Objective: Botulinum toxin works at the neuromuscular junction by inhibiting the release of acetylcholine from the presynaptic membrane. It has been indicated for limb spasticity in patients with upper motor neuron lesions. The paralytic effect of this toxin usually lasts for 3 to 4 months, and repeated injections are needed to maintain the effect. This study was performed to investigate whether electrical stimulation can prolong the paralytic effect induced by botulinum toxin type A.

Method: Ninety male Sprague-Dawley rats, 30 for control and 60 for experimental, were studied. Botulinum toxin type A (Dysport^Ⱂ) was injected into the gastrocnemius muscle in the experimental groups (10 units for group 1 and 5 units for group 2), and normal saline 0.05 ml was injected into the same muscle in the control group. Thirty minutes of electrical stimulation was applied to the injected muscle with surface-stimulating electrodes. The stimulation was given once a day for 3 times in subgroup E1 and once every other day for 6 times in subgroup E2. No electrical stimulation was applied to subgroup N. Amplitudes of action potentials were measured serially on the injected muscles. At the third week, hematoxylin-eosin stained sections and synaptophysin immunohistochemical stained sections were examined.

Results: 1) At the second week after the toxin injection, amplitudes of action potentials maximally declined to 2.1∼3.7% in group 1 and to 4.0∼5.3% in group 2, compared to the initial amplitude. The amplitudes were beginning to recover from the third week. 2) Electrically stimulated groups demonstrated significantly more depressed amplitudes than non-stimulated group N. These effects lasted till week 2∼4. 3) Hematoxylin-eosin staining for muscle sections showed degenerative changes of muscle fibers. Synaptophysin immunoreactivity in the muscle demonstrated multiple synaptophysin-positive areas in a muscle fiber of the toxin injected muscle.

Conclusion: Transient electrical stimulation to the botulinum toxin injected muscles seems to enhance the paralytic effects of the toxin.

Objective: The purpose of this study was to evaluate the anti-inflammatory effect of steroid in the neuroma plays a key role in the development of neuropathic pain.

Method: Materials consisted of 21 male Sprague-Dawley rats (8 weeks old, 180∼200 g), which were divided into a steroid (n=9) and control group (n=12). Neuropathic pain was produced by unilateral transection of the superior caudal trunks at the level between the S3 and S4 spinal nerves. We compared two groups of rats, the steroid group injecting 1 ml (40 mg) of Methylprednisolone (Depo-Medrol), and the control group injecting 1 ml of nomal saline on operation site just after operation.

Behavioral reactions to mechanical allodynia were checked using a von Frey hairs of 2.0 g (19.6 mN) bending force at pre-operation, post-operative 1, 4, 7, 10 & 14 day to evaluate the steroid effect on the development of neuropathic pain.

Results: The steroid group exhibited less tail-flick frequencies to mechanical stimulation: 14.8⁑17.0%, 28.1⁑18.3%, 38.1⁑28.3% at post-operative 4, 7, 10 days respectively in control group; 30.3⁑21.2% 43.6⁑21.3%, 47.2⁑20.8% at post-operative 4, 7, 10 days, respectively. But there was no significant difference between both groups at post-operative 14 days. The steriod reduced the pain at early stage of neuropathic pain development, but failed to decrease the pain level in late stage.

Conclusion: These results suggest that the steroid induced anti-inflammatory effect in the injured neuroma is not a key factor in the development of neuropathic pain.

Objective: The purpose of this study were to investigate the temporospatial, kinematic data and energy consumption in hemiplegic patients according to the types of ankle-foot orthosis (AFO), and to determine the most effective type of AFO for gait training.

Method: A prospective study was performed for 10 patients with hemiplegia who was able to walk independently at indoor level. The temporospatial, kinematic data and energy consumption were compared in each five different conditions: 1) barefoot, 2) donning AFO with posterior leaf spring (PLS), 3) donning PLS with the distal part of metatarsal head trimmed off (PLS-C), 4) donning hinged PLS (HPLS), 5) donning hinged PLS with the distal part of metatarsal head trimmed off (HPLS-C).

Results: With four types of PLS, maximal ankle plantar flexion was significantly decreased, however we didn't find any difference in kinematic data of the pelvis and hip as compared with barefoot and with PLS, HPLS, HPLS-C and maximal knee extension angle was significantly decreased compared with barefoot. With HPLS-C, cadence and walking speed significantly increased and double support time and oxygen cost significantly decreased as compared with barefoot.

Conclusion: This study showed increased walking speed, decreased energy cost and improved

Objective: The purpose of this study was to compare and analyze the differences between weight bearing through the plegic and nonplegic lower extremities in hemiplegic patients in various standing conditions.

Method: We used digital scales to measure weight bearing among 13 hemiplegic patients when they performed comfortable standing, maximal weight shifting to each lower extremity, step standing with each foot on a step, and maximal weight shifting to each lower extremity again.

Results: 1) Patients bore significantly more weight on their nonplegic lower extremity than on their plegic one during comfortable standing (p＜0.05).

2) They bore significantly more weight on their nonplegic lower extremity than on their plegic lower extremity when maximal weight shifting was done (p＜0.01).

3) They bore very significantly more weight on the lower extremity that was not on the step during step standing regardless of whether it was plegic or nonplegic (p＜0.001).

4) When maximal weight shifting was done again, the weight bearing of plegic lower extremity was insignificantly decreased compared to that before step standing (p＞0.05) and the weight bearing of nonplegic lower extremity was insignificantly increased (p＞0.05).

Conclusion: Step standing was a very useful training method of facilitating the weight bearing in hemiplegic lower extremity.

Objective: This study is aimed to evaluate a sit-to-stand (STS) pattern in the children with spastic diplegic cerebral palsy in comparison with the normal children.

Method: Fifteen young children with spastic diplegic cerebral palsy and 21 normally developed children were recruited as subjects. A motion analysis system using a Motion analyzer (Vicon 370 M.A. with 6 infrared cameras) was used to examine the STS task. The changes in joint angle, moment, and power of each joints in lower limbs, total duration of STS transfer and each transitional points were assessed.

Results: Total duration of STS in patients was 2.44 sec, which was significantly prolonged in comparing with 1.10 sec in normal control. The major prolongation of STS occurred in the phase of vertical movement of center of mass (CoM). Cerebral palsied children showed more anterior pelvic tilting and hip flexion throughout STS transfer than normal control. Asymmetries in initial angle of ankle and maximal momentum of knee extension were shown in spastic diplegic children with cerebral palsy, but not in normal control. Less extension momentum and power of knee joint and more plantar flexion momentaum of ankle joint were observed in cerebral palsy in comparing with those of normal children.

Conclusion: This study showed that STS pattern in spastic diplegic cerebral palsy was quite different from that of normal children. The characteristics of STS pattern in these children was slowness of speed; mainly from slowness of vertical displacement of CoM, and more anterior

pelvic tilt, hip flexion and earlier abrupt change of knee extension. As well, the major moments required for this task in these patients occurred at hip and ankle joints instead of knee joint.

Objective: Because the treatment of children with cerebral palsy needs much time and efforts, the parents are suffering from longstanding treatment and financial problems. Home therapy based on the neurodevelopmental treatment strategy might help to solve these problems extending the time of treatment and helping carry over the effects of the treatment. The purpose of this study is to evaluate current difficulties in managing the children with cerebral palsy and needs of the parents, so that we can obtain a basic information to make the educational program for home therapy.

Method: A cross-sectional study was performed by questionnaire from the parents of cerebral palsy.

Results: The parents recognized the importance of home therapy and were enthusiastic to manage their children at home in 72.7%. However, 38.2% of the parents were lack of practical idea about the skill and knowledge of home therapy, and 51.7% had much burden about time and the expenses of the treatment.

Conclusion: The needs of home therapy for cerebral palsy by parents were high enough to develop the home program. Thus, practical program of home therapy with education of the parents can improve motor development of the children with cerebral palsy and reduce the time and expenses.

Objective: The maturation in the central nervous system and the myelination of visual pathway were shown to be reflected by the visual evoked potential (VEP) response recordings. The purpose of this study was to establish normal value of flash visual evoked potentials in preterm infants, especially left to right difference.

Method: Forty-one preterm infants from 31 to 40 weeks of corrected age had been made VEP records using Cadwell Excel EMG/EP system. Some in whom weekly VEP records had been made at least 3 times were included in longitudinal study and others in occasionally VEP records were included in cross-sectional study. Infants with neurological problems or anomalies, perinatal infectious and other severe systemic disease were excluded.

Results: 1) In the VEP study, we were able to establish the reference ranges for N300 peak latency at various corrected ages. 2) The latency of N300 peak latency was not significantly correlated with birth weight, sex, head circumference. 3) The latency of N300 peak decrease linearly, the age increased and also the decrement of N300 peak latency was accelerated at 37 weeks of gestational ages.

Conclusion: Although VEPs from preterm infants have several peaks, N300 latency is the most prominent and the most reproducible. It has been considered the most important component of the preterm VEPs.

Objective: The patients with spinal cord injury (SCI) suffered by a lot of complications that influence the quality of life both physically and mentally. The purpose of this study was to evaluate the epidemiology of patients with spinal cord injury in incidence of the complication according to the injury level and period.

Method: Retrospective study was done in 554 patients with SCI who discharged from Yonsei University Medical Center from January, 1987 to December, 1996. We investigated the incidence of each complication such as respiratory, cardiovascular, genitourinary, musculoskeletal, and dermatologic complications according to the neurologic level and each period (1987∼1991, 1992∼1996).

Results: Among the 554 cases, urologic complication (40.3%) was the most common complication followed by dermatologic (39.0%), musculoskeletal (33.6%), cardiovascular (27.1%) and so on. The most common complications of each system were autonomic dysreflexia (13.2%) in cardiovascular, pneumonia (9.6%) in respiratory, contracture (27.8%) in musculoskeletal, urinary tract infection (34.3%) in urologic, hemorrhoid in gastrointestinal, and central pain (24.0%) in neurogenic complications. The most common site of pressure sore was sacral area (58.9%). There was no significant difference in each complication according to the injury period.

Conclusion: Urologic complication was the most prevalent in patients with SCI followed by dermatologic, musculoskeletal and so on. These basic results would be helpful for prevention and management of the complication of SCI.

Objective: To investigate the influence of electronic filter setting change on the parameters of motor and sensory nerve conduction studies.

Method: Median motor and sensory nerve conduction studies were performed in 25 neurologically healthy adult subjects with a mean age of 29 years (range, 20∼50). Compound muscle action potentials (CMAPs) and sensory nerve action potentials (SNAPs) were recorded after fixing the low frequency filter cutoff value of 1 Hz, 10 Hz, 100 Hz and 300 Hz and by changing high frequency filter cutoff level from 10 KHz to 0.5 KHz. Onset and peak latency, amplitude of CMAPs and SNAPs were measured and the area of CMAPs were also recorded. Dantec Counterpoint MK2 machine was used. Skin temperature was maintained at 34^oC or above.

Results: As the high frequency filter was changed from 10 KHz to 0.5 KHz, the mean amplitude of SNAPs and CMAPs decreased by 33.5%, 3.3%, respectively. Onset and peak latency prolonged significantly below the high frequency filter level of 2 KHz (p＜0.01). When the low frequency filter was varied form 1 Hz to 300 Hz, large differences were seen in amplitude (69.7%) and area (86.5%) of CMAPs and amplitude of SNAPs (36.6%) (p＜0.01), but onset latency was not changed. Peak latency of CMAPs decreased by 20.8%, however, the peak latency of SNAPs reduced slightly (1.4%) (p＞0.01).

Conclusion: Significant alterations in parameters of CMAPs and SNAPs were produced by modification of filter setting. Optimum filter setting is recommended in nerve conduction study and filter parameters must remain constant when determining normal values and when performing serial studies on patients.

Objective: To determine the function of the normal upper trapezius and scalenus medius muscles during neck motion by quantitative eletromyographic analysis.

Method: Nine subjects were evaluated electromyographically with monopolar fine wire electrodes. The isometric tilting and rotation of neck with manual resistance were performed in the sitting position. The Root Mean Square (RMS) and Mean Rectified Voltage (MRV) were recorded.

Results: The RMS and MRV of upper trapezius muscle were significantly higher at each degree of ipsilateral rotation than contralateral rotation. But the RMS and MRV of scalenus medius muscle were significantly higher at each degree of contralateral rotation than ipsilateral rotation. The RMS and MRV of upper trapezius and scalenus medius muscles were significantly higher at ipsilateral tilting than at contralateral tilting.

Conclusion: Based on these results, we concluded that the upper trapezius muscle acts more in ispilateral rotation, while scalenus medius muscle acts in contralateral rotation, and upper trapezius and scalenus medius muscles act in ipsilateral tilting.

Objective: Sural nerve conduction study is known to be one of the sensitive tests for detecting neuropathies. In peripheral neuropathy, the distal sural nerve, lateral dorsal cutaneous branch of sural nerve (LDCBSN), may be more easily affected than proximal portion of the sural nerve. To evaluate the clinical application of LDCBSN conduction study and amplitude comparison between sural nerve and LDCBSN in peripheral neuropathy.

Method: Antidromic conduction studies were performed for sural nerve and LDCBSN and amplitude between two nerve responses were obtained in 30 controls (mean age, 46) and 30 patients with diabetic neuropathy (mean age, 54), but obtainable sural sensory response. The active recording electrodes were placed were placed over the dorsolateral surface at the midpoint of the fifth metatarsal for LDCBSN and posterior aspect of lateral malleolus for sural nerve. The stimulating electrodes were placed 12 cm proximal to the active electrodes in both nerves.

Results: LDCBSN response was obtainable in all controls and not obtainable in 7 diabetic patients in whom the amplitude of sural response was less than 5 uV. The amplitude of LDCBSN to sural nerve was approximately 35% in controls and 22% in diabetic patients, which was statistically significant (p=0.00).

Conclusion: LDCBSN conduction study is sensitive test to detect peripheral neuropathies and amplitude ratio of LDCBSN to sural nerve can be used in the evaluation of peripheral neuropathies.

Objective: The previously established method of carpal tunnel syndrome (CTS) diagnosis is relatively troublesome and risk of misleading due to uncertainty of exact distance measurement for stimulation. If we use the wrist crease, an anatomical landmark, there might not be error in length measurement for stimulation at any wrist position. This study was performed to evaluate the wrist stimulation method in the diagnosis of CTS for it's convenience and reducing the errors.

Method: Seventy healthy adults and sixty-five patients with clinical and electrophysiologic evidence of CTS were studied. Sensory nerve action potentials (SNAPs) in second and fifth digit were recorded antidromically with stimulation at a distance of 14 cm from recording electrode and stimulation at wrist crease. The ratio and difference of distal latency and ratio of amplitude between median and ulnar SNAPs were assessed.

Results: The ratio and difference of distal latency and ratio of amplitude in the 14 cm stimulation method were 1.52⁑0.28, 1.59⁑0.91 msec, 1.26⁑0.27 in the right, 1.43⁑0.14, 1.29⁑0.42 msec, 1.18⁑0.20 in the left, respectively in the men patients, and those of women patients were 1.48⁑0.35, 1.43⁑1.04 msec, 1.18⁑0.30 in the right, 1.53⁑0.30, 1.46⁑0.80 msec, 0.75⁑0.36 in the left. In wrist crease stimulation, those of men patients were 1.72⁑0.39, 1.74⁑0.98 msec, 1.22⁑0.24 in the right, 1.53⁑0.21, 1.31⁑0.46 msec, 1.25⁑0.29 in the left, and those of women patients were 1.67⁑0.46, 1.56⁑1.01 msec, 0.63⁑0.32 in the right, 1.68⁑0.37, 1.56⁑0.82 msec, 0.68⁑0.30 in the left. These results showed a significant positive correlation between the patients group and the control group in two stimulation methods (p＜0.001).

Conclusion: Based on the result of this study, wrist crease stimulation method is a quick and easy procedure, which would be recommended in the early diagnosis of CTS.

Objective: To investigate the clinical feature and quantitative electromyographic (QEMG) findings in the patients with post-polio syndrome (PPS).

Method: Eleven patients who had clinical evidences of antecedent poliomyelitis were evaluated with standardized clinical history, physical examination and QEMG study. If a patient had fulfilled provisional criteria for PPS, he was regarded as PPS and six patients had fulfilled the criteria. Other patients were treated as control group with stable poliomyelitis. Manual muscle testing and needle EMG study including quantitative motor unit analysis was performed at the tibialis anterior and vastus medialis muscles. The existence of abnormal spontaneous activity and parameters of quantitative motor unit analysis, mean duration and amplitude of motor unit action potentials (MUAPs), were compared between PPS and control groups. The correlation between the muscle strength and parameters of QEMG was investigated.

Results: Abnormal spontaneous activities were noted in 4 out of 11 patients (36.4%) and three of these 4 patients were PPS. Mean duration and amplitude of MUAPs of tibialis anterior and vastus medialis muscles were not different significantly between the PPS and stable poliomyelitis group (p＞0.05). The parameters of MUAPs were poorly correlated with muscle strength.

Conclusion: Distribution of abnormal spontaneous activities and parameters of QEMG study were not different in PPS and stable poliomyelitis patients. QEMG study may not have additional benefit in differentiating PPS from stable poliomyelitis.

Objective: The sympathetic skin response (SSR) was measured in patients with chronic renal failure (CRF) for diagnosis of uremic polyneuropathy and its correlations with nerve conduction study (NCS) and clinical autonomic symptoms were investigated.

Method: The SSR was measured in 15 patients with CRF on regular hemodialysis, aged 26 to 67 years. With median nerve stimulation at the wrist using the extremity without arteriovenous fistula, the SSR was recorded from both palm and sole simultaneously. The responses were interpreted as normal (presence) or abnormal (absence). Routine nerve conduction study was also performed in the same extremities and clinical autonomic symptoms were investigated.

Results: Nine of fifteen patients (60.0%) had symptoms suggestive of autonomic dysfunction: the most frequent findings were orthostatic dizziness and sweating problem. The SSR was absent in four of fifteen patients (26.7%). There is no significant relationship between SSR and autonomic symptoms (P＞0.05). The nerve conduction study was abnormal in eight of fifteen patients (53.3%), and the SSR was absent in two of seven patients with normal NCS. There is no significant relationship between NCS and SSR (P＞0.05).

Conclusion: Although the proportion of abnormal SSR was small, it may be a valuable method in the assessment of uremic polyneuropathy in conjunction with routine nerve conduction study in CRF patients.

Objective: We used the radiologic foot mapping system to evaluate the characteristics of hallux valgus.

Method: We studied the radiographs of 47 feet of 29 patients who had the hallux valgus. The weight bearing foot AP and lateral views of both sides were taken. The hallux valgus angle, first and second, first and fifth, and second and fifth metatarsal angles were measured with conventional methods. In addition we measured metatarsus primus varus (MPV) and proximal first metatarsal inclination (PFMI) angles. On lateral views, we measured calcaneal pitch, talar pitch and arch depth. By mapping system, we marked T1 through T5, MH1 through MH5, MB1 through MB5, CC, TN and NC, respectively.

Results: The first and fifth metatarsal angles were significantly larger in the patients with hallux valgus (p＜0.05). The metatarsus primus varus angle was significantly larger in the patients with hallux valgus (p＜0.05). The X coordinates at T1 and MH1 were significantly larger in the patients with hallux valgus (p＜0.05). The Y coordinates of the MB1, NC and TN were significantly larger negative values in the hallux valgus patients (p＜0.05).

Conclusion: In hallux valgus, the first metatarsocuneiform joint is the site of origin of metatarsus primus varus. The lateral splaying was present from the 5th toe to tarsal bones in hallux valgus groups.

Objective: The aim of this study is to know the usefulness of ultrasonographic evaluation in the musculoskeletal disease.

Method: Thirty-nine cases with musculoskeletal pain were evaluated by physical examination, Cyriax selective tension technique, simple X-ray, electromyography, arthrography, Computed tomography, Magnetic resonance image and the high-resolution realtime ultrasonography to define the location of pain. The ultasonographic results were compared to other diagnostic methods.

Results: The ultrasonographic findings are as follow; 22 tendinitis, 7 entrapment neuropathies, 6 bursitis, 2 ligament injuries, and 2 rotator cuff injuries. Clinical diagnosis were matched with ultrasonographic findings in 30 cases out of 39. The most common ultrasonographic findings in 22 tendinitis cases were hypoechogenicity in affected tendon. Ultrasonographic findings in 7 entrapment neuropathies were 6 nerve swellings and 1 nerve flattening.

Conclusion: The ultrasonography can provide detailed images of musculoskeletal system, including tendons, nerves and subcutaneous tissue. Therefore the ultrasonography is very useful in diagnosis and treatment of some musculoskeletal diseases such as tendinitis and entrapment neuropathy.

Objective: To investigate the diagnostic value of ultrasonography for limited finger joint mobility in diabetes and association between limited finger joint mobility and the presence of diabetic chronic complications.

Methods: Ultrasonography were performed in 13 non insulin-dependent diabetes with limited finger joint mobility and 15 non insulin-dependent diabetes without limited finger joint mobility matched for similar ages, sexes and durations of diabetes. Controls consisted of 12 healthy volunteers with no evidence of diabetes mellitus.

Ultrasonography was used to measure flexor tendon and tendon sheath thickness of the third and fourth fingers in the volar aspect of both hands. We evaluated neuropathy, nephropathy and retinopathy in all diabetic patients and investigated association between limited finger joint mobility and the presence of diabetic chronic complications.

Results: Thickness of flexor tendon sheath of the third and fourth fingers were significantly increased in the diabetes with limited finger joint mobility compared to the diabetes without limited finger joint mobility (p＜0.01). Also, flexor tendon thickness of the third finger was significantly increased in the diabetes with limited finger joint mobility compared to the diabetes without limited finger joint mobility (p＜0.05). The diabetes with limited finger joint mobility had a significantly increased frequency of the diabetic chronic complications (p＜0.05).

Conclusion: In the diabetes with limited finger joint mobility, thickening of flexor tendon sheath and tendon were shown by ultrasonography. This finding suggests that ultrasonography can be used to diagnose limited finger joint mobility in the diabetes. Limited finger joint mobility is closely associated with diabetic chronic complications.

Objective: The purpose of this study is to evaluate the effectiveness and safety of aerobic exercise program in cardiac patients.

Method: Twenty patients participated in 6 weeks of aerobic exercise with telemetry monitoring as an outpatient rehabilitation program. For the comparison of physiologic changes, we used graded exercise test (GXT) by means of modified Bruce protocol before and in 6 weeks after aerobic exercise training. Exercise prescription for cardiac rehabilitation was composed of intensity, mode, frequency and duration. By use of EKG telemetry and monitoring of blood pressure and Borg RPE (ratings of perceived exertion) scale, we were monitored patients status during exercise.

Results: In six weeks after aerobic exercise training, the hemodynamic and metabolic responses were improved and statistically significant parameters were as follows: exercise time, maximal METs, resting heart rate, maximal heart rate, submaximal rate pressure product, maximal expired volume, maximal oxygen consumption rate and anaerobic threshold.

Conclusion: We concluded that six week cardiac rehabilitation program is useful and safe to improve the aerobic capacity for cardiac patients.

Objective: To investigate the influence of psychologic factors and stress on chronic pain syndrome and predictive factors of chronic pain.

Method: The subjects were 23 patients with chronic pain. The age was ranged from 25 to 66 years with an average of 45. We measured pain with initial visual analogue scale (VAS), one-week total VAS, and tenderness threshold by pressure algometer. We evaluated the degree of depression, anxiety and disability with chronic pain and the impact of stress of major versus minor daily events. Association between degree of pain and psychologic factors was studied by regression and stress of major versus minor daily events by correlation analysis. Predictive factors for chronic pain were determined by multiple regression analysis. Association of daily fluctuation of pain severity and stress from minor life events was also studied.

Results: One-week total VAS was associated with initial VAS (r=0.601, p＜0.05). Initial VAS had association with depression and anxiety. Predictive factors for one-week total VAS were initial VAS, static anxiety, and pain disability (r=0.624, p＜0.05).

Conclusion: Depression, anxiety, pain disability from chronic pain, and stress were major influencing factors in patients with chronic pain.

Objective: The purposes of this study are to find out the characteristics of patients with pain in outpatient practice of rehabilitation medicine and to provide basic data for outpatient management.

Method: We surveyed a hundred one outpatient practices with questionnaire including the distribution of diagnosis, pain site, disease related with pain, pain treatment method, etc.

Results: 1) Distribution of diagnosis was traumatic brain injury (TBI) 10.5%, stroke 14.8%, spinal cord injury (SCI) 10.8%, musculoskeletal disorder (MSD) 55.8% and others 8.1% in training hospital, and TBI 6.7%, stroke 10.6%, SCI 14.0%, MSD 58.7% and others 10.0% in non-training general hospital, and TBI 2.6%, stroke 4.9%, SCI 2.9%, MSD 78.3% and others 11.3% in private clinic. 2) The most common site of pain was low back area. 3) The most common disease related with pain was myofascial pain syndrome. 4) Trigger point injection and physical therapy were performed for pain treatment in most of outpatient practice, whereas local injection and nerve block were less used.

Conclusion: We believe that this study's results will provide helpful basic-data for management of outpatient with pain.

Objective: To compare intraarticular steroid injection with and without capsular distension in the treatment of adhesive capsulitis of the shoulder

Method: Fifty-five cases those were clinically diagnosed as adhesive capsulitis of the shoulder were randomly assigned to one of two treatment groups. 28 cases were treated by intraarticular steroid injection with capsular distension (group 1) and 27 cases by steroid injection alone (group 2). They were evaluated by visual analogue scales, Cyriax stages of arthritis, and active shoulder range of motion (flexion, abduction, external rotation and internal rotation). Follow up assessments were made one week and one month after injection.

Results: There were no statistically significant differences in Cyriax stages and VAS between two groups. But in the group 1, shoulder range of motion showed significant improvement in flexion and internal rotation at one week, and flexion at one month.

Conclusion: Intraarticular steroid injection with cspsular distension had no advantage over steroid injection alone in pain reduction, but can help the patients to achieve better range of motion, especially flexion and internal rotation, in treatment of adhesive capsulitis of the shoulder.

Objective: To evaluate the efficacy of epidural injection for spinal stenosis with symptoms of low back pain, pseudoclaudication, or radiating pain.

Method: Thirteen patients with spinal stenosis which were confirmed by the computed tomography (CT) studies were treated with epidural injections of steroids and local anesthetics for three times with 1 week interval. The efficacy of epidural injection was assessed by visual analogue scale (VAS), pain rating score (PRS), treadmill test, and jump test.

Results: 1) The VAS, PRS, pain free walking distances, and jump heights were checked right before injection, and at 1 week and 3 months after injection. The VAS and PRS were significantly decreased after epidural injection. The pain free walking distances and the jump heights were significantly increased after epidural injecton.

Conclusion: Epidural injections of steroid and local anesthetics are effective in the short term period, but also in the long term period for patients with spinal stenosis.

Objective: To evaluate how to influence static lumbar lordosis by different heel heights in normal adults and patients with spondylolisthesis.

Method: The lumbolumbar angles, lumbosacral angles and slip angles were examined while standing on barefoot, on heel support with 5 cm heel, and with 10 cm heel in 14 normal adults and 10 patients with first grade of spondylolisthesis. Standing lumbar spine lateral view was performed by one half hour adaptation with corresponding shoe types.

Result: The lumbolumbar angles (angles between upper margin of 2nd lumbar body and low margin of 5th lumbar body) and the lumbosacral angles (between upper margin of 2nd lumbar body and low margin of 1st sacral body) in normal are 36.8⁑6.5^o, 50.1⁑9.5^o on barefoot, 36.0⁑7.3^o, 49.6⁑7.4^o on heel support with 5 cm heel, and 36.1⁑7.6^o, 49.7⁑8.3^o with 10 cm heel. Lumbolumbar angles and lumbosacral angles in 10 patients with spondylolisthesis 38.8⁑8.3°on barefoot, 47.2⁑10.4^o on heel support with 5 cm heel, 38.3⁑7.0^o, 47.7⁑9.2^o with 10 cm heel. The slip angles in 10 patients with spondylolisthesis are 29.8⁑1.2^o on barefoot, 30.2⁑1.8^o on heel support with 5 cm heel, and with 10 cm heel.

Conclusion: The changes of heel height did not significantly influence the lumbar lordosis in normal adults and patients with spondylolisthesis. There were no significant differences in average slip angle according to heel height in patients with spondylolisthesis were found.

Objective: The purpose of this study is to document the prevalence and patterns of use of alternative therapies and effectiveness in a rehabilitation medicine outpatient practice.

Method: This study was performed that a random sample of 200 patients of rehabilitation outpatient were given a questionnaire addressing their use of alternative therapies.

Results: One or more alternative therapies had been used by 51.3% of subjects for their presenting problem. The most common therapies were acupuncture, oriental medicine, chiropractic and massage. Musculoskeletal pain syndrome involving the low back and shoulder were the most common problems of use of alternative therapies. Of the patients who used alternative treatments, 40.2% reported some degree of efficacy.

Conclusion: A significant proportion of rehabilitation outpatients use alternative therapies and frequently perceived a benefit from them. Incorporating alternative therapies into physiatric practice is a desirable future direction for the speciality.

Objective: This study had three objectives: 1) to investigate the rehabilitation professionals' way of thinking on physical, psychological and social characteristics of older patients: 2) to assess their actual knowledge level about aging; and, 3) to deduce and analyze the influences that cause these different kinds of perceptions and attitudes.

Method: Total 239 rehabilitation professionals (including rehabilitation doctors, nurses, physical therapists, occupational therapists, speech therapists, social workers, psychologists, prosthetists & orthotists) responded to our questionnaire were included in this study. Self-addressed questionnaires were composed of two categories: 1) the perception of older patients compared with younger patients: and 2) the actual knowledge level about aging.

Results: 1) There were significant (p＜0.05) differences by job classification on a speculative disposition with the physical characteristics, motive of treatment, emotional characteristics, and discharge problem of older patients. 2) There were also significant (p＜0.05) differences by job classification in the actual knowledge level about aging by job classification. A higher score on the questionnaire correlated with a more optimistic view of the motive of treatment, emotional characteristic and discharge problem.

Conclusion: Many rehabilitation professionals have a misconceptions about older patients due to insufficient knowledge on aging. Therefore we propose an objective understanding of older patients along with proper education on aging to provide an effective rehabilitation treatment.

The aim of this study is to investigate the mechanism of motor recovery using both functional Magnetic Resonance Imaging (fMRI) and Transcranial Magnetic Stimulation (TMS) in a patient with hemorrhagic contusion on the right basal ganglia area. Functional MRI showed that the left primary sensorimotor cortex and the supplementary motor area were activated when the right fingers performed the flexion-extension exercise. On the other hand, the bilateral primary sensorimotor cortex and the left premotor area were activated with the excerise of left hand. Brain mapping for both abductor pollicis brevis muscles (APB) using TMS revealed that ipsilateral motor evoked potentials (MEPs) were obtained at left APB. Ipsilateral MEPs of left APB showed delayed latency and lower amplitude compared to that of right APB when stimulated at the left motor cortex. We concluded that ipsilateral motor pathway from undamaged motor cortex seems to contribute to the motor recovery in this patient and combining TMS with fMRI may provide a powerful tool for investigating the mechanism of motor recovery.

Guillain-Barre syndrme (GBS) has several subtypes that are divided by clinical, electro- physiological, and pathological findings. A novel form of GBS, that is termed acute motor axonal neuropathy (AMAN), is characterized by the selective involvement of motor fibers, and is associated with anti-GM1 antibodies.

A 8-year-old male patient were developed ascending, symmetrical paralysis, and areflexia, but no sensory disturbance. Elevated titers of serum IgG anti-GM1 antibodies were detected. His thoracolumbar spine magnetic resonance imaging (MRI) revealed thickening of cauda equina and enhancement of anterior nerve roots of T12-L1 spinal level after Gd-DTPA infusion. Electrophysiological diagnosis was acute motor axonal neuropathy (AMAN). We report this case with review of the literature.

Ischemic myelopahty of spinal cord after cardiac arrest is rarely reported. In general brain stem and spinal cord is less vulnerable to ischemic injury than cerebrum and cerebellum. Ischemic myelopathy usually occurs in the midthoracic region (T3∼T8) and rarely reported after cardiac arrest.

In this case previously healthy 62 year old patient suffered from cardiac arrhythmia for a few days and then developed cardiac arrest and sustained paraplegia due to ASIA class B spinal cord injury. After paraplegia MRI showed predominant involvement of the anterior horn cell area in the midthoracic region.

We report a patient with reactive arthritis induced by recent streptococcal infection. A 27 year man had suffered from fever, sore throat and pain on left sternoclavicular joint. Arthritis occurred two days after tonsillitis and involved left sternoclavicular joint. Left sternoclavicular joint showed redness, swelling and tenderness. There were no growth of microorganism in blood cultures, no evidence of group A β-streptococcus in throat cultures, but antistreptolysin-O (ASO) and c-reactive protein (CRP) serum titers were elevated in sequential monitoring. Bone scan showed focal hot uptake at left sternoclavicular joint and Gallium scan showed diffuse inflammation at left sternoclavicular joint and soft tissue biopsy around sternoclavicular joint showed mild chronic inflammation. We suspected septic arthritis and prescribed empirical antibiotics but his symptoms were wax and wane. From the poor responsiveness to antibiotics, sustained high titers of ASO and recent history of tonsillitis, we confirmed poststreptococcal reactive arthritis, and attempted high-dose anti-inflammatory drug (aspirin 6 gram). Left sternoclavicular and shoulder pain improved.

Innervation anomalies are well-known sources of erroneous interpretation in motor nerve conduction studies. The extensor digitorum brevis (EDB) muscle is supplied by the deep peroneal nerve and is commonly used as recording point in peroneal motor conduction study. If the compound muscle action potentials (CMAPs) are not evoked with EDB muscle recording without any symptoms or signs of peroneal neuropathy, we should lead one to consider either technical pitfall or anomalous innervation. We experienced an anomalous innervation in a woman in whom the bilateral EDB muscles were innervated exclusively by the tibial nerve. This was proved using a monopolar needle electrode for recording in extensor digitorum brevis (EDB) and flexor digitorum brevis (FDB) muscles, which encoded acceptable shape of CMAPs on tibial nerve stimulation. To avoid erroneous interpretation of electromyographic and nerve con