The primary treatment goal of torticollis is to prevent the craniofacial deformities, limitation of neck movements and long-term postural changes.

In order to offer precise guidelines for the treatment of torticollis regarding the cosmetic and functional results, we analyzed 99 torticollis children retrospectively for the ages at diagnosis and the start of treatment, the duration of treatment, the problems at first visitation, and the size of sternocleidomastoid mass.

These patients visited the department of rehabilitation medicine, Holy Family Hospital from April 1991 to June 1997.

The results showed that there was no relation between the number of problems at first visitation and the age at the start of treatment, but the group with 1 problem had a significantly shorter duration of treatment than the groups with more than 4 problems.

The ages at diagnosis and at the start of treatment for the patients with a palpable neck mass were younger than those of the patients without a neck mass. The duration of treatment was longer for the patients with a larger size of mass by the ultrasonography of the neck.

The ages at diagnosis and at the start of treatment, and the duration of treatment were all younger and shorter in the cosmetically satisfactory group than those of the cosmeticlly unsatisfactory group. However there was no significant difference between the functionally satisfactory group and unsatisfactory group in the ages at diagnosis and at the start of treatment, and the duration of treatment.

In conclusion, when the treatment of torticollis was started early, especially at less than 3 months old, better cosmetic results were obtained, even though functional results were relatively satisfactory by the proper rehabilitation treatments. We want to emphasize that it is important to detect and treat the torticollis as early as possible for the better cosmetic results.

The purpose of this study is to evaluate the efficacy of epidural injections with steroids and local anesthetics for the low back pain patients.

Two hundred fifty patients with low back pain and sciatica were selected for the study. The patients were treated with the epidural injection of steroid(Depo-medrol^Ⱂ) weekly for 2 weeks and local anesthetics(lidocaine and bupivacaine) daily via epidural catheter. The efficacy of epidural injections was assessed with the Visual Analog Scale(VAS) on pre- and 2weeks post-epidural injections. The VAS scores of pre- and post-epidural injections were 6.14⁑2.14 and 3.65⁑1.93(p＜0.05) respectively. The VAS scores were not different by the disease subgroups(p＞0.05). By the main symptoms, VAS scores were reduced prominently in patients with the pseudoclaudication symptom after post-epidural injections.

In conclusion, epidural injections of steroid and local anesthetics are effective for patients with a low back pain and sciatica in the short term. Further prospective long-term follow up studies will be necessary in the future.

The purpose of this study was to see whether there were any correlations between the clinical findings and outcomes after the epidural steroid injection(ESI), and to determine which of the clinical findings might be of importance as favorable signs to predict a good result with the ESI.

The present study involves 23 elderly patients(18 females and 5 males) with spinal stenosis. The participants were divided into several subgroups according to the clinical features, such as presenting symptoms, age, duration of symptoms and physical findings. Subjects received the epidural injection of 80 mg Depo-Medrol with 6 ml of 1.5% lidocaine solution. The subjects completed a questionnaire before the ESI, and at three weeks and two months after the ESI respectively. The questionnaire included three scales on symptom severity, physical function, and satisfaction. The visual analogue pain scale was utilized as well.

At three weeks, satisfaction outcomes were encountered in 82.6 percent of the sudjects. Differences in the satisfaction between the subgroups according to the duration of symptoms and abnormal physical findings were statistically significant(P＜0.05). The total scores of symptom severity and physical function had improved from the baseline values(P＜0.0001). However, the score changes in each subgroup, for the duration of symptoms differ statistically same (P＜0.05) as assessed by the visual analogue pain scale. The results at two months were similar to those of at three weeks. Approximately 78.3% of the patients reported the satisfactory results. Although the follow up period was short, the results demonstrated that the epidural steroid injection afforded much improvement in clinical symptom and physical function in elderly patients with the lumbar spinal stenosis. The only significant difference was the satisfaction outcomes in the groups with short duration of symptoms. The determination of persisting outcomes from the ESI would require a long-term follow-up study.

The purpose of this study was to obtain the normative values for variable parameters of lumbar function with the isoinertial triaxial dynamometer in normal subjects and to compare these values with those of the patients with chronic low back pain.

In 82 normal subjects and 27 patients with chronic low back pain, the variable parameters including lumbar range of motion (ROM), maximum isometric torques, and maximum isoinertial velocities were measured with the isoinertial triaxial dynamometer in three axes (rotation, flexion-extension, and lateral flexion). In normal subjects, all parameters except lumbar ROM of all three axes were significantly higher in the male group than the female group. However, other anthropometric variables such as age, height, weight, and body mass index were little correlated with each parameter. Therefore, the normative values were obtained only in consideration of the gender. In patients with chronic low back pain, all parameters except the maximum isometric torques in the female group were significantly lower than those in normal subjects. In addition, the decrease of maximum velocities during the isoinertial exercise was highly correlated to verbal rating scales (VRS) in most axes, especially in the female patient group, but the duration of low back pain was little correlated with the various parameters measured with the isoinertial triaxial dynamometer.

In conclusion, all parameters measured with the isoinertial triaxial dynamometer in all three axes were significantly lower in patients with chronic low back pain than those in normal subjects except maximum isometric torques of female group. It was suggested that maximum isoinertial velocities were more reliable and significant than maximum isometric torques for the objective assessment of chronic low back pain.

Purpose of this study is to evaluate the temperature lowering effects of the local cold air application on the skin surface and the muscle of different depth, and to observe whether the rebound rise of the temperature occurs after the cold air application.

Subjects were prepared in a relaxed prone position. Cold air of CRAis(Kyung-won Century, Korea) was applied to the gluteal area of 20 healthy subjects for 5 minutes. The skin and intramuscular temperatures were measured by a thermogram(Infrared system, Sweden) and digital thermometers(Barnant company, USA). The temperatures were measured before and 30 seconds after the cold air application, and then every 5 minutes for the next 110 minutes. The few variables were considered that might affect the temperature changes. The thermometer-probes were inserted into the outer quadrant of the gluteal muscle below 5 cm from the iliac crest with the depth of 2 cm, 4 cm, and 6 cm respectively. ANOVA was used for the analysis of the data. The resting temperature of the skin surface was 32.6⁑1.2℃, and the lowest temperature was 12.9⁑3.3℃ after 5 minutes of cold air application. The resting intramuscular temperatures with 2 cm, 4 cm, and 6 cm depth were 36.5⁑0.2℃, 36.9⁑0.2℃, and 37.1⁑0.2℃ respectively (p＜0.05). The lowest temperature in 2 cm, 4 cm, and 6 cm depth was 35.1⁑0.7℃, 36.2⁑0.4℃, and 36.9⁑0.3℃ respectively(p＜0.05). The mean duration to reach the lowest temperature was 20, 25, and 45 minutes respectively. The temperatures in the skin and the muscle with the depth of 2 cm, 4 cm, and 6 cm after 2 hours on cold air application were 32.2⁑1.1℃, 36.2⁑0.5℃, 36.6⁑0.3℃, and 36.9⁑0.3℃(p＜0.05) respectively. The temperatures in the skin and the muscle were significantly lower after 2 hours than before the cold air application(p＜0.05).

The change of skin surface temperature was more rapid than that of the muscle and the deeper the muscle was the lesser the temperature change. In conclusion, the effect of cold air application for 5 minutes lasts up to 2 hours and the rebound rise of the temperature due to reactive vasodilatation seems not to occur in the gluteal muscle.

The purposes of this study are to investigate the effect of the cold air application in the skin and intraarticular temperature changes and to observe the rebound temperature changes after cooling.

We recorded the changes of the skin surface and intraarticular temperatures of knees during and after the cold air application. The intraarticular temperature was measured by a temperature probe inserted into the knee joint cavity and the skin temperature by the infrared system. Eighteen healthy subjects were examined. The knee was cooled by a 5-minutes application of CRAis (Kyung-won Century, Korea) machine and the intraarticular and skin temperatures of knees were measured at every 0.5-minute during and after the cold therpy, then at every minute for 5 minutes, and every 5-minute for the next 110 minutes. We also evaluated the variables that might affect the skin and intraarticular temperature changes.

Results showed that the mean skin temperature dropped from 31.8℃ to 10.5℃ immediately after the cold air application for 5-minutes. The mean intraarticular temperature dropped from 33.9℃ to 30.0℃ after the cold air application for 5-minutes. Two hours after the initiation of treatment with cold air, the mean intraarticular temperatures did not recover to the baseline values(p＜0.01). No significant correlations were found between the body mass index with the intraarticular and surface temperatures of knees. A highly significant correlation was noted between the baseline skin surface and intraarticular temperatures(p＜0.01).

In conclusion, the reduction of the joint temperature by the cold air application using CRAis machine can be a useful treatment method for the synovitis of knees.

To evaluate the clinical value of a new self assessment method of pain, so called pain rating score(PRS), we performed the visual analogue scale, verbal rating scale, McGill pain questionnaire, and PRS on 60 patients with complained neuro-musculo-skeletal pain.

The results showed that the reliability of PRS was very high.

The PRS was a simple, easy, and comprehensive method to assess the pain for its intensity, frequency, duration, and aggravating factors.

The PRS was very sensitive for the change of pain.

Based on the above results we have concluded that, the new self assessment method of pain, pain rating score(PRS), is a valuable and useful clinical method which is simple, easy to perform and comprehensive.

Postherpetic neuralgia(PHN) is a common complication of herpes zoster and one of most common intractable conditions in pain clinics. The PHN is defined solely by the persistence of pain after the herpes zoster. There has been no known pathophysiology for the PHN and the role of scars, local muscles, tendons and ligaments has not been addressed.

The characteristics, duration, and location of the referred pain were evaluated along with the electromyographic(EMG) examination of involved muscles. Then treatment was given under the concept of a myofascial pain syndrome till the pain was completely resolved. Most of the patients with acute or chronic pain were relieved from the pain.

This study revealed a practical and important new concept on herpes zoster related pains. In some cases of herpes zoster, acute herpes zoster seems to be an initiating factor to form an acute trigger point in the muscles of the related area. And uncomplicated trigger points neglected in an acute stage become chronic intractable problems, when they were neglected.

In conclusion, myofascial pain syndrome should be taken into account when a postherpetic neuralgia is diagnosed. The recognition of this possible relationship between PHN and myofascial pain syndrome and an early proper care can greatly reduce the suffering of patents from chronic pain.

Thirty-eight patients with a musculoskeletal chest wall syndrome were evaluated for the musculoskeletal findings of chest wall. All patients had the chest wall tenderness and the typical chest pain could be reproduced by the palpation. There was no significant difference in the diagnostic features of the pain for the onset, location, characteristics, duration, radiation, and area of references for chest pain among the different groups of the patients. However, a reproduction of pain by palpation and the pressure threshold difference between the lesion and control points by using pressure algometry was a reliable and specific diagnostic tool. Pressure threshold difference was correlated with numerical rating scale by the correlation coefficient 0.96. The common causes of the chest wall syndrome were the myofascial pain syndrome, chostochondritis, sternalis syndrome, rib-tip syndrome, xiphodynia in order. Six patients had chest wall disorders in conjunction with other associated intrathoracic condition. Thirty-two patients had an isolated chest wall syndrome. Chest wall syndrome should be considered in all patients with the chest pain, as its recognition could help the patient management.

A portable ultrasound scanner has been developed to provide a noninvasive technique of measuring the bladder urine volume. This study was undertaken to determine if bladder volumes could be accurately measured in a group of spinal cord injury patients on a clean intermittent catheterization program, using a portable ultrasound scanner(BladderManager PCI 5000). We assessed the effects of different patient positions, presence of central obesity and bladder types by the urodynamic study on the accuracy of measurements as well as the inter-tester difference. Ultrasound measurements of urine volume performed by two physicians were compared to the volumes obtained by catheterization in 17 spinal cord injury patients. Subjects were tested in the seated and supine positions. The results showed a good correlation between the catheterized volumes and ultrasound measurements (Pearson correlation coefficient=0.97, r²=0.88). The mean % error was 18% for the catheterized volumes within the ranges of 45ml-640ml. But the ultrasound measurements revealed a significantly higher % error for the bladder volumes less than 200ml. Ultrasound measurements were more accurate in a supine position and among the non-obese subjects(p＜0.05). There was no significant difference in the ultrasound measurements between areflexic type bladder and hyperreflexic type bladder neither in the inter-tester measurements..

We conclude that the Bladder Manager PCI 5000 is not an accurate tool for the assesssment of post-void residual urine volumes, however it can be a useful tool for the patients with neurogenic bladder who are performing volume-directed clean intermittent catheterization, in reducing the unnecessary catheterization or preventing the bladder overdistensions.

Heterotopic ossification(HO) is a formation of ectopic bone around joints in the soft tissues. It often occurs after the central nervous system injuries, burns, and joint replacements. It causes an important morbidity in the rehabilitation population. The etiology, pathogenesis, prophylaxis, and treatment of HO are still unclear even though there have been many investigation on the prevention of HO among the patients with spinal cord injury. The prevention effect of EHDP on HO formation still remains controversial. A randomized clinical trial was performed to assess the prevention effect of EHDP on HO formation in 73 patients (control group: 40 cases, study group: 33 cases) as a prospective study. EHDP was given to the study group for 12 weeks; 20 mg /kg /day for 2 weeks followed by 10 mg/kg/day for 10 weeks. The patients were followed up with the serial physical examinations, serum alkaline phosphatase levels, and plane radiographs for one year period after the injury.

The results revealed that HO developed in eight cases(20.0%) among the control group and two cases(9.1%) among the study group. There was no significant difference in the incidence of HO between two groups(p＞0.05). The mean duration from the injury to the detection of HO was 113 days. Twelve of 15 HO sites(80.0%) were detected within the 6 months after injury. Seven patients developed the HO in one site, two in two sites, and one in three sites. The sites of HO were 6 in hips, 4 in knees, 2 in shoulders, 2 in pelvis, and one in elbow. The results of this study do not support the prevention effect of EHDP on HO formation among the patients with spinal cord injury.

Deformity due to the diabetic foot causes repetitive and excessive pressure to the certain areas of a foot, which may result in ulcers and pains. Therefore, it is necessary to measure the pressure of the sole for the prevention and management of the diabetic foot lesions. The computerized foot scan system is one of the direct methods to measure the excessive pressure from the deformity of a foot. However, it is not usually affordable in a developing country due to its high cost, space occupancy, and lack of trained personnel. Manual counting using Harris mat is another rather affordable method, however it has problem of the time consumption for a quantitative measure and poor in reproducibility. The purposes of this study were to obtain the objective and quantitative data from Harris mat footprints of diabetic patients by using Paint Shop Pro^Ⱂ and to apply the same method to the patients with other foot lesions. Fifty three cases(twenty four males and, twenty nine females) who were referred due to the diabetic foot lesions were evaluated. The average age was 56.62±8.03 years and the duration of diabetes mellitus was 104.93±79.53 months. By the Paint Shop Pro^Ⱂ, the highest pressure was recorded at the first toe(thirteen cases), followed by the calcaneal area (also thirteen cases) and the first metatarsal head area (seven cases) in order of the right foot. Of the left foot, the highest pressure was recorded at the first toe (fourteen cases), followed by the calcaneal area(twelve cases) and the third metatarsal head area(nine cases). By the manual analysis, the highest pressure was recorded at the calcaneal area (thirteen cases), followed by the first toe(ten cases) and the fifth metatarsal head area (six cases) in order of the right foot. Of the left foot, the highest pressure site was the first toe(fourteen cases), followed by the calcaneal area(fifteen cases) and the third matatarsal head area(seven cases) in order of pressure level.

Based on these results, we have concluded that the Paint Shop Pro^Ⱂ analysis method is an easy and inexpensive foot pressure measurement system which is clinically applicable. However further researches for the test-retest reliability and a comparison with the computerized foot scan system would be required for the standardization of this method.

The purpose of this study was to detect where the center of pressure in foot would be located at the end point of loading response and the terminal stance by the dynamic plantar pressure measurement.

Seventeen adults who had the usual feet without a pathologic gait were evaulated simultaneously by the motion analysis using VICON 370, and the plantar pressure measurement using EMED-SF. Two devices were set in the 60 Hz frame. The foot was divided into 3 different zones; hindfoot, midfoot, and forefoot.

The end point of loading response was located at the 1.92⁑1.46 frame distal to the hindfoot- midfoot borderline. The end point of terminal response was located at the 2.27⁑1.96 frame distal to the maximal pressure points of metatarsal head.

Authors could differentiate each period of stance phase; the initial contact, loading response, mid-stance, terminal stance, and preswing, using the analysis of center of pressure by the dynamic plantar pressure measurement.

A new program for the quantitative evaluation of dysmetria, was developed and compared to the other well known clinical tests. Upper extremity motor coordination was evaluated in ten traumatically brain injured subjects using the conventional clinical evaluation methods and a computer based evaluation system with a touchscreen. The relationship between the results of clinical evaluation and computer based drawing test was determined by Pearson and Spearman rank correlation coefficients. There were significant correlations between the results of clinical tests and computer based drawing test.

In conclusion, we could evaluate the dysmetria quantitatively by a newly developed program. This tool can be used in many clinical situations for the evaluation of dysmetria or other movement disorders.

Respiratory insufficiency is a common cause of morbidity and mortality in patients with Duchenne muscular dystrophy(DMD). In these patients, progressive muscle weakness is a major factor in the development of respiratory insufficiency. Therefore, the physical training program to improve the strength and endurance of respiratory muscle could conceivably improve respiratory function and prevent respiratory complication in patients with DMD.

The purpose of this study is to examine the effects of inspiratory muscle training on respiratory function of DMD patients according to functional state.

Eighteen DMD patients who were registered at the Muscle clinic of Yong Dong Severance Hospital were assessed for the pulmonary function using the routine pulmonary function test and measurements of maximal static pressures at 6 weeks before the training, at the beginning of training, and after the end of 6 week-training. The first 6 weeks were used as a control period. Inspiratory muscle training consisted of breathing through Threshold inspiratory muscle trainer (IMT) at 30% of patients' maximal inspiratory pressures(MIP) for 15 minutes twice a day and the 'endurance time' was recorded weekly for an assessment of inspiratory muscle endurance.

This study showed significant improvement of MIP and endurance time after the training in both ambulatory and wheelchair-bound patients. The amounts of improvement were greater in the patients with a better functional state and greater baseline forced vital capacity.

We conclude that, in the early stages of DMD, inspiratory muscle training with pressure threshold device is more useful when the forced vital capacity is well preserved.

Isometric contractions of muscles in upper extremities occur frequently during ordinary daily activities. The isometric handgrip exercise can be one of the best methods for the evaluation and treatment of patients with disability of upper extremity. However these isometric contractions can impose sudden and significant high stresses to the cardiovascular system.

The purpose of this study was to document the torque patterns and cardiovascular responses of subjects by the isometric handgrip exercises and hopefully to provide a guidance for the safe evaluations and prescriptions of isometric exercises.

Eighty healthy male subjects from 21 to 60 years of age performed isometric handgrip exercises using a Baltimore therapeutic equipment work simulator. The peak torque, time to peak torque, and torque at each second were measured by a six-second isometric strength trial program. The blood pressure and heart rate were measured simultaneously at rest and at each minute during isometric exercises at 30%, 50%, and 70% of the peak torque.

There were no differences in the peak torque, time to peak torque, and torque at each second between age groups(p＞0.05). After the onset of peak torque, the torque gradually decreased and recorded 72.8% of the peak torque at 6 seconds.

The mean arterial pressure and heart rate increased significantly during exercise(p＜0.001), but returned to the resting state immediately when the exercise stopped. The mean arterial pressures were significantly different when the duration of exercise prolonged at 50% and 70% of the peak torque(p＜0.05). And also the mean arterial pressures increased significantly when the strength of exercise increased as well(p＜0.001).

We have concluded that attentions should be given to patient's cardiovascular state, and duration and strengh of exercise when the isometric handgrip exercises are prescribed for the evaluation and treatment of patients.

A sepsis or multiple organ dysfunction occurs frequently in the intensive care unit and causes a significant number of mortality and morbidity. Somtimes polyneuropathy of varying severity occurs in association with a sepsis or critical illness. Since the clinical evaluation is often difficult, electrophysiologic studies are employed to reveal a definitive evidence for polyneuropathy.

The purpose of this study was to investigate the frequency of polyneuropathy and to determine the electrophysiologic features of critically ill patients.

The subjects were 23 patients between ages of 42 and 72 with a sepsis or systemic inflammatory response syndrome combinded with the multiple organ failure.

The results revealed reductions in the amplitude of compound motor action potential and sensory nerve action potential, as the most marked abnormality. Needle EMG revealed the signs of denervation of limb muscles. Approximately 65.3% of adult patient with sepsis or multiple organ dysfunction has an axonal polyneuropathy.

We suspect that the axonal polyneuropathy is related to the severity of multiple organ dysfunction.

Our previous study of motor evoked potentials(MEPs) in predicting functional recovery of hemiparesis of stroke patients showed a significant relationship between upper extremity MEP and functional outcomes.⁵⁾ But there were some controversies in predicting a functional outcome of lower extremity, especially the gait status, with the upper extremity MEP.

In this study, we included lower extremity MEP to evaluate the role of MEP in predicting a functional outcome of hemiparetic patients. We compared the responsiveness of upper and lower extremity MEPs with the functional outcome measured by modified Barthel Index and gait status.

Responsiveness of lower extremity MEP was correlated with a good functional outcome regardless of the upper extremity MEP. The upper extremity MEP's known predictive value was thought to be due to its close relationship with the lower extremity MEP.

Motor unit number estimation(MUNE) was performed in the thenar muscles of 22 hemiplegic patients without a peripheral nerve lesion using the statistical method. The studies were done bilaterally in the affected and unaffected sides. The distal latency and conduction velocity of median nerve in the affected side were not different from those in the unaffected side. But the amplitude and area of the compound muscle action potential in the affected side were smaller than those in the unaffected side. Motor unit numbers in the affected side decreased than those of the unaffected side, especially in the first 6 months after the onset of hemiplegia. And the motor unit numbers in the affected side decreased as the muscle strength decreased. Single motor unit potential(SMUP) area in the affected side increased after 1 year from the onset of hemiplegia. The estimation of the number of motor units in the thenar muscles of hemiplegic patients could be an indicator for predicting recovery of the muscle power in hemiplegia.

It has been reported that the electrical stimulation of nerves can cause the changes of anterior horn cell excitability and conduction velocity of the nerves in vivo and vitro studies. The purpose of this study is to evaluate the electrophysiologic changes of the peripheral nerves near the spinal cord by the electrical stimulation. Subjects were 20 healthy volunteers, with the age of 21 to 27 years. The conditioning current was an interferential current of 10 Hz and 100 Hz with the maximal tolerable intensity (18∼20 mA). Conditioning stimulation was applied to the paraspinal area between T9 and T12 for 15 minutes. Before and after the conditioning stimulation, we measured the peripheral nerve conduction, H-reflex, F-wave, and somatosensory evoked potential (SEP) of the tibial nerve. The results after the conditioning revealed that the tibial motor and sensory conductions were unchanged but the latency of the H-reflex was significantly prolonged with a significant reduction of H amplitude and H/M ratio (p＜0.01). The latency, duration, and F-ratio of the F-wave were significantly increased and the amplitude of the F-wave was significantly reduced (p＜0.01). P1 latency was significantly prolonged in the cortical tibial SEP (p＜0.01). Change of N1P1 amplitude was not meaningful (p＞0.05). There was no statistical difference between the changes by a high or low frequency stimulation. These results suggest that a certain conditioned electrical stimulation of peripheral nerves near the spinal cord may cause the decrement of anterior horn cell excitability, and the inhibition of the alpha motor nerve and sensory nerve conductions near the spinal cord.

The low rate repetitive nerve stimulation test(RST) using the electric stimulation has been known the best procedure among the electroliagnostic evaluations for the neuromuscular transmission. However, the electric stimulation often causes a considerable discomfort and pain during the procedure. On the contrary, the magnetic stimulation is much easier and less painful in activating to activate the deep seated nerves. The purpose of this study was to compare the effect of repetitive magnetic and electric stimulation for the induction of compound muscle action potentials(CMAP) of abductor digiti quinti and deltoid muscles in 25 healthy subjects.

The results were showed there were no significant differences in the amplitudes of CMAP of axillary and ulnar nerves between the magnetic and electric stimulations. And there were no significant differences in the decremental ratio of CMAP between the magnetic and electric stimulations. The magnetic stimulations were less painful for the subjects than electric stimulations in both proximal and distal muscles.

In conclusion, the magnetic stimulation proved to be a useful method for repetitive nerve stimulations in the diagnosis of neuromuscular disease.

The F wave has been thought to be useful in assessing the proximal neuropathy such as radiculopathy. However the sensitivity of F wave in radiculopathy is varying from 18% to 65%. The aim of this study is to compare the relative diagnostic value of 20 averaging technique and 20 sequential stimulation technique in recording the F waves and to determine the usefulness of F wave for the evaluation of radiculopathy.

Animals employed were rabbits that were divided into a study group of 17 rabbits(31 legs) and control group of 14 rabbits(25 legs). In the study group, the sciatic nerve was exposed after the dissection of gluteus maximus muscle and the nerve trunk was traced up to reach the spinal canal level. One of the two nerve roots composing the sciatic nerve was dissected randomly. F wave parameters were measured using both of 20 averaging technique and 20 sequential stimulation technique.

The parameters which showed significant change after the root dissection were the amplitude by employing 20 electronic averaging technique, and mean latency, minimal latency, mean amplitude by employing 20 sequential stimulation technique.

We concluded that 20 electronic averaging technique had no benefit over the 20 sequential stimulation technique and F wave measurement was not useful for the electrodiagnosis of radiculopathy because of the wide range of control values.

The purpose of this study was to detect the motor neuron losses in progressive neurologic diseases before the weakness or wasting of muscles became apparent using the motor unit number estimation technique. Method for estimating the number of motor units based on electrical stimulation of motor nerves was introduced first by McComas. The author describe the method which was applied to the median nerve innervated thenar muscles in healthy subjects. This study showed that the results of motor unit number estimation were 196.9⁑56.2 in male, 187.6⁑79.2 in female, and the most influencing factor for the number of motor unit was the size of amplitude or area of compound muscle action potential.

For the diagnosis of carpal tunnel syndrome (CTS), a sensory conduction study of median nerve is the most sensitive parameter, by either antidromic or orthodromic recording. Many different sensory recordings have been developed to detect the mild or early cases of carpal tunnel syndrome. A comparison of the median and ulnar sensory responses using the 4th digit either orthodromically or antidromically has been one of the methods. However, a simultaneous comparison of both antidromic and orthodromic methods on the 4th digit has not been documented. For the comparison between the median and the ulnar sensory nerve conduction of the 4th digit recorded antidromically or orthodromically, conduction studies of the median and ulnar sensory nerves were performed using standard methods in normal populations as well as in patients with carpal tunnel syndrome. We studied 31 CTS patients (46 hands) with mean age of 54 years old (range, 25∼70). Also, 51 subjects (102 hands) with mean age of 48 years old were studied as control. The difference of antidromic latencies between the median and the ulnar nerves was less than or equal to 0.4 msec in the control subjects and greater than or equal to 0.5 msec in the patients with carpal tunnel syndrome. The difference of orthodromic latencies was less than or equal to 0.5 msec in the control subjects and greater than or equal to 0.5 msec in the patients with carpal tunnel syndrome. By the antidromic and orthodromic methods, the mean difference between latencies of the median or ulnar nerve was not statistically significant. However the amplitude of median or ulnar nerve was 2 times larger by the antidromic method than by the orthodromic. We concluded that the latency difference of 0.5 msec or greater between the median and ulnar nerve sensory conductions from the 4th digit would be valuable for the diagnosis of CTS. The antidromic methods with larger amplitude may be more technically convenient to determine CTS than the orthodromic methods.

Visual evoked potentials(VEPs) are the cerebral electrical activities recorded from the occipital scalp following a flash or pattern stimulation and can detect the lesions of sensory visual pathways. Although the VEPs change with the maturation of CNS in children, a few studies have documented the maturational changes in premature infants. Using the light- emitting diode goggles, VEPs were studied in 131 neurologically intact infants of 28∼41 weeks gestational age or 34∼59 weeks postmenstrual age.

The VEPs were analysed by three waveforms; normal, abnormal, and flat, and four patterns; N₃₀₀, P₂₀₀-N₃₀₀, P₁₀₀-N₁₅₅-P₂₀₀-N₃₀₀, and P₁₀₀ pattern. Normal waveforms were 63 of 131 VEPs(48.1%). Of the normal waveforms, N₃₀₀ patterns were 38.1%, P₂₀₀-N₃₀₀ 36.5%, P₁₀₀-N₁₅₅-P₂₀₀-N₃₀₀ 19.0%, and P₁₀₀ 6.4%. Each pattern correlated with the postmenstrual age. These findings support the hypothesis of VEP pattern changes according to the maturation of the visual system with age.

Recently, botulinum toxin has been widely used for the management of spasticity. However it's mechanism of action in the skeletal muscle has not been well clarified. This study was performed to investigate the histopathologic changes in the skeletal muscle after botulinum toxin injection, and to determine the clinical standards of muscle fiber conduction study as an objective indicator for the changes of muscle fiber.

As a study group, 35 Sprague Dawley rats were injected intra-muscularly with the botulinum toxin type A around two heads of right gastrocnemius muscle. After the injection of botulinum toxin, histopathologic studies and muscle fiber conduction studies were performed in 5 rats of the study group at 0, 1, 3, 5, 7, 14, and 28th day respectively.

Based on the morphologic studies, the mechanisms of paralysis following the botulinum toxin injection were found to be both myogenic and neurogenic, and the motor function recovered through the formation of new motor end-plate and proliferation of Schwann cells.

The muscle fiber conduction study revealed that the mean latencies of study group at 1, 3, 5, 7, and 14th day after the injection of botulinum toxin were significantly prolonged than those of the control group(p＜0.05).

The prolongation and slow recovery of latencies in a muscle fiber conduction study after the injection of botulinum toxin significantly reflect the morphologic changes of paralized skeletal muscles.

Vestibulocollic reflex(VCR) which stabilizes head position in space is essential for an adequate motor performance, and maintenance of balance and posture. The purpose of this study was to measure the VCR in brain stem lesion patients and to evaluate the usefulness of the VCR study in the evaluation of brain stem lesions.

The VCR evoked by free fall of the head was measured by the electromyographic signal of the sternocleidomastoid muscles. Twenty normal and ten brain stem lesion subjects were studied by lying supine with the head cradled in a sling, and the VCR was evoked by an abrupt head drop while the sling was released. The electromyographic signal was recorded with surface electrodes from the sternocleidomastoid muscles.

In normal subjects, the initial small burst with an onset latency at 20.61⁑3.25 msec was obtained followed by the later larger burst of sternoceidomastoid electromyographic response. But in the subjects with a brain stem lesion, the initial latency was delayed to 46.10⁑10.65 msec and the waveform was smaller and dispersed than that of the normal subjects.

The VCR evoked by free fall of the head showed delayed latency and dispersed waveform in patients with a brain stem lesion. This method could be used for the evaluation of brain stem lesions.

Radical neck dissection(RND) has been a standard treatment for the head and neck cancer with metastasis to the cervical lymphatics. The sacrifice of the spinal accessory nerve innervating trapezius muscles creates a definite deficit of the shoulder function. Therefore, the modified radical neck dissection(MRND) preserving one or more structures of the spinal accessory nerve, internal jugular vein or sternocleidomastoid muscle was introduced to minimize the postoperative morbidities.

We studied the shoulder function by clinical examinations and electrodiagnosis for the various types of neck dissection in 39 cases of 24 patients and compared the results of each test according to the types of neck dissection.

Correlation between the clinical parameter and electrodiagnostic results showed a statistical significancy.

The functional results of trapezius muscle in the group of modified radical neck dissection were better than those of the radical neck dissection. The fact that 80% of the cases in the RND group presented incomplete denervation of the trapezius muscle, suggests the innervation of other nerves to this muscle.

Forty five percents of the cases in the MRND group which presented partial denervation of the trapezius muscle, might be due to the damages during operations.

To preserve the spinal accessory nerve, a careful manipulation of the nerve is required. Further studies including an anatomic dissection and intraoperative electrophysiologic evaluation of the trapezius muscle should be performed for the better rehabilitation outcomes.

Cerebrotendinous Xanthomatosis is a rare inherited autosomal recessive disorder characterized by an increased plasma cholestanol level and the accumulation of sterol in tendon and nervous system. The primary biochemical abnormality is a defect in the synthesis of bile acid due to a lack of hepatic mitochondrial sterol-26-hydroxylase activity. The clinical symptoms usually begin in the 2nd decade and include cataract, xanthoma, and progressive neurological dysfunction. There are variable abnormal findings in the eletrophysiologic and radiologic evaluation. The usual treatment consists of long-term administration of the chenodeoxycholic acid (CDCA or UDCA) or cholic acid, which may correct the biochemical abnormality. We report a case of Cerebrotendinous Xanthomatosis in a 32 year old male patient suffered from gait disturbance and tendon xanthoma in both achilles tendons and left knee area.

Significant illnesses or a major trauma including spinal cord injury can induce the changes of thyroid hormone metabolism, leading to the findings of "Euthyroid Sick Syndrome(ESS)". The physicians should be aware of these changes in order to interpret thyroid function test correctly after the spinal cord injury.

We report three cases of ESS after the spinal cord injury. On a routine evaluation, they showed a low serum T3 level, and the T3 level returned to the normal range on a follow up study without any specific treatment.