New insights in the pathophysiology of stroke have been developed in the past few years. The progress in this area has led the development of diagnostic devices and new treatments. No specific therapy has proven efficacious in treating acute ischemic stroke, because of major differences between animal models and human stroke, the heterogeneity of stroke pathogenesis, and the lack of consensus on stroke management in each subtypes of stroke.

A good general management is an important factor for the better prognosis than specific therapy in different types of stroke. General management of stroke includes cardiac and pulmonary care, metabolic maintenance, blood pressure control, and prevention of bedsores and phlebitis. Thrombolytic therapy, anticoagulation and antiplatelet agent therapy are kinds of specific therapies in acute ischemic stroke. It has to be emphasized that patients be referred early. In animal studies, focal ischemic insult requires 3-4 hours to progress to cerebral infarction. Six hours after onset of stroke has been arbitrarily defined as the limit to initiate reperfusion on positron emission tomography in human.

The entry of calcium into the cells via receptor-mediated membrane channels is an important factor in ischemic neuronal death. Oxygen free radical is an another factor in the ischemic damage. Calcium channel antagonists and scavengers of oxygen free radicals will have beneficial roles to prevent ischemic neuronal injury.

The correction of risk fators is very important in the prevention of stroke. This study was designed to investigate the risk factors of stroke patients and to correlate these risk factors with Functional Independence Measure(FIM) scores to be used for possible prognostic values in rehabilitation program.

The subjects were 75 patients from 36 to 84 years of age. Data collection was done through chart reviews on risk factors of stroke including hypertension, transient ischemic attacks or previous stroke history, diabetes mellitus, heart disease, cigarette smoking, alcohol intake and hypercholesterolemia. Risk factors in stroke by the order of frequency were hypertension(68.0%), previous stroke history(38.7%), heart diseases(22.7%), hypercholesterolemia(24.0%), and diabetes mellitus(16.0%). The frequency of hypercholesterolemia, diabetes mellitus, heart disease, smoking in cerebral infarction group was higher than in intracerebral hemorrhagic group. There was no stastically significant correlation between risk factors and FIM scores.

The results suggest that hypertension was the most important risk factor in stroke and the rate of risk factors was higher in cerebral infarction than in cerebral hemorrhage.

The experimental evidences suggest that the roles of basal ganglia are cognition and emotion through the corticostriatothalamocortical relationship. The patients with lesions in the caudate nucleus have high incidences of cognitive and behavioral abnormalities accompanied with the motor paralysis. In these patients, the accurate assessment of neuropsychologic dysfunctions and the prompt application of cognitive rehabilitation programs are important for the functional restoration.

We evaluated the patients with stroke of basal ganglia for the clinical and neuropsychological characteristics in relation to the involved substructures of basal ganglia. Fourteen patients were evaluated for the clinical neurologic examinations, functional assessment by functional independence measure(FIM), speech assessment, and various neuropsychological tests for the assessment of attention and memory functions. The results were analysed according to their lesion sites. Of the nine patients with stroke at the right basal ganglia, five patients had neglect of the contralateral hemispace and one had dysarthria. On the other hand, of the five patients with stroke at the left basal ganglia, none had hemispatial neglect and three had aphasia or dysarthria. Of the six patients with caudate lesions, three had aphasia or dysarthria, whereas of the eight patients without caudate lesion, one had dysarthria. The scores of Wechsler memory test were significantly lower in the patients with caudate lesions(p＜0.05). Among the FIM subscales, the scores of communication and social cognition were significantly lower in the patients with caudate lesions(p＜0.05). The Motor Score was significantly lower in the patients with putamen lesions(p＜0.05). Among the FIM subscales, the scores of self care and locomotion were significantly lower in the patients with putamen lesions(p＜0.05).

Hemiplegic gait is characterized by slow and poorly coordinated movements of the affected limb resulting from foot drop or equinus deformities. Ankle-foot orthoses(AFO) are frequently prescribed to improve the gait pattern of hemiplegics. Plastic AFO with different trimlines in controlling ankle motion can cause variable biomechanical effects.

In this study, we analysed the biomechanical effect of donning AFO on hemiplegic gait and assessed whether any differences resulted when the AFO was modified. Gait events, plantar pressure, foot contact and centers of pressure(COP) parameters were measured with F-scan pressure sensitive insole system in 21 hemiplegic stroke patients with Brunnstrom's lower extremity stage 3. And those parameters were compaired in each of four different conditions: 1) before donning AFO, 2) donning AFO without any modification, 3) donning AFO with the distal part of metatarsal head trimmed off, 4) donning AFO with third condition and weaning a cushioned heel shoes.

After donning AFO, total contact area and contact width were increased, and initial contact COP and mean COP were displaced medially. But contact length was not changed and initial contact COP and mean COP were not displaced anteroposteriorly. Anteroposterior displacement of COP, slope and velocity of COP were not also changed after donning AFO. Among various AFO adjustments, there were no significant changes of plantar pressure, foot contact and COP parameters.

The results suggest that 1) AFO provides mediolateral stability, but does not provide additional functional rocker actions during stance phase and 2) There were no definite different biomechanical actions among various adjustments of plastic AFO in hemiplegic gait of Brunnstrom's lower extremity stage 3.

The Loewenstein Occupational Therapy Cognitive Assessment(LOTCA) battery provides an initial profile of the cognitive abilities of the brain-injured patient that can be used as a starting point for occupational therapy intervention and as a screening test for further assessment. Reliability and validity for the LOTCA have been reported in the literatures. This study investigated the relationship between LOTCA scores and functional assessments in 34 brain-injured patients, consisting of 21 stroke patients and 13 traumatic brain injury patients.

Subjects were administered the LOTCA and, as functional assessment tools, the Cognitive Capacity Screening Examination(CCSE) and the Modified Barthel Index(MBI) upon referral to occupational therapy initially, and again at discharge.

The initial and the last LOTCA scores were significantly related to the initial and the last CCSE scores and the MBI scores, respectively, in brain-injured patients. Each of the last LOTCA scores, CCSE scores, and MBI scores increased significantly compared to the initial scores. There were no significant differences in the initial and the last LOTCA scores, CCSE scores, and MBI scores between stroke patients and traumatic brain injury patients. Greater LOTCA gain was significantly related to greater MBI gain.

These results suggest that the LOTCA battery for brain-injured patients is related not only to cognitive function, but also to functional evaluation as activities of daily living and functional recovery at discharge.

Early diagnosis of cerebral palsy may help to provide early therapeutic intervention.

The early treatment of cerebral palsy is critical in the prevention of deformity and promotion of normal movement patterns. However, it is difficult to identify those who are at substantial risk of cerebral palsy before the age of one, particularly in its mild and moderate forms. The purpose of this study was to analyze and establish an efficient early diagnostic tool for cerebral palsy. The subjects in this study were 247 infants selected from outpatients at the Rehabilitation Hospital of Yonsei University from December, 1987 to March, 1996. The infants had problems in motor development or a past history of perinatal risks and all were under one year of corrected age.

The assessments included a structured developmental history taken from the child's parents, evaluation of motor development status, and neurological examiniations including assessment of muscle tone, several primitive reflexes and Vojta's postural reactions. These infants were assessed every 2∼3 months. According to the findings of developmental milestones, muscle tone, and Vojta's postural reactions, we divided the patients into high and low risk groups.

The final diagnosis confirmed that 126 children had cerebral palsy, 43 children had other diagnoses while 78 children turned out to be normal.

We found that diagnosis of cerebral palsy during the first six months of postnatal period relied mainly on abnormal muscle tone, Vojta's postural reactions, developmental motor delay, a positive finding of asymmetric tonic neck reflex and a negative finding of optical righting reaction. The sensitivity and specificity of the evaluation methods were 91.1% and 66.7%, respectively in the first six months of postnatal period.

In conclusion, we have proved that the delayed motor development, abnormal muscle tone and abnormal Vojta's postural reactions are very valuable tools for the early diagnosis of cerebral palsy.

The urinary tract infection(UTI) is a very common complication of rehabilitation patients with neurogenic bladder. Proper diagnosis and early treatment are very important for the long term rehabilitation outcomes. Many reports are available in the literature on the characteristics of UTI in spinal cord injury(SCI) patients, however only few reports appear on non-SCI patients.

We have done comprehensive chart reviews of 1,251 patients with neurogenic bladder who were admitted to the rehabilitation medicine department, PMC from January 1982 to August 1996. Patients were divided into 4 groups: patients with stroke, spinal cord injury, traumatic brain injury and other neurologic diseases, and we have studied: incidence of UTI, commonly cultured organisms, antibiotic sensitivities, urinary pH, voiding methods, and residual urine volumes.

The incidences of UTI are 50.9% for all patients, 48.1% in Stroke, 72.3% in Spinal cord injury, 38.9% in Traumatic brain injury, and 34.1% in other neurologic diseases. There has been increase of Gram(⁢) cocci and decrease of Gram(⁣) rod during study period. Commonly cultured organisms are Escherichia coli(E. coli), Pseudomonas, Klebsiella. The decreased antibiotic sensitivities are noted in almost all organisms. Positive correlations are found between the incidence of UTI, high urine pH, high residual urine volumes, and use of catheters.

In conclusion, despite of many variable factors, the trends of UTI in each groups show no significant difference.

Due to lack of evidences on the central and peripheral mechanisms of electrical stimulation in vivo, the purpose of this study was to investigate the influence of afferent stimuli, transcutaneous electrical nerve stimulation and microcurrent, on the electrodiagnostic study of normal subjects.

Electrodiagnostic study was performed before and after the application of afferent stimulion of the right popliteal fossa on 30 healthy female volunteers. After the transcutaneous electrical nerve stimulation, latencies of SEP, H-reflex, and F-wave, and H-amplitude changed significantly(p＜0.01). After the microcurrent stimulation, latencies of SEP, H-reflex, and F-wave, and motor nerve conduction velocity changed significantly(p＜0.01).

The results of this study prove that transcutaneous electrical nerve stimulation and microcurrent may cause changes of the anterior horn excitability and the conduction of the nervous system in vivo. Microcurrent may have a different mechanism of action compared to transcutaneous electrical nerve stimulation by having more localized inhibitory effects on the peripheral nerve. However, further investigation is needed to assess their mechanisms of action and the precise relevance of stimulation parameters.

Residual latency is the difference between the expected and measured terminal latencies in nerve conduction study. The main contributors to the residual latency are the nerve tapering in the hand and fingers and the neuromuscular delay. We measured median motor and sensory residual latencies in the controls and in patients with diabetes mellitus(DM) to establish the normal values, to evaluate the diagnostic value of the residual latency in diabetic polyneuropathy. we studied 50 healthy controls and 100 diabetic patients with or without polyneuropathy.

The normal residual latency values were 1.42⁑0.41 msec(mean⁑SD) in motor part and 0.44⁑0.20 msec in sensory part of median nerve. The standard deviation of residual latency in median motor nerve was decreased by 12% as compared with that of distal latency in the patient with diabetic polyneuropathy. Duration of DM and age were not related to the residual latency of median nerve.

The results suggest that the residual latency of median motor nerve provides a narrower normal range in the diagnosis of diabetic polyneuropathy irrespective of duration of DM or age.

The characteristics of the surface recorded F responses including minimal latency, mean latency, amplitude, duration, area and shape were investigated in the posterior tibial nerves of rabbits. During a train of 100 stimuli, each F wave was divided by the recurrence of shape into repeaters and nonrepeaters. There was no significant difference between the parameters of repeaters and nonrepeaters such as mean latency, minimal latency, amplitude and area. These findings suggest that the associated discharges of motor neurons generating the repeaters of F wave represented no definite distinctions from that of nonrepeaters in the aspect of the neuron size or the number of neurons contributing to each parameters of F wave. After the sciatic nerve was exposed, it was minimally injured by compression and then F responses were studied. Mean latency and minimal latency were prolonged, and amplitude and area were diminished in post-injured group. The frequency of repeater waves was increased but was not a useful parameter in the assessment of injury model due to a wide range of normal value.

The sympathetic skin response(SSR) is a simple test to assess sympathetic nerve function through sudomotor activity after electric stimulation. However the electrophysiologic characteristics of sympathetic skin response have not been fully documented regardless of the impending necessities. To understand the characteristics of central conduction of SSR by taking SSRs in various central nervous system diseases, 336 SSRs were measured in 14 stroke patients, 6 spinal cord injury patients and 2 traumatic brain injury patients and analysed by classifying into no response(NR), slight and normal groups.

In stroke patients, normal SSRs were obtained more in hemiplegic side than non-hemiplegic side after both limb stimulations. And normal SSR were obtained more in left hemiplegic patients than right hemiplegic patients even though number of subject was limited. The patterns of SSR in traumatic brain injured and spinal cord injured patients were not so closely correlated with severity of clinical symptoms and abnormal somatosensory evoked potentials.

The sympathetic skin response seems to be exclusively under the control of central nervous system of which the subcortex would be regarded as the sudomotor reflex center.

Pudendal nerve somatosensory evoked potential(PSEP) study has been utilized for the evaluation of neurogenic dysfunctions of bowel, bladder and sex. However, the reluctance of sexual organ exposure during the study can be a serions limiting factor. Sacral dermatomal somatosensory evoked potential(SDSEP) study stimulating sacral dermatome can be an alternative or a supportive method for the PSEP study.

The purpose of this study is to present the techniques, normal values and clinical significance of SDSEP study in spinal cord injured patients. Thirty control subjects and thirty-five spinal cord injured patients were enrolled for the study. Using ring electrodes, S3 dermatome was stimulated by Nicolet Viking IV EMG/EP system. Evoked responses were recorded at the cortex(Cz'-Fz) by the needle electrodes. The latencies and amplitudes of SDSEP and PSEP responses were obtained and analyzed. In control subjects, the P1 latencies of SDSEP were 34.72⁑2.68 msec for the right and 33.54⁑1.95 msec for the left. The N1 latencies were 43.06⁑2.31 msec for the right and 42.14⁑2.29 msec for the left, respectively. The P1N1 amplitudes of control subjects were 0.73⁑0.40 ㄍV for the right and 0.69⁑0.22 ㄍV for the left. The coincidence of SDSEP and PSEP was 86.7% of the spinal cord injured patients.

In conclusion, SDSEP study could be used for the evaluation of neurogenic dysfunctions of bladder, bowel, and sex in conjunction with the PSEP study.

The peripheral nerves can restore their impaired function after injuries from trauma or surgery. The known factors affecting the recovery of damaged peripheral nerves include the severity of damage, nerve growth factor(NGF) from the damaged area and the concentrations of fibrinogen and thrombin. One of polypeptides, transforming growth factors beta(TGF-β) has been known to be related to inflammation and healing process of various wound. The TGF-β has to three subtypes, TGF-β₁, TGF-β₂ and TGF-β₃. This study was performed to explore the effects of TGF-β subtypes on the recovery phase of damaged nerve. Sciatic nerves of rat were compressed 200 dyne/mm². The latencies were measured by stimulation of proximal and distal portion of compression injury site and expression of TGF-β isoforms was studied in proximal and distal nerve of compression site and spinal cord by using avidin-biotin complex immunoperoxidase technique.

The latencies were increased at one week after nerve injury and then recovered progressively following 4 weeks. The latencies were restored to almost normal values at 4 weeks after nerve injury. TGF-β₁ and TGF-β₃ were expressed weakly at the cytoplasm of Schwann cell in the distal portion after 12 hours of injury. The values of TGF-β₁ and TGF-β₃ were increased at 3rd day after injury and lasted till the 4th week which was the end point of nerve regeneration. The changes of proximal portion were different from those of distal portion. TGF-β₁ and TGF-β₃ of proximal portion showed stronger positive reaction than that of distal portion and the reaction was peaked at 3rd day after injury. TGF-β subtypes were rarely present at neuronal cells and astrocytes in spinal cord from 12th hour to 3rd day after injury. The TGF-β subtypes were weakly appeared at the 1st week after injury and successively increased to 4th week at which the latencies were restored to almost normal value. The patterns of revelation of TGF-β subtypes showed that TGF-β₁ was predominant at neuronal cell and TGF-β₂ was at glial cells.

We suggest that TGF-β subtypes might be related to the regeneration process of nerve injuery.

We examined 16 patients with unilateral tongue deviation using magnetic stimulator in order to evaluate central hypoglossal nerve palsy following brain injury.

Surface recording electrodes were placed at the apex and anterolateral one thirds of tongue. Magnetic stimulation was performed at vertex and occiput. On occiput stimulation, the mean latency was 3.77⁑0.36 msec in affected side and 3.89⁑0.47 msec in sound side for male patients, and 3.94⁑0.61 msec, 3.90⁑0.55 msec respectively for female patients. The mean amplitude was 0.85⁑0.63 mV in affected side and 2.64⁑2.32 mV in sound side for male patients and 1.00⁑0.23 mV, 3.56⁑0.40 mV respectively for female patients. There was significant difference between affected side and sound side for amplitude.

On vertex stimulation, the mean latency was 8.61⁑0.83 msec in affected side and 7.50⁑0.80 msec in sound side for male patients, and 9.66⁑1.14 msec, 6.48⁑0.44 msec respectively for female patients. The mean amplitude was 0.77⁑0.59 mV in affected side and 1.23⁑1.08 mV in sound side for male patients and 0.52⁑0.23 mV, 1.15⁑0.64 mV respectively for female patients. There was significant difference between affected side and sound side for latency and amplitude.

Measurement of spinal range of motion(ROM) can be effectively used in guiding the direction of therapy, determining the patient's response to rehabilitation treatment and functional assessment. However for a method of measurement to be commonly used in clinical and research settings, it must be easy to perform, rapid and highly reliable. The purpose of this study was to determine the possibility of clinical application of 2-dimensional motion analysis system to measure spinal ROM in patients with low back pain(LBP).

Subjects included 10 healthy males and 10 patients with LBP. Using Electronic Digital Inclinometer (EDI 320) and 2-dimensional motion analysis system, thoracic, lumbar and pelvic ROMs were measured for trunkal flexion, extension, lateral flexion and rotation. Also proportions of decreased ROMs in LBP patients relative to healthy subjects and movement patterns of each spinal segment according to time sequence were investigated.

LBP patients compared to normal subjects showed significantly low spinal ROM(P＜0.05) except thoracic and pelvic ROM for extension. When looking at the change of each spinal ROM in respect to time with motion analysis system, normal subjects showed synchronized and sigmoid motion curve time from the initiation to the end of motion in all areas of spine during 4 motions. LBP patients took longer time from the initiation to the end of each motion, and showed smaller initial change and fluctuation in spinal ROM during each motion compared to normal subjects.

The results of this preliminary study suggest that 2-dimensional motion analysis system can be effectively used for measuring spinal ROM in patients with LBP.

The purpose of this study was to measure the foot pressure distribution of normal children. Static and dynamic pressure, dynamic pressure-time integral, relative impulse, static pressure distribution between forefoot and heel, and the percentage of contact time in each phase of the gait cycle were measured from 68 normal children by the in-sole pressure measurement system. The measurements were perfomed while standing and walking with their comfortable speed using the in-sole pressure measurement system.

The sites of the greatest static pressure, dynamic pressure-time integral and relative impulse were obtained from the 2nd and the 3rd metatarsal head areas. And the dynamic pressure was obtained from in the lateral heel area. The forefoot to heel load ratio was about 6 to 4 in the static state. The contact time was greatest during the push-off phase., In-sole pressure measurement system, Static pressure, Dynamic pressure,

Variations in the distribution and the magnitude of the forces in the foot may reflect painful conditions and abnormalities of structure or function. By tracking the path of the instantaneous COP(center of pressure) during stance phase, the balance and pattern of progression can be determined, but parameters on COP have not been standardized nor widely applied to clinical settings yet. To quantify the COP parameters and to evaluate the clinical applicability of COP, within subject experimental design was used. Twenty six subjects with age of sixties who had no history of foot problems were recruited. Foot contact and COP parameters were measured and compared between flat foot, low heel and high heel shod walking.

1) Gait cycle parameters, 2) foot contact parameters such as total contact area, contact length, contact width, and 3) COP parameters such as initial contact COP, mean COP, anteroposterior and mediolateral displacement of COP, slope of COP, velocity of COP during each functional rocker were measured with F-scan pressure sensitive insole system.

In normal flat foot walking, COP of initial contact and mean COP were anatomically correspond to the center of the heel and to the center of the sole respectively. COP displacements corresponded to 83% of foot contact length anteroposteriorly and 18% of forefoot contact width mediolaterally. Slope of COP was about 6 degrees inwardly directed. Velocities of the COP during each functional rocker action were even and about 22∼27 cm/sec around.

In high heel shod walking, COP of initial contact was displaced 1.73 cm anteriorly and mean COP was displaced 0.31 cm medially and 1.89 cm anteriorly. Anteroposterior displacement of COP was also reduced. Velocity of the COP during heel rocker was faster and velocity during ankle rocker was slower compared to flat foot walking, which suggests excessive heel rocker and reduced ankle rocker action in high heel shod walking.

In conclusion, COP parameters measured by pressure sensitive insole system may reflect the biomechanical alteration of the foot quantitatively and may be useful in assessing the biomechanical function of the foot.

Botulinum toxin develops muscular paralysis through the inhibition of acetylcholine release from presynaptic membrane in neuromuscular junction. It has been used clinically to treat strabismus, blepharospasm and spasmodic dysphonia. Recently it was introduced for the treatment of limb spasticity as well. Serial compound muscle action potential(CMAP) amplitudes were measured and repetitive nerve stimulation test(RNST) was performed with 2Hz and 30Hz on the rat gastrocnemius muscle to observe the effect of muscle paralysis. Also, Periodic acid Schiff (PAS) staining sections of the muscle for glycogen was studied to quantify the degree of muscular paralysis.

Thirty Sprague-Dawley rats, 10 for control and 20 for experimental group were studied for 12 weeks. Normal saline 0.025 ml and 0.125 ml was injected into gastrocnemius muscle in cotrol group 1 and 2, respectively. Botulinum toxin type A(Botox) was injected 5.0U/0.025 ml in experimental group 1, 2.5U/0.025 ml in group 2, 2.5U/0.125 ml in group 3, and 0.5U/0.025 ml in group 4. The amplitudes of CMAP declined markedly by 81.1% to 96.5% of basal amplitudes on the first week after Botox injection, but slightly recovered on 12th week by 20.8% to 42.2% with greater recovery in lower dose group. RNST with 2Hz produced no remarkable 1 : 5 amplitude change in experimental group. RNST with 30Hz produced marked increment in 1 : 5 amplitude up to 24.4%. PAS staining for muscle sections showed residual glycogen after tetanic stimulation due to neuromuscular block by Botox.

Tethered spinal cord syndrome can be defined as a low conus medullaris extending below L2 vertebral level and/or a thickened filum terminale above 2 mm in diameter. Among the neurologic symptoms, neurogenic bladder and bowel is the most common and leaves significant sequale that the patients being disabled not physically but socially. Early recognition and detethering operation are recommended but proper bladder management with regular follow-up should be accompanied for better prognosis.

Here, three cases of the neurogenic bladder with tethered spinal cord syndrome who primarily had myelodysplasia are presented with review of the articles.

Chronic progressive radiation myelopathy(CPRM) is a rare but serious complication of radiation therapy. It's exact cause is unknown and the diagnosis is usually made based on the exclusion of other causes of myelopathy. Magnetic resonance imaging(MRI) with gadolinium- diethylenetriamine pentaacetic acid(DTPA) enhancement seems to be useful for the diagnosis of CPRM. There is no known effective treatment and the complication is irreversible.

We report a case of CPRM after radiation therapy for subglottic cancer which was not respond to high-dose steroid therapy with review of literature.

Diffuse idiopathic skeletal hyperostosis(DISH) is a relatively common disorder. It is a noninflammatory disease occuring predominantly in middle aged elderly men characterized by calcification and ossification of the anterolateral aspects of vertebral column. It's clinical manifestations are minor: usually cervical stiffness, trunk stiffness and moderate pain. However some severe neurologic complications can occur due to spinal cord compression. We report a case with DISH who got spinal cord injury after minor trauma.

A 65-year-old man admitted to the neurosurgery department with a complaint of weakness in lower extremities and paresthesia in upper extremities which were developed after slip down. He had a 10 year history of slowly progressive neck stiffness and weakness in lower extremities. Plain X-ray does not reveal any evidence of fracture in cervical spine or sacroilitis but showed calcification of the anterior longitudinal ligament. The disc spaces were maintained well. MRI showed ossification of the posterior longitudinal ligament causing severe narrowing of the vertebral canal and compression of the spinal cord. Under the diagnosis of spinal cord injury with DISH, the patient was treated conservatively. Despite these treatment, neurologic impairment aggrevated. Surgical decompression of cervical and thoracolumbar spinal cord was done and the patient improved to the quadcane ambulation level.

Partial hand amputation may leave a significant functional limitations for amputee that are difficult to ameliorate by either orthoses or prostheses. Many kinds of devices have been tried to promote the function and cosmesis. Cosmetic hand was the best answer to the person with first and second metacarpophalangeal joint disarticulation and the strength and range of motion of remaining three fingers were not in optimal status till now. We applied a new device of wrist driven prehension prosthesis consist of forearm stabilizer, short opponens, actuator rod, artificial thumb, artificial index and attached 2 rings was designed and fabricated. As a result, it is possible to provide considerable improvement in function and cosmesis with this new device.

Trigeminal neuropathy commonly presents prolonged disorder of sensation in the distribution of the fifth cranial nerve of unilateral side and involves more than one division. We are reporting a case of a pure trigeminal motor neuropathy without sensory symptoms.

38-year-old man suffered from a mild common cold followed by progressive weakness and wasting of right masticatory muscles without pain or sensory change. Neurological examination revealed sunken cheek and temple area with weakness of the masticatory muscles and normal sensation of the face and normal taste. And all other cranial nerve were intact. Electrophysiological study revealed abnormal spontaneous activities with no voluntary motor unit potentials from the right temporalis and masseter muscles. The masseter reflex examination elicited by reflex hammer stimulation showed very small amplitudes from the right side. Trigeminal evoked potential, brainstem evoked potential and electrophysiological trigeminal blink reflex were normal. The imaging studies of the brain(CT and MRI) demonstrated atrophy of the right trigeminal motor nerve innervated muscles suggesting a pure trigeminal motor neuropathy without sensory involvement. We suspected a viral infection as the cause of their condition.

The Osler-Rendu-Weber syndrome is characterized by multiple telangiectasic lesions usually involving the mucous membranes, face and distal extremities. It is a congenital malformation inherited as an autosomal dominant trait and the lesions usually appear during adulthood. The major symptoms are recurrent epistaxis and gastrointestinal bleeding, but they may cause intracranial hemorrhage at the white matter of the brain stem, cerebellum and diencephalon. We report a case of typical autosomal dominant trait Osler-Rendu-Weber syndrome associated with intracranial hemorrhage at the right basal ganglia.