Objective: We observed the nature of ipsilateral weakness, not hemiplegic side after stroke. And we studied correlation between ipsilateral weakness and neurologic recovery of hemiplegia.

Method: This study was prospective, follow-up clinical trial. Ipsilateral motor power was checked serially in 20 subjects using Nicholas Manual Muscle Tester (NMMT) (shoulder abduction, wrist extension, hip flexion, ankle dorsiflexion). The subjects are first attacked hemiplegic stroke patients. Other outcome measures are Mini-mental Status Examination (MMSE) and National Institutes of Health Stroke Scale (NIHSS). We studied correlations between motor power recovery in ipsilateral limbs and recovery of neurologic impairment in hemiplegic limbs of stroke patients through SPSS 7.0 program.

Results: Ipsilateral motor power in early stage stroke patients is significantly low compared with that of normal subject except ankle dorsiflexion (p＜0.05). Comparing ipsilateral proximal with distal limbs power in pre and post multidisciplinary rehabilitation program, upper proximal part recovered faster than the distal part, but which was not statistically significant. Recovery of ipsilateral upper proximal and distal limb weakness is associated with neurologic recovery in hemiplegic side.

Conclusion: After the stroke, ipsilateral upper limb motor weakness does occur and which follows similar neurologic recovery pattern to the hemiplegic side. Ipsilateral cortical and subcortical tracts take effect on the neurologic recovery of contalateral side.

Objective: To investigate the functional outcome with regard to cognitive deficits in patients with aneurysmal subarachnoid hemorrhage (SAH).

Method: Two hundred thirty-four patients who underwent surgical procedure for aneurysmal SAH were enrolled. Medical records of the patients were reviewed.

Results: Mental confusion (52.1%) was more common symptom than the motor (20.3%) and language (30.9%) impairment in patients with aneurysmal SAH. Neurological grade at admission (Hunt and Hess grade), cerebral vasospasm, and mental confusion were major prognostic factors. In terms of functional outcome, patients with mental confusion showed lower Functional Independence Measure (FIM) scores at admission and on discharge, lower FIM gain and FIM efficiency, and longer hospital stay with statistical significance than those without confusion.

Conclusion: The patients with cognitive deficits achieved poor functional outcome in the patients with aneurysmal SAH. More attention to cognitive impairment is necessary to achieve better rehabilitation goal.

Objective: The purpose of this study is to evaluate the patterns of voiding dysfunction of stroke patients during rehabilitation.

Method: We evaluated 53 patients with complaints of voiding dysfunction following the strokes. After the comprehensive history and physical examination, all patients underwent cystometric study and males underwent the transrectal ultrasound.

Results: The incidences of detrusor hyperreflexia, detrusor areflexia, and normal finding on the cystometry were 50.9%, 32.1%, and 17.0%, respectively (p＜0.05). There was a significantly high incidence of detrusor hyperreflexia in the groups of subcortical lesion, large lesion, and the over 3 months after stroke (p＜0.05). However, there was no statistical difference on cystometric findings according to the other characteristics of the stroke such as the age, sex, type of stroke, cognition, aphasia, and diabetes mellitus. The incidences of irritative, obstructive, and mixed symptoms according to the presenting voiding complaints were 49.1%, 32.1%, and 18.9%, respectively (p＜0.05). There was no significant statistical difference on the cystometric findings according to the 3 voiding symptom groups as well as none of significant statistical difference on prostate enlargement in males in according to the 3 voiding symptom groups.

Conclusion: Only with the pattern of voiding, we could not predict the cystometric finding or the presence of bladder outlet obstruction. Thus, we recommend the further studies including cystometry and evaluation of the bladder outlet obstruction for the treatment of voiding dysfunction of stroke patients during rehabilitation.

Objective: To analyze the factors affecting on the level of the quality of life of stroke patients and their family caregivers.

Method: Among the stroke patients receiving rehabilitation treatment at forty three out patient clinic in university hospitals, 289 stroke patients who scored over 24 out of 30 points in MMSE-K and their family caregivers were interviewed using questionnaires.

Results: The main contributory variable on the quality of life (QOL) of caregivers was the socio-demographic factor and QOL of caregivers was improved with decreasing age, the higher level of education, the less burden of care and the better condition of patient. High correlation coefficients were showed between QOL of stroke patients and ADL, QOL of caregivers and burden of care, and the burden of care and the neurological impairment. The main contributory variable on the QOL of stroke patients was clinical characteristics factor and QOL of stroke patients was improved with increasing the levels of cognitive function and ADL performance, decreasing the level of neurological impairment, the more social support from friends and the less burden of caregivers.

Conclusion: In order to improve the QOL of stroke patients, not only patients' physical factors, but psychological factors, socio-demographic factors and QOL of caregivers should also be considered.

Objective: Traumatic brain injury is related to the acute stress response, and this can be accompanied by an elevated serum glucose level. So we estimated the influence of hyperglycemia on neurologic, functional status and outcome.

Method: We studied the 139 traumatic brain injured patients who had been admitted to the department of neurosurgery from 1996 to 2000, retrospectively. We reviewed initial serum glucose level, postoperative glucose level, and Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS). We compared these values with functional independence measure (FIM) scores. Patients were divided into two groups according to the initial serum glucose level, then we analyzed the correlation between glucose level and GCS, GOS, FIM.

Results: The correlations of early hyperglycemia with GCS, GOS, initial FIM scores were significant (p＜0.01). But serum glucose levels were not correlated with plateau FIM scores (p＞0.05). Patients with unfavorable neurologic outcome after 10 days from head injury had significantly high serum initial and postoperative glucose levels than those with favorable neurologic outcome (p＜0.01).

Conclusion: In patients who had received rehabilitation therapy with moderate or severe head injury, early hyperglycemia were significantly correlated with initial FIM scores, GCS, GOS, but not with the plateau FIM scores.

Objective: The purpose of this study is to evaluate gait characteristics using kinematic analysis in children with hemiplegic spastic cerebral palsy.

Method: Fifty-seven non-operated spastic hemiplegic children who were able to walk independently without any walking aid were recruited as subjects. Three-dimensional kinematic gait analysis using a motion analyzer (Vicon 370 M. A. with 6 infrared cameras) were performed in all patients. Changes in joint angle of hip, knee and ankle in sagittal plane were evaluated to classify gait pattern and also the temporospatial values were measured to determine any differences between groups.

Results: Gait patterns were able to be classified into 6 groups. Group I had a minimal gait disturbance, a drop foot pattern. Group II showed hip and knee flexed, with normal ankle range. Group III showed hip, knee, and ankle flexed. Group IV showed genu recurvatum with tibia progression, Group V showed genu recurvatum with tibia arrest. Group VI showed stiff crouch gait. However, the temporospatial values between groups were not significantly different.

Conclusion: This classification system would be useful for converting the vast quantitative information of gait analysis into descriptive and clinically relevant patterns. Therefore, it would be helpful for the clinician to understand underlying pathology and plan appropriate treatment.

Objective: To evaluate the clinical utility of the dynamic gastrocnemius length, calculated with gait analysis after phenol or botulinum toxin block in spastic cerebral palsy.

Method: Gastrocnemius muscles were injected with phenol or botulinum toxin. Kinematic gait parameters including dynamic gastrocnemius length were surveyed with 3-dimensional gait analysis system before and after the procedure.

Results: The dynamic gastrocnemius lengths improved significantly after block of calf muscles, except 3 cases which showed severe genu recurvatum. The vertical displacement of the center of gravities and the maximal ankle dorsiflexion angles after the block were not significantly different from those before the block.

Conclusion: Dynamic gastrocnemius length calculated with gait analysis can be used as a tool to determine the efficacy of spastic calf muscle block, in the absence of severe genu recurvatum. In case of associated severe genu recurvatum, other parameters may be substituted.

Objective: To evaluate the efficacy of botulinum toxin type A in the treatment of spasticitc and dystonic upper limbs in a group of cerebral palsy children

Method: Eighteen children with cerebral palsy who did not have fixed contractures in the wrist and hand were enrolled (mean age 9.0 years; range 6∼15). Measurements were obtained before and at 1 and 3 months after botulinum toxin A injections. Assessments included spasticity (modified Ashworth scale), range of motion of thumb and functional assessments including Melbourne assessment of unilateral upper limb function and Jebsen Taylor hand function test. Hand and forearm muscles were injected with 1∼3 u/kg botulinum toxin.

Results: Spasticity measured by modified Ashworth scale decreased by 1 month and diminished spasticity continued for 3 months. Range of motion of thumb increased by 1 and 3 months. In Jebsen hand function test, patients showed functional improvements in item 6 (lifting light weight object) and item 7 (lifting heavy object). Melbourne assessment of unilateral upper limb function scores improved from a mean value of 92 at baseline to a mean value of 101 at 1 month and a mean value of 105 at 3 months.

Conclusion: Botulinum toxin A would be helpful in some selected cerebral palsy patients with upper limb dysfunction. But further research including randomized controlled study is needed on the use of botulinum toxin A to improve function.

Objective: The ultrasonographic (US) findings of the sternoocleidomastoid muscles (SCM) in patients with congenital torticollis were studied to evaluate the correlation between the US findings and outcome of physical theraphy.

Method: We studied 52 patients diagnosed as congenital muscular torticollis. We evaluated the thickness, mass, echogenicity and echotexture of both SCM muscles. The US findings of the SCM muscles were divided into 5 grades according to the severity. The physical theraphy included heat theraphy and passive stretching of involved muscle. The outcomes of the treatment were evaluated by physical examination and follow-up US examination.

Results: Neck rotation of lesion site comparing to non-lesion site was improved significantly from 83.0⁑16.5% to 94.9⁑7.16% and lateral flexion from 77.9⁑18.1% to 90.5⁑12.4% after the treatment. In 20 US follow-up cases, thickness ratio of the involved SCM muscle decreased significantly from 177.8⁑46.2% to 158.3⁑83.1%. The therapeutic effect tends to be low with higher grades of the US findings. But, there were no significant statistical correlation between age and treatment outcome.

Conclusion: The US findings of the SCM muscles had a significant correlation with the outcome and the duration of treatment.

Objective: It is a widely accepted belief that paraspinal muscles tend to show spontaneous activity on needle electromyography early on in a radiculopathy and distal muscles become abnormal later on. But most studies have shown the limitations of using symptom duration when interpreting electrodiagnostic findings in radiculopathy. The purpose of this study was to determine the relationship between symptom duration and abnormal spontaneous activity in S1 radiculopathy confined to abnormal H-reflex.

Method: A retrospective study that collected the informations on symptom duration and spontaneous activity in paraspinal muscle and gastrocnemius for 112 patients with S1 radiculopathy diagnosed by unilateral H-reflex abnormality was undertaken.

Results: Abnormal spontaneous activity in paraspinal muscle had shown a significant negative correlation with symptom duration, that is a tendency to decrease its expression over symptom duration. On the contrary abnormal spontaneous activity in gastrocnemius muscle was rare at first a few weeks and became to show after 7 weeks. Patients with symptom duration over 1 year had higher incidence of having no abnormal spontaneous activities both in paraspinal and gastrocnemius muscle.

Conclusion: These results suggested that symptom duration had a potential role in the diagnosis of S1 radiculopathy when H-reflex were abnormal unilaterally.

Objective: The purpose of this study is to find out whether amplitude ratio and area ratio have correlation with nerve conduction velocity in the diabetes mellitus patients.

Method: Median and deep peroneal motor nerve conduction study was performed in thirty-five normal control group and sixty diabetes mellitus patients group. The motor conduction velocity, amplitude ratio, and area ratio of the compound muscle action potential (CMAP) were measured. The experimental subjects were divided into 6 subgroups (in median nerve: M1, M2, M3, in peroneal nerve: P1, P2, P3) according to the median value of conduction velocity of each nerve; group M1 (n=35) and P1 (n=30): normal control group, group M2 (n=25) and P2 (n=30): below the median value of motor nerve conduction velocity in diabetes mellitus patients, group M3 (n=23) and P3 (n=29): above the median value of motor nerve conduction velocity in diabetes mellitus patients.

Results: There was no significant difference of area ratio between the each subgroups in both median and peroneal nerves. There was a significant difference of amplitude ratio between the M1 and M2 subgroups. There was a significant difference of amplitude ratio between the P1 and P2, P3 subgroups.

Conclusion: According to above results, the decrease of amplitude of compound muscle action potential along with the decrease of conduction velocity seems to be helpful in the electrophysiologic diagnosis of diabetic neuropathy.

Objective: To identify the relationship between the location of motor points of gastrocnemius and soleus and the skin surface landmarks.

Method: Compound muscle action potentials (CMAPs) of each lattice of gastrocnemius and soleus in 11 healthy subjects were recorded. Standardized reference lines were made as follows: 1) a horizontal reference line (popliteal crease) and 2) a vertical reference line drawn between mid-points of the horizontal reference line and inter-malleolus connection line. The CMAPs were mapped horizontally and vertically 1cm width to the standardized reference lines. Location of motor points was mapped to the skin surface in the ratio of length of the vertical and horizontal reference lines.

Results: The motor point of medial head of gastrocnemius was located at 41.0⁑6.1% distal and 54.6⁑19.2% medial to the mid-point of horizontal reference line. The location of the motor point of the lateral head of gastrocnemius was 35.7⁑5.2% distal and 48.5⁑15.1% lateral, respectively. In the soleus, the motor point was at 68.6⁑8.0% distal and 10.5⁑9.0% lateral, respectively.

Conclusion: The motor point of the lateral head of gastrocnemius was located more proximally relative to medial head, and the motor point of soleus was located at slightly lateral side of the vertical reference line. The author concluded that mapping of motor points of the gastro-soleus muscles would increase accessibility in performing phenol motor point block or botulinum toxin injection for management of spasticity or abnormal tonicity of the ankle.

Objective: The effect of the local steroid injection for the carpal tunnel syndrome (CTS) is well known, but there have been a few report of electrophysiologic evaluation for the effect of the local steroid injection. So this study was done to reveal the effect of local injection with triamcinolone acetonide (TA) into the carpal tunnel using the electrophysiologic changes and the improvement in symptoms.

Method: The triamcinolone acetonide (40 mg/ml) was injected to 43 patients (70 wrists) with the CTS diagnosed clinically and electrophysiologically. And the patients were reevaluated with the visual analogue scale and the electrophysiologic study every month. The mean duration of follow-up was 6 months, and the mean number of the injection was two times.

Results: The improvement of symptoms was noted in 90% of the cases, and most of the electrophysiologic parameters revealed significant improvement after the local injection of TA. The number of injection did not correlate with the visual analogue scale and the electrophysiologic parameters.

Conclusion: The local injection of TA into the carpal tunnel in the patients with CTS may be an effective therapeutic modality to improve the symptoms and the electrophysiologic parameters.

Objective: To evaluate the effects of botulinum toxin A (BT) dilution volume and post- injection exercise with electrical stimulation on muscle paralysis.

Method: Eighteen New Zealand white rabbits are randomly assigned to 0.1 ml dilution group, 0.5 ml dilution group or control group. Control group did not receive any injection and 10 units of BT was diluted with 0.1 ml (B1) or 0.5 ml (B5) normal saline and injected to the both gastrocnemius muscles. The right lower limbs of experimental groups did not have any treatment after botulinum toxin A injection (B1C, B5C) and left lower limbs had stretching exercise after injection (B1S, B5S) for 2 hours using the pneumatic kicking machine. Electrical stimulation was also applied to the gastrocnemius muscle with the intensity of 20 mA to 30 mA to evoke plantar flexion of ankle joint. Muscle paralysis effect of BT was evaluated with compound muscle action potential (CMAP) amplitude of gastrocnemius muscle with the sciatic nerve stimulation before and 1 week after injection.

Results: There were significant CMAP amplitude decreases in all animals after BT injection. There were significant decreases of CMAP amplitudes in B5 group compared with that of B1 group (p＜0.001). Left limbs with stretching exercise and electrical stimulation showed lower CMAP amplitude (p=0.01) compared with right limbs which did not have any treatment after BT injection.

Conclusion: To maximize muscle paralysis effect of the botulinum toxin A, increasing dilution volume and performing post-injection stretching exercise with electrical stimulation are considered a good strategy.

Objective: The purpose of this study was to develop a new neuropathic pain model in rat.

Method: Twenty Sprague-Dawley adult male rats, 10 for control and 10 for experimental, were anesthetized and their sciatic nerves were exposed. In an experimental group, exposed nerve was injured with 10 volts electrical current for 10 seconds. The mechanical and thermal allodynia and pain behavior were evaluated in pre-electrical injury and post-injury 1, 2, 3 days, 1, 2, 3, 4, 6 and 8 weeks. The mechanical allodynia was evaluated by the frequency of response to 5 stimulations of von Frey hairs (4.31 and 4.56) and the thermal allodynia was tested by withdrawal latency to stimulation with radiant heat. Spontaneous pain behavior (paw shaking, paw elevation) was observed for 5 minutes in the cage.

Results: The experimental group exhibited significantly higher withdrawal frequency to mechanical stimulation: from post-injury 3 days to 6 weeks for von Frey hair 4.31 and from 2 days to 4 weeks for von Frey hair 4.56 (p＜0.05). There was no difference between two groups in withdrawal latency to radiant heat stimulation. The experimental group showed spontaneous pain behavior but control group did not. In electron microscopic finding, prominent myelin destruction and axonal sprouting were observed in experimental group.

Conclusion: These results suggest that a new neuropathic pain model can be made by 10 volts electrical injury for 10 seconds to rat sciatic nerve.

Objective: To investigate the neuropathic changes induced by nucleus pulposus and possible role of nitric oxide (NO) in the pathogenesis of painful radiculopathy.

Method: Autologous nucleus pulposus was harvested from the rat coccygeal intervertebral disc and grafted to the sciatic nerve. Pain behavior, neurophysiologic and pathologic changes were compared between autografted and sham operated group during 14-day-period. Western immunoblotting and immunohistochemistry with anti-nitrotyrosine mouse monoclonal antibody were used to compare the NO production and nerve damage in autografted and sham operated nerve tissues.

Results: Mechanical allodynia and thermal hyperalgesia were observed 2 days after autograft of nucleus pulposus and persisted during 14-day-period (p＜0.05). Motor nerve conduction latency was delayed and compound muscle action potential amplitude was decreased 5 days after autograft (p＜0.05). Histologically, nucleus pulposus induced severe inflammatory reaction with fibroblast proliferation and foamy macrophage infiltration, which were persisted during 14-day- period. More nitrated proteins were detected consistently in nerve tissues with autograft of nucleus pulposus and immunohistochemical staining of nitrotyrosine was prominent around foamy macrophages.

Conclusion: These data suggest that nucleus pulposus induce mechanical allodynia, thermal hyperalgesia and nerve dysfunction through inflammatory reaction with macrophage infiltration. NO and NO related tissue injury may play an important role in the pathogenesis of painful radiculopathy.

Objective: To study the reaction of tissues in the carpal tunnel after repeated flexion of wrist in order to verify the pathophysiology and pathomechanism of the carpal tunnel syndrome as a cumulative trauma disorder.

Method: Six groups of adult rabbits (5 rabbits were allocated to each groups) were exposed to repeated contractions of the wrist flexors by the median nerve stimulation at the elbow level for different durations; 2 days, 1 week, 2 weeks, 3 weeks, 4 weeks, and 5 weeks. Histological evaluation, morphometric analysis, and electrophysiological studies were carried out after the stimulation.

Results: There were no typical nor consistent findings in the tissues in the carpal tunnel except the median nerve. Inflammatory cell infiltration and edematous changes were noted in the epineurial tissue of median nerve. Decrease of large myelinated fibers and changes of fiber shape were observed in the median nerve. On the morphometric analysis, fiber diameter was smaller in groups of longer exposure duration. Changes were most prominent in 5 weeks group and in the periphery of the nerve fascicle in all the groups. Significant reduction of amplitude and increase of duration of compound muscle action potential were noted on electrophysiological study of the median nerve.

Conclusion: The authors concluded that repeated experimental wrist flexion could give rise to an injury of the median nerve in the carpal tunnel. Accumulation of microtrauma of median nerve by epineurial edema and direct mechanical compression seems to be the pathomechanism of the carpal tunnel syndrome as a cumulative trauma disorder.

Objective: This study was designed to investigate the effect of elbow flexion on the maximal strengths of supination, pronation, and grip which are important component of hand function.

Method: The maximal isometric strength of supination and pronation using BTE work simulator and grip strength using hand-held dynamometer were measured in thirty normal adult subjects. Maximal voluntary contraction for 5 sec was performed at the 0, 45, and 90 degrees of elbow flexion randomly.

Results: 1) The maximal isometric strengths of supination and pronation were significantly higher at the 0 degree, and lower at 90 degrees of elbow flexion (p＜0.05). 2) The maximal grip strength at the 0 degree of elbow flexion was significantly higher than that of 45 and 90 degrees of elbow flexion (p＜0.05).

Conclusion: The strengths of supination, pronation, and grip were affected by the elbow flexion, which were higher in the extended position of elbow. Therefore the elbow angle should be considered and individualized treatment program should be designed in hand rehabilitation to improve strength and to minimize the incidence of overuse disorder.

Objective: To investigate the correlation of multifidus muscle atrophy on MRI findings with clinical findings in low back pain patients.

Method: Medical records of 80 patients presenting with low back pain were retrospectively reviewed. Their MR images were visually analysed to know lumbar multifidus muscle atrophy, disc herniation, disc degeneration, spinal stenosis and nerve root compression.

Results: Multifidus muscle atrophy increased from the upper lumbar level to the most caudal intervertebral level. It was bilateral in the majority of the cases. Multifidus muscle atrophy was well correlated with patient's age, referred leg pain, and disc degeneration. However, duration of low back pain, disc herniation, spinal stenosis, nerve root compression, sex, weight, height and BMI had no correlation with multifidus muscle atrophy.

Conclusion: Examination of multifidus muscle atrophy should be considered when assessing MR images of lumbar spine. It may help for further evaluation and planning the treatment modalities of low back pain.

Objective: To assess the prevalence and contributing factors for myofascial pain syndrome in male adolescents and to evaluate the association of thoracic kyphosis and myofascial pain syndrome.

Method: Four hundred thirteen male students of three high schools and one middle school were randomly selected. With the diagnostic criteria of palpable taut band, spot tenderness and pain recognition, myofascial pain syndrome in trapezius and infraspinatus were diagnosed. Thoracic kyphosis and pressure pain threshold were measured and contributing factors were collected with questionnaire. The relation between thoracic kyphosis and pressure pain threshold was evaluated and contributing factors for myofascial pain syndrome were compared.

Results: The prevalence of myofascial pain syndrome was 31.5% in trapezius and 1.0% in infraspinatus. Mean pressure pain thresholds were low in latent trigger point and myofascial pain syndrome group in comparison with normal group (p＜0.05). There was no statistically significant correlation between thoracic kyphosis and pressure pain threshold. Aging and uncomfortable desk and chair were associated with high risk of myofascial pain syndrome.

Conclusion: Myofacial pain syndrome is common in male adolescents and inadequate posture due to uncomfortable desk and chair rather than physical attributes like thoracic kyphosis is a contributing factor. Proper education and prevention are needed.

Objective: To establish the objective method of diagnosing the myofascial pain syndrome through diagnostic ultrasound and pathology.

Method: Hamstring muscles of 7 female house rabbits, weighing 2.5∼3.0 Kg, were studied. The existence of nodule was confirmed by palpation and through diagnostic ultrasound. A horizontal length, vertical length, thickness, and an area of hyperechoic region were measured. Hyperechoic regions were biopsied and stained with hematoxylin-eosin.

Results: All examined rabbits had muscular nodules in the medial hamstring. Characteristic increase of echogenecity was observed in the medial hamstring muscles. Some uneven hyperechoic areas were seen in the lateral hamstring muscles. Fatty degeneration and giant round cells were observed in the medial hamstring where the echogenecity was increased. The giant round cells were observed only in the lateral hamstring.

Conclusion: Increased echogenecity of the medial hamstring muscle is probably contributed by muscles cells with fatty degeneration and giant round cells, and some portions of hyperechogenecity of lateral hamstring requires further study.

Objective: To evaluate the prevalence and prosthetic uses of lower extremity amputee in one Korean county.

Method: We asked community health worker in Hwa Sung Goon to recruit lower extremity amputees. We contacted them by telephone and tried to know their prosthetic uses, adaptations and their behavior about prosthetic usage. Also, we recruited all lower extremity amputees in Hwa Sung Goon.

Results: In Hwa Sung Goon, the prevalence of lower extremity amputees was 35 persons per 100,000. 93.8% of them had prostheses, more than half of them were not satisfied with their prosthetic use. For last 10 years, they changed into new prosthesis per 2.3 years.

Conclusion: In one Korean county, the prevalence of lower extremity amputees was 0.03%. Most of them used their prosthesis, and walked independently. Their compliances with rehabilitative intervention were very low.

Dominantly inherited spinocerebellar ataxias (SCAs) are a group of the heterogenous neurodegenerative diseases that are characterized by chronic progressive cerebellar ataxia associated with various combinations of other neurological signs. Clinical classification is difficult because of the phenotypic overlap. With the evolution of molecular genetics, the loci and mutations for many of the ataxias have been identified, allowing more definitive molecular classification.

We experienced 42 years-old man who presented with progressive both lower leg weakness, dysarthria, ataxia, ophthalmoplegia, and nystagmus. The family history was remarkably suspicious. We could not observe the upper extremity weakness, definite evidences of peripheral neuropathy and myopathy in electrodiagnosis. No abnormal findings in blood chemistry and brain MRI. We performed polymerase chain reaction (PCR) and polyacrylamide gel electrophoresis (PAGE) analysis, found that his gene contained expanded CAG repeats (CAG repeat number was 72). Although no effective treatment exists for most the ataxic syndromes, the accurate diagnosis and the genetic counseling are often important to the patient's family for prognostication.

A 29 years old woman had suffered from posterior neck and right shoulder pain for one year. She was given a spinal manipulation that was by a non-licentiate at a non-hospital. Posterior neck and shoulder pains were worsened and headache was developed after the spinal manipulation. She was recommended to be kept on the manipulation. Although physical finding was non-specific, radiologic findings of CT and MRI revealed atlantoaxial subluxation. After cervical immobilization and anti-inflammatory drug medication for three months, she recovered and did return to her work. We expect that atlantoaxial subluxation after spinal manipulation is not rare even in healthy young person without underlying pathology and can progress to serious complications unless detailed examination and management are undertaken.

Infiltrative polyneuropathy is an infrequent complication of lymphoma or leukemia. The polyneuropathy can occur in patients with known malignancy, but sometimes it has been initial manifestation of underlying disease. The diagnosis was usually made at autopsy, because more common causes of polyneuropathy were frequently considered during life and many cases showed negative results on sural nerve biopsy. We experienced a case of steroid responsive polyneuropathy due to infiltration of malignant T cell on peripheral nerves prior to lymph node biopsy.

The radiation exposure has multiple complication of various organs. Especially, the Food and Drug Administration has recently issued a bulletin warning of the risks of acute skin injury occurring during fluoroscopically guided procedures. Physicians need information about typical radiation doses during fluoroscopically guided various procedures and estimates of entrance skin dose must be monitored using thermoluminescent dosimetry, film badge dosimetry, pocket dosimetry and on-line computer system. Current National Council on Radiation Protection and Measurements recommended are that yearly total body dose should not exceed 50 mSv (5 rem) and that life time dose measured in millisieverts should not exceed one's age in years multiplied by 10.

Types of skin injury are erythema, alopecia, dry desquamation, invasive fibrosis, dermal atropy, telangiectasia, moist desquamation, skin necrosis and secondary ulcer. Also, long-term exposure caused skin cancer.

We experienced personally pigmentation on the finger nail and the hand after repeated fluoroscopically guided procedures. Thus, we report this case for giving warning to the physiatrist by the complications due to frequent exposure during procedures.