Objective: The objective of this study is to evaluate the effect of therapeutic cold on the recovery process after an incomplete muscle strain injury.

Method: We made incomplete muscle strain injuries with the predefined extent. Unilateral tibialis anterior (TA) tendons were detached at their distal insertions and stretched beyond the complete rupture points. The incomplete strain injury point was identified on the deformation- tension curve. We strained each TA of 18 rabbits to 20% deformation point and held for 2 seconds. After injury, we applied ice packs for 5 minutes on unilateral TA. Histologic findings were examined at 1, 2 days, 2, 4, 5 weeks.

Results: Incomplete strain injuries were occurred at 19.36⁑4.02% deformation. In the acute phase, cold applied TA showed fewer (15.4⁑4.2) inflammatory cells infiltration than control TA (21.8⁑5.3) at LPF (×40). But, there was no significant difference between cold applied TA and control in the recovery phase.

Conclusion: It is possible to develop certain amount of incomplete muscle strain injuries. The results of this study suggest that the cold therapy may reduce the inflammatory reaction in the acute phase of muscle strain injury. The findings provide no significant support for the positive or negative effect of cold therapy on incomplete strain injury.

Objective: This study was designed to evaluate the effect of growth hormone on bone mineral density of corticosteoid-induced osteoporosis in male rat.

Method: Twenty Sprague-Dwaley male rats was studied, divided into four group, each group has 5 rats. The group 1 was treated with saline. The group 2 was treated with corticosteroid (Methylprednisolone 10 mg/kg). The group 3 was treated with corticosteroid and growth hormone (recombinant human growth hormone 0.5 IU/kg). The group 4 was treated with growth hormone after corticosteroid treatment. The treatment duration was 6 weeks for each group. After six weeks of hormone administration, the animals were sacrificed, the bilateral femur were removed and tested for bone mineral density using dual energy X-ray absorptiometry and examined histomorphometrically.

Results: Administration of growth hormone after corticosteroid therapy, the growth hormone could reverse the decrease in body weight and bone mineral density induced by corticosteroid therapy (p＜0.05).

Conclusion: When growth hormone is administrated after corticosteroid therapy, the growth hormone can protect the osteoporosis in male rats induced by a high dose of corticosteroid.

Objective: To identify the neurobehavioral impairment in the traumatic brain injured (TBI) patients and to determine the relationship between the neurobehavioral impairment and functional recovery.

Method: We analyzed and compared Functional Independence Measure (FIM) scores and neurobehavioral psychometry results in 16 patients with severe TBI. The neurobehavioral psychometry tests included Minimental Status Examination (MMSE), Galvestone Orientation and Amnesia Test (GOAT) as screening tools, Korean Wechsler Intelligence Scale (KWIS) for intelligence, Wechsler Memory Scale-Revised (WMS-R) test for memory function, Color Trail test (CTT) 1 and 2 for attention and concentration, Grooved Pegboard Test (GPT) and Finger Tapping Test (FTT) for motor function, Wisconsin Card Sorting Test (WCST) for executive function, and Symptom Checklist-90-Revision (SCL-90-R) for personality.

Results: At discharge, neurobehavioral psychometry of the TBI patients showed impairment of the attention and concentration as demonstrated by severe and moderate impairment in CTT 1 and CTT 2, repectively. Memory disturbance was also noted by the result of mental retardation in WMS-R. But GOAT and MMSE showed normal, KWIS was below average. Motor dysfunction was seen in GPT and FTT and mild executive dysfunction in WCST. Functional recuperation was influenced by attention and concentration, as the FIM score has significant correlation with CTT 1 and FTT.

Conclusion: The TBI patients have the pervasive neurobehavioral impairment, especially severe dysfunction in the memory, attention and concentration. And functional recovery was significantly correlated with attention. The neurobehavioral psychometry will be useful in neurobehavioral evaluation in TBI patients. A further prospective study using Neurobehavioral psychometry would bring a more precise and valuable information.

Objective: To assess the incidence of tracheal aspiration in the brain injury patients with laryngeal penetration, and to investigate the relationship between the type of laryngeal penetration and the severity of tracheal aspiration.

Method: One hundred videofluoroscopic swallowing tests in brain injury patients who showed laryngeal penetration were analyzed retrospectively. Laryngeal penetrations were classified into three groups: anterior, posterior and both. The incidence of the tracheal aspiration among the laryngeal penetration was evaluated. The severity of the tracheal aspiration was analyzed into the three groups: mild, moderate and severe. Each type of the laryngeal penetration were compared with the severity of the tracheal aspiration.

Results: Seventy-one patients showed the tracheal aspiration among the 100 patients with laryngeal penetration. The incidence of tracheal aspiration according to the type of the laryngeal penetration was 100% in both, 86.8% in posterior, and 50.9% in anterior type. The more severe tracheal aspiration was associated with the higher proportion of the posterior and both types.

Conclusion: The incidence of tracheal aspiration in laryngeal penetration was 71%. More severe tracheal aspiration occurred with both & posterior laryngeal penetration than anterior type.

Objective: To investigate the frequency and nature of dysphagia of traumatic brain injured (TBI) patients, and to examine the relationship of clinical parameters with the dysphagia.

Method: Forty-two TBI patients were included in this study. We examined clinical parameters such as Glasgow coma scale (GCS), duration of coma, and posttraumatic amnesia (PTA), hospital stay, rehabilitation stay, functional independence measure (FIM) gain, and efficiency as functional outcomes. We classified the brain lesions into two categories: focal and nonfocal lesion according to the findings of the brain CT imaging. We performed videofluoroscopic swallowing study (VSS) for patients with dysphagia.

Results: Eighteen (42.8%) out of total 42 TBI patients had dysphagia. The presence of dysphagia had significant relationship with GCS, duration of PTA, hospital and rehabilitation stay, and FIM gain. Duration of dysphagia was positively correlated with duration of coma, and hospital and rehabilitation stay, but negatively correlated with FIM gain and efficiency. Duration of dysphagia was longer in patients with nonfocal brain lesion than those with focal brain lesion. On VSS findings, common problems were impairment of tongue control and prolonged pharyngeal transit time. Majority of patients had combined problems in oral and pharyngeal phases.

Conclusion: Dysphagia was common problem in TBI patients, and occurrence and duration were correlated with several clinical parameters and with prognosis of TBI patients.

Objective: Rising from a sitting position is a very common, yet essential activity in daily life. The activity to perform the sit-to-stand (STS) transfer is a prerequisite for upright mobility. This study aims to provide fundamental data concerning the execution of the STS, and in particularly the followings: 1) how do the angles of the lower limbs change throughout the process of rising from a chair; 2) how much motion torque and power in each joint are required per kilogram of body weight to complete the STS transfer?

Method: Twenty-one children who have developed normally and could understand the command requested are involved as subjects. Their age ranged from 3 to 5 years old. Motion analysis of STS transfer were assessed with the Vicon 370 M.A (Oxford Metrics Limited, United Kingdom). The changes in joint angle, maximal moment and power in lower limb were calculated throughout the STS transfer.

Results: A series of transition points was observed in the angles of the hip, knee and ankle joints throughout the sit-to-stand movements, which was classified into five stages. The first stage is trunk and hip flexion phase; second stage, buttock take-off; third stage, ankle dorsiflexion and knee extension; forth stage, just-standing; fifth stage, stabilizing phase. The extension moment of each joint is 0.65 Nm/kg on right, 0.71 Nm/kg on left in hip, 0.41 Nm/kg on right, 0.38 Nm/kg on left in knee and 0.21 Nm/kg on right, 0.22 Nm/kg on left in ankle joint. The extension power is 0.60 watt/kg on right, 0.68 watt/kg on left in hip, 0.59 watt/kg on right, 0.50 watt/kg on left in knee and 0.15 watt/kg on right, 0.15 watt/kg on left in ankle joint.

Conclusion: A consistent pattern was observed throughout the sit-to-stand transfer and six transition points were observed in the angles of the hip, knee and ankle joints throughout the STS transfer. By these 6 points, the movement of the STS transfer was classified into 5 stages. Major changes in angle, moment, and power of each joint were observed in sagittal plane. There were no side to side difference during the STS transfer.

Objective: To evaluate the changes of the respiratory patterns associated with swallowing in athetoid cerebral palsied patients (CP), and to understand its relationship with their dysphagia and aspiration.

Method: Seven adult athetoid CP and seven control subjects were selected for this study. Each subject performed swallowing tasks in upright sitting position, and submental electromyography and respirography by pneumobelt on mid-abdomen were recorded simultaneously. Swallowing tasks were composed of swallowing 5 cc, 75 cc of water, and chewing a cookie. And athetoid subjects performed videofluoroscopic swallowing study (VFSS) for each food texture.

Results: 1) In athetoid CP, respiratory patterns during swallowing were variable and more irregular than the resting tidal breathing. 2) In athetoid CP, completion time of the swallowing task and recovery time to the resting tidal breathing after swallow were significantly prolonged (p＜0.01). 4) Athetoid subjects had significantly higher rate of postdeglutitive inspiration than that of the controls (p＜0.01). 5) In correlation with the VFSS findings, aspirated group of the athetoid subjects had significantly higher rate of postdeglutitive inspiration than that of non-aspirated group (p＜0.05).

Conclusion: Respiratory-swallowing coordination was disrupted in the athtoid CP, and their higher rate of postdeglutitive inspiration suggested the higher risk for aspiration of the food materials, especially in drinking of large amounts of liquid.

Objective: To observe the prognostic value of brainstem auditory evoked potentials (BAEP) for prediction of cerebral palsy (CP) in the high-risk neonates.

Method: Eighty-one high-risk neonates were subjected to take the history of illness, neurological examination, developmental assessment, BAEP study within one month after birth. They had been checked for detection and management of the CP in period of 12 to 56 months after birth. Associating factors were observed about their gestational age at birth, 1-minute Apgar score, history of asphyxia and/or intubation, and hyperbilirubinemia and/or exchange transfusion.

Results: Abnormal BAEP findings were seen in 38 of 81 (46.9%) high-risk neonates and 6 of 81 (7.4%) were diagnosed as a CP. Five of 6 CPs and 42 of 75 non-CPs had been abnormal in BAEP study. Neonatal BAEP study showed 83.3% sensitivity, 44% specificity, 98.4% false positive and 2.9% false negative in predicting CP. Asphyxia showed high correlation with abnormality of BAEP and CP (p＜0.01). Gestational age, low birth weight, toxemia, germinal matrix hemorrhage (GMH) grade II and intubation were correlated with CP (p＜0.05) but not with the abnormality of BAEP.

Conclusion: It is suggested that BAEP study of high-risk neonate is useful in prediction of CP because of low false negative and high sensitivity.

Objective: It was reported that nocturnal polyuria in cervical cord injured patients may be due to attenuation of diurnal variation of antidiuretic hormone (ADH) level. However, it has been unclear whether the attenuation of diurnal variation of ADH level caused nocturnal polyuria and bladder overdistension. To improve the management of neurogenic bladder with overdistension during the night, we investigated whether the attenuation of diurnal variation of ADH level is the cause of nocturnal polyuria or bladder overdistens-ion in patients with cervical cord injury.

Method: The subjects consisted of 17 patients with cervical cord injury. The age distribution ranged from 31 to 63 years with an average of 41.5 years. The duration of illness ranged from 5 months to 4 years. Oral intake was restricted below 2,000 ml per day. We measured urine volume and urine osmolarity during the day (8 AM∼8 PM) and night period (8 PM∼8 AM) and the level of plasma ADH and serum osmolarity at 2 PM and 2 AM.

Results: Plasma ADH level was 0.81⁑0.51 pg/ml during the day and 1.04⁑0.65 pg/ml during the night (p=0.17). Urine volume was 1050⁑410 ml during the day and 970⁑550 ml during the night (p=0.92). The average of urine osmolarity was 450.4⁑182.8 mosm during the day and 558.4⁑359 mosm during the night (p=0.25). The average of serum osmolarity was 292.4⁑14.5 mosm during the day and 290.4⁑9.3 mosm during the night (p=0.53).

Conclusion: This study showed that there was no significant difference in each parameter for two periods and urine volume was not increased in spite of attenuation of diurnal variation of ADH level. Therefore this indicated that attenuation of diurnal varia-tion of ADH was less likely responsible for nocturnal polyuria in patients with cervical cord injury.

Objective: To investigate the changes of cerebral and cardiovascular hemodynamics in response to postural change in tetraplegics after cervical spinal cord injury.

Method: We studied 5 healthy volunteers and 14 cervical cord injured patients with orthostatic hypotension. We continuously monitored heart rate (HR), blood pressure (BP) by volume clamp photoplethysmography, and cerebral blood flow velocity (BFV), pulsatility index (PI) of middle cerebral artery (MCA) by transcranial Doppler sonography at rest and during head-up-tilt (HUT). Tilt table set at 30^o initially and then increased gradually 10^o every 5 minutes up to 80^o.

Results: In the control group, BP and BFV of MCA remained unchanged during HUT. Although a decrease of BFV observed in all patients during both systolic and diastolic phases, the degree of BFV drop during diastolic phase, especially early diastolic phase was much greater than that during systolic phase. The change of BFV of MCA was significantly correlated with that of systemic hemodynamic parameters, especially systolic BP. After rehabilitative therapy for one month, there was no definite evidence of the change in cerebral autoregulation.

Conclusion: This study suggests that we can use systemic hemodynamic parameters for predicting changes of cerebral blood flow in response to orthostatic hypotension, but we fail to observe any compensatory mechanism of cerebrovascular system to maintain cerebral blood flow against systemic hemodynamic collapse.

Objective: To evaluate the effect of different kind of abdominal corsets on pulmonary function and energy consumption in the patients with cervical spinal cord injury.

Method: Five subjects with quadriplegia due to cervical spinal cord injury were enrolled. A quantitative evaluation of vital capacity, tidal volume, and oxygen consumption was done using K4b² (COSMED, Italy) under following six conditions; 1) supine position without abdominal corset, 2) sitting position without abdominal corset, 3) supine position with non-elastic abdominal corset, 4) sitting position with non-elastic abdominal corset, 5) supine position with elastic abdominal corset, 6) sitting position with elastic abdominal corset. Wilcoxon signed-rank test was applied for statistical assessment of group difference.

Results: Vital capacity and tidal volume in the condition with elastic abdominal corset were significantly increased than those of the condition without corset (p＜0.05) or of the condition with non-elastic corset (p＜0.01) in both sitting and supine position. Vital capacity and tidal volume in the condition with non-elastic abdominal corset were significantly decreased than those of the condition without corset (p＜0.05) in both sitting and supine position. Oxygen consumption was least in the condition with elastic abdominal corset (p＜0.05).

Conclusion: These results demonstrated that the elastic abdominal corset is beneficial in improving the efficiency of breathing for the patients with cervical spinal cord injury. However, non-elastic abdominal corset is harmful to these patients.

Objective: To study the erectile response to intracavernosal injection of prostaglandin E1 in 33 spinal cord injured men with neurogenic erectile dysfunction.

Method: The erectile response was assessed by the penile palpation. Thirty three subjects (mean age, 35.5 years) were studied. They received a testing dosage starting from 2.5 μg with increasing dosage (maximum 40 μg) to achieve an erection. The positive response accounts for the sufficient erection lasting for more than 30 minutes.

Results: After the injection, 30 subjects (90.9%) achieved the positive response and the mean duration of erection was 59.2 minutes. Of the 30 positive responders, the mean dosage needed to induce positive response was 5.8 μg in the patients with cervical cord injury (12 subjects), 13.1 μg in the patients with thoracic cord injury (12 subjects), and 33.3 μg in the patients with lumbar cord injury (6 subjects). The mean dosage required for the positive response was different according to the pre-injection erectile function of the subjects. For the positive response, it required 7.7 μg in a full erection with short duration group (14 subjects), 9.4 μg in a partial erection group (8 subjects), and 30.6 μg in no erection group (8 subjects). No systemic side effect or complication was noted except for the prolonged erection in 1 subject.

Conclusion: The intracavernosal injection of prostaglandin E1 appears to be a safe and effective treatment for the treatment of erectile dysfunction in spinal cord injured men. The dosage depends on the level of spinal cord injury and pre-injection erectile function.

Objective: The study was designed to document the effects of regular drainage after penile vibrator stimulation on the quality of semen in spinal cord injured (SCI) men.

Method: Three tetraplegics and eight paraplegics, aging from 20 to 39 years with neurological levels of C7 to L4 were examined between 1 and 11 years after injury (mean; 4 years 11 months). None had ejaculated after the injury. Eleven responders to penile vibrator stimulation (PVS) were prospectively examined. We used a vibrator (POWER MASSAGER^Ⱂ) with a frequency of 100 Hz and an amplitude of about 2.0 mm. Stimulations were performed mostly 2∼3 times per week. Semen quality was characterized by semen analysis every visits. We compared baseline values with the values of post-treatment 1∼3 months.

Results: The percentage of motile sperm and the total count of motile sperm per ejaculate were low but increased substantially with treatment.

Conclusion: We concluded that repeated ejaculation treatment, for at least 1 month, using the vibrator technique improves semen quality in SCI men who have not ejaculated earlier after injury.

Objective: The purposes of this study were to compare the quality of semen obtained by vibratory and electrical stimulation according to the injury level and to investigate the changes of semen by repeated ejaculations in spinal cord injured patients.

Method: Seventeen spinal cord injured men had repeated ejaculations at least three times with vibratory (Ferticare^®) and electrical stimulation (Seager^®) at weekly interval.

Results: In patients with lesions above the T10 level, the response rate was 91.7% by the vibratory stimulation and 100.0% by the electrical stimulation. The percentage of adequate sperm quality (total count of motile sperm ≥ 5⁓10⁵) was 81.8% by the vibratory stimulation and 66.7% by the electrical stimulation. In patients with lesions at and below the T10 level, all patients responded to the electrical stimulation, but not to the vibratory stimulation. The percentage of adequate sperm quality was 82.6% by the electrical stimulation. The quality of semen obtained by the vibratory stimulation was better than that of the electrical stimulation (p＜0.05). Sperm quality didn't improve through the repeated ejaculations.

Conclusion: The vibratory ejaculation may be more effective in obtaining the adequate sperm quality in patients with lesions above the T10 level. However, the electrical stimulation may be more effective in patients with lesions at and below the T10 level. Repeated ejaculations for a short period may be ineffective for a sperm quality improvement.

Objective: To know the category, incidence, severity and clinical correlation, we evaluate the patient with neuropathy due to electrical burn on the basis of the electrodiagnostic findings and clinical feature.

Method: We reviewed the electrodiagnostic findings of 30 patients who had been referred for the evaluation of the neuromuscular symptoms due to electrical burn. The clinical factors such as the input and output of the electrical current, current pathway, associated injury, neuromuscular symptoms and signs were investigated by the chart review and phone interview.

Results: 1) The 67% of the cases had the peripheral neuropathy and the 40% had the central nervous system lesion. 2) The median nerve was the most frequent injured nerve by electrical burn and then ulnar nerve was the next. 3) The 82% of the mononeuropathies were related to the entrance site of the electricity and the 35% were related to the exit site. 4) The central nervous system lesion was highly correlated with the current pathway through the head.

Conclusion: The mononeuropathy, one of the peripheral neuropathies is closely related to the entrance and exit site of electrical injury. The central nervous system lesion was highly related to the current pathway through the head.

Objective: To show the prevalence of the dorsomedial cutaneous nerve (DMCN) injury in the hallux valgus and to evaluate whether the sensory nerve damage contributes to pain and sensory impairment in the great toe.

Method: Sixty feet of healthy adults (normal group) and 26 feet of patients with hallux valgus (hallux valgus group) were evaluated with sensory nerve conduction study of DMCN. The prevalence of the nerve injury was compared between the two groups. Sensory nerve action potentials of DMCN in hallux valgus feet were analyzed and compared according to the patient's symptom and the severity of the radiographic measurements of the feet.

Results: The prevalence of DMCN injury was 42.3% of the hallux valgus group. The peak latency of the DMCN sensory action potential of the symptomatic feet showed statistically significant delay compared to the asymptomatic group (p＜0.05). Delay of the peak latency and decrement of the amplitude of the DMCN were statistically significant among the three groups as the valgus deformity worsened (p＜0.05).

Conclusion: DMCN injury should be considered in addition to soft tissue injury or arthritis in the differential diagnosis of the pain, burning sensation or numbness associated with hallux valgus.

Objective: To observe the change of sympathetic skin response (SSR) before and after sympathectomy in patients with idiopathic palmar hyperhidrosis and to find the usefulness of SSR for assessment of the effects of sympathectomy

Method: The SSR was measured in 20 patients with palmar hyperhidrosis and 20 normal control group. Ten days after thoracoscopic sympathectomy, SSR was also measured. A 50∼150 V stimulus was applied over the median nerve and SSR was recorded on bilateral palms and soles with Viking IV (Nicolet Biomedical Ins., U.S.A.). Patient's satisfaction with operation was assessed by questionnaire.

Results: Absent or unstable SSR recordings rate was increased and amplitudes of SSR were significantly decreased in patients with palmar hyperhidrosis compared with control group. After sympathectomy, SSR was absent in all cases on bilateral palms and these results were correlated with clinical improvment. All patients who had undergone surgery showed significant clinical improvement for palmar hyperhidrosis and about 75% of the cases were found to have compensatory sweating from other site of the body.

Conclusion: Abnormal sympathetic nerve system responses were observed in patients with palmar hyperhidrosis. SSR recordings and clinical manifestations were influenced by sysmpathectomy.

Objective: To determine the normal variations of end level of the dural sac in Korean subjects by magnetic resonance imaging (MRI).

Method: The corresponding vertebral level of termination of the dural sac was evaluated by MRIs in two hundred adult Koreans (118 males, 82 females). We excluded the subjects with spine fracture, significant spinal deformity or spinal stenosis. End level of the dural sac was described in terms of their corresponding vertebral level. The vertebral levels were further divided into upper, middle, lower level, and intervertebral disc levels from the L5 to S3 vertebra.

Results: The most frequent end level of the dural sac was at the S1-S2 intervertebral disc level (22.5%) which was followed by the upper portion of S2 (21.5%) and the middle portion of S2 (17.0%). There was no significant difference in end level of the dural sac between male and female subjects.

Conclusion: The dural sac most frequently ended at the S1-S2 intervertebral level and the end level of dural sac were located from the L5-S1 intervertebral level to the mid-point of S3. In a clinical setting, variable levels of the dural sac termination should be considered in an unexpected dural puncture during a caudal anesthesia or injection.

Objective: To measure lumbar multifidus muscles by ultrasonography and to study its correlation with the isometric peak touque of back.

Method: Bilateral L5 and S1 multifidus muscle sizes of 18 healthy volunteers were measured in prone position by ultrasonography with 7.5 MHz, 40 mm-length probe. Multifidus muscles were identified using anatomic landmark-spinous process and lamina and vertical and horizontal diameter were measured. Boundary of muscle was traced and cross sectional area was measured.

Lumbar spinal range of motion (ROM) and isometric peak torque of three axes-flexion/ extension, rotation and lateral flexion-were measured by Isostation B-200^R back muscle tester.

Results: Multifidus muscle cross sectional areas were well correlated with isometric peak torque in all direction of movements. Muscle size and lumbar spine ROM showed no correlation.

Conclusion: Ultrasonographic measure of lumbar multifidus muscles could be a useful tool to estimate back muscle function.

Objective: The purpose of this study was to evaluate hemodynamics for diabetes mellitus (DM) by transcranial Doppler sonography (TCD) and to evaluate the influences of risk factors to cerebral hemodynamics in DM.

Method: We examined 54 normal persons, 17 patients with DM without risk factors, and 15 patients with DM and risk factors. The risk factors were hypertension, smoking, and hyper lipidemia (total cholesterol ＞240 mg/dl, low density lipoprotein ＞160 mg/dl). Mean blood flow velocity (MBFV) was also analyzed by Angiodine 2 Doppler system operating at 2 MHz frequency from each subjects.

Results: There was a significant decrease of MBFV in the diabetes in comparison to control groups (p＜0.05). There was a significant decrease of MBFV in the diabetic risk group as compared to diabetic non-risk group (p＜0.05). There was significantly increased total cholesterol, low density lipoprotein, low density lipoprotein/high density lipoprotein ratio in the diabetic risk group as compared to diabetic non-risk group (p＜0.05). MBFV significantly decreased with increasing concentration of HbA1C and duration of DM (p＜0.05).

Conclusion: We suggest that transcranial Doppler sonography can be used as one of the useful screening tests for early detection of cerebrovascular diseases in DM.

Objective: To investigate the clinical usefulness of scintigraphy for the evaluation of dysphagia in patients with brain lesion and to clarify the most useful quantitative parameter for detection of aspiration using scintigraphy.

Method: For 42 patients with dysphagia, swallowing evaluations were done by videofluoroscopy and scintigraphy. According to videofluoroscopic findings these patients were grouped into three; aspiration, laryngeal penetration and no penetration group. Quantitative parameters from scintigraphy were measured and compared among three patients groups and normal control; these parameters were oral discharge time (ODT), pharyngeal transit time (PTT), oral residue (OR), pharyngeal residue (PR), pharyngeal swallowing efficiency (PSE) and oro-pharyngeal swallowing efficiency (OPSE). Sensitivity and specificity of these parameters detecting aspiration were also evaluated according to the videofluoroscopic findings.

Results: In aspiration group ODT, PTT, PSE and OPSE were 1.18⁑1.14 sec, 1.80⁑1.49 sec, 86.05⁑61.42%/sec and 38.21⁑28.65%/sec respectively, all of which were significantly different from the other groups, but OR and PR were not different statistically. According to the ROC (Relative Operating Characteristic) table, sensitivity and specificity of OPSE were 72.7 and 80.7% respectively, which were the highest among the parameters.

Conclusion: Scintigraphy was useful to quantitative dysphagia in patients with brain lesion. Sensitivity and specificity of swallowing efficiency was higher than time and residue parameters. OPSE was considered to be the most useful quantitative parameter for detecting aspiration.

Objective: To observe changes in reflex threshold and gain in spastic muscles and to find useful parameters in biomechanical assessment of spasticity.

Method: Ankle plantar flexor muscles of twenty two hemiplegic patients were stretched by isokinetic dynamometer. Stretching was done at the velocities of 10^o/sec, 300^o/sec, and at the threshold velocity (e.g. lowest velocity at which electromyographic evidence of stretch reflex was recorded). Peak eccentric torque, torque at joint angle of 20^o, torque threshold angle, and stiffness index were measured.

Results: Peak eccentric torque and stiffness index were increased and torque threshold angle was decreased in hemiplegic side. Peak eccentric torque and stiffness index were increased at 300^o/sec compared to 10^o/sec. Stiffness index showed significant correlation with modified Ashworth scale at 300^o/sec and threshold velocity.

Conclusion: Both reflex threshold and reflex gain were changed in spastic muscles. Stiffness index was thought to be one of useful parameters in biomechanical assessment of spasticity.

Objective: The purpose of this study was to evaluate the difference for each variable on plain radiologic study of the foot between weighted and non-weighted routine plain anterior-posterior and lateral views in flatfoot children diagnosed by Harris mat footprint.

Method: Both feet of thirty-four children over two-year old, who had been diagnosed as flatfooted by modified Rose' classification using Harris mat footprint were included. We studied plain roentgenogram images, including anterior-posterior and lateral views, in both standing (weighted) and sitting (non weighted) position of the feet of the patients. We measured the following variables; arch height (AH), calcaneal pitch (CP), talocalcaneal angles from lateral view (TCALA) and anterior-posterior view (TCAAP), talo-first metatarsal angles from the lateral (TFML) and anterior-posterior view (TFMA).

Results: Each variable revealed no significant difference between boys and girls (p＞0.05); neither was there any significant difference noted in each parameter between the right and left feet (p＞0.05). All the variables of plain foot roentgenogram on weighted state were significantly different from the data of non-weighted state, except TCAAP (p＜0.05). CP was the only parameter which showed significant difference according to severity of flatfoot by modified Rose'classification.

Conclusion: Because most of the flatfoot in childhood is hypermobile type, it is necessary to take plain radiologic studies of the feet both in weighted and non weighted state and to compare both data of each variable. In addition, it is prefer to use plain radiologic study of foot both in weighted and non weighted state with footprint as the screening method of pediatric flatfoot lesions.

Objective: To obtain a effect of intraarticular injection of Sodium Hyaluronate in the patient with degenerative osteoarthritis without restriction of activities of daily living.

Method: Twenty-five patients were participated in this study. These patients are diagnosed as degenerative osteoarthritis by clinical symtoms and radiographic findings. Sodium hyaluronate, 2.5 ml, 3 mg/ampule, were injected intraarticulary without local anesthesia once a week for 5 times consecutively. For evaluation of the effectiveness of sodium hyaluronate, we assess the parameters for subjective and objective symtoms scored from 0 to 3 on 3 items, and for activities of daily living scored from 0 to 4 on 4 items. And then, we compared these data between pre-injection and at post-injection 2, 4, and 5 weeks. Changes of subjective and objective symtoms, and activities of daily living are assessed using Kellgren's X-ray grading of degenerative osteoarthritis. Improvement of the subjective pain is recorded by visual analogue scale.

Results: 1. Subjective and objective symtoms, and activities of daily living with time progression were significantly increased at post-injection 4, 5 weeks compared with pre-injection status (P＜0.05). 2. Subjective and objective symtoms, and activities of daily living according to Kellgren's X-ray classification were significantly increased at stage II and III (P＜0.05). 3. Visual analogue scale is significantly decreased after injection (P＜0.05).

Conclusion: Intraarticular injection of sodium hyaluronate showed improvement of patient's subjective and objective symtoms, and activities of daily living. The improvement was pronounced in the cases of high grade of degenerative osteoarthritis (stage II, III) according to Kellgren's X-ray classification as well as low grade (Stage I).

Objective: To assess the efficacy of spinal manipulation for the patients with acute low back pain.

Method: Twenty patients with acute low back pain have been received spinal manipulation 3 times per week. The 10-point scale and the distance of the fingertips from the floor on maximum forward flexion (fingertip-flexion test) were checked pretreatment, immediately posttreatment, 2 days posttreatment, 1 week posttreatment, and 2 weeks posttreatment.

Results: The results were as follows: 1) The 10-point scale at pretreatment, immediately posttreatment, 2 days posttreatment, 1 week posttreatment, and 2 weeks post-treatment were 10.0⁑0.0, 5.8⁑1.4, 2.2⁑1.0, 1.1⁑0.2, and 1.0⁑0.0, respectively (P＜0.01). 2) The fingertip-flexion test at pretreatment, immediately posttreatment, 2 days posttreatment, 1 week posttreatment, 2 weeks posttreatment were 35.4⁑8.4 cm, 22.4⁑7.0 cm, 14.1⁑4.9 cm, 7.4⁑3.6 cm, and 5.4⁑4.6 cm, respectively (P＜0.01).

Conclusion: In our study, the spinal manipulation for the patients with acute low back pain offered significant efficacy and appeared to be a reasonable therapeutic option. But the effectiveness of this method leaves a critical aspect that should be dealt with in future studies.

Objective: To investigate the changes of gait patterns in hemiplegic patients with ankle foot orthosis (AFO) and with functional electrical stimulation (FES).

Method: Fifteen hemiplegic patients who can walk independently with cane participated in this study. Kinematic gait analysis was performed for all subjects using three-dimensional gait analysis system in barefoot, wearing AFO, and applying FES. The mean values of each gait trials were taken and statistically analysed by repeated measures of ANOVA.

Results: Genu recurvatum at stance phase and excessive ankle plantar flexion at stance and swing phase were decreased after wearing AFO. Excessive ankle plantar flexion at swing phase were decreased after applying FES.

Conclusion: The results showed that the FES is useful for the correction of hemiplegic gait as mush as of wearing AFO.

Objective: Lower extremity orthoses are important in the rehabilitation of the patients with stroke and traumatic brain injury. But it is unknown how much they are used in the social activity after the discharge from the hospital. This study was carried out to investigate the status of using orthosis in social activity and complaints about orthosis.

Method: The questionnaires were given to 42 cases with stroke and 17 cases with traumatic brain injury.

Results: The user of lower extremity orthosis in social activity were 55.9%, and the causes of disuse were patient's poor condition, improved gait pattern, inappropriate design and defect of orthosis, and patient's refusal. The degree of satisfaction with orthosis for comfort, external appearance and weight were 79.3%, 86.2%, and 72.4%, respectively.

Conclusion: Physiatrists should give more attention in orthosis at follow-up of patients with stroke and traumatic brain injury and make efforts to improve function and external appearance of orthosis.

Objective: To describe the inappropriate application of spinal orthosis and the frequency of the noncompliance and to identify the relating factors for compliance of spinal orthosis in patients with spinal metastasis.

Method: Twenty patients diagnosed as spinal instability due to spinal metastasis and applied with Knight-Taylor thoracolumbosacral orthosis or Knight lumbosacral orthosis were interviewed about the mobility and pain. Visual analogue scale (VAS) about severity of back pain and discomfort was also applied to each patient.

Results: Nine of the twenty patients were considered as being in poor compliance group. Six of eleven patients with good compliance had inappropriate application method or fitting problems. Inability to walk, poor walking endurance, greater degree of discomfort were related to the poor compliance of the spinal orthosis in patients with spinal metastasis.

Conclusion: Even with intensive education about the need for spinal orthosis and the method for application, there is high probability that the patients did not use the orthosis or use the orthosis incorrectly especially when patients cannot walk (or cannot walk enough time) and complain severe discomfort.

Several studies report varing incidence of spinal cord injury without radiologic abnormality (SCIWORA) from 21% to 66% in children. Fifty-five percentage of SCIWORA involves the cervical cord. The mechanisms of neural damage of SCIWORA include flexion, hyperextension, longitudinal distraction and ischemia. But spinal cord infarction related to vertebral arterial injury is rare.

The authors report a case of selective spinal cord infarction on gray matter with unilateral vertebral artery injury after a minor trauma, in a 4-year-old boy. Neurological signs and symptoms developed 12 hours after the trauma. Initial postcontrast magnetic resonance imaging (MRI) showed an enhancement in the left vertebral artery. Follow up postcontrast MRI showed a selective signal change on the central gray matter and unilateral vertebral artery. We present this case with the review of literatures.

Mirror writing is script that runs in the direction opposite to normal, with individual letters also reversed. A Right handed woman suddenly developed mirror-writing. After traumatic brain injury without definitive lesions on MRI, she could not discriminate between right and left by herself. Several theories, including motor, visual dominance, spatial disorientation and supplementary motor hypotheses, have been proposed to explain such. We believe that availability of mirror engrams induce reversal of normal left-to-right writing pattern including mirror-writings.