Objective: To evaluate the changes of motor unit number estimation (MUNE) and the amplitude of compound muscle action potential (CMAP) according to severity of nerve injury in rat.

Method: The sciatic nerve was compressed with two different severity (mild, severe) in 20 rats each. MUNE was performed in gastrocnemius of rat using the Poisson statistics. MUNE and amplitude of CMAP were compared according to severity of injury at two and four weeks after injury.

Results: The MUNE and amplitude of CMAP were significantly diminished at two and four weeks after nerve injury in severely injured rat. Both values were also diminished at two weeks after injury in mildly injured rat. The amplitude of CMAP was slightly increased at four weeks after mild injury despite of further decrement of MUNE.

Conclusion: The MUNE and amplitude of CMAP changed differently according to severity of nerve injury in rat, which might represent different denervation and reinnervation process.

Objective: To evaluate the changes of maximum fibrillation potential amplitude and root- mean-square (RMS) value of denervation potential after nerve injury using power spectrum analysis.

Methods: The sciatic nerve was transected in 8 rats, and was compressed in 6 rats. Denervation potentials were collected in gastrocnemius using monopolar needle weekly after nerve injury. The change of RMS value of 1 second epoch of denervation potentials with time was evaluated and compared with the change of maximun fibrillation potential amplitude.

Results: In nerve-transected rat, the RMS value declined linearly with time after injury. On the contrary, the amplitude of fibrillation potentials declined much rapidly during first 3 weeks. In nerve-compressed rat, both the RMS value and amplitude of fibrillation potential increased for 2 weeks after injury, and declined thereafter. As the result of simple regression analysis, the changes of RMS value correlated better than changes of fibrillation amplitude in all 8 nerve-transected rat.

Conclusion: The RMS value of denervation potentials correlated well with time after nerve injury in animal experiments. Measurement of the RMS value might be helpful to evaluate the time after peripheral nerve injury, but long-term human data should be essential for clinical application.

Objective: The purpose of this study was to find out diagnostic clue for the carpal tunnel syndrome. So we investigated the postional relationships between the structures, the degree of entrance of the muscle bellies in the carpal tunnel, the location of flexor retinaculum (FR) and the cross sectional area to the tunnel of the tendons, the median nerve and the soft tissues occupied with the wrist.

Method: Seventy-seven wrists of Korean adults's cadavers were dissected. Fifty-three wrists were examined by posteroanterior view of X-ray. The area of each structure was measured by image analyzer (Optimas Co. WA). The upper and lower borders the FR were confirmed at the sagittal plane after sagittal section.

Results: Frequency of the bellies of FDS, FDP and lumbricalis observed in each finger, the length of these bellies entering into the carpal tunnel were obtained. The cases that the third and fourth FDS were located side by side, the second FDS tendon under the third FDS tendon and the fifth tendon under the fourth FDS tendon were most common. The cases that the median nerve was bordered on the third FDS and the second FDS deep inside of the median nerve were most common. Mean length of the FR was 32.1 mm. The cases that the location of the upper margin of the FR was 10 mm and 15 mm from the end of radius were most common (44%). The cases that the margin of FR was 5 mm and 10 mm from the base of the 3rd metacarpal bone were most common (52%). The cross sectional area ratios to the carpal tunnel of the tendon, median nerve and connective tissues were 30%, 4%, 66% at the level of the pisiform bone, 36%, 4%, 60% at the level of the hook of hamate and 28%, 3%, 67% at the level of the lower margin of the FR, respectively.

Conclusion: These results could help to understand the etiology of the carpal tunnel syndrome and would be a helpful information to the diagnostic imaging of the carpal tunnel.

Objective: The purpose of this study was to evaluate the short- and long-term effects of exercise on neuropathic pain.

Method: Pain responses between rats in the exercise and control groups were compared to evaluate the effects of exercise in neuropathic pain. Materials consisted of 30 male Sprague-Dawley rats (8 weeks old, 180∼200 g), which were divided into an exercise group (n=15) and a control group (n=15). Neuropathic pain was produced by partially injuring the nerve innervating the tail. Running exercise was given on a Rota-rod treadmill exercise machine for 3 weeks (3.1 Km/day, 6 cycle of 9 minutes exercise and 1 minute rest). Behavioral reactions to mechanical allodynia were checked using a von Frey hairs of 2.0 g (19.6 mN) bending force at 10 minutes, 1 hour and 24 hours post-exercise to evaluate the short term effects of exercise. Behavioral reactions to mechanical and thermal allodynia with 4^oC or 40^oC were evaluated 7, 14, 21 and 28 days following exercise.

Result: The exercise group exhibited less tail-flick frequencies to mechanical stimulation from 58.8⁑6.8% to 41.1⁑5.4%, 37.6⁑13.2% at 1 and 24 hours post-exercise compared to the control group, but there was no significant difference between the groups at weeks 1 through 4. In the exercise group, the decrease of tail-flick frequencies were blocked by naloxone (2 mg/kg i.p.). It is suggested that long-lasting muscle exercise (e.g. running) which influences central endorphin mechanisms giving analgetic effects.

Conclusion: The results of this study support the hypothesis that the exercise can reduce neuropathic pain in the acute stage.

Objective: The purposes of this study were to examine overall quality of life (QOL) in long term stroke survivals and to identify variables that predict QOL after stroke.

Method: Subjects were 51 stroke patients (male; 28, female; 23) with stroke onset at least 6 months previously. Interview, measurement of depression and QOL were performed at outpatient clinic after discharge. Review of medical records included characteristics of stroke and communication disorders. Interview questionnare included caregiver, religion, education level, occupation and income. Depression and functional status was measured by the Beck depression inventory (BDI) and modified Barthel index (MBI), respectively. QOL was measured with the use of 5-item (activity, daily living, health, support, outlook) version of the Quality of Life Index (QLI) and its range of scores is 0∼10. We compared QLI scores according to various factors obtained from medical records and questionnaire.

Results: Mean duration after onset of stroke was 33.6 months (range, 6∼216 months). The mean score of QLI were 7.0⁑2.1. Low MBI score, communication disorder and depression had a negative effect on QOL (p＜0.05). Sex, age, occupation, caregivers, religion, education level, income, duration after stroke onset and side of hemiplegia had no effect on QOL (p＞0.05).

Conclusion: Low MBI score, depression and communication disorders would be negative predictors of QOL and identification of these factor may assist stroke patients in coping their personal and social life.

Objective: The purpose of this study is to evaluate the effects of intramuscular botulinum toxin A injection for the improvement of hand function in spastic hemiplegia.

Method: We have studied 8 patients with spastic hemiplegia. Botulinum toxin A was injected into target muscles with electromyographic guidance. Before injection, muscle activity patterns were evaluated by dynamic electromyography. Follow-up assessments were performed at three months after injection.

Results: There were continuous activity patterns in all dynamic electromyography of target muscles. Dynamic electromyography of antagonist muscles in five patients showed normal phasic activity pattern but it showed absent pattern in other three patients. Mean modified Ashworth scale decreased significantly after injection. There were an improvement in functional classification and a significant increase of mean scores of unilateral hand skills after injection in patients with normal phasic pattern of antagonist muscles.

Conclusion: Botulinum toxin A can improve the impaired hand movement and function in spastic hemiplegia by reducing spasticity and contracture of the target muscles in cases of normal phasic activity in antagonist muscles and continuous activity in target muscles.

Objective: The purposes of this study are to find out the long-term effect of motor point block using phenol on spasticity and gait pattern of spastic cerebral palsy children and to examine contributing factors for success of phenol block in functional implication of cerebral palsy.

Method: We injected 5% phenol into muscles of 35 cases with spastic cerebral palsy under the electromyographic monitoring. Pre, immediate post, and follow-up evaluations for type and severity, grade of spasticity, range of motion, and gait patterns by locomotion rating scale (LRS) were analyzed.

Results: The degree of spasticity was reduced dramatically by block, but this effect returned back to the level of pre-block state on follow-up evaluation. There was much improvement in pes equinus, genu recurvatum and scissoring tendency, while little change was observed in crouch gait and hind foot instability. These effects have been sustained on follow-up evaluation. The gait speed, deviation to normal gait, and instability in walking were significantly improved after block and on follow-up. Maintenance of adequate range of motion and good standing balance were the most important contributing factors determining the success in phenol block. Initial spasticity, initial and post LRS score were not significant.

Conclusion: After phenol block, spasticity returned back to the level of pre-block state but improvement in locomotion activity was maintained over 8 months on follow-up evaluation. The maintenance of adequate range of motion and good standing balance were the most important contributing factors determining the success in motor point block for improving locomotion activity.

Objective: To investigate bone mineral density (BMD) and biochemical markers of bone turnover in cerebral palsy patients according to the severity and type.

Method: BMD and biochemical markers of bone turnover were examined in 30 normal children and 57 children with cerebral palsy. They were 10 to 15 years old and divided into 5 groups: Group I, 30 normal children; Group II, 11 with moderate spastic cerebral palsy; Group III, 10 with moderate non-spastic cerebral palsy; Group IV, 24 with bed-ridden spastic cerebral palsy; Group V, 13 with bed-ridden non-spastic cerebral palsy. The bed-ridden cerebral palsy subjects were further divided into two groups: one with treatment of anticonvulsants more than 5 years; the other with no experience of anticonvulsants treatment. BMD and its T-score on the dominant forearm were measured in all subject, and the level of serum osteocalcin and urine deoxypyridinoline were measured in cerebral palsy patients in early morning.

Results: The bed-ridden cerebral palsy children were shorter, weighed less, and also showed significantly lower value of BMD and T-score on the distal radio-ulnar and the distal end of radial bones compared to those of the normal and the moderate cerebral palsy. These parameters were not significantly different between spastic and non-spastic types of same severity of cerebral palsy. There's no difference in the level of serum osteocalcin and urine deoxypyridinoline between each group of cerebral palsy. In cerebral palsy groups, the level of serum osteocalcin remained in the normal range of the same age group of the normal, however, the urine deoxypyridinoline levels were significantly higher than those of the same age groups of the normal. No difference in either BMD or biochemical markers of bone turnover was observed in bed-ridden cerebral palsy groups regardless of anticonvulsants treatment.

Conclusion: A couple of factors accounting for lower BMD in bed-ridden cerebral palsy are as follows: 1) the increase in activity of bone resorption rather than formation, 2) the diminish of muscle use and the decrease of mechanical stresses on the bone. In addition, these results also suggest no effect of anticonvulsants on lower BMD.

Objective: The aims of this study were to know the effects of long time bed immobilization on the heart rate variability and to know the correlation between the heart rate variability and other anthropometric parameters.

Method: The subjects of this study were 60 normal sedentary persons as control group and 22 patients who had been immobilized for a long time because of musculoskeletal problems without any systemic diseases. The heart rate variabilities were measured through the R-R interval variation at rest, deep breathing and valsalva maneuver. These values were compared between control and patient group and were analysed for correlation with age, weight, height, body mass index (BMI), amounts of smoking (pack years), spans of immobilization and physical activity scale (PAS).

Results: The mean heart rate variability of patients were 0.132⁑0.072, 0.216⁑0.109, and 0.289⁑0.171 in rest, deep breathing and valsalva maneuver respectively which were lower than the corresponding 0.176⁑0.085, 0.314⁑0.146, and 0.322⁑0.174 of normal control group. The heart rate variabilities were negatively correlated with age, BMI and amounts of smoking but positively correlated with the height. The physical activity scale of preimmobilization state was negatively correlated with resting heart rate variability but was positively correlated with heart rate variability during deep breathing and valsalva maneuvering state.

Conclusion: The long bed immobilization significantly decreased the heart rate variability and the heart rate variability could be used as a useful tool to measure the effects of immobilization on the heart.

Objective: The purpose of this study is to present epidemiological data on patients with spinal cord lesion admitted to the Rehabilitation Hospital, YUCM.

Method: Review of medical records of 590 patients with spinal cord injury admitted to the Rehabilitation Hospital, YUCM from 1987 to 1996 retrospectively.

Results: 1) Sex: Males account for 79.6% of the SCI patients. 2) Age: The largest number of injuries occurs in the 20∼29 years of age group (32.5% of patients). 3) Etiology: Trauma accounts for 91.2% of all spinal cord injuries. The leading causes of traumatic spinal cord injury are traffic accidents (57.6%) and falls (26.4%). 4) Level of injury: Complete tetraplegia accounts for 20.5% of all SCI patients, incomplete tetraplegia 23.9%, complete paraplegia 38.8% and incomplete paraplegia 16.5%. In tetraplegics, incomplete injuries increased from 40% in 1987∼1991 to 56.7% in 1992∼1996. 5) Methods of bladder management: 87% of patients voids by reflex. Intermittent catheterization is practiced by 8% of patients

Conclusion: Epidemiologic data of 590 patients admitted to the Rehabilitation Hospital, YUCM, from 1987 to 1996 is presented with changes of epidemiology in each period. The patients suffered SCI from trauma, and traffic accidents and sports as causes were increasing. Female patients and incomplete injuries were also increasing. Mean duration of hospitalization decreased.

Objective: We studied the prevalence of abnormal spontaneous activities in hemiplegic upper limbs, its nature and correlation with various clinical features.

Method: Forty-seven patients with hemiplegia from various central nerve system disease within about four months from disease onset were included in the study. The patients who showed obvious clinical evidence of peripheral nerve system disease were excluded. Motor and sensory nerve conduction studies (NCS) of median and ulnar nerves in hemiplegic limbs and motor nerve conduction studies of axillary nerve in both side were done. The cases demonstrating abnormal NCS were excluded in data analysis. Needle electromyography (EMG) was done in proximal muscles (deltoid, supraspinatus, infraspinatus, biceps brachii) and distal muscles (abductor pollicis brevis, abductor digiti quinti and first dorsal interosseous). Muscle strength of shoulder abduction and mass grasp were measured by manual muscle test. Development of shoulder hand syndrome was investigated through clinical examination.

Results: Mean period from onset of hemiplegia to EMG examination was 45.2⁑23.8 days (8∼108 days). Abnormal spontaneous activities were observed in 78% of patients in one of the muscles examined and were found more frequently in distal muscles than proximal muscles. Frequency of spontaneous activities was not significantly related to the time after onset of disease during the first 4 months. Spontaneous activities were more frequently observed in distal muscles with strength of less than good or fair grade. Patients with spontaneous activities showed tendency to higher incidence of shoulder hand syndrome but there was no statistical significance.

Conclusion: Hemiplegic upper limbs showed frequent abnormal spontaneous activities without definite peripheral nerve involvement. Its unique pattern of distribution should be kept in mind when we meet hemiplegic patients in electromyographic consultation.

Objective: The purpose of this study was to examine the sensitivity and characteristics of F-wave abnormalities detected by various parameters in patients with lumbosacral radiculopathies and to evaluate the relationship of F-wave with needle EMG.

Method: The study was performed on 37 patients with lumbosacral disc herniation, which was confirmed by MRI and the patients with clinical lumbosacral radiculopathies (single lesion of L5 in 28 cases, S1 in 1 case, double lesion of L5 and S1 in 8 cases). F-waves were recorded by stimulating peroneal and tibial nerves at the ankle. Minimal latency (F min), maximal latency (F max), latency difference between F min and F max (F dif), mean duration (F dur) and side to side difference between sides in F min and F max were measured. Conventional nerve conduction study and needle EMG were also examined.

Results: The abnormal parameters of F-wave were so varied that the results could not lead any apparent conclusions as to which parameters were the most sensitive. However, F min and F dur seemed to be abnormal more frequently than F max and F dif. While the needle EMG showed abnormalities in 28 patients (75.7%), at least one of the different F-wave parameters was found to be abnormal in 18 patients (48.6%). Moreover, no significant relationship was observed between the abnormal findings of EMG and F-wave (p＞0.05).

Conclusion: The conventional needle EMG appears to be the more useful electrophysiological technique in the diagnosis of lumbosacral radiculopathies. Concerning the additional usefulness of F-wave, further study will be necessary.

Objective: To find simple screening method for assessment of patients with diabetic neuropathy by use of brief questionnaire, scored physical examination including vibration perception threshold, and mixed median conduction study.

Method: Subjects were 24 patients with diabetes mellitus. Conventional nerve conduction study was performed in 24 patients and the patients were divided into two groups: 11 patients with polyneuropathy; 13 patients of normal findings. The questionnaires were given for evaluation of sensory function in all the subjects. The questionnaires were followed by physical examination including two point discrimination, vibration perception threshold by using biothesiometer, 10 gram filament test, pin prick test, DTR check, and muscle strength test. Abnormality was determined by the number of positive responses or abnormal clinical findings. Finally, we recorded the conduction velocity and amplitude of median mixed nerve and compared these parameters to values of 20 normal adults.

Results: The questionnaire and physical exam scores were higher in patients with polyneuropathy (p＜0.01). The patients with polyneuropathy showed higher vibration perception threshold values (p＜0.01) and slower conduction velocity and smaller amplitude of median mixed nerve (p＜0.05). In correlation with conventional nerve conduction study, the median mixed nerve conduction velocity had higher kappa value than amplitude in screening for diabetic polyneuropathy.

Conclusion: We suggest the questionnaires, scored physical examination, vibration perception threshold, and median mixed nerve conduction velocity to be a simple screening method for assessment of patients with diabetic plyneuropathy.

Objective: To investigate the role of tendon reflex test in the diagnosis of diabetic peripheral neuropathy.

Method: Patellar tendon reflex (PTR) and achilles tendon reflex (ATR) were recorded in forty six diabetic patients and thirty seven normal adults by delivering tendon taps with an electric reflex hammer. Forty six diabetic patients were divided into two groups based on nerve conduction study and diabetic neuropathy score: group 1 consisted of nineteen patients with peripheral neuropathy, group 2 consisted of twenty seven patients without peripheral neuropathy. Multiple regression equations using latency as a variable dependent on age and height were used and upper crossing of the ⁢3 standard deviation level with regression on height and age was considered abnormal.

Results: Mean latencies of PTR and ATR were prolonged in the diabetic patients in comparison with the controls (p＜0.01) and were prolonged in group 1 compared to group 2. In group 1, PTR was abnormal in 14 cases (sensitivity: 73.6%, specifity: 88%) and ATR was abnormal in 13 cases (sensitivity: 68.4%, specifity: 85.1%). In group 2, PTR was abnormal in 3 cases and ATR was abnormal in 4 cases.

Conclusion: Tendon reflex test would be a valuable supplement to conventional nerve conduction studies for detection of diabetic peripheral neuropathy, especially in the proximal segment.

Objective: The purpose of this study was to establish the normal values of tendon reflexes (T-reflex) in upper extremities of normal Korean adults.

Method: T-reflex responses were recorded in 30 normal volunteers by delivering tendon taps with a hand operated electric reflex hammer. From 5 repeated trials of each subject, the shortest onset latency and duration, the largest peak to peak amplitude of compound muscle action potentials were chosen for representative values.

Results:

1) There was no significance in the side-to-side differences for all values.

2) Mean values of latency were 13.8⁑1.1 msec in males, 12.4⁑0.9 msec in females for biceps T-reflex and 13.0⁑1.1 msec in males, 11.3⁑1.0 msec in females for triceps T-reflex and there were significant differences between males and females.

3) Height and upper arm length showed a significant positive correlation with biceps and triceps T-reflex latency (p＜0.001).

Conclusion: We believe that our results can be used as a guideline researching the tendon reflexes in upper extremities.

Objective: To determine the frequency, involved nerves and sites of entrapment neuropathy in string players.

Method: The subjects were 24 string playing musicians and age matched 24 normal controls. Questionnaire, physical examination were taken in the musicians and the electrodiagnostic study was performed in both the musician and the control groups. Electrodiagnostic study included nerve conduction study of median and ulnar nerves. The distal motor latency, segmental motor conduction velocity, distal sensory latency, and amplitude of sensory nerve action potentials were measured. Each parameter of nerve conduction study was compared in two groups and was correlated to the string playing duration.

Results: Three musicians (12.5%) were diagnosed as entrapment neuropathy: One, left ulnar neuropathy at the elbow and the wrist and left median neuropathy at the wrist; Two, left ulnar neuropathy at the elbow. Ulnar motor conduction velocity of right forearm segment and left elbow segment were significantly reduced in the musicians compared to those of the controls (P＜0.05). The distal sensory latency of left ulnar nerve was significantly prolonged in musicians compared to that of the controls (P＜0.05). The string playing duration significantly correlated with the distal motor latency of right median nerve (R=0.632, P＜0.05) and the distal sensory latency of left median nerve (R=0.518, P＜0.05).

Conclusions: These results suggest that some entrapment neuropathies could be developed due to cumulative trauma in string players. Elbow and wrist segment of left ulnar nerve, forearm segment of right ulnar nerve are possible sites of entrapment neuropathy in string players.

Objective: To assess the analgesic effect of midazolam, a short acting benzodiazepine. in patients who underwent needle electromyography (EMG).

Method: A double-blind study was performed. Thirty minutes before the EMG examination, 2 tablets of midazolam (7.5 mg/T) was administered by mouth to 28 examinee in experimental group and 2 tablet of placebo to 30 examinee in control group. Level of pain was assessed by pain rating index (PRI) of McGill Pain Questionaire and Visual Analogue Scale (VAS) after EMG study. Resistance to needle EMG was evaluated immediately and 7 days after study.

Results: PRI and VAS were significantly lower in the midazolam group than the control group (P＜0.05). Resistance of patients to EMG study was also significantly lower in the experimental group (p＜0.05).

Conclusion: These results showed that pain from needle EMG could be reduced by premedication with midazolam.

Objective: This study was designed to investigate the effect of different sites of recording electrodes on auditory evoked potentials (AEPs) in healthy adults and to analyse these potentials properly.

Method: Eleven healthy adults, 7 males and 4 females, without any history of disease or conditions causing hearing difficulties were selected. AEPs were performed on these subjects with 4 different methods, i.e. different recording sites, Cz-Ai, Cz-Fpz, Ai-Ac, and Ai-Cs₇. Auditory stimulation was given by rarefaction clicks of 75dB intensity and 11.1 Hz frequency, and responses were recorded with surface electrodes.

Results: The amplitudes of peak I and V were larger with vertical recordings, that is the vertex-auricle (Cz-Ai) or vertex-7th cervical spine (Cz-Cs₇) recordings, compared to horizontal recordings of both auricle (Ai-Ac) or extracephalic electrodes. The largest amplitude ratio of peak V/I was with vertex-7th cervical spine (Cz-Cs₇) recording.

Conclusion: Changes in AEPs with respect to the sites of recording and reference electrodes are thought to be due to the vector of brain stem auditory nuclei and pathways. It might be helpful to consider these changes in the evaluation of brain stem lesions.

Objective: To obtain reference values of early potential latency and amplitude of pudendal SEP in Korean normal women and to correlate those values with height and age.

Method: Twenty-three normal female with mean age of 45.27 years were evaluated for pudendal SEP. Stimulation was applied on the dorsal aspect of the clitoris with a bar electrode. Onset, P1, N1, P2 latencies and P0-P1, P1-N1, N1-P2 amplitudes were measured and those of both sides were analyzed.

Results: The mean latency of P0, P1, N1, P2 were 29.0⁑2.83 msec, 35.5⁑2.91 msec, 45.1⁑4.10 msec, 56.3⁑5.20 msec by the right pudendal nerve, and 28.6⁑3.11 msec, 35.2⁑2.93 msec, 45.0⁑3.83 msec, 56.5⁑5.33 msec by the left pudendal nerve. The amplitude ranges of P0-P1, P1-N1, N1-P2 were 0.31∼2.45 uV, 0.11∼2.24 uV, 0.21∼2.62 uV by the right pudendal nerve, and 0.29∼2.46 uV, 0.25∼2.21 uV, 0.12∼5.07 uV by the left pudendal nerve. There was tendency of prolongation of the latency with increasing the height. There is no difference of amplitude according to the height and the age. There was no significant difference between right and left sides in mean latency and range of amplitude of pudendal nerve SEPs, and between premenopause and postmenopause.

Conclusion: Normal reference of female pudendal SEP were established. We suggest that pudendal SEP can be used as one of useful diagnostic tools for female urogenital and neurologic disease.

Objective: This study was designed to assess the influences of skin temperature and age on latency and amplitude of the sympathetic skin response (SSR).

Method: We examined the sympathetic skin responses in 77 normal subjects aged 25 to 73 years. With stimulation of both median nerve and both tibial nerve at the wrist and ankle, the SSRs were recorded from both palms and soles simulaneously. To determine the effects of skin temperature change on SSR, we examined the SSRs in 12 healthy subjects before and after heating. The heat was applied on right forearm by infra-red lamp.

Results: The mean latency and the mean amplitude of SSR with stimulation of the right median nerve at the wrist were 1.47 sec and 6.08 mV at the right palm, 1.50 sec and 6.07 mV at the left palm, 1.95 sec and 3.38 mV at right sole, and 1.95 sec and 3.09 mV at left sole. There was no side-to-side difference in the latency and the amplitude. Regardless of the site of stimulation, latency was longer at the sole than at the palm, and amplitude was greater at the palm than at the sole (p＜0.05). The latency of the SSR was positively correlated with the age of subjects (p＜0.05), and the amplitude was negatively correlated with the age of subjects (p＜0.05). At higher skin temperature, the latency of SSR was shortened and the amplitude was reduced significantly (p＜0.05).

Conclusion: The amplitude of the SSR decreases with aging and the latency increases with aging. As the skin temperature rises, the latency and amplitude show tendency to decrease. We suggest that the skin temperature and age are important factors to be considered carefully in assessing the SSR parameters.

Objective: The purpose of this study was to evaluate the most effective stimulating electrode in TENS for pain relief, and to apply to the treatment of patients with neck and shoulder problems.

Method: The objects were 30 patients with neck and shoulder problems. In 10 of them, insulated needle electrodes were inserted into a trigger point and electrical stimulation given through the electrodes. In 10 of them, non-insulated needle electrodes were applied as the same method. The others were treated with lidocaine injection into a trigger point and electrical stimulation given through the surface electrode. The effects of pain relief were assessed by visual analogue scale (VAS), pain rating score (PRS), and pain algometer.

Result: In the group with insulated needle electrode, the average score was reduced 48.33⁑24.84% in VAS score and 52.00⁑17.55% in PRS, the pressure of pain algometer was increased 34.97⁑15.33%. In non-insulated needle electrode group, reduced 43.16⁑34.62% in VAS score and 43.73⁑34.85% in PRS, the pressure was increased 22.28⁑30.62%. The score reduction of surface electrode group was 20.61⁑15.73% in VAS score and 18.22⁑16.27% in PRS, the pressure-pain threshold increased as 9.05⁑12.81%.

Conclusion: The results suggest that insulated and non-insulated needle electrodes were more effective stimulating electrode in TENS for pain relief than surface electrode.

Objective: The purpose of this study was to investigate the risk factors of adhesive capsulitis and the effect of intra-articular steroid injection in spinal cord injured patients.

Method: Fifty spinal cord injured patients participated in this study. The risk factors of adhesive capsulitis were compared between fourteen patients with adhesive capsulitis and thirty-six patients without one. Methylprednisolone acetate 40 mg mixed with 0.5% lidocaine 2 ml was given into glenohumeral joint space in adhesive capsulitis group and their pain and range of motion (ROM) were analyzed.

Results: 1) The incidence of adhesive capsulitis was higher in patients with higher injury level, older age and delayed start of rehabilitation therapy.

2) 10 cm visual analogue scale scores were significantly decreased after intra-articular steroid injection (p＜0.01).

3) The shoulder ROM was increased after intra-articular steroid injection.

The shoulder ROM at pre-injection was 126^o in flexion, 113^o in abduction, 64^o in external rotation and 51^o in internal rotation. The shoulder ROM at 4 weeks after injection was 138^o in flexion, 131^o in abduction, 74^o in external rotation and 77^o in internal rotation.

Conclusion: There was a trend that the incidence of adhesive capsulitis was higher in patients with higher injury level, older age and delayed start of rehabilitation therapy. Further, it was suggested that intra-articular steroid injection was effective for reducing pain and improving ROM.

Objective: This study was designed to evaluate the long term effect of the epidural injections with steroid and local anesthetics in the low back pain patients by assessments of Visual Analog Scale (VAS) scores and several relating factors that influence good results.

Method: Seventy two low back pain patients with or without sciatica were treated with epidural injections of weekly steroid (methylprednisolone acetate) and daily local anesthetics (lidocaine and bupivacaine) for 2 weeks via an epidural catheter. The efficacy of the epidural injections was assessed with Visual Analog Scale (VAS) score at the day of admission (VAS1), discharge (VAS2) and during the long term follow up period (VAS3)(mean：14 months, 8∼24 months).

Results: VAS1, VAS2 and VAS3 were 6.22⁑2.03, 3.36⁑1.49, and 3.39⁑1.45 respectively. VAS2 and VAS3 were significantly different with VAS1 (p＜0.05).

Conclusion: Epidural injections of steroid and local anesthetics are effective not only in the short term period, but also in the long term peroid for patients with low back pain with or without sciatica

Objective: To investigate the biomechanic influence of body weight unloading on the hemiplegic gait and to provide database for producing optimal strategies of gait training through body weight unloading (BWU) in hemiplegic patients

Method: We evaluated dynamic electromyographic data, temporal parameters of gait, and energy consumption in 20 hemiplegic patients walking on a treadmill with 0%, 10%, 20%, 30% and 40% of their BWU at their comfortable walking speed.

Results: 1) Stance phase and double limb support phase significantly decreased, and swing phase and single limb support phase increased according to BWU.

2) Asymmetricity of temporal parameters of gait improved according to BWU.

3) O₂ rate, O₂ cost, O₂ pulse and heart rate significantly decreased with increasing BWU.

4) Muscular activities of rectus femoris, vastus medialis and biceps femoris decreased at initial contact and first half of stance phase and activities of medial gastrocnemius significantly decreased during entire stance phase with increasing BWU.

Conclusion: BWU during treadmill locomotion would be advantageous as a therapeutic approach to retrain gait in hemiplegic patients.

Objective: The purpose of this study is to analyze the distribution of plantar pressure in six balletpositions and to compare those between the skilled and unskilled ballet dancers.

Methods: Thirty eight feet of healthy ballerina were evaluated by EMED-SF (Novel GMBH Inc. Ger.) system to analyze six positions of ballet. At each position, we estimated the static and dynamic positions. The forefoot was divided into 6 different zones on the basis of head of metatarsal bones. The degree of discipline was assessed by 3 expert ballerina.

Results: In each position, there were significant peak pressure distribution areas. In the skilled ballerina, there was less difference in peak pressure between the static and dynamic positions in comparision with the unskilled ballerina. In the skilled ballerina, more forces are distributed to M6 area in releve position and to M3 and M6 areas in turnout positions.

Conclusion: Six basic ballet positions could be analyzed by plantar pressure measurement. There were some differences in the distribution of planter pressure in some ballet positions between the skilled and unskilled ballet dancers.

Objective: To study the acromial type, acromial angle, acromial tilt and subacromial distances which known as extrinsic factors of subacromial impingement syndrome in groups of subacromial impingement syndrome and normal control.

Method: The radiography of shoulder named shoulder series composed of AP view, arch view and impingement view was performed in thirty patients with subacromial impingement syndrome and ninety persons with normal adult and we measured the acromial type, acromial angle, acromial tilt, subacromial distances and subacromial spur.

Results: Mean subacromial distances of impingement group were 11.3⁑2.4 mm in AP view, 11.1⁑2.5 mm in arch view and those of normal control group were 11.1⁑2.2 mm in AP view, 10.4⁑1.9 mm in arch view. Incidences of acromial type I,II,III in impingement group were 15 (50%), 10 (33.3%), 5 (16.7%) respectively and those in normal control group were 20 (22.2%), 46 (51.1%), 24 (26.7%) respectively. Incidence of subacromial spur was 19 (63.3%) in impingement group and 52 (57.8%) in normal control group.

Mean subacromial spur size was 10.0⁑5.4 mm in impingement group and 12.4⁑4.5 mm in normal control group. Mean acromial angle was 27.1⁑8.3 degree in impingement group and 29.1⁑8.7 degree in normal control group. Mean acromial tilt was 28.0⁑6.39 degree in impingement group and 31.8⁑3.4 degree in normal control group.

Conclusion: No significant statistical difference between subacromial impingement syndrome group and normal control group in acromial type, acromial angle, acromial tilt and subacromial distance known as extinsic factors of subacromial impingement syndrome

Objective: The purposes of this study were to evaluate the causes of intoeing gait and to investigate the association between femoral anteversion and tibial torsion.

Methods: The subjects were 23 children with intoeing gait. The association between increased femoral anteversion and external torsion of the tibia was investigated by computed tomography and 3-dimensional computed tomography. The tibial torsion angle was measured by computed tomography. Femoral anteversion angle was measured by computed tomography and 3-dimensional computed tomography.

Results: The intoeing gait was caused by increased femoral anteversion in 67.4% of the cases, by internal tibial torsion in 21.7% and by other factors in 10.9%. There was a clear correlation between the degree of femoral anteversion and the degree of external torsion of the tibia.

Conclusion: The results of this study indicate that most common cause of intoeing gait is increased femoral anteversion and that in cases of increased femoral anteversion, compensatory external torsion of the tibia develops during growth.

Objective: To evaluate the effectiveness of nonsurgical treatment and to evaluate the usefulness of ultrasonographic assessment in postburn hypertrophic scar.

Methods: The subjects were twenty-seven burn patients with hypertrophic scar. Hypertrophic scars were treated by four different methods: triamcinolone acetonide injection (Group I), pressure garment application (Group II), combination treatment of triamcinolone acetonide and garment (Group III) and no treatment (Group IV). To assess the effectiveness of each treatment method, ultrasonographic measurement of scar thickness and punch biopsy of scar were done before and after treatment.

Results: After 4 weeks treatment, the scar thickness decreased by 14.9⁑9.4% in Group I, 4.7⁑8.4% in Group II and 20.5⁑13.2% in Group III. However the scar thickness increased by 10.0⁑13.5% in Group IV (no treatment). The pathologic findings didn't show significant change.

Conclusion: The TA solution injection therapy and pressure garment therapy were effective methods for the treatment of the postburn hypertrophic scar, but the combinations of both therapies was more effective than each single therapy. The ultrasonography can be used as objective measure to assess effectiveness of therapy.

Objective: To determine the usefulness of Jebsen hand function test in rheumatoid arthritis patients

Method: The experimental subjects were divided into 3 groups (Group 1：17 persons; control, Group 2：21 persons; RA without hand deformity, Group 3：16 persons; RA with hand deformity). They were assessed by Jebsen hand function test. Further included assessments were grip and pinch strength, joint deformity counts, and visual analogue scales.

Results: Jebsen hand function test scores were significantly decreased in rheumatoid arthritis patients compared with control. Jebsen hand function test scores were well correlated with visual analogue scales in group 2 and correlated with joint deformity counts in group 3.

Conclusions: Jebsen hand function test would be useful tool for the evaluation of hand function in the rheumatoid arthritis patients with hand deformity.

Objective: Poor head and neck support during sleep can exacerbate the neck pain. Based on the ideal sleep posture and pillow suggested by Cyriax, we designed a new cervical pillow and compared the degree of pain reduction, quality of sleep and pillow satisfaction with a low hospital pillow and a high pillow.

Method: The newly designed pillow has a built-in pressure-adjustable air bag in the cervical area and provides normal cervical lordotic curve in supine position and maintains cervical and thoracic vertebrae to form a horizontal line in side-lying position. Thiry-four patients with cervical pain used low hospital pillows for the first week of 3-week randomized crossover design study. They were subsequently randomly assigned to use each of the other two pillows for 1-week period. Outcomes were measured using visual analog scale, sleep questionnaire and a pillow satisfaction scale.

Result: Compared with the other 2 types of pillows, subjects using the newly designed pillow showed much reduced pain intensity, increased duration of sleep and sleep quality and better pillow satisfaction.

Conclustion: We designed a cervical pillow with built-in pressure adjustable air bag and it can significantly reduce pain intensity and improve quality of sleep in patients with cervical pain.