpeak latencies. According to those results, we conclude that the increased serum bilirubin levels affect the amplitudes of the peak waves rather than the latencies or interpeak latencies of brainstem evoked potentials in full-term neonates.

The purpose of this study was to determine if there are changes between preoperative and postoperative somatosensory evoked potentials(SEP) in patients with low back pain who underwent surgery and if the changes of SEP and symptom improvement correlate. 40 patients who had low back pain and underwent surgery for lumbosacral disc herniation or spinal stenosis verified by magnetic resonance image were studied. In preoperative examination, physical examination(including straight leg raising, motor and sensory examination, deep tendon reflexes), SEP were done. Postoperative examinations were done in postoperative 1 week and 1 month. In postoperative 1 week SEP study there were no changes in 23 patients, improvement in 8 patients and aggravation in 4 patients(odds ratio=2, confidence interval 0.15∼0.6). In postoperative 1 month SEP study there were no changes in 10 patients, improvement in 11 patients and aggravation in 1 patient(odds ratio=8.33, confidence interval 0.012∼0.705). There was significant improvement in SEP after the operation in preoperative 1 week and in 1 month. There was no significant correlation between symptom improvement and improvement of SEP(P=0.507) but in patients with symptomatic improvement, there was improving tendency of SEP. Further study would be necessary with more cases.

The aim of this study is to classify the foot type in Korean according to digital formula and metatarsal formula using foot X-rays(anteroposterior view) of 201 persons' right feet.

Results were as follows:

1) The most common digital type of Koreans was Egyptian foot (50.2%), and next common type were squared foot (29.4%), and then Greek foot (20.3%).

2) The most common metatarsal type was index plus type (55.7%) and next common type were index plus minus type (33.3%), and then index minus type (10.9%).

3) The hallux valgus was closely associated with index plus type foot (p<0.001).

4) There was significant correlation between digital formula and metatarsal formula (p<0.001).

5) There was significant correlation between first metatarsophalangeal angle and first intermetatarsal angle (p<0.001).

According to the above mentioned morphologic classification of foot, the correlation between each foot types and foot deformities, ideal foot wear in Koreans should be studied further.

The purpose of this study was to evaluate a isometric shoulder muscle strength of normal men and women in three age groups. 128 healthy Korean adults between the ages of 20 to 79 were studied(men were 59 and women 67). Isometric shoulder strength was measured by Nicholas hand-held dynamometer for flexors, extensors, abductors, adductors, external rotators, and internal rotators of shoulders. Testing was performed with the subject supine according to the modified Bohannon's method. There was a tendency which was dominant side weakness in external rotators compared with nondominant side in more than 40 years old of both men and women. Analysis with paired t-test showed that measured shoulder strength for flexors, extensors, and abductors in dominant side had significantly more(p<0.05) strength(kg) than nondominant side in Korean adults.

In conclusion, this hand-held dynamometer is a convenient and beneficial instrument for the evaluation of shoulder strength and it could be used as a screening test for the diseases causing muscle weakness.

Osteoporosis is a major cause of chronic disability in older women. Although the eiology of this disease is multifactorial, accelerated bone loss early in menopause may result in subsequent osteoporotic fracture.

To assess the effect of physical activity pattern on bone mineral density in women, we studied two groups of nonsmoking women with different exercise regimens.

There were ten women who performed aerobic(AER) exercise and eighteen women who supplemented aerobic with muscle-building activities(MB) for 50min/day for 4 months.

Resting energy expenditure, caloric, protein, and calcium intake, and total body weight were not statistically different among the two groups. No increase in bone mineral density(BMD) in both groups was appeared, but were found significantly decrease in urine pyridinoline(PYD) and deoxypyridinoline(D-PYD) level in both groups after training.

We conclude that exercise is a major determinant of bone remodeling and bone mass by both local factors and possible systemic factors.

The implications of these findings for the prevention of osteoporosis warrant further intervention.

A small negative evoked potential is often recorded before the median thenar or ulnar hypothenar compound muscle action potential(CMAP) with supramaximal stimulation and has therefore been termed the premotor potential(PMP). This PMP was first described by Simpson and attributed to a nerve action potential arising from terminal motor fibers before their muscular innervation. Several authors have since explored whether this potential arises from terminal motor nerve fibers or from sensory nerve fibers.

At now investigators generally accepted the concept of the sensory nature of the PMP. The goals of this study were to explore the diagnostic availability of PMP on the patients with abnormal conventional sensory conduction studies and to determine reference values for the following characteristics of the median PMP, and ulnar PMP: amplitude, onset latency, peak latency, and the interpeak interval(IPI), which is the time between the onset of the PMP and the onset of the CMAP.