The purpose of this study is to evaluate any significant changes of the platelet parameters in pre-stroke stage and post-stroke stage compared with those of control group, and to determine any correlation of the platelet parameters with outcome of stroke patients as well as cerebral lesion size. We reviewed 53 charts of stroke patients who were admitted to neurology service first and then rehabilitation unit of Asan Medical Center.

The results of study revealed that there were no significant changes in mean platelet volume and platelet counts of stroke patients in pre-stroke stage, acute stage (＜48 hours after stroke) and chronic stage (＞4 months) as compared with those of control group. Furthermore, there were no significant changes of platelet parameters between survived group and expired group in pre-stroke stage and post-stroke stage. This study showed no correlation between the size of cerebral lesion and the platelet parameters. The review of FIM(functional independence measure) scores of sampled patients failed to demonstrate any functional correlations with platelet parameters.

In cerebral infarct patients, there were no significant differences of platelet parameters between each groups. There was also no significant correlation between the size of cerebral lesion, functoinal outcomes and platelet parameters. However, future study on prognostic values of platelet parameters in cerebral infarct patients needs to be carried out.

Among complications arising from spinal cord injury(SCI), chronic gastrointestinal(G-I) problems and bowel dysfunction have not received as much attention as the other fields of medical and rehabilitation research, even though their incidence is not negligible. Among SCI patients, we therefore investigated chronic G-I problems and bowel dysfunction, where the degree of these was such that activities of daily living(ADL) were significantly affected or long-term medical management was required.

Detailed semi-structured individual interviews were conducted with 72 traumatic SCI patients. The incidence of chronic G-I problems was very high(62.5%), most were associated with defecation difficulties such as severe constipation, difficult with evacuation, pain associated with defecation, or urgency with incontinence. These problems had an extensive impact on ADL in particular, they restricted diet (80%), restricted out door ambulation(64%), and caused unhappiness with bowel care(62%).

These chronic G-I symptoms were vague and very subjective, but significant enough to affect quality of life. Bowel dysfunction was not related to severity of injury, and bowel habits had generally settled within six months of SCI. With regard to frequency, time, and method of defecation, bowel care habits varied very considerably among individuals, and in relation to the extent to which practical results matched the level of expectation generated by a physician's recommended care program, individual satisfaction was also very subjective. We therefore suggest that an appropriate bowel program should be properly designed and adequate training provided during the early stage of rehabilitation.

This retrospective study reviewed clinical and electromyographic (EMG) findings in 106 patients with cervical pain syndrome.

The purpose of this study was to test the validity of clinical tests (neck compression test, manual muscle test, sensory test, deep tendon reflex) in the diagnosis of cervical radiculopathy. Electromyographic studies were interpretated as positive finding with the presence of abnormal spontaneous activities of limb and paravertebral muscles and the clinical tests were interpretated by the presence or absence of abnormalities. The results showed that the neck compression and manual muscle tests correlated well with the EMG findings but the sensory test and deep tendon reflex were not.

It is suggested that the neck compression and manual muscle tests may be helpful in the diagnosis of radiculopathy.

Intermittent catheterization has reduced the frequency of urinary tract infection(UTI), calculus formation and vesicourethral reflux in spinal cord injured(SCI) patients. Still the residual urine (RU) following catheterization has been suggested as one of the possible causes of UTI.

The purpose of this study was to identify the effect of postures on RU following catheterization, for the rehabilitation of neurogenic bladder in SCI patients. The inclusion criteria were: SCI patients with neurogenic bladder; completion of bladder rehabilitation program; good sitting balance and intact hand function. twelve SCI patients fulfilled the criteria and completed ultrasonographic RU measurement in sitting and supine posture following catherterization, respectively. We also studied the frequency of UTI, the functional type of neurogenic bladder and the postures during bladder evacuation at home.

All patients had ultrasonographical evidence of RU following catheterizations both in sitting and supine postures. Residual urine volume following catheterization was significantly smaller in sitting posture than in supine posture(p<0.05). Frequency of UTI was significantly lower in the patients who performed catheterizations in sitting posture than in supine posture(p<0.05).

In conclusion, bladder training in sitting posture would be better than in supine posture to minimize RU in SCI patients with good sitting balance and intact hand function.

Treatment of the trigger points(TrP) is the most important thing for management of myofascial pain syndrome(MPS). The most effective treatment of TrP is local injection with various types of drug or dry needling, but the effectiveness of each drug was not the same by each investigator. The purposes of this study are to evaluate diagnostic value of Digital Infrared Thermographic Imaging(DITI) for trigger points and therapeutic effects of lidocaine and normal saline by DITI. This study included 15 patients who have TrP on upper trapezius muscles as a patient group and 10 normal adults as a control group. 2 cc of 2% Lidocaine was injected to the TrP of upper trapezius muscles in a patient group and to one side of upper trapezius muscles in a control group. One week after the first injection, 2 cc of normal saline was injected by the same method in a patient group. DITI was taken sequentially, preinjection(Pre), immediately after injection(P0), 15(P15), 30(P30), 60(P60) minutes and 24 hours(P24h) after injection. The parameters, temperature difference(ԤT) of both sides, changes of ԤT(ԤdT), visual analogue scale(VAS) were recorded at each point. It was considered abnormal, when the ԤT was above 0.6^oC. The patient group was subdivided as Group I(hot spot), Group II(cold spot) and Group III(no difference) according to preinjection thermographic findings of TrP. The results were as follows: 1) ԤT of control group was within 0.52^oC(95% confidence interval), 2) the numbers were 9 in Group I, 3 in Group II and 3 in Group III, and the sensitivity and specificity of hot spots for MPS were 81.8% and 57.1%, respectively, 3) ԤT was more reduced after lidocaine- than normal saline-injection, 4) VAS was more reduced after lidocaine- than normal saline-injection, especially in Group I and II. It is concluded that DITI can be used as one of the diagnostic tools for TrP and lidocaine is more effective than normal saline for the treatment of TrP.

The purpose of this study was to evaluate the effectiveness of topically applied capsaicin cream for the treatment of chronic low back and posterior neck pain. Fourty-one patients with chronic low back or posterior neck pain of more than 6 months despite comprehensive management in our rehabilitation department were selected for this study. Of these subjects, a group of 21 patients used capsaicin cream, and the other 21 patients used NSAID gel as a control group. Pain intensities in both groups were measured with the visual analogue scale(VAS) before the treatment, 2 weeks and 5 weeks after the treatment. McGill Pain Questionnaire(MPQ) was used before and 5 weeks after the treatment. According to followed-up VAS, MPQ-number of words chosen, and MPQ-pain rating index, there was an evidence of effective pain relief by capsaicin cream for the low back and posterior neck pain 5 weeks after the treatment. We conclude that continuous use of capsaicin cream for 5 weeks can be beneficial for the chronic pain patients in relieving pain and subsequently helping their rehabilitation process.

Thermography shows skin temperature changes in various conditions of body. Skin temperature changes according to the subcutaneous blood flow which is regulated by the autonomic nervous system. Peripheral neuropathic pain can be influenced by the sympathetic activities which also can change the skin temperature of affected sites.

To evaluate the usefulness of thermography in the detection of peripheral neuropathic pain, authors analyzed thermographic images of 47 cases with peripheral nerve injuries of upper extremities.

The peripheral nerve injuries were confirmed by Electromyographic studies in all of the cases. The peripheral neuropathic pain was present in twenty three cases.

The results show that 97.5% of nerve injury patients with pain and 45.8% of nerve injury patients without pain had abnormal thermograms with a mean temperature changes of △ T=0.99^oC △T=0.13^oC respectively. Authors conclude that thermography can be an usefal tool for the detection of peripheral neuropathic pain.

The Postpoliomyelitis syndrome(PPS) is characterized by new neuromuscular symptoms such as muscle weakness, joint pain, fatigue, and occasional new neuromuscular impairments. Although the development of PPS shows individual differences, it usually occurs many years after the recovery from an acute paralytic poliomyelitis. The purpose of this study was to investigate the incidence and the clinical features of PPS.

The subjects were 33 patients(26 males and 7 females) who had partial recoveries of motor function, ten or more years of functional stabilities, and residual muscle atrophies. The mean age was 36.8⁑7.7 years with the range of 23∼59 years. The average onset age of acute poliomyelitis was 2.3⁑1.5 years. The questionnaires asking their current physical conditions and three major categories of PPS symptoms, weakness, fatigue, and pain were used.

As the sequelae of poliomyelitis, 66.7% of the subjects showed scoliosis and 39.4% had claw toes. Thirty six percents of the subjects were using orthoses including wheelchair, KAFO, and crutches.

According to the questionnaire study, 72.5% of subjects had at least one of the three major symptoms. And 36.4% of them reported all of three categories of PPS symptoms. The onset age of the new neuromuscular symptoms was 34.2⁑8.3 years which was about 32 years after the original acute poliomyelitis.

Further researches to investigate the importance and the impacts of proper managements and to develop educational plans for the PPS including exercise programs, cardiopulmonary and energy-conservation trainings are recommended.

Burn patients with associated limb amputations present demanding rehabilitation problems, many of which might lead them to chronic issues. The authors studied 77 male and 9 female burn patients with amputations. Most amputations occurred with high voltage electrical burns. The fingers were the most frequent target for amputations. The most frequent site of amputation was the entrance at the right side and multiple amputation in nature.

The prosthetic fittings were delayed because of burn wounds and grafts and fragile skin at the stump. Also, limited range of motion, decreased strength, hypertrophic scar contracture, heterotopic ossification and bony overgrowth were additional limiting factors.

We conclude that early rehabilitation intervention would be critical to prevent complications and to improve rehabilitation outcome of burn amputee patients.

The effect of electrical nerve stimulation are controversial because of the inconsistent variables of stimulating current and electrophysiologic study. The purposes of this study are to reconfirm the electrophysiolgic changes by electrical stimulation of the peripheral nerve that had been reported in 1993, and to monitor how long they will be maintained. In this study, the following conditioning stimulations were applied to 20 healthy volunteers; interferential current(frequency: 80∼100 Hz, intensity: 27∼34 mA) on the sacral paraspinal area. The H reflex, the F response, and the somatosensory evoked potential(SEP) of the tibial nerve were evaluated as the electrophysiologic study before, immediately after, 30 minutes, 60 minutes, and 120 minutes after the above conditioning stimulation. The following results were obtained;

1) Latencies of the H reflex, the F response and the SEP(P1), and the F wave conduction time, the F wave conduction velocity and the F ratio in the tibial nerve conduction study were increased by conditioning stimulation of the proximal peripheral nerves(P＞0.01).

2) Changes of the amplitude of the H reflex, the H/M ratio, and the amplitude(P1N1) of the tibial SEP were not significant in the same conditioning stimulation(P＞0.05).

3) Prolongations of the latencies of H reflex, F response and P1 SEP of the tibial nerve were the most significant immediately after conditioning stimulation and sustained for 45 minutes after conditioning on average (P＜0.01).

The above results suggest that certain conditional electrical stimulation of the peripheral nerves causes reversible changes in the conduction of the H reflex, the F response and the SEP and they may be inhibitory effect of the proximal conduction via the spinal cord.

Quantitative analysis of abnormal spontaneous activities, motor unit action potentials and interference patterns were recorded in 55 subjects with traumatic peripheral nerve injury to understand the changes of electromyographic signals.

We analyzed amplitudes of fibrillation potentials and positive sharp waves at rest, amplitude, duration, spike duration and polyphasicity of motor unit action potentials at minimal contraction, and the root mean square(RMS), and mean rectified voltage (MRV) at maximal contraction.

The amplitudes of fibrillation potentials and positive sharp waves had negative correlations with the duration of peripheral nerve injury but the amplitudes of motor unit action potentials, RMS, and MRV had positive correlations.

Therefore electromyographic evaluation could be used for the estimation of the duration of peripheral nerve injury.

Polyneuropathy is a common complication of chronic renal failure and usually remains stable or improves with hemodialysis. The purpose of this study was to investigate the usefulness of somatosensory evoked potential(SEP) study for the evaluation of polyneuropathy in chronic renal failure(CRF) patients who were on hemodialysis. The clinical findings, conventional nerve conduction study and SEP study were analyzed and compared in 30 patients with chronic renal failure before and after hemodialysis. Abnormal electrophysiological findings were shown in 25 patients(83.3%) of whom 8 patients showed abnormal somatosensory evoked potential(SEP) study only. Therefore it would be useful to perform both the somatosensory evoked potential(SEP) study and conventional nerve conduction study(NCS) for the evaluation of polyneuropathy. Improvement of somatosensory evoked potential(SEP) finding is correlated well with that of clinical symptoms after hemodialysis.

Therefore, somatosensory evoked potential(SEP) study can be used to monitor with progression of polyneuropathy in patients with chronic renal failure(CRF) who were on hemodialysis.

This study was designed to verify the validity of bulbocavernosus reflex latency(BCRL) and pudendal somatosensory evoked potential(SEP) in the evaluation of neurogenic erectile dysfunction and to lay out a scheme to uplift the diagnostic accuracy of BCRL and pudendal SEP. Eighty four subjects who were referred to Seoul National University Hospital EMG laboratory for the evaluation of the erectile dysfunction were examined. At first, history taking, physical examination, measurement of serum hormone level, rigiscan with audiovisual sexual stimulation were performed. In the next step, intracorporial papaverine injection, nocturnal penile tumescence test, BCRL and pudendal SEP were performed as indicated. Then the results of BCRL and pudendal SEP were compared to the final diagnosis obtained through additional studies. Psychogenic cause was most common and neurogenic, vascular, and hormonal causes followed. The diagnostic sensitivity of BCRL and pudendal SEP in the discrimination of neurogenic cases from nonneurogenic cases was 89.5% and 93.7%, respectively. The specificity was 89.7% and 64.7% in order. Among twenty seven subjects with abnormal BCRL or pudendal SEP, eight subjects were confirmed as psychogenic impotence at the final diagnosis. But psychogenic impotence was not found among nine subjects who had abnormal BCRL and pudendal SEP. Twenty three subjects with abnormal BCRL were divided into delayed latency group and no response group. Among thirteen subjects of delayed latency group, psychogenic cases were six and among ten subjects of no response group, psychogenic case was not found. In the evaluation of neurogenic impotence, BCRL was a sensitive and specific tool while pudendal SEP was sensitive but less specific. BCRL alone or pudendal SEP alone would be inadequate for the evaluation of neurogenic impotence, especially in discrimination with psychogenic one. To improve diagnostic accuracy in the evaluation of impotence, BCRL and pudendal SEP should be checked out all together. In the situation when only BCRL is available, it is recommendable to take unevokable bulbocavernosus reflex as meaningful.

Leprosy is an infectious disease caused by Mycobacterium leprae and characterized by dermal and peripheral nerve lesions. The facial nerve is also frequently involved in leprosy. There are a few electrophysiologic studies on the facial nerve involvement in leprosy patients, but there is no electrophysiologic study on the facial nerve involvement in cured leprosy patitents. So we performed facial nerve conduction study and Blink reflex study in 19 cured leprosy patients who have been managed with Dapsone for a long time. Facial motor latencies were prolonged in 11 patients(57.9%).: 10 of 15 patients in lepromatous type; 1 of 4 patients in tuberculoid type. Prolonged latencies were shown in temporal branch, zygomatic branch, buccal branch, and mandibular branch in 9(47.4%), 6(31.6%), 5(26.3%), and 3(15.8%), respectively. Blink reflex study suggests combined facial nerve and trigeminal nerve lesion in 2 patients.

The real-time ultrasonography is a simple, noninvasive procedure that is most suitable for application in pediatric practice. The ultrasonographic appearance of various disorders in children such as progressive muscular dystrophies, infantile spinal muscular atrophy, congenital myopathies, and motor neuropathies has been found to be strikingly abnormal.

We have done a pilot study using real-time ultrasonography in children with Duchenne muscular dystrophy in an attempt to correlate their clinicopathologic profiles with scan findings. Echogenicity and delineation of fascia at midthigh and midcalf muscle were measured using a real-time linear array ultrasound scanner in 12 Duchenne mucular dystrophy patients attending our Muscle Clinic, as a double-blind pilot study matched against 10 controls.

The ultrasonic scan findings in normal children revealed no echogenicity of muscle, distinct echogenicity of bone and delineation of fascia. But all Duchenne muscular dystrophy patients had increased echogenicity of muscle and decreased echogenicity of bone, and some patients had interruption of delineation of fascia. Duchenne muscular dystrophy patients who were unable to raise from standard height chair showed higher grade of echogenicity at midthigh level than the patients who were able to raise from standard height chair. But this result was not applicable at midcalf level.

We concluded that the real-time ultrasonography was useful diagnosis method in Duchenne muscular dystrophy. In addition, when the real-time B ultrasonography was applied to midthigh level, the ultrasonic scan findings could reflect indirectly the functional ability of Duchenne muscular dystrophy patients.

The understandings of the characteristics of eccentric exercise are very important because all sports and daily activities under the gravity force should be well coupled between concentric contraction and eccentric contraction as accelerator and decelerator respectively. We tested 40 knee flexors and extensors of 20 normal young persons at different anglular velocities of 60^o/sec and 120^o/sec using Cybex 6000(A division of Lumax, New York) isokinetic dynamometer in order to know the characteristics of eccentric isokinetic contraction parameters by comparing with concentric isokinetic parameters.

Compared to the concentric isokinetic contraction, eccentric isokinetic the peak torque and average power values of knee extensor and flexor muscles showed negative values which means that eccentric contractions were coupled with concentric contractions as decelerator and energy absorptioner. The peak torque values of eccentric contraction were 38∼61%, 44∼79% higher in flexor and extensor, respectively than those of concentric contraction and not so decreased as the peak torque of concentric contraction decreased in high angular velocity. The average power values of knee flexor and extensor muscles were definitely low in eccentric contracton than those of concentric contraction but were increased simultaneously with high angular velocity contraction. Further studies about the velocity dependency, muscle soreness, methodology to measure real eccentric activities and other parameters of eccentric contraction are needed imminently.

The purpose of this study was to estimate mean pressure thresholds over several skeletal muscles, grip and pinch strengths in female telephone operators.

Pressure thresholds on muscles of neck and shoulder were measured with a pressure algometer, and grip and pinch strength were measured with a Jamar dynamometer and a Jamar pinch gauge in 904 female telephone operators.

The pressure threshold was highest in the supraspinatus and lowest in the cervical paraspinals. There was no statistically significant difference between right and left corresponding muscles. The mean grip strength was 22.29 kg in the right hand, 21.97 kg in the left hand. The mean tip pinch strength was 0.56 kg in the right, 0.51 kg in the left. The mean lateral pinch strength was 2.21 kg in the right, 2.12 kg in the left. The mean palmar pinch strength was 1.82 kg in the right, 1.66 kg in the left.

There was no significant correlation between grip, pinch strength and age(p＞0.05). There were positive correlations between height, weight and grip strength. There were positive correlations between exposure duration to visual display terminal and pinch strength.

Spontaneous bacterial peritonitis(SBP) is a diffuse bacterial infection of peritoneum without an apparent intra-abdominal source of infection. Initially, it was believed to be associated with an alcholic liver cirrhosis, however, its clinical spectrum has been broadened and now it is thought to be a variant syndrome rather than an unique complication of liver cirrhosis.

A 25 year old quadriparetic man with a low-grade astrocytoma of cervicomedullary junction underwent a partial resection of tumor and a course of radiation therapy. While recieving rehabilitation therapy, the patient developed sudden abdominal pain, constipation and fever. The laboratory findings including CBC, plain abdominal X-rays, gastroduodenal endoscopy, abdominal ultrasonography were not specific. Physical examination revealed rebound tenderness over the epigastric region and signs suggesting paralytic ileus. A diagnostic peritoneal lavage was performed and its result was compatible with SBP even though no specific orgnisms were identified. The patient was taken parenteral antibiotics. On the 13th day of treatment, his symptoms and physical signs were subsided and antibiotics were discontinued. The patient remained symptom free until rehabilitation therapies were completed.

Heterotopic ossification(H.O.) is a common complication in spinal cord injured patients. The majority of heterotopic ossification in spinal cord injury occurs around hip joints. Fracture of femur is also a quite common complication in spinal cord injured patient, however H.O. associated with femur fracture at the hip was rarely reported.

The author experienced femur neck fracture in a spinal cord injured patient with preexisting H.O. The proper management of femur neck fracture and the prevention of H.O. were reviewed and discussed.

Peripheral neuropathy constitutes a rare clinical manifestation in the neurofibromatosis. Eleven cases of peripheral neuropathy associated with the neurofibromatosis have been reported. We report a sensorymotor peripheral neuropathy in 2 cases of neurofibromatosis.

Congenital hemihypertrophy is a rare idiopathic condition, first described by Meckel in 1822 and represents enlargement of a part or entire side of the body without associated vascular or neurologic disease. Wagner recorded the first case in the 1839. Hemihypertrophy is to be differentiated from hemiatrophy(which involves unilateral subnormal development, muscle weakness, or neurologic deficit) and the syndromes of hemidystrophy. Approximately 25∼50% of the reported cases of hemihypertrophy have been associated with hamartomas or congenital defects, especially genitourinary anomalies. The early detection of asymptomatic intraabdominal tumor in patients with congenital hemihypertrophy is important

We report 3 cases of congenital hemihypertrophy with discussion of the clinical manifestations and associated anomalies, which were rarely reported in domestic literatures.

Familial hypophosphatemic ricket (Vitamin D-resistant ricket), first described by Albright in 1937, has been known to be transmitted as an X-linked dominant trait in most families. Children with this disease would show growth retardation with characteristic clinical features such as congenital alopecia, genu varum or genu valgum, coxa vara and waddling gait. Although the physical features associated with this disease have been documented frequently, the potential involvement of auditory pathway due to abnormal bone formation in skull has not been explored frequently.

We report a twenty six-month-old female child with familial hypophosphatemic ricket who presented abnormal findings of brainstem auditory evoked potential study. The impaired hearing function should be alerted as one of possible accompanying disabilities of the disease.