Objective: Post-stroke dysphagia occurs in the form of lingual discoordination, pharyngeal dysmotility, and delayed swallowing reflex. The purpose of this study is to define the pattern of post-stroke swallowing disorder according to the location of brain lesion.

Method: Thirty-nine post-stroke patients and ten normal persons participated to perform the videofluoroscopic swallowing study (VFSS) with fluid and semisolid gastrograffin. Brain lesions were classified by cortical, subcortical, or brainstem groups and by the involved hemisphere.

Results: There was no difference of swallowing pattern between the cortical and subcortical lesions. However patients with brainstem lesion more frequently showed incomplete laryngeal elevation, prolonged pharyngeal transit time, failure of cricopharyngeal muscle relaxation, and aspiration than with cortical and subcortical lesions (p＜0.01). In the patients with cortical and subcortical lesions, aspiration occurred before the laryngeal elevation due to discoordination of laryngopharynx. Whereas in the brainstem lesion, aspiration occurred after the laryngeal elevation due to incomplete laryngeal closure. Premature posterior spillage (p＜0.05), poor laryngeal elevation(p＜0.05), and tracheal aspiration (p＜0.01) were more frequently seen in the patients with right hemispheric dysfunction than the left.

Conclusion: Discoordination of the tongue, oropharynx, and laryngopharynx is predominant in the cortical and subcortical lesion, whereas incomplete laryngeal closure and failure of cricopharyngeal muscle relaxation are predominant in the brianstem lesion.

Objective: To investigate complications of stroke patients with regard to incidence, predisposing risk factors and their effect on the patients's prognosis during rehabilitation management.

Method: Two hundred fifty nine patients with stroke admitted to Department of Rehabilitation Medicine were included in this study. We analyzed types of stroke, incidence of complications, outcome of rehabilitation treatment and the length of the hospital stay.

Results: Of the 259 patients who had received rehabilitation, shoulder pain occurred in 59 patients (22.8%), depressions in 24 (9.3%), falls in 24 (9.3%) and pneumonia in 21 (8.1%); 112 patients (42.9%) had a total of 174 complications. The incidence of complication was higher in patients who had lower initial FIM score or previous cardiac disease. The patients with complication had longer rehabilitation hospital stay and lower FIM gain and efficacy.

Conclusion: Early detection and treatment of the complications of acute stroke patients during rehabilitation will shorten the length of the hospital stay and improve the overall prognosis of the patients.

Objective: This research aimed to define the usefulness of the computerized neuropsychological test (CNT) for evaluation of cognitive deficit in the patients with brain injury.

Method: Twenty five subjects with brain injury (16 males, 9 females) were enrolled. Their mean age was 39.2 years. All patient were assessed their cognitive function using CNT. The CNT consisted of digit span, verbal learning test, visual span test, visual learning test, auditory continuous performance test, auditory controlled continuous performance test, visual continuous performance test, visual controlled continuous performance test, word-color test, hypothesis formation test and trail making test. Scores of each subtest on CNT analysed according to the brain lesion and involved hemisphere of the patients.

Results: In patients with left hemisphere lesion, scores in digit span and verbal-learning test were lower than that of right side lesion (p＜0.05). In contrast, patients with right hemisphere lesion showed significantly lower scores in visual span and visual-learning test (p＜0.05). The patients with frontal lobe lesion marked lower scores in verbal-learning and word-color test than the patients without frontal lesion (p＜0.01). Whereas the patients with parietal lobe lesion showed significantly lower scores in visual learning test (p＜0.05) than the patients without parietal lesion.

Conclusion: The cognitive deficit following the brain lesion could be characterized using CNT. CNT is considered to be used as a useful tool in the patients with brain injury for the assessment of their cognitive function.

Objective: To investigate the clinical usefulness of the motor cortex mapping using transcranial magnetic stimulation (TMS) in stroke patients.

Method: Five stroke patients were studied. A piece of cloth which marked at 1 cm interval was fixed on the patient's head. Motor cortex mapping for abductor pollicis brevis muscles (APB) was performed with a butterfly coil or with a round coil if motor cortex mapping was impossible.

Results: Ipsilateral motor pathways were discovered from the unaffected motor cortex to the affected APB in patient 1. This patient showed delayed latency and low amplitude of ipsilateral motor evoked potentials (MEP) that seems to be evoked from the descending motor pathway rather than the corticospinal tract. In patient 2 and 3, contralateral motor pathways traveled from the affected hemisphere to the affected APB. The short latency and high amplitude of MEPs seems to be attributed to the corticospinal tract. In patient 4, no MEP was evoked by any hemisphere or magnetic stimulator. We believe that the affected APB had no motor pathway, and it correlated well with the poor motor function of her hand. In patient 5, contralateral pathways from the affected hemisphere to the affected APB were present. In this patient, the parameters of the motor cortex map such as the amplitude of MEP, the number of MEP evoked site, and the excitatory threshold were improved after 2 months, which correlated well with clinical improvement.

Conclusion: Motor cortex mapping using TMS is clinically useful for the evaluation of the characteristics of motor pathways and the change of motor cortex excitability in stroke patients.

Objective: The aim of the present study was to understand biomechanical characteristics during the process of initiation of gait (IOG) from the standing position in hemiplegic patients.

Method: We recorded the ratio of the vertical forces of both limbs to body weight and the movement of net center of pressure (COP) on two force platforms during the process of initiation of gait (IOG) from standing in 10 normal control and 10 hemiplegic patients and processed these data using ELITE DMA acquisition program. All data were collected with uninvolved limb and involved limb and compared each other by independent samples t-test.

Results: 1) In 10 hemiplegic patients, nine patients began taking a step with an uninvolved limb in the first, followed by an involved limb. 2) The period of IOG of the swing limb was 0.80 sec when patients walked with an uninvolved side and those of the stance limb was 1.60 sec with involved side. When the control group walked, the period of IOG of the swing limb was 0.70 sec and those of stance limb was 1.50 sec. The period of IOG of the swing limb in uninvolved side and those of the stance limb in involved side showed significant longer than control group. 3) The latency of IOG of swing and stance limb was significantly more prolonged than control groups. 4) Anteroposterior (AP) and mediolateral (ML) distance of net COP from release to unloading with uninvolved limb showed significant longer than control groups. 5) The velocity of net COP displacement from start to release with involved limb was significantly slower than control groups.

Conclusion: This pattern of IOG could be used as one of the tools to evaluate postural control during gait training in the hemiplegic patients with gait disabilities, and it can be used as a basis for specific therapeutic intervention, and it allows evaluation of the effectiveness of treatment.

Objective: The videofluoroscopic swallowing study (VFSS) has been accepted for standard method of dysphagia evaluations. But there is no research for oropharyngeal effects depending on the change of viscosity.

Method: The 10 normal subjects without dysphagia symptom or history were participated. 4 test foods were selected according to viscosity which was measured by line spread test (LST); thick semiblended diet: LST 1 cm, Yoplait: LST 2.44 cm, tomato juice: LST 3.67 cm, 35% diluted barium: LST 4.15 cm. Each foods were swallowed 3 times during VFSS. We measured oral transit time (OTT), pharyngeal delay time (PDT), pharyngeal transit time (PTT), and cricopharyngeal opening time (CPOT)

Results: There was linear correlation between OTT and LST (cm)(r=⁣0.965, P＜0.05). As the score of LST increased, PDT tended to increase linearly, but there was no statistical significance (r=0.949, P=0.509). PTT and CPOT had no significant correlation with viscosity.

Conclusion: The viscosity affected OTT and PDT. The test foods of VFSS and dysphagia diet shoud be selected by viscosity measures.

Objective: To evaluate clinical features in general and possible complications in Duchenne muscular dystrophy (DMD) which could be used for comprehensive rehabilitation management.

Method: One hundred and seventy-two patients with DMD were followed over 3 year period to provide clinical profile causing impairment and disability. We measured height, weight and manual muscle testing (MMT) when the patients visited the hospital. And we could measure pulmonary function, electrocardiogram (EKG), and intelligence quotient (IQ) test in cooporative patients.

Results: The median height and weight of DMD boys were normally distributed before age 12, but during the second decade height was markedly reduced, and weight was no longer normally distributed. The MMT measurement showed loss of strength in a fairly linear fashion according to increasing age, and extensor of lower extremities were weaker than flexors showing typical contractures of legs. There was a direct relationship between pulmonary function and MMT scores of upper extremities. There was a high occurrence (40%) of abnormal EKG, but none of the patients had a history of cardiovascular complication. DMD children suffered wide spectrum of psychological disturbance such as somatic complaints, attention and emotional problems in addition to expected psychological problems due to chronic disease and its progression, and 50.9% of them were below average on the IQ test.

Conclusion: These data on DMD subjects provide clinicians with useful information regarding the prevalence and severity of measurable impairment at different stages of the disease.

Objective: To evaluate changes of colon transit time according to prokinetic medication and characteristics of the anorectal manometry in patients with neurogenic bowel due to spinal cord injury.

Method: Twelve patients with cervical and thoracic cord injury were enrolled, and classified into complete and incomplete spinal cord injury according to the severity of injury. The colon transit time before and after prokinetic medications were measured. The anorectal manometry was performed after the first study of colon transit time.

Results: The colon transit time of pre-prokinetic medications were 17.1⁑12.6 hours for the right colon, 26.9⁑13.2 for the left colon, 21.5⁑14.0 for the rectosigmoid colon, and the total transit time was 65.5⁑5.3 hours. The time of post-prokinetic medications was 14.3⁑7.6 hours for the right colon, 25.8⁑10.3 for the left colon, 7.4⁑5.3 for the rectosigmoid colon, and the total transit time was 33.1⁑11.5 hours. The rectosigmoid colon transit time and total colon transit time were significantly different between pre- and post-prokinetic medications (p＜0.05). In the anorectal manometry, mean resting anal pressure was 33.3⁑10.7 mmHg and maximal resting anal pressure was 99.0⁑43.4 mmHg. There were no difference in the colon transit time and anorectal manometry between complete and incomplete injured patients.

Conclusion: The difficulties of defecation in spinal cord injured patients were not only due to uncontrolled anal sphincter but also due to dysfunction of colon motility. The prokinetic medications were effective in reducting the rectosigmoid and total colon transit time.

Objective: To investigate the effect of peripheral nerve stretching on motor evoked potentials (MEP) as a method of facilitation.

Methods: Twenty three normal healthy volunteers were enrolled. Transcranial magnetic stimulation (TMS) was applied to the contralateral scalp at 7 cm lateral to Cz using 90 cm round coil. Intensity of stimulation was adjusted to 90% of maximal stimulation intensity. Recording was done on the abductor pollicis brevis muscle in three different conditions; firstly resting state, secondly voluntary contraction of abductor pollicis brevis muscle, and lastly with stretching of median nerve. The onset latency and amplitude were obtained and compared between three conditions.

Result: The amplitude of MEP was significantly increased in the condition with muscle contraction and peripheal nerve stretching compared with resting state. The latency was shortened in the condition with muscle contraction with statistical significance and with peripheral nerve stretching without significance.

Conclusion: We concluded that stretching of peripheral nerve can be used as a method of facilitation of MEP. This method is considered to be useful especially for the patients with motor paralysis or poor cooperarion for voluntary contraction.

Objective: The purposes of this study were to evaluate the diagnostic value of dermatomal somatosensory evoked potentials (DSEPs) in the unilevel/unilateral lumbosacral radiculopathies.

Method: The study was performed on 41 patients with herniated lumbosacral disc which was confirmed by magnetic resonance imaging, and the patients with clinical lumbosacral radiculopathies (L5 radiculopathy in 33 cases and S1 radiculopathy in 8 cases). Stimulation sites were over the dorsum of the foot on the distal fifth metatarsal bone for the S1 dermatome and at the interdigital web space between first and second toe for the L5 dermatome. Recordings were made at Cz' and reference to Fz. Conventional nerve conduction study, needle EMG and H-reflex were also examined.

Results: While the needle EMG showed abnormalities in 32 patients (78.0%), the abnormalities of DSEPs were in 13 patients (31.7%): 33.3% for the L5 radiculopathy and 25.0% for the S1 radiculopathy, respectively. Moreover, there was no significant relationship between the abnormal findings of needle EMG and DSEPs (p＞0.05). The H-reflexes were abnormal in 6 of 7 patients (85.7%). And then two of them were found abnormal in S1 DSEPs.

Conclusion: The conventional needle EMG appears to be the more useful electrophysiological technique in the diagnosis of lumbosacral radiculopathies. The ultimate diagnostic value of DSEPs in lumbosacral radiculopathies is doubtful and controversial.

Objective: To investigate the anatomy of the ulnar nerve according to the degree of elbow flexion and to obtain optimal elbow position for ulnar nerve conduction study.

Methods: Eleven elbows in nine cadavers were dissected. We estimated the 10 cm elbow segment to be the distance between 2 points, 4 cm distal and 6 cm proximal to the center of the cubital tunnel, which was determined to be the halfway point between the medial epicondyle and olecranon with elbow position in extension and 45^o, 90^o, 135^o flexion. Anatomical measurements of the actual length of ulnar nerve, distance between medial epicondyle and ulnar nerve, and distance between medial epicondyle and olecranon were obtained in each position. The actual length of the ulnar nerve was measured between two points of the ulnar nerve closest to the landmarks of the estimated 10 cm with flexible ligature.

Results: The actual lengths of ulnar nerve were 10.23 cm, 10.00 cm, 9.44 cm, and 9.08 cm in elbow extension, and 45^o, 90^o, 135^o flexion, respectively. The difference between actual length and estimated lengths were least in 45^o elbow flexion (p=0.0001). The distance between medial epicondyle and olecranon increased with increasing elbow flexion (p=0.0001). However, there was no difference in the distance between medial epicondyle and ulnar regardless of the elbow position. As a result, the ulnar nerve seemed to have migrated anteriorly in the cubital tunnel with increasing elbow flexion.

Conclusion: This study suggest that the optimal angle in ulnar nerve conduction study would be 45^o flexion, under the condition that the distance measurement is through the halfway point between the medial epicondyle and olecranon.

Objective: To know if changes in compound muscle action potential (CMAP) of human extensor digitorum brevis (EDB) muscle can be enhanced by increase in dilution volume of botulinum toxin type A.

Method: In 11 healthy volunteers, 2.5 U of botulinum toxin (Botox^Ⱂ, Allergen Inc.) in a volume of 0.1 ml normal saline was injected in EDB muscle and the same dose with the dilution volume of 0.5 ml was injected in the opposite side. We measured the pre- and post-injection M-wave amplitude and area of EDB muscle.

Results: The mean post/pre injection amplitude ratio of CMAP were 0.49⁑0.21 with the 0.1 ml of dilution volume and 0.40⁑0.12 with the 0.5 ml of dilution volume. The mean post/pre injection area ratio of CMAP were 0.51⁑0.18 with the 0.1 ml of dilution volume and 0.44⁑0.15 with the 0.5 ml of dilution volume. There was no significant difference between the two dilution volumes.

Conclusion: Five fold increase in dilution volume did not enhance the paralyzing effect of botulinum toxin type A in human EDB muscles.

Objective: To define arthrographic findings in patients with frozen shoulder and to evaluate the therapeutic effect of arthrographic capsular distension and rupture.

Method: Thirty patients who were clinically diagnosed as frozen shoulder were enrolled. During a trial of intra-articular injection of 35 mL of fluid which contained 8 mL of 1% lidocaine, 2 mL of prednisolone (80 mg) and 25 mL of radiocontrast material, arthrographic findings and the occurrence of iatrogenic capsular tear were observed. Passive range of shoulder motion (percent of normal, %) at flexion, abduction, internal rotation, and external rotation was measured at pre- and 1 week post-injection. The therapeutic effect of the procedure was statistically analyzed by paired Student's t-test.

Results: Mean age of the subjects was 57-years-old (range: 40∼76 years) and mean duration of the symptom was 6 months (2∼42 months). A decreased joint volume of less than 10 mL (100%), poor or absent filling of the axillary recess or subscapular bursa (75.9%), nonfill of the biceps tendon sheath (37.9%), and irregularity of capsular insertion (31.0%) were typical abnormal arthrographic findings. In one week after arthrographic distension and rupture, the passive range of shoulder motion was significantly (p＜0.05) increased at flexion, abduction and external rotation, of which the range of external rotation was the most remarkably increased (mean, 23.9%).

Conclusion: Distension arthrography was useful for increasing shoulder motion in frozen shoulder, especially at flexion, abduction and external rotation.

Objective: To investigate dose-related effects of repeated intraarticular steroid injection on the experimental arthritis.

Method: Twenty-four adult male rabbits received Zymosan A into their right knee joint for experimental arthritis. After a week, they were injected with 2 mg (group I; n=9), 10 mg (group II; n=7) or 20 mg (group III; n=8) triamcinolone acetonide into their right knee weekly interval for 4 weeks. We measured weekly changes of the weight and the mediolateral diameter of both knees for the calculation of edema index. ^99mTechnetium pertechnate (^99mTc) uptake measurement were performed before the first steroid injection and a week after the final steroid injection. All rabbits were sacrificed and histologic examinations of their proximal tibia were performed.

Results: A progressive weight loss and changes of edema index were evident for all rabbits (p＜0.05) and difference among the groups was not found (p＞0.05). ^99mTc uptake significantly decreased after the steroid injection in group I (p＜0.05) but it was not profound in others (p＞0.05). In the histological findings, fibrillation-frayings and fissures of the surface were similar in all rabbits, but loss of nuclear stains and cyst formations were increased prominently in group III than group I (p＜0.05).

Conclusion: Low-dose repeated steroid intraarticular injections are safe and effective treatment in arthritis though no definite evidence of chondroprotection, and high-dose steroid injections accelerate degeneration of the arthritic cartilage.

Objective: The purpose of this study is to identify how the isotonic and isometric mixed excercise training for 12 weeks take influence on the muscular strength, muscle size and foot pressure (by EMED^Ⱂ) in patients with degenerative knee joint disease.

Method: Seven patients with degenerative knee joint disease were chosen for the experimental objects and were trained isotonic exercise program for twelve weeks. Before and after exercise, Cybex^Ⱂ, Computed Tomography and EMED^Ⱂ were examined.

Results: After exercise program, peak torque, peak torque %Bwt and average power were significantly increased at 60^o/sec and 180^o/sec in both knee flexors and extensors. But peak torque ratio flexor/extensor were not significantly increased. Cross-sectional area of quadriceps and hamstrings were significantly increased. But there were no significant difference in the peak pressure at the heel and time (from initiation of initial contact to peak pressure at the heel).

Conclusion: We knew that isotonic and isometric mixed exercise training to the patients with degenerative knee joint disease for 12 weeks improved the muscular strength and muscle size, but this is not influenced on heel pressure. So, there may be needed to study with kinetic and kinematic analysis to more experimental patients.

Objective: The purpose of this study was to determine the normal value of cervical motion in Korean adults.

Method: Five hundred healthy subjects, 250 men and 250 women between third decades and seventh decades completed this study. The Cervical Range of Motion (CROM) instrument was used to measure six cervical motions and horizontal head motion.

Results: The elderly group had significantly less motion than the younger group for all six motions and horizontal head motions (p＜0.05). Women had greater range of cervical motions than men in all cervical motions (p＜0.05).

Conclusion: The method using the CROM instrument seems to be useful for primary and follow up test of cervical disease.

Objective: To determine the changes of posterior bulging of the lumbar intervertebral discs with flexion and extension movement of the spine in patients with central disc bulges or disc degeneration.

Method: Twenty patients with low back pain were studied. Nine patients had central type disc bulging and eleven patients had disc degeneration only. The spines were scanned in neutral, flexion, and extension positions in a vertically open 0.5T MR scanner. Degree of posterior bulging of the lumbar intervertebral disc of the pathological level was measured.

Results: In the patients with disc bulge, posterior bulging of the disc decreased in all of the patients by 0.8⁑0.6 mm with flexion of the spine and increased in 77.8% of the patients by 1.0⁑0.8 mm with extension of the spine. In the patients with disc degeneration, posterior bulging decreased with flexion in 36.7% of the patients. With extension, posterior bulging increased in 55.6% of the patients.

Conclusion: This study found that patients with low back pain and central disc bulges have consistent and marked discrepancies in posterior bulging with flexion-extension in comparison with our previous study with asymptomatic patients with normal MRIs.

Objective: The purpose of this study is to evaluate the loss of bone mineral density on ovariectomized (ovx) rat in young and old rats.

Method: Total 110 Sprague-Dawley female rats which composed of 3 months aged 88 rats and 12 months aged 22 rats were used. They were divided randomly into 5 ovx groups (15 rats for each group) and 5 sham operation group (7 rats for each group). The bone mineral density was measured by Hologic 4,500 Fan Beam bone densitometry at the time of second postoperation week, 4th week, 8th week, and 16th week in young aged group and 4th, 8th week in old aged group.

Results: The bone mineral density in young ovx rats was decreased measured at 2 week, 4 week and 8 week, but not 16 week compared with that of sham operation rats (p＜0.05). In old rats, there was no significant change in bone mineral density between ovx and sham group (p＞0.05).

Conclusion: For the purpose of osteoporosis inducing experiment, young aged rat is more reliable for the detection of bone density change than old aged rat and the bone mineral density change will be continued at least 16 week postovariectomy period.

Objective: To evaluate the effects of gabapentin and clonidine on neuropathic pain in an experimental pain model.

Method: 24 male adult rats were anesthetized and the sciatic nerve was exposed. Each exposed nerve was electrically injured with 10 volts for 10 seconds by two needle electrodes. Rats were divided into three groups by treating with gabapentin, clonidine and sham. Gabapentin and clonidine were given orally from post operation day 3 to 7 in gabapentin and clonidine groups respectively. To evaluate the presence of mechanical allodynia, withdrawal frequency was tested by Von Frey hair in the same days. After post operation day 7, all the medications were discontinued and mechanical allodynia was evaluated at post operation day 14.

Result: Neuropathic pain was developed after electrical injury in all the rats. Withdrawal frequency is more decreased in gabapentin and clonidine groups than sham group in post operation day 4 to 7. The withdrawal frequency was 2.88⁑0.83, 2.75⁑0.89, 3.13⁑0.99, 3.25⁑1.28 in gabapentin group and 3.38⁑0.92, 4.50⁑2.20, 3.25⁑1.17, 3.50⁑0.93 in clonidine group in post operation day 4, 5, 6, 7, respectively. In post operation day 14, withdrawal frequency was increased and showed no difference compared to the sham group.

Conclusion: Gabapentin and clonidine can suppress the neuropathic pain in an experimental pain model. There was no different effect on the neuropathic pain suppression between gabapentin and clonidine.

Objective: To survey the prevalence of cumulative trauma disorders (CTDs) and to analyze the ergonomic factors in the paper reviewing workers.

Method: Five hundreds and twenty subjects of paper reviewers were collected from 'National Medical Insurance Association' who had been exposed to risky working environment regarding CTDs. The subjects were first screened by occupational medicine specialists and confirmed by physiatrist. The subjects were also examined by serologic test, radiologic imaging, and electrodiagnostic study. Ergonomists analyzed the job element to identify the risk factors by baseline checklist of CTDs.

Results: Among the workers, 51 (9.8%) of 520 were confirmed to CTDs, the prevalance of myofascial pain syndrome was 22 (43.1%), that of medial epicondylitis was 13 (25.5)%, lateral epicondylitis 8 (15.7%) and others. Pain scale of National Industrial Occupational Safety Health Institute symtoms criteria was highest in the shoulder girdle and the next was in the neck, in the wirst and fingers. The ergonomic risk score was highest 2.56 in the 'verifying' job, and the next 2.20 in 'the 2nd examination' job and 'the 1st examination' job, 1.72 in 'correcting' job.

Conclusion: The result would be helpful for the prevention and management of CTDs in the paper reviewing workers.

Lissencephaly results from a neuromigrational arrest during first and second trimester of pregnancy and shows hypotonia, marked mental retardation and seizure as predominant features. Myelination is a perinatal process and co-occurence of migrational disorder with myelination disorder is rare. We report a 17-month-old male with mixed quadriplegia and mental retardation with type 1 lissencephaly and dysmyelination of cerebral white matter diagnosed by magnetic resonance imaging.

Congenital Achilles tendon contracture is an autosomal dominant disease which is relatively rare. The disease manifests itself as 'toe walking'. Since the clinical condition is relatively benign, it is easy to be overlooked by the clinicians. To the patients, it presents problems of ambulation and activities of daily living. We present a case of 23 year old man who has been walking on his toes. The patient had a difficulty in squatting and tieing shoes and performed poorly gym activities. The patient's father and brother also walked on toes, which made the patient become indifferent to his condition. Upon physical examination, plantarflexion contractures of both ankle joints were 10 degree and the knee were 5 degree. We could not find any abnormal findings in motor or sensory function tests of both lower limbs. Deep tendon reflexes on patella and ankle were within normal range. There were no abnormalities in ankle X-ray, electromyography, blood sample test including muscle enzymes. Gait analysis showed increased ankle plantarflexion moment during entire gait cycle, increased knee flexion during terminal stance, and decreased both knee flexion during initial swing.

Castleman's disease is a rare clinicopathological entity characterized by multicentric angiofollicular lymph node hyperplasia and sometimes associated with polyneuropathy. We report 4 cases identified with diagnosis of Castleman's disease by lymph node biopsy and peripheral polyneuropathy. They had a hypesthesia of all limbs, gait disturbance, weakness of distal lower limbs and enlargement of lymph nodes. Among them 2 patients were combined with POEMS (polyneuropathy, organomegaly, endocrinopathy, increase of M protein, skin change) syndrome. Motor and sensory nerve conduction velocities were below 70% of lower normal limit, the amplitudes of compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) were reduced. Deterioration of nerve conduction study was more severe in lower limb than the upper. More denervation potentials were found in lower limbs than the upper and in distal limbs than the proximal. As disease getting worse, the slower conduction velocity and lower amplitude of CMAP and SNAP were observed.

Rehabilitation in patients with bilateral upper extremity amputation presents a considerable problem for prosthetic training. This is a report of a bilateral transhumeral amputee and a bilateral transradial amputee admitted for intensive prosthetic rehabilitation. They underwent bilateral upper extremity amputation due to electric burn. They were successfully fitted with conventional body-powered prostheses. The problems in rehabilitation of adult bilateral upper extremity amputees were discussed and the patients' compliance was assessed. In our two cases, good acceptance and functional benefit were noted. Thus, we suggest that multidisciplinary approach including prosthetists with full discussion should be a very important factor for specialized comprehensive prosthetic training of multiple complexed amputee.