Objective: In a rat model of peripheral neuropathy, to determine whether neuropathic pain is related to the α-2 adrenergic receptor.

Method: The neuropathic pain was produced by unilateral transection of the superior caudal trunk between the S3 and S4 spinal nerves. These animals showed the behavioral signs of neuropathic pain in the tail. Two weeks after the neuropathic surgery, tail withdrawal responses to the mechanical stimuli with von Frey hair (2.0 g) were examined 1, 2 and 24 hrs following the administration of clonidine, α-2 receptor agonist. One week after the clonidine test, the same behavioral test was done after the administration of clonidine along with yohimbine, α-2 receptor antagonist.

Results: Clonidine significantly reduced the frequency of tail response and yohimbine reversed the clonidine-induced anti-allodynic effect.

Conclusion: These results suggest that neuropathic pain is related to the sympathetic nervous system via α-2 adrenergic receptor.

Objective: This study involves an experiment using functional magnetic resonance imaging (fMRI) to delineate neural network and laterality of language related brain activation for spoken and written Korean words in normal adults.

Method: Eight normal right-handed Korean males, aged 20∼33 years, were investigated. Language tasks consisted of auditory and visual verb generation tasks. In fMRI, twenty slices were obtained for each functional volume using single shot echoplanar image sequences. Data were motion corrected, coregistered, normalized, and statistically analyzed using SPM-96 software. The number of activated voxels were counted in each hemisphere to calculate the laterality index according to each language task.

Results: In auditory verb generation task, inferior frontal gyrus and superior temporal region were activated in the left side. Right temporal lobe was also activated in the superior and middle temporal areas. Other activated area included medial frontal lobe. Lateralization index of auditory verb generation task was ⁢78.6⁑30.7. In visual verb generation task, inferior frontal gyrus was activated in the left side. Medial frontal lobe, both lateral occipital lobe, and left parietal lobe were also activated. The laterality index was ⁢87.6⁑10.1.

Conclusion: We could delineate cortical regions subserved for spoken and written Korean language and laterality of language related brain activation using fMRI. These results can contribute to understand underlying mechanism of language disorders in brain injury patients and to investigate the pattern of reorganization of language network after rehabilitation.

Objective: To identify the clinical characteristics of the patients with hypoxic-hypotensive brain injury (HBI) and to compare the prognosis of HBI with patients with traumatic brain injury (TBI).

Method: Six patients with HBI and sixteen patients with TBI, who had been comatose for more than 8 hours, were enrolled. The functional status was evaluated by the Functional Independence Measure (FIM) score.

Results: The causes of HBI were: two respiratory arrest, three cardiac arrest, and one hypotensive shock. Most patients had memory disturbance, confusion, spasticity, contracture of joints, and weakness after the HBI. Other problems included dysphagia, ataxia or tremor, dementia, and concomitant medical problems. Among these clinical features, confusion and spasticity were serious obstacles in rehabilitation. The HBI patients had lower initial and discharge total FIM score, total FIM gain, total FIM efficacy, cognitive FIM efficacy, and motor FIM efficacy than the TBI patients. The HBI patients had a poor outcome due to more widespread brain damage, medical complications, and delayed rehabilitation treatments as compared with TBI patients.

Conclusion: We concluded that HBI patients had more diffuse and severe deficit than TBI patients.

Objective: To evaluate the effect of methylphenidate on cognitive function especially on working memory and visuospatial attention in the patients with traumatic brain injury (TBI).

Method: Eighteen subjects, 16 males and 2 females, with TBI were enrolled. Their mean age was 34.2 years old. A double-blind placebo-controlled study was designed. The baseline cognitive assessment was performed before the administration of drug. Two days after the baseline study, 20 mg of methylphenidate or placebo was administered. The second cognitive assessment was performed 2 hours after the treatment. The follow-up assessment conducted two days after the second test. Cognitive assessments consisted of 'one-back working memory task' and 'endogenous visuospatial attention task', designed using SuperLab Pro 2.0^Ⱂ software.

Results: In one-back working memory test, there was significant improvement of response accuracy in methylphenidate group in comparison with placebo group (p＜0.01). Significant shortening of reaction time was also seen after the administration of drug in methylphenidate group (p＜0.05). In endogenous visuospatial attention test, significant improvement of response accuracy was noticed after the administration of drug in methylphenidate group (p＜0.05).

Conclusion: These results demonstrated that the administration of methylphenidate was beneficial in improving cognitive function following TBI. The effect was prominent in the accuracy of working memory.

Objective: To evaluate the results of driver training program for the handicapped.

Method: Retrospective study on the 699 disabled who participated in the two-months driver training program at the NRC (National Rehabilitation Center) from January 1995 to May 1998.

Results: 1) Of these subjects, 70.4% were men and 29.6% were women. 2) According to the disability grading system by the Ministry of Health and Social Welfare of Korea, 19.2% of the subjects had the first grade disability, 28.2% the second grade, 26.3% the third grade, 18.3% the fourth grade, 6.3% the fifth grade, and 1.4% the sixth grade. 3) The licensing rate was 74.6% for the first grade, 64.7% for the second grade, 70.9% for the third grade, 73.6% for the fourth grade, 55.8% for the fifth grade, and 70% for the sixth grade. 4) The licensing rate was the highest in the subjects with spinal cord injury (79.2%) and the lowest in the subjects with stroke (45.0%). 5) Overall, 78.2% of subjects licensed with automatic transmission and 21.8% with hand- control. On the other hand, in the subjects with spinal cord injury, 42.5% licensed with automatic transmission and 57.5% with hand-control.

Conclusion: The mean licensing rate of this program was 69.2%. Further study is required for the effect of cognitive function on driving test and various driving aids to promote the licensing rate for the handicapped.

Objective: To determine allele frequencies of apolipoprotein (Apo) E according to the type of stroke in Korean and to investigate the relationship between the Apo E genotype and serum lipid profile as well as outcome after stroke.

Method: Fifty-eight stroke patients admitted between January and December 1999 were enrolled. The serum concentrations of total cholesterol, triglyceride, and HDL-cholesterol were measured. The LDL-cholesterol concentration were calculated by Friedwald formula. Apo E genotypes were determined by polymerase chain reaction (PCR) and polyacrylamide gel electrophoresis (PAGE). The outcome of stroke was measured by functional independence measure (FIM) scores.

Results: Most frequent Apo E genotype was E 3/3 (72%), followed by E 3/4 (17%), E 2/3 (9%) and E 2/2 (2%). The level of total serum cholesterol and LDL-cholesterol were lower in the stroke patients who have ε2 allele in comparison with the patients without that allele. ε4 allele does not influence on the outcome of stroke patients measured by FIM.

Conclusion: Most frequent Apo E genotype was E3/3. ε2 allele influenced on the serum cholesterol level in stroke patients. However, ε4 allele does not correlate with worse prognosis in stroke patients in this study.

Objective: To evaluate the immediate effect of neuromuscular electrical stimulation in reducing spasticity and to compare antispastic effect of low frequency electrical stimulation with that of high frequency electrical stimulation.

Method: The subjects were 10 hemiplegic patients with stroke (n=7) and traumatic brain injury (n=3) and double blind test was used. For three days, one of sham, 30 Hz and 99 Hz electrical stimulation was respectively applied to rectus femoris and hamstring muscles at random order once a day. The evaluation of spasticity was done by using the Modified Ashworth scale, beats of ankle clonus, F/M ratio and relaxation index of knee by pendulum test before and after electrical stimulation.

Results: The result of the study revealed statistically significant immediate decrement of spasticity in hemiplegic patients after electrical stimulation, but there was no statistical different effect according to the frequency of electrical stimulation.

Conclusion: Neuromuscular electrical stimulation is useful in reducing spasticity. Further investigation to assess the long therapeutic effect of low and high frequency electrical stimulation will be needed.

Objective: The aim of this study was to develop objective evaluation method of spasticity which reflects the characteristics of lengthening velocity-dependent stretch reflex of spasticity.

Method: Kinematic analysis for knee angle and rectus femoris muscle lengthening parameters, and dynamic EMG were performed simultaneously during pendular movement of spastic lower leg for thirty two patients with spasticity and ten normal control subjects. Angular parameters consist of angular relaxation index (ARI), maximal angular velocity (MAV), angular threshold (AT) and angular velocity threshold (AVT). And lengthening parameters consist of lengthening relaxation index (LRI), maximal lengthening velocity (MLV), lengthening threshold (LT) and lengthening velocity threshold (LVT).

Results: 1) ARI, MAV, AT, and AVT according to Modified Ashworth scale (MAS) were 1.32⁑0.11, 303.84⁑45.11 deg/sec, 44.19⁑13.81 deg, 262.15⁑33.54 deg/sec in MAS I, 1.16⁑0.16, 279.92⁑42.94 deg/sec, 30.33⁑6.02 deg, 247.65⁑35.92 deg/sec in MAS II, and 0.95⁑0.14, 241.31⁑19.98 deg/sec, 20.55⁑2.68 deg, 209.11⁑48.11 deg/sec in MAS III (P＜0.05). 2) LRI, MLV, LT, and LVT according to MAS were 1.27⁑0.11, 0.58⁑0.07, 1.164⁑0.14, 0.53⁑0.05 in MAS I, 1.12⁑0.09, 0.53⁑0.05, 1.150⁑0.08, 0.42⁑0.04 in MAS II, and 0.99⁑0.10, 0.44⁑0.01, 1.137⁑0.15, 0.36⁑0.02 in MAS III (P＜0.05). 3) There were significant correlation between various pendulum test parameters and MAS.

Conclusion: Muscle lengthening parameters as well as knee angular parameters were sensitive parameters reflecting the degree of spasticity. LVT is the most sensitive parameter among all parameters (p＜0.01).

Objective: The present study was undertaken to determine the value of developmental assessment, multimodality evoked potentials, brain magnetic resonance image (MRI) and electroencephalography (EEG) and to identify correlations between each evaluation.

Method: Developmental assessments such as Bayley scales of infant development and Vineland social maturity scale, brain MRI, EEG and evoked potentials findings were evaluated in 45 children with spastic cerebral palsy to assess the developmental level and abnormalities of the anatomical structure of the brain and to elucidate the relationship between the test methods.

Results: 1) Mean mental developmental index (MDI) and psychomotor developmental index (PDI) were 69.6 and 68.6, respectively and mean Vineland social maturity quotient (SQ) was 76.1 and there was a significant correlation between the MDI, PDI, and SQ in cerebral palsied children. 2) Abnormal findings of brain MRI and EEG were found in 73.3% and 44.4% of the cases, respectively. 3) There was significant correlation between findings of brain MRI, auditory evoked potentials, visual evoked potentials, median somatosensory evoked potentials and social quotient.

Conclusion: Developmental assessment, multimodality evoked potentials, EEG, and brain MRI would be a useful method to evaluate the maturity of brain and estimate the level of development.

Objective: The purpose of this study is to survey the health and functional status of adult cerebral palsy.

Method: This study included 47 patients who have cerebral palsy between the ages of 20 and 45 years. We evaluated the functional status by the interview and questionnaire, the medical status including a detailed medical history, with emphasis on the musculoskeletal system.

Results: 1) In the functional status, the number of non-functional ambulator increased from ten cases (21.3%) to fourteen cases (29.8%) in proportion to the incidence of fracture. 2) In the medical status, thirty-seven cases (78.8%) had more than one musculoskeletal complaint. Twenty-three cases (48.9%) had gastric discomfort, twenty-five cases (53.2%) had dental caries and thirty cases (63.9%) had speech disturbance. 3) Only eleven cases (23.4%) had undergone the comprehensive rehabilitation.

Conclusion: To prevent and minimize the physical disabilities and musculoskeletal complications of adult cerebral palsy, we need more active medical intervention, active research on the methodology and comprehensive rehabilitation.

Objective: To investigate the effects of dynamic (hinged) and solid ankle-foot orthoses (AFO) on the gait characteristics in spastic cerebral palsied children and to find out which AFO has a more beneficial effect on correcting the abnormal gait pattern in those children.

Method: The subjects were 40 children with spastic cerebral palsy (CP) who were able to walk independently without walking aids. Their ages were ranging from 2 to 12 years. Children were randomly prescribed to dynamic or to solid AFO. Twenty-four children got solid AFO and 16 children got hinged AFO. Gait characteristics were evaluated by computer based kinematic gait analysis while they were walking with AFO and on barefoot. Gait characteristics on barefoot and with hinged AFO and with solid AFO respectively were compared.

Results: Temporospatial parameters while walking on barefoot were not significantly different from those while walking with AFOs. While walking with hinged AFO, the maximal knee extension angle during stance phase was decreased in comparison with that on barefoot (p＜0.05). Ankle dorsiflexion angle on hinged AFO was increased throughout the gait cycle (p＜0.05). While walking with solid AFO, ankle dorsiflexion angle at initial contact, at 98% of gait cycle and at maximal ankle dorsiflexion angle in stance phase were increased in comparison with that on barefoot (p＜0.05). There was no significant difference of changes after wearing orthoses between hinged and solid AFO.

Conclusion: Both types of AFOs exerted a positive effect on ankle motion, not in knee or hip joints in the children with spastic cerebral palsy. The gait characteristics during walking with both AFOs were not significantly different, even if the hinged type might be more effective in preventing knee hyperextension in stance phase and in improving maximal ankle dorsiflexion during the swing phase.

Objective: To describe the characteristics of specific swallowing abnormalities in children with cerebral palsy and identify the risk factors related to aspiration via videofluoroscopy.

Method: Thirty-one children with cerebral palsy, aged from 1.3 years to 15.5 years, were investigated. After taking feeding history and physical examination, videofluoroscopic swallowing studies (VFSS) were performed according to the modified Logemann's protocol with liquid and puree mixed with barium. The swallowing patterns of oral and pharyngeal phase and presence or absence of aspiration were observed.

Results: In VFSS, children with cerebral palsy showed oral phase abnormalities in 87.1% (27/31) including impairment of bolus formation, food pocketing and pharyngeal phase abnormalities in 83.9% (26/31) including pooling in valleculae, weak pharyngeal peristalsis.

Conclusion: The majority of children with cerebral palsy evaluated in this study had swallowing abnormalities. The main swallowing impairments were tongue movement in oral phase and pharyngeal peristalsis in pharyngeal phase.

Objective: Athetoid cerebral palsy is a nonprogressive disorder, due to hypoxic injury or jaundice in basal ganglia, characterized by impairment of postural reflexes, arrhythmical involuntary movements, and dysarthria. Dysarthria is a group of motor speech disorder resulting from a disturbance of motor control of the speech mechanism. The purpose of this study is to evaluate the acoustic characteristics of dysarthria in athetoid cerebral palsy.

Method: We investigated the acoustic characteristics of dysarthria in 8 male patients with athetoid cerebral palsy and 6 males as a control group using Computerized Speech Laboratory (i.e., Multi-Dimensional Voice Program (MDVP), Visi-Pitch, and Electroglottography) and Nasometer.

Results: In the MDVP analysis, average fundamental frequency, jitter, and shimmer are significantly increased in patient group as compared to control group (p＜0.05). In the Visi-Pitch analysis, maximal phonation and diadochokinetic rate are significantly decreased in patient group (p＜0.05). The athetoid cerebral palsied patients have many pitch breaks. Nasalance is not significantly decreased in patient group in comparision with control group.

Conclusion: We think that average fundamental frequency, jitter and shimmer are increased and maximal phonation time and diadochokinetic rate are decreased in athetoid cerebral palsied patients.

Objective: In patients with a history of acute paralytic poliomyelitis, late progressive muscle weakness, fatigue, pain may arise, a symptom complex of known as post-poliomyelitis syndrome (PPS). Dysphagia may also develop in some PPS patients. The purpose of this study was to assess the presence of is swallowing difficulty in polio survivors and to describe the nature of the swallowing difficulty.

Method: Polio survivors answered the questionnaire pertaining to swallowing function and received a videofluroscopic evaluation of the oral and pharyngeal phases using 3 consistencies of material: liquid barium; semisolid barium paste; boiled yolk of an egg coated with barium.

Results: Of the 16 subjects, 8 had subjective symptoms of swallowing difficulties. All of the 6 PPS patients, regardless of whether they had symptoms of swallowing difficulties, had some abnormal oropharyngeal function through video fluoroscopic swallowing study.

Conclusion: In patients with post-polio syndrome, there is progressive deterioration of swallowing functions similar to that in the muscles of the limbs. This swallowing dysfunction is not related with their subjective symptoms.

Objective: To investigate the influence of five different recording electrodes on the various parameters of sensory nerve action potentials (SNAPs).

Method: Median sensory nerve conduction study was performed in 50 normal subjects using different five types of recording electrodes-disc electrode, ring electrode, bar electrode and two kinds of felt-tip bar electrodes (type 1 and 2). The interelectrode distances between active and reference electrodes were set at 4 cm for the disc and ring electrodes. The bar electrode, felt-tip electrodes type 1 and 2 were fixed at interelectrode distances of 3 cm, 3.7 cm and 2.3 cm, respectively. Onset and peak latency, onset to peak amplitude, peak to peak amplitude and duration of negative spike of SNAPs were measured. These parameters were compared using ANOVA test.

Results: Onset and peak latencies of SNAPs recorded from five different electrodes were not different (p＞0.05). Onset to peak and peak to peak amplitudes of SNAPs recorded from felt-tip type 2 electrode were significantly reduced compared to other electrodes (p＜0.05). Onset to peak amplitude of SNAPs was also reduced when the ring electrode was used (p＜0.05). The negative spike durations of SNAPs recorded from felt-tip type 2 and bar electrodes were shorter than other electrodes recording (p＜0.05).

Conclusion: Onset and peak latencies of SNAPs were not affected by the types of electrodes used. Shortening of interelectrode distance may be a main cause of reduction of peak to peak amplitude and negative spike duration of SNAPs.

Objective: To investigate the reliability of distoproximal latency ratio of median sensory nerve as a diagnostic criterion of carpal tunnel syndrome (CTS) in patients with diabetic polyneuropathy.

Subject: Electrophysiologic study was performed in 264 hands of 208 patients with diabetes. Forty eight hands (24 subjects) without diabetes mellitus or CTS were included as a normal control group. Another 48 hands having CTS without diabetes mellitus were also included as a CTS control group.

Method: Clinical and electrophysiologic findings were included to detect carpal tunnel syndrome in patients with diabetic neuropathy. Sensitivity and specificity of various electrodiagnostic parameters to confirm clinical CTS were obtained.

Results: Diabetic neuropathy was diagnosed in 66.3%, and median neuropathy was diagnosed in 52.7%. CTS was found in 32.2% as determined by the distoproximal latency ratio. The sensitivity of distoproximal latency ratio as a diagnostic tool for CTS was the highest (95.1%) and the specificity was the second highest (51.3%) among 5 different electrodiagnostic criteria of CTS.

Conclusion: The results suggest that distoproximal latency ratio is an important parameter with high sensitivity in determining CTS in the patients with diabetic polyneuropathy.

Objective: To determine if stretching the sciatic nerve in control and patients with lumbosacral radiculopathy significantly alters F-wave parameters.

Method: We studied F-waves in the deep peroneal & posterior tibial nerves of 20 patients with unilateral lumbosacral radiculopathies and 22 controls. F-waves were recorded bilaterally in the neutral position and supine in 30^o & 60^o straight leg raising (SLR). F-wave parameters included minimal latency (F min), maximal latency (F max), mean latency (F mean), latency difference between F min and F max (chronodispersion), mean duration (F dur) and side to side difference in F min, F max, F mean and F dur.

Results: In controls, the F-wave latency was found to be longer in supine with SLR than in neutral position. In patients with lumbosacral radiculopathy, significant differences of F max, F mean and F dur between sides during 30^o SLR were noted in the deep peroneal nerves, but all parameters in the posterior tibial nerves during SLR were not changed.

Conclusion: In this study, we observed significant changes in F-wave latency in control during straight leg raising, but no significant changes in patients with lumbosacral radiculopathy. For the clinical application to lumbosacral radiculopathy, further study is needed.

Objective: To compare current perception threshold with nerve conduction study, we measured current perception threshold (CPT) in healthy control and patients with carpal tunnel syndrome (CTS).

Method: Twenty control subjects and twenty patients with CTS were included. Latency and amplitude of median and ulnar motor and sensory nerves were measured. The sensory current perception threshold was measured at the distal interphalangeal joint of third and fifth fingers and the palm with electrical current of 5 Hz, 250 Hz, and 2,000 Hz in frequency. We compared the results of the nerve conduction study with the data of the CPT.

Results: We found that measuring of the sensory threshold might detect carpal tunnel syndrome, especially with 2,000 Hz and 250 Hz stimulation and that CPT data correlated to sensory latency and amplitude of the median nerve.

Conclusion: The sensory threshold test might be useful for diagnosis and follow up test in carpal tunnel syndrome.

Objective: To determine the functional outcomes of the patients with total hip replacement and to evaluate the variables associated with the functional recovery.

Method: Subjects were 188 patients, who had undertaken total hip replacement between March 1, 1997 and July 31, 1999 at Asan Medial Center. The four functional milestones including sitting, standing, 50 m walking, and climbing stairs were evaluated.

Results: The average duration of treatment was 8.3⁑7.0 days, and the days required for sitting were 1.9⁑1.0; standing 2.4⁑1.8; walking 50 m 6.4⁑4.3; climbing stairs 7.9⁑4.5 days. In results of analysis of each variable, male patients showed faster functional improvement than female patients in standing and climbing stairs. The patients of age 60 years and over had slower recovery in sitting and standing. The patients with sequelae of septic hip or Legg-Calve-Perthes disease had slower recovery than the others in standing. The patient with the use of cement showed rapid improvement in sitting and standing. Those who could bear full weight had rapid recovery than those with partial weight.

Conclusion: We would like to suggest that careful consideration on characteristics of each patient should be given in determining the duration of rehabilitation management of the patients who had total hip replacement.

Objective: To determine the therapeutic efficacy of fluoroscopic and electrical stimulation guided perineural selective nerve root injection in cervical radiculopathy patients.

Method: The gold standard of the diagnosis of cervical radiculopathy was based on clinical features, MRI and electrodiagnostic findings. Considering the natural regression of pain in cervical radiculopathy, only patients (n=27, 14 male and 13 female) who had suffered from persisting or aggravating pain for at least 6 weeks or longer duration after the onset of symptoms, were received a selective nerve root injection (SNRI) of steroids to a target nerve root.

Patients were followed up at 2 weeks and 2 months, and interviewed via telephone or re-examined at an average of 37.8 weeks 68 weeks after injection by a independent physician. Criteria for a successful outcome were greater than 50% reduction of pain on visual analogue scale and an ability to return to previous level of function.

Results: High proportion of patients reported a successful outcome at 2 weeks (88.9%, 24 of 27 patients). Twenty-two of twenty-four patients reported the outcome at 2 months and 20 of 22 patients were followed up for an averrge period of 37.3 weeks. Among these 20 patients 19 patients satisfied with the result of SNRI at an average follow up period of 68 weeks. There was no significant difference of the efficacy according to the duration of the symptoms. There were no complications in any of the patients after injections.

Conclusion: Fluoroscopic and electrical stimulation guided selective nerve root injections of corticosteroids were an effective and safe treatment modality in cervical radiculopathy. These could be considered as a first line treatment before a surgical intervention in whom another conservative treatments are not effective.

Objective: The goal of this study was to compare the therapeutic and the functional value between translaminar approach and transforaminal approach of epidural steroid injection in patient with refractory radicular pain.

Method: Among 31 patients with unilateral herniated nucleus pulposus (HNP) which was confirmed by physical examination and magnetic resonance imaging (MRI), 17 patients received a transforaminal approach and 14 patients received a translaminar approach. All patients were evaluated by independent observer and were checked by visual analogue scale (VAS), functional score before and 1 day, 2 weeks and 4 weeks after injection.

Results: The VAS of transforaminal approach was significantly lower than that of translaminar approach after 2 weeks and after 4 weeks (p＜0.05), although there were no statistical difference before and 1 day after injection. The functional score of transforaminal approach was significantly higher than that of translaminar approach after 4 weeks (p＜0.05), although there were no statistical difference before and 1 day, 2 weeks after injection. The translaminar approach needs more frequent injection (p＜0.05).

Conclusion: This study suggests that both translaminar approach and transforaminal approach could be valuable to the initial management of refractory radicular pain, but the duration of therapeutic effects was relatively short in translaminar approach. Transforaminal approach will be the promising treatment of refractory radicular pain, because it has better therapeutic efficacy, safety and longer duration of therapeutic effects than translaminar approach.

Objective: This study is designed to compare the therapeutic effect of continuous epidural injection with catheter and intermittent epidural injection without catheter in the patients with low back pain.

Method: One hundred and nine patients with low back pain were randomly divided into two groups. First group (49 patients) were treated with two or three times of intermittent epidural injections with steroid mixed with local anesthetics. Second group (60 patients) were treated with continuous steroid mixed with local anesthetics injection through epidural catheter. The effect of the epidural injections was assessed by visual analog scale (VAS) at pre-injection and post- injection.

Results: Pre- and post-injection VAS scores of the first group were 6.5⁑1.2 and 3.5⁑1.5, respectively. Pre- and post-injection VAS scores of the second group were 6.2⁑1.6 and 2.3⁑1.1, respectively. VAS score changes between pre-and post-injection were significant (p＜0.01) in both groups. VAS score changes between two groups were greater (p＜0.01) in the second group. The more severe the disc herniation (protrusion and extrusion) in MRI finding, the more marked VAS score changes in the second group. When morbidity period was less than 1 year, the VAS score changes in the second group were greater (p＜0.05).

Conclusion: The therapeutic effect of catheter inserted continuous epidural injection is better than that of intermittent epidural injection in patients with low back pain.

Objective: To evaluate the efficacy of intra-articular hyaluronic acid and steroid injection in osteoarthritis of the knee.

Method: Among 653 patients with osteoarthritis, 531 patients were participated in this study. They were divided to three groups; A, treated with hyaluronic acid 2.5 ml intra-articular injection once a week for 5 times; B, hyaluronic acid 2.5 ml once a week for 5 times with triamcinolone 20 mg once at the first time; C, only triamcinolone 20 mg at the first time. Before injection, X-ray with standing view were checked and divided according to Kellgren's grade of osteoarthritis. The amount of pain relief was assessed by pain rating score (PRS) and visual analogue scale (VAS) 1 week before and 1 month after the treatment.

Results: The degree of pain relief by PRS and VAS were all improved at 1 month after injection compared with pre-injection status (p＜0.001). Intra-articular hyaluronic acid injection was more effective in Kellgren's grade I, II than in III, IV in pain relief and hyaluronic acid with steroid injection was more effective in III, IV.

Conclusion: The results suggest that intra-articular hyaluronic acid injection would be effective for the treatment of patients with osteoarthritis.

Objective: To investigate the relationship between the curvature of the cervical spine and various clinical parameters and to identify the validity of new curvature measurement methods.

Method: The cervical spine curvature was assessed on lateral view of plain radiographs by three measurement indices. Index 1 is the ratio of length of line drawn by C2-C7 posteroinferior points and the longest length of vertical line to the posterior curve of C2-C7. Index 2 is the angle formed by three points of index 1. Index 3 is the sum of each distance from line drawn by C2-C7 posteroinferior point to C3-C7 posterior mid-points. The difference of each group and the relationship between pain scale and three indices were statistically analyzed by t-test and Pearson's correlation test.

Results: Sixty-three percent of control group patients showed a straight or kyphotic curvature and younger women group was more likely to have a straight curvature than other age groups. The newly designed measurement methods reflect the diagnostic significance of cervical curvature type measurement. Cervical lordosis did not exactly correlate with pain scale, symptom duration and the difference of clinical diagnosis. But the patients showing interval changes of pain scale were revealed the correlative change of curvature indices with each correlation coefficient of ⁣0.43, ⁣0.69 and ⁣0.55 respectively.

Conclusion: The altered cervical curvature is less valuable for the diagnostic significance and did not relate to the pain scale and duration, but cervical curvature reflect the interval change of the pain scale.

Objective: To evaluate working condition in way of measuring working posture and muscle tension using the desktop personal computer and notebook personal computer having different screen height.

Method: Seventeen healthy men performed wordprocessing task in three workstation: desktop PC on the conventional computer table (DPC (on)); desktop PC under the 'inside' type computer table (DPC (under)); notebook PC on the table (NPC). The viewing distance and angle, head and neck angle, thoracic bending and trunk inclination were measured. Muscle tension of right posterior neck muscle, upper trapezius, sternocleidomastoid (SCM), and upper back muscle was also measured by integrated electromyogram (IEMG).

Results: 1) The viewing distance was the longest in DPC (under). 2) The lower the screen height, the more downward viewing angle and more flexed position in upper neck. 3) The posterior neck muscle tension was the lowest in DPC (on). 4) Stooped position was most frequently seen in NPC and the highest tension of posterior neck muscle and upper back muscle was shown in NPC. 5) In relation between postural analysis and muscle tension, muscle tension decreased with increasing backward reclining position, and the neck and thorax became more erect with increasing in viewing distance.

Conclusion: These results suggest that the stooped posture was worst and most frequently seen in NPC. If neck flexion is avoided, DPC (under) position could lessen the visual and musculoskeletal problem. More Ergonomical study would be needed about working posture using computer.

Objective: To investigate the deficit of static and dynamic postural control in patients with chronic ankle sprain using dynamic posturography.

Method: Twenty patients with unilateral recurrent ankle sprain and functional instability were assessed by Samsung medical center ankle injury score and by computerized dynamic posturography (EquiTest^Ⱂ system, Neurocom^Ⱂ, international, INC; USA).

The posturography test was performed 3 times at 6 different simulated conditions such as fixed of force platform/open eyes/fixed of screen (condition 1), fixed/closed/fixed (condition 2), fixed/open/movement (condition 3), sway/open/fixed (condition 4), sway/closed/fixed (condition 5), sway/open/movement (condition 6). We evaluated anteroposterior sway of center of gravity of the patients and calculated equilibrium scores. We compared the equilibrium scores of patient group and normal data reported previously. We also compared the equilibrium scores of two subgroups of the patients according to severity of ankle injury.

Results: Patients showed significantly low equilibrium scores than normal one at the condition 4, 5 and 6 (p＜0.05). The group B with severe ankle injury revealed low equilibrium scores at the condition 4, 5 and 6. Especially the group B showed statistically significance at condition 5 (p＜0.05).

Conclusion: Patients with chronic ankle sprain showed the deficit of dynamic postural control due to the proprioceptive dysfunction of injured ankle than normal person.

Objective: The purpose of this study was to determine the usefulness of manual medicine therapy in adhesive capsulitis of shoulder.

Method: Twelve patients with adhesive capsulitis of shoulder were treated with the muscle energy technique of Greenman in manual medicine therapy. The muscle energy technique of Greenman was repeated 6 times for each subject. The therapeutic effect of manual medicine therapy was assessed by the shoulder range of motion (ROM) and visual analogue scale (VAS) before and after the treatment. Two patients took the fluoroscopic examination before and after the treatment.

Results: After the manual medicine therapy, active range of shoulder motion were increased by 30.0^o in forward flexion, by 21.2^o in abduction, by 11.2^o in external rotation, and by 18.7^o in internal rotation, respectively. The visual analogue scale was decreased after treatment. None of the subjects complained pain during treatment. The mobility of shoulder joint was improved and the rhythm of scapulohumeral joint was restored.

Conclusion: The manual medicine therapy is an effective, tolerable and noninvasive treatment method for the painful adhesive capsulitis of shoulder.

Fumarase catalyzes the conversion of fumarate to malate in the Krebs cycle. Fumarase deficiency is a rare inborn error of metabolism and is inherited in an autosomal recessive manner. It causes mitochondrial encephalomyopathy. The symptom is characterized by developmental delay and hypotonia.

We report here a case of a 32-month-old child who was initially refered because of spastic quadriplegia, delayed development and poor feeding.

The musculocutaneous nerve has a short course and is deeply placed before piercing the coracobrachialis muscle at the point where it is relatively fixed by branches along its course between biceps brachii and brachialis muscles. Therefore, an isolated palsy of the musculocutaneous nerve is extremely rare and usually caused by stab, cut or bullet injuries. An isolated musculocutaneous nerve palsy, sparing the coracobrachialis muscle, can occur after heavy exercise of the arm musculature and has a good prognosis. We report a patient with an isolated musculocutaneous nerve palsy caused by motorcycle accident.

Os odontoideum is a rare anomaly of the second cervical vertebrae, which is a separated ossicle from the body of the axis. This abnormality of the odontoid process can result in an atlanto-axial instability & subsequent cervical cord compression. In spite of the high prevalence of atlanto-axial instability due to the ligamentous laxity of atlanto-axial joint, the frequency of neurologic symptoms is relatively low in the patient of the Down syndrome. The asymptomatic atlanto-axial instability by trauma may progress to Os odontoideum in Down syndrome population and may cause cervical cord compression. Therefore, early recognition and an appropriate management of patients with atlanto-axial instability can significantly reduce the morbidity and mortality.

We report a case of Os odontoideum in a child with Down syndrome, who had an atlanto-axial instability which resulted in the cervical cord compression.