The effect of non-freezing local cooling on nerve injury in rabbits was studied by measuring the changes of latencies and amplitudes of the compound action potentials, as well as the histological and needle electromyographic changes.

The experimental rabbits were divided into three groups: Experimental Group 25, Sham 19, and Control 15. Non-freezing cooling, 1-5℃, was applied to the sciatic nerve after exposing at the proximal thigh. The Control and Sham Groups did not show any electrophysiologic or histologic changes after procedure. In the Experimental Group, after the proximal nerve damage, the nerve conduction study showed significant decrease in the amplitude with the stimulation of the proximal and distal regions, without any changes in the latencies. The needle electromyography of the gastrocnemius muscles began to show the positive sharp waves and the fibrillation potentials on the third day after the non-freezing cooling, while the histological changes began immediately after the cooling on the electron microscopic examination. The axonal degenerative changes at the level of cooling were most pronounced during the first 3-7 days after the cooling, and the regeneration process began to notice on 14-28 days after the cooling.

The fiber degeneration was significantly greater for unmyelinated fibers than myelinated fibers. The electrophysiologic and histologic results suggest that the nerve injury induced by the local non-freezing cooling is primarily due to the proximal axonal damage, i.e., axonotmesis process, with greater vulnerability of the unmyelinated fibers.

It is difficult to estimate the range of motion(ROM) of the cervical and lumbar spine because the spinal region consists of multiple small, inaccessible segments unlike the simple extremity hinge joints. However Knowing the normal range of motion is important in evaluating the disability and the reposonse to treatment. Generally, normal ROM values represented by American Medical Association & American Academy Of Surgeons have been clinically used, but the age factor was not considered in those values. The purpose of this study was ⸁ to determine the normal values of cervical, lumbar ROM of healthy volunteers aged from 13 to 69 years by using gravity & magnetic goniometer; ⸂ to determine the age and gender differences on the ROM; ⸃ to examine the interrater and intrarater reliability of measurements; and ⸄ to compare our clinical measurements with the radiological measurements. Our measurement techniques demonstrated high correlation with the radiologic values with good interrater and intrarater reliabilities. All ROM values decreased significantly with age, however, gender was not a factor.

A comprehensive knowledge of the spinal kinematics is important for the understanding of the clinical analysis and management of spinal problems. Measurement of the range of spinal motion is valuable for evaluation of disability and therapeutic effect associated with spinal disorders. But it is difficult to measure precisely the range of spinal mot ion which is complex as a functional spinal unit.

The purposes of this study were to measure the range of spinal motion using 2-dimensional motion analysis system and to identify clinical applicability of this method compared to that of spinal motion using inclinometer.

Ten healthy males volunteered for this study(mean age 22.5 years, range 20-32 years).

We measured the range of spinal motions in flexion, extension, lateral flexion and rotation using two methods of electrodigital inclinometer(EDI 320) and 2-dimensional motion analysis system. And we also measured the range of segmental motions in thoracic, lumbar spines and hip joint, and calculated the proportions of the range of segmental motions to gross motions.

The results were as follows:

1) In the method of 2 dimensional motion analysis system, the average range of motion of flexion was 26.2±4.7° in thoracic segment, 50.8±5.3° in lumbar segment, and 63.5±10.4° in hip joint, respectively. The range of motion of extension was 13.9±3.3° in thoracic segment, 26.7±5.8° in lumbar segment, and 4.1±1.5° in hip joint, respectively. The range of motion of lateral flexion was 31.7±4.4° in thoracic segment, and 14.2±2.8° in lumbar segment, respectively. The range of motion of rotation was 37.7±3.8° in thoracic segment, and 11.4±1.8 in lumbar segment, respectively.

2) The proportions of each segmental range of motion to gross motion were thoracic 19%, lumbar 36%, hip 45% in flexion, and thoracic 32%, lumbar 59%, hip 9% in extension, and thoracic 69%, lumbar 31% in lateral flexion, and thoracic 77%, lumbar 23% in rotation.

3) There was no statistically significant difference between electrodigital inclinometer and 2-dimensional motion analysis system in flexion, lateral flexion and rotaion. But in 2-dimensional motion analysis system, the average range of motions of hip extension and gross extension were significantly less than those in electrodigital inclinometer.

We concluded that 2-dimensional motion analysis system as well as electrodigital inclinometer were highly applicable for measurement of the range of spinal motion in clinical setting.

This study has been designed to investigate the clinical applicability and usefulness of the Korean CADL (Communicative Abilities in Daily Living) in evaluating the functional language abilities and to assess the characteristics of the aphasic patients after stroke.

Twenty stroke patients with aphasia were involved in this study and the results were as follows.

1) Each categorical scores and total CADL scores of aphasic patients were significantly lower than those of normal controls.

2) Total CADL scores of aphasic patients were highly correlated with total scores of the Boston Diagnostic Aphasia Examination (BDAE).

3) Total CADL scores of normal controls were not significantly different in both sexes, but in aphasic patients those of males were significantly higher than those of females. And expressive aphasia was more common in men; global and receptive aphasics were somewhat more common in women than men.

4) Expressive aphasics tended to be younger than global and receptive aphasics.

5) Scores of CADL & BDAE were high in order of anomic, expressive, receptive, and global aphasia.

Our conclusion is that this Korean CADL appeared to be a valid and reliable method to measure the functional communicative abilities of the aphasic patients after stroke.

Dysphagia is common and serious problem in stroke patients. The poststroke dysphagia with aspiration is associated with dehydration, malnutrition, pneumonia, sepsis and death.

The aim of this study was to evaluate the characteristics of dysphagia in stroke pateints using videofluoroscopy(VFS) test, for the purpose of establishing the guideline to manage dysphagia.

Twenty five stroke patients who complained of swallowing difficulty were evaluated using with videofluoroscopy with liquid and semisolid materials. The twenty subjects who had not swallowing difficulty were evaluated as a control group.

The results were as follows:

1) Fifteen patients showed abnormal findings in VFS; Two patients showed the abnormal findings in oral phase, four patients in pharyngeal phase, and remaining nine patients in oral phase and pharyngeal phase.

2) Ten patients revealed aspiration on videofuoroscopy(VFS). Two patients showed aspiration in preswallowing phase, three patients during swallowing phase, four patients in postswallowing phase, and remaining one patient showed during swallowing phase and postswallowing phase.

3) The Pharyngeal Transit Time(PTT) of bulbar lesion group was significantly prolonged compared to it of pseudobulbar lesion group. And the PTT of aspiration group was significantly prolonged compared to it of control group.

The videofluoroscopy was useful examination for establishing the treatment guideline for dysphagia with stroke, because we could get objective data about oral and pharyngeal phase respectively, and also types, mechanisms, and severity of aspiration.

In back pain, psychological factors are often major importance in both development and persistence of symptoms, and current conceptualizations of clinical diagnosis argues for the importance of simultaneous assessing the varied components and effects of pain. Unfortunately, we lack knowledge of the mechanisms by which they influence each case.

Therefore, the purpose of this study was to investigate the psychometric characteristics and pain behaviors in low back pain patients who are secondarily gained by their pain and to understand their psychodynamics. Pain qustionnaire which included the personal history of patients and their behavioral aspects, Symptom Checklist 90 Revision(SCL-90-R), McGill pain questionnaire, Visual Analogue Scale and pain drawing were obtained from 94 low back pain patients with secondary gain and from 79 patients without notable secondary gain, and psychometric characteristics and pain behaviors of the different two groups were then compared.

The data show that: ⸁ The pain was more progressive in patients with secondary gain than without that and the patients with secondary gain had poorer expectancy of cure. ⸂ Mean SCL-90-R t-score of patients group with secondary gain was significantly higher than that of patients group without secondary gain on Somatization(SOM), Interpersonal-Sensitivity (IS), Anxiety(ANX), Paranoid Ideation (PAR), Psychotism(PSY), Global Severity Index(GSI) and Positive Symptom Total(PST) scales, but all the scales were within normal range near to 50 and by SCL-90-R profile, somatization attitude was most prevalent. ⸃ Mean score of Visual Analogue Scale(VAS), Pain Rating Indices(PRI) on sensory, affective, evaluative dimensions and total sum of McGill pain questionnaire were significantly higher in patients group with secondary gain, and two groups showed difference in selecting pain describing words. ⸄ Frequency of nonorganic patterns of pain drawing and the number of pain symbols used were significantly higher in patients group with secondary gain. ⸅ Mean score of Visual Analogue Scale(VAS), Pain Rating Indices(PRI) on affective, evaluative dimensions of McGill pain questionnaire, and prevalence of nonorganic patterns of pain drawing were significantly higher in chronic cases.

These findings emphasize the importance of adopting a broader approach to multi faced problem of low back pain, and suggest that these tests be useful indicators of therapeutic strategy and prognostic evaluation.

Pain drawing is a well known method to describe pain, both to guide diagnostic work in cases with or without root syndromes and to follow results of treatment. A specially designed pain drawing, which describe four pain dimensions : pain quality, pain duration, pain intensity and pain distribution, was administered to 123 patients referred to an department of rehabilitation medicine because of low back pain.

The following results were obtained.

1) The mean age of degenerative spondylosis was higher than those of other low back pain.

2) The quality of low back pain was represented to cramping, numbness and aching in order.

3) Low back pain was frequently radiating to the buttock, posterior thigh and leg, in which the herniated nucleus pulposus(HNP)(11 cases) was most frequently hurt with a sensation of numbness, but also the back muscle pain(3 cases) had same complaints.

These results indicate that from the features of the pain drawing alone, it was possible to predict the present of HNP, but it might not be a sufficiently valid instrument for assessing low back pain patients to allow it to be used for individual diagnosis without other examinations.

Straight leg raising test(SLR) is a useful clinical test to demonstrate an inflammatory compressive process across a spinal nerve roots. In a retrospective study of 44 patients(men 18, women 26) suffering from low back pain this symptom was evaluated. Radiologic findings were classified by the hernia size and electrodiagnostic studies were classified by the grade of abnormal spontaneous activities. Two aspects were investigated: 1) the correlation between straight leg raising test and radiologic findings, and 2) the correlation between straight leg raising test and electrodiagnostic study. The limitation of the SLR test was not correlated to size or position of the hernia, however, electrodiagnostic findings was well correlated. It must be presumed that additional factors, such as inflammatory reactions affecting the nerve roots, are of importance for the magnitude of SLR test.

Neck and back pain are common problems in industrialized countries. Among chronic conditions, neck and back problems are the most frequent cause of limitation of activity. The purpose of this study is to determine the aggravating factors of neck and back pain and to demonstrate the effect of comprehensive rehabilitation approach through back school program. We studied 2510 patients with low back or neck pain who were admitted to the department of rehabilitation medicine of Yong Dong Severance Hospital from 1987 to 1994.

The major results were as follows:

1) Chronic patients were 81.1%.

2) Of the aggravating factors, sports injury, longtime driving and shortterm weight gain increased annually. In posterior neck pain patients, aggravation by typing and computer work was remarkable.

3) Teenage and overweight patients were increased annually.

4) Patients attending back school program had much improvement of pain compared with the others.

These results of this pilot study are being applied to a back school program.

Diabetic neuropathy is one of the most frequent peripheral neuropathies, which result in many serious clinical problems. The purpose of this study is to find the most sensitive electrodiagnostic examination method for the early diagnosis of diabetic neuropathy, and to investigate the correlations between elecrodiagnostic findings and clinical factors such as age, sex, Body Mass Index (BMI), duration of diabetes mellitus, HbA1C level, and other diabetic complications. Seventy-four diabetic patients were examined with peripheral nerve conduction (NCS), F-wave and sympathetic skin response (SSR) studies. The average age of the patients was 53.0±12.7 years, and average duration of diabetic mellitus was 8.0±6.4 years. Sixty-seven patients had suffered from peripheral or autonomic neuropathic symptoms and 29 patients had suffered from other diabetic complications. Forty-five patients (60.8%) among 74 showed abnormal findings in NCS. In F-wave study, 24 patients (33.8%) among 71 had abnormal findings, and 49 patients (66.8%) among 74 were found to have abnormal findings in SSR study. The duration of diabetes mellitus and BMI had significant effect on the results of electrodiagnostic studies. Peripheral nerve conduction study was especially strongly affected by the duration of diabeties mellitus. In the group of patients with duration of diabetes mellitus less than 5 years, the frequency of abnormal findings was higher with SSR than with NCS. This findings can suggest that autonomic nervous system could be involved earlier than the peripheral nervous system in diabetic neuropathy.

In conclusion, peripheral nerve conduction and sympathetic skin response studies are the sensitive electrodiagnostic method for detection of diabetic neuropathy in early stage.

F-wave is useful in the evaluation of proximal segment of peripheral nerve which is inaccessible to conventional nerve conduction study, because it is believed to result from antidromic stimulation of motor nerve fibers. The purpose of this study is to determine the diagnostic usefulness of three F-wave parameters in patients with diabetes mellitus.

The average F-wave latency(F-mean), the minimal F-wave latency(F-min), and the minimal-to-maximal latency difference of F-wave(F-range) were evaluated in 60 normal healthy subjects(male 39, female 21) and in 20 patients(male 14, female 6) with diabetes mellitus. The values of F-mean and F-min were significantly prolonged in patients with diabetes mellitus in both ulnar and tibial nerves(p<0.01). The value of F-range in diabetes mellitus was significantly prolonged in tibial nerve(p<0.05). These three F-wave parameters may be a sensitive method in the early detection of possible diabetic neuropathy when conventional sensory and motor conduction studies are normal in the face of clinical evidence.

Diabetes Mellitus (DM) is the most common serious metabolic disorder having substantial peripheral nervous system (PNS) complications. Involvement of the autonomic nervous system and the PNS represents one of the four major complications of DM, along with retinopathy, nephropathy, and vascular disease.

DM makes nerves vulnerable for minor repetitive trauma, and carpal tunnel syndrome (CTS) is reported as more common in diabetic individuals.

The purposes of this study were to correlate CTS with diabetic polyneuropathy (DMPN), to evaluate sensitivity and specificity for diagnostic criterias of CTS and to correlate with the changes in respect to age, duration, and various blood components such as glucose, blood urea nitrogen (BUN), creatinine, glycosylated hemoglobin (HBA1C) in CTS of DM. We assessed 150 DM patients (male 74, female 76) for DMPN and CTS. The parameters of diagnostic criteria in CTS were as follows: median-ulnar motor latency difference, ratio of wrist-palm sensory latency, median sensory latency across the wrist, median-ulnar sensory difference to ring finger, and median-radial sensory difference to thumb. And we also attempted DMPN with CTS in according to age, duration, blood glucose, BUN, creatinine, and HbA1C.

The results are as follows:

1) There is a significantly higher incidence of CTS in diabetic patients with DMPN (51.8%) than those without DMPN (34.3%).

2) Median sensory latency across the wrist shows the greatest sensitivity (98%) in the diagnosis of CTS in DM.

3) Median-ulnar motor latency difference shows the greatest specificity (100%) in the diagnosis of CTS in DM.

4) There are no significant differences in age, duration, blood glucose, BUN/Cr, and HbA1C between the patients of DM with CTS and those without CTS.

In conclusion, we recommend regular electroneurophysiologic examination for CTS in patients with DMPN by evaluation of median sensory latency across the wrist with median-ulnar motor latency difference.

Carpal tunnel syndrome, the most common entrapment neuropathy, refers to a group of signs and symptoms resulting from compression of the median nerve at the wrist. It can be treated surgically or nonsurgically. Controversy still exists whether nonsurgical treatment or surgical resection of the transverse carpal tunnel ligament is preferable. The division of the transverse carpal tunnel ligament for relief of carpal tunnel syndrome has been a standard operative procedure since the early 1950s.

To monitor the subjective and electrophysiologic effect of open carpal tunnel decompression and find factors useful in predicting postoperative prognosis, we evaluated 28 patients with 44 involved wrists.

The change of subjective symptom and electrophysiologic finding was evaluated by modified Levine's symptom severity scale and nerve conduction study in median nerve.

The results were as follows,

1) After carpal tunnel released operation, there were significant improvement in subjective symptoms and electrophysiological findings.

2) Young age and abnormality in median motor nerve conduction study preoperatively are favourble prognostic factors.

3) The electropysiologic study reflected clinical improvement, especially sensory than motor component.

The purpose of this prospective study was to evaluate the peripheral nerve injuries included brachial plexus injury and reflex sympathetic dystrophy in hemiplegic limbs of stroke.

The subjects were 40 cases with stroke and were classified according to the Brunnstrom stages, Modified Ashworth Scales, and degrees of subluxated shoulder. The electrodiagnostic study, triphasic bone scan, and radiologic examination were performed on all subjects.

The patients with diabetes mellitus, renal failure, trauma, and herniated intervertebral disc disease were excluded.

The results were as follows;

1) The abnormal spontaneous activities were shown in 57.5% in hemiplegic upper extremity and 25% in lower extremity regardless of peripheral nerve injuries.

2) The higher Brunnstrom stages were, the lesser abnormal spontaneous activities were.

3) The patients were diagnosed on reflex sympathetic dystrophy (RSD) in 50% by physical examination, 27.5% by radiologic examination and 15% by triphasic bone scan, Each tests were significantly correlated.

4) The patients were diagnosed as brachial plexus injuries (BPI) in 12.5% and the incidence tends to be increased with increment of degree of subluxation.

Painful limitation of the shoulder in hemiplegia has a bad influence to the shoulder function and the activity of daily living. The purpose of this study is to evaluate the effect of trigger point injection to the passive ROM of hemiplegic shoulder. Twenty hemiplegic patients were randomly divided into two groups that were ten and ten. Group A was injected to the trigger point of affected shoulder by 1% lidocaine combined to the therapeutic exercise and group B was applied by conventional therapeutic exercise only. Passive ROMs of the affected shoulders were checked before, 1 week, 1 month and 2 months after the therapy. Passive ROMs of them were more increased in Group A than in group B, which was statistically significant in all directions of the shoulder motion except the shoulder extension of 1 week. We thought that the trigger point injection is more helpful intervention to increment the passive ROM than therapeutic exercise only in hemiplegic shoulder manaement.

The somatosensory evoked potential(SEP) is an objective reproducible neurophysiologic measure of assessing the integrity of sensory pathways.

The purpose of this study was to evaluate the values of the median nerve SEP as prognostic indicator of functional outcome after the stroke based on modified Barthel index(MBI), disability rating scale(DRS), and functional independence measure(FIM) scores. A sample is 68 patients with hemiplegia. The SEPs were classified into 3 groups based on wave patterns(no response, abnormal wave, normal wave).

The results were as follows:

1) The duration of rehabilitative treatment in group 3(normal SEP) was significantly shorter than the other groups.

2) The MBI scores in group 3 were significantly higher than the other groups.

3) The FIM scores in group 3 were significantly hihger than the other groups.

4) The self-care, mobility, locomotion, and social cognition scores in FIM in group 3 were significantly higher than the other groups.

Therefore, the study shows that the median nerve SEP is helpful to predict the functional prognosis among hemiplegic patients.

It is important to know the prognosis of patients with diffuse axonal injury for planning of rehabilitation program. This study was designed to evaluate the prognostic value of Somatosensory evoked potential (SEP) in patients with diffuse axonal injury.

Glasgow coma scale (GCS), Glasgow outcome scale (GOS) are categorized into two groups separately and brain computerized tomography (Brain CT) findings are classified into 6 categories.

We studied the correlation of the median nerve and posterior tibial nerve SEP and Glasgow coma scale (GCS), brain computerized tomogram (Brain CT) and Glasgow outcome scale (GOS) in 47 patients with diffuse axonal injury. The SEP findings that concerned are P1 latency and P1N1 amplitude were divided in 3 categories: no response (0), abnormal response (I), normal response (II).

The results were as follows:

1) SEP had a good correlation with GCS and brain CT.

2) Normal findings of SEP study had good prognosis.

3) SEP had a good correlation with GOS.

Thus, SEP were help to predict the outcome in acute stage and during the course of diffuse axonal injured patients rather than brain computerized tomography on admission.

4) Follow-up study of SEP were more valuable prognostic factor in diffuse axonal injured patients.

The importance of proper management of the neurogenic bladder has been well recognized. However, there are few reports which have further studied the methods of bladder management in children with spinal cord injuries.

The purpose of this study is to describe the types of voiding difficulty, to determine the frequencies of urinary tract complications and infections, and to establish the clinical effectiveness of bladder training in children with spinal cord injuries during their hospital stay.

Twenty six children with neurogenic bladder were trained with a timed voiding technique including stimulation, to achieve a balanced bladder.

As a result of this training, 24 of the children (92.3%) attained a balanced bladder. All 20 subjects with upper motor neuron signs revealed the hyperreflexic type of neurogenic bladder, and 4 among 6 subjects with lower motor neuron signs revealed the areflexic type. There were two cases of vesicoureteral reflux, and no subject showed abnormality in the intravenous pyelogram. Bacteriuria was documented in 20 subjects, although 17 cases were asymptomatic.

In conclusion, we propose to manage these patients with a conservative method using Credé and percussion, because it is relatively safe and useful method.

The etiology of cerebral palsy (C.P.) has been attributed to birth related events such as fetal distress, intrapartum asphyxia, and causes that may impair the blood flow to the brain of newborn infants. Recent studies failed to predict accurately the likelyhood of developing CP when these previously accepted risk factors were taken into consideration.

Hypothesis that prenatal and/or genetic aspects may be responsible for cases of C.P. of unknown origin has been accepted by certain investigator.

The higher incidence of C.P. in multiple pregnancies and the possibility of investigating the genetic and environmental background in this population have made twin studies a very attractive model of research.

This study was planned to investigate prenatal and perinatal factors influencing the development of C.P. twins and to evaluate the possible causes of the C.P. in twins.

Sixteen twin C.P. children were evaluted at Department of Rehabilitation Medicine, St. Mary's Hospital, The Catholic University of Korea, School of Medicine, between March 1991 and July 1995.

The results were as follows:

1) 9 (57%) children were low birth weight below 2500 g at birth.

2) 11 (69%) children had prematurity less than 36 weeks at birth.

3) First baby group had more predominent incidence of CP than second baby group.

4) 10 (63%) children were monozygotic twins.

5) Distributions of CP type were spastic diparesis (44%), spastic quadriparesis (37%), and spastic hemiparesis (19%).

6) Fate of co-twin were CP/CP (50%), CP/stillborn (25%), CP/normal (19%), and CP/dead (6%).

7) Radiologic findings were periventricular leukomalacia (4 cases), brain atrophy (4 cases), porencephalic cyst (2 cases), cerebellar degeneration (1 case).

In summary, the data obtained in this study would be helpful for identifying and assessing the children with CP in twin pregnancy.

The main goal of the management of adolescent scoliosis is to prevent progression of scoliotic curve and to prevent or manage the secondary complication, resulting from mechanical effect of scoliotic posture such as pain, functional disability, psychologic problem, cardiopulmonary problem, weakness or paralysis and cosmetic problem. Subjects were 76 male and female adolescent scoliosis inpatients received comprehensive rehabilitation program which consist of scolisis correction exercise, a self-scoliosis correction device using biofeedback mechanism, postural education, heat therapy, breathing exercise and three-point pressure thoracolumbosacral brace for the indicated patients. The effect of the comprehensive rehabilitation therapy for the scoliosis correction were evaluated by calculating the scoliosis correction angle from the initial and followup whole spine AP and lateral views. Overall 92% of patients showed significant improvement of scoliosis (p<0.001). Male to female ratio were 1:2.6 and 85.6% of the scoliosis were idiopathic by etiology. The more severe the initial scoliosis, the more vertebral rotation and the lesser the scoliosis correctability (p<0.0001). Greatest improvement is noted in the patients with 11 degrees to 20 degrees of initial angle. Further observation is needed for the subject group until bone maturation and ceasation of scoliosis progression.

It is well known that temperature affects the parameters of the nerve conduction studies. The purpose of this study is to determine variability of the skin temperature in the different areas of the hand at room temperature. Using Viking IV the temperature was measured at 12 locations in the hand. The average temperature was over 34℃, and the difference among subjects ranged from 2.7 to 4.9℃. We recommended that on nerve conduction studies the hand temperature should be checked and maintained at 34℃ or above preferably at the mid palm area.

Central pain is acknowledged as a complication of patients with spinal cord injuries that interferes with rehabilitative management. In this study objective evaluation of central pain in the patients was tried through the investigation of the digital infrared thermal imaging.

The subjects of this study were 21 injured patients with central pain in the lower extremities and 12 patients without pain who were admitted to the Department of Rehabilitation Medicine, Yonsei University College of Medicine between May 1, 1995 and September 30, 1995. The Mean age of the patients with central pain was 37.2 years old and the mean duration after injury was 9.0 months. The most common characteristic of central pain was a tingling sensation which occurred in 14(60.9%) patients. The distribution of the absolute temperature of the skin surface was between 30.4℃ and 31.5℃ in patients without pain and between 29.3℃ and 30.6℃ in patients with pain. The temperature of the skin surface were significantly lower in the patients with pain at the anterior thigh, anterior leg, dorsal foot and sole.

Our results showed that the skin temperature of patients with central pain was significantly lower than that of the patients without pain. The central pain may influence the autonomic nervous system to regulate the vasomotor activity which could result in the lowered skin temperature.

The purpose of this study was to evaluate cold effect to reduce pain by using visual analogue scale(VAS), two point discrimination and pressure threshold.

The subjects were 26 healthy adults without history of chronic pain, neurological abnormality and psychologic problem.

The results were as follows:

1) The mean temperature which initiated pain and erythema were 10.49℃ and 8.97℃, respectively.

2) As decreasing skin temperature, visual analogue scale(VAS) was decreased and two point discrimination was increased, but the pressure pain threshold was not changed.

3) At basic skin temperature, the VAS of dominant side is higher than that of non-dominant side.

4) Cold therapy of one side of the body doesn't change the sensory parameters of the contralateral side.

This study was due to determine the therapeutic outcome of chronic cervical radiculopathy and the factors which influence the outcome of treatment. The subjects were 53 patients with cervical radiculopathy who had long-standing symptoms over 6 months without upper motor neuron signs. Of theses with chromic cervical radiculopathy, 29 patients were managed with conservative treatment and 24 patients underwent surgical treatment.

Symptomatic improvement was shown in 83% of 29 patients in conservative treatment group and 75% of 24 patients in surgical treatment group, respectively. There was no significant difference between the results of two treatment groups.

In the patients group of conservative treatment, several factors, such as, age, sex, symptoms and radiologic grade, radiologic type, the number of involved roots, traumatic history were investigated whether they have influenced the results of treatment or not. In patients with chronic cervical radiculopathy, there were no factors that influenced the outcome significantly. Of all 22 patients without trauma history, excellent outcome was shown in 5 patients and none of the patients with trauma history. So trauma history should be considered importantly for outcome measurement in patients with chronic radiculopathy and further evaluation of psycho-social status would be needed.

The Hoffman reflex has been used to study integration of the first sacral spinal segment and its afferent-efferent pathway. H-reflexes recorded from other level has not been used routinely because of technical difficulties and lack of normative data.

The objectives of this study were to standardize the parameters of FCR H-reflex and to investigate the clinical availability of FCR H-reflex study in the 6th or 7th cervical radiculopathies.

We recorded the H-reflex from flexor carpi radialis in 60 healthy subjects as control, and 40 patients who were considered to have the 6th or 7th cervical radiculopathies by needle electromyography. The normal subjects were divided into three groups by the length of their upper extremities. The 38 limbs were measured below 80cm(Group A), 46 limbs from 80 cm 89.9cm(Group B), and another 36 limbs above 90 cm(group C). And the latencies of FCR H-reflex were standardized by the length of their upper extremities. We compared the latencies of FCR H-reflexes and the findings from MRI.

The results were as follows;

1) The mean values of the parameters of FCR H-reflex in healthy subjects were 13.86±0.49msec in latency and 1.12±0.67mV in amplitude.

There was no significant difference of the latencies and amplitudes of FCR H-reflexes between sides and sexes.

2) The mean latencies of FCR H-reflex were 13.28±0.38 msec in group A, 13.98±0.28 msec in group B, and 14.08±0.60 msec in group C, and there was significant difference(P<0.001). A single regression equation was calculated for FCR H-reflex as a function of arm length; `Latency of FCR H-reflex=0.047×arm length(cm)+9.9'. This relationship was highly significant(P<0.001).

3) 34 patients(85%) showed abnormal latencies of FCR H-reflexes in group of patients.

4) 4 patients with normal findings from MRI showed normal latencies of FCR H-reflexes.

In conclusion, we present the reference value of the latency of FCR H-reflex and the measurement of the latency of flexor carpi radialis H-reflex in consideration of patient's arm length proved helpful to increase accuracy for diagnosing sixth or seventh cervical radiculopatheis.

The electrodiagnostic findings in 48 patients with Guillain-Barré syndrome were retrospectively analyzed to determine the correlation between elecrodiagnostic findings and the functional outcome. Electrodiagnostic protocol included distal motor latency, amplitude, velocity, the degree of conduction block, motor conduction velocity, and fibrillation potential density. Function was evaluated by functional status index proposed by Miller at nadir, 2 months and 6 months after onset. After 6 months, 13 patients were able to walk independently and 6 patients were ambulatory with varying degrees of impairment. The distal motor latency, the degree of conduction block and motor conduction velocity did not correlate significantly to the functional status index, but the mean amplitude of distal compound muscle action potential and fibrillation potential density were found to be powerful predictors of outcome.

Peroneal motor nerve conduction study is commonly done by recording over the extensor digitorum brevis. Since atrophy of extensor digitorum brevis is not rare, proximal peroneal nerve conduction study is often needed recording over tibialis anterior. To decide optimal position of active electrode in proximal peroneal nerve conduction study, we selected 4 sites between tibial tuberosity & lateral malleolus, and analyzed waveforms of compound motor action potentials in 20 healthy subject.

The best recording site was proximal 2/5 or 40% between tibial tuberosity & lateral malleolus, showing maximal amplitude & optimal waveforms. Mean latency & amplitude at this site were 3.76±0.40 msec and 13.25±1.18 mV, and the mean distance between stimulating & recording elecrode was 13.50±0.85 cm.

In order to investigate the activation site of the facial nerve on the transcranial magnetic stimulation, we studied 113 patients with the hemifacial spasm from March 1994 to December 1995.

The abnormal muscle responses(AMR) of the involved side were measured with the antidromic electrical stimulation, the compound muscle action potentials(CMAP) of both sides were measured with the orthodromic electrical stimulation at the stylomastoid foramen and at the distal nerve branches, and the motor evoked potentials(MEP) of both sides were measured with the transcranial magnetic stimulation at the mentalis and the orbicularis oculi, respectively.

The measured latencies of the AMR were 8.69msec from the mentalis and 9.10msec from the orbicularis oculi, respectively. We calculated the latencies of the AMR using the latencies of the CMAP and those of the MEP to identify the origin of the MEP. The latencies of the calculated AMR were 6.10msec from the mentalis and 6.23msec from the orbicularis oculi. The differences between the measured and the calculated latencies of the AMR were statistically significant(p<0.01).

According to the above results, the actual activation site of the facial nerve on the transcranial magnetic stimulation seems to be the area distal to the origin of the AMR, possibly the labyrinthine segment.

Congenital bilateral perisylvian syndrome(CBPS) is a recently described disease entity characterized by pseudobulbar palsy, dysarthria, epilepsy, mental retardation, and dysplastic lesions in the bilateral perisylvian area on MRI.

Dysarthria is a striking clinical manifestation of this syndrome and recognition of specific pattern of dysarthria, therefore, is very important in diagnosing this disease entity. We investigated the acoustic, aerodynamic, and electrophysiologic characteristics of dysarthria in 9 patients with CBPS using computerized speech laboratory, Visi-Pitch, Aerophone II, Nasometer, and multichannel dynamic electromyography.

In the patients with CBPS, frequency of first and second formants(F1 & F2) of vowel /i, u, o/ and F1 of /e/ were distorted. Breakdown of formant structure and breathiness were also visualized in wide and narrow band spectrogram. The voice onset time, total duration of meaningless three syllables were significantly prolonged, especially for velar and lateral consonants, and diadochokinetic rate was decreased in comparision with normal controls, reflecting disturbance of oral motor control. Aerodynamic study revealed that patients with CBPS had significantly lower mean and peak air flow for stop consonants, which indicate difficulties to maintain the tension of vocal fold during aspiration and phonation. Nasalance was markdly increased as well. Multichannel dynamic electromyography of genioglossus, cricothyroid, and orbicularis oris muscles was carried out in 6 out of 9 patients. This analysis showed weakness of muscle activity in two patients, sustained contractions in other two patients, and combined features in the remaing two patients.

It is concluded that involvement of tongue muscles is the most responsible for dysarthria in patients with CBPS. In addition, velopharyngeal and laryngeal muscles are also contributing in creating dysarthria. The quantitative and qualitative analysis of dysarthria in acoustic, aerodynamic, and electrophysiologic aspects enabled us to understand the underlying pathophysiology, to differentiate it from other types of dysarthria caused by other neurological diseases, and to estimate the efficacy of rehabilitative treatment in patients with CBPS.

Continued rehabilitation treatment and care after being discharged from the hospital are extremely important for patients to achieve an effective and successful rehabilitation management. For this cause, the Department of Rehabilitation, Presbyterian Medical Center has organized home visiting group and send them to the houses of its discharged patients to reeducate them and their assistants. The home visiting group has also evaluated their home care status by using home visit evaluation forms. However, due to the difficulties in evaluating their home care status objectively with our own evaluation forms, this study has utilized the ESCROW Profile to evaluate the home care status and compared with the MBI. A sample of 47 stroke patients and 23 spinal cord injury (SCI) patients was selected and evaluated by both MBI at the time of being discharged and ESCROW profile when visiting their homes.

The results are as follows;

1) The mean scores of the MBI at the time of being discharged were 42.44 for the stroke and 51.95 for the SCI. The mean scores of ESCROW when visiting patients' homes were 14.36 for the stroke and 12.17 for the SCI. These results indicate that the mean score of the ESCORW for the SCI was getting better home care than the stroke patients.

2) The study shows that the result of MBI and ESCORW profile were inversely correlated and that the mean score of MBI for the successful home care group was higher than that of the unsuccessful group. These findings suggested that the more the functional activity, the better the home care status.

3) The study also shows that there are significant differences between the stroke and the SCI in the categories of 'outlook' and 'work or school status' among ESCORW profile.