Although tremendous studies have been published for prognostic evaluation of stroke patients, there's no definite conclusion until now because of diverging methodology and criteria for recovery. I discussed the ambivalent points of prognostic factors in clinical findings, radiological findings and electrophysiological findings.

There's no doubt that the prognosis of stroke patients depends on combination of multiple factors, not by one single factor. And one should remember that the aim of prognostic evaluation in stroke patient is to provide more efficient treatment to patients, no to select a good candidate for rehabilitation treatment.

I believe that more efficient prognostic evaluation will be possible in near future with standardization of methodology.

The purpose of this study is to clarify the clinical usefulness of Computerized Balance Evaluation and Training System(COBETS) in treating the patients with balance disturbance. Twenty- three patients who received rehabilitative management due to their balance disturbance after brain damage were treated either by conventional physical therapy(PT) or by visual biofeedback balance training(VBBT) using COBETS for 4 weeks. The static and dynamic postural balance were evaluated at pre- and post-treatment conditions using COBETS balance assessment software. The neurologic and functional assessment and somatosensory evoked potential study were performed as well.

Comparing with the control group, the patients treated by VBBT showed significantly improved static and dynamic postural control.

The central somatosensory conduction time(CCT) was measured by recording the cerebral and spinal evoked potentials following median nerve stimulation in 24 traumatic brain injury patients. The findings of evoked potential study correlated to the functional independence measure(FIM), mini mental status examination(MMSE) and Glasgow outcome scale(GOS).

The CCT of head injured patients was prolonged compared to that of the controls. The CCT with stimulation of the affected side was significantly prolonged compared to that with non- affected side. Abnormal CCT was related to the poor functional status measured by FIM and GOS. There`s no significant difference between groups of absent evoked potential and prolonged CCT by FIM score.

These results suggest that the CCT correlates with the functional status of head injured patients. Follow up studies are required to evaluate whether the CCT could be a valuable prognostic indicator or not.

It is often difficult, on the basis of clinical examination and conventional investigations, to evaluate the functional impairment of brain in children with cerebral palsy in which early detection remains a challenge. This study was designed to know the usefulness of single photon emission tomography(SPECT) of the brain with technetium-99 m hexamethylpropyleneamineoxime (^99mTc-HMPAO) as a semiquantitative method of determination of right-left asymmetries in tracer uptake and a change in antero-posterior regional cerebral blood flow(rCBF) distribution. We investigated 33 children with cerebral palsy aged from 4 months to 48 months(mean 19.3 months). The results were as follows: right to left ratio and regional index of a transverse view were useful to quantify the decrease of tracer uptake in left hemiplegia, but not in right hemiplegia who were all mild in severity, and in tetra- and diplegia in which cerebral lesions were found bilaterally; cortico-cerebellar ratios of a sagittal view were found useful to detect a decrease of rCBF distribution in tetra- and diplegia ,which was not distinct by means of right to left ratio and regional index on transverse view.

The results suggest that semiquantitative analysis of ^99mTc-HMPAO Brain SPECT would be a valuable complementary tool for determination of topographical involvement in cerebral palsy.

In 12 Reflex Sympathetic Dystrophy(RSD) patients(13 cases) after the acute stroke, Three- phase Bone Scintigraphy(TBS) was performed to evaluate whether the amount of radioisotope reflects the disease activity of RSD. The diagnosis of RSD was based on Kozin's criteria(definite or probable group) and scintigraphic findings(increased radioisotope uptake in all three phases). Initial TBS was performed within 10 days after the onset of clinical symptoms and it was followed up within 5days after the short term steroids therapy. Before and after the steroids therapy, patients were evaluated with respect to pain, swelling and allodynia. Radioisotope uptake of ROI(Regions Of Interest) of all three images was calculated semiquantitatively in initial and follow up scintigraphy.

Pain, swelling and allodynia of the affected hand were improved in all patients after short-term oral corticosteroids therapy. Radioisotope uptake in blood flow image(11 patients, 12 cases) and blood pool image(11 patients, 12 cases) were decreased(p＜0.05), but radioisotope uptake in delayed image was not decreased(p＞0.05).

We concluded that radioisotope uptake in blood flow and blood pool images could reflect disease activity of RSD. It was suggested that decreased capillary vascular permeability by corticosteroids resulted in decreased blood flow and blood pool. The semiquantitative evaluation of TBS may be useful for monitoring the response to therapeutic intervention.

The role of inflammatory mediators in RSD and pharmacologic effect of corticosteroids were also discussed.

Possible mechanisms of neurologic recovery in spinal cord injury were postulated by Ditunno Jr. JF in 1987. The first window encompasses recovery from neurapraxia within 6 to 8 weeks. The second window covers the period from 2 to 8 months after the injury. Recovery during this period might be due to peripheral sprouting of intact nerves to denervated muscle and hypertrophy of functioning muscles. The third window of recovery happens usually beyond 8 to 12 months when axonal regeneration may play a role in further increases in strength.

On the basis of these possible mechanisms, we measured the neurological and functional recovery rate according to the periods of these possible mechanisms of motor recovery through 12 months following injury in 21 traumatic spinal cord injury patients.

The results were as follows:

1) Neurologically, the most rapid recovery was shown within 6 to 8 weeks after injury, during the phase of recovery from neurapraxia.

2) Most of functional recovery occured in the period between 2 month and 8 month of the compensatory phase.

3) Statistically significant correlation between motor and functional recovery was shown among the incomplete spinal cord injury group.

These data would be helpful in planning a timely appropriate rehabilitation program by understanding the time-course of neurologic recovery and prognostication of neurologic and functional recovery in the spinal-cord injured.

One of the sequelae of spinal cord trauma which start soon after the onset of injury is the loss of the calcium from bone. Bone mineral and matrix resorption causes negative calcium balance, and eventually osteoporosis.

Etidronate disodium(etidronate) is an oral diphosphonate compound known to reduce bone resorption through the inhibition of osteoclasic activity. Since continuous oral treatment with high doses of etidronate may lead to the impairment of bone mineralization and the cessation of bone remodeling, a ideal therapeutic regimen consist of the intermittent cyclical administration of the diphosphonate in a dose that inhibits bone resorption.

To assess the effect of etidronate on bone metabolism and bone mineral density after spinal cord injury, we studied two groups of 7 spinal cord injury(SCI) patients with etidronate and 7 SCI patients without etidronate. Seven patients of treatment group received oral etidronate (5 mg/kg/day) for 2 weeks followed by a 10-week period in which no drugs were given. This sequence was repeated 4 times, for a total of 48 weeks.

The results showed that the patients receiving etidronate had siginificant decrease in the serum osteocalcin(OC), urine deoxypyridinoline(D-PYD) level but no increase in their mean bone density.

We can carefully conclude that intermittent cyclical therapy with etidronate siginificantly reduces bone metabolic rate and inhibit bone mineral loss on osteoporosis in spinal cord injury patients.

According to the World Health Organization(WHO), handicaps exist when individual is unable to fulfill expected social roles. The purposes of this study were to assess the handicap in spinal cord injury(SCI) outpatients, and to investigate the correlation of handicaps, impairments, disabilities and depression.

Eighty-five SCI outpatients were evaluated by the Craig Handicap Assessment and Reporting Technique(CHART), Katz scale, neurologic level and Frankel classification and Beck Depression Inventory (BDI). Seventy(82.4%) were male and 15(17.6%) were female. Average age of the subjects was 34.5 years with the age range of 18 to 63. The subjects were devided into four groups: complete quadriplegics (9), incomplete quadriplegics(12), complete paraplegics(41) and incomplete paraplegics(23). There was no significant statistical difference in total CHART scores between male and female subjects. However, male subjects had higher mobility and social integration scores than female subjects. The occupation score was low and the social integration score was high in all groups. No correlation was found between sex, severity and the level of injury, time since injury and the CHART scores. However, significant correlation was noted between the CHART scores and BDI scores.

We can carefully conclude that the CHART can be a valuable tool in the assessment of handicaps of disabled people. Futher extensive studies are recommended to identify the factors which might influence the handicaps of spinal cord injury persons.

This prospective study following American Association of Electrodiagnostic Medicine recommended criteria in the diagnosis of Carpal Tunnel Syndrome(CTS) evaluated the sensitivity of multi-electrodiagnostic parameters and usefulness of residual latency in CTS.

In 45 symptomatic hands of 26 patients with clinical diagnosis of CTS, 8 electrodiagnostic parameters-median motor distal latency, median motor residual latency, median sensory onset latency, median sensory peak latency, median to ulnar sensory onset latency difference(digit 4), median to ulnar sensory peak latency difference(digit 4), median to radial sensory onset latency difference(digit 1), median to radial sensory peak latency difference(digit 1)-were compared to the normative data obtained from the age-matched control group.

In 31 CTS hands without polyneuropathy, median to ulnar sensory latency difference(digit 4), median to radial sensory latency difference(digit 1), median sensory peak latency have same sensitivity(71.0%).

In 8 CTS hands with delayed proximal median motor nerve conduction velocity which were indiscernible from polyneuropathy in routine nerve conduction study, residual latency was more sensitive than median to ulnar sensory latency difference and median to radial sensory latency difference.

Sensitivity difference between sensory onset latency and sensory peak latency was negligible in the electrophysiologic diagnosis of CTS.

We concluded that residual latency measurement was a very useful and convenient method in the diagnosis of CTS, especially in the patients with delayed proximal median motor conduction velocity.

Pain, numbness, and weakness in the upper extremity are the common problems among wheelchair users. The prevalence of nerve injury of the upper extremity in the wheelchair users has been reported variously by many authors in other nations. To determine the prevalence, location, and risk factors of upper extremity peripheral nerve entrapment among wheelchair users, we performed clinical and electrodiagnostic assessments on both upper extremities of wheelchair users (n=49) and able-bodied controls (n=49).

The prevalence of nerve entrapment of the upper extremity among the wheelchair users was 15.6% according to clinical criteria, and 46.9% according to electrodiagnostic criteria. Electrodiagnostically, median nerve entrapment was identified in 28.6% of tested cases, and ulnar nerve entrapment was identified in 22.4% of tested cases among wheelchair users. The carpal tunnel was the most common site of nerve entrapment. The duration of wheelchair use was found to be correlated negatively with median wrist to palm and wrist to digit sensory conduction velocity, whereas age correlated positively with distal median and ulnar motor latency.

The evaluation of peripheral nerve disorders has traditionally relied on clinical history, physical examination and electrodiagnostic studies. The electrodiagnostic study is currently the most popular procedure to analyse the nerve lesion, but it is painful and its result is operator dependent. The purpose of this study is to evaluate the significance of MRI signal change of denervated muscle in peripheral nerve as an adjuvant study of electrodiagnostic study. After the compression of sciatic nerves in 20 rabbits and severance of scitic nerve in 10 rabbits, the signal change of both T1WI(TR; 450 msec, TE; 15 msec) and T2WI(TR; 3,000 msec TE; 90 msec) of calf muscles were compared with EMG findings of the same muscles. Signal intensity ratio(SIR) of calf muscles was measured and compaired with the grade of abnormal spontaneous activity in the same muscles in needle EMG study. Serial studies were done on 4th day, 1 week, 2 weeks, 3 weeks, 4 weeks, 6 weeks, 8 weeks, 10 weeks after sciatic nerve injury. Among 25 rabbits showing abnormal spontaneous activity in needle EMG, the signal intensity of both T1WI and T2WI was increased in 13 rabbits. The signal intensity began to increase at 1 week in 10 rabbits and 2 weeks in 3 rabbits following nerve injury which was about 1 week later than appearance of abnormal spontaneous activity in needle EMG study. There were no signal intensity increase in rabbits which showed no abnormal spontaneous activity in needle EMG study. The signal intensity ratio and grade of abnormal spontaneous activity had a good correlation(Spearman's correlation coefficiency : 0.635). The signal intensity of 3 rabbits which showed regeneration evidence in needle EMG study returned to normal. These findings suggest that MRI study of denervated muscle can be used as an evaluation method for severe peripheral nerve injury, howeverits value is doubtful in mild peripheral nerve injury.

Twelve patients with lumbar arachnoiditis were investigated by means of magnetic resonance imaging. The results showed three groups of different anatomic features: The group I showed conglomeration of nerve roots residing centrally within the thecal sac. The group II demonstrated clumped nerve roots attached peripherally to the meninges. The group III showed increased soft tissue signal within thecal sac. The overall clinical manifestations and electromyographic findings were also investigated; Ten(83%) patients complained of increased, non-radicular, leg pain with activities, such as standing or walking. There were muscle spasms and cramps in the legs in seven(58%). There appears to be no specific clinical and electromyographic findings characteristic to each of the three groups, except that the group III showed more prominent clinical symptoms than those of the other two.

In conclusion, MRI is useful in establishing the diagnosis of lumbar arachnoiditis, as well as seperating three different anatomic features. And we found that increased, non-radicular pain with activities and muscle spasms and cramps appeared to be characteristic to lumbar arachnoiditis, and the group III showed more prominent clinical symptoms than the other two groups.

Analysis of insertional activity is a routine part of the clinical electromyogrphic examination. It provides an information of muscle excitability but it's clinical significance has not perfectively accepted yet. This study was designed to evaluate clinical usefulness of insertional activity through quantitative analysis in the diagnostic field of pathology.

Monopolar needle electrode was inserted briefly in the biceps brachii, paralumbar spinal and tibialis anterior muscles of the normal and denervated muscles. Total duration and spike duration of the insertional activity were measured 10 times in each muscle and averaged. Within spike duration we measured turns, mean amplitude, turns/amplitude, RMS, mean frequency and median frequency.

The measured parameters of insertional activities were not significantly different according to the muscle in normal controls. In denervated muscles, the turns, mean amplitude, RMS, mean frequency and median frequency were decreased but turns/amplitude was increased compared to those of normal controls. But there were no difference in total duration and spike duration between normal and denervated muscles. In denervated muscles the muscle power was positively correlated with turns, mean amplitude, RMS, mean frequency and median frequency, and the grade of abnormal spontaneous activities was inversely correlated with turns, mean amplitude, RMS, mean frequency and median frequency.

Therefore quantitative analysis of insertional activity could be a useful method for the diagnosis of neuromuscular disease.

The evaluation of peripheral nerve disorders has traditionally relied on clinical history, physical examination, and electrodiagnostic studies. The electrodiagnostic study is currently most popular procedure. The purpose of this study is to assess the significance of the changes of amplitude and area of compound muscle action potentials(CMAPs) in peripheral nerve injury. After compression of sciatic nerve in 65 Korean house rabbits, the amplitude and the area of CMAPs were compared to each other before and after compression injury.

The correlation coefficients between the changes of the parameters, amplitude and area, were obtained at a scheduled interval, and the parameters were also assessed when the evidence of denervation and regeneration was seen. In addition, the relationship between the degree of abonormal spontaneous activities and each parameter was assessed.

At preinjury state, there was a significantly high correlationship between two parameters. The correlation coefficients were 0.764 and 0.756 with distal and proximal stimulations respectively in abductor hallucis recordings, and 0.649 in gastrocnemius recording. At postinjury, there was more significant high correlationship between two parameters. The correlation coefficients were 0.955 and 0.962 with distal and proximal stimulations respectively in abductor hallucis recordings, and 0.930 in gastrocnemius recording. Nineteen cases showed denervation activities at postinjury 4th day. Of those cases, the amplitude was decreased earlier in 2 cases and the area in 3 cases at the same day. Of 10 cases regenerated, the amplitude was normalized earlier than the area in 2 cases. There was a significant decrement tendency in both amplitude and area with the degree of abnormal spontaneous activities.

Therefore, both the amplitude and the area of CMAPs are good quantitative indices of peripheral neuropathy and useful parameters in long-term follow up study.

The powers of the low-frequency(LF) and high-frequency(HF) components characterizing heart rate variability (HRV) appear to reflect, in their reciprocal relationship, changes in the state of the sympatho-vagal balance occurring during orthostatic stress with head-up tilt.

We studied 24 healthy volunteers (median age, 23.1 years) who were subjected after a rest period to a series of passive head-up tilt steps chosen from the following angles: 0⁰. 15⁰, 30⁰, 45⁰, 70⁰, and 90⁰ under the condition of frequency controlled respiration(0.25Hz) in order to get data of the Korean young adults.

During head-up tilt, heart rate and normalized low frequency power(LF_N : 0.05∼0.15 Hz) of HRV showed significant increase(p=0.000), but normalized high frequency power(HF_N : 0.2∼0.3 Hz) and total power showed progressive decrease(p=0.000, p＜0.01 respectively). Male showed significantly higher LF_N and lower HF_N than female at tilt table angle 0⁰(p＜0.01).

Power spectral analysis of HRV appears to be capable of providing a noninvasive quantitatibve evaluation of graded changes in the state of the sympatho-vagal balance.

Respiratory failure and pulmonary infection are the major causes of death in the Duchenne muscular dystrophy patients.

The purposes of this study are to evaluate pulmonary function of Duchenne muscular dystrophy patients, to verify usefulness of the measurements of maximum static pressures and to define functional classes in Duchenne muscular dystrophy patients.

Forty two Duchenne muscular dystrophy patients were assessed for pulmonary function by a routine pulmonary function test and the measurements of maximum static pressures. This study showed significant negative correlations between the subject's functional class and the values of forced vital capacity(FVC), maximum inspiratory and expiratory pressures(MIP and MEP). Significant reduction of maximum static pressures began earlier than FVC in the course of disease. The MEP was as low as 64% of the predicted value before FVC and MIP showed demonstrable decline.

A pulmonary care program focusing on maintaining adequate respiratory pressures is suggested to start early for the childwith Duchenne muscular dystrophy.

The pendulum test, recognized as a reliable measure of spasticity, has been replaced in this study by a video-based two dimensional motion analysis system. Using twenty five patients with spasticity(21 males, 4 females; mean age 46.6 year-old) in their lower legs due to lesions affecting the central nervous system and twenty two persons without any evidence of hypertonia(all males; mean age 23.4 year-old), five parameters such as relaxation index(RI), amplitude ratio(AR), torque at maximal acceleration velocity, number of swing and swing time were obtained for the purpose of documenting the reliability of the video-based two dimensional motion analysis system for the evaluation of spasticity.

The values of RI(P＜0.05), AR(P＜0.01), and swing time(P＜0.05) in patients with spasticity were significantly lower than control, whereas the value of torque in patients was significantly higher than control(P＜0.01). Spearman's correlation coefficients of the RI(r=⁣0.70894, P＜0.001), AR(r=⁣0.71832, P＜0.001), number of swing(r=⁣0.59037, P＜0.05) and swing time(r=⁣0.59648, P＜0.01) showed a statistically significant negative correlation with the modified Ashworth scale, whereas that of torque(r=0.59037, P＜0.01) showed a significant positive correlation.

In conclusion, a pendulum test using a video-based two dimensional motion analysis system is a simple, and a reliable method for the quantitative evaluation of spasticity.

Recently, increased emphasis has been placed on the need for rehabilitation professionals to objectively evaluate a patient's potential for and progress toward a return to normal function. But as medical recovery nears completion, additional questions are commonly asked by physicians regarding work function and ability to return to full active employment. In the past, therapists have attempted to reestablish the work situation using real tools, but these machines were expensive, have space limitations and in some cases, potentially dangerous as well.

A Baltimore Therapeutic Equipment(BTE) Work Simulator overcomes these shortcomings. It can be used for isometric and isotonic evaluation and treatment and assisted in providing the information needed to make determinations regarding progress in therapy, return-to-work status and job modifications.

We are going to obtain normative isometric, dynamic and endurance of grip strength, key pinch strength and three point pinch strength data using BTE Work Simulator model WS20. We also compare these data between ages and sexs.

This study will be helpful in clinical applications of the BTE Work Simulator and providing the more specific job related occupational therapy and developing special vocational rehabilitation program.

The myofascial pain syndrome patients usually have characteristic personalities. The purpose of this study is to investigate the psychological characteristics of myofascial pain syndrome patients. We reviewed medical records of fifty-four patients with myofascial pain syndrome for their Minnesota Multiphasic Personality Inventory, Visual Analogue Scale, and psychological interview notes.

On MMPI profile, the patients scored high in hypochondriasis, hysteria and depression scales, which are the triad of neurosis. According to stress factors and occupations, the psychologic responses were different. We have compared the severity of pain according to different life stress and occupations. VAS scores of the student group were higher statistically in the occupation comparison and of the marital problem group were higher in the life stress comparison.

It is suggested that psychologic intervention on myofascial pain syndrome patients should be stressed for the management of pain.

Myofascial trigger point(TP) is characterized as an impaired energy metabolism. We hypothesized that the use of dextrose as an energy supplement for TP injection would be more effective than saline or lidocaine. Sixty four typical myofascial pain patients were treated with TP injections. Among them 23 were injected with 5% dextrose water(D/W Group), 20 with normal saline (N/S Group), and 21 with 0.5% lidocaine (Lidocaine Group). Visual analogue scale(VAS) and pressure threshold algometer(kg/cm²) were used as measuring tools before, immediately after, and 7 days after the injection therapies. Mean VAS scores were 6.78 before, 5.19 immediately after, and 3.39 seven days after the injections, and the treatment effects were greater after the second and third injections. Mean differences of pressure threshold were 0.37 before and immediately after injections, and 0.42 before and 7 days after injections. Significant elevation of threshold was noted after the second and third injections. Mean VAS were not significantly different in three groups before and immediately after injections. But after 7 days, only D/W Group showed significantly lower score of 2.39, compared to 3.85 in N/S Group and 4.05 in Lidocaine Group(P＜0.01). Mean pressure threshold before and immediately after injections was not different in each group. After seven days D/W Group also showed significantly higher value of 2.49, compared to 1.91 in N/S Group and 2.07 in Lidocaine Group(P＜0.05). We have concluded that 5% dextrose water would be the preferable choice for TP injection.

The purpose of this study is to assess agreement and sensitivity of sacroiliac joint pain provocation tests with fluoroscopically guided, diagnostic sacroiliac joint block.

Thirty patients with sacroiliac joint area pain and without other obvious sources of pain were selected. The patients were tested with 11 kinds of sacroiliac pain provocation tests before and after sacroiliac joint block and their pain relief scales were measured before block, after 30 minutes, 1 week, and 2 weeks.

According to pain relief scale at 30 minutes after sacroiliac joint block, the patients were divided into 3 groups - response group that was 100-70% pain relief; 9 cases(30%), partial response group that was 69-30% pain relief; 15 cases(50%), and nonresponse group that was 29-0% pain relief; 6 cases(20%). In the response and the partial response group, the sensitivity of pain provocation tests were 88.5% in FABERE, 53.9% in Erichen, 50.5% in Yeoman, 43.3% in Minor, and 38.5% in Gaenslen test. Gamma statistic for agreement in the 5 superior sensitive tests was 0.80 between Minor and Gaenslen test, 0.67 between Yeoman and Minor test, 0.48 between Yeoman and Gaenslen test, and 0.44 between FABERE and Minor test. Pain relief scale 2 weeks later were above 60% in response group and above 50% in partial and nonresponse group.

In conclusion, combining the FABERE test and another sensitive test, we enhance diagnostic power for sacroiliac dysfunction.

Muscle functions are limited in patients with osteoarthritis of knees. In patients with osteoarthritis, isokinetic testing of knee musculature reveals decreased peak torque and increased walking time(50-ft). The purpose of this study was to demonstrate deficiency in muscular performance of knee, and the relationship between walking time and isokinetic parameters of muscular strength, endurance and pain of knee in patients with osteoarthritis of knees. The subjects were divided into a control group and the study group. The control group consisted of 40 persons without a knee pain, and the study group consisted of 30 patients with osteoarthritis of knees. The peak torque of patients in the study group was decreased by 16∼21%, compared to that the control group. There was a negative relationship between the walking time and the endurance of knee extensors(r=⁣0.7195). These findings suggest that exercises to increase the strength and endurance of extensors and flexors of knees should be emphasized in the rehabilitation program for the osteoarthritis of knees.

Rotator cuff injury and impingement syndrome have been thought to be related to the structure of acromion, such as subacromial distance, acromial type, acromial spur and acromial angle. Evaluation was done in 90 normal shoulders without impingement or rotator cuff injury, using shoulder X-ray series, composed of AP view, impingement view, and arch view.

As results, 52(52.8%) of them had subacromial spur by the impingement views. The spur size was 12.4⁑4.5 mm and increased with age without statistical significance(p＞0.05). The subacromial distance was 11.1⁑2.2 mm in AP view and 10.4⁑1.9 mm in arch view without statistical difference for age and sex(p＞0.05). Among 90 normal shoulders, the acromion was quite often curved Type II, 51.1%, type I, 22.2%, and type III 26.7%. Mean acromial angle was 29.1^o in arch view and increased with age(p＜0.05). Mean acromial tilt was 31.8⁰ without significant difference for age and sex(p＞0.05).

These results suggest their clinical relevance to the impingement syndrome and the rotator cuff injury.

As the survival rate of preterm infants increasing, much perinatologic concern has been paid to the possibility of their getting into cerebral palsy. The purpose of this study is to determine the relationship between the early periventricular abnormalities and the incidence of cerebral palsy among preterm infants, and then to estimate the value of periventricular leukomalacia(PVL) as the prognostic factor by verifying the clinicopathological correlation of it with cerebral palsy. We have selected 174 cases with periventricular abnormality in early ultrasonographic findings among the survival preterm infants. 163 of them were followed up successfully to verify the incidence of cerebral palsy. Sequential ultrasonographic observations had been made at the interval of 7 or 10 days. Periventricular abnormalities could be classified into three types, which consist of the PVL(including cystic PVL), suspicious PVL, and periventricular echodensity without tissue loss. Associated lesions such as intraventricular hemorrhage, ventriculomegaly, brain atrophy were evaluated. Diagnosis of cerebral palsy was confirmed after following up more than 2 years of age, and the correlations of periventricular abnormalities with the clinical type and severity of cerebral palsy were analyzed. The 24.5% (40/163) of our samples revealed periventricular leukomalacia and the 17.8% (29/163) of them were diagnosed as cerebral palsy. The 65% (26/40) of preterm infants with definite PVL were cerebral palsy and their relative risk ratio for cerebral palsy is 26.7. Without PVL, there were no explicit correlations between cerebral palsy and associated abnormalities. Most cases with cerebral palsy turned out to be the spastic diplegia. In the cases with cystic lesions especially, the clinical outcome appear to be more severe. We've reached the point that the presence of PVL in preterm infants had a strong correlation with the development of cerebral palsy. Moreover, the association with cystic lesions is not only a strong correlation with cerebral palsy, but also a poor prognostic value for functional outcome.

Previous studies proved that, the high-heeled shoes caused postural changes, a loss of foot function, and deformities of foot. However the lumbar lordosis in gait is rarely measured. The purposes of this study were to compare kinematics and kinetics between high-heeled and high-forefoot gait by skin markers, and to find the influence of heel height to lumbar vertebral alignment. We used the Vicon 370 three-dimension Gait Analysis System.

In the present study, the lower extremity biomechanics in high-heeled and high-forefoot shoes were examined in 20 Korean female subjects. Results showed that the double support phase increased in high-forefoot gait in linear parameters. In sagittal plane kinematics, the lumbar lordosis slightly increased in high-forefoot gait, but that did not increase in high-heeled gait. The knee flexion and ankle plantarflexion increased in high-heeled gait, but ankle pantar flexion reduced in high-forefoot gait. Clinically the change of ankle motion was not significantly influenced to the lumbar lordosis. However, high-heeled shoe users with low back pain are probably influenced by the overstress of paraspinal muscles and vertebral ligments. Further studies are required for more precise analysis of high-heeled and high-forefoot gaits.

The purpose of this study was to determine the effects of high heeled shoes on plantar pressure and muscle fatigue. The subjects were 36 women who were divided into three groups, i.e., high heel, middle heel and low heel. The mean height of each heel was over 7 cm, 5 cm and below 2 cm respectively. The plantar pressure was measured by F scan system.

The fatigue of subjects was evaluated with endurance time and voluntary maximal contraction that was measured by Cybex 6000 system and the degrees of foot pain and fatigue by visual analogue scale.

With high heeled shoes, the plantar pressure was shifted from hindfoot to forefoot, and from the lateral part to the medial part in forefoot. With all shoes, the plantar pressure was generally increased in the forefoot after 8 hours. Especially the pressure of medial and middle parts of forefoot was significantly increased on high heeled shoes. Voluntary maximal contraction and endurance time was significantly decreased in subjects with high heeled shoes for 8 hours. The degrees forefooot pain and fatigue by visual analogue scale were very significantly increased in subjects with high heeled shoes. With low heeled shoes, the fatigue was the least degree and the middle heeled shoes are recommendable for cosmetic needs and lesser fatigue and pain.

In conclusion, when women were in high heeled shoes for a long time, the pressure of forefoot and foot pain and fatigue were increased. Therefore, these effects of high heeled shoes on the plantar pressure and fatigue should be considered in women with high heeled shoes.

Hereditary spastic paraplegia(HSP) is a familial disorder which is inherited by autosomal dominant, autosomal recessive or sex linked pattern. Strumpell first described a familial case of spastic paraplegia characterized by progressive weakness and spasticity of the lower limbs.

We have experienced two cases of hereditary spastic paraplegia with mental retardation and extrapyramidal symptoms with variable severity. They were sisters. Physical examination revealed increased deep tendon reflexes in all four extremities with extensor plantar reflex, and sensory losses mainly affecting joint position and vibration sensations. One case was dysmorphic. The pattern of inheritance was uncertain but considered as an autosomal recessive type. Electrodiagnostic study revealed mild slownesses in motor conduction velocities, reduced amplitude of sensory nerve action potentials and profuse abnormal spontaneous activities in distal lower extremity muscles. Somatosensory evoked potentials were not obtainable from both lower extremity stimulations, but attenuated responses without delayed latencies were obtainable from both upper extremity stimulations.

The posterior tibial muscle is considered a plantar flexor as well as an invertor of the foot, which acts as a key muscle to the medial longitudinal arch by locking the talar joints in normal gait. Rupture of the posterior tibial tendon can cause a valgus deformity of the hindfoot and an abduction deformity of the forefoot which produces a typical flat foot and a talar dislocation in severe cases.

The tendon of posterior tibial muscle can be ruptured spontaneously after the age of 40 from chronic stress at the ankle joint, or by sports injury and trauma. Severe foot deformity which can be prevented by early diagnosis and appropriate treatment often occurs from misdiagnosis as a chronic ankle sprain or a congenital flat foot.

We report two cases of foot deformities caused by spontaneous and traumatic rupture of posterior tibial tendons with their clinical manifestations and MRI findings.

Baker's cyst is commonly associated with intraarticular pathology such as degenerative arthritis. Few cases of neural compression by a Baker's cyst in the popliteal fossa have been reported with intraarticular pathology. We report a case of peroneal nerve compression by an atypical Baker's cyst in a child without intraarticular pathology. A 10-year-old boy had 6-month history of the left foot drop without a known trauma. There was no swelling or pain in the knee. The electrodiagnostic study demonstrated a profound lesion of the deep peroneal nerve and a mild denervation of the superfical peroneal nerve. Magnetic resonance images displayed an atypical Baker's cyst originating from the popliteal fossa and extending to the posterolateral side of the fibular head. Clinical and electrophysiological findings improved after aspiration of the cyst.

We report a case of combined multiple muscle deficiency around shoulder and upper back. His chief complaint was difficulty in shoulder abduction above his head.

After thorough evaluation using electromyography, isokinetic muscle testing and magnetic resonance imaging, despite of mild symptom, he showed multiple muscle deficiency such as bilateral whole trapezius, latissimus dorsi and unilateral partial pectoralis major and serratus anterior muscle.