The myofascial pain syndrome is a chronic pain disorder that is characterized by its physical findings such as trigger points, palpable muscle band, etc.

The local twitch response of palpable muscle band is one of the characteristic physical findings in myofascial pain syndrome but no definite objective method to evaluate the local twitch response is present.

Authors think that the electromyographic evaluation in myofascial pain syndrome is essential because its suggested pathophysiology focuses on the muscle system. Thus we performed electromyographic recordings of local twitch response in myofascial pain syndrome and discussed standardization of the method.

The summary are:

1) The motor unit activity of local twitch response is greater than that of the control subjects, responded to snapping palpation.

2) The difference between patients and control subjects is greater in the superficially located electrode and in the snapping the most tender site of trigger point.

3) We suggest the electromyographic evaluation of local twitch response as a diagnostic tool in myofascial pain syndrome.

To evaluate respiratory function in cervical cord injury, we carried out the pulmonary function test and arterial blood gas analysis on 30 patients with cervical cord injury who were admitted to the Rehabilitation Center, Yonsei University Medical College from June 1986 to March 1990.

The results were as follows:

1) In the cervical cord injury group, vital capacity, expiratory reserve volume, and inspiratory capacity were 1.92 L, 0.31 L, and 1.59 L, which were 53.5%, 24.8%, and 65.2% respectively of the control group values (p<0.01). However, tidal volume was 0.65 L (86.7% of the control group) which indicates normal range.

2) Forced vital capcaity, forced expiratory volume in 1 second, and forced expiratory flow at 25 to 75% were 1.97 L, 1.72 L, and 2.05 L in the cervical cord injury group representing 52.8%, 54.8%, and 55.2% respectively of the control group values (p<0.01)

3) FEV₁/FVC was 86.2% and this means that the respiratory pattern was not obstructive but restrictive.

4) There was no significant difference in pulmonary function test between complete and incomplete spinal cord injury (SCI).

5) In the arterial blood gas analysis, all results were within normal limits and there was no significant difference between complete and incomplete SCI.

6) There was no significant difference in arterial blood gas analysis and pulmonary function test between mid (C4, 5) and low cervical cord injury (C6, 7).

Cortical component of the somatosensory evoked potential elicited by median nerve stimulation was attenuated by passive, active movement of ipsilateral hand and tactile, vibratory stimulation of hand.

This study was carried out to investigate the effect of a variety of "interfering" stimuli on the median derived somatosensory evoked potentials and its mechanial interaction. The interfering stimuli were passive, active movement and tactile, vibratory stimuli on ipsilateral hand and the potentials were recorded over Erb's point, cervical spine and scalp.

The results are as follows:

1) The latencies of Erb's, cervical and cortical potentials were 9.15±0.41, 12.60±9.79, 18.25±0.77 msec, respectively in Baseline recording and the differences of latencies with interfering sensory stimuli were not statistically significant (p>0.05).

2) The amplitudes of Erb's, cervical potentials were 3.91±1.39, 4.15±1.04uV, respectvely in baseline recording and the differences of amplitudes with interfering sensory stimuli were not statistically significant (p>0.05).

3) The amplitude of cortical potential were 4.76±1.86 uV in baseline recording and the mean percentages of amplitude reduction were 37.29±13.34% (3.01±1.36 uV) by vibratory stimuli, 26.94±10.21% (3.45±1.39 uV) by active movement, 19.47±10.40% (3.83±1.58 uV) by passive movement and 12.05±10.91% (4.19±1.73 uV) by tactile stimulation. These were statistically significant (p<0.001).

4) The amplitude reduction of cortical potential is related to the central interaction, not to the peripheral interaction.

This study is mentioned a new method of treatment in musculoskeletal inflammatory conditions in rehabilitation.

Twenty patients were treated with iontophoresis (direct current 4milliampere, 20minutes). Treatment drugs were 1 cubic centimeter, 4milligrams per milliliter of dexame-tasone sodium phosphate had an excellent relief of pain and symptoms, one reported moderate relief, and one patient had little change. There were no significant side effects. It was concluede that iontophoresis is an effective mode of deliverying ionized anti-inflammatory drugs to inflamed tissues. It is effective, painless, and safe treatment.

Diagnostic approach method using postural reactions after Bojta was intorduced to Korea in early 1980' through Kinderzentrum München in West Germany. But the most of data about postural reactions came from outside of Korea.

Authors analyzed the results of examination using postural reactions on 199 infants who had complain of delayed development.

Results were as follows:

1) Nearly half of infants (43.2%) were recognized by parents before 6 months of corrected age.

2) Many infants had risk factors of low or high birth weight and premature or postmaturity (21.5%, 18.0% respectively). This tendency was prominent in the group of 4∼7 abnormal postural reactions.

3) Proportion of infants who need observation of treatment according to Vojta's criteria were 17.1%, 36.2% respectively.

4) The most frequent abnormal postural reaction was Vojta reaction (65.3%).

5) Frequent pathological reflexes were hand grasping, supurapubic stretch, crossed extension, and Galant reflex in order.

6) Frequent accompanied diseases in neonatal period were neonatal jaundice requiring exchange transfusion, neonatal seigare, sepsis, congenital anomalies, hypoxia, and respiratory distress syndrome.

Muscular dystrophy is usually considered to be a chronically progressive disease leading to disability in physical, psychological and social aspects. Management should include early diagnosis, establishment of a rehabilitation plan, maintenance of ADL and ambulation as long as possible, anticipation of complications, development of a program for prevention and supportive counselling of the patient and family.

We studied 106 progressive muscular dystrophy patients under the headings of type, electromyographic findings, family history, muscle enzyme levels, functional stage and vital capacity.

The results of these studies were as follows:

1) 106 patients comprised 66 cases of Duchemme type, 23 cases of limb-girdle type and 17 cases of facioscapulohumeral type.

2) Duration from symptom onset to initial visit was 3.7 years in Duchenne type, 8.1 years in limb-girdle type and 8.5 years in facioscapulohumeral type.

3) Suspected symptoms in family members were reported 30.3% in Duchenne type, 21.7% in limb-girdle type and 47.1% in facioscapulohumeral type.

4) Change of functional stage in Duchenne type was from 2.5 to 3.1 after 8.5 month follow up.

5) In the same age group, functional stage of the early visit group was higher and the rate of progression was slower than in the late visit group.

6) After intensive pulmonary care program, vital capacity increased in the group with high level of functional stage.

The effects of electromyographically triggered electric muscle stimulation on extensor digitorum communis were evaluated in 10 hemiplegic patients whose onset of hemiplegia was longer than 6 months. All patients had been treated with conventional physical therapy and they show no further improvements in motor function.

Patients were asked to extend MP joints as much as possible. At the same time, the EMG signals from extensor digitorum communis were displayed on the screen. When the amplitudes of singnals reached near to their maximum, electrical stimulation on the muscle was done for 2 seconds with preset mode. Of 10 patients, 3 patients show remakable imporvements in quantitative EMG value and active extension and 1 patient show improvements in action MP extension.

1) The occupational injured patients have some characteristic problems during their treatment with lack of motivation or psychosocial adaptation on disability.

2) This study was conducted to locate the causes of problem concerning to the rehabilitation of industrial accident patients.

3) The study was subjected to 326 cases (310 male, 6 female) which have been treated as inpatients at Industrial Rehabilitation Hospital, and the subjected were analyzed the causes of injuries, the status of disabilities and the vocational training program including psychosocial backgrounds. The results were as follows:

The age in average was 36.8 years in male and 44.9 years in female. The occupations prior to injury were mining 104 cases (31.9%), construction 94 cases (28.8%), manufacturing 83 cases (25.5%), transport & express 19 cases (5.8%). The most frequent cause of injury was fall down 95 case (29.1%), and struck by, caught in, overexertion respectively. The disabilities were pain 114 cases (30.8%), limited range of motion of joint 97 cases (26.2%), cord injury 90 cases (24.3%), amputation 30 cases (8.1%), hemiplegia 22 cases (5.9%), among these 370 disabilities the 44 cases (11.9%) were noticed as multiple disabilities. The lesions of injury were spine in 157 cases (29.1%), fractures in 154 cases (28.5%), back injury in 97 cases (18.0%), joint injury in 71 cases (13.1%). The level of spine lesion was at lumbar spine 40.0%, thoracic spine 39.5%, cervical spine 16.6%, and sacral spine 1.9%, and the associate injury of spinal cord were 88.5% in cervical spine, 51.6% in thoracic spine, and 48.5% in lumbar spine. The site of the fracture was tibia & fibula in 22.1%, femur in 18.8%, radius & ulna in 14.3%. In joint injuries, the knee joint was most frequent site in 54.9%. The average duration of treatment prior to transfer to the Rehabilitation Hospital was 385.9 days at more than 2 hospitals. The duration of admission at Industrial Rehabilitation Hospital is 454.5 days in average from 16 days to 1956 days. The admission at indicated cases were noted in 60.5% which included only nursing care needed 12.1% patients. Among the total 326 cases, only 19.0% who 29.4% years old in average were under taking vocational training rehabilitation program, and 58.7% of cooperated 46 subjects had taken legal action to get compensation payment.

These findings indicate that average stay in Rehabilitation Hospital are longer and most of patients are lack in motivation, due to unable to accept of their disabilities and too much depend on the compensation. The 39.5% of patients are indicated to be disadvantage on economic condition with discontinuation of monthly compensation salary if discharged. A permanent nursing home for the severely disabled patients who need constant nursing care should be innovated by government. It is also suggested that psychosocial rehabilitation program should be enhanced with the medical rehabilitation program.

Heterotopic ossification, or the periarticular formation of bone, occurs frequently as a secondary complication of severe spinal cord trauma, head trauma, burn, total joint arthroplasty and other neurologic injuries. The etiology is still unknown. It's clinical manifestations are pain, swelling, limitation in range of motion and progressive deterioration in function, soon thereafter. Because of the late detection of this lesion there is some delay when to start medication, or when to do physical therapy. The purpose of this study is to find out the importance of the early diagnosis and treatment of heterotopic ossification. We analyzed the clinical course of Heterotopic ossification in 21 patients (spinal cord injury: 12, head injury:9) who had admitted to St. Mary's Hospital, Catholic University of Medical College, from January 1985 to June 1989.

The results were as follows:

1) The mean age were 43.1 years. 83.3% of all the spinal cord injured patients were older than 30 years and 75.0% of all the head injured patients were older than 50 years.

2) Male was more affected than female in both case.

3) The common site of heterotopic ossification were hip, knee in spinal cord injury, and knee, shoulder, hip, elbow and ankle in head injury I order.

4) The mean duration from the injury to the onset of clinical manifestation was 17 days. Serum alkaline phosphatase began to rise on 127th day and radiological bone formation could be seen on 214th day post injury.

5) The risk factors related to ectopic bone formation in spinal cord injured patients were spasticity (100%), age over 30 years (83.3%), presence of pressure sore (58.3%) and completeness of lesion (58.3%), while those in head injured patients were spasticity (100%) and type of brain injury (ICH; 50.0%).

Thus serial determinations of the serum alkaline phosphatase and follow-up check of roentgenograms at frequent intervals are prerequisites to early diagnosis and early treatment of ectopic bone formation in high risk patients.

The purpose of this study was to obtain precise information about the state of the physically disabled and the attitude of the physically disabled themselves, their families and nondisabled members of their rural community about their disability and rehabilitation, in order to provide basic data for planning and evaluating the Community-Based Rehabilitation Project for this community.

Those enlisted in this survey involved 672 households which were 5% of the total households in North Wanju County. From August 8∼12, 1988, 2,719 persons were investigated. The results were as reported.

The prevalence of all the disabled was 2.83% of the population; the prevalence of physically disabled persons was 2.06%. Of all the disabled, 72.7% were physically disabled.

The male: female ratio was 1.4：1. Of the physically disabled 39.3% were in their sixties and 67% were older than fifty.

Strokes among the physically disabled represented the most frequent diagnosis of the disabled while joint contracture and ampuation took second and third place.

The most common age for occurance of a physical disability was during the sixties and this group represented 25% of all disabilities. The second most frequent period was from age 0∼10 which occupied 23.3% of all disabilities. Postnatal disabilities were the cause of 92.9% of all physical disabilities.

More than two-thirds of the physically disabled detected did have a history of medical examination or treatment. A hospital or private clinic was the most frequent place for receiving medical care. Only 14.3% of the physically disabled received physical therapy.

Twenty-seven percent of the physically disabled were dependent in their activities required for daily living. Thirty-nine percent used braces or prostheses. The most frequent desire of these persons for their rehabilitation was medical treatment.

There was a much higher incidence of illiteracy and unemployment among the physically disabled and a higher proportion of their families received medicaid and low incomes than the Nondisabled families.

All of the physically disabled, along with their families and nondisabled residents of their communities, had a relatively higer level of concern for the disabled and a better acceptance of the rehabilitation facilities, as well as a healthy view point about the social life of the disabled.

There was a relatively low level of preception of rehabilitation terminology among all of the people who were investigated. They had a somewhat passive attitude toward rehabilitative care and the socialization of the disabled.

In contrast, the nondisabled residents held a critical view point toward the status of the disabled person's social welfare. The educational level of the residents was reflected in their perception and attitude toward the disabled and their rehabilitation.

The pathogenesis of the peripheral neuropathy induced by vincristine is poorly understood, but interference of vinca alkaloid with microtubule assembly suggests that microtubule changes could be important. We have seen a 27-year-old female patient who complained of generalized weakness after receiving an overdose of vincristine in the treatment of Hodgkin's disease. The physical examination and electrodiagnostic study are compatible with polyneuropathy.

Middle latency responses (MLRs) are a series of scalp evoked potentials occurring between 8-50 msec following onset of an acoustic stimulus. The latencies and interpeak amplitudes of the potentials are affected by stimulus intensity, frequency, type of sound, age, temperature and frequency filter setting. The purpose of this study is to demonstrate the effects of intensity, frequency and type of stimuli.

The subjects of this study were 20 normal volunteers between 23 to 33 years of age.

The major results were as follows:

1) The absolute latencies of MLR became significantly shorter with increment of stimulus intensity and frequency (p<0.05).

2) The interpeak amplitudes of MLR became significantly greater with increment of stimulus intensity (p<0.05), while there was no significant change with increment of stimulus frequency.

3) Click-elicited MLR showed shorter absolute latencies and greater interpeak amplitudes than in tone-elicited responses, significantly (p<0.05).

4) The detection rates of MLR became significantly higher with increment of stimulus intensity and with click stimui (p<0.05).

5) There was significant correlation in latencies between V wave of BAEP and Na wave of MLO (p<0.05)

To evaluate the characteristic changes in muscles of knee joint after meniscal injury and the necessity of preoperative and postoperative isokinetic exercise program, we performed the isokinetic tests of the knee muscles periodically, preoperative state, postoperative 3 months, postoperative 6 months and compared each other.

The results were as followings;

1) In preoperative state, there were about 10% torque dificit in uninvolved knee extensor & flexor muscle and 33% torque deficit in involved knee extensors, and 27.7% torque deficit in involved knee flexors.

2) The recovery rate of extensor muscle power after menisectomy was faster in uninvolved side than involved side. The muscle power of extensor of uninvolved side came up to normal level within 3 months after menisectomy but that of involved side improved slowly and came up to normal level after 6 months postoperatively.

3) The recovery rate of flexor muscle power after menisectomy was also faster in uninvolved side than involved side and the flexor muscle power came up to normal level earlier than extensor muscle power.

4) The muscle imbalance between uninvolved and involved knee was about 22% at preoperative state but increased to 26% at postoperative 3 months, then, decreased to 13% at postoperative 6 months.

5) The hamstring to quadriceps imbalance (H/Q ratio) was 9.3 at preoperative state but increased to 22% at postoperative 3 months then, decreased to 6.6% at postoperative 6 months.

6) Therefore, we think that the isokinetic exercise is essential program in rehabilitation of knee muscles after menisectomy, especially in early postoperative phase.

And we think that, the isokinetic exercise for extensor is more necessary than flexors and the high velocity isokinetic exercise is more useful.

Since isokinetic exercise equipment can give an evaluation of muscle strength with great accuracy and objectivity, it is more widely using as the one of the important methods in rehabilitation and sports medicine.

The aim of this paper is to determine the normative strength values for wrist flexor and extensor and to set up the accurate measuring criterion of the strength in case of manual muscle test of wrist comparing variation of strength as the change of elbow joint angle.

This test is carried out for the strength of wrist flexor and extensor on the condition that the subjects are 30 healthy men from 3rd to 4th decade at the speed of 60^o/sec and the elbow were flexed at 90^o and 45^o and were extened at 0^o.

The results were as follows:

1) The mean peak torque of elbow flexor were 9.12±2.08 ft-lbs at 90^o of elbow angle, 7.17±1.67 ft-lbs at 45^o, 5.02±2.78 ft-lbs at 0^o.

2) The mean peak torque of elbow extensor were 4.52±1.76 ft-bls at 90^o of elbow angle, 3.52±1.85 ft-lbs at 45o, 2.17±1.45 and 43.2% at 0^o.

3) The ratio between the peak torque of two muscle group at 90o of elbow angle were 49.5% at 90^o at 90^o at elbow angle, 46.9% at 45^o and 43.2% at 0^o.

According to above data, the peak torque of two muscle group at 90^o of elbow angle were significant higher than at 45o and 0o of elbow angle, therefore we concluded that the manual muscle test of wrist flexor and extensor had better be performed at 90^o of elbow angle.

Tilt table have been done to help the patients with spinal cord lesion overcome postural hypotension and also to improve trunk balance and coordination.

This study was performed to observe the hemodynamic effects of head-up tilt in twenty-two patients with spinal cord lesion.

1) Most patients showed orthostatic hypotension and increased heart rate, and the changed amounts are larger upon patients with cervical cord injury than thoracic cord injury.

2) Amounts of decreased bleed pressure and increased heart rate were reduced by extended tilt duration in patients with spinal cord lesion.

3) In patients with cervical cord lesion, continual tilt table-using group showed less changing of blood pressure and heart rate than intermittent tilt table-using group.

Perceptual dysfuction following stroke causes a high proportion of failure in activites of daily living.

The authors have assessed perceptual function in 30 normal adults and 20 stroke patients. The degree of perceptual function of normal adults and patients and relationship between perceptual dysfunction and activities of daily living and cognitive function in stroke patients were investigated.

The results are as follows:

1) Among the twelve items of perceptual function tested in normal adults, maximum score was not obtained in 5 items, that is, finger agnosia, tactile agnosia, figure ground, form constancy and position in space.

2) Among items in the perceptual function, function in body scheme was decreased significantly for right hemiplegics and in left hemiplegics, decrease in function on spatial relations and unilateral neglect showed a significant difference when compared to right hemiplegics.

3) Among the perceptual function, the 4 items in spatial relations showed significant positive correlation with each other.

4) Dysfunction in perception was directly related to decrease in activities of daily living and dysfunction in cognition in stroke patients.

Ultrasound is primarily useful as a deep as a deep heating agent at present because it produces a rise of tissue temperature in selective areas requiring heat for therapeutic purposes. There are many factors influencing the temperature distribution in areas exposed to ultrasound but standardized criteria are lacking for sites in human beings, especially in scapular area.

Sixteen patients suffering from myofascial pain in shoulder area recieved ultrasound at the intensities of 0, 0.5, 1.0, 1.5, 2.0 W/cm² for 10 minutes in infraspinous fossa. tissue temperatures were recorded near the interface between scapular bone and infraspinatus muscle (depth: 3-5 cm) using clinical thermomerer. Results are followings.

1) Ultrasound at an intensity of 1, 0.5(0) W/cm² caused the decrement of tissue temperature at a rate of 0.01^oC/mim for 10 minutes (p<0.05)

2) Tissue temperaturerose at a rate of 0.05, 0.09, 0.17, 0.26^oC/min. for 10 minutes with 0.5, 1.0, 1.5, 2.0 W/cm² respectively (p<0.05).

3) All patients that received the ultrasound of 2.0 W/cm² reported warm sense but the beginning points of warm sense are of wide range, ranging from 37.4^oC to 40.2^oC (average 39.0^oC). Patients generally felt warmth when they received 1.5 W/cm² intensity, at the speed of 3-4 sec/circle.

4) Minimal conditions of ultrasound therapy in infarspinous muscle area should preferably be 10 minutes in duration, 1.5-2.0 W/cm² in intensity, in moderately slow stroking method.

To establish a diagnostic test for femoral neuropathy we have stimulated the femoral nerve above and below the inguinal ligament in 42 persons of healthy Korean free of axonal or muscular disease.

Mean latencies from above the inguinal ligament to the motor point of the vastus medialis are 5.5±0.5 msec in men, 5.1±0.5 msec in women and those below are 4.6±0.4 msec in men 4.2±0.5 msec in women.

The average delay across the inguinal ligament is 0.9±0.3 msec when the average distance across stimulating electrode is 4.9±0.1 cm.

This study is useful in differentiating neuropathic disease from myopathic or others in patients with distal atrophy.

Antidromic radial and median compound sensory nerve action potentials (CSNAP) were recorded from the index and middle fingers in 30 subjects, Eighty percent subjects had radial CSNAPs at the base of index finger, and had thirteen percent subjects at the base of middle finger. Sudden reduction was showed radial CSNAPs amplitude was small size and wide variability among individuals, Radial CSNAPs from index and middle fingers seem to have limited direct clinical utility, Contamination of median CSNAPs by radial CSNAPs is negligible or absent (when there is unavoidable spread of the stimulus to the radial nerve), if median sensory responses are recorded from the distal half (exept for PIP joint) of the index or middle finger.

This study was carried out in five Korean rabbits of 3 months old of age to investigate the temperature change in tissue by ultrasound therapy. Ultrasound was applied to gluteal area of rabbits with the intensity of 1.0 Watt/cm², 1.5 Watt/cm², 2.0 Watt/cm², and 3.0 Watt/cm² for 15 minutes. And the tissue temperature was measured with Thermister needle at skin, subcutaneous tissue, 1 cm depth muscle, 2∼3 cm depth muscle without media application, after media application for control, and this measurement was repeated in 2.5 minutes, 5.0 minutes, 7.5 minutes, 10.0 minutes and 15.0 minutes after ultrasound application.

With 1.0 Watt/cm², intensity, there was no temperature change in deep tissue but the temperature of skin was significantly increased after 15 minutes application.

With 1.5 Watt/cm², intensity, there was no temperature change in deep tissue but the temperature of skin was significantly increased after 2.5 minutes application.

With 2.0 Watt/cm², intensity, there was no temperature change in deep tissue, but the temperature of skin was significantly increased after 2.5 minutes application and the temperature of subcutaneous tissue was elevated after 15 minutes application.

With 3.0 Watt/cm², intensity, the temperature of 2∼3 cm depth muscle was significantly increased after 10 minutes application, and the temperature of 1 cm depth muscle and the temperature of subcutaneous tissue was significantly increased after 7.5 minutes application and the temperature of skin was elevated 2.5 minutes application.

These results show that the ultrasound therapy should be done with 3.0 Watt/cm2 for more than 7.5 minutes to induce the temperature elevation in deep tissue.