Visual perceptual dysfunction in stroke patients causes a failure in activties of daily living and learning. Therefore, the correct diagnosis and remediation of visual perceptual dysfunction are important.

Since the mechanism of visual perception is not well studied, it is difficult to treat visual perceptual dysfunction effectively. In this study, we tried to correlate visual perceptual dysfunction with anatomical lesion of brain for the use of visual perceptual training.

We assesed the visual perception and the brain lesions of fiftroke patients, with Motor-Free Visual Perception Test(MVPT), and brain computerized tommography respectively. The visual responses of contralateral side of the lesions were diminished. The raw score of MVPT was low in patients with lesions in both parietal and, right temporal lobes. The right parietal lobe lesions correlated with tests for figure-ground and visual closure, and the left parietal lobe lesions with visual processing time.

The result suggests that the right parietal lobe has an important role in visual perceptions. The right temporal, and the left parietal lobes as well as the subcortex of both hemisphere also has significant roles in visual perceptions.

The Neurobehavioral Cognitive Status Examination(NCSE) is a evaluation tool of which many physicians use to assess the cognitive function of neuropychologic patients in a brief and quantitative fashion. We scored 10 components of NCSE in 45 stoke patients and compared the difference in scores between right hemiplegia and left hemiplegia according to lesion side, and we also compared the difference between patients with cerebral infarction and hemorrhage.

This study was intended to know the usefulness of the NCSE in the fields of stroke rehabilitation in which the cognition of patients were very important. The mean scores of the patients caused by infarction was higher than that of the hemorrhage except only repetition of language part, especially the scores of attention and naming were high with statistical significance. The mean scores of the left hemiplegia were higher than that of the right hemiplegia except repetition and calculation but all valuses are not significant. Because the scores of the NCSE are influenced by the language function, it is not so useful in comparing stroke patients according to lesion side. But it is very useful in comparing the difference according to the causes of stroke, infarction or hemorrhage respectively and following up patients intrapersonally as a cognitive evaluation tool.

Hydrocephalus occurs frequently after stroke and has been reported to affect the functional outcome. We investigated 77 stroke patients retrospectively to evaluate whether or not hydrocephalus affects the functional outcome. The patients were divided into three groups: Group 1, 20 patients without hydrocephalus; Group 2, 28 patients with early onset hydrocephalus; Group 3, 29 patients with delayed onset hydrocephalus. Functional status was evaluated by 3 functional indices, Mini-Mental Status Examination(MMSE), Barthel index, and PULSES profile. These 3 functional indices were compared between pre- and post-rehabilitation stages in Groups 1 and 2, and compared among pre-rehabilitation, post-hydrocephalus, and post-rehabilitation stages in Group 3.

Significant functional improvements were shown in the post-rehabilitation stage in Groups 1 and 2 (P<0.05). In Group 3, the functional improvements were shown in the post-rehabilitation stage when compared to the pre-rehabilitation stage, but without statistical significance. However, significant functional improvements were demonstrated in the post-rehabilitation stage compared to the post-hydrocephalus stage in Group 3 (P<0.05). In comparing the three groups, the final functional outcome was found to be best in Group 1 and worst in Group 3.

We suggest that the time from the onset of hydrocephalus to diagnosis and management is more important than the presence of hydrocephalus itself in the stroke patient in respect to functional outcome.

Fall is a major threat to the stroke patients. The purpose of this study is to find out the potential risk factors for recurrent falls in the stroke patients.

The subjects were sampled 20 hemiplegic fallers who experienced at least one fall at the stroke center of Hangkang Sacred Heart hospital. Balance subscale and gait scale of Tinetti was used as a screening test for referral to mobility fuction. The potential contributing factors for fall were social activity, impulsivity, congnition, motivation. These factors were correlated with falls. The authors also surveyed the places, postures of activities, and injurires from falls.

The falls occurred 2.5 times average in studied subjects and is most of subjects the first fall occurred in their first month of standing and gait training. 58.3% of falls occurred indoor(33.3% in room), 29.2% at hospital, 12.5% outdoor. The activities related to fall were walking 36.8%, rising from a chair 36.8%, sitting 10.5%. Although, most(75%) of injuries were soft tissue contusions or strains, the other 25.1% of falls accompanied fractures. The femur fracture was 18.8%, and compressed spine fracture was 6.3%. The social activity was most strongly correlated with falls with high correlation coefficent of 0.72. The other factors were not significant with lower coefficient values, balance scale of 0.35, gait scale of 0.24, motivation of 0.40, congnition of 0.26, impulsivity of ⁣0.19. It was suggested that activity plays an important mediating risk factor for falls in the stroke patients.

These data support the concept of preventive strategy for falls in the stroke patients who are at risk.

Cerebral ischemia in experimental animals was worsened by hyperthermia, whereas was improved by hypothermia. Whether these observations apply to human beings with stroke is unknown. The objective of this study is to determine the relation between body temperature of stroke patient on admission and infarct size and functional recovery. In a retrospective study, 101 charts of stroke patients who had been admitted to the hospital were reviewed. Initial body temperature on admission, infarct size, and functional recovery were checked and analyzed. Based on body temperature differences, cases were divided into three groups, hypothermia, normothermia, and hyperthermia group. Infarct size was measured by computed tomography. Functional recovery was evaluated with functional independence measure(FIM) on admission and discharge. Multiple regression of ANOVA and Student's T-test were used for statistical analysis. Results disclosed that body temperature had no correlation with functional recovery but cases with initial high body temperature trended to increase in infarct size.

The present study was designed to investigate the effects and action mechanism of electrical stimulation on functional recovery following spinal cord injury in Sprague-Dawley rats. Electrical stimulation with 0.2 ms, 20 Hz, 1-3 V was applied to the sciatic nerve for 4 hours/day during 6 days following dorsal hemisection of the T10 spinal cord. After 7 days of spinal cord injury, mechanical properties of muscle contraction including contraction time, half relaxation time, maximum twitch tension, maximum tetanic tension, and fatigue index were measured in the soleus and medial gastrocnemius muscles, and the number of c-fos immunoreactive cells was counted in the upper lumbar cord. In mechanical properties of muscle contraction of normal rats, contraction time and half relaxation time of the soleus muscle were 1.5 times and 2 times as long as those of the medial gastrocnemius muscle, respectively. And fatigue index of the soleus muscle was 0.19⁑0.4 and the medial gastrocnemius muscle was 0.82⁑0.03. According to the above characteristics, the soleus muscle was mainly composed of slow muscle fibers and the medial gastrocnemius muscle was composed of fast muscle fibers. Maximum twitch tension, maximum tetanic tension, and fatigue index of both muscles following spinal cord injury were decreased significantly compared to the control group (p<0.01). In electrically stimulated rats following spinal cord injury, maximum twitch tension, maximum tetanic tension, and fatigue index were significantly increased compared to spinal cord injured rats. The number of c-Fos immunoreactive cells was increased markedly at the upper lumbar cord in electrically stimulated rats.

These results may suggest that electrical stimulation not only prevents from muscle atrophy in slow and fast muscles through efferent nerve fibers, but also promotes functional plasticity through afferent nerve fibers by activating silent synapse and regulation of receptors for neurotransmitters.

A noninvasive measurement of residual urine or bladder volume would reduce number of unnecessary catheterizations and be useful for an intermittent catheterization program in the management of neurogenic bladder. The purpose of this study is to evaluate a portable ultrasound instrument for the measurement of bladder volume and to assess the effect of several factors such as trabeculation or soft tissue thickness on the accuracy of the measurements. Nine patients with neurogenic bladder dysfunction underwent 480 bladder volume measurements using a portable ultrasonographic device(BVI-2500 BladderScan) before 60 intermittent catheterizations. Ultrasonographic measurements of urine volume were compared with catheterized urine volumes. The mean difference was 46.42⁑39.15 cc and the mean percentage error was 23.32⁑19.31%. Mean differences of each bladder capacity were not affected by bladder capacity, and mean percentage errors tend to decrease as the bladder capacity increase. Bladder trabeculation and soft tissue thickness had no effect on the accuracy of the measurements. The ultrasonographic measurements detected the presence of residual urine volumes of ≥100 cc with a sensitivity of 81% and a specificity of 93%. The repeatability(Mean/SD) was 23%. The accuracy had no correlation with the frequency of scanning.

We conclude that BVI-2500 bladder scan portable ultrasonographic device is a useful tool for the management of neurogenic bladder dysfunction in spinal cord injured people. Trabeculation and soft tissue thickness has no effect on the accuracy of the measurements.

As a standard method for the measurement of post-void residual urine volume, the urethral catheterization is commonly used. However, it is frequently associated with the discomfort of the patients, urethral trauma and urinary tract infection. A noninvasive method of determining the residual urine volume could minimize unnecessary catheterizations and be useful in the management of neurogenic bladder in the patient with spinal cord injury(SCI). This study was undertaken to evaluate the accuracy of a portable ultrasound scanner for measuring bladder volumes in SCI patients undergoing bladder training and to determine the factors affecting its accuracy. Sixty patients with SCI were included in this study. Two investigators performed the ultrasound measurement of the post-void residual urine volume alternately and the same procedures were repeated. After that, the urethral catheterization was done. In comparison of the residual volume measured by two different methods, the correlation coefficient(R²) of the two different methods was 0.996 and the mean value of difference between the residual volume measured by ulltrasound and by catheterization was 21.6 ml. The accuracy of the ultrasound measurements was not affected by gender, types of the neurogenic bladder, shape of the bladder, trabeculation of the bladder and central obesity. The results indicate that the portable ultrasound scanning method is a useful non-invasive method and can be substituted for the urethral catheterization in determination of bladder volumes in patients with SCI.

Generally, regular exercise is known to help to improve lipid metabolism. In the spinal cord injured, relative inactivity to able-bodied person causes altered lipid profiles and, in turn, possibly increases cardiovascular mortality. We performed this study to measure serum lipid profiles in paraplegics and to evaluate effect of regular exercise on lipid profiles. The subjects are 21 paraplegics, who are divided into 2 groups, 10 SCI athletes and 11 SCI non-athletes. The serum levels of lipoproteins in these subjects were measured and compared each other. The levels of serum HDL-cholesterol were lower in the order of, non-athlete group, athelte group, and normal control group, and there was a significant difference between athlete and non-athlete groups. The ratios of total cholesterol to HDL-cholesterol were higher in the order of non-athlete group, athlete group, and normal control group, and there was a significant difference between control and non-athlete groups. The serum levels of total cholesterol, LDL-cholesterol, and triglyceride in three groups showed no significant differences.

In conclusion, serum levels of HDL-cholesterol were positively affected by regular exercise, and it is advised that the HDL-cholesterol levels of spinal cord injured should be checked regularly for follow-up examinations.

The purpose of this study was to establish the normal values of tendon reflex in normal Korean adults. Ankle tendon reflex(ATR), patellar tendon reflex(PTR) and medial hamstring tendon reflex (MHTR) responses were recorded in 96 limbs of 48 normal Korean adults by delivering tendon taps with an electric reflex hammer.

Latency to the onset of the triggered response, peak to peak amplitude and duration of the wave were measured after several repetitions. Minimum latency and duration of the elicited response were chosen to calculate normal means. Side differences were also evaluated. As amplitude showed a marked interindividual variation and side to side variation, lowest recorded value was selected to represent the lower limit of normal.

Mean values of latency, duration and amplitude were 30.27⁑3.18 msec, 11.05⁑1.08 msec and 1.98⁑0.89 mV for ATR, 16.37⁑1.58 msec, 20.63⁑1.68 msec and 1.56⁑0.76 mV for PTR and 20.25⁑2.14 msec, 10.95⁑1.57 msec and 0.71⁑0.56 mV for MHTR. Age, height, and leg length showed significant correlation with the latency of ATR, PTR and MHTR latency(P<0.001).

We believe our results can be used as guideline researches in clinical practice.

In this study, we measured the intervertebral foramina on the plain radiographs of cervical spine of fifty three patients who were over forty-year-old, and with single or multiple unilateral cervical radiculopathies on EMG. In order to determine if the foraminal stenosis on plain radiographs can determine the presense of radiculopathy, four parameters such as vertical diameter, mid-transverse diameter, inferior transverse diameter, and area were measured by a digital caliberator(CD-15C, Mitutoyo, Japan) and an image analyzer(VIDAS 2.0, Kontron, Germany) in 194 foramina of both sides(affected and unaffected groups). Another 80 foramina were also measured as control group in ten age-matched patients who did not show any abnormality on EMG.

In control group, C4/5 intervertebral foramen showed maximal values of the parameters among foramina, with vertical diameter of 10.55⁑0.35 mm(mean⁑S.D.), mid-transverse diameter of 6.22⁑0.33 mm, inferior transverse diameter of 5.09⁑0.19 mm and area of 0.77⁑0.05 cm². The minimal values were noted in C6/7 foramen except those of the vertical diameter which were noted in C4/5 foramen. The mid-transverse diameter and area of C7/T1 intervertebral foramen of affected group were significantly smaller than those of control and unaffected groups(p＜0.05). The other values in affected group were also smaller among the groups but they did not reach statistical significance.

In conclusion, the mid-transverse diameter and area of intervertebral foramen on plain cervical radiographs are somewhat useful to determine the encroachment of nerve root within the intervertebral foramen, especially in the lower cervical spine, in patients with cervical radiculopathy.

In clinical settings, electrodiagnosis is used for the differential diagnosis of neuropathy and myopathy, as well as detremining severity and localization of lesions in the neuromuscular system. By many authors, various methods of the study and factors influencing the results were verified so far. However, the results vary according to methods or influencing factors during electrodiagnostic studies. Since there has been no standardization in methods of the study and study environment, we sometimes feel difficulties in interpretation of study results and in exchage of findings of study among laboratories. In this study, we have collected standards and norms used by different electrodiagnostic laboratories in Korea, hoping that we can come up with one nationwide standards and norms in Korea.

Sixteen legs in eight cadavera were dissected to observe the anatomic course of the superficial peroneal nerve around the ankle and the superficial peroneal sensory conduction study was performed in twenty-eight normal subjects. The anatomic course of the superficial peroneal nerve around the ankle was in two types, type I and type II. Type I was 13 cases(81%) and type II was 3 cases(19%). In type I, the nerve penetrated the crural fascia and became subcutaneous at 8.8⁑1.1 cm proximal to the ankle joint and divided into two major branches at 2.6⁑1.1 cm proximal to the ankle. Medial and intermediate dorsal cutaneous nerves were located at 47%(⁑3.4%) and 35%(⁑4.9%) of the intermalleolar distance from lateral malleolus, respectively. In type II, the medial and intermediate dorsal cutaneous nerve arose seperately from the superficial peroneal nerve at 8.0⁑0.9 cm proximal to the ankle joint. Medial and intermediate dorsal cutaneous nerves were located at 49%(⁑5.6%) and 33%(⁑4.0%) of the intermalleolar distance from the lateral malleolus, respectively. Superficial peroneal sensory conduction study was performed based on the findings of type I. The mean distal latencies and amplitudes were 3.21⁑0.35 msec, 12.1⁑3.37 ㄍV and 3.17⁑0.37msec, 14.54⁑4.60 ㄍV in medial and intermediate dorsal cutaneous nerves, respectively.

Electrophysiologic study including needle electromyograpy(EMG) was done in 66 patients with spina bifida who were referred to EMG laboratory. We have classified neurological impairments of spina bifida patients according to electrodiagnostic findings and the electrophysiologic study findings were compared with Magnetic Resonance Image(MRI) findings, and manual muscle test findings. Also electrophysiologic study findings were compared with urodynamic study(UDS) finding for the evaluation of neurogenic bladder in the same subjects.

55% of spina bifida patients had cauda equina lesions electrophysiologically and the most commonly involved, root was L5, and the next was S1. 42% of the subjects were normal electrophysiologically.

61% of patients with abnormal MRI findings had normal EMG findings. EMG findings did not correlated well with manual muscle tests in 44% of the subjects. Also in 44% of subjects, the electrophysiologic study was did not agree with urodynamic study findings.

In conclusion, we asserts that cauda equina lesion is a most common lesion in spina bifida patients and electrophysiologic study is superior than MRI or manual muscle test in detecting neurologic deficit of spina bifida patients. However, electrophysiologic study alone offers less accurate information than urodynamic study for the evaluation of neurogenic bladder in spina bifida patients.

This study was performed to evaluate of temperature effects on motor unit action potentials by automatic method in twenty healthy adults. Twenty separate motor unit action potentials were recorded in the biceps brachii with concentric needle electrodes at the three different skin temperatures. The skin temperature of the arm was cooled with coldpack below 24^oC and warmed with infrared above 38.5^oC.

The measured parameters of motor unit action potentials were amplitude, duration, area, spike duration, spike area and number of phases and turns. As the skin temperature was decreased, all parameters except number of turns were increased(p＜0.05). And the larger changes were developed by cooling than warming. At three temperature settings, rise time was inverse relationship with amplitude and number of phases and turns. And in general other parameters of motor unit action potentials showed significant positive correlation.

Therefore the temperature is a very important considering factor and must be standardized or controlied during analysis of motor unit action potentials.

The role of skin temperature is very important in clinical neurophysiology but has often been neglected. In nerve conduction studies, lower normal temperature affects slower conduction velocities and increased nerve (sensory or mixed) action potential amplitudes. To determine the normal skin temperature in various parts of upper and lower extremities within close approximation of the nerve passages, the temperature was measured using Physitemp^Ⱂ Model BAT-12 (Accuracy 0.1^oC, Clifton, New Jersey, U.S.A.). Fifty-three neurophysiologically healthy adults (Age range, 22∼77 years old) were tested : upper extremity, 20 (male, 7 ; female, 13) ; lower extremity, 33 (male, 11 ; female, 22). The total points of skin temperature measurement were 21 : upper extremity, 10 ; lower extremity, 11. The skin temperature for the upper and lower extremities was 34.6⁑0.9^oC (range, 32.6∼36.7^oC) and 33.4⁑1.1^oC (range, 28.1∼35.7^oC), respectively. Although it is frequently time consuming, monitoring normal skin temperature will result in greater electrodiagnostic accuracy.

Although electrodiagnostic sympathetic skin response(SSR) has been widely assessed the detail procedure, such as filter setting and stimulus intensity, has not been standardized yet. This study was performed to establish optimal settings for SSR recording. In 18 healthy subjects, SSRs were recorded in the left hand while stimulating the right median nerve. The data were analyzed for frequency and amplitude domains and statistically evaluated using the methods of analysis of variance(ANOVA) and regression analysis.

The peak frequency of SSR signal was 18.59⁑8.26 Hz, and the frequency of major signals ranged from 0.5 to 2 Hz. The amplitude of SSR was linearly regressed on the intensity of electical stimulus according to the equation: y=2.60x+277.89(p＜0.05). The latency of SSR was linearly decreased with the intensity of electrical stimulus with the relationship: y=1445.46⁣1.60x (p＜0.05).

On the bases of these results, we conclude that a proper filter setting for SSR measurement would be 1∼100 Hz, and at stimulus intensity below 128 mV, the higher the stimulus intensity, the amplitude was bigger and the latency was shorter.

The medical records of twenty-one patients with suprascapular nerve palsy were reviewed retrospectively. Nine patients had isolated suprascapular nerve lesions and twelve patients accompanied axillary nerve lesions. In trauma cases, combined nerve lesions were common and severe. In three cases isolated suprascapular nerve lesions were noted spontaneously. Isolated infraspinatus muscle lesions were noted in four cases which were due to compressions of suprascapular nerves at the spinoglenoid notch, and in one case from ganglionic cyst was diagnosed by ultrasonography. At initial examination, three patients showed complete and eighteen patients showed incomplete lesion. Eight patients with incomplete lesion and one patient with complete lesion were followed up. Seven patients with incomplete lesion showed regeneration between 1∼7 months after injury. Therefore electrodiagnostic study is necessary to evaluate severity and level of nerve lesion and regeneration.

The purposes of this study were to identify lumbar lordosis in low back pain patients and to investigate differences in lumbar lordosis in low back pain patients according to etiologies.

On the basis of the findings of spinal roentgenogram, MRI, and SPECT imagies, the patients were divided into four groups; 1) facet syndrome with facet joint inflammation or degenerative change, 2) disc herniation including disc bulging or extrusion, 3) combined low back pain accompaning facet joint lesion with disc herniation, 4) simple low back pain with no abnormal imaging findings.

There were statistically significant decrease in low back pain patients compared with normal controls in terms of lumbosacral curvature. No sex and age differences were observed within low back pain patients and normal controls in terms of lumbosacral curvature. The review disclosed a significant decrease of the lumbosacral angle in order of simple low back pain, disc herniation, combined low back pain compared with normal controls. But facet syndrome patients showed no change of lumbosacral angle. Patients with disc bulging showed no significant decrease of lumbosacral angle compared with normal controls but patients with disc extrusion showed significant decrease.

It is believed that the decrease of lumbosacral angle in low back patients results from a pathokinesiological effort to keep facet joint from pressure stemed from facet overlying and to minimize the shearing force over lumbosacral joint. The facet joint stiffness due to inflammation may play a major role in no change of lumbosacral angle in facet syndrome patients. In conclusion, different causes of low back pain should be taken into consideration for the assessment of lumbosacral angle.

Tuberculous spondylitis occurs commonly by the hematogenous spread of infectious organism, Mycobacterium tuberculosis, from the primary foci of the pulmonary and genitourinary systems. Spinal involvement is the most common among tuberculosis of the musculoskeletal system. Tuberculous spondylitis is not easily diagnosed in its early stages and furthermore it is hard to know whether or not the vertebrae are involved by simple X-ray study. The incidence of neurologic deficits varies from 4 to 50%. If the disease is not diagnosed and treated promptly, paraplegia may occur from vertebral collapse. A retrospective study was performed to evaluate the clinical features of tuberculous spondylitis in 51 patients (male 25, female 26), age range of 4-79 years (mean, 36.2⁑18.7). Clinical symptoms, signs, radiological findings and laboratory findings were reviewed. The latest follow ups were done with telephone interviews to evaluate their general improvement and neurological recoveries.

Back pain was the most frequent symptom, followed by sensory disturbance and gait difficulty. Twenty one patients had kyphotic deformity, 7 had lower extremity paralysis, and 29 patients were accompanied by pulmonary tuberculosis. The involved spinal segments were C2 through S1 with the most common site of thoracolumbar spines. The average erythrocyte sedimentation rate (ESR) was 42.1⁑23.5 mm/hour before medical or surgical treatment and 19.6⁑12.6 mm/hour after treatment. The acid-fast bacillus test was positive in only 6 patients. Electrodiagnostic studies and bone scans showed positive findings in 75% and 86%, respectively. Back pain was relieved in 90% of the patients with medical or surgical treatment. In patients with paralysis, initial kyphotic angle and degree of vertebral body loss were significantly greater than in patient without paralysis. When treated surgically early after the leg paralysis, patients with paralysis improved their neurologic deficits and gait better than when treated after 2 months.

The purpose of this study is to evaluate the effects of intramuscular botulinum toxin A injection in cerebral palsy. We studied 25 children with cerebral palsy(age 3 to 20 years old). Among them, 14 children were spastic diplegia; 5 were athetoid quadriplegia; 3 were spastic hemiplegia; and 3 were mixed type(spasticity and athetosis). Botulinum toxin A was injected into the target muscle groups with electromyographic guidance. The dose was calculated in unit/body weight basis. Followup assessments were performed at 1 and 3 months after injection. After injection, 11 out of 16 children(68.8%) had a one-level improvement in ambulatory status. The passive range of joint motion increased significantly after injection. Modified Ashworth scale decreased significantly after injection. In 23 out of 25 children, there were a significant increase of the mean GMFM(gross motor function measure) total score and mean GMFM scores for all dimensions at three months after injection. There were the distant effects after injection in spastic diplegia. In conclusion, botulinum toxin A tretment would improve the motor function and ambulatory status in cerebral palsy by reducing hypertonicity, spasticity, dynamic contracture and athetoid movement.

Selective posterior rhizotomy(SPR) is a neurosurgical procedure designed to alleviate spasticity and has been successfully used for children with spastic cerebral palsy. We evaluated eleven children who had follow up over 6 months after SPR among sixteen children who underwent SPR from August 1995 to July 1996. The authors have analyzed the status of the children with spastic cerebral palsy before and after operation to determine the effects of this therapy on muscle tone, functional grade, gross motor function and gait pattern. Gross motor function was measured by gross motor function measure(GMFM) scale.

Postoperative tests showed reduction in muscle tone in all cases compared with preoperative assessments. Functional grade was increased in 90% of the cases more than one grade. The total gross motor mean score change between the preoperative and 6 months postoperative score was 16. Gross motor scores were analysed in each of 5 dimensions(88 conditions), i.e., lying and rolling, sitting, crawling and kneeling, standing, and walking·running·jumping. Gross motor score for each dimension improved in all cases. The greatest improvement was seen in sitting scores. The results of gait analysis of 2 ambulatory patients showed increased range of motion of hip and knee joints throughout the gait cycle and increased ankle dorsiflexion during swing phase. These results showed that SPR combined with intensive postoperative rehabilitation for children with spastic cerebral palsy had a significant positive effect on gross motor function.

Recent advances in the technology of neonatal intensive care have greatly improved the survival rate of high-risk infants who would otherwise have died. However, the surviving infants still have higher risks of long-term neuro-developmental disabilities such as cerebral palsy.

As a result, early intervention programs are advocated for the detection and remediation of neuromotor abnormalities in risk infants. A number of assessment scales and screening tools have been developed for the evaluation of infant neuromotor functions in western countries. Infant Neurological International Battery(INFANIB) was established by Ellison and Browning in 1985. INFANIB consists of assessment of posture, extremity and axial tone, primitive reflexes and postural reactions. This is relatively simple and easier for examiner and less burdensome to examinee. So we have used INFANIB as assessment tool for the detection of neurodevelopmental abnormal infants since 1993 and studied correlation between INFANIB results and neuromotor outcome for 2 years in 70 risk infants.

All the infants of the abnormal results group (29 cases) on the initial INFANIB examination grew into either cerebral palsy (26 cases) or minor neural dysfunction group (3 cases) on the follow-up examinations. All the infants of the normal results group (12 cases) appeared to be in normal developmental outcomes on the follow up. However, the transient results group (29 cases) showed variable outcomes, which were 9 cases of cerebral palsy, 6 cases of minor neural dysfunctions, and 11 cases of normal development.

INFANIB test results of the infants were highly sensitive and specific with the follow up examinations. Normal INFANIB results can be used to reassure parents of risk infants and an early intervention programs can be started to abnormal INFANIB infants. It can be used as a reliable screening tool for suspicious neurologically deviant neonates and infants. However the transient groups showed diverse neuromotor outcomes, they should be carefully monitored during infancy and childhood.

The physical activity has an important physiological and psychological benefit for all people, and the exercise program has a key role in the management of diabetes. This article presents exercise recommendations for people with diabetes. Though the patients with diabetes may give many benefits from regular physical exercise, there may be several hazards from exercise as well.

We assessed 30 patients with type 2 Diabetes Mellitus and 15 normal control subjects with sedentary life-style for their workload, heart rate on maximal performance and maximal oxygen uptake, change of blood glucose level after exercise using bicycle ergometer and Astrand nomogram.

The workload, heart rate on maximal performance and maximal oxygen uptake were lower in diabetic patient than control subjects.

Blood glucose decreased in diabetic patient than control subjects, after exercise and the lowered value was maintained until 60 minutes after exercise.

The maximal oxygen uptake was lower in diabetic patients than control subjects. The blood glucose decreased in both diabetic patients and normal control after exercise.

Isotonic exercise occurs when the tension or torque generated by a muscle is constant throughout the movement. In practice it is very difficult to maintain the tension constant. Evaluation of isotonic exercise should include the works of concentric and eccentric contraction and the changes in tension and torque during joint motion. However, optimal evaluation tools for isotonic exercise has yet to be developed.

We authors, used virtual reality motion analysis system(VRMAS) which was codeveloped by us and EMG system(Cardwell Excel). Healthy male adult subjects(n=10) were recruited from hospital personnel. After dominant upper arm and trunk of each subject was fixed with velcro, he was instructed to repeat flexion and extension of his dominant elbow grasping dumbell (9 kg) in hand with maximal velocity as possible as can until the point of exhaustion. We measured the elbow angle, the angular velocity, torque, power, total work and the work of concentric and eccentric contraction during exercise.

The results were as follows: there were four distinct elbow flexor muscle contractions during flexion and extension of the elbow with the first and the second contractions during concentric contraction and the third and the fourth contractions during eccentric contraction. Between the peaks of contraction, motion was maintained due to the momentum that was generated. Of the ten subjects, seven had higher concentric work than eccentric work with the eccentric work being higher in the remaining three. But there was no statistic significance between the works of concentric contraction and eccentric contraction(p>0.05). The biggest work was observed in the fourth contraction, while the third contraction showed the least work(p<0.05).

In conclusion, there were four distinct muscle contractions during elbow isotonic exercise and the works of each muscle contraction were different. This result is contrary to the definition of isotonic exercise. This study also shows that the VRMAS could be a very useful evaluation tool for several types of isotonic exercise.

건강한 성인남자의 제일배부골간근을 대상으로 정밀분해법을 이용하여 빠르게 이완한 경우와 느리게 이완한 경우의 운동 단위의 발화양식에 대하여 다음과 같은 결과를 얻었다. 탈 동원 순서의 역전은 느리게 이완한 경우와 빠르게 이완한 경우에 각각 운동 단위 쌍의 10.3%, 13.8%에서 나타났는데 통계적으로 의미있는 차이는 없었으며 이들은 모두 비슷한 동원 역치를 갖는 운동 단위들 사이에서 일어났다. 탈동원 역치는 이완속도가 증가함에 따라서 높게 나타났다. 결론적으로, 근육이 이완하는 동안에도 운동단위는 크기 원리(size principle)의 기본적인 기전에 따라서 순서적으로 탈동원되지만 비슷한 크기의 운동단위들 사이에서 탈동원 순서가 역전되어 나타날 수 있다.

The obturator nerve is originated in lumbar 2, 3, 4 roots and inserted at the inner muscle of thigh, by way of sacral ala and obturator foramen. In the case of pelvic surgery or obstetric trauma, the obturator neuropathy is occasionally occurred. However, the obturator neuropathy is rarely seen in the orthopedic accident.

In literature, one case of obturator neuropathy is reported after 2,012 cases of total hip replacement surgery. The useful diagnostic tools of obturator neuropathy are needle EMG on the obturater nerve innervated muscle, not conduction test on the nerve.

We report of a case of obturator neuropathy after closed reduction of posterior hip dislocation complicated by traffic accident with a brief reviewed of literatures.

Syringomyelia can occur as a complication of tuberculous meningitis despite of appropriate chemotherapy and almost it is founded with motor and sensory disturbances.

We have experienced a case of an extensive syringomyelia & syringobulbia in tuberculous

meningitis who complained only mild numbness & diplopia without specific motor disturbance.

So we think that we should not overlook even mild symptoms and have to evaluate the syringomyelia timely by radiographic study.

Motor point block with phenol solution has the advantage of technical ease, bedside performance, and repetition as necessary in reducing spasticity. To our knowledge, however, complicating stress fracture that occur during the course of treatment after motor point block has not been described. We report the occurance of stress fracture of the head of right talus after motor point block with phenol solution. A 17-year-old boy had a gait disturbance due to excessive plantar flexion and inversion of right ankle by spasticity. Percutaneous motor point block to right tibialis posterior and right gastrocnemius was done with 7% aqueous phenol solution. Just after the block, he began to bear his weight on right heel and physical therapy including gait training was started. He complained of right ankle pain a week after resumption of weight-bearing while walking. Bone scan and magnetic resonance imaging of right ankle revealed stress fracture of talus of right foot. This case illustrated that physiatrists involved in the management of such patients should be aware that secondary stress fractures can occur.