The higher cognitive functions of human brain are hypothesized to be selectively distributed across large-scale neural networks interconnected cortical and subcortical areas. Recently, advances in functional imaging made it possible to visualize the brain areas activated by certain cognitive function in vivo. Out of several technologies currently available for brain activation study, functional magnetic resonance imaging (fMRI) is increasingly being used because of its superior time resolution and finer spatial resolution. The technique is non-invasive without radiation hazard, which allow to take repeated multiple scans within the same individual. The most common approach to fMRI of brain is the one using 'blood-oxygen level dependent (BOLD)' contrast, which based on the localized hemodynamic changes following neural activities in the certain areas of brain.

With functional imaging techniques including fMRI, neural networks subserving for higher cognitive functions such as language, memory, attention, and visuospatial functions could be visualized. Neural substrates of human emotion and motivation behaviors also begin to be unveiled. Brain mapping with functional imaging is a very useful method for detecting eloquent areas in a neurosurgical setting to prevent the residual disabilities. One of the issues recently having attention in the field of functional imaging is the reorganization of neural network following brain injuries. Much research results using fMRI identified intra- and/or interhemispheric reorganization of neural networks accompanied with functional recovery after brain injury. Effects of learning and rehabilitation on the extent and pattern of neural reorganization was also delineated. fMRI will be a very useful tool for developing of various rehabilitation treatments, which promote successful functional recovery by maximizing the plasticity of brain.

Objective: To determine the posturographic characteristics of the stroke patients due to various brain lesions.

Method: Stroke patients capable of standing without assistive devices were included. Patients were divided into three groups according to the lesion distribution: cerebral; brain stem; cerebellar. Quantitative computerized posturographic studies were performed to determine the subject's response to sensory (sensory organization test, SOT) and motor translations (motor control test, MCT).

Results: Equilibrium scores of 4th (EQ4), 5th (EQ5) and 6th (EQ6) conditions and visual (VIS) and vestibular (VEST) ratio of SOT were significantly lower in brainstem and cerebellar lesion groups in comparison with normal population. In addition, prolonged latencies for medium and large backward and forward translations were noticed in the brainstem lesion group. However, there was no significant difference between cerebral lesion group and normal population. According to the lesion distribution, cerebellar group showed increased incidence of abnormalities of EQ4 score. Brainstem group showed increased incidence of abnormalities in EQ5, EQ6 score, VEST ratio and prolonged latency for large forward translation.

Conclusion: We found that posturography revealed characteristic appearances according to the various brain lesions, especially in cerebellum and brainstem stroke patients.

Objective: The present study evaluated the characteristics and natural history of stroke patients.

Method: Seven hundred and sixty seven consecutive patients admitted through acute care facility were reviewed. All medical records including age, case fatality, risk factors and radiological findings including CT or MRI were reviewed. To investigate the activities of daily living (ADL) of stroke patients, follow-up study was done in 303 patients through telephone interview or direct contact. Stroke was subdivided into cerebral infarct, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH).

Results: The proportion of stroke subtypes were infarct (45.9%), ICH (34.7%) and SAH (19.4%). The recurrence rate of stroke was higher in the infarct patient. Higher percentage of fatality was noted in the SAH patient. Higher incidence of hemorrhage was still observed compared to western country. Hypertension is the major risk factors for all stroke subtypes. But among hypertensive individuals, only 29% patients controlled the hypertension. Fifty-eight percent of stroke patients regained independent ADL.

Conclusion: The result of this study shows the clinical pictures of stroke patients. Further research was needed to investigate the trends of stroke and control of risk factors and attention must be paid to the patients who is dependent in ADL.

Objective: The purpose of this study is to assess the changes of skin temperature quantitatively in the stroke patients with reflex sympathetic dystrophy syndrome (RSDS) using thermography according to their clinical phases as well as changes after treatment.

Method: Patient group was consisted of 17 stroke patients with RSDS. Mean onset time of RSDS after stroke was 10.6 weeks. All patients were assessed by triphasic bone scan and clinically classified by phase I, II, and III. Control group was consisted of 9 stroke patients without RSDS. Temperature difference between affected side and unaffected side in wrist and hand regions were assessed in all subjects using Thermovision 570 (Agema Infrared Systems, USA) when initial clinical diagnosis was made. Seven patients were reassessed after high dose steroid and physical therapy.

Results: In patients with phase I RSDS, affected wrist and hand showed higher temperature distribution than the unaffected side. On the other hand, patients with phase II and III showed lower temperature in the affected side. The mean temperature difference in patients with phase I RSDS was significantly greater than control group. After treatment, skin temperature of affected side was decreased in phase I patients, but increased in phase II patients. Skin temperature difference tended to be normalized after successful treatment.

Conclusion: Using thermography, temperature change of affected hand can be assessed quantitatively in stroke patients with RSDS. The thermography is considered to be a useful tool for evaluation of clinical phases and treatment effect in these patients.

Objective: To identify the incidence and characteristics of language disorders in patients with traumatic brain injury (TBI), and to understand the differences of language disorder according to the degree and lesion of brain damage and the outcomes after proper language training programs.

Method: The subjects were 24 adult TBI patients. Seventeen patients with language disorder were examined with language disorder screening test. The characteristics of the language disorders were evaluated according to the degree and lesion site of the brain injury. Prognosis of the language disorders was studied. The tests were performed at the initiation and termination of the language treatment program.

Results: The incidence of language disorders was 91.7%. At the initial evaluation, all items showed a low rate of correct response, but at the final evaluation, the statistically significant improvement was noted in all items. There was no difference between moderate and severe brain damages at final evaluation. Focal lesion group revealed higher rate of correct response than diffuse lesion group on comprehension, expression, reading, and calculation at final evaluation.

Conclusion: The TBI patients showed diffuse language dysfunction on fluency, comprehension, expression, reading, writing, and calculation. But the majority of these patients showed satisfactory recovery, especially the focal brain lesion showed the better outcome. These patients with focal lesion were needed precise language evaluation and more intensive language treatment program.

Objective: To investigate the defecation pattern after discharge in stroke patients with bowel problems.

Method: Subjects were 50 stroke patients who underwent rehabilitation program and discharged to home. The information about the defecation pattern were taken through interview or review of medical records as follows: anatomical lesion site, consciousness, admission period, operation history, co-morbidity, ambulation distance, water & food intake, assistive device use, voiding dysfunction, urine output, stool softner use, fecal incontinence, and defecation frequency. We compared the defecation frequency according to the various factors obtained from the medical records and interview.

Result: The defecation frequency were significantly higher in patients without co-morbidily or fecal incontinence, with longer-distance ambulation, large amount of water & food intake (p＜0.05). There was no significant change in the defecation frequency according to age, sex, anatomical lesion, operation history, admission period, use of assitive devices, consciousness, voiding dysfunction, or urine output (p＞0.05).

Conclusion: Considering the various factors noted above, comprehensive rehabilitation program to relieve bowel problems should be established in the rehabilitation management of stroke patients.

Objective: To investigate incidence, characteristics, and risk factors of insomnia and to compare the functional outcomes between insomnia and non-insomnia group in rehabilitation patients.

Method: Sixty nine consecutive admissions between May and June, 1999 have been evaluated. The St. Mary's Hospital Sleep Questionnaire were employed and medical records of the patients have been reviewed.

Results: Incidence of insomnia was 60.9%. The most common type of insomnia was difficulty in maintaining sleep during the night (interrupted type). 66.9% of the total patients with insomnia had recognizable causal factors. The common factors influencing insomnia were somatic symptoms, environmental, and psychological factors. On discharge, lower FIM gain was noted in insomnia group even though statistical significance was not found.

Conclusion: Since sleep disturbances have been common to the rehabilitation patients, and may influence functional outcome, early diagnosis and therapeutic intervention may be needed.

Objective: The purpose of this study is to evaluate the effect of functional electrical stimulation (FES) on hemiplegic shoulder subluxation in post-acute stroke patients.

Method: Forty-four patients who had shoulder subluxation as a consequence of their first stroke were included and randomly assigned to either a control group (22 subjects) or a study group (22 subjects). Patients in both groups received physiotherapy and used an arm sling. The study group received, FES therapy to shoulder muscles (supraspinatus and posterior deltoid) for 30 minutes, five days a week for 6 weeks. The effect of FES therapy was evaluated by assessment of the severity of subluxation using radiologic measurements before and after treatment.

Results: 1) The severity of subluxation was significantly increased after 6 weeks (p＜0.05) in the control group. In the study group, it was reduced but the difference was not statistically significant (p＞0.05). 2) In the group of patients with early treatment (onset duration, less than 6 months), the control group showed a significant increase in subluxation (p＜0.05), but the study group showed significantly reduced (p＜0.05) shoulder subluxation after treatment period. 3) In the group of patients with mild shoulder subluxation before treatment (less than 1 finger breadth), the control group showed a significant increase in subluxation (p＜0.05), but the study group showed significantly reduced (p＜0.05) shoulder subluxation after treatment period.

Conclusion: The FES therapy is effective in preventing and reducing the severity of hemiplegic shoulder subluxation in post-acute stroke patients, especially if duration since stroke onset was less than six months and the severity of subluxation before treatment was mild.

Objective: The purposes of this study were (1) to determine the effectiveness of intensive rehabilitation on ambulatory recovery in patients after hip fracture with previous cerebrovascular accident; (2) to define the difference in the ambulatory outcome of the hip fracture patients according to their previous history of stroke.

Method: One hundred and seventy-three cases with hip fracture were studied. All patients were divided into two groups: Group A with and Group B without a history of stroke prior to the fracture. The following information was obtained in each patients: age, sex, type and side of fracture, side of hemiplegia, duration of hospitalization, concurrent disease. Ambulatory status was divided as satisfactory (walking with quad-cane or walking frame or mono-cane) or nonsatisfactory (confined to wheelchair or to a bed) accordong to their recovery after rehabilitation.

Results: Twenty three percent of patients have the history of stroke with hip fracture on hemiplegic side and 51.4% of them regained their prefracture level of ambulation. No significant difference was found in the incidence of concurrent disease, length of hospital stay, and functional recovery between hip fracture patients with and without a history of stroke.

Conclusion: We conclude that rehabilitation of the stroke patient with hip fracture is worthwhile and comprehensive rehabilitation should be done in hip fracture patients with or without hemiplegia.

Objective: To investigate plasma lipid changes in pre- and poststroke patients and to evaluate the difference of these changes between hemorrhagic and ischemic strokes.

Method: Two hundred thirty five stroke patients who underwent blood tests for health check-up before stroke were included in this study. Lipids profile among blood tests included total cholesterol, triglyceride, low density lipoprotein cholesterol, and high density lipoprotein cholesterol. These tests were taken again within 48 hours, at 1 week, and 3 months after stroke. Prestroke lipid profile was compared with the control group, which was composed of two hundred forty seven healthy men.

Results: The difference between lipid profile of prestroke and within 48 hours after stroke was not statistically significant. Total cholesterol at 1 week after stroke was significantly lower, but its concentration increased at 3 months after. There's no significant changes in triglyceride, low density lipoprotein cholesterol, or high density lipoprotein cholesterol according to time. There was no significant difference in lipid profile between the ischemic and hemorrhagic strokes and no significant changes between the subtypes of ischemic stroke were noted.

Conclusion: Our results suggest that the lipid profile after stroke is changed, so the lipid profile taken after stroke are not reflect clearly the state of prestroke lipid concentration.

Objective: The purpose of this study was to investigate the influence of hyperactive stretch reflexes and contralateral adductor spread on the prognosis of gait in cerebral palsy with spastic diplegia and to investigate the reflex characteristics of spastic patients according to motor development.

Method: Thirty three children with spastic diplegia were examined. Compound muscle action potentials elicited by electrical hammer were used for quantification of stretch reflexes. Clinical spasticity was evaluated with the modified Ashworth scale and re-evaluation was done at least for 18 months. The patients were classified as 3 groups according to the stage of motor development: Group I consisted of children who were unable to sit; Group II children were able to pull to stand but unable to walk independently; Group III children could walk independently more than ten steps. Reflex irradiation, amplitudes of compound muscle action potentials, amplitude ratios, and Ashworth scores were analyzed and compared between the groups. Twenty four normal infants and 18 children were examined as control.

Results: Contralateral adductor responses were elicited with patellar tendon tap stimulation in all spastic diplegic children. The amplitudes of contralateral adductor were 2.41 mV in group I, 1.75 mV in group II, and 1.21 mV in group III. The amplitude ratio of contralateral adductor to rectus femoris were 0.53 in group I, 0.40 in group II, and 0.26 in group III, respectively, and correlated with the degree of spasticity.

Conclusion: The stretch reflex responses in children with cerebral palsy with spastic diplegia were highly exaggerated, and correlated with motor development. Spread of reflexes to contralateral adductor muscle would be in clinical and electrophysiological value.

Objective: To investigate the survival rate and the prevalence of cerebral palsy in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants as well as the risk factors for the development of cerebral palsy.

Method: We reviewed medical records of 471 VLBW infants admitted to Asan medical center from 1989 to 1997 retrospectively.

Results: Ninety seven infants died before discharge from hospital, 7 died during follow-up, 55 status unknown due to discharge against medical advice, 26 discontinued follow-up. At corrected chronologic age of 2 years old, the prevalence of cerebral palsy was 10.5%, delayed development 4.5% and normal development 85.0%. Survival rate and prevalence of cerebral palsy among survivors remained statistically insignificant with time. Cerebral palsy was found in 8.5% of VLBW and 19.2% of ELBW. Decreasing gestation, abnormal neurosonographic findings, assisted ventilation, bronchopulmonary dysplasia, sepsis were risk factors associated with increased odds for cerebral palsy.

Conclusion: The prevalence of cerebral palsy in VLBW infants admitted to this hospital were comparable with recent studies from developed countries, and some of the predictors of cerebral palsy, ie, gestation period, neurosonographic findings, history of respirator use and sepsis, were also similar to those of western countries.

Objective: To determine the clinical utility of ice water test for the urodynamic study in neurogenic bladder of spinal cord injured patients.

Method: Warm water (20∼30^oC) urodynamic studies were performed on 66 spinal cord injured patients. Subsequently, ice water (4∼8^oC) urodynamic studies were performed. We determined the ice water test to be positive if the reflex volume of ice water urodynamic study is lower than the volume of the warm water urodynamic study.

Results: Ice water test was positive in 24 (55.8%) and negative in 19 (44.2%) of the 43 patients showing hyperreflexic detrusor activity in warm water urodynamic study. Ice water test was negative in all 23 cases showing areflexic detrusor activity. No significant difference was found between positive and negative ice water test groups for the level of injury, sex, age, extent of injury and duration since injury. If water was cool enough, positivity of ice water test was not affected by infusion rate. There was no difference between the two urodynamic studies of maximal bladder pressure and compliance.

Conclusion: This study suggests that ice water urodynamic study is a useful method for the evaluation of hyperreflexic neurogenic bladder activated by cold specific receptors via C afferent fibers in spinal cord injured patients.

Objective: The aims of this study were to evaluate the common gastrointestinal problems, diet and bowel care patterns, and to estimate the colon transit time in spinal cord injury (SCI).

Method: Fifteen chronic spinal cord injured persons with upper motor neuron type neurogenic bowel were studied by measuring the colonic transit time and interviews. The colon transit time was studied by using radioopaque markers.

Results: Mean total colonic transit time was 43.79 h with right colonic transit time 13.71 h, left colonic transit time 20.36 h, and rectosigmoid colonic transit time 9.71 h. The right colonic transit time was delayed in 35.7% of the subjects, left colonic transit time in 64.3%, and rectosigmoid colonic transit time in 21.4%. The common gastrointestinal problem in SCI were constipation (66.7%). The defecation difficulty (73.3%) was the most significant subjective symptom. Delayed colonic transit time was shown in 80% of perceived 'constipation' group. The average time spent for the defecation was 64.7 minutes per day. 73.3% of the subjects did not control the diet.

Conclusion: Spinal cord injured persons of upper motor neuron type neurogenic bowel in Korea showed significantly delayed colonic transit time than non SCI adults, similar delayed colon transit time as Western SCI persons who consume less fibers in daily diets.

Objective: The purposes of our study were to determine the effect of serial radioisotope renography on the diagnostic evaluation and therapeutic intervention of spinal cord injured patients and to determine the characteristics of renographic findings in spinal cord injured patients.

Method: Three hundred and two spinal cord injured patients were examined with radioisotope renography using Technetium-99m mercaptoacetyltriglycine. Forty-two of 302 patients were examined in serial studies. Intravenous pyelogram, urodynamic study, 24-hour creatinine clearance, and voiding cystourethrogram were also performed. Radioisotope renography was correlated with diagnostic procedures and therapeutic interventions. Therapeutic interventions included changes in medication and bladder management.

Results: The renal functions in the left kidney were better than the functions in the right kidney after spinal cord injury (p＜0.01). If neurogenic bladders were managed properly, renal functions improved after the shock stage of injury (p＜0.05). Patients with significant improvement in their renal function underwent changes in proper medication and methods of bladder management (p＜0.05). Renal function changes were correlated with the type of neurogenic bladder and maximal detrusor pressure (p＜0.05). No significant renal function changes were found between the groups according to the completeness of injury and gender.

Conclusion: Radioisotope renography is a good initial indicator to show problems that required management changes. Serial radioisotope renographic findings give valuable informations about the urinary tract in spinal cord injured patients.

Objective: To evaluate the usefulness of a newly devised portable cystometer to measure the pressure of bladder in a low cost and easier accessability.

Method: This study was performed in 47 patients with a conventional instrumental cystometer (Jupiter 8000, Wiest) and the newly devised portable cystometer. In the supine position, we measured the maximal intravesical pressure, abdominal pressure and bladder volume with the portable cystometer just after the measurement of the maximal detrusor pressure and bladder volume with the conventional instrumental cystometer. Paired t-test was utilized to analyze and compare the result.

Results: 1) There was no significant difference in the average maximal detrusor pressures measured by maximal intravesical pressures minus abdominal pressures, which were 38.32⁑20.97 cmH₂O by the conventional instrumental cystometer and 40.02⁑20.70 cmH₂O by the portable cystometer (p＞0.05). 2) There was no significant difference in the average bladder volumes at maximal detrusor pressure, which were 302.13⁑83.92 cc by the conventional instrumental cystometer and 314.04⁑94.17 cc by the portable cystometer (p＞0.05).

Conclusion: We conclude that there is no significant difference between the conventional instrumental cystometer and the portable cystometer in the measurement of detrusor pressure and bladder volume. We believe this portable cystometer would be a useful tool to evaluate the function of bladder in a low cost and easier accessability.

Objective: To investigate the current state of the psychological aspects for the sexual function in spinal cord injured (SCI) men and to provide a basis of sexual rehabilitation program.

Method: Seventy-seven spinal cord injured men and 87 healthy adults participated and completed Derogatis Sexual Functioning Inventory (DSFI). This questionnaire consisted of 10 subtests such as sexual information, experience, drive, attitude, psychological symptoms, affect, gender role, sexual fantasy, body image, and sexual satisfaction.

Results: Compared with healthy adults, SCI men had lower sexual experience, drive and satisfaction with a statistical significance (p＜0.05). They also had more psychological distress symptoms, negative affect, and negative body image (p＜0.05). There was no significant differences between tetraplegia and paraplegia, complete and incomplete injury, nor inpatient and outpatient. However, the SCI men with independent mobility had significantly greater sexual satisfaction, compared with the SCI men with dependent mobility (p＜0.05).

Conclusion: Most SCI men had psychologic sexual dysfuctions as well as organic problems, especially among the married men with dependent mobility. We suggest that more aggressive intervention of sexual rehabilitation need to be provided for this group.

Objective: The purpose of this study was to obtain and access baseline data and factors influencing activities of daily living(ADL) in the patients with spinal cord injury(SCI).

Method: 65 complete SCI patients who were admitted to the Wonju Christian and Severance hospital from January 1990 to february 1998 were studied. A questionnaire contained 15 items of ADL and factors such as cause, level, age and sex distribution, duration, employment status, religious status, medical payment, income source and complications. We compared each level of SCI according to each variables.

Results: The income source and employment status were associated with adjustment of ADL in patients with SCI.

Conclusion: Financial independence was the most important factor to improve adjustment of ADL in patients with SCI.

Objective: The aim of the present study was to investigate the pain intensity, quality, and pattern in experimental muscle pain.

Method: Eleven healthy adults and eleven myofascial pain syndrome (MPS) patients participated in this study. Hypertonic saline (5%) was injected into upper trapezius, infraspinatus and tibialis anterior muscles of 11 healthy adults. A continuous recording of ongoing pain intensities of the local pain and referred pain was measured. After pain had subsided, the subjects completed a Korean version of the McGill Pain Questionnaire (MPQ). This study included 11 patients who have trigger point on upper trapezius muscle. Pain pressure thresholds (PPTs) and pain intensity ratings of different pressure stimuli in upper trapezius muscles were compared with experimental group.

Results: In experimental group, local pain became maximal after one minute and referred pain after one and a half minutes. At that time, Visual analogue scale (VAS) score was 3.8 and 1.9 each other. The referred pain of upper trapezius muscle primarily radiated to the posterolateral side of neck. The one of infraspinatus muscle radiated to the shoulder joint and anterolateral side of upper arm area and the one of tibialis anterior muscle radiated to the shin and dorsum of ankle joint. The PPTs were found to be significantly lower in upper trapezius muscle of patients with myofascial pain syndrome (MPS) than in those of experimental group. The slope of VAS to different stimuli showed the linear relationship at both group, and in that of patient groups was found to be significantly steeper than in that of experimental group. The experimental muscle pain group had no difference in pain quality compared with MPS patients except affective subscale.

Conclusion: The present results suggest that intramuscular injection of hypertonic saline can be used a experimental pain model of MPS, and PPTs and pain intensity ratings of different pressure stimulus are valuable tools for quantitative description of chronic and experimental muscle pain.

Objective: This study was purposed to find the ideal carrier waveform in burst wave in Functional Electrical Stimulation (FES) for upper limbs after selection of proper site of electrode.

Method: The 10 healthy men's non-dominant hands were studied. In 5 muscles (adductor pollicis, flexor digitorum sublimis, flexor pollicis longus, extensor digitorum communis and extensor pollicis brevis), the site where electric stimulus induced the best of purposed response was selected. A burst wave contains three carrier waveforms : sine, triphasic & rectangular. The amount of mean current was measured during key grip and open motion. Discomfort of subject was scored by three degree and compared among three waveforms.

Results: The amount of mean current in key grip and open motion is lowest at triphasic wave (31.3 mA, 50.5 mA) and highest at rectangular wave (79.4 mA, 82.1 mA). For the discomfort, rectangular waveform provoke the greatest discomfort in key grip and open motion. There is no statistical difference between sine and triphasic waveform.

Conclusion: In FES of upper limbs, triangular wave can be an useful carrier waveform which require less amount of current for performing the same motion and less discomfort than rectangular or sine waveform.

Objective: To compare motor evoked potential stimulated by round coil with that stimulated by butterfly coil.

Method: Thirty control subjects were studied using magnetic stimulation by round coil and butterfly coil. Stimulation sites were cortex, cervical spine and lumbar spine. Recording electrodes were located on biceps brachii, abductor digiti minimi and tibialis anterior muscles.

Results: There were no significant differences between latencies of motor evoked potentials using round coil and those using butterfly coil in all tested muscles. In all muscles, amplitudes were significantly higher in stimulation with round coil than with butterfly coil. Above results were shown in both cortical and spinal motor evoked potentials.

There were significant correlations between latencies of motor evoked potentials, heights, and arm lengths.

Conclusion: We can record motor evoked potentials more easily with round coil than butterfly coil.

Objective: To obtain normal data of quantitative sensory test (QST) in Korean adult.

Method: The subjects were 85 normal adults aging from 30 to 69 years old, who had no abnormal sensory and neurologic problem. We performed following three QSTs on dominant side and one verbal questionnaire. 1) Semmes-Weinstein monofilament wire system (0.05 G, 0.2 G, 2 G, 4 G, 10 G, 300 G) for touch sensation, 2) Rydel-Seiffer Tuning Fork for vibration sensation, 3) TSA-2001 Thermal sensory analyser for thermal sensation, 4)University of Texas Subjective Peripheral Neuropathy verbal questionnaire.

Results: 1) Touch perception score measured with Semmes-Weinstein monofilament wire system, declined with age (p＜0.01). 2) Vibration perception score measured with the tuning fork, declined with age in foot (p＜0.01). 3) Warm sense and heat pain threshold measured with TSA-2001 thermal sensory analyser increased with age, and cold sense and cold pain threshold declined with age. 4) Weight showed negative correlation with vibration perception score in man's foot.

Conclusion: Normal data of three sensory test obtained from this study could be used for the early detection of peripheral neuropathy or loss of "protective sensation".

Objective: This study was performed to evaluate the prevalence of new neuromuscular symptoms and disabilities and the psychological characteristics-depressioin, anxiety, type A behavior, loneliness, and also to determine any relationships between physical and neuropsychological characteristics in a group of post-polio syndrome (PPS).

Method: By 70 answered questionnaire, the polio survivors were grouped into PPS and Non- PPS. This questionnaire consisted of questions about acute polio problems; new health problems, fatigue severity scale, visual analog scale, weakness scale, Frenchay activity index, ambulation disability index; socio-economic problems; neuro-psychological inventories, Beck depression index, Spielberger state-trait anxiety inventory, revised UCLA loneliness scale, type A personality score.

Results: The median time from polio to the onset of new health problems was 27.6 years. Fatigue, muscle and/or joint pain, weakness in previously affected and unaffected muscles were most common newly appearing problems. The symptoms of PPS was consistent with the distribution of the anterior horn cell; spinal cord, brain stem, cerebral hemisphere, Reticular Activating System (RAS). Neuro-psychological evaluations revealed that fatigue scale was correlated with depression, type A personality.

Conclusion: In PPS group, pain, weakness, fatigue, autonomous symptoms, decreased concentration were more serious than in Non-PPS group. The fatigue in PPS group was correlated with type A personality, depression, sleep disturbance and concentration problem.

Objective: To examine the effects of unilateral leg exercise on the contralateral leg and the cross training effect according to the training intensity.

Method: Nineteen healthy males volunteered to be subjects for this investigation and were divided into a training group (N=13) and a control group (N=6). One leg of each subject in the training group was randomly assigned to a six week, three day/week isokinetic strengthening training program for concentric knee extension-flexion performed at 60 degrees/second (group A, N=6) and 180 degrees/second (group B, N=7). The control group did not train for six weeks. The strength of the knee extensor and flexor was tested before and after the six week period training by Cybex 770 dynamometer.

Results: In both groups A and B, the training resulted in significant increase of knee extensor strength in trained limb compared to control group. However, the strength increment of untrained limb was not significant compared to control group.

Conclusion: There was no significant cross training effect following unilateral leg strength exercise.

Objective: This study was performed to evaluate the prevalence of new neuromuscular symptoms and disabilities and the psychological characteristics-depressioin, anxiety, type A behavior, loneliness, and also to determine any relationships between physical and neuropsychological characteristics in a group of post-polio syndrome (PPS).

Method: By 70 answered questionnaire, the polio survivors were grouped into PPS and Non- PPS. This questionnaire consisted of questions about acute polio problems; new health problems, fatigue severity scale, visual analog scale, weakness scale, Frenchay activity index, ambulation disability index; socio-economic problems; neuro-psychological inventories, Beck depression index, Spielberger state-trait anxiety inventory, revised UCLA loneliness scale, type A personality score.

Results: The median time from polio to the onset of new health problems was 27.6 years. Fatigue, muscle and/or joint pain, weakness in previously affected and unaffected muscles were most common newly appearing problems. The symptoms of PPS was consistent with the distribution of the anterior horn cell; spinal cord, brain stem, cerebral hemisphere, Reticular Activating System (RAS). Neuro-psychological evaluations revealed that fatigue scale was correlated with depression, type A personality.

Conclusion: In PPS group, pain, weakness, fatigue, autonomous symptoms, decreased concentration were more serious than in Non-PPS group. The fatigue in PPS group was correlated with type A personality, depression, sleep disturbance and concentration problem.

Objective: The purpose of this study was to evaluate the ultrasonographic (US) findings in the shoulder impingement syndrome and to correlate them with the Hawkins and Kennedy's clinical stages.

Method: 41 patients with suspected shoulder impingement syndrome were evaluated. All patients were divided into 3 clinical groups according to Hawkins and Kennedy and US examination was done in each group.

Results: US findings were as follows. In stage I, there were 3 normal findings, 5 tendinitis of the rotator cuff (RC), 2 partial thickness tear of RC, and 0 full thickness tear of RC. In stage II, 6 normal findings, 13 tendinitis of RC, 3 partial thickness tear of RC and 2 full thickness tear of RC. In stage III, 0 normal findings, 1 tendinitids of RC, 1 partial thickness tear of RC, and 5 full thickness tear of RC.

The most common findings in the tendinits of RC were tendon thickness, focal hypoechogenicity and calcification. In partial thickness tear of RC, focal hypoechogenicity and impingement in abduction were most common findings. In full thickness tear of RC, the irregular humeral head surface and the biceps tendon effusion were most common findings

Conclusion: The ultrasonography is a valuable means of evaluating the shoulder impingement syndrome and its findings have good correlation with clinical stages

Objective: To evaluate the effects of facet joint injection in the conservative management of osteoporotic spinal compression fractures

Method: Among 27 patients with osteoporotic spinal compression fractures which were confirmed by plain radiography and bone densitometry (dual energy x-ray absorptiometry), 9 patients were control group and 18 patients received facet joint injection treatment. Facet joint injection of thoracolumbar spine was done under fluoroscopic guide with 1% lidocaine 1 ml and triamcinolone 10 mg at each joint above and below the level of compression fracture at both side. Main outcome measures were visual analog scale (VAS), spinal movement (modified Schober's and lateral bending test), and physical activity from bed-ridden state (grade I) to outdoor activity without pain (grade V). The treatment outcomes were assessed before injection, 2 weeks and 4 weeks after injection.

Results: There were significant decrease in VAS at 2 weeks and 4 weeks after injection in the study group (p＜0.05). Physical activity was significantly improved at post injection 2 weeks and 4 weeks (p＜0.05). There were no significant differences between the two groups in spinal movement.

Conclusion: These results suggest that facet joint injection of thoracolumbar spine is useful method in the conservative management of painful osteoporotic compression fractures.

Objective: To examine the correlation between bone mineral density and intervertebral disc degeneration through retrospective study.

Method: Bone mineral density (BMD) and Magnetic resonance (MR) image of lumbar spine from 61 postmenopausal women were assessed to examine the correlation between bone mineral density and intervertebral disc degeneration. We determined BMD of lumbar spine using the dual energy X-ray absorptiometry (DEXA). And we evaluated signal intensity of intervertebral disc, disc height and disc herniation at each lumbar disc level using the MR image. The correlation between BMD (mean value of 2nd, 3rd and 4th lumbar spine BMD) and the sum of grading scores of intervertebral disc degeneration was assessed in all the patients.

Results: There was a positive correlation between BMD of lumbar spine and the sum of grading scores of intervertebral disc degeneration (r=0.415, p value=0.00087).

Conclusion: Bone mineral density has an inverse correlation to intervertebral disc degeneration and which is important when considering degenerative spinal disease and osteoporosis.

A 45-year-old man with a long history of nephrotic syndrome presented with low back pain and progressive weakness of both legs for one day. Physical examination showed an acutely ill-appearing patient with a loss of both femoral artery pulses. Immediate digital subtraction angiography of abdominal aorta revealed total occlusion of the distal abdominal aorta. Transvascular embolectomy using urokinase was undertaken 6 hours later. Digital subtraction angiography after embolectomy revealed both common ilicac arteries to be patent with good distal flow. Electrodiagnostic examinations (post embolectomy 5th and 45th day) revealed peripheral polyneuropathy of both lower extremity. Anticoagulation therapy was continued and the patient was discharged several months later. During this period, there was improvement in both lower limbs from power of grade 1 to 4 except for both ankle dorsiflexors which had not recovered.

We report a rare case of peripheral ischemic polyneuropathy of both lower extremities as the result of acute abdominal aortic occlusion.

This study was designed to evaluate the usefulness of pudendal nerve block in the dorsal approach under EMG monitoring. The patient is placed in the prone position. The location of pudendal nerve is identified using the both ischial tuberosities and greater trochanter. We have performed the pudenal nerve block with 5% phenol solution, under the EMG monitoring. The patient was able to void with percussion method. There has been no impairment in urinary continence.

We experienced an excellent effect of bilateral pudendal nerve block in the dorsal approach, under EMG montoring, using 5% phenol solution in detrusor sphincter dyssynergia of neurogenic bladder.