Objective: To determine the effect of exercise in the early phase of reinnervation after sciatic nerve injuries in the rat.

Method: Thirty six rats, Sprague-Dawley (weight, 200 to 220 g), were divided into the normal control and experimental groups. Using a haemostatic forceps, crushing injuries to the bilateral sciatic nerves were induced in the experimental group. The experimental group was further divided into exercise groups by the duration of daily swimming and initiation (duration since injury) of exercise after nerve injury (A, 2 hours/day and day 1; B, 30 minutes/day and day 1; C, 2 hours/day and week 2; D, 30 minutes/day and week 2) and non-exercise group (E). After completion of 5-week program the test results were evaluated by 1) sciatic nerve motor conduction study recorded at the gastro-soleus muscles, 2) measurement of soleus muscle tension, and 3) hematoxylin-eosin stain & alkaline ATPase stain (pH 9.4) of the soleus muscles.

Results: Nerve conduction study revealed significantly prolonged latency in group C and decreased amplitude in the group C, D. Peak twich tension decreased significantly in group C, D & E. Maximal tetanic tension was increased significantly in the group A compared to C. Both type I and II muscle fibers atrophied significantly in all the experimental groups compared to the normal control group with no changes of the composition of two muscle fibers.

Conclusion: Swimming applied from the early phase after sciatic nerve injury may be beneficial in early recovery of muscle tension. Overexercise in the early stage of reinnervation, however, may hamper the functional return of the damaged muscle by nerve injury.

Objective: The purpose of this study was to titrate the nerve block effect of phenol with different concentrations of phenol solution by electrophysiological and mechanical measurements.

Method: Right tibial nerves of twenty three adult rabbits were blocked by phenol solution with different concentrations (3%, 5%). Nerve conduction study for compound muscle action potential (CMAP), tension by electrical stimulation, and stiffness (slope) of stretch reflex of the triceps surae were performed after nerve block (4 weeks, 8 weeks, 16 weeks). The ratios of each values of right limb to those of left limb were used to evaluate the nerve block effect.

Results: The ratios of CMAP amplitude, tension, and slope of 3% group were 0.36, 0.55, and 0.56 at 4 weeks and those of 5% group were 0.21, 0.25, and 0.58. There were statistically significant differences of the CMAP amplitude and tension ratios, however there was no statistically significant difference of the slope ratio between two groups at 4 weeks. The ratios of CMAP amplitude, tension, and slope of 5% phenol group were increased with time.

Conclusion: Nerve block effects by 5% phenol solution were greater than 3%. These data suggest that nerve block effect can be titrated with concentration of phenol solution.

Objective: To prove that the skin of paralysed limb of spinal injured rat is more susceptible to a thermal injury than control, and to find out that the possible relating factors for explaining the increased susceptibility of skin.

Method: Of total 69 male Sprague-Dawley rats, 50 were randomly divided into two groups, the spinal injured of which cords were transected at T10-13 level and the control. They were subdivided into 5 subgroups according to the duration of thermal injury. Infrared ray was used for thermal injury. Arterial cannulation was done in the femoral artery for blood gas analysis. Temperature was measured with a digital thermometer. Biopsy samples were stained with HE, and also immunohistochemical staining for heat shock protein 70 (HSP-70) was done.

Results: After thermal injury, the spinal injured group showed more severe tissue damage and a higher temperature elevation than the control. There was a tendency of decreased blood pH and pO2, and increased pCO2. Contrary to the control, the immunoreactivity of HSP-70 was very tiny or rarely present in the spinal injured group.

Conclusion: This study suggest that the increased susceptibility of skin to the thermal injury in spinal injured rats may be related to the vasomotor instability. And, the poor expression of HSP-70 from the skin of spinal injured rat can be a factor for the explanation of the defective cellular protective response in spinal cord injury.

Objective: To study the effect of pregnancy on knee joint contracture in the rat, because the laxity of peripheral joint increases during pregnacy.

Method: We evaluated the difference of contracture between the pregnant and non-pregnant female rats after 3 week of knee immobilization using a wire. The femorotibial angle at immobilization status was 30^o. After immobilization, the femorotibial angle were measured using X-ray after removal of wire at 50 g and 100 g weighted state on the tibia. To study the change of fibroblast in immobilized knee joint ligament, immunohistochemical staining for actin was performed using α-smooth muscle actin antibody (DAKO, Denmark).

Results: The femorotibial angles were 116.7⁑9.2^o and 97.3⁑18.0^o after wire removal, in the immobilized pregnant and nonpregnant rats respectively. The femorotibial angles at 50 g and 100 g weighted state were 136.8⁑7.2^o and 144.7⁑3.8^o, respectively in the immobilized pregnant rats and 129.4⁑12.7^o and 136.3⁑8.9^o in the immobilized non-pregnant rats. The angles of pregnant group were significantly larger than those of non-pregnant group (p＜0.05). In immobilized pregnant and non-pregnant rats, the α-smooth muscle actin was moderately expressed in fibroblast of anterior and posterior cruciate ligaments of the knee by immunohistochemistry, while there was no expression of α-smooth muscle actin in fibroblast of the ligaments in the non-immobilized knee.

Conclusion: Joint contracture develops to a lesser degree in pregnant rats than in non-pregnant rats and α-smooth muscle actin is expressed in fibroblast of contractured knee ligaments.

Objective: To examine the effects of two stimulation waveforms on wound healing in rats.

Method: 30 Sprague-Dawley rats with a 7-mm diametrical round incision including skin and subcutaneous tissue on the dorsum were divided into three groups. A(n=10) and B groups(n=10) were given rectangular and triangular monophasic pulsed current 1 hr daily until the wound healed completely (duty cycle 10%, absolute spatial current density 0.022 mA/cm² for A group and 0.011 mA/cm² for B group), and C group (n=10) received no electrical stimulation. As the indicator of wound healing effect, percentage of reduction in wound area, duration of complete healing and antibacterial effect were evaluated and statistically compared among three groups.

Results: The mean values of percentage of reduction in wound area were 75.1⁑3.0% for A group, 74.2⁑5.1% for B group and 68.7⁑5.4% for C group. The mean values of duration of complete healing were 11.1⁑1.3 days for A group, 12.0⁑1.4 days for B group and 16.1⁑1.0 days for C group. The mean antibacterial effect were 0.5⁑0.5 for A group, 0.6⁑0.5 for B group and 2.1⁑0.6 for C group on 2 days post wounding, and 0.4⁑0.5 for A group, 0.5⁑0.5 for B group and 1.4⁑0.7 for C group on 6 days post wounding. Although those for A and B groups were significantly different from those for C group, no significant difference in all values of three indicators existed between A and B groups.

Conclusion: Results suggest that two stimulation waveforms have no significantly different effects on wound healing in rats.

Objectives: To report the results of functional magnetic resonance imaging (fMRI) experiment to delineate brain network for auditory language tasks in normal Korean adults.

Method: Five normal right-handed Korean males, aged 20∼33 years, were investigated using fMRI technique. Language tasks consisted of auditory listening and verb generation tasks. In fMRI, twenty slices were obtained for each functional volume using single shot echoplanar image sequences. Eighty-four volumes were obtained for each functional run. Data were motion corrected, coregistered, normalized, and statistically analyzed using SPM-96 software (Wellcom Department of Cognitive Neurology, Oxford, UK).

Results: Functional activation were detected in superior temporal region (coordinates: x=⁣64, y=⁣42, z=2) in the left side and superior to middle temporal lobe (coordinates: x=50, y=⁣20, z=2) in the right side for auditory listening task. Auditory verb generation task activated inferior frontal gyrus (coordinates: x=⁣56, y=16, z=14), superior temporal region, and medial frontal region in the left side. Right temporal lobe was also activated in the superior to middle temporal areas. Activation was more extensive in the left side for both language tasks.

Conclusion: Our results can remarkably delineate cortical and subcortical regions subserved for auditory language processing. These results can be contributing to understand the underlying mechanism of language disorders in brain-injured patients and to investigate the pattern of reorganization of language network after rehabilitation.

Objective: Early detection and identification of the aspiration in stroke patients are essential for the prevention of respiratory complications. The purpose of this study is to develop a simple, easy-to-use, quantifiable functional dysphagia scale for stroke patients using videofluoroscopic swallowing study findings.

Method: Oral and pharyngeal videofluoroscopic swallowing study findings of a consecutive series of 103 stroke patients were analysed. Items of the functional dysphagia scale were determined by the polychotomous linear logistic regression analysis between videofluoroscopic findings and aspiration. The sensitivity and specificity of the scale, and correlation between the total score of the scale and aspiration grade were measured.

Results: The final scale included the following eleven items; The score of lip closure, bolus formation, residue in oral cavity, oral transit time, triggering of pharyngeal swallow, laryngeal elevation and epiglottic closure, nasal penetration, residue in valleculae, coating of pharyngeal wall after swallow, pharyngeal transit time. The sensitivity and specificity of the scale for detecting supraglottic penetration and subglottic aspiration were 81.0%, 70.7% and 78.1%, 77.9% respectively. The total score of the scale was significantly correlated with the severity of aspiration. (Spermann correlation coefficient r=0.58943, p=0.00001).

Conclusion: We developed functional dysphagia scale using videofluoroscopic swallowing study in stroke patients, which could be used as a simple, easy-to-use, quantifiable method to evaluate the severity of the dysphagia.

Objective: To compare the effects of early and late treatment and to evaluate the contributing factors for the therapeutic outcome in cerebral palsy children.

Method: Three hundred twenty four children with delayed development including cerebral palsy who were admitted to the Department of Rehabilitation at Yonsei University Medical Center from January 1992 to December 1995 were studied. They were divided into two groups according to the initiation of treatment: early and late treatment groups. Early treatment was defined as treatment started at or before 6 months and the late treatment was after 6 months. They were also divided into groups according to the diagnosis, responsiveness to treatment and initial motor quotient. And then the motor developments during the follow-up period between each groups were compared as the effects of treatment.

Results: The development of the motor milestone was faster in the early treatment group than in the late treatment group. The group which initially showed a higher motor quotient had a higher response rate to the treatment and a faster development of the motor milestone than the group with a lower motor quotient.

Conclusion: These results suggest that the initiation of treatment and the severity of delayed development are important contributing factors for an outcome of treatment.

Objective: Purposes of this study were to measure the optional five kinds of parameters in children's footprint, to seek what parameters are significant to follow the change of the children's feet and to get the values of normal ranges in children aging from 9 to 72 months.

Method: Subjects were 286 children (572 feet) having no neurologic or musculoskeletal problems. They were divided into seven groups according to age. Five optional parameters of footprint are medial arch angle, lateral concave ratio, angle between transverse axis and long axis, fifth metatarsal angle, and angle between long axis and fifth metatarsal line.

Results: 1) Medial arch angles were significantly increased from 10.03^o (group I) to 41.23^o (group VII). 2) Lateral concave ratios were significantly increased from 31.75% (group I) to 61.48% (group VII). 3) Angles between long and transverse axes were not significantly different. 4) Fifth metatarsal angles were significantly increased from 83.00^o (group I) to 91.04^o (group VII). 5) Angles between long axis and fifth metatarsal line were not significantly changed.

Conclusion: These results suggest that three components-the medial arch, the transverse axis and the fifth metatarsal line-were considered to be available parameters to follow the development of feet. And it is also proposed that our values of their normal range will be helpful to detect abnormalities of children's developing feet.

Objective: The purpose of this study was to analyze relationships between injury-related variables, demographic variables, disability, handicap and life satisfaction of persons with spinal cord injury.

Method: Data was collected through personal interviews of 96 persons with spinal cord injury. Neurologic variables, demographic variables, FIM (functional independence measure) scores and CHART (Craig Handicap Assessment and Reporting Technique) scores were obtained. Life domain satisfaction measure, a self-administered questionnare containing 12 items, was used to assess the life satisfaction.

Results: Life satisfaction was related with the total CHART score (p=0.00), severity of disability (p=0.02), annual family income (p=0.019) and employment status (p=0.008). Life satisfaction was not related with the level of injury, age, duration of injury, sex or marital status (p＞0.05). Social integration was the most strong predictor of life satisfaction (p=0.00). Economic-self sufficiency (p=0.004) and FIM scores (p=0.018) were also predictors of the life satisfaction.

Conclusion: The result of this study provides an evidence that social integration and employment warrant a priority in rehabilitation efforts to promote the quality of life following spinal cord injury.

Objective: A warfarin-baclofen interaction has been postulated, but has not been documented in the literature. The purpose of this study is to investigate the drug interaction between warfarin and baclofen in rats.

Method: Twenty Sprague-Dawley rats (250-300 gm), divided into a control and a study group were used. 0.02 mg/day of warfarin was administered intraperitoneally without baclofen for the first three days. Daily blood samples were drawn after six hours of warfarin adminstration for measurement of prothrombin time (PT) and International Normalized Ratio (INR). On the fourth day, the rats in the study group were given 0.02 mg of warfarin and 0.6 mg of baclofen intraperitoneally. For the control group, 0.02 mg of warfarin was administered on all four days. PT and INR measurements were taken at 3 hours, 6 hours, and 24 hours after the administration of warfarin with or without baclofen.

Results: Mean INR value was significantly increased by concomitant baclofen administration after 6 hours, resulting in 1.72 for the control group with warfarin alone and 2.74 for the study group with warfarin and baclofen (p＜0.05).

Conclusion: The concomitant administration of warfarin and baclofen affects the anticoagulant effect of warfarin. Physicians should be aware of the risk for increased anticoagulant effect of warfarin when baclofen is also administered.

Objective: Spasticity has been reported to be one of the common complications in patients with spinal cord injury. The purposes of this study were to investigate the proper dosage, the therapeutic and undesirable effects of clonidine with combined used of baclofen for the management of spasticity.

Method: A prospective study was performed for 17 patients with spinal cord injury who did not improve spasticity with 80 mg baclofen administration. The degree of spasticity was assessed in the more-affected knee by modified Ashworth scale, pendulum test at pre-treatment and at 7 days after receiving clonidine. We also investigated the complications and subjective satisfaction.

Results: Seven of 13 patients with spinal cord injury showed subjective improvement in spasticity. We found significant improvement in the relaxation index by pendulum test after administration of more than 0.3 mg of clonidine. There was no significant difference between the subgroups depending on the extent of spinal cord injury. We didn't find any serious complication in adjuvant clonidine therapy.

Conclusion: Adjuvant clonidine therapy can be effective in spasticity of spinal cord injured patients without serious complication.

Objective: To compare the change of oxygen consumption and heart rate between walking and running at the same condition of treadmill in healthy male college students.

Method: Twenty healthy male college students completed steady-state treadmill test at 3 mph and 5 mph, separately, by walking and running. During the each 6 minutes treadmill test, oxygen consumption (VO₂), heart rate (H.R), oxygen consumption ratio of maximal oxygen consumption (% VO_2max), and heart rate ratio of maximal heart rate (% HR) were measured each minute.

Results: The showed that mean heart rate were 123.40⁑4.62 beats/min and oxygen consumption were 12.84⁑1.94 ml/kg/min, in 3 mph walking. The mean heart rate were 139.90⁑6.80 beats/min and oxygen consumption were 16.51⁑1.78 ml/kg/min in 5 mph walking. The running showed that mean heart rate were 187.55⁑6.74 beats/min and oxygen consumption were 26.45⁑3.11 ml/kg/min in 3 mph walking. The mean heart rate were 168.45⁑13.34 beats/min and oxygen consumption were 21.05⁑2.00 ml/kg/min in 5 mph walking. There were significant differences (p＜0.05) in mean heart rate, VO₂ between the 3 mph walking and running, the 5 mph walking and running.

Conclusion: We concluded that 3 mph walking and running and 5 mph running were an effective exercise to promote health in healthy college students.

Objective: The purpose of this study was to investigate cardiac events and ischemic heart disease in patients with stroke. The patients were studied by myocardial perfusion SPECT (single photon emission computed tomography) and evaluated the functional outcome after rehabilitation.

Method: Subjects were 31 patients with stroke who had myocardial perfusion SPECT for abnormal findings on the electrocardiography. There were eighteen patients with ischemic stroke: 12 patients with hemorrhagic stroke; and one patient with both ischemic and hemorrhagic stroke. We screened the patients for the hypertension, diabetes mellitus, previous history of stroke, smoking, alcohol use, and hyperlipidemia as risk factors of ischemic stroke and ischemic heart disease. For the dichotomous classification of positive or negative myocardial perfusion SPECT, reversible and persistent defects were considered as positive. We investigated the functional outcomes on the admission and discharge using the Modified Rankin scale (MRS) and functional independence measure (FIM) scores. Cardiac events in patients with stroke were investigated.

Results: The myocardial perfusion SPECT was positive in 10 of 18 patients (55.6%) with ischemic stroke. Four out of ten patients with ischemic stroke had cardiac events. Positive myocardial perfusion SPECT was significantly associated with cardiac events (p＜0.05). Risk factors of ischemic stroke with positive myocardial perfusion SPECT was more numerous than those of ischemic stroke with negative myocardial perfusion SPECT (p＜0.05). However there was no statistically significant difference between functional outcome and findings of myocardial perfusion SPECT (p＞0.05).

Conclusion: The results of our study suggested that myocardial perfusion SPECT is useful in the screening of silent ischemic heart disease in patients with ischemic stroke and to assess future cardiac events of them.

Objective: To find out the incidence of reduced median conduction velocity of forearm (MNCV-F) in carpal tunnel syndrome (CTS) and to compare clinical and electrophysiologic characteristics of CTS with reduced MNCV-F and to observe the changes of reduced MNCV-F after carpal tunnel release.

Method: One hundred and fifty nine hands with CTS are divided into two groups; MNCV-F of 50 m/sec and above as group I and that of below 50 m/sec as group II. For the electrophysiologic comparison, median sensorimotor distal latency, peak-to-peak amplitudes and abnormal spontaneous activity of abductor pollicis brevis were observed and for clinical comparison, sensorimotor symptoms, Phalen and Tinel sign were observed. Twenty four hands which had successful carpal tunnel release were examined for the changes of MNCV-F.

Results: The hands with reduced MNCV-F were 29 among 159 hands. Sensorimotor distal latency were significantly prolonged and sensorimotor amplitudes also significantly reduced in group II. Sensory change and Phalen signs were more frequently observed in group II. MNCV-F in group I had not changed after carpal tunnel release, but MNCV-F in group II was improved significantly. The changes MNCV-F in group II were much delayed than the improvement of parameters of distal conduction studies.

Conclusion: The incidence of reduced MNCV-F in CTS was 18.24%. Patients with reduced MNCV-F had more severe CTS both electrophysiologically and clinically. Reduced MNCV-F had improved significantly, but there was significant time gap between the electrophysiologic improvements of distal and proximal portions of nerve. This findings may suggest that retrograde degeneration may play a partial role in reduced forearm motor nerve conduction velocity of the median nerve in CTS.

Objective: The purpose of this study was to determine the relationship of abnormal parameters in commonly tested peripheral nerves and clinical findings in diabetic neuropathy.

Method: Parameters in tested peripheral nerves are all 18 as follows; Distal latency and amplitude of median motor, median sensory, ulnar motor, ulnar sensory, tibial motor, peroneal motor, and sural sensory (14) plus conduction velocity of median motor, ulnar motor, peroneal motor, and tibial motor (4). Person who had at least one abnormal parameter out of 18 parameters counted as abnormal group and then it was divided 3 groups depending on numbers of abnormal parameter as follows; one to two abnormal parameters as mild group, three to five as moderate group, and more than 6 as severe group.

Results: The factors which were correlated with number of abnormal parameters on nerve conduction study (NCS) were 1) duration of diabetes mellitus and 2) age of patients but not the level of HbA1c (p＜0.05). The involved nerves in the order of frequency were sural sensory (49.7%), peroneal motor (43.2%), median sensory (32.7%), ulnar sensory (31.2%), median motor (29.6%), and ulnar motor (23.1%). In persons having mild grade on NCS, amplitude of sensory nerve action potential (SNAP) was more frequently involved than distal latency of SNAP. Among the parameters, amplitude of median compound muscle action potential (CMAP), amplitude of ulnar CMAP, distal latency of ulnar SNAP and the amplitude and distal latency of tibial CMAP seemed to be less affected in diabetic neuropathy.

Conclusion: The amplitude of SNAP seemed to be valuable parameter in detection of early diabetic neuropathy.

Objective: To determine whether flexion and extension of the wrist joint produce the change in the conduction study of the median nerve in the normal and diabetic patients, and to compare the susceptibility of median nerve compression injury in two groups.

Method: Thirty healthy adults as control and thirty diabetic patients without carpal tunnel syndrome were studied. The wrist joint was maintained in flexion or extension position for 5 minutes before performing conduction study. The variables used for statistical analysis included the mean difference of amplitude and latency in median motor and sensory responses in neutral, flexion, and extension positions.

Results: The results showed that significant differences in the latency and amplitude of median motor and sensory responses between neutral, extension, and flexion of wrist within each group (p＜0.01). The differences in the median sensory latency (p＜0.01), amplitude (p＜0.05) and the change of wrist-palm segmental conduction velocity (p＜0.01) were statistically significant between the diabetes and the normal control.

Conclusion: The results of this study suggest that median nerves are susceptible to compression pressure in diabetic patients. Therefore, the position of the wrist joint should be considered in the median nerve conduction study.

Objective: To compare the R3 response of the blink reflex in medullar and spinal cord lesion and to investigate whether the reflex arc of the R3 response descend to the cervical spinal cord or not.

Method: We have studied 3 patients with medullar lesion and 5 patients with cervical spinal cord or vertebral lesion. Normal ranges of the R3 response refer to the results suggested by Moon et al.

Results: In 3 patients with medullar lesion, two patients with lateral medullar lesion showed delayed R3 latency or no evoked potential. Four patients with cervial spinal cord lesion showed no R3 response. In one patient with disc protrusion R3 was normal.

Conclusion: Our results support the hypothesis that the reflex arc of the R3 response descend to the cervical spinal cord.

Object: The purpose of this study was to establish the normal values of sternocleidomastoid (SCM) tendon reflex in normal Korean adults.

Method: The study for SCM tendon reflex was performed in 41 normal adults using electric reflex hammer. The compound muscle action potentials (CMAP) of SCM muscle were obtained by SCM tendon tapping. From 5 repeated trials of each subject, the shortest latency and the largest peak-to-peak amplitude of CMAP were chosen for the representative value.

Results: Mean values of latency and amplitude were 2.19⁑0.27 msec and 0.70⁑0.38 mV for SCM tendon reflex. There was no significant difference in the latency and amplitude regardless of side or sex (p＞0.05). The age and height showed no signifiant correlation with latency and amplitude of SCM tendon reflex (p＞0.05).

Conclusion: We believe that our results can be used as an evaluation method of upper cervical spinal cord.

Objective: The aim of this study was to evaluate the clinical usefulness of motor evoked potentials (MEPs) in predicting functional motor recovery of acute stroke patients.

Method: Nineteen acute stroke patients were assessed clinically by manual muscle test (MMT) & modified Barthel index (MBI) and SEP & MEP at about 10 days after stroke. Follow up clinical assessments were performed by MMT, MBI & gait evaluation after two months of rehabilitation program.

Results: 1) In the acute phase of stroke, there was a significant relationship between MEP and motor function. 2) The presence of MEPs in hemiparetic upper & lower extremities was correlated with better functional outcome than the absence of MEP in at least one extremity. MEP was better than SEP in predicting functional outcome following acute stroke. 3) The presence of MEP in hemiparetic abductor pollicis brevis muscle was correlated with a better functional improvement, contrarily the absence of MEP in abductor hallucis muscle was correlated with a worse functional outcome.

Conclusion: We concluded that MEP study is a useful assessment tool in predicting functional outcome of acute stroke patient. However, the absence of MEP does not necessarily indicate a poor prognosis. So further study is needed to clarify this controversy.

Objective: Intraoperative somatosensory evoked potentials (SEPs) are widely used for the early detections of cerebral ischemia during temporary occlusive procedures of the parent vessels in aneurysm surgery. This study intended to evaluate the usefulness of median nerve SEPs during intracranial aneurysm surgery.

Method: Between September 1995 and June 1997, we monitored 42 aneurysm patients in Uijongbu St. Mary's hospital. Median nerve SEPs were detected on scalp and cervical spine during surgery. We measured latencies, amplitudes of N20 and N13 waveforms and central conduction time (CCT, N20-N13). We analyzed pre- and post-surgical radiologic findings and changes of neurologic signs.

Results: The delayed latencies, CCT, and reduced amplitudes of median nerve SEPs during intraoperative monitoring were closely related to neurological deficits after surgery.

Conclusion: Intraoperative SEPs are useful in preventing clinical neurological injury during surgery of intracranial aneurysm and in predicting which patients will have unfavourable outcomes.

Objective: Inappropriate neural control of the quadriceps femoris muscle group has been implicated in patellofemoral pain syndrome (PFPS) and the methods of biomechanical assessment of PFPS has been developed recently. The aims of the present investigation were to evaluate the effects of therapeutic exercise in the alleviation of PFPS and to develope objective clinical test for PFPS.

Method: We investigated the onset time of the isometric contraction of vastus medialis oblique muscle (VMO) and the vastus lateralis muscle (VL) under four different conditions: knee flexion and extension in weight bearing (standing) and non-weight bearing (sitting on chair) situations. For each condition, onset times of EMG activities and onset times for VMO and VL were determined from five trials of isometric contraction. In addition, we compared knee flexor and extensor torques in control group and subjects with PFPS. To evaluate the effects of the exercise we compared the onset time difference (onset time of VL-onset time of VM) and quadriceps muscle torque at pre- and post- exercise in PFPS groups.

Results: In PFPS group, onset time of VMO during knee extension was significantly longer than the onset time of VL and the knee extensor torque was considerably weaker in comparison with normal group. Although onset time difference was not changed after exercise program, there were significant increase in knee extensor torque in subjects with PFPS.

Conclusion: The role of exercise in the rehabilitation of quadriceps functions is to reduce the pain, to strengthen the knee extensor, and further accurate diagnostic tools and methods for the result of therapeutic exercise in PFPS are needed.

Objective: To investigate the frequency, nature and risk factors of musculoskeletal problems in pregnancy.

Method: We obtained the information through a questionnaire and physical examination of full-term (gestational age over 38 weeks) pregnant women. Prevalence, onset time, severity and risk factors of musculoskeletal problems were analyzed.

Results: Among the 70 pregnant women, 37 women (53%) complained of low back pain which was the most common musculoskeletal problem in pregnancy. Other problems were hand symptoms (31%), lower extremity joint pain (31%), leg cramp (29%), chest pain, shoulder pain and neck pain. Previous history of low back pain was significantly correlated with the occurrence of low back pain in pregnancy. Weight gain during pregnancy and amount of time of housework during pregnancy were significantly correlated with carpal tunnel syndrome. Pregnant women suffering from leg cramp were significantly old in age.

Conclusion: Prevalence of musculoskeletal problems during pregnancy was relatively high and several risk factors were related with occurrence of those problems. So, prophylactic risk factor control would be necessary to reduce musculoskeletal problems during pregnancy.

Objective: The purpose of this study was to find out the usefulness of ultrasonographic evaluation in shoulder impingement syndrome.

Method: The patients with positive impingement sign (49 patients) at shoulder joint were evaluated. The Ultrasonograms of shoulder were performed at first visit and 4 weeks later. The patients who showed abnormal findings were treated with subacromial steroid injection. In order to check the efficacy of injection, we also used questionnair which consist of active range of motion, shoulder pain score, and visual analogue scale.

Results: 16 among 49 patients (32.7%) had abnormal ultrasonograms as follows; only fluid collection in subacromial bursa was shown in 3 patients (6.1%), only fluid collection in biceps long head tendon sheath in 4 (8.2%), partial thickness tear of supraspinatus tendon (SSP) in 6 (12.2%), and full thickness tear of SSP in 3 (6.1%). Follow-up ultrasonograms were performed after subacromial steroid injection on 4 patients and 3 among the 4 patients showed marked improvement ultrasonographically. 23 among 49 patients were recruited and showed marked improvement in each questionnaire.

Conclusion: Ultrasonography gave good information in management of impingement syndrome furthermore it could be used as a primary imaging technique evaluating rotator cuff disease.

Objective: Many amputees do not use their prostheses consistently because of the unhelpfulness or discomfort. In this point, this survey was to assess the prosthetic problems in their function and willingness to use.

Method: We investigated the 18 burn induced upper extremity amputees of Hankang Sacred Heart Hospital Burn Center with the questionnaire or interview.

Results: The mean age was 39.6 years at the time of amputation & 43.3 years at the time of survey. Their amputation levels were composed of 72.2% of below elbow and 27.8% of above elbow. The using time of prosthesis was revealed that 'all day long' use in 50%, 'going out' use in 33.3% and 'living activity' use in 11.1%. Their complaint for prosthetic problems were discoloration (38.9%), poor appearance (27.8%), sweating (27.8%) and inadequate function (22.2%). Considerable number of them suffered from residual burn wound or scar in contact with a socket (27.8%) and itching and tingling sensation (22.2%). Employment was not accomplished in 61.1% of the amputees.

Conclusion: The information thus obtained in this investigation would be expected to be helpful in the prosthetic prescription and rehabilitation training of upper extremity amputees for their welfare.

Kyphotic deformity arising from the failure in formation of a vertebral body is an uncommon condition showing late complications of gross spinal angulation, paraplegia, impaired bladder function and cardiopulmonary deficiencies. Congenital hemivertebra constitute approximately 6% of anomalies associated with congenital spinal deformities. The natural course of this disease remains unpredictable, especially regarding the development of neurological impairment. Only a few numbers of patients with severe kyphosis due to congenital dorsal hemivertebra have been reported.

We present a 40-year-old man with severe thoracic kyphosis. Gait difficulty due to paraplegia occurred at the age of fifteen with progressive development of the right lower limb pain and later impairment of bladder function. He had no cardiopulmonary deficiencies. Radiological findings showed a wedge shaped dorsal hemivertebra and cord compression at the eleventh level of thoracic vertebra. In view of the poor prognosis of surgical intervention he was fitted with an Jewett brace so that further neurological impairment was avoided. We report a rare case of congenital kyphosis due to dorsal hemivertebra in adult with progressive neurological impairment.