Transcutaneous electrical nerve stimulation(TENS), Interferential current therapy(ICT) and Laser are commonly used physical modalities for pain relief in the field of rehabilitation medicine. As many other physical modalities for pain relief, the therapeutic benefits have not been confirmed neurophysiologically by animal research, because of its difficulty of applying to animal. But fictive tail-flick test is an animal research model under anesthesia to evaluate pain, which is capable of applying a physical modalities to animal.

To evaluate the pain relieving effect of physical modalities, we measure the latencies of fictive tail-flick reflex in rat before, immediately after and 20 minutes after TENS, ICT and Laser application. And β-endorphin levels in cerebrospinal fluid of rat were measured quantitatively by radioimmunoassay after TENS, ICT and Laser.

The results obtained were as follows:

1) The latencies of both immediately after and 20 minutes after TENS were 49.25±8.29 msec and 48.80±7.32msec were significantly delayed comparing with that of before TENS(32.97±4.79msec). The latencies of both immediately after and 20 minutes after ICT were 43.75±14.48msec and 47.42±15.07msec were also significantly delayed comparing with that of before ICT (33.23±6.76msec). But no significant chages were observed after Laser application.

2) The β-endorphin levels in cerebrospinal fluid were elevated significantly in TENS(68.19±26.03pmol/l) and ICT group(67.77±20.15pmol/l) comparing with control group(52.27±13.22 pmol/l). But no significant changes were observed in Laser group(49.22±14.06pmol/l).

Above results indicates that pain relief by TENS and ICT was confirmed neurophysiologically, which lasted after completion of TENS and ICT, and central descending inhibition of pain by β-endorphin proved to be a mechanism of pain relief by TENS and ICT.

Severity of disability and rehabilitation outcome were investigated using functional independence measure(FIM) in 37 patients with stroke and influencing factors on the final outcome were delineated.

Analysis revealed that FIM score and presence of aphasia at admission were highly correlated with FIM score at discharge(R⒁=0.629, 0.494, p<0.01). The patients with temporal lobe lesion showed significantly lower FIM score at discharge than the patients with lesion in extratemporal area(p<0.05). Subscales of FIM score including `sphincter control', `communication' and `social cognition' were considerly lower in the patients with temporal lobe lesion(p<0.05). The age, type of lesion and involved hemisphere were not significantly correlated with FIM score at discharge.

We conclude that the FIM score at admission, the presence of aphasia and the location of lesion will be a relevant factors in predicting the functional outcome in the patients with stroke.

Hip deformity is one of the most common problems in children with cerebral palsy. Hip subluxation and dislocation are caused by a combination of factors, including neurological immaturity, spastic muscle imbalance, the absence of normal motion and weight bearing, and flexion-adduction contracture of the hip. Hip deformity results in significant morbidity in terms of pain, postural difficulty, interference with ambulation, and difficulty in perineal hygiene.

In many cerebral palsy, rehabilitation therapy is focused on treatments for equinus deformity of the foot that is easily detectable. Hip deformity, however, is not so readily detectable and early opportunities for proper management of hip problems is often missed. It is, therefore, necessary to prevent hip deformity by early evaluation and management of the hip.

The purposes of this study are to determine the proper measurements for hip deformity in young cerebral palsy patients, and the correlation of hip deformity with neurological involvement, ability of ambulation and severity of spasticity.

Thirty-three children with cerebral palsy(mean age: 32months, 22 males, 11 females) were evaluated by measurement of the migration index, acetabular index, central edge angle and neck shaft angle from bilateral hip APs, and 21 children of this group were additionally evaluated by measurement of the femoral anteversion angle from hip ultrasonograms.

The results are as follows:

1) Among the 66 hips, 19 hips(28.8%) were found to be subluxated and none were dislocated.

2) Thirteen hips were above 33.3% on the migration index and had a central edge angle of less than 15°, 1 hip was above 33.3% on the migration index with normal central edge angle and 5 hips had a central edge angle of less than 15° and were within the normal migration index range.

3) Among 42 hips that were evaluated by hip ultrasonograms, 33 hips(78.6%) had increased femoral anteversion angles and 12 of the 33 hips with increased femoral anteversion(36.4%) were found to be subluxated. The migration index value was significantly higher in the increased femoral anteversion group than in the normal group.

4) The incidence of hip subluxation was 50.0% for quadriplegia, 31.6% for diplegia, and 6.3% for hemiplegia. The migration index value for quadriplegia and diplegia was significantly higher than for hemiplegia. The femoral anteversion angle for quadriplegia was significantly higher than for diplegia.

5) The incidence of hip subluxation was 9.1% in independent walkers, 40.9% in dependent walkers, and 36.4% in nonwalkers. The migration index value in dependent walkers was significantly higher than in independent walkers.

6) There were 24 spastic cerebral palsy patients and 17 of the 48 hips of spastic type(35.4%) were found to be subluxated. Only 2 of 18 non spastic hips(11.1%) were found to be subluxated. The incidence of hip subluxation was 25.0% for mild, 32.1% for moderate, and 100.0% for severe spastic types. The migration index for the severe spastic type was significantly higher than for mild.

From the results of this study, we conclude that the migration index and central edge angle are highly correlated with hip subluxation, and the degree of neurological involvement, ability of ambulation and severity of spasticity influence hip deformity in young cerebral palsy patients. Therefore, the measurement of the migration index and femoral anteversion angle at regular intervals may be helpful in early detection and proper management of hip deformity in cerebral palsy.

Spasticity is one of the most troublesome problems in the management in cerebral palsy. This study was conducted to observe the effects of the electrical stimulation therapy to spasticity. 16 cerebral palsy children were treated with reciprocal electrical stimulation on tibialis anterior and gastrocnemius for 6 weeks. Three times of assessments of spasticity, before, immediately after and 24 hours after treatment were made for modified Ashworth scale, passive range of motion, reflex excitability test, ankle T-reflex and gross motor function measure.

The results were as follows:

1) After 6 weeks of electrical stimulation therapy, modified Ashworth scale, gain of the reflex excitability test, amplitude of the ankle T-reflex were significantly reduced and the passive range of motion and ankle dexterity were significantly increased(p<0.05). 2) The reductions of spasticity were maintained for 24 hours 3) The functional improvement measured by gross motor function measure could not be found. The reciprocal electrical stimulation therapy was effective in the management of the spasticity in cerebral palsy children. However we could not find any functional improvement because the duration of treatment was relatively short.

The purpose of this study was to evaluate the occupational history of patients with idiopathic carpal tunnel syndrome and its contribution to the development of the disease.

We reviewed medical records of 160 patients who were diagnosed as having unilateral or bilateral carpal tunnel syndrome by electrodiagnostic study at Seoul National University Hospital 1991 to 1994. Among those whose etiology were considered to be idiopathic, we interviewed 79 patients and evaluated the occupational history.

The summary of the results is as follows:

1) Of the 71 women with idiopathic carpal tunnel syndrome, 31% had occupation or prior occupational history and most said their occupations made them use their hands more severely than those of housewives.

3) There were no difference in symptom severity between patients with and without occupational history but patients with occupational history had showed tendency to have bilateral carpal tunnel syndrome and significantly longer symptom duration.

4) Age at the time of diagnosis showed no difference, but age of symptom onset were significantly lower in patients with occupational history in spite of their relatively lesser burden from housework than those without.

We concluded that occupation had some contribution to the development of idiopathic carpal tunnel syndrome and shortened the time period to develop symptom in women.

Diabetic femoral neuropathy is a syndrome manifested by unilateral or bilateral, often asymmetric muscle weakness and atrophy proximally in the lower limbs. It often accompanied by pain in the thigh and sometimes also in the lumbar and the perineal region. The purpose of this study was to find out the incidence of diabetic femoral neuropathy and to evaluate the factors that influence diabetic femoral neuropathy using peripheral nerve conduction study, and clinical and laboratory findings. Our study was based on 44 cases of diabetes mellitus who were admitted to Wonju Christian Hospital and received electrodiagnostic study.

The summary of results were as follows:

1) Of the 44 cases of diabetes mellitus, 33 (75%) cases were diagnosed as diabetic neuropathy, and in the group of diabetic neuropathy, 18 (54.5%) cases were concomitant with diabetic femoral neuropathy. There was no cases of diabetic femoral neuropathy alone.

2) Major clinical findings of diabetic femoral neuropathy were sensory change in the anterior thigh, atrophy and weakness of the quadriceps muscle, diminished patellar tendon reflex.

3) The risk for diabetic femoral neuropathy significantly increased as the duration of diabetes and the levels of PC 2hr glucose (p<0.01).

4) In the group of diabetic femoral neuropathy, the axonopathy was more prominant than the demyelination.

According to these results, we concluded that the incidence of diabetic femoral neuropathy in diabetic neuropathy was high. From this study it is recommended that femoral nerve conduction study be included with electrodiagnostic study of diabetic neuropathy, especially if the patient has a history of long duration of diabetes mellitus or increased level of PC2hr glucose.

Carpal tunnel syndrome(CTS) is one of the most common peripheral nerve entrapment syndrome. Recently, the effect of wrist flexion and extension posture on median sensory nerve conduction has been considered valuable as an assessment of early CTS. Therefore, we perfomed this study to determine whether flexion or extension of the wrist would produce a change in distal sensory latency of the median nerve and to determine delay pattern on median sensory nerve latency according to a time sequence.

Control group is consist of 15 healthy adults without evidence of peripheral neuropathy and CTS group is consist of 15 patients with evidence of median neuropathy at wrist in conventional nerve conduction study. We measured distal latency and amplitude of median sensory nerve at neutral position of wrist at first, and then with a wrist extension splint, we measured distal latency and amplitude at every 30 second up to 5 minutes. Thereafter, with a wrist flexion splint, we measured the same as above.

The result were as follows: The change in peak latency of the median sensory evoked response after wrist flexion for 5 minutes is 0.05 msec in control group and 0.10 msec in CTS group. There were no significant differences between two groups. The change in peak latency of the median sensory evoked response after wrist extension for 5 minutes is 0.09 msec in control group and 0.19 msec in CTS group. There were significant differences between two groups. The differences between peak latencies of the median sensory evoked response after wrist flexion and extension for 5 minutes were significant. The maximal latency delay occurs within first 30 seconds in both wrist flexion and extension groups of CTS. In wrist flexion group of CTS, most of latency delay occur within 2.5 minutes, in wrist extension group of CTS, latency delay occur up to 5 minutes.

We think that the test of wrist flexion and extension posture by means of wrist splint on median sensory nerve conduction should considered as an assessment of early CTS without evidence of median neuropathy on the conventional nerve conduction study.

The purpose of present study is to compare the results about urinary tract infection between the antibiotic (ofloxacin) administration and bladder irrigation using KM_nO₄ solution in patients with neurogenic bladder.

The most common kind of infectious bacteria was Pseudomonas aeruginosa but Klebsiella pneumonia and Escherichia coli were also common. When ofloxacin was administered, the rate of successive treatment was 70.0%. But when bladder irrigations with KM_nO₄ solution were tried, the rate of successive treatment was only 16.7%. The results were stastically significant.

The treatment results concerned with bladder tone(positive and negative ice water test), voiding method(self-voiding or intermittent catheterization and indwelling catheterization or condom drainage) and disability type(cerebrovascular accident and spinal cord injury) were not statistically significant.

When we treat the urinary tract infection associated with neurogenic bladder, ofloxacin administration is better than bladder irrigation using KM_nO₄ solution.

Urinary tract infection is the most common complication and major cause of death in patients with spinal cord injury. To diagnose a urinary tract infection, it is necessary to examine the bacterial colony count in urine culture study. However, this needs lots of time and costs, equipments, and a specialist for interpretation. Therefore, only the urinalysis is frequently used as a screening test for urinary tract infection.

The purpose of this study were to compare the sensitivity and specificity between bacteriuria and pyuria in the patients who showed positive finding in urine culture study; to evaluate the clinical usefulness of bateriuria and pyuria as a screening test for urinary tract infections in patients with spinal cord injury.

The subjects of this study were 67 cases among the patients with spinal cord injury who were admitted to the Wonju Christian Hospital from January 1991 to March 1995.

The results were;

1) The overall incidence of urinary tract infection was 88.1%, being 85% in men an 100% in women.

2) The sensitivity of the bacteriuria was 57.6 % and the specificity was 87.5%. Whereas the sensitivity of the pyuria was higher at 66.1% and the speciticity was much lower at 62.5%.

3) There was a much higher population in the asymptomatic group, 42 cases(71.2%) in the group of patients with urinary tract infection.

4) We found that 14 species of different organisms in urine culture study. Of all, Escherichia coli was the most common organism.

In conclusion, combined study of both urinalysis and urine culture study is suggested as a screening test in the patients with spinal cord injury.

In thoracic and lumbar burst fractures, neurological status at injury is important factor for understanding of prognosis of spinal problems. Measurement of neurological status is valuable for initial radiological studies and clinical studies.

This study was planned to evaluate the various factors affecting neurologic severity and to estabilish the criteria for neurologic involvement of the thoracolumbar burst fractures.

The results were as follows:

1) Displacement of vertebral body measured on lateral plane X-ray showed significantly difference between paralytic and non-paralytic groups(p<0.01), but there were no differences in kyphotic angle and anterior wedging angle and anterior height loss between two groups.

2) A-P diameter of compromised neural canal and percent of compromised surfare of neural canal showed significantly differences between paralytic and non-paralytic groups(p<0.01).

3) There was neurological deficits in cases with displacement of vertebral body higher than 5.3mm, compromised area of neural canal higher than 39.6%, A-P diameter of compromised neural canal less than 7.99mm.

An objective tool for diagnosing and grading lesions of the inferior alveolar nerve was needed because the nerve may be damaged after removal of mandibular third molars, mandibular osteotomies, fractures, tumors, and infections. So this study was performed to establish Korean normal adults' values and to evaluate the normal physiology of blink reflex with stimulation of the mental nerve. The mental nerve blink reflex responses were studied in 30 healthy volunteers, 18 men and 12 women, and its R2 latencies were measured and analysed. The mental nerve blink reflex responses were all evoked and consisted of an ipsilateral late(R2) component and contralateral late component with similar latencies. Eye closure resulted in facilitation of the mental nerve blink reflex in the form of latency shortening. The latencies were longer and the responses were easily habituated by repetitive stimulation, compared with the blink reflexes with supraorbital nerve stimulation. And no right-to-left latency difference was observed.

The mental nerve blink reflex test was easy to perform and offered equally consistent results and valuable objective informations in diagnosing of inferior alveolar nerve injury, so the test enables further clinical application.

The facial nerve was evaluated by electrical and magnetic stimulation in 20 normalcon-trols and 30 brain injured patients who had facial palsy clinically and participated in the rehabilitation program. The facial nerve injury was classified by central and peripheral types based on neurological examinations. Latency, amplitude, and peripheral, and central conduction time(PCT, CCT) were estimated by stylomastoidal, transcranial, and cortical stimulations.

The results were as follows;

1) At stylomastoidal, transcranial and cortical stimulations, there was no significant difference in mean latency and mean amplitude between both sides of the controls and intact side of the facial nerve injured groups.

2) At cortical stimulation, there was significant difference in mean latency and mean amplitude between involved side and intact side in the central facial nerve injured group.

3) At stylomatoidal, transcranial and cortical stimulations, there was significant difference in mean latency and mean amplitude between involved side and intact side in the peripheral facial nerve injured group.

4) There was significant difference in central conduction time between involved side and intact side in the central facial nerve injured group.

5) There was significant difference in central & peripheral conduction times between involved side and intact side in the peripheral injured subgroup that shows prolonged central conduction time beyond 2 standard deviation than that of controls.

6) There was significant difference in peripheral conduction time between involved side and intact side in the peripheral injured subgroup that shows prolonged central conduction time within 2 standard deviation than that of controls.

In conclusion, magnetic stimulation can be used for electrodiagnostic tests in differential diagnosis of central and peripheral facial nerve injuries.

Motor evoked potentials(MEP) were elicited in the thenar muscles of 32 normal subjects via transcranial magnetic stimuli to obtain normal parameters of MEPs as well as a standard methodology, and to evaluate the significance of excitability threshold in neurophysiologic and clinical investigation. The threshold intensity was determined at relaxed state and MEPs were recorded with suprathreshold stimuli during voluntary contraction. Central motor conduction time(CMCT) was 8.16±1.02msec in non-facilitation and this value was shorten to 5.99±0.81msec with facilitation and not affected with stimulus intensity. The intensity of excitability threshold was 62.9±11.4%/65.9±9.7% (right/left), CMCT was 6.04±0.81/5.94±0.82msec (right/left) in MEPs recorded from abductor pollicis brevis muscle. Increased threshold was found in aged group(>40 years), but CMCT was not correlated with age. The threshold intensity was correlated with visual and auditary simple reaction time, but CMCT was not correlated. We conclude that it is desirable to investigate MEPs by 120% stimulus intensity of excitability threshold in minimal voluntary contraction (facilitation) as the standard method in clinical investigation. The excitability threshold may be involved in the excitability of central neural network and the high cortical motor function as well as the excitability of pyramidal tract and spinal motor neuron pool.

548 Korean high school girls and 565 high school boys were preliminarily screened for spinal deformities including scoliosis, thoracic kyphosis and lumbar lordosis by forward bending test and physical examinations and three dimensional skeletal analysis system. The subjects were confirmed for scoliosis by whole spine radiography, which was seen a Cobb's angle of more than 10 degrees. The difference of scoliosis prevalence rate, degree of curvature, pattern and direction of curvature between female and male high school students were evaluated. The overall scoliosis prevalence rate screened by three dimensional skeletal analysis system as angle of more than 10 degrees was 17.8% in female and 8.1% in male. 12.4% of the cases in female and 9.2% in male showed thoracic kyphosis of more than 45 degrees by three dimensional skeletal analysis system.

In addition, lumbar lordosis of more than 50 degrees was seen in 0.4% of female cases and 0.5% of male cases. 44 out of 96 female students and 29 out of 46 male students who revealed estimated scoliosis angle of more than 10 degrees by three dimensional skeletal analysis system took the confirmative radiographical study, which revealed the prevalence of scoliosis as a 33 out of 548(6.0%) cases in female and 19 out of 565(3.4%) cases in male with Cobb's angle of more than 10 degrees.

Isokinetic measurement of trunk strength is a reliable and objective method if affecting factors are controlled well. Authors wanted to know the relationship between the constitutional factors of subjects and data from isokinetic trunk strength measurement. Fifty three healthy volunteers were measured for body weight, height, chest circumference and waist circumference as constitutional factors. After warming-up exercise for 5 minutes on bicycle ergometer, trunk strength measurement for flexor and extensor was done using isokinetic instrument with trunk unit. Four repetitions at 4 different angular velocities(30°/sec, 60°/sec, 90°/sec, 120°/sec) with 24 seconds of resting interval between each angular velocity were done. With the resulting isokinetic data, comprehesive parameters such as average performance ratio(APR) and muscle performance index(MPI) were calculated. Normative data of peak torque, peak torque angle, total work, APR and MPI were obtained. MPI was highly correlated with height and body weight(r>0.7, P<0.001), moderately correlated with waist and chest circumference(r>0.4, P<0.01). In multiple regession analysis, APR and MPI could be explained well by constitutional factors(r²>0.6, P<0.05).

It has been reported that electrical stimulation of nerves brings about changes of the anterior horn cell excitability and the nerve conduction in vivo and in vitro. The purpose of this study is to evaluate the electrophysiologic changes by 90-100Hz electrical stimulation of distal peripheral nerves. The conditioning stimulation was applied to 20 healthy subjects that was the interferential current of 90-100 Hz frequency under the maximal tolerable intensity(average 30mA). The site of conditioning stimulation was the distal tibial and peroneal nerves of one foot. Before and after conditioning stimulation, we investigated the peripheral nerve conduction, the H reflex, the F wave, and the somatosensory evoked potential(SEP) of the ipsilateral tibial nerve proximal to the conditioned site. The latency of tibial motor conduction, the latency of H reflex, the duration of F wave, and the P1 latency of tibial nerve SEP were increased significantly(P<0.05), and the F ratio was decreased(P<0.05) by the conditioning stimulation. The amplitude and the duration of tibial motor conduction, the amplitude of H reflex, the H/M ratio, the duration and the conduction velocity and time of the F wave, the P1N1 amplitude of tibial nerve SEP, and the latency of sural and postrior femoral cutaneous sensory conduction were not changed by conditioning stimulation. These results suggest that certain conditioned electrical stimulation of distal peripheral nerves can bring about the inhibitory effect to the alpha motor fiber conduction and to the conduction related with sensory activity in the spinal cord.

Motor unit characteristics (amplitude, area, duration, phase, turn and polyphasic MUAP) were measured using a monopolar needle and narrow bandpass (500Hz to 10kHz) in paracervical muscles in 51 subjects (26 men and 25 women) aged from 18 to 66 years (mean age, 39.14 years). Motor unit action potentials (MUAP) were analyzed with the decomposition method.

1) Mean values of MUAP parameters were as follows: amplitude 745.24±295.19μV, area 491.51±218.23μVms, duration 4.14±0.56msec, phase 3.48±0.35, turn 3.18±0.49, polyphasic 14.28±11.49%.

2) Mean values of amplitude and area were significantly higher in men than in women (P<0.01).

3) Mean values of MUAP parameters of paracervical levels were not significantly different.

4) MUAP parameters showed no significant correlation with age.

Paracervical MUAP analysis can be used to increase the diagnostic yield.

The purpose of this study was to investigate electrophysiologic changes of dynamic F waves between rest and postexercise in neurogenic claudication and to evaluate diagnostic sensitivity of dynamic F wave. To improve the sensitivity of F wave, we designed averaging technique after alking for 20 minutes with back extended, and termed it as dynamic F wave. Walking for 20 minutes produced either increased F mean latency and F chronodispersion or unelicitability. These changes after postexercise suggested ischemic induced conduction block and slowing in proximal motor axons. So, we studied 30 healthy controls and 30 patients with neurogenic claudication.

The results were as follows;

1) In control group, conventional conduction studies and dynamic F waves were statistically insignificant.

2) In patient groups, conventional conduction studies were insignificant, but dynamic F waves were statistically significant.

3) Among patient groups, spinal stenosis and lumbosacral radiculopathy had more effect on dynamic F waves than herniated intervertebral disc.

4) Diagnostic sensitivity of dynamic F waves was 40% in patient groups.

In conclusion, dynamic F waves are not sensitive technique in the diagnosis of neurogenic claudication, but it increase the specificity of the electrophysiological investigation in relation to particular clinical features by positional change in spinal stenosis and herniated intervertebral disc.

The effects of ankle position on H-reflex were studied in 40 healthy subjects. Ankle position was maintained passively by means of the foot-plate in control position, that is neutral (dorsiflexion 0° and plantarflexion 0°), dorsiflexion 10 degree, 20 degree, plantarflexion 10 degree, 20 degree, and maximal plantarflexion. H-reflex excitability was evaluated by the ratio of the threshold of H-reflex to that of M-wave (H/M threshold), and the ratio of maximal amplitude of H-reflex to that of M-wave (H/M amplitude).

The results showed that H/M threshold and H/M amplitude were decreased at dorsiflexed position compared with those at neutral position. Thus dorsiflexed ankle position might modulate the α-motor neuron excitability of H-reflex. But there were no significant changes in H/M threshold and H/M amplitude during plantarflexion up to 20° compared with those at neutral position. At maximal plantarflexed position it was also observed that there was decremental H/M amplitude, but there was no change in H/M threshold, so, it might be due to change of recording muscle status. H-reflex of just below M-wave threshold resembled the maximal H-reflex, and it also might represents the α-motor neuron excitability of H-reflex.

In case of prone position with ankle out of bed, ankle position would be about 20 degree plantarflexed if a person had no ankle joint contracture. It is suggested that measuring the H-reflex, there is no need to make the ankle neutral strictly, if not dorsiflexed.

Difference of the H-reflex latency as measured by electromyography is known as a useful diagnostic test for lumbosacral root syndrome.

The H-reflex and Achilles tendon reflex(ankle jerk) utilizes similar neural pathways, except that the H-reflex method bypasses the muscle spindle.

The T-reflex method was found to be simple, time conserving, non-invasive, and provided a quantitative measure of the NCVs of the peripheral nerve and lumbosacral root syndrome. Thus, it may be useful for the early detection of related impairment of the peripheral nerve and lumbosacral root.

The authors performed an achilles tendon reflex test by the electrical hammer method which utilizes similar electrophysiological pathways as the H-reflex method. We also studied the usefulness of this method in comparison to the H-reflex method.

Method: A comparative study between the H-reflex and T-reflex was carried out from January 1995 to January 1996. The control group for this study contained 32 healthy participants who had had no previous problems with their lumbosacral area. The experimental(patient) group consisted of 24 patients who had visited the RM OPD during this period and were diagnosed with lesions using MRI and Needle EMG. The EMG was carried out using the Saphire 4ME by Medelec and an electrical hammer. All of the participants in the study were examined while they were in the prone position.

The results are as follows:

The average latencies of the control group were 27.85msec and 29.65msec using the H-reflex and T-reflex respectively. However, taking into account the age and height differences of the members of the control group, the difference in the average latencies were found to be insignificant(p>0.05). Furthermore, 19 cases or 79.2% of the experimental(patient) group were found to be abnormal using the H-reflex method, while the T-reflex method found 17 cases or 70.8% to be abnormal. Combining the H-reflex and T-reflex methods, 17 cases or 70.8% were found to be abnormal. From this study the authors have concluded that there is no significant difference between the results using either the H-reflex or the T-reflex methods.

The purpose of this study is to demonstrate the effects of low power laser irradiation on the superficial radial sensory nerve conduction. Both forearm of twenty three healthy adults were irradiated helium-neon and infrared laser by Helium-Neon 12 Combi Scanner(Felas co.). Average intensity was 23mW, irradiance was 23 mW/cm² and fluence was 0.69 J/cm²-13.8 J/cm². No significant changes were noted among pre-laser test, during laser test(1 min, 5 min, 10 min) and post-laser test(after 5 min, 60 min) in the superficial radial sensory nerve conduction (latency, amplitude, duration). We concluded that applied intensity of helium-neon and infrared laser irradiation in our laboratory wasn't alter conduction of superficial radial sensory nerve conduction study in normal adults.

This study was conducted to compare the effects of transcutaneous electrical nerve stimulation(TENS) and silver spike point(SSP) therapy on experimental pain threshold.

Thirty healthy adult male and female subjects were assigned randomly to a treatment group or to a control group. Experimental pain threshold at calf was determined with pain threshold of electrical stimulation and nociceptive flexion reflex. Only the group receiving TENS or SSP exhibited a significant increase in experimental pain threshold. The comparable control group did not exhibit significant pretest-posttest difference in experimental pain threshold. In treatment group, no significant differences were observed between the pain thresholds after TENS and SSP therapy.

The results suggest that TENS and SSP therapy can increase pain threshold and the effects on pain threshold are the same.

The purpose of this study is to evaluate the effect of trigger point injection on the motor point in the chronic pain produced by untreated radiculopathy. The clinical manifestations of the radiculopathy include dermatomal, myotomal and sclerotomal changes. The tenderness of the motor point is the one of myotomal changes of the radiculopathy.

We studied 78 radiculopathy patients confirmed by electromyography, MRI, CT or myelography and classified into 4 groups(A: 4th lumbar radiculopathy, B: 5th lumbar radiculopathy, C: 5th lumbar and 1st sacral mixed type, D: 1st sacral radiculopathy) by the distribution of the radicular pain, dermatomal change and motor weakness. The patients were taken drug, physical theraphy and trigger point injection on the muscles of relevant myotome. 30 radiculopathic patients taken only drug and physical theraphy were studied for control.

The VAS(Visual Analogue Scale) improvement ratio of the study group was 64.7% and the control group was 40.9%(p<0.01).

This study was designed to investigate the effect of hot pack or cold pack application on the soreness after injection into a myofascial trigger point of the upper trapezius muscle in 45 patients.

All patients were injected on the trigger points and divided into 3 groups: hot pack, cold pack and control groups. Hot and cold packs were applied in each 15 patients of hot and cold pack groups, respectively for 20 minutes after trigger points injection, and no pack was applied in 15 patients of control group.

A degree of improvement of postinjection soreness was assessed by the subjective pain intensity(visual analogue scale; VAS) and the pressure pain threshold of trigger point using pressure algometer. The VAS was assessed 20 minutes, 24 hours, 48 hours, and 72 hours after trigger point injection with hot pack or cold pack application. The pressure pain threshold was assessed before injection, immediately, 20 minutes, and 3 to 7 days after injection with hot pack or cold pack application.

Significant improvement of pressure pain threshold was observed at 3 to 7 days after injection in the hot pack group. On the other hand, the VAS was significantly decreased at 20 minutes, 48 hours, and 72 hours after injection in the hot pack group.

Therefore, hot pack application after injection is helpful to decrease the post injection soreness.

Somatosensory Evoked Potential(SEP) study was useful for the electrodiagnostic evaluation of the peripheral nerve, spinal cord and cerebral cortex.

SEPs were recorded on the Erb's point, C5 spinous process and scalp in response to median, ulnar and radial nerve stimulation at the wrist of 25 normal subjects.

The purpose of this study was to provide Korean standard value of upper limb short latency SEP. Following results were obtained.

1) The mean latencies of the N9, N13, N20 potentials were 9.62±0.53, 13.14±0.71, 19.06±0.88msec; 9.93±0.59, 13.93±0.96, 19.58±1.03msec; 10.81±0.87, 14.96±1.13, 20.87±1.17msec respectively in median, ulnar and radial SEPs.

2) The mean amplitudes of the N9, N13, N20 potentials were 5.03±2.25, 2.42±0.75, 6.57±2.61mV; 2.50±1.31, 1.30±0.58, 3.45±1.58mV; 1.18±0.50, 0.74±0.17, 2.34±1.31mV respectively in median, ulnar and radial SEPs.

3) There was significant correlation between the arm length and the latency, and between the height and the latency.

Vestibulocollic reflex(VCR) which stabilizes head position in space is essential for adequate motor performance, maintaining balance and posture. Vestibulocollic reflex evoked by acoustic stimulation was measured by the averaged surface myoelectric signal of the sternocleidomastoid muscles. The sound stimulation(0.1 msec, 95 dB, 5 Hz click) through headphone was given to the ears bilaterally and electromyography were recorded from surface electrode over the sternocleidomastoid muscles and averaged simultaneously.

The P1 potential latency was 11.33±0.97 msec, N1 19.67±2.64msec, P2 25.91±3.26msec, N2 31.38±3.39msec and P3 40.44±3.64msec. The P1N1 potential amplitude was 45.26±20.82μV and N1P2 potential amplitude was 26.42±16.34μV. The P1 and N1 potentials were present in all subject, but P2, N2 and P3 potentials were present in most but not all subject.

Brainstem auditory evoked potential study was performed in 20 healthy young adults with earlobe recording and nasopharyngeal wall recording techniques. The peak latency, interpeak latency and amplitudes of five waves were evaluated to compare the clinical usability of the two methods and to understand the relationship between the waves and generator sources. Active electrode was placed at the ipsilateral earlobe with silver-silver chloride surface, disk electrode in earlobe recording technique. For nasopharyngeal wall recording, we designed specific recording electrodes which are made of silver bulb (diameter 2.5mm) with 10cm extended insulated lead. The tip of the recording electrode is placed at the nasopharyngeal wall through nasal cavity to approach anatomically closer site from the generator sources, brainstem. The reference electrode was placed at Fz in both methods. Nasopharyngeal wall recording reveals longer peak V latency, larger amplitude in peak II and IV, and smaller amplitude in peak III than ear-lobe recording (p<0.05). The difference may be originated from the change of anatomical and spatial orientation between active electrode and potential generator sources.

Event related potential(ERP) can be evoked by psychological or cognitive internal events.

The purpose of this study was to determine the mean latency and mean amplitude of ERP as a property of P300 in 20 controls and 35 patients with traumatic brain injury(TBI) who were classified into three groups based on the Glasgow Coma Scale(GCS).

The mean latency and the mean amplitude of P300 were 309.9±21.0msec and 4.27±1.79 μV respectively in normal controls. The mean latency of P300 was prolonged with statistically significant in the moderate and severe TBI patients, but not in mild TBI patients. In all three groups of TBI patients, the mean amplitude was reduced, which is not statistically significant. The degree of severity of injury was positively correlated with the mean latency of P300 in patients with TBI.

In conclusion, these findings are suggestive that the latency of P300 may be useful in electrodiagnostic assessment of patients with TBI.

Energy expenditure in walking is increased in various condition such as flexed knee, or extended knee. By evaluating the oxygen consumption rate of walking with knee flexion restriction, we suspect which degree takes less energy for walking in the patient with flexion contracture.

Twenty healthy adult men participated in this study. The flexion restriction of the knee was performed by wearing the dial-lock brace by 10 degree interval(from 70° to 0°). Each volunteer was studied at comfortable and fast walking speed(61.6m/min, 93.8m/min).

At comfortable walking speed, without brace takes 15.4ml/kg/min, with brace no restriction takes 15.4ml/kg/min, 60°flexion restriction takes 15.9ml/kg/min, 40°flexion restriction takes 16.6ml/kg/min, 20°flexion restriction takes 17.1ml/kg/min, 0°flexion restriction takes 17.9ml/kg/min, the oxygen consumption rate was increased gradually until complete flexion restriction.

At fast walking speed, free walking(without brace) takes 24.2ml/kg/min, with brace no restriction takes 25.0ml/kg/min, 60°restriction takes 26.6ml/kg/min, 40°restriction takes 28.3 ml/kg/min, 30°restriction takes 31.9ml/kg/min, 0°restriction takes 33.7ml/kg/min, the oxygen consumption rate was showed remarkable increase between 40° and 30°flexion restriction.

The effect of cognitive-behavioral therapy on chronic low back pain and associated physical and psychosocial disability was evaluated. 40 chronic low back pain patients were assigned randomly to a control(conventional therapy, group ⸁ and the cognitive-behavioral treatment(conventional therapy plus cognitive-behavioral therapy, group ⸂ Cognitive-behavioral therapy was performed by 6 sessions. Patient-self reports and observational measures were obtained pretreatment and posttreatment. Pain intensity of group 2 was decreased and depressive symptom, dysfunctional attitude and pain disability of group 2 were significantly improved compared with that of group 1.

We conclude that cognitive-behavioral therapy on chronic low back pain should be recommended.