Gait analysis has been proved to be useful in clinical decision making, post intervention evaluation, prosthetic and orthotic evaluation and in other biomedical researches in pathologies of the neuromusculoskeletal system. With recent development of technologies comprehensive gait analysis with kinematic analysis, kinetic analysis, dynamic electromyography and energy expenditure measurement has been introduced in clinical setting. Available methods from observational analysis to complicated computerized motion analysis systems were reviewed to help choose most suitable method since there are many different ways to reach the similar goal according to the patient population, budget, space, personnel and time.

Spinal cord electrical stimulation has been used to decrease spasticity in spinal cord injured patients. With this therapeutic method, the polarity of the applied electrical field and the frequency of the stimulation is critical for a satisfactory therapeutic result. However, frequencies widely ranging from 20 Hz to 1,500 Hz have been used in clinical trials, and results were variably reported. So, this study was designed to determent the optimal frequencies for spinal cord stimulation.

In eight cats which were hemisected at the T11 level, spasticity was markedly present in sex cats. Immediately after surgery, all reflex and locomotor hindlimb activity was depressed ipsilaterally in the six cats. At the end of the first week postoperatively, muscle tone and deep tendon reflexes began to increase and the hindlimb partially regained waking capability and a marked degree of spasticity appeared by the fourth week postoperatively.

Cathodal stimulation was applied at the L2 level using currents of less than 1 mA at 50, 100, 250, and 500 Hz with a duration of 0.25 msec in these six cats. Electromyographic changes in hamstring and quadriceps muscles (during spasticity induced by dorsiflexion of the paw or by painful stimuli) were monitored. Spasticity was markedly suppressed at 100 Hz in four cats, and moderately in the other two cats. But it was variable, usually increasing at 250 Hz and 500 Hz.

According to the above results, 100 Hz is the most effective frequency for spinal cord stimulation to release spasticity in spinal cord injured cats.

Local steroid injection to the recently compressed nerve might facilitate the recovery of conduction block. Steroid relieves high-tissue pressure secondary to inflammatory reaction such as edema or cell infiltration.

The purpose of the study was to investigate the effect of local steroid injection in acute experimental compression neuropathy with complete conduction block of the caudal nerves of 31 rats. The day after compression, the compression site was injected with 0.4 mL dexamethasone acetate (4 mg/mL suspension) in eleven rats (group A), and 0.4 mL normal saline in another eight rats (group B). The remaining twelve rats (group C) received no injection. The amplitudes of the compound muscle action potential (CMAP) and motor nerve conduction velocity (NCV) over the compression segment were measured before and after nerve compression. The recovery rate of amplitude of CMAP and NCV in group A was significantly higher than that in groups B or C (p<0.05).

A pressure algometer is an instrument that, when pressed against the body surface, can measure pressure only. It would tend to reduce the variation among the subjects, and diminish the observer bias and variation by the standardization of the pressure application. So it has been successfully employed for the assessment of general sensitivity to pain. Localized tenderness, as measured by pressure algometer, can be the diagnostic hallmark of tender spots and trigger points. But this technique may be influenced by such factors as sex, time, obesity etc.

The purpose of this study was to obtain the information about various factors to be considered influencing pressure pain threshold. Also the inter- and intraobserver reproducibility of pressure pain threshold were studied.

We examined 95 normal Korean young adults over 7 muscles in the upper trunks and concluded the following.

1) The pain threshold of levator scapulae is the highest one and that of trapezius is the lowest one.

2) There was no significant difference in pressure pain threshold between two observers.

3) This method shows high reproducibility in pain threshold measurement at 30 min or one day after.

4) There is no significant correlation between pressure pain threshold and body mass index.

All heating modalities produce the desirable therapeutic responses of analgesia, increased metabolism, and decreased viscosity of collagen primarily by temperature elevation. The temperature distribution produced in the tissues and the site of peak temperatures should bel understood for selection and application of the modality.

The purpose of this study was to evaluate the changes of temperature and pain (VAS) produced by the superficial heating modalities with 100 W and 150 W infrared, hydrocollator pack, whirlpool, and paraffin.

The modalities were applied to 86 patients with low back pain and joint deformities or contractures of extremities. A statistically significant differences in temperature elevation and pain reduction were found setween the different heat modalities during application. Hydrocollator pack and paraffin applied on the low back showed the highest degree of elevation of skin temperature in 10 minutes. Infrared of 100 W white bulb on the hand produced the least degree of temperature elevation after 30 minutes application. With hydrocollator pack application low back pain was reduced most outstandingly, in 10 minutes but with the infrared application on the hand little pain was produced in 5 minutes instead.

Although segmental and dermatomal somatosensory evoked potentials have been used in the diagnosis of lumosacral radiculopathy, etc, the unilateral or bilateral normal intertrial variations of these responses have not been investigated. Without investigation of these basic parameters, determination of what constitutes a normal somatosensory-evoked potentials (SEP) is difficult. In 30 normal subjects, The results were as follows. The mean P1 latencies from superficial peroneal nerve, sural nerve, L5 dermatome, S1 dermatome were 41.4±2.2 msec, 42.2±2.3 msec, 46.8±3.1 msec, 47.1±3.2 msec. The mean N1 latencies were 50.6±2.8 msec, 51.5±2.6 msec, 56.1±3.4 msec, 56.3±3.2 msec. The mean amplitudes were 1.5±0.6 uV, 1.3±1.0 uV, 1.3±0.7 uV, 1.0±0.5 uV. The ipsilateral intertrial variations, arithmetic mean side to side differences and maximal potentials side to side differences with stimulation of the superficial peroneal nerve, sural nerve and L5 and S1 dermatomes with respect to P1 and N1 latencies and peak-to-peak amplitudes were investigated. Considerable ipsilateral intertrial variation was observed and side-to-side comparison reveals a further increase in the above measured parameters. The maximal potential side-to-side differences were even more remarkable than the side-to-side differences. We also suggest an additional parameter with which to evaluate SEPs: the maximal side-to-side latency difference.

Low back pain is a common problem, and the resulting disability frequently contains nonorganic, psychological and social elements that are difficult for the busy clinician to assess.

The nonorganic physical signs are distinguishable from the standard clinical signs of physical pathology. The patients with multiple nonorganic physical signs tend to show no organic pathology in computed tomography or magnetic resonance imaging.

It is suggested that the nonorganic physical signs can be used as a simple clinical screening method to help identify patients who need detailed psychosocial assessments in order to determine their cause of low back pain.

A quantitative study of the trunk muscle strength was performed in patients with chronic low back pain using isokinetic dynamometer and compared with healthy controls to determine the role of trunk muscles in low back pain. Most patients demonstrated decreased peak torque and total work of trunk muscles and weakness was more outstanding in trunk extensors than flexors and in women than men. The total work % by body weight and trunk flexors/extensors ratio of total peak were increased. In conclusion, the patient with low back pain had a greater weakness in trunk extensors and experienced more pain on trunk extension.

This study was done to establish the standard of oxygen consumption, heart rate, and RPE (Rating of Perceived Exertion) scale related to mode and intensity of exercise by using the treadmill, bicycle ergometer and arm ergometer which had been commonly used as tools of exercise prescription, to compare the exercise indices between modes of exercise and to know whether the heart rate and RPE predict the amount of oxygen consumption or not.

Twenty young healthy male volunteers, who had no history of cardiopulmonary disease and had never been expert athletes recently, participated in this study. Oxygen consumption per minute, hear rate, and Borg's RPE scale were measured using treadmill, bicycle ergometer and arm ergometer.

Simple significant regression equations were obtained between exercise indices (oxygen consumption, oxygen consumption per body weight, heart rate, RPE scale) and exercise load parameters (treadmill speed, ergometer work rate). Oxygen consumption and heart rate showed no significant difference between arm and leg exercise, but RPE scale of arm exercise showed more increase than that of leg exercise as the work rate increased. Oxygen consumption could be predicted by heart rate and RPE with simple significant regression equations. In submaximal exercise range (below 7.5 METS) heart rate showed little difference between arm and leg exercise under the same amount of oxygen consumption but we think further studies including the measurement of blood pressure and cardiac output will be necessary to confirm the influence of exercise mode on cardiac load.

The pain on cervical or lumbar areas with radiation to extremity was well known symptoms of radiculopathy involving cervical or lumbosacral roots. The root lesion can be diagnosed by clinical findings, myelography, computed tomography (C.T.) or magnetic resonance imaging (M.R.I.), and electromyography. The electromyography has been regarded as a sensitive and specific method for the evaluation of radiculopathy, but its distribution was poorly studied yet.

The purpose of this study is to disclose the distribution of electromyographic abnormalities of the radiculopathy. Since January 1988 to December 1992, 172 cases of cervical and 334 cases of lumbosacral radiculopathy were analysed by retrospective study.

The results were as follows;

1) Subjects were divided into 4 groups: unilateral involvement of a single segment (40.1%), unilateral involvement of multiple segments (22.0%), bilateral involvements of a single segment (20.9%), bilateral involvements of multiple segments (16.9%) in cervical radiculopathy and unilateral involvements of a single segment (38.4%), unilateral involvements of multiple segments (10.5%), bilateral involvements of a single segment (30.3%), bilateral involvements of multiple segments (20.7%) in lumbosacral radiculopathy. The most common single radiculopathy was C7 in cervical and L5 in lumbosacral radiculopahty.

2) The mean duration of symptoms was significantly longer in the group with changes of motor unit potential and firing rate only than the groups with abnormal spontaneous activities of extremities and paravertebral muscles.

3) In cervical radiculopathy, the mean age of the subjects with involvement of multiple segments was 48.5±12.4 years and that of the subjects with single segment was 50.1±15.2 years (p>0.05), and the mean age of the subjects with bilateral involvement was 52.4±13.0 years, while that of the subjects with unilateral involvement was 47.1±13.6 years (p<0.05). In lumbosacral radiculopathy, the mean age of the subjects with involvement of multiple segments was 49.3±14.4 years, while that of the subjects with single segment was 43.3±15.6 years (p<0.05), and the mean age of the subjects with bilateral involvement was 47.5±14.7 years, while that of the subjects with unilateral involvement was 42.6±15.7 years (p<0.05). These findings suggest the degenerative process with age.

4) C.T. or M.R.I. findings were well correlated with the electromyographic findings in the evaluation of the side of involvements but not the segment.

5) The side of radiculopathy was not directly related to the side of symptoms. The subjectis who had bilateral radiculopathy with unilateral symptom were 27%, 40% in cervical and lumbosacral radiculopathy, respectively.

Electromyographers should be aware of the high frequency of multiple segments and bilateral involvements so that complete examinations can be planned and performed.

The purpose of this study was to investigate the influence of the size of active muscle mass on the responses of the blood pressure and the heart rate to isometric contraction.

The isometric torques of the flexors and extensors of the knee (90^o), ankle (0^o), elbow (90^o) and wrist (0^o) were measured for 6 seconds in 30 normal, healthy men, between the ages of 20 and 29 years, using the Extremity Training & Rehabilitation System (Model No. Cybex 340).

The peak torque and the time to peak torque were measured for each contraction. In addition, heart rate and blood pressure were recorded simultaneously at rest and immediately following contraction completion at 1 and 3 minutes.

The increase in heart rate and blood pressure during isometric contraction was independent of the size of the contracting muscle mass (p<0.05). The mean increment ratio was 17.3% for systolic blood pressure, 13.2% for diastolic pressure and 39.9% for heart rate.

The mean rime to peak torque for the large muscle groups was longer than the mean time to peak torque for the small muscle groups (p<0.01).

It was concluded that the magnitude of the cardiovascular response to isometric exercise is not influenced by the size of the contracting muscle mass.

The epidemiology of traumatic spinal cord injury has been not as well examined in Korea. This study examined the influence of selected demographic and epidemiologic variables on 112 patients with traumatic spinal cord injury at the time of injury during a 6-year period. These variables included age, preinjury occupation, topographic level, completeness of spinal cord injury, and time, week and season, and mechanisms of the injury. The leading cause of traumatic spinal cord was falls (42.0%), followed by motor vehicle accidents (39.3%). Paraplegia accounted for 70.5% of the traumatic spinal cord injuries, and quadriplegia accounted for the remaining 29.5%. Traumatic spinal cord injury occurred most commonly in June, summer, the time of midday to 6 P.M. and on Saturday.

Fifty three diabetic patients were investigated to determine the sensitivity of the sympathetic skin response test (SSR) for detection of sudomotor dysfunction and its clinical correlation with other autonomic function tests, autonomic symptoms and degree of peripheral neuropathy.

SSR was absent in both hands and both feet in 15 of 53 patients (28.3%). SSR was absent only in both feet in 17 of 53 patients (32.1%). Nerve conduction velocities (NCV) were abnormal in 30 of 53 patients (56.6%). Valsalva test was abnormal in 12 of 52 (23.1%) who had the test, and orthostatic hypotension was present in 13 of 53 patients (24.5%). Statistically significant correlation was found between nerve conduction velocity, Valsalva test, and the SSR. Autonomic symptoms and orthostatic hypotension did not have significant correlation with the SSR.

These results suggest that the SSR is a valuable and sensitive test for early detection of dysautonomia in diabetic patients.

A considerable body of clinical literature discusses patient adjustment following spinal cord injury (SCI) and previous investigators have reported on association between psychological variables and rehabilitation. However, there are few empirical data and methodologic problems which did not easily replicate.

The present study examined the effects of standardized psychologic measures and time since insight on specific rehabilitation process and outcome in initial rehabilitation hospitalization. The Minnesota Multiphasic Personality Inventory (MMPI), and the Derogatis Symptom Check List (SCL-90-R) were administered to 27 complete paraplegic patients on admission to inpatient rehabilitation program.

Patients who did show high scores on personality measures of hypochondriasis, depression, hysteria and more transient depression index tended to require longer hospitalization. Personality measures of hypomania, age, marital status and level of injury were significantly correlated with level of self- care skills at discharge. Higher scores of paranoia, schizophrenia and hypomania related to lower ratings of responsibility to self- care and motivation. Time since accurate insight was not significantly correlated to any dependent variables.

Results emphasized the importance of the personality traits and psychologic states during SCI inpatient rehabilitation and suggested that, for some patients, psychologic intervention directed at modifying certain psychologic features may facilitate adaptive rehabilitation process.

Cardiopulmonary problems outlank problems of the urinary system as the most common problems involved in the death of patients with spinal cord injury, both during the acute phase and also during later years, especially in quadriplegics. These studies were undertaken to see whether respiratory muscle training can improve pulmonary function in the cervical cord injured. Nineteen patients with cervical cord injury participated in a program of respiratory muscle training for 6 weeks. Respiratory muscle training consisted of spiroflow blow bottle, incentive spirometry and resistive exercise for sternocleidomastoid and upper trapezius muscles.

The pulmonary function test revealed restrictive type in 14 out of 19 subjects before respiratory muscle training and improved to normal range in 7 subjects after 2 weeks of training. The vital capacity, forced expiratory volume in 1 second and inspiratory reserve volume increased significantly by 2 weeks and the forced vital capacity increased progressively over the first 4 weeks but there is no significant interval change in tidal volume and expiratory reserve volume after respiratory muscle training. The difference in pulmonary function test between the complete and incomplete cervical cord injured are not significant.

The respiratory muscle training program is necessary to improve the pulmonary function and should be maintained at least 4 weeks and followed by continuous training program in the cervical cord injured.

It is well documented that the frequency spectrum of myoelectric signal shifted toward lower frequency during a sustained isometric contraction, and several studies used this changes to quantify the localized muscular fatigability. However only few studies have compared fatigability of different muscles using spectrum analysis.

The aims of the present study were: (1) to compare the patterns of changes of frequency spectrum with increasing force in different muscles (2) to compare the fatigability of several muscles that are known to have different muscle fiber composition during sustained submaximal isometric contraction, and (3) to evaluate the effects of immobilization and strengthening exercise on behavior of frequency spectrum.

Four muscles (biceps brachii, triceps brachii, tibialis anterior, soleus) of control, immobilized and trained group were tested on brief contraction at four different levels (20% MVC, 40% MVC, 60% MVC, 80% MVC) and sustained isometric contraction at 80% MVC (maximal voluntary contraction). The changes of MPF (mean power frequency) and RMS (rectified mean square) voltage analyzed on each study, and the differences of those changes among muscles and groups were evaluated.

The results were as follows:

1) During the graded contraction, the significant range of frequency spectrum was below 150 Hz on the biceps brachii and triceps brachii. On the other hand, the frequency spectrum of the tibialis anterior and soleus were broadened to 400 Hz.

2) The MPF of the tibialis anterior and soleus were increased with increasing force level during graded contraction. On the contrary, the MPF of triceps brachii were decreased with increasing force level. These findings were influenced neither by immobilization nor strengthening exercise.

3) During sustained isometric contraction at 80% MVC, the frequency spectrums from all the muscles examined shifted toward lower frequency and the MPF were decreased. The slope of MPF changes was lowest for triceps brachii and highest for soleus, which means that the triceps has high fatigability and the soleus has low fatigability.

4) The MPF of immobilized group was significantly lower than that of control group on all the muscles studied during graded contraction.

5) The slope of MPF decrease of triceps brachii became significantly less steep by immobilization. On the other hand, the slope of soleus became steeper by immobilization. These findings suggested that the fatigability changed differently by immobilization on different muscles.

6) The strengthening exercise affects significantly neither the pattern of changes of MPF with graded increasing force nor the slope of MPF decrease during sustained isometric contraction.

From the above results, it was concluded that there were differences in fatigability, in mechanism developing additional contratility, and in changes of fatigability by immobilization of different skeletal muscles according to their muscle fiber composition.

This study was done to determine the imbalance of weakness between knee flexor and extensor by isokinetic test in degenerative joint disease (DJD), the efficacy of quadriceps isometric strengthening and to know whether the result of isokinetic test correlated with radiologic grade, visual analogue scale (VAS), duration of pain or body mass index.

51 patients with degenerative joint disease of knee who met the clinical criteria of American Rheumatology Association and the Kellgren's radiologic grade II or more, were evaluated with Cybex II+ isokinetic dynamometer. VAS, duration of pain and body mass index of them were measured, too.

In isokinetic test result, the torque values were significantly lower in DJD patients than normal and the hamstring to quadriceps ratio (H/Q ratio) was significantly higher in DJD patients than normal; 62.3% vs. 51.6% in 6th decade. 5 of 7th decade and 4 of 8th decade showed no measurable torque value at angular velocity 180 degree/sec. Radiologic grade, VAS and duration of pain showed no significant correlation with the result of isokinetic testing.

In conclusion, we think that, in DJD patients strengthening of knee musculature, especially knee extensor should be emphasized. In 7th decade or more, it would be better to measure the isokinetic torque value at low angular velocity of measure the isometric torque for measuring the strength of knee musculature.

This study was designed to investigate the effectiveness of gangliosides and dexamethasone on nerve regeneration. Experimental neuropathy with complete conduction block was produced by mechanical compression of surgically exposed sciatic nerves of 80 rats. 80 rats were divided into four groups (control group, ganglosides group, dexamethasone group, dexamethasone-gangliosides group). The experimental groups were treated by gangliosidese 10 mg/kg/day, dexamethasone 10 mg/kg/day and gangliosides 10 mg/kg/day plus dexamethasone 10 mg/kg/day intramuscully for 8 weeks. The control group received no injection.

The latency and amplitude of compound action potential were measured at the sciatic nerve by electromygraphy machine (Excell, Cadwell, U.S.A.), and the number of myelinated axon were measured in nerve specimen by imaging analysis system (VIDAS 2.0 Kontron, W.Germany) before and weekly after compression injury.

In gangliosides group, the latency and amplitude of CMAP and number of myelinated axon were significantly recovered; in dexamethasone group, only latency of CMAP was significantly recovered compare to control group. It is concluded that gangliosids are effective in nerve regeneration but dexamethasone is not.

This is a review and clinical analysis of 444 cases of work-related burn patients who were admitted to the burn center of Hangang Sacred Heart Hospital, College of Medicine, Hallym University during the 3 years from January 1990 to December 1992.

The purpose of this study is to show the status of work-related burned patients.

The results are as follows:

1) The highest incidence of age group was between 21 and 30 years old (182 cases, 40.1%).

2) Sex distribution was 412 males (92.8%), 32 females (7.2%).

3) The most common cause was flame burn (66.0%), and the next was electrical burn (13.3%).

4) The average burned surface was 30%.

5) The average length of stay was 57 days.

6) The most common employment sector was manufacturing, followed by trade.

7) The most frequent complication was joint contracture, followed by hypertrophic scar.

8) 23 patients were required amputation.

Development of a painful shoulder and limitation of ranges of motion in the hemiplegic patient is a significant and serious problem. The subscapularis muscle is the prime internal rotator of the shoulder and plays a critical role commonly seen in spastic hemiplegia. The subacromial area of the shoulder is a location of pain-producing structure in hemiplegic patient.

Twenty-five patients with chronic spastic hemiplegia, limited range of motion especially in external rotation, and painful shoulders underwent subscapular nerve block by needle insertion of the subscapularis muscle and iontophoresis at subacromial bursa. Three to six ml of 5% phenol was injected. Patients' age ranges from 42 to 71 (mean: 58.7) and the durations of hemiplegia from 13 to 81 weeks (mean: 33.5).

Statistically, significant improvements of range of motion of hemiplegic shoulder were observed in flexion (19.3^o), abduction (18.1^o), and external rotation (19.4^o). Subjective reduction of shoulder pain following phenol blocks to the nerves to the subscapularis muscle and iontophoresis at subacromial bursa was also noted. Subscapularis nerve block and iontophoresis at subacromial bursa is a new and potentially useful technique in the management of the painful hemiplegic shoulder.

H-reflex is a kind of late response which can be used in the proximal nerve conduction study, especially in the diagnosis of S1 radiculopathy of the lower extremity. H-reflex is also noted in the flexor carpi radialis muscle of the upper extremity and can be used in the diagnosis of cervical radiculopathy. But H-reflex in other muscles of upper extremity is not commonly studied yet. The FCR, ECR and ADQ H-reflex study was performed in 20 normal adults (40 cases) and the 20 patients with cervical radiculopathy to establish the normal values and evaluate the significance of the upper extremity H-reflex study in cervical radiculopathy.

The mean values of H-reflex latency in normal control group were 17.45±3.11 msec in FCR, 18.57±5.22 msec in ECR and 26.23±1.55 msec in ADQ. And the mean value of the side-to-side difference were 0.74±0.44 msec in FCR, 0.51±0.37 msec in ECR and 0.51±0.37 msec in ADQ. The mean value of interlatency time (ILT) were 14.95±3.08 msec in FCR, 14.72±5.75 msec in ECR and 23.35±1.77 msec in ADQ. And the mean value of the side-toside difference were 0.52±0.37 msec in FCR, 0.45±0.42 msec in ECR and 0.56±0.40 msec in ADQ.

A study of the upper extremity H-reflex in 20 patients with cervical radiculopathy revealed abnormal H-reflex findings in 9 patients among 12 patients, which showed abnormal spontaneous activity in only the paracervical muscles and in 8 patients among 8 patients, which showed abnormal spontaneous activity in the paracervical and the upper extremity muscles.

H-reflex study in the upper extremity would be helpful to diagnose cervical radiculopathy.

Ankylosing spondylitis is a chronic inflammatory disease which most frequently affects the sacroiliac joints of young men, and also the synovial joints of the whole spine. Bony fusion of these joints and ossification along the longitudinal ligaments lead to total immobility of the vertebrae resulting limitation of motion and respiratory insufficiency. We assessed the effects of rehabilitation management in ankylosing spondylitis. Thirty three patients treated at Young-dong Severance Hospital from October, 1984, to July, 1993 were analysed clinically.

The lower the spinal level, the more restricted spinal mobility was found. And there were significant improvements in finger to floor distance, occiput to wall distance, Schober index, chest expansion and vital capacity by comprehensive rehabilitative management.

According to the above results, we concluded that intensive rehabilitative management including patient education was very helpful in increasing spinal flexibility and therefore preventing further disability in patients with ankylosing spondylitis.

Burn is one of the most catastrophic physical injury. Rehabilitation from any physical injury, including burns, is largely influenced by psychologic variables. The ultimate quality of life of burned patients is based on interactions between their physical disabilities and their psychologic responses to their injury. We want to know how physical disabilities resulting from burn influence on psychodynamic response at acute stage using the Minnesota Multiphasic Personality Inventory (MMPI).

We could get the MMPI results from thirty-three patients. The results showed normal range of mean MMPI T-score of all clinical scales, significant difference in hypomania scale between male and female groups, and also significant difference in hypomania scale between group related to butane inhalation and the other groups.

However we could not find any psychological change resulting from burn at acute phase in case of using MMPI. Therefore we decided that we would rather choose another types of method, especially depression or anxiety scale in next time.

Cognitive evoked potential is a series of waves made by endogenous brain response following a cognitive stimulus. There are several kinds of waves such as N1, P2, N2, P3 and slow waves and only P3 wave is clinically applicated widely. It is important, however, to set a standard for normal latency of P3 wave because of its wide variation especially according to age.

We studied 93 normal Koreans using auditory odd-ball paradigm and got the following conclusions about the latencies of P3 waves and its relation to age.

1) The range of latency was between 264 and 446 ms, and the average latency was 343,4±37.6 ms.

2) The average latency was decreased by 9.93 ms/year in the below 15 years of age group, but increased by 1.21 ms/year in the above 19 years of age group.

3) The latency was decreased dramatically in both groups of below 10 years and above 60 years of age.

Twenty-four healthy young men were fitted with telemetrized electrogoniometer to measure hip, knee, ankle joint excursions in sagittal plane, also fitted with foot switches to measure heel and toe contact time. All of the acquired data were sampled by and stored in a computer system and determination of the mean values and dispersions were made. Major attention was focused on the area of angle-angle diagram loops to discuss the parameters which would be useful to evaluate the neuromuscular coordination and control and be of value in interpreting and assessing the diagram. Here we introduced some parameters and its normal value.

In order to establish the reliability of method, comparison of the result of the test and retest were performed.

The conclusions were as following

1) The test were reliable except some of foot switch information due to its easy malfunctioning.

2) The parameters introduced such as perimeter, area, P_A value, α angle, β angle, two diameters of diagram, may be useful to evaluate neuromuscular coordination and control and to classify the type of angle-angle diagram.

Treatment of the fracture and dislocation of the cervical spine is based upon the principle of dislocation reduction and anatomical approximation without causing or increasing any neurological damage.

The question about the neurologic outcome of operative intervention and stabilization versus conservative management remains one of the controversies in medicine today. This study is designed to evaluate the effect of surgical intervention versus conservative treatment in cervical spine injuries in view of functional improvement with comparison of modified Barthel Index (MBI) scores in the two groups and to evaluate the effect of the comprehensive rehabilitation treatment.

Eighty cervical spinal cord injury patients were evaluated, who were admitted to Severance hospital from January 1, 1979 to June 30, 1993. The average MBI score after comprehensive rehabilitation significantly increased from 12.9 to 34.2 in surgically treated group with complete spinal cord injury (p<0.001) and from 17.3 to 27.5 in conservatively treated group with complete spinal cord injury and from 25.7 to 47.1 in surgically treated group with incomplete spinal cord injury (p<0.01) and from 24.9 to 49.2 in conservatively treated group with incomplete spinal cord injury (p<0.01).

However, without regard to the status of completeness in injuries, there is no significant difference in MBI scores between surgically treated and conservatively treated groups.

And frequency of the instability was 13.3% in surgically treated group and 10.0% in conservatively treated group and there was no significant differences in the two groups.

Rehabilitation after spinal cord injury (SCI) is a complex process involving an array of adaptations to changes in both physical and psychosocial functioning. The purpose of this study was to obtain baseline data about the current social activity and adjustment of the spinal cord injured after discharge after rehabilitation treatment. The subjects of this study were 27 male spinal cord injury patients who were admitted to the Wonju Christian Hospital.

A questionnaire containing employment status, duration of injury, marital status, social activity, bladder management, home improvement, and complications returned from the 27 men with spinal cord injuries.

The major results were as follows:

1) Employment status and social activity did not correlate with the duration after injury.

2) There was an increase in the use of suprapubic cystostomy.

3) The social activity did not correlate with the level of injury.

4) The higher the modified Barthel Index score was, the more active were they in social activity.

5) Postinjury employment rate in spinal cord injuries was approximately 29.7%.

6) Common complications in the order of appearance after spinal cord injuries were constipation, pain, and joint contracture.

In conclusion, the result of this study seems to suggest that social activity did correlate with modified Barthel Index score but did not correlate with time since injury and level of injury.

The refractory period of an axon is the time during which the ability to conduct an action potentials is altered following initiation and propagation of a nerve impulse. A refractory period is demonstrable in peripheral motor and sensory nerves in response to repetitive stimulation, and is influenced by the diameter of the axons comprising the nerve. To evaluate the usefulness of measuring the refractory period in early diagnosis of diabetic polyneuropathy, we compared the absolute, relative, and true relative refractory period of the distal portion of the sensory median nerve of 20 healthy controls to those of 20 diabetic patients (Group I) without evidence of polyneuropathy in conventional nerve conduction studies and 29 diabetic patients (Group II) with polyneuropathy.

The results were as follows;

1) The fasting and postprandial 2 hour blood sugars were not significantly different between group I & II. The HbA1c level was significantly higher in group II.

2) The absolute, relative, and true relative refractory period were 0.74±0.04, 3.26±0.14, 2.51±0.16 msec in healthy controls, 0.73±0.03, 3.72±0.23, 2.99±0.22 msec in group I, and 0.75±0.03, 4.23±0.48, 3.48±0.47 msec in group II, respectively.

3) There was no significant difference in absolute refractory period, but the relative and true relative refractory period were longer in group II than in group I and were loner in group I than in healthy controls.

4) In group II, the true relative refractory period was longer in patients with axonal degeneration and demyelination than those with demyelination only. Therefore, the axonal degeneration might be a major factor affecting relative refractory period.

With above results, the refractory period measurement is a useful method for early diagnosis of diabetic sensory neuropathy.

During a voluntary contraction, the H-reflex could be obtained at lower stimulus intensities in the tibialis anterior muscle and a more clear separation of the H-wave from the M-wave was possible. The aim of choosing tibialis anterior is the relative ease in eliciting response over this muscle and the potential utility of this test in the evaluation of L4, L5 radicular compression, the latter being quite common in lumbar intervertebral disc prolapse.

H-reflex from tibialis anterior muscle (TAH-R) was recorded in 20 healthy subjects by averaging 100 responses from the maximal contracting tibialis anterior muscle after repetitive submaximal stimulation of common peroneal nerve. Subsequently, the test was applied to 22 patients with clinical and radiologic evidence of L5 or L4, L5 radicular compression. They were studied using stimulus intensity enough to produce just visible twitch in the muscle, stimulus duration of 1.0 msec, stimulus rate of 3 Hz and the muscle force to keep the foot in complete dorsiflexion as sufficient as possible. The take-off point was sharp and in no healthy subject was there any difficulty in measuring the latency to onset point. Abnormalities included significant right-left latency difference within the normal range of absolute latencies, unilateral or bilateral prolongation of latency to onset point and attenuation or absence of the response. Among the patients, 21 out of 22 cases of L5 or L4, L5 radicular compression had abnormal findings.

We concluded that the examination of the H-reflex from tibialis anterior muscle is easily performed and can be useful in the diagnosis of L4, L5 radicular compression.

Carpal tunnel syndrome (CTS) has been known to be frequently accompanied by cervical radiculopathy, which has been called as double crush syndrome (DCS). The objective of this study is to find out how often the CTS is accompanied by the cervical radiculopathy, and if there are any significant causative factors for this association. 126 patients with CTS proven by electrodiagnostic test were reviewed and divided into 2 groups; simple CTS (without concurrent cervical radiculopathy) and DCS group. Then, their clinical and electrophysiological differences were analyzed and the results were as follows.

1) Ninety-five patients out of 126 (75.4%) had probable concurrent cervical radiculopathy.

2) Complaints of pain in the neck, shoulder and upper arm were significantly more common in the DCS group than in the simple CTS group (p<0.05)

3) No significant difference between the DCS group and the simple CTS group existed in mean age, female percentage, sensory change or weakness of hand, bilaterality of CTS, and severity of abnormal nerve conduction studies of median nerve.

4) On needle electromyographic examination, the incidence for abnormal spontaneous activities such as fibrillation or positive sharp wave from abductor pollicis brevis muscle was higher in DCS group compared with simple CTS group (p<0.05). In flexor carpi radialis muscle and abductor digiti quinti muscle or first dorsal interosseus muscle, abnormal spontaneous activities appeared in DCS group only.

Therefore, clinically as well as electrophysiologically suspected CTS should be differenciated from cervical radiculopathy and looked for coexistence of cervical radiculopathy (DCS) by complete needle electromyographic examination including paracervical muscles.