The incidence of traumatic brain injury (TBI) has increased with the advanced technology of society. A careful evaluation of associated problems, initial severity, and complications is important for the acute management and rehabilitation of patients with TBI. To predict the rehabilitation potentials of patients with TBI, we have retrospectively investigated the causes, types of injury, associated problems, and complications in 186 patients and also assessed the rehabilitation outcomes by measuring the functional gains according to the types of brain injury and the initial severities evaluated by the Glasgow coma scale in 82 patients. The functional gains were measured by differences of the Mini-mental status examination, PULSES profile, and Barthel index of pre- and post-rehabilitation states. The incidence of TBI was highest in the 3rd decade men and the most common cause was a traffic accident (120 cases, 64.5%). The types of brain injury were a diffuse axonal injury, 87 cases (46.8%); epidural hematoma, 21 cases (11.3 %); subarachnoid hemorrhage, 25 cases (13.4%); subdural hematoma, 28 cases (15.1%); and intracerebral hematoma, 25 cases (12.9%). Common associated problems were fractures and injuries of nervous system. The 7th cranial nerve and the peroneal nerve were the most common injuries for cranial and peripheral nerves, respectively. Common complications were pulmonary and skin disorders. Total hospital stay and the duration for rehabilitation were not significantly different by the types of injury. Functional gain tended to be higher in the intracerebral hematoma compared to the other types of brain injury. The functional gain was statistically higher in patients with initial severity of moderate degree according to the Glasgow coma scale. In conclusion the moderate traumatic brain injured patients seem to have a higher potential for the good functional outcome.

The rehabilitation therapy as well as the initial medical management for stroke patients should be started early to be effective. However, a little attention has been paid to the interval between the onset of stroke and rehabilitation therapy.

We studied the delay from the onset of stroke to the start of rehabilitatioin therapy and its impact on outcomes.

This study was performed retrospectively on 807 acute stroke patients who were admitted to Asan Medical Center to evaluate the interval between ictus of stroke and hospital arrival or rehabilitation therapy and to compare in the ischemic and hemorrhagic groups.

Forty seven percents of the stroke patients arrived after 24 hours of the onset of stroke and 70% of stroke patients started their rehabilitation therapy 1 week later. Hemorrhagic patients started their rehabilitation therapy significantly earlier than the ischemic patients.

This delay in hospital arrival may be attributed to the lack of awareness about the symptoms and early signs of stroke by the patients, general public, and even medical personnels. The delay in rehabilitation therapy from the onset of stroke can be prevented by the public compaigns emphasizing the better outcome with earlier rehabilitation treatment.

Parkinson's disease(PD) is characterized clinically by bradykinesia, rigidity, tremor, and disturbance of posture and equilibrium. A higher incidence of fractures in PD patient has been reported, however the studies of musculoskeletal complications in PD have been negligible.

The purposes of this study were to investigate the incidence of osteoporosis and spinal compression fracture in PD patients and to evaluate whether the incidence were affected by the severity of PD.

Bone mineral density(BMD) in 21 patients(5 males and 16 females) with idiopathic PD was measured by dual energy X-ray absorptiometry(DXA) and compared with an age adjusted control group(32 females). The patients were divided into two groups according to the Hoehn and Yahr(H-Y) stage as mild or severe and the BMD was compared. Simple x-ray studies of thoracolumbar spine were performed to find out the presence of spinal compression fractures.

The results showed that the BMD of PD patients was significantly lower than control subjects. The PD patients with high H-Y stage(severe group) had lower BMD scores with no statistical significance. The spinal compression fractures were noted mainly at mid-thoracic area and thoraco-lumbar junction. Spinal t-score in patients with a compression fracture was significantly reduced. No significant correlation exists between back pain and a compression fracture.

The purpose of this study is to evaluate the effectiveness of intramuscular botulinum toxin A injection in cerebral palsy with foot deformities using roentgenogram. We have studied 26 children with cerebral palsy(age 3 to 13 years old). They were twenty spastic diplegias, three hemiplegias and three mixed types(spasticity and athetosis). The botulinum toxin A was injected into gastrocnemius or peroneous muscles with an electromyographic guidance. Before injections, passive joint angles of the ankle were assessed by the goniometric measurements. A plantar-flexion angle of talus, dorsiflexion angle of calcaneous, and talar-calcaneal divergence angle were measured using the lateral and anterior-posterior roentgenograms of the foot with weight- bearing for the assessment of equinovalgus of ankle. Follow-up assessments were performed at 1 and 3 months after the injection. At 1 month after the injection into gastrocnemius muscle, there was an increased range of passive ankle joint motion, decreased plantar-flexion angle of talus, and increased dorsiflexion angle of calcaneous. These changes were still significant at 3 months after the injection. After the injection into peroneous muscle, the talar-calcaneal divergence angle was significantly decreased. This study provides the evidence that the treatment with botulinum toxin A improves the ankle joint motion in cerebral palsy with feet deformities by reducing hypertonicity, spasticity and dynamic contracture. In addition, the lateral and anterior- posterior roentgenograms of the foot with weight bearing seems to be the simple and objective methods to evaluate the effectiveness of intramuscular botulinum toxin A injection in cerebral palsy with foot deformities.

The current available treatment methods of spasticity are consisted of physical therapies, medications, surgeries, injections of phenol or botulinum, and electrical stimulations. The purposes of this study were to evaluate the effectiveness of surface electrical stimulation in reducing spasticity in the spinal cord injured patients, to find out carry-over effects of electrical stimulation and to find out the factors influencing the effects of the treatment.

The subjects were 10 quadriplegics with the cervical cord injuries. The electrical stimulation was applied to the antagonists of major spastic muscles of the knee joints for 2 weeks. The evaluation of spasticity were done by using the modified Ashworth scale, beats of ankle clonus, patellar tendon reflex(latency and amplitude), and relaxation index of patellar knee by pendulum test before and after treatment sessions.

The results of the study revealed no statistically significant changes in relaxation index, modified Ashworth scale, ankle clonus and the latency and amplitude of patellar tendon reflex(P＜0.05), however there were tendencies of improvement in relaxation index and modified Ashworth scale after the stimulations. We could not find out statistically significant factors influencing the effects of the surface electrical stimulation.

Further investigations to assess the mechanism of electrical stimulation and the adquate parameters of electrical stimulation in a larger population of subjects will be needed.

Dysesthetic pain syndrome is a common disabling painful sequelae of spinal cord injury patients.

The purposes of this study were to gather the general informations of pain in spinal cord injury patients and to investigate the correlation between the various factors affecting pain severity.

Twenty-seven spinal cord injury patients with dysesthetic pain were evaluated by medical histories, physical and neurological examinations. The pain intensity was measured by a visual analogue scale.

Twenty-one subjects were males and six were females. The mean age of patients was 35.1 years.

The patients were classified into five pain categories : diffuse pain, segmental pain, root pain, visceral pain, and non-neurogenic pain. Nineteen patients (70.4%) were categorized into diffuse pain group, six patients (22.2%) into both diffuse and segmental pain group, two patients (7.4%) into root pain group and five patients (18.5%) into perianal pain group.

According to this study, the only significant factor affecting the severity of dysesthetic pain in spinal cord injury patients was the severity of spinal cord injury. Pain appeared earlier and more intensely in the complete spinal cord injury patients. There was no correlation between the severity of pain and the level of lesion, age, or the posterior tibial nerve SEP response.

Many studies have failed to prove the health effects of herbicides on exposed Vietnam veterans. The main difficulties for the studies have been the methodologic weakness, the time delay from the onset of exposure to the assessments and inability of measuring exposure amount.

The purpose of this study is to evaluate human health effects among Vietman veterans who were exposed to herbicides while staying in Vietnam.

The subjects were patients who visited to Taegu veterans hospital between November, 1995 and July, 1996. Any veterans stationed in Vietnam for six or more months between 1966 and 1973 were included in this study. We performed a comprehensive study including a neurologic test, physical examination, medical history, serum and urine chemistry, electrodiagnostic study and a roentgenographic study.

We have found that the patients with peripheral neuropathy were 24 cases, soft tissue sarcoma 1 case and Buerger's disease 1 case. And many other diseases were also diagnosed in these patients. However we were unable to find the strong evidences of association between the clinical illness and the exposure to herbicides.

Statistical methods are widely used for the analysis of data obtained from experimental or observational studies. We examined the statistical methods used for papers published in the Journal of Korean Academy of Rehabilitation Medicine in 1996. The issues included the mean, coefficient of variation, t-test, chi-square test, ANOVA and type IV error. The mean and the standard deviation in descriptive statistics and the t-test in inferential statistics were most frequently used. Statistical methods should incorporate statistical modelling and the needed assumptions. Trials of new statistical models and methods are recommended.

Magnetic resonance imaging(MRI) is clearly more reliable than computer tomography and myelography in radiological diagnosis of lumbar herniated intervertebral disc. Moreover, MRI can also detect degenerative changes of intervertebral discs. The purpose of this study was to determine the utility and accuracy of MRI in conjuntion with the diagnosis of lumbar herniated intervertebral disc and to compare findings with operative findings.

Comparisons of operative findings and MRI were done in 133 cases. Each patients had been diagnosed by MRI as having lumbar herniated intervertebral disc. MRI findings included those of spin echo T1-weighted images and T2-weighted images, gradient echo T1-weighted images and T2-weighted images, and gadolinium-DTPA enhancement when needed.

In 32 protrusion disc cases diagnosed by MRI, 28 cases were confirmed by operation and four were actually extrusion disc. In 77 cases diagnosed by MRI as extrusion disc, 72 cases were confirmed by operative findings, while 5 cases were found to be protrusion disc. 4 cases of sequestration disc diagnosed by MRI were confirmed by operative findings. Specific dimensions of MRI use yielded the following results: protrusion disc indicated 84.8% in sensitivity, 95% specificity, 87.5% in accuracy; extrusion disc showed 94.7%, 86.5%, 93.5%, respectively; and sequestration disc revealed 100% in all categories. In this study, the average accuracy of lumbar herniated intervertebral disc diagnosed by MRI was 93.6% on average.

Accordingly, MRI has shown itself to be a good diagnostic tool for determining anatomical and biological change in lumbar herniated intervertebral disc.

임신중 요통은 비교적 증상이 경미하고, 하흉추부·요추부·천장관절부에 흔히 생기는 것으로 알려져 있다. 대부분의 경우는 그 증상이 자연소멸되지만 연구자들은 약 27%의 산모에서는 출산 6개월후에도 요통을 호소하는 것으로 보고되어 있다. 임신중 요통 발생에 관계되는 인자에 대해서는 아직 정확히 밝혀진 바는 없지만 그동안의 연구들에서는 신장과 체중, 임신전 비만정도, 임신중 체중의 증가, 태아 체중, 임신중 활동정도 및 직업 등은 유의한 위험인자가 아니라는 점에 대해서는 대체적으로 동의하고 있으며, 산모의 연령, 다산 및 요통의 과거력 등에 대해서는 아직 의견의 일치를 보지 못하고 있다. 또한 그 원인에 대해서는 여러 가지 의견들이 있지만 대체적으로, 신체역동학적 으로 나타나는 요추부의 과도한 하중 및 혈중 릴랙신이 증가하여 생기는 천장관절의 기능 부전이 주 요인으로 알려져 있다. 따라서 연자들은 한국인에서 임신중 요통의 분포 및 양상이 외국의 보고와 어떻게 다른 지, 통증의 양상의 표현은 어떤지, 임산부의 체형이 요통의 발생과 관련이 있는 지, 요추 후만의 증가가 요통의 발병에 중요한 역할을 하는 지를 알아보고자 1997년 3월부터 9월까지 산전관리를 위하여 성모병원 산부인과를 방문한 202명의 산모를 대상으로 본 연구를 시행하여 다음과 같은 결과를 얻었다.

한국인 산모에서 임신기간에 관계없이 요통의 유병률, 통증이 나타나는 시기 및 통증 부위는 다른 나라 여성들과 유사한 양상을 보였다. 산모의 연령, 출산 횟수, 신장 및 체중 등은 산모의 요통 발생에 큰 영향을 미치지 않는 것으로 보이며, 반면에 요통의 과거력은 산모의 요통을 예측하는 데 도움을 줄 것이라고 판단된다. 또한 요추 후만의 정도는 산모의 요통과 밀접한 관계가 있음을 알 수 있었다.

The diagnostic value of nerve conduction study of spinal stenosis is far limited due to its deeply located lesion and its very short length of diseased nerve compared to the relatively long length of total conduction distance. Recently it became possible to stimulate the deep sited spinal nerve roots non-invasively with magnetic stimulation. The authors made a new method to calculate the motor nerve conduction time of lumbar spinal root using magnetic stimulation and planned to verify the delayed conduction time in patients with spinal stenosis who didn't show any abnormalities in the conventional electrophysiologic studies(peripheral nerve conduction velocity, F-wave and needle EMG).

Three steps of magnetic stimulation were applied to vertex(transcortical stimulation), T12 spinous process(thoracic stimulation) and S1 spinous process(sacral stimulation), and three channel recording were performed at rectus abdominis(RA), right and left abductor hallucis(AH) simultaneously. Central motor conduction time(CMCT) was calculated by time difference between vertex and spinal stimulation at RA and AH. Lumbar-segment motor conduction time(LMCT) was defined as conduction time by subtracting CMCT of RA from CMCT of AH. The results as follows;

LMCT was delayed in the group of patients with spinal stenosis(5.36⁑2.11 msec) compared to the normal control group(4.05⁑1.23 msec), but the range of LMCT was not quite different individually. Dividing the patients group into multi-level and single-level spinal stenosis group, LMCT in the multi-level spinal stenosis group was 6.12⁑1.95 msec which was significantly different from that of single-level(4.48⁑1.96 msec). The authors conclude that LMCT, the short segmental motor nerve conduction study of lumbosacral nerve root, is useful to confirm the entrapment of spinal nerve root across the lumbosacral spinal canal and is also non- invasive, simple and applicable to any other spinal nerve roots.

The purpose of this study were to obtain the prevalence of the physically disabled order as a basic data for the planning of Community-Based Rehabilitation in a rural community and to evaluate the seventy of the physically disabled by according to the physical disability grade.

The total residents in the community were surveyed to in May 1996. The prevalence of the physically disabled was 6.92% of the total population. The male: female ratio was 1:0.7. The most freguent age for the on set of physical disability was sixties and this group represented 35.5% of all physical disabilities. The majority of the physically disabled was graded an 10 th, 11 th, 12 th grade.

The prevalence of the physically disabled in this study was higher than that a the previous study due to the inclurion of more mild disability groups were important in the prevalence of the physically disabled.

The main objectives of this study were to assess the age related changes of biochemical indices of bone turnover in postmenopausal osteoporotic females, and to assess the correlations of these indices with bone mineral density(BMD) of lumbar spine measured by dual energy X-ray absorptiometry(DEXA). Subgects were 70 osteoporotic women in pre and postmenopausal periods. The results showed that Postmenopausal women had higher level of Osteocalcin(OS) and Deoxypyridinoline(DPYD) with lower level BMD of lumbar spine compared with premenopausal women. Age, height, and weight had significant correlations with BMD of lumbar spine. Also a significant correlation was observed between the OS and DPYD. Pre and postmenopausal osteoporotic women(5, 10, 15 year duration) were similar for the rate of bone turnover. These results indicate that the biochemical indices used in our study are the potential markers to predict an age related change of BMD, as well as bone turnover rate of the lower BMD subjects. The combination of BMD measurement and assessment of the bone turnover rate by measuring biochemical indices would be helpful for the screening and treatment of patients with risks of osteoporosis.

Traumatic knee contracture is a common complication after an operative procedure. It occurs mainly due to an intraarticular adhesion and results in a significant knee dysfunction and disability. Patients with a contracture have different ways of recovery, however there is no reliable clinical data regarding a recovery to the full range of motion after knee injury. A proper therapeutic plan is needed to the physiatrists during a rehabilitation of the traumatic knee contracture. The purpose of this study was to obtain a clinical insight into the course of recovery to the normal range of motion after a traumatic knee contracture. One hundred and fourty-seven cases of traumatic knee contracture patients who underwent an operative treatment at the Department of Orthopedic Surgery, St. Mary's Hospital between the years of 1992 to 1996, were reviewed. Knee contractures were most frequent in the second and third decades with a traffic accident being the most common cause. A factor that influenced regaining a normal range of motion was the injury type with an earlier recovery in the order of an injury to the meniscus, cruciate ligament, collateral ligament, a complex injury, and a bone fracture. Persistent contracture groups showed a higher incidence of bone fractures around the knee and open surgeries, while there was no discrepancy in sex, age, and operation time. In conclusion, the results of this study are expected to give some insights to clinicians and to help them in treating patients with the traumatic knee contracture after operation.

Dysfunction of the autonomic nervous system is reported to occur at an incidence of 20% to 40% in diabetes. The clinical symptoms include orthostatic hypotension, vomiting, diarrhea, bladder dysfunction, male impotence, sweating, etc. Two simple noninvasive tests, sympathetic skin response (SSR) and R-R interval variation (RRIV), were used to assess autonomic functions. We performed SSR and RRIV on the diabetic patients and controls. The patients were classified into 4 groups (group I: without peripheral neuropathy or dysautonomia, group II: with dysautonomia only, group III: with peripheral neuropathy only, group IV: with both peripheral neuropathy and dysautonomia). We also tried to correlate their clinical dysautonomic symptoms and the results of nerve conduction studies (NCS) and of SSR and RRIV.

The subjects of this study were 82 diabetic patients, 20 to 73 years old with the mean age of 53, and 12 controls.

Latency, amplitude, and loss of SSR all showed a significant difference in relation to the dysautonomic symptoms. The loss of SSR in the foot showed a remarkable difference in group I.

In groups III and IV, three RRIVs (Valsalva ratio, E:I ratio, 30 : 15 ratio) showed a significant decrease compared with the control group, and in group II, only the 30:15 ratio showed a statistically significant decrease.

In conclusion, the changes in SSR and RRIV were significantly associated with the dysautonomia. Among these, loss of SSR in the foot and decrease in the 30 : 15 ratio were useful parameters for early detection of diabetic autonomic neuropathy without peripheral neuropathy.

Digital infrared thermal imaging(DITI) has been proposed as a diagnostic aid in patient with many disease entities, such as the cardiovascular, the neurologic, the musculoskeletal diseases and so on. Supporters of thermography state that normal patients have the normal thermograms and abnormal patients have the abnormal thermograms. The purpose of this study was to determine how much a cigarette will affect skin temperature change in the course of normal day's smoking.

Twenty one healthy smokers(mean age, 27.4⁑5.1 years old) and fourteen nonsmokers(mean age, 24.4⁑1.6 years old) took parts in the study. All were male. The cigarette consumption averaged 14.0 per day. Smokers maintained their smoking habit in the ambient temperature before on initial measurement and smoked a cigarette in the controlled laboratory room. Measurements were taken for 5 minutes, 1 hour and 2 hours afterward. The skin temperature of the face, the both palms and the both soles was measured using Dorex^Ⱂ digital infrared thermal imaging system.

In all sessions, the skin temperature was higher on the face and lower on the sole. There were no significant differences of skin temperature on both sides of body in all subjects(p＞0.05). The skin temperature of all measured parts was significantly lower in the smoking group before and 5 minutes after smoking(p＜0.01). There were no significant differences of skin temperature between smoker and nonsmoker after 1 hour of smoking(p＞0.01).

The influence of voluntary muscle contraction and alteration of muscle length on compound muscle action potential (CMAP) was studied in 20 healthy volunteers. The CMAPs were evoked by a supramaximal stimulation and recorded by a surface electrode array. Onset latencies were not significantly changed regardless of the muscle length and contraction. On shortening of the muscle there was a decrease in an area and duration of CMAP with no significant changes in an amplitude. During muscle contractions, there was an increase in amplitude and a decrease in area and duration. On a lengthening of the muscle with relaxation, the amplitude of CMAP decreased with an increased area and duration. During a voluntary contraction, there was a decrease in amplitude, area, and duration. The results are considered due to a peripheral factor such as an alteration of temporal or spatial summation rather than a central mechanism. We conclude that in nerve conduction studies, it is important to monitor the finger position and muscle relaxation to differentiate the waveform changes from the muscle length or contraction and those from the nerve lesions.

Measurements of local shoulder muscle function during shoulder abduction are of a great interest in biomechanics research and in ergonomic applications. There have been so many opinions that the supraspinatus muscle acts in synergy with the deltoid muscle as a single unit throughout the shoulder abduction. However the specific actions of deltoid and supraspinatus muscles have been subjects of controversy. Electromyography is an established evaluation method of biomechanical study. It reflects the electrical activity at the muscle membrane level and indirectly the mechanical output of the muscle. The purpose of this study was to evaluate the role of deltoid and supraspinatus muscles during shoulder abduction by the comparison of motor unit action potentials using a quantitative electromyographic analysis method, to provide a good insight into the biomechanics of shoulder abduction.

Motor unit action potentials of deltoid muscle were seen earlier than those of supraspinatus muscle at the time of initiation of shoulder abduction. The Root Mean Square (RMS) voltage of deltoid muscle was increased gradually from 0^o to 90^o of shoulder abduction, and then decreased gradually above 90^o to 180^o of shoulder abduction. The RMS voltages of deltoid muscle were significantly higher than those of supraspinatus muscle at each degree of shoulder abduction wholly. There was no differences in the RMS voltages of deltoid muscle, during shoulder abduction between the loading of 1 kg and without loading. However, the RMS voltages of supraspinatus muscle were significantly higher in the loading state than without loading. The Mean Rectified Voltages (MRV) were similar to the RMS voltages of deltoid and supraspinatus muscles during shoulder abduction.

Based on these results, we concluded that the deltoid muscle was not only an initiator but also a major contributor in shoulder abduction, where as the supraspinatus muscle acts as a secondary muscle for the initiation of shoulder abduction and a supporting muscle when there is a resistance against shoulder abduction.

The reference values of motor unit action potentials(MUAP) of first dorsal interosseous and tibialis anterior muscles were measured in 50 healthy subjects. The MUAPs were recorded with a concentric needle electrode and extracted with a decomposition method. Sixty six patients with neuropathy were also studied in the same way with a count of outliers and measurement of mean values.

The mean values of amplitude, area, duration and thickness were 667.74±204.34 ՌV, 992.26±253.18 ՌVms, 9.75±1.95 ms and 1.49±0.26 ms, respectively in the first dorsal interosseous muscles, and 612.88±140.13 ՌV, 1172.84±199.21 ՌVms, 11.41±2.48 ms and 1.93±0.34 ms respectively in the tibialis anterior muscles. There was no significant difference in age and gender of normal subjects. The amplitude was the most sensitive parameter to detect abnormality in a count of outliers and measurement of mean values. The outliers count in duration showed a higher sensitivity than the measurement of mean values(p＜0.05), but not in amplitude, area or thickness.

Based on the results of this study, the count of outliers was more sensitive than the measurement of mean values in the diagnosis of patients with neuropathy. Further more, less numbers of MUAPs were needed for the evaluation of the outliers count. Through this method we could save the evaluation time and the patients felt more comfortable.

Medial femoral cutaneous nerve(MFCN), a sensory branch of the femoral nerve, supplies the skin over the anteromedial aspect of the thigh and knee. Posterior femoral cutaneous nerve(PFCN), comprised of fibers originating from the anterior and posterior divisions of the first three sacral segments, supplies the skin over the posterior aspect of the thigh.

Forty nerves of twenty healthy adults, ages from 20 to 58, were tested. The onset and peak latencies of MFCN were 2.3⁑0.2 ms and 2.9⁑0.2 ms respectively. The baseline to peak amplitude was 6.5⁑2.3 ㄍV. The onset and peak latencies of PFCN were 2.4⁑0.2 ms and 2.9⁑0.2 ms respectively. The baseline to peak amplitude was 7.1⁑1.7 ㄍV.

Many factors have been identified which to affect the rate of propagation of impulses along motor fibers. These include temperature changes around the nerve, diameter of the axon, degree of myelinization, age of infants, and local environment of the nerve. Motor nerve conduction velocity and Hoffman's reflex latency have been used to assess the degree of myelination and maturation of the nervous system. The conduction velocities in infants of a short gestational age are significantly lower than those of the fullterm infants. The extrauterine myelination and maturation might increase nerve conduction velocity. We measure the median motor nerve conduction velocity, compound muscle action potentials amplitude and H-reflex latency of premature infants to determine the neurological maturation after birth. The premature infants with gestational age above 37 weeks have a significantly higher conduction velocity and a shorter H-reflex latency than those of gestational age below 37 weeks. The premature infants with weight over 2.5 kg have a significantly higher conduction velocity, larger compound muscle action potentials amplitude and a shorter H-reflex latency than those of weight below 2.5 kg. And there is a statistically significant negative correlation of the H-reflex latency with the postmenstrual age. The determination of motor nerve conduction velocities and H-reflex latencies seem to be an additional method in assessing the degree of maturity in infants after birth.

The purpose of this study was to investigate the maturation characteristics of neonates.

Ninety three neonates underwent a somatosensory evoked potentials(SEPs) testing. Twenty four point seven percent of them were neonates at risks including the neonatal asphyxia, low birth weight under 1500 g, or a suspicious CNS abnormality.

Seventy five point three percent of neonates showed normal median SEPs, and 24.7% of them showed abnormal or a flat response. The mean latency of the first cortical component(N1) was 25.3⁑5.4 msec, duration 16.3⁑5.5 msec and amplitude 1.00⁑1.27 ㄍV.

Thirty one point two percent of neonates showed normal posterior tibial SEPs, and 68.8% showed abnormal or a flat response. The mean latency of the first cortical component(P1) was 44.9⁑5.6 msec, duration 17.5⁑3.9 msec and amplitude 0.47⁑0.38 ㄍV.

This result suggests that the maturation of rostal nervous system develops earlier than the caudal system.

Linear decrease of the cortical latency with post-menstrual age reflects maturation of the central pathway and not merely maturation of the peripheral nerves. But our study showed much less frequency of recordings of the tibial nerve SEPs than the median nerve responses, which suggested that the maturation of spinal cord and lower-limb nerves would be slow, in addition to that the length of pathway was increasing. This result suggests that the maturation of the proximal shorter nervous pathway develops earlier than the distal longer pathway.

The purpose of this study was to evaluate clinical features of diabetic neuropahty. The clinical symptoms and signs were investigated in individuals with diabetes mellitus by a questionnaire of 17 items about motor, sensory, and autonomic symptoms and signs, and then electrodiagnostic study was performed.

One hundred and one patients with diabetes mellitus aged 31 to 88 years participated. The most frequent complaint was tingling sensation in the distal extremities and the most frequent sign was decreased or absent ankle jerk. The least frequent symtom or sign was motor weakness. Eighty point two percent of patients showed electrodiagnostic abnormalities. Abnormal ankle jerk, tingling sensation, and paresthesia in patients with abnormal electrodiagnstic study were 60.5%, 58.0%, and 29.6%, respectively. Clinical diabetic neuropahty was diagnosed of the patients when both tingling sensation and decreased ankle jerk were present.

We conclude that clinical symptoms and signs of diabetes mellitus may be useful for diagnosis of diabetic neuropathy.

The purposes of this study were to verify the effect of selective nerve root injection for sciatica caused by lumbosacral radiculopathy and to compare the difference of the therapeutic effects with the various clinical parameters and the morphologic types of herniated intervertebral disc on MRI finding.

Forty-two patients, 14 males and 28 females, with an average age of 51 years (range, 26∼71) and an average duration of symptoms of 17.8 months (range, 1∼120) presenting with sciatica thought to be due to lumbosacral nerve root compromise were admitted to the study. All of the patients underwent clinical examination and lumbosacral MRI. Epiradicular infiltration of corticosteroids and local anesthetics by the transforaminal route under the image intensifier was done as a treatment. All the patients were followed up at 2 weeks and 3 months after the injection.

A high proportion of patients made a satisfactory relief of sciatica with a selective nerve root injection at 2 weeks (85.7%) and 3 months (76.2%) follow-up. Among the patients who showed a significant symptom relief at 3 months, 12 patients were followed up and the relieved symptoms lasted for 6 months to 1 year in majority of those patients. In a few patients with clinical improvements at 2 weeks after the injection, the symptoms recurred at 3 months (9/36, 25%) and between 6 months to 1 year (3/12, 25%). There were no differences of the therapeutic effects according to the duration of the disease, neurologic findings on physical examination and the MRI findings of herniated intervertebral discs.

The selective nerve root injection can be an effective therapeutic modality for the treatment of sciatica in lumbosacral radiculopathy.

Local steroid injection in carpal tunnel syndrome(CTS) is widely practised for the relief of symptoms such as pain and paresthesias. We evaluated the effects of the injection with electrophysiologic changes and improvement in pain and paresthesias.

27 patients, 40 cases with carpal tunnel syndrome diagnosed clinically and electrophysiologically were injected with 40mg of triamcinolone acetonide. Patients were reevaluated with the visual analogue scale and electrophysiologic parameters after 2 to 4 weeks. Then we split up the patients into "excellent", "good" ,"poor" group by the degree of responses to the injections. In order to predict the injection effect, we analyzed several clinical and electrophysiologic factors: duration of symptoms, Phalen test, prolongation of distal motor latency of the median nerve, denervation evidence of the abductor pollicis brevis muscle.

Symptom relief was noted in the 89% of the cases[excellent(75%), good(14%)], and there was no statistically significant correlation between any of the above four factors and the degree of the symptom responses. Among the electrophysiologic parameters motor distal latency, motor residual latency, sensory onset and peak latency, median to radial sensory onset and peak latency difference reflected the clinical improvements(p＜0.05). But there was some cases that improved clinically but deteriorated electrophysiologically(2 cases in motor distal latency, 5 cases in motor residual latency, 1 case in sensory peak latency, none in sensory onset latency).

In conclusion we find that local steroid injection in CTS is an effective therapeutic modality for the symptom remission and it also showed changes in electrophysiologic parameters. And among these parameters sensory distal latency seems to be the most appropriate electrophysiologic parameter which best reflects the improvement of pain and paresthesias.

The posterior tibial nerve was partially blocked with 7% phenol solutions for the relief of severe spasticity in cerebral palsy and brain injured patients. Forty patients were included in this study. Among them thirty five patients were cerebral palsy and five patients were brain injured.

A phenol injection was performed to the posterior tibial nerve at the popliteal fossa with the patients in a prone position. Total injected dose in each patient was 0.40 to 4.00 cc (average 2.06⁑0.96 cc). The dose was far below the toxic level and no significant side effects were noted except for a few cases of local paresthesia and tenderness. The range of dorsiflexion of the ankle was increased and the gait pattern improved in most of the patients one month after the injection. The H-reflex latency was prolonged after the injection compared with the pre-injection latency.

The phenol injection can greatly facilitate the rehabilitation process of the patient by reducing the need for physical therapy and bracing, increasing the patient's ambulation ability, and decreasing the development of secondary leg deformities.

In conclusion, with the easiness, simplicity, safety, low cost, and a selective reduction of spasticity in the group of muscles, the remarkable therapeutic benefits of posterior tibial nerve blocked with 7% phenol solutions warrant the more widespread use of this technique in younger cerebral palsy patients before developing fixed soft tissue contractures.

To determine the therapeutic effect of closed-needle irrigation of knee for pain from osteoarthritis(OA), we conducted a randomized, single blind, 8 week prospective trial study. A comparison was done between the closed-needle irrigation of knee and standard conservative treatment in 30 patients with non-end stage OA of the knee. Statistically significant differences (P＜0.05) favoring closed-needle irrigation of knee over conservative treatment were noted by the Visual Analog Scale for pain in these patients. Overall assessments on effectiveness of therapy by patients(Patient's global assessment) and physician(Knee rating scale) were also statistically superior among closed-needle irrigation group. We conclude that the closed-needle irrigation of knee for the treatment of pain from osteoarthritis is an effective treatment and is superior than the traditional conservative treatment in therapeutic effect.

Currently the evaluations of upper extremity motion have relied on a task-oriented approach to gain an accurate clinical picture of the functional capacities. As it is, an adequate and objective system to estimate upper extremity function is yet to be developed.

Authors used the virtual reality motion analysis system(VRMAS) which was developed by us for the purpose of investigating the kinematics of upper extremity motion during drinking a cup of water. Four healthy male adult subjects were recruited from the hospital personnels. After each subject sat down on a chair resting against the backrest in a neutral position, in front of a table he was instructed to drink the content of the cup from the table.

The data was analized and showed the following results. While drinking, the hand movements were smooth and linear. There were six distinct stages during drinking a cup of water; a reaching for the cup(stage 1), picking up the cup and carrying the cup to the mouth(stage 2), extending neck and drinking from the cup(stage 3), flexing neck(stage 4), replacing the cup to the table(stage 5), and returning to the start position(stage 6). During the stage 1 and 2, of all joint motions, the shoulder adduction and elbow flexion were most prominent. The stage 3 showed the most complex movements in shoulder flexion, forearm pronation, and wrist extension which were simultaneous. Remaining stages were the reversal of the first three stages. We could observe the ranges of motion of neck, shoulder, elbow, and wrist joint as well as the relationships of these joints at the same time.

In conclusion, VRMAS could be a very useful evaluation tool for the upper extremity motion and for obtaining the kinematic data from the upper extremity motion analysis.

The purpose of this study is to compare the effectiveness of the Rolyan, hemisling, remodified Bobath, and the newly designed triangular Bobath slings. Sixteen patients with a shoulder subluxation were evaluated by the simple shoulder AP X-rays with and without slings. The hemisling was applied with the elbow flexed at 90 and 120 degrees. The radiologic evaluation for the detection of shoulder subluxation was done by measuring the vertical and horizontal displacement on a plain AP view. The mean value of vertical displacement without a sling application was 5.21 cm which was reduced to 4.30 cm by a triangular Bobath sling application and 4.32 cm by a hemisling application at 120°elbow flexion. These two slings significantly corrected the vertical displacement, but other were not. In nine of sixteen patients, the triangular Bobath sling was the best sling for the vertical correction. All slings except a hemisling increased the horizontal displacement even though it was not statistically significant. The triangular Bobath sling improved the discomfort of the axilla better than the remodified Bobath sling.

The results support that the triangular Bobath sling was the best among 4 slings for the correction of shoulder subluxation, although a reduction in lateral displacement and an improvement in applicability need to be explored further.