The purposes of this study were to measure the normal value of peak torque of lumbar extensors at various degrees of lumbar flexion and to compare this with the chronic low back pain patient. 100 normal subjects, 70 men(age, 49.0±5.3) and 30 women(age, 48.1±7.4), completed isometric lumbar extension strength test. 26 low back pain subjects, 9 men(age, 35.3±14.7) and 17 women(age, 42.6±10.1), completed isometric lumbar extension strength test. Normal male peak torques of lumbar extensors were 125±38 Ft-lbs at 0 degree, 164±43 at 12 degree, 200±43 at 24 degree, 221±46 at 36 degree, 241±50 at 48 degree, 257±50 at 60 degree, and 262±51 at 72 degree of lumbar flexion. Normal female peak torques of lumbar extensors were 78±24 at 0 degree, 105±27 at 12 degree, 120±38 at 24 degree, 135±35 at 36 degree, 142±37 at 48 degree, 151±40 at 60 degree, and 157±41 at 72 degree of lumbar flexion. Normal peak torques of lumbar extensors increase as degrees of lumbar flexion increase. Body weight is more correlated with peak torque than body mass index. Male peak torques of lumbar extensors with low back pain were 91±47 Ft-lbs at 0 degree, 129±46 at 12 degree, 156±57 at 24 degree, 178±61 at 36 degree, 197±54 at 48 degree, 217±61 at 60 degree, and 218±52 at 72 degree of lumbar flexion. Female peak torques of lumbar extensors with low back pain were 45±24 at 0 degree, 73±28 at 12 degree, 98±32 at 24 degree, 117±44 at 36 degree, 130±40 at 48 degree, 138±41 at 60 degree, and 148±36 at 72 degree of lumbar flexion. Peak torques of lumbar extensors with low back pain increase as degrees of lumbar flexion increase. Comparison of the normal male peak torque of lumbar extensors with low back pain group revealed statistical differences at 48 and 72 degree of lumbar extensors. And the female group revealed statistical difference at 0, 12, and 24 degree of lumbar flexion.

Dysphagia is a disorder of the swallowing mechanism and presents a major problem in the rehabilitation of stroke patients. In the present study, computerized laryngeal analyzer (CLA) was used for noninvasive assessment of the pharyngeal phase of the swallowing mechanism. Laryngeal elevation was measured with pressor sensor placed on the skin over the thyroid cartilage. In the study, CLA was applied at each posture of neck flexion, neutral, and extension in stroke group and control group. Significant differences were found in each of these parameters measured in control group and stroke group. The quantitative measurements may aid the physician in choosing the appropriate therapy during the course of recovery.

The onset latency of swallowing was delayed in stroke group than control group at all posture of neck(p<0.05). The pharyngeal transit time (PTT) was longer at extension than flexion and neutral posture of neck in stroke group(p<0.05). The PTT was longer in stroke group than control group at all posture of neck, but not significant(p>0.05). The amplitude of swallowing was decreased in stroke group at extension and neutral posture of neck compared to those of control group(p<0.05), but there was no significant difference between stroke group and control group in neck flexion (p>0.05).

The purpose of this study was to find prognostic indicators of dysphagia recovery after stroke. 26 dysphagic patients with history of aspiration divided into two groups, oral feeding group and persisting aspirating group(continue tube feeding after acute stage of stroke rehabilitation). We evaluated the neurologic locus of stroke lesion, Functional Independence Measure(FIM) score, parameters of the bedside swallowing test and videofluoroscopic modified barium swallow. The neurologic locus of stroke lesion was not correlate with the recovery of aspiration due to stoke. The low FIM score(less than 50), large amount of pharyngeal residue, decreased clearing ability of residue, and delayed pharyngeal transit time(over 3 sec) were bad prognostic indicators of dysphagia recovery. We may use these criteria for the recommendation of continuous tube feeding especially, Percutaneous Endoscopic Gastrostomy(PEG) in dysphagic patients after stroke

The oropharyngeal swallow of 26 patients with dysphagia was studied quantitatively and qualitatively using videofluoroscope. Videofluoroscopic examination was done with head in neutral position, and with three different consistency of test meals; thin liquid, thick liquid, and solid. When aspiration or laryngeal penetration was noted in neutral position, the study was repeated with different head positions. We compared them with each other and with 25 normal subject(previously presented).

11/26(42%) patients revealed laryngeal penetration or aspiration at least with one consistency of test meal. Aspiration occurred more frequently in thin liquid than thick liquid or solid. Head position change successfully eliminated aspiration in 10/10 patient(100%). Other one patient could not change his head position.

9 numerical parameters were derived and calculated for quantitative examination. Liquid meal oral discharge time, pharyngeal delay time, and pharyngeal transit time were significantly increased in patients with aspiration than in patients without aspiration. Also significantly increased than those of normal controls.

Because different test meal consistency gave different values, direct comparison of values regardless of meal consistency was fruitless. And because all the process of swallowing cannot be expressed as numerical parameters, qualitative examination of videofluoroscopic result was essential.

In conclusion, liquid meal oral discharge time, pharyngeal delay time, and pharyngeal transit time were useful parameters in differentiating and quantifying dysphagia. Aspiration can be reduced when appropriate position assumed. Calculated values were different according to the consistency of the test meal. Quantitative analysis was helpful, but qualitative examination of videofluoroscopy was essential.

Shoulder pain is the one of the most frequent and serious complicatsion in hemiplegia, which impedes effective rehabilitation. A prospective study was performed to evaluate the shoulder pain, related causative factors and radiologic findings in 35 stroke patients. Triphasic bone scan and simple radiologic evaluation of shoulder were performed at the beginning of rehabilitation treatment. The degree of shoulder pain, spasticity, passive range of motion(ROM) and subluxation were evaluated weekly and followed up for at least 3 months.

The incidence of shoulder pain was 62.9%(22/35). It developed in 5.7±2.7 weeks after the onset of stroke. The muscle tone was increased slightly and mean modified Ashworth scale was 0.77±0.69 at the onset of shoulder pain. The duration of flaccid stage was longer in patients with shoulder pain than in patients without shoulder pain. The degree of spasticity was inversely correlated well with shoulder pain(r=-0.43, P<0.05). The shoulder pain was also correlated well with the degree of uptake in triphasic bone scan(r= 0.61, P<0.05). The more limited ROM of shoulder presented, the more severe pain was. However, there was no relationship between shoulder pain and the degree of subluxation.

Therefore, a special precaution is needed to prevent shoulder pain in flaccid stage and the triphasic bone scan is a useful study in predicting shoulder pain in hemiplegic patients.

Ability to control postural balance is a prerequisite for standing and gait training during the period of rehabilitation in patients with balance disorder. Precise and quantitative assessment of balance deficit as well as development of effective training methods are the important areas of research in this field.

The purposes of this study are ⸁ to assess the test- retest reliability and clinical feasibility of Computerized Balance Evaluation and Training System(COBETS) developed by Department of Medical Engineering and Department of Rehabilitation Medicine at Chonbuk National University and ⸂ to quantitatively assess the static and dynamic postural control ability of the patients with balance disorders due to various causes using COBETS and compare them with the results of normal control subjects.

The subjects consist of 21 patients with brain damage by stroke, head injury, or surgical procedure to control intractable epilepsy, 5 patients with lower extremity amputation, 6 patients with unilateral total hip replacement, and 50 normal control subjects. Fifteen out of 50 normal control subjects performed subsequent two trials to evaluate the test- retest reliability of the COBETS. There was no statistically significant difference between the results of first and second trials in static and dynamic postural sway measured by COBETS. Therefore, the COBETS is considered to have sufficient test- retest reliability. In the patients with brain damage, amputation, and hip joint replacement, static postural sways during comfortable, narrow, and affected one- leg stance were significantly increased than normal control subjects. Abnormal results in somatosensory evoked potential study and presence of motor weakness were negatively influenced to the results of static postural sway. In all the patients groups, the movement time, path error, and peripheral sway were markedly increased in forward and affected lateral directions compared with normal subjects. Abnormal sensory and motor findings also negatively influenced to some parameters of dynamic postural control. However, there was no difference in the postural sway among the patients groups divided by the causes of balance disorder.

The COBETS is considered as a reliable and clinically useful tool for quantitative assessment of static and dynamic postural control in the patients with balance disorders. Its usefulness for the training of balance control is subject to be defined in future.

Traumatic spinal cord injury causes profound changes in blood pressure, pulse rate and cardiac rhythm. Because the cardiovascular system is highly dependent on autonomic influences, acute spinal cord trauma might interfere with the complex mechanisms involved in cardiovascular homeostasis. These abnormalities has been generally attributed to autonomic instability. However, relatively little attention has been paid to the acute aspects of autonomic dysfunction in humans.

Therefore, this study was performed retrospectively on 62 patients with acute spinal cord injuries to evaluate incidence, time course and severity for cardiovascular instability. In this study, the incidence of persistent bradycardia and hypotension in the cervical injury group was significantly higher than that of the thoracolumbar injury group. These signs occurred earlier in the cervical group than the thoracolumbar group and also lasted longer in the cervical group. This study suggests that there is a direct correlation between the level of spinal cord injury and the incidence of cardiovascular problems.

The McGill Pain Questionnaire consists primarily of 3 major classes in word descriptors-sensory, affective and evaluative-and is used in the studies of clinical and experimental pain. The purpose of the study is to analyze characteristics of the central pain in patients with spinal cord injury and to compare with the musculosleletal pain using McGill Pain Questionnaire(MPQ) Korean version.

The subjects of this study were ninety-nine patients with spinal cord injury who were admitted to Ajou University Hospital or registered with other social agencies, and thirty patients with musculoskeletal pain who were treated at the rehabilitation medicine out patient clinic of Ajou University Hospital. Central pain had significantly higher sensory, miscellaneous and total scores of MPQ Korean version than the musculoskeletal pain. There were no correlations between visual analogue scale and each dimension of MPQ Korean version except evaluative dimension in central pain. Central pain had significantly higher scores than musculoskeletal pain in subclasses such as spatial, punctate, incisive, thermal and coldness. The most frequently chosen words were "radiating"(46%) in central pain and "throbbing"(32%) in musculoskeletal pain of all subjects.

In conclusion, the central pain has no difference in pain intensity but shows bizzare and diverse character compared with the musculoskeletal pain. Authors suggest that MPQ Korean version can be an useful measuring tool for the evaluation and the follow up of the central pain of spinal origin.

Purpose: The purpose of this study is to find out the immediate effect of motor point block using phenol on the degree of spasticity and the gait patterns of children with spastic cerebral palsy and then to ascertain the cases to which these findings are most beneficial.

Subjects & Methods: We injected 5% phenol into spastic muscles of 33 cases with spastic cerebral palsy under the electromyographic monitoring. The clinical evaluation for type and severity of cerebral palsy was performed before the block and then, observations on both the degree of spasticity using `modified Ashworth scale' and the range of motion were made before and after the procedures. Finally, the gait patterns before and after block were analyzed by using locomotion rating scale for gait analysis.

Results: The degree of spasticity, which was measured with modified Ashworth scale, was reduced dramatically through our phenol block - i.e. from 2.8 to 1.2 -. The limited range of motion in some cases was not increased significantly after block. The constant pes equinus state resulted in the state that heel contact is occasionally possible. There was also much improvement in genu recurvatum and scissoring tendency, while little change was observed in crouch gait and hind foot instability. The speed of gait, deviation to normal gait and instability in walking were improved significantly after block, but their locomotion state was still moderately incomplete. When comparing the different outcomes of motor point block with one another according to the severity, the cases in moderately disabled state improved most dramatically. The group with both high degree of spasticity and the full range of motion in their joints improved by far the better after motor point block.

Conclusion: The immediate effect of motor point block with phenol solution can be best described as a dramatic relief of spasticity and tip toeing. but other problems such as other abnormal gait patterns and locomotion activity or state improved little, if any. The moderately disabled children with both high degree of spasticity and the full range of motion in their joint could get the best of our findings.

Since the myofascial trigger point(MFTrP) has been described fifty years ago, its underlying pathophysiology has been remained unclear. The diagnosis also depends on the characteristic pain, tenderness and physical findings, which is very subjective. In recent years, some physicians investigated the objective findings of MFTrP, using the pressure algo meter and thermography. We investigated the electromyographic findings of MFTrP to evaluate the clinical usefulness of local twitch response(LTR) and sympathetic skin response(SSR), and to evaluate the electrophysiologic characteristics of MFTrP.

21 patients, diagnosed as myofascial trigger point syndrome on upper trapezius and so on, were evaluated for the triggering pain with visual analog scale(VAS), pressure threshold(THpr) using pressure algometer(Dolorimeter), LTR with concentric needle electrode and SSR on the palm. There was a significant negative correlation between VAS and THpr, but no significant correlation with electromyographic findings of LTR. Thus LTR could support the existence of MFTrP electrod iagnostically, but, could not explain the clinically correlated severity of MFTrP. There were only 3 patients showing abnormal SSR, who were all complaining the sympathetic symptoms on the affected arm with reffered pain. Even though referred pain to arm and hand existed, SSR was normal because suggested autonomic dysfunction of MFTrP is localized mechanism.

Among the 13 patients underwent the trigger point block, 8 patients who showed no residual LTR immediate after MFTrP block, had a great symptomatic improvement of MFTrP in a week, but 5 patients who showed the residual LTR did not. Regardless of complaint of pain and soreness immediate after block, loss of LTR would be predicted as a good treatment result.

In some cases, spontaneous EMG activity exist within the 3-4mm sized focus of MFTrP, although the taut band of MFTrP is 3-4cm length and depth. But this focus of MFTrP is a electrophysiologic changes within a muscle, not a structural changes seen by ultrasonography.

Duchenne muscular dystrophy(DMD) is an X-linked recessive disease, caused by the mutation of dystrophin gene at Xp21. The dystrophin produced by this gene is therefore absent on the membrane of muscular fiber in the patients with DMD. Recently, it is known that the dystrophin has also been located on the myoepithelial layer of sweat gland in the mice.

We studied the sympathetic skin response(SSR) in a group of DMD patients and a control group to evaluate the function of sympathetic nerve and sweat gland in DMD patients.

Significant prolongation of latency of SSR in the palm and sole was noted in the group of DMD patients compared to the control group. However, there was no significant difference in the amplitude of SSR between two groups. In the patient group, the rise in latency of SSR was closely correlated with the duration of symptoms and weakly associated with the stage of the illness.

Therefore the latency of SSR may be a useful index in assessing the function of sympathetic nerve and sweat gland in DMD patients. These results could be a consequence of a lack of dystrophin at myoepithelium of sweat gland in DMD patients.

We studied diabetic central neuropathy(DCN) that is not well-known neurologic disorder, for confirming its existence and then presenting objective diagnostic criteria and methods. Thirty-six diabetics(NIDDM: 30, IDDM: 6), mean age 53.1 years, 21 males and 15 females, were compared with 36 controls, mean age 51.5 years, 18 males and 18 females, electrophysiologically. First, we diagnosed peripheral polyneuropathy(PN) in diabetics by means of Diabetic Neuropathy Staging(DNS) developed at the University of Michigan and classified diabetics into two groups; group I indicates diabetics with PN, group II diabetics without PN. Second, we studied central(cortico-cervical and cortico-lumbar) motor conduction time(CMCT) by means of magnetic motor-evoked potentials(MEP) and central somatosensory conduction time by means of somatosensory-evoked potentials(SEP) stimulating on median and posterior tibial nerves.

There were no significant differences(p>0.05) statistically in cortico-cervical CMCT between diabetics and controls. There were significantly more prolonged(p<0.01) in cortico-lumbar CMCT between diabetics and controls. In median nerve-evoked 3-channel SEP, N13-N20(cortico-cervical) interpeak latency was significantly more prolonged(p<0.01) in diabetics than controls. In tibial nerve-evoked 2-channel SEP, P38-N22(cortico-lumbar) interpeak latency was significantly more prolonged(p<0.01) in diabetics than controls. In 30 patients(83.3%) of 36 diabetics, the study revealed central conduction delay in view of that above 2 or more abnormalities representing central conduction delay, that is, central neuropathy. In 10 patients(33.3%, M:7, F:3) of diabetics with central neuropathy(30 patients), even though they had no PN, central conduction delay was revealed.

Conclusively, in view of representing central conduction delay in 83.3% of patients, we believe that more active evaluations are needed in diabetics representing nonspecific central neurologic symptoms, for example, psychomotor slowing or cognitive dysfunctions, and MEP and SEP are useful in diagnosing DCN.

The importance of neuropathy in the pathogenesis of foot lesions has been well recognized in diabetes. Blood flow in ischemic limbs has been extensively investigated but the circulation of limbs affected by peripheral neuropathy has received little attention. Some studies on blood flow in peripheral neuropathy have shown a remarkable increase in resting flow, transcutaneous venous oxygen tension, and vascularity, along with loss of the spontaneous variations which occur normally with sympathetic activity of the foot in patients with diabetes. The aim of present study is to find out the effects of somatic and autonomic nervous function in early change of blood flow of foot in diabetic patients. We have studied fifty-one patients of non-insulin-dependent(type II) diabetes with no history of hypertension or diabetic foot ulcers. The evidence of neuropathy was screened by nerve conduction studies and sympathetic skin response of both lower extremities. Blood flow of dorsalis pedis and posterior tibial arteries was measured by portable doppler machine and presented as pressure index (ankle-to-arm systolic pressure ratio). The patients with sympathetic dysfunction showed significant decrease in pressure index compared to normal control and diabetic patients with normal sympathetic function, suggesting that changes of the blood flow occur in diabetic patients with sympathetic dysfunction.

Carpal tunnel syndrome, the entrapment neuropathy of median nerve within the carpal tunnel of the wrist, is a kind of cumulative trauma disorders, and major problem in occupational health, particularly in occupations requiring highly repetitive hand motions.

We examined 337 telephone operators, 674 hands to detect the incidence and the risk factors of carpal tunnel syndrome, and the efficient screening electrodiag nostic method.

The symptomatic hands without slowing were 53 hands(7.9%) and the asymptomatic slowing hands were 30(4.5%). 44 hands(6.5%) had symptoms or signs of carpal tunnel syndrome with slowing on nerve conduction, so diagnosed as carpal tunnel syndrome. The age, obesity and wrist dimension were risk factors of carpal tunnel syndrome. The hands with symptoms or slowing had lower grip strength and higher vibration threshold in the middle finger tip compared to normal group. The most sensitive method of nerve conduction was latency of median nerve at palm to wrist. This method was reliable and efficient nerve conduction study so can be recommended as screening procedure for identification of carpal tunnel syndrome in industrial settings.

Slowing in forearm median nerve conduction in patients with carpal tunnel syndrome(CTS) has been described. But the cause of slowing is still unclear whether it is related to a technical artifact on electrodiagnostic approach or pathophysiologic changes in the proximal segment of median nerve. To investigate the possible retrograde degeneration of median nerve in the forearm segment(wrist to elbow) in patients with known carpal tunnel syndrome, the median nerve conduction studies were performed in 23 normal persons as control and 25 patients with carpal tunnel syndrome. To evaluate the median nerve conductions in the forearm, the recording bar-electrode were placed at the volar aspect of the wrist and stimulating electrodes were applied at the elbow area. The mixed nerve action potentials and conduction velocities were measured.

The median mixed nerve action potential(FNAP) amplitudes recorded at the wrist and motor nerve conduction velocity(MMCV) in patients with carpal tunnel syndrome patients were significantly reduced compared to those of control group(p<0.05). However, the median mixed nerve conduction velocity(FNCV) was not reduced significantly. The median mixed nerve action potential amplitudes demonstrated positive correlation with the decrease of motor and sensory action potential amplitudes and velocities.

This result suggests that the retrograde degeneration progresses as the carpal tunnel syndrome progresses and the retrograde degeneration may play a major role in reduced motor nerve conduction velocity of the median nerve in the forearm. We propose that FNAP amplitude and MMCV might be used to evaluate the severity of retrograde degeneration in patients with carpal tunnel syndrome.

In order to define the role of steroid injection as a method of treatment of carpal tunnel syndrome, this study was performed on twenty-four hands(bilateral injections were done in ten patients) in fourteen patients. One to five times injection were done in each hand by one physiatrist who used the same technique. Follow-up periods after last steroid injection averaged 103 days(61∼193 days). Hands that initially had mild symptoms and findings of less than one year's duration, no evidence of thenar atrophy, median sensory latencies of 4.3 msec or less and median distal motor latencies of 5.7 msec or less had more satisfactory responses to injections. Man had also satisfactory responses to injections. Completely responsed symptoms were night awakening(88%), pain(66%), tingling sense(40%), weakness(25%) and numbness(0%), in orders.

The clinical findings and the ultrasonographic appearance of the sternocleidomastoid muscles of 40 children with torticollis were studied to evaluate the correlation between the clinical findings and the ultrasonographic findings and to know whether the ultrasonographic findings could be the prognostic factors of the treatment outcome. This is preliminary study to find out the ultrasonographic findings of congenital muscular torticollis.

In physical examination, we checked range of motion of neck, facial asymmetry and plagiocephaly. Ultrasonsography was done in a week after the first visit and in ultrasonography, the echogenicity, echotexture, margin, size and shape of the mass were evaluated. Of 40 children, 29 children were due to congenital muscular toricollis, 9 children were due to posture(postural torticollis), and 2 children were due to strabismus. Of 29 congential muscular torticollis patients, 25 children showed fibromatosis colli(nodular form in 11 children, fusiform in 14 children) and 4 children showed only asymmetric thickness of sternocleidemast oid muscle. The relationship of the clinical findings and ultrasonographic findings were evaluated. The margin in ultrasonography and the range of motion of the neck had significant correlation(P<0.05) but the other clinical findings and other parameters of ultrasonography did not have significant correlation.

In conclusion, ultrasonography is simple method to evaluate the patients with torticollis and some of the ultrasonographic parameters have some correlation with clinical features of torticollis. To be used as a prognostic factor, further study would be necessary.

To investigate the skeletal muscle changes, intramuscular injections of local anesthetics were performed using animal, Sprague-Dawley rat.

The experiments were composed of two procedures, experiment I and II. In experi ment I, single injection was performed using 0.4 cc of 1 and 2% of procaine and lidocaine.

In experiment II, repeated injection of 0.4 cc of 2% lidocaine on weekly bases 3 times were performed.

The experimental rats were divided into five groups in experiment I: Four experimental groups 40(10 rats for each local anesthetics) and Control 10 and were divided into two groups in experiment II: Experimental group 8 and Control 4. The muscle biopsies were performed in 15 minutes, 2, 4, 8 and 16 days after injection in two experiments.

No muscle fiber changes were shown in control group, and 1~2 % procaine, and 2% lidocaine injected groups of experiment I and control group of experiment II. In the groups of single and repeated injections of 2% lidocaine, muscular inflammatory changes were shown on 2 and 4 days after injection. The changes were more extensive in the group of repeated injections. The inflammatory reaction was usually abated on 8 days after injection and the muscles appeared to be normal in quality and quantity on 16 days after injection. These histopathologic results indicated reversible muscular changes.

Although the muscular changes are reversible after local anesthetics injection, the concentration of local anesthetics and injection interval should be considered to minimize the muscle fiber changes in the repeated injections.

We tried to assess the effect of sequential intermittent pneumatic compression therapy in patients with lymphedema and analyze the potential prognostic factors in response to the therapy. Ninety lymphedema patients were included in the analysis. Among them, thirty-six subjects who were in clinical stage 2 or 3, infection-free and free of documented metastasis in the involved extremity were treated with the Lympha-Press. All patients were admitted for 3 days clinical trial. Comparison of circumferential limb measurements before and after a 3-day treatment period was performed. As a result of sequential intermittent pneumatic compression therapy, the volume reductions of arm and leg were 37.95±12.27% and 35.21%±24.42%, respectively. The calf, wrist and lower forearm levels showed the greatest reduction. In contrast with this, the proximal levels of arm and leg showed comparatively poor reduction than distal levels. Almost 90% of arm patients and 76% of leg patients experienced significant reduction (>25%) after therapy. The previous history of secondary infection was significantly associated with the extent of initial leg edema. But the duration and the previous history of radiotherapy or secondary infection were not a negative prognostic factor for response of pneumatic compression therapy.

This study clearly indicates that sequential intermittent pneumatic compression therapy is an effective treatment for lymphedema regardless of the duration of edema and previous history of radiotherapy or secondary infection.

Osteoporosis is the most common generalized skeleta l disease, which lays a significant socioeconomic burden to Korea. The early diagnosis and treatment of osteoporosis are of the great interest to minimize the economic consequence. We have studied vertebral BMD and bone scan of 30 patients with osteoporotic compression fractures. The purpose of this study was to in vestigate the effect of osteoporotic compression fracture on bone mineral density(BMD). We have measured the vertebral heights, vertebral bone mineral density, and bone scan counts of vertebral bodies on osteoporotic patients. Vertebral BMD was measured from T12 to L4 using dual photon absorptiometry. Anterior(Ha), middle(Hm), and posterior(Hp) height of vertebrae were measured from T12 to L4, and the spinal deformity indices(Ha/Hp, Hm/Hp, and Hp/Hi ratios) were calculated. The bone scan counts were measured from T12 to L4, and bone scan ratios were calculated. The BMD of fractured vertebrae was significantly higher than that of non-fractured vertebrae. The spinal deformity indices were not correlated to the BMD of fractured vertebrae. The bone scan ratio was correlated to the BMD of fractured vertebrae. This study suggests that the increased BMD observed in fractured vertebrae is related to metabolic effect of compression fractures rather than mechanical effect.

Patients who have had strokes or other central nervous system disorders, often walk with stiff legged gait on the affected site. We analyzed the gait of adult hemiparetic and paraparetic patients who were community ambulators with stiff legged gait using a three dimensional motion analyzer and the dynamic electromyography. The purpose of this study is ⸁ to classify the dynamic EMG pattern of quadriceps muscle during preswing and swing-phase ⸂ to evaluate the characteristics of the kinematic motion curve of the knee in stiff legged gait.

Dynamic EMG patterns of quadriceps muscle during preswing and midswing phase could be classified into four classes(Class I: rectus femoris and vastus medialis and vastus lateralis fire simultaneously, class II: rectus femoris and one of vasti fire simultaneously, class III: only rectus femoris fires, class IV: no abnormal firing of rectus femoris and vasti).

All of paraparetic patients had sufficient hip flexor strength and the class III EMG pattern was the most frequently observed pattern in these patients. Hemiparetic patients showed diverse dynamic EMG patterns with a similar frequency(4 cases of class I, 6 cases of class III, 5 cases of class IV).

In the kinematic analysis, a dimpling on the motion curve of the knee during preswing and initial swing-phase was the most characteristic finding which reflected the blocking or delay of the knee flexion(smooth convexity which reflected the progressive increase of flexion disappeared.). It was noted most frequently in paraparesis patients who had the class III EMG pattern. In hemiparesis patients who had poor hip flexor strength, there was no dimpling on the motion curve of the knee even though they showed the class III EMG pattern. Only half numbers of hemiparesis patients who had sufficient hip flexor strength with the class III EMG pattern showed a dimpling on the motion curve.

The muscle strain injury(MSI) is one of the most common form of occupational or sports related muscle injuries. Heat has been used to prevent the MSI for a long time. However, it has been little known about the pathophysiology of the MSI and heat action on it.

To clarify the effect of intramuscular temperature elevation on active(eccentric) strain injury, we stretched the muscle by the speed of 10cm per second to produce strain injury on tibialis anterior(TA) and extensor digitorum longus(EDL) in seventeen rabbits with their neurovascular supplies preserved. During the stretch, the peroneal nerves were electrically stimulated simultaneously to evoke muscle contraction with and without infrared ray irradiation on muscles. Also, to specify the location of lengthening during active strain, we attached markers on the muscles and did the motion analysis.

Following results were obtained. The length increments of stretch in heated TA and EDL at the time of total disruption were 40.3±13.76% and 43.6±16.62%, respectively. But those of non heated TA and EDL were 35.5±12.13% and 34.4±15.83%, respectively, which were significantly lower than those of heated TA and EDL(p<0.05). The absorbed energy in heated TA and EDL until the time of total disruption were 175±39.5N·% and 248±47.0N·%, respectively. But those of non heated TA and EDL were 134±36.1N·% and 184±43.2N·%, respectively, which were significantly lower than those of heated TA and EDL(p<0.05, p<0.01). But there was no difference in peak force on the time of total disruption between two groups. The distal muscle segments including distal musculotendinous junction were the most lengthened parts in both muscle groups but the distal muscle segments of heated muscle groups showed more length increment than that of non heated muscle groups statistically. The most frequent site of total disruption by active strain injury was the distal musculotendinous junction in both groups.

In conclusion, the result that the heated muscles showed larger musculotendinous length at the time of total disruption than non heated muscles supports that intramuscular temperature elevation has preventive effect on muscle strain injury, not by increasing contractile ability but by improving extensibility of musculotendinous units. And it is the distal muscle segment including distal musculotendinous junction that lengthens and absorbs the energy mostly.

The purpose of this study was to investigate alterations in his tochemical properties in the gastrocnemius & soleus muscles of rats following hindlimb suspension for 1 week. A modification of the Morey and Musacchia models was used to determine atrophic responses of rat muscle. The weights of rat's whole body and of gastrocnemius and soleus muscles were affected by suspension. A reduction of type I distribution was accompanied by an increase in type II fibers. The cross sectional area of all fiber types was reduced after suspension. These results suggest that type I fibers showed greater susceptibility than type II fibers and some amount of type I fibers might have been converted to type II fibers.

Neurogenic claudication can be difficult to diagnose despite of strict radiologic criteria for lumbar stenosis. Because canal dimensions can change with body posture, and neuroimaging studies are usually done only in the supine position, not all patients with neurogenic claudication will have CT scan documented stenosis. This study evaluated changes in F wave minimal latency, chronodispersion and SEPs from the lower limbs after walking in normal thirteen subjects and twelve patients with lumbar spinal stenosis. In normal subjects, only F chronodispersion showed a significant decrease for both the peroneal and tibial nerves(p<0.05) after walking. Patients with spinal stenosis had markedly increased F chronodispersion in the peroneal nerve(p<0.01) but had minimal changes of the F minimal latency and SEPs. In conclusion, the marked changes of F chronodispersion after walking increase the diagnostic sensitivity in patients with spinal stenosis, who do not have abnormal nerve conduction and electromyographic findings.

In diagnosis of carpal tunnel syndrome, there are many techniques with high sensitivity. Among them, the median-radial latency difference(MRLD) is one of the most useful technique in screening mild carpal tunnel syndrome with high sensitivity, no painful discomfort to patients and no motor artifact.

In this study, we examined the effect of the thumb position(radial abduction and adduction) on the MRLD. Because the stimulation sites of the median sensory and superficial radial nerves are different from each other, the free movement of the thumb in this examination is not avoidable.

The results are 1) there is no significant effect of the thumb position on median sensory latency. 2) There is no significant effect of the thumb position on superficial radial latency. 3) There is significant effect of the thumb position on MRLD(P<0.01). Therefore, if we diagnose the mild carpal tunnel syndrome with MRLD, the thumb position must be maintained in neutral position through the examination.

We examined 16 healthy adults in order to evaluate the hypoglossal nerve using magnetic stimulation. Surface electrodes were located in apex and anterolateral third of tongue. We stimulated two sites of head, vertex and occiput.

For occiput stimulation, the mean latency was 3.77±0.32 msec in male and 3.81±0.36 msec in female, for vertical stimulation, 6.94±0.56 msec, 6.91±0.52 msec respectively. For occiput stimulation, the mean amplitude was 4.84±2.80 mV in male and 5.09±2.88 mV in female, for vertical stimulation, 1.96±1.34 mV, 1.15±0.64 mV respectively.

We studied a group of spinal cord injured patients, using two different mattresses, to analyze statistically the pressure measured over sacral area and skin changes developed on the dorsal skin surface of patients for specific duration of time.

Local pressure measured at sacral area and skin change score were lower on a Bazooka system than common hospital mattress. And the weight, BMI(Body Mass Index) and % IBW(Ideal Body Weight) of patients significantly correlated with the skin changes developed on the dorsal skin surface after lying on common hospital mattress for 2 hours. But skin changes developed after lying on a Bazooka system for 8 hours didn't correlate with these variables. Therefore a Bazooka system may be effective in the prevention of pressure ulcers for spinal cord injured patients.

Ammonia is a colorless alkaline gas with a sharp pungent odor. It is widely used in industry and there are several case reports on deleterious pulmonary damage. Ammonia is also highly neurotoxic that interferes energy metabolism in the brain even with a small amount and causes encephalopat hy in patients with severe liver disease.

We experienced two patients with toxic encephalopathy and followed- up for 18 months. We assumed that ammonia was supposed to play a major role in the dysfunction of their brains. In our cases, the possible mechanisms of brain damage are as followings: ⸁ ammonia has direct toxic effect on brain by altering the energy metabolism, ⸂ inhalation of ammonia results in severe pulmonary damage and it may aggravate brain injury, and ⸃ besides ammonia itself, relatively hypoxic environment that they were exposed can take part in the brain injury.

We herein report a case of infantile neuroaxonal dystrophy(INAD) with protracted course. The 3 year old patient suffered from ataxia, gait disturbance, oculomotor disturbance, psychomotor regression and bilateral pyramidal tract signs since the age of two. Similar neurological symptoms occurred in his elder brother, beginning at the age of one, who eventually died at the age of four. Magnetic Resonance Imaging(MRI) of the patient showed progressive atrophy of cerebral cortex and cerebellum with diffusely increased T2 signal in bilateral cerebellar hemisphere. The patient's brother revealed similar findings. MRI of the suspected cases may facilitate early diagnosis of INAD, and since it is a well-established autosomal recessive neurodegenerative disaese, early and appropriate genetic counseling of the parents is required.