To determine the efficacy of isometric quadriceps setting exercise for degenerative osteoarthritis, we conducted a randomized 10-week rabbit study comparing electrical stimulation therapy(EST) group with non-EST group. Degenerative osteoarthritis of the knee was established by immobilization of the rabbit's knee for 6 weeks. This was followed either by natural course for further 4 weeks, or by eletrical stimulation of quadriceps femoris during 4 weeks using a low-freguency pattern of activation. Diameter and range of motion of knee joint, radiologic finding, histology of cartilage of femur and tibia, and mean fiber area of the quadriceps femoris were compared between two groups. EST group showed less swelling of the knee joint and less flexion contracture of the knee joint, more muscle fiber area(182.4 %) than control. Radiologic finding and histology of cartilage of femur and tibia were not different between two groups. According to above results, we concluded that electrical stimulation therapy strengthen the quadriceps femoris and lessen degenerative change of the capsule and connective tissue of the knee joint but has no effect on the change of the articular cartilage.

Thirty men were tested for isokinetic knee strength using Cybex II+ at velocity of 90°/sec. In set one, the subjects were tested with fixing the non esting leg at 90° and the testing session consisted of one-legged isokinetic extension exercise test and flexion exercise test. In extension exercise condition, three maximal isokinetic extensions were done with performing isometric contractions of the extensors of non-testing leg in regard to the isokinetic testing legs(reciprocal mode), and then three maximal isokinetic extensions were done with contractions of the flexors of non-testing leg(concurrent mode). In flexion exercise condition, three maximal flexions in a concurrent mode and a reciprocal mode, respectively were also performed. We measured peak torque(PT) of the extensors and flexors of the testing leg and recorded myoelectrical signals from the knee muscles of the non-testing leg. PT of the knee extensors and flexors of the testing leg were of significantly higher value at reciprocally induced action of the non-testing leg(p<0.001). The mean root mean square(RMS) values recorded from the muscles of non-testing leg were of significantly higher value at reciprocal mode also(p<0.01). In set two, the testing was done in two different isokinetic extension-flexion knee testing conditions. For the first condition, testing was done with a bar in front of the ankle joint of the non-testing leg, thus limiting extension movement of the leg as is the usual testing method at present. For the second condition, the non-testing leg was fixed at 90° flexion and the non-testing leg was induced to contract reciprocally in regard to the isokinetic testing legs. PT of extensors of the second condition showed a significantly higher value compare to the first condition(p<0.001).

By fixing non-testing leg and making it to contract in a reciprocal manner with the testing leg, we can eliminate the shifting of non-testing leg and prevent the possible decrement in strength due to a bilateral deficit, and get an additional isometric exercise effect on non-testing leg.

Diabetic neuropathy is one of systemic complications of diabetes mellitus and its incidence was variously reported to be from 5% to 60%. The exact pathophysiologic mechanisms of diabetic neuropathy are unclear, and the pathology of nerve in diabetic neuropathy is also unclear, for some suggested segmental demyelination as primary lesion and others axonal degeneration and demyelination. It is also unclear which electrodiagnostic parameter is most sensitive in the diagnosis of diabetic neuropathy. So, our purpose was to find out ⸁ the effect of hyperglycemia in the induction of diabetic neuropathy. ⸂ the most sensitive eletrodiagnostic parameters. ⸃ the primary pathologic lesion in diabetic neuropathy. ⸄ the difference of sensitivity to hyperglycemia between animals.

We induced diabetes in rabbits and rats with alloxan, which selectively destroysislet cells of pancreas. In the first part of experiment, we tried to induce various levels of gluoce according to different levels of alloxan injected, but we failed. The blood glucose levels, which were moderately high returned to normal levels after 2 weeks of follow up. So, we decided to inject 150mg/kg of alloxan to induce diabetes in rabbits. The inductionrate was 36% and the average blood glucose level was 351±142mg/dl. We performed electrophysiologic studies every week for 8 weeks but we failed to find out any evidence of diabetic neuropathy. We performed follow up studies for 12 weeks in 5 rabbits, 16 weeks in 2, 24 weeks in 2 but we also failed. The pathologic findings, which were performed at 8, 12, 16, 24 weeks of follow up also showed no evidence of diabetic neuropathy. We performed similar studies in mice with alloxan and we found out that in mice it was possible to induce diabetic neuropathy as other reports. As a conclusion, for we have failed to induce diabetic neuropathy in rabbits, we could not find out the effect of hyperglycemia in the induction of diabetic neuropathy, the most sensitive eletrodiagnostic parameters, and the primary pathologic lesion in diabetic neuropathy.

In rats, the involvement of myelin and axon occured nearly at the same time, which was 5 weeks after the induction of diabetes. There might be some difference in sensitivity to diabetic neuropathy between rats and rabbits.

The spatial relationships between the needle and individual muscle fibers play the most important role in determining the waveform. The rise time helps estimate the distance between the recording tip of the electrode and the discharging motor unit. The resistance and capacitance of the intervening tissue act as a high-frequency filter. The measurement of the rise time confirms the suitability of the recorded potential for quantitative analysis. Another quantitative analysis of the EMG is the power spectrum analysis, which is influenced by number of motor units firing near the electrode and 'tissue filter' effect. The aim of this study was to investigate the relationship of the power spectrum and rise time. To examine this relation the extensor digitorum communis muscle was examined in 10 healthy subjects with a very weak voluntary contraction. The rise time and power spectrum was obtained from 10 MUAPs in each subject with a monopolar needle electrode. The mean power frequency as well as median power frequency of the MUAP were increased with decreasing rise time of MUAP. The study thus indicates that the amount of high frequencies in the power spectrum is greater in a MUAP with a shorter rise time. We concluded that power spectrum analysis may be used a factor to determine if a MUAP is acceptable for inclusion in analysis.

Unilateral hemiplegia after stroke has the higher prevalence of fractures on the paralyzed limb than on the nonparalyzed limb. The purpose of this study was to measure the degree of dimineralization in paralyzed limb and to correlate the degree of dimineralization and the rehabilitation program. The bone mineral content(BMC) and bone mineral density(BMD) were measured in both limbs of unilateral hemiplegic patients by dual photon absorptiometry. The BMC of the paralyzed limb was reduced by 13.51% and 7.52% in upper and lower limb, respectively. The change of BMC in hemiplegic limb turned out to be significantly correlated with the time of poststroke, onset time to tilting table standing and onset time to gait training. The BMC of upper limb had reverse correlation with Brunnstrom's stage. We concluded that the earlier rehabilitation program could reduce the dimineralization in paralyzed limb.

The flat foot gains significant clinical attention because of its harmful effects not only on the ligamentous structures of foot but on the lower leg musculature, knee and hip joint. And especially the flexible flat foot changes with dynamic body weight appliance. So we studied 40 normal person's three dimensional motion analysis of foot and ankle complex during stance phase of walking to assess the dynamic change of medial longitudinal arch and other structures.

We concluded as below;

1) Medial longitudinal arch was mostly widen when 45% of gait cycle. And mean widening of angle was 4.2degree and standard deviation was 3.3degree.

2) If a navicular angle without weight bearing would be greater than 155.4degree, then that foot could be diagnosed as rigid flat foot.

3) If a navicular angle widening during stance phase would be greater than 10.8 degree, then that foot could be diagnosed as flexible flat foot.

In addition to proposing the diagnostic criteria for rigid and flexible flat foot, we present the relationship among the dynamic angles of MP joint, subtalar joint and arch height which needs further biomechanical research.

The human body sways continuously to maintain balance while a person is standing upright. This paper describes a method for adjusting biomechanics platform measures of sway for balance during quiet standing. Ten healthy men between the age of 23 and 35 participated. Area and zero crossings measures of sway were determined in double and single leg stance. Results indicated that: ⸁ No significant difference was found on mediolateral sway frequency and anteroposterior sway frequency during two-legged stance(p>0.05), ⸂ The postural sway in a mediolateral direction increased significantly with onelegged stance(p<0.05). However, there was no significant difference of frequency and traveled area between each side of leg(p>0.05). It is recommended that this study provides a useful data for future research of the postural abnormalities of disabled patients as another method in the computer aided implementation.

Among various test methods for evaluation of postural control, posturography(PG) using force platform is well known as one of the most quantitative, sensitive and convenient method in normal subjects and in patients with impaired postural control.

The purpose of this study was to obtain the effect of vision and proprioception on postural control in hemiplegic patients, to compare postural control of normal with that of hemiplegic and to get characteristics of postural control in hemiplegic patients.

We recorded the movement of the center of gravity for 45 seconds on force platform in 18 normal control and 16 hemiplegic patients under the conditions of eye-open or eye-closed on the stable surface and on the hard sponge, and processed these data using posturography software to acquire 5 parameters of posturography, i.e. maximal sway(mm), trace length(mm), speed(mm/sec), area(mm²) and its mean radius(mm).

The results were as follows:

1) In hemiplegic patients, visual deprivation only didn't cause any loss of balance and under impaired proprioception the 5 parameters of PG were increased. Both visual and proprioceptive loss, when balance is controlled by only vestibular function, caused the increase of the 5 parameters of PG.

2) Compared with normal control, hemiplegics showed the increase in the maximal sway, mean radius and area, and the decrease in the speed and trace length of PG.

With the results above, postural control of hemiplegic patients were affected more by propriception than by vision and hemiplegic patients showed the impaired postural control compared with normal control.

A balancemeter with a visual output consists of two force platform was used to evaluate body weight distribution in healthy subjects. The purpose of this study is to find a any relation between distributed partial body weight and measured graded weight bearing using balancemeter. Balancemeter is composed of force plate, multiplexer circuit, A/D conveter, and IBM PC. Force plate contains an array of 20 force sensing resisters for each foot, and produces the out put according to the force applied to the sensors. Twenty volunteers between the age of 23 and 35 participated. The data of graded weight bearing on each leg were measured while 50%, 60%, 70%, 80%, 90% and 100% of their body weight was distributed to the each leg on the balancemeter. The result shows a significant relation between asked percent of body weight and measured graded weight bearing on the balancemeter(left: r=0.96, p<0.01, right: r=0.92, p<0.01).

Nineteen adults with no known swallowing difficulty were studied by videofluoroscopy, scintigraphy and swallowing electromyography. By these tools the pharyngeal transit time was measured in 3 positions (neutral, chin up, chin down) and in 2 diets (fluid, soft blend diet). The purposes of this study are to estimate normal values of the pharyngeal transit time in videofluoroscopy, scintigraphy, swallowing electromyography, to ascertain changes of the pharyngeal transit time according to position and diet. Through this study we found normal values of the pharyngeal transit time in various positions and diets in each tool. According to position, the pharyngeal transit time was prolonged in chin up position, and swallowing electromyography was most sensitive to positional change.

According to diet, the pharyngeal transit time was prolonged in soft blend diet than fluid, and scintigraphy was most sensitive to dietary consistency.

The purpose of this article is to present the degree of recovery according to causes, level of injuries and other associated factors of brachial plexus injury. One hundred and forty five cases from 1989 to 1994 were reviewed. The injury was classified as supraclavicular and infraclavicular lesion according to Leffert's definition in addition to root, trunk, division and cord level.

Supraclavicular injuries were 77.9%, infraclavicular injuries, 15.2% and double level, 6.9%. The most common cause of injury was motor vehicle accident. The causes of injury were significantly different in relation to the above and below the clavicle. The level of the brachial plexus injuries caused by pedestrian and motorcycle accidents and contusion by falling objects was only supraclavicular. Cervical root avulsion injuries were related to obstetric delivery, contusion, and motor vehicle and motorcycle accidents. The satisfactory recovery occurred in most of the infraclavicular lesions. The degree of recovery according to the level of cervical root and brachial root was different. Cervical root injury was much worse than brachial root injury. The accompanied fractures had no adverse effect to the degree of recovery.

We conclude that the most valuable predictive factors of prognosis are the cause of injury and the evel of injury ass supra- or infraclavicular.

The diagnostic relevance of recording motor evoked potentials after magnetic stimulation of midclavicular point was evaluated in 47 healthy adults and 2 patients with brachial plexus lesion. The object of this study was to establish a normal protocol and values for magnetic stimulation of the brachial plexus region.

Compound muscle action potentials were obtained with abductor pollicis brevis, abductor digiti minimi, biceps, triceps, deltoid, infraspinatus, latissimus dorsi, and rhomboid major recordings bilaterally.

The results were as follows:

1) The onset latencies of compound muscle action potentials(CMAP) obtained by magnetic stimulation on midclavicular point showed no significant difference between two sides.

2) The amplitudes obtained with magnetic stimulation showed no significant difference between two sides.

3) The onset latencies of compound muscle action potentials obtained by magnetic stimulation on midclavicular point in 2 patients showed absence of CMAP with abductor digiti minimi recording and prolonged latencies for abductor pollicis brevis, biceps, triceps, deltoid recordings. These findings were consistent with clinical topography and severity of brachial plexus.

The magnetic stimulation can be used in addition to electrodiagnostic tests currently available for the evaluation of the brachial plexus.

Thirty-five patients with axillary nerve paralysis were reviewed retrospectively by clinical charts and electrodiagnostic records to establish causes and severity of the nerve lesion, associated adjacent nerve involvement and recovery. The main cause of the injury was motor vehicle accident(48.6%). The palsy developed after axillary block in one case and axillary artery bypass graft in other case. There was a nontraumatic isolated axillary nerve injured case. The palsy was related with blunt shoulder trauma in 13 cases and fracture or dislocation of the shoulder in 12 cases. Prior to the electrodiagnostic examination, the diagnosis was not clinically suspected or seriously considered in 51.5% of the lesions. The most common combined adjacent nerve involvement was the suprascapular nerve and the axillary nerve injury was more severe in the patient with combined other nerve lesions. All of the incomplete and many complete patients(66.7%) were improved at the electromyographic reexamination in 2 to 5 months after injury. So serial electro-diagnostic study is recommended monthly for the first 3~5 months to evaluate nerve regeneration and proper management plan.

Spatial neglect is among the most disabling features of stroke. Subjects with spatial neglect have a lower chance of regaining independence or returning home after discharge. There are many tests assessing various aspects of spatial neglect. Line bisection test is a short and simple test of spatial neglect which has often been included in research batteries of stroke subjects. We have used this test to define the normal range of line bisection errors in horizontal and vertical planes, to compare subjects with normal and impaired line bisection in respect to pre-stroke demographic factors, prevalence of prior stroke and indices of current stroke, and indices of current stroke deficit, to define a more exact lesion in relation to the visual neglect and to understand the pathomechanism.

We have studied 57 controls and 44 stroke patients and the results are as follows;

1) The normal range of line bisection errors for controls was about 11.5mm from the true midpoint.

2) The mean age was 56.4 years with 75% of patients in their fifties and sixties in stroke patient. Sex ratio was 1.9:1.

3) 32 patients had infarcts and 12 patients hemorrhages.

4) 18 patients had horizontal neglect, 14 patients vertical and 12 patients had both.

5) From this study visual neglect in relation to age, sex, etiology and lesion was negligible. But in 13 patients with repeated stroke, 7 patients had vertical visual neglect.

6) Patients with lesions in right parietal lobe or basal ganglia was related to visual neglect(p<0.01).

The purpose of this study was to investigate the effect of functional electrical stimulation(FES) of the wrist and finger flexors and extensors on the function of the hemiplegic upper extremity. Fine wire electrodes were implanted percutaneously into the extensor digitorum commun is, extensor carpi radialis, abductor pollicis longus, flexor carpi ulnaris, flexor carpi radialis and brachioradialis muscles of the affected upper extremity in a chronic hemiplegic stroke patient. Electrical stimlator unit was connected to the electrodes to stimulate the target muscles. Thirty minute FES session was given 4 times a day for 6 months. Improvement of the hemiplegic upper extremity was noted in gross motor function but not in fine motor function. This study suggests that the FES program can be one of the effective treatment methods to improve the function of upper extremity in the chronic hemiplegic stroke patients.

This study was done to measure the oxygen consumption during activities of daily living(ADL) in hemiplegia.

Seventeen hemiplegic patients who were able to accomplish independent ADL without history of cardiopulmonary disease participated in this study. Oxygen consumption during sitting rest, writing, feeding simulation, lower body dressing, and walking were measured using Oxylog oxygen consumptionmeter.

Oxygen consumption during ADL in hemiplegia was lower than that of normal subjects. Energy efficiency of ADL by affected side was lower than that of by unaffected side. Energy efficiency of ADL and walking in more recovered patients was better than that in less recovered patients.

In order to assess the physical health status of the elderly with the age 65 or above, activities of daily living (ADL) and instrumental activities of daily living (IADL) were measured. One hundred and thirty-five elderly residents from Metropolitan Seoul were selected for the study. 14 items from Modified Barthel Index (its modification form) and 14 items from Modified Lambeth Disability Screening Questionnaire (the 3rd edition) were used. Assessments were done thru individual interview.

The frequency of disability was the highest in `heavy homework(63.7%)' followed by `performing your job(47.4%)' in 28 items from Modified Barthel Index and Modified Lambeth Disability Screening Questionnaire. In reliability test, the value of Cronbach α was 0.4771 in Modified Barthel Index and 0.8917 in Modified Lambeth Disability Screening Questionnaire.

We have concluded that the IADL assessment of Modified Lambeth Disability Screening Questionnaire is more accurate than Modified Barthel Index in assessing physical health status and disability of the elderly.

This study attempted to identify the psychological characteristics of low back and cervical pain patients. The demographic data, pain related variables, medical diagnosis, MMPI scores, compensation status, psychiatric consultation variables of 100 patients were analysed. Total patients were classified into four clusters. Cluster 1 was regarded as normal. Cluster 2 was characterized by elevation on Hs, D, Hy and is so called `depressives' profile. Cluster 3 was characterized by elevation on Hs, Hy and is so called `conversion V' profile. Cluster 4 was, like Cluster 1, within normal limit but generally more elevated than cluster 1. Patients with complaints of both lumbar and cervical pain were significantly more distributed in cluster 2, 3. Patients who were in compensation status and took psychiatric consultation were also significantly more distributed in cluster 2, 3. So cluster 2, 3 patients may be in need of psychotherapy in order to improve pain treatment outcome. The result of this study suggest that MMPI cluster subtypes is valid and useful to intervention of pain patient's rehabilitation.

Chronic low back pain is a difficult problem, especially, in patients who had been operated. Characteristically they showed pain behavior and used to refractory to any kind of treatment. Failed Back Surgery Syndrome is a group of disorders with persistent or recurrent symptoms following spinal surgery, with hallmarks of back pain, sciatica, and functional impairment. We investigated 37 chronic low back pain patients who have been operated at least once. They were reviewed medical records and were taken MagnevistⰒ-enhanced magnetic resonance imaging in the postoperative periods. This paper presents the causes of failed back surgery syndrome in the bases of clinical symptoms and MRI findings.

The results were as follows;

1) Among 37 patients, patients who had pain-free-interval less than 6 months were 29 and more than 6 months were 8.

2) In 19 patients who had revealed radiating leg pain, 7 patients were suffered from low back pain, and the rest complainted low back pain and radiating leg pain.

3) In the magnetic resonance imaging of them, epidural fibrosis were 15 cases, recurrent or remained HIVD were 9, normal postoperative findings were 6, the other level of HIVD were 5, and the rest were lumbar instability and spinal stenosis.

4) The 2nd operation were performed to 8 patients. They were remained HIVD in 5 cases and the rest was epidural fibrosis.

5) In Patients whose pain free interval was less than 6 months, epidural fibrosis is were 16 cases, remained or the other level HIVD were 9 and normal postoperative MRI finding were 4 cases.

In this study on attempt was made to evaluate and manage autonomic dysreflexia in spinal cord injury through investigation and analysis of urodynamic studies. The subjects of this study were 91 patients with spinal cord lesions above the 7th thoracic segment who were admitted to the Rehabilitation Hospital, Yonsei Medical Center between Mar 1, 1993 and Dec 31, 1994.

The results are as follows:

The subjects with autonomic dysreflexia were 27 male and 6 female patients including 19 complete and 14 incomplete spinal cord injured patients. The trigger factors of autonomic dysreflexia were bladder distension, bladder percussion, rectal distension, ingrowing nail. Autonomic dysreflexia occurred more frequently in quadriplegics than in high paraplegics. The patients with severe spasticity had a high incidence of autonomic dysreflexia. Mean bladder pressure was significantly higher in patients with autonomic dysreflexia and mean bladder compliance was also significantly lower in this group.

Our data shows that autonomic dysreflexia is more frequently encountered in quadriplegics. Therefore, careful evaluation for autonomic dysreflexia is a necessity in this group. Also urodynamic studies can be valuable to detect autonomic dysreflexia in patients with spinal cord lesion above the 7th thoracic segment.

The magnetic stimulation of the brain and nerve root was performed on 27 normal healthy person and 17 patients with fifth lumbar radiculopathy. The motor evoked potentials were recorded bilaterally by surface electrodes applied to the tibialis anterior, peroneus longus, gastrocnemius, and abductor hallucis. Mean peripheral and central motor conduction time in tibialis anterior and peroneus longus was significantly prolonged in lesion side of patient group. This study was concluded that magnetic stimulation of the brain and nerve root is an effective and painless technique for the evaluation of nerve root lesion.

Transcutaneous electrical nerve stimulation(TENS) for human beings has been used increasingly as the therapeutic tools, but there has been little clear explanation for site, intensity, freguency and duration of stimulation, mechanism of action and therapeutic effectiveness.

The purpose of this study was to investigate the mechanism of action of TENS by recording the H-reflex after TENS application.

The 33 healthy adult volunteers were stimulated by TENS for 5 min or 15 min or 30 min. The onset latency, amplitude, and H/M ratio of H-reflex were measured before, and immediately, at 15 min and 30 min after stimulation of TENS.

Onset latency of H-reflex was significantly delayed immediately after application of TENS but recovered at 15 min and 30 min after stimulation of TENS, irrespective of duration of stimulation of TENS. Amplitude of H-reflex was not significantly changed. H/M ratio of H-reflex showed variable change.

As the above results, we could not find the long lasting effect of conventional TENS on the H-reflex that favored endorphin theory. We concluded that the polysynaptic inhibition of spinal motoneuron excitability was favored as the mechanism of conventional TENS.

he electrically elicited blink reflex has been extensively studied to evaluate the trigeminal and facial nerve as well as pathologic process in the brainstem. In some recent neurophysiological examination procedures, the electrical stimulation has being replaced by the magnetic stimulation because the magnetic stimulation is less painful and more tolerable to the patients and also gives almost same results as the electrical stimulation. We studied the blink reflex with 40 normal subjects stimulated both magnetically and electrically to investigate the characteristics of the blink reflex evoked by these two methods and the possibility of whether the painless magnetic stimulation could be used in lieu of the conventional electrical stimulation at clinical setting.

The statistical evaluation of the R1, R2 and R2' latencies of the blink reflex following the magnetic and electrical stimulation did not show any significant difference between these two methods(p>0.05). In addition, almost all subjects who experienced both stimulation methods stated that the magnetic stimulation was much less painful and much easier to tolerate than the electrical stimulation.

In conclusion, these results confirm that the magnetically elicited blink reflex is equivalent to the electrically elicited blink reflex and can be substituted for the conventional technique of electrical stimulation.

An electrophysiologic diagnosis of mild carpal tunnel syndrome(CTS) is affected by laboratory error, diagnostic method, hand temperature and age of subject. To control for these variables and improve for detection of mild CTS, we have introduced comparative testing of other nerves in the same hand; median to radial sensory latency difference(MRLD, <0.5 msec in normals), median to ulnar sensory latency difference(MULD, ≤0.4 msec in normals), ratio of median palm latency(MPL/MSL, >0.44 in normals). One hundred and twenty-eight patients with the clinical symptoms consistent with CTS and 53 persons as control, invited Kyung Hee medical center from 1992 to 1993 year were studied. Among 45 patients diagnosed to mild CTS, there were thirty-two females(73.3%), 29(65.9%) aged 40 to 59 years and 9(17.8%) affected bilaterally. The MRLD, MULD, MPL/MSL, MSL and MML had sensitivity of 86.8%, 62.3%, 7.5%, 58.5% and 54.7% in turn. Therefore, MRLD may be a sensitive indicator of mild CTS that can be measured quickly with a minimum of discomfort. We recommend our method for screening of mild CTS before other specific study.

Functional electrical stimulation(FES) has been shown to increase muscle bulk and strength and prevent muscle atrophy in complete paraplegic patients. There are some controversies about the effects of FES on spasticity.

In order to assess the effects of FES on muscle strength and spasticity, 15 complete thoracic spinal cord injured patients were investigated in this study. The subjects were divided into two groups with 5 patients as a control group and 10 patients as a FES treatment group.

We measured the changes of peak torques of the knee extensors at the speed of 30°/sec, 60°/sec, 90°/sec, 120°/sec, and 150°/sec of isokinetic exercise. The changes of thigh circumferences and the changes of spasticity after a 6-week FES treatment period were recorded.

The results are as follows;

1) The peak torques of knee extensors at 30°/sec, 60°/sec, 90°/sec, 120°/sec, and 150°/sec of angular velocities were significantly increased in FES treatment group after 6 weeks of treatment compared to control group(p<0.05).

2) There was no statistical difference between two groups in the changes of thigh circumferences(p>0.05).

3) In the FES treatment group, 5 patients showed no change in spasticity, one showed decreased spasticity and 4 patients showed increased spasticity. 5 patients of control group showed no change in spasticity.

The above results may lead to the conclusion that functional electrical stimulation was helpful in increasing muscle strength in complete thoracic spinal cord injured patients. Additionally, there was a tendency of increasing spasticity with a long term functional electrical stimulation.

Twenty-four male subjects with Duchenne Muscular Dystrophy(DMD) were assessed for hand function using the timed Jebsen test of hand function. We carried out this study in order to determine the correlation between Jebsen test and already established Brooke's upper extremities functional rating scale, age, range of motion measurement in wrist joint and strength of wrist muscles. On Jebsen test, there was significant correlation between most of the subtests of Jebsen test and age(p<0.01). But subtests reflected in learning ability and fine motor coordination of hands such as writing, card turning(simulated page turning), and stacking checkers were preserved regardless of aging. This study reveals significant negative correlations of subtests of Jebsen test with limitation of radial deviation and weakness of wrist extension(p<0.01). The univariate regression analysis results suggested a positive relationship between the Jebsen and Brooke scale(R2=0.71, 0.75). However, the Jebsen test was found to be a more discriminative assessment of hand function than the Brooke scale among the DMD patients. The Jebsen test might be used instead of the Brooke scale as a method of following DMD patients progress over time and during treatment trials. In addition, exercise program focusing on maintaining strength in muscles and range of motion of distal upper extremities to allow as much independent function as possible for the child with DMD is suggested.

Chronic obstructive pulmonary diseases (COPD) is a chronic disorder of airflow limitation that is often progressive. It not only limits patient's activities of daily living because of coughing, sputum and dyspnea, but also causes an economic lose due to the unemployment. The prevalence can be reduced by early detection and prevention through smoking cessation. Until today, the proper rehabilitation treatment for them has not been done well. To get an effective and comprehensive pulmonary rehabilitation program, we were interviewed patients with COPD, such 34 issues as physical, psychological, social, and vocational problems. The number of interviewed patients were 83; 60 men and 23 women. The average age and morbidity period were 65.7 years old and 12 years respectively. Out of the patients, 77.1% has experience of smoking. The average numbers of admission and cost were 2.79 times and ￦55,000 per month. Class IV (38.6%) was turned out to be the major case in COPD disability scale, and so was scale III (39.8%) in Scale of life satisfaction. The frequency of communication with family members was as follows; frequently (61.4%), by request (25.3%), and indifference (13.3%). Many patients requested that the government provide aids for medical treatment for them(44.6%). Therefore, our results suggest that further controlled of pulmonary rehabilitation programs which are medical management, cessation smoking, chest physical therapy, medical insurance and vocational rehabilitation are needed for patients with COPD.

Trigger point injection is often used in clinical situation for treatment of myofascial pain syndrome. This study was designed to compare the therapeutic effects of lidocaine injection with that of dry needling. Trigger point injections with 1% lidocaine were given to 23 patients while dry needling was performed on trigger points in 22 patients. Effects was assessed by measuring the subjective pain intensity(Verbal Rating Scale;VRS) and the pressure pain threshold of trigger points by pressure algometer. Follow up assessments of subjective pain intensity and pressure pain threshold were performed immediately, 1 day, 3 days, and 7 days after the injection or dry needling.

Significant improvement of the measured VRS was occurred immediately after 1% lidocaine injection and 1 day after the dry needling. On the other hand, pressure pain threshold was significantly increased immediately, 3 days, 7 days after lidocaine injection and 3days, 7 days after dry needling.

In conclusion, there was no significant difference in the effectiveness of the two treatment methods for the myofascial pain.

Hemophilia, a genetically determined disorder, is characterized by abnormality of the coagulation mechanism due to functional deficiency of a specific factor, namely VIII or IX.

The purpose of this study was to determine the various clinical aspects of hemophilia in evidence at the present time as well as to provide the basic concept for comprehensive rehabilitation management.

All of twenty-five cases were male. A positive family history was obtained in 64% of the cases, in descending order; brother, maternal uncle, maternal cousin, and maternal grand-father.

Hemophilic arthropathy was present in 14 cases(56%) and the incidence increased significantly with age. The weight-bearing joints were most commonly affected, with frequency of involvement being, in descending order: knee, elbow, ankle, and hip.

Conclusively, we suggest comprehensive rehabilitation management and multidisciplinary team approach for the hemophiliacs.

The functional electrical stimulation system is being developed for restoring function of spinal cord injured patients. But limitations of current system are electrode failure, muscle fatigue, cumbersome electrical hardware, and an inefficient usermachine interface.

Muscle fatigue in tetanic isometric contractions is defined as the decrease in force due to sustained stimulation.

This study comprises a comparison of fatigue between normal control (N=10) and spinal cord injured (SCI) patients (N=4) induced by electrical stimulation (ES) at different frequency (20, Hz, 80 Hz) and stimulation pattern (continuous, intermittent), and a comparison between maximal voluntary contraction (MVC) and ES in normal controls, respectively.

Fatigue was expressed in two ways: the time for the force to fall to 50 percent of the initial force (T⁵⁰), and the percentage of the initial contraction force (ICF) remaining at T50.

The results were as follows:

The T⁵⁰ of MVC was significantly shorter than that of 20 Hz continuous ES in normal control (p<0.01). The T⁵⁰ of normal controls was significantly longer than that of SCI patients with 20 Hz, 80 Hz continuous ES, respectively (p<0.01). The T⁵⁰ of 20 Hz contunous ES was significantly longer than that of 80 Hz continuous ES in normal control and SCI patients, respectively (p<0.01). And the percentage of the ICF remaining of intermittent ES at the point of T⁵⁰ in continuous ES is greater than that of continuous ES in 20 Hz, 80 Hz of normal control and SCI patients, respectively (p<0.05).

In conclusion, muscle fatigue phenomenon was noted less with low frequency and intermittent ES than with high frequency and continuous ES.