Rheumatoid arthritis(RA) is a chronic systemic autoimmune disease with high mortality. Treatment of RA has always been challenging since the early recognition of this disease back in mid 18th century. The etiology of RA is still unknown and specific therapy for the cure is yet to come. Multidisciplinary approach is required for the management and drug therapy is one of the many management modalities for this chronic disease.

Drugs ranging from simple analgesics to antiinflammatory drugs to powerful immunomodulators have been used for the treatment of RA with varying success. In the last decade, the major change in the therapeutic approach to the treatment of patients with RA has been the widespread use of methotrexate alone or in combination with other conventional disease modifying autirheumatic drugs(DMARDs). Despite the availability of agents that are believed to be disease modifying, many patients either do not respond adequately to available agents or must discontinue their use because of intolerable or dangerous adverse reactions.

For this reason, researchers continue to search for more efficacious and less toxic agents for patients with RA.

The branching sites of dorsal cutaneous branch of the ulnar nerve (DCBUN) from the ulnar nerve proper in the forearm have been described. To demonstrate the precise branching point, we dissected 28 upper extremities of 14 cadavers. The mean value of this point proximal to the styloid process was 87mm: The mean value of the fascicular separation was 217mm. We also confirmed that DCBUN is positioned more either toward medial epicondyle or olecranon to the ulnar nerve proper in the ulnar groove. DCBUN with this anatomic arrangement at the elbow may be less vulnerable to injury or compression than the fascicles of ulnar nerve proper which innervate the palm side of medial two digits and the hand intrinsic muscles. Therefore, understanding the anatomy of DCBUN may be helpful in the electrodiagnostic and surgical procedures: 1, This sensory branch may be used as a donor on an anastomosis of other nerve injuries; 2, Iatrogenic injury of this nerve due to diagnostic and surgical procedures such as arthroscopy at the wrist is preventable.

The aim of this study is to compare the role of magnetic motor evoked potentials(MEPs) with somatosensory evoked potentials(SEPs) in predicting functional recovery of hemiparesis in stroke patients. Twenty-five stroke patients were evaluated clinically and electrophysiologically at about one month after stroke. Outcome parameter was the modified Barthel index, gait state at discharge. MEP was better than SEP at predicting an outcome in terms of functional recovery. MEP has high positive specificity and SEP has high negative specificity in terms of gait state. So MEP in conjunction with SEP may offer a means of more accurately predicting functional outcome following stroke than can be achieved with SEP. There was a significant relationship between MEP and motor function.

Prospective studies establish cognitive status as an important determinant of post-stroke rehabilitation success. The Neurobehavioral Cognitive Status Examination (NCSE), a screening method that assesses cognition in a brief but quantitative fashion, uses independant tests to evaluate the cognitive function within ten independant cognitive ability area. For the study of prognostic value of initial NCSE for functional improvement of stroke patients, we analyzed the correlation between the initial NCSE and the changes of Barthel Index(BI) score during 1 month of rehabilitation.

The sum of normal subitems in NCSE was significantly correlated with changes in BI score in 34 stroke patients(p<0.01). Among the subitems of NCSE, construction, memory, and similarity were the the best predictors of functional improvement (p<0.01).

Therefore, the NCSE provides both a rapid and sensitive measure of cognitive function and it appears to predict the change of functional status as a result from inpatient stroke rehabilitation.

Duchenne and Becker muscular dystrophies are X-linked, recessive disease characterized by progressive muscular weakness. Since they are serious disorders for which at present there is no effective treatment, a great deal of emphasis has been given to prevention. To date, however, no precise analysis is available on the mutation of dystrophin gene in Korean patients, thus it is difficult to provide proper genetic counselling.

In this study, we investigated the deletion pattern of dystrophin gene which is the most common cause of the mutation of the dystrophin gene to develop a effective strategy for detecting deletion and to provide a basic data for genetic counselling in Korean patients. We analyzed DNA samples taken from 82 Korean patients from 80 families with clinical picture suspected to having Duchenne or Becker muscular dystrophy using polymerase chain reaction with 19 pairs of primers and Southern hybridization with cDNA 4-5a probe. The results were as follows:

1) At least one DNA frgment could not be amplified from the peripheral blood DNA of the 43 patients from 41 families by polymerase chain reaction. Two pairs of brothers showed same deletion pattern.

2) Exon 49 was the most frequently deleted(20 patients from 19 families). Only one of the 19 amplified fragment was deleted in 27.9%(12/43), more than 1 exon was deleted in the remaining 72.1%(31/43). Deletion were more frequent in central region(34/43) than in the 5' terminal region(9/43).

3) Additional deletion was not found by the Southern hybridization using cDNA 4-5a probe in the patients whom deletion in polymerase chain reaction could not be found.

According to the above results, we can eliminate the need for invasive, expensive, and time consuming procedure such as biopsy or Southern hybridization for about half of patients suspected to having Duchenne or Becker muscular dystrophy. The use of multiplex polymerase chain reaction encompassing the primer pairs corresponding to the exon 17. 45, 49, and 51 would have detected 76.7%(33/43) deletions found in Korean patients. With this observation, our approach to detect deletion will initially be the polymerase chain reaction including the primers of the exon 17, 45, 49, and 51. When a deletion is not found in them, the remaining patients were examined with the rest pairs of primers. If no deletion was found in polymerase chain reaction, then the Southern hybridization with cDNA probe will be carried out.

Pes valgus is common in cerebral palsy with spastic diplegia with severe peroneal spasticity. Pes valgus consists of eversion and equinus inclination of the calcaneus and abduction of midfoot, resulting in prominence of the head of the talus medially. Pronation of the foot or flat foot is one of the cause of the entrapment of the tibial nerve in or below the tarsal tunnel and causes burning or sharp shooting pain from the medial side of the ankle into the foot. But the children with cerebral palsy could hardly express pain.

The medial and lateral mixed plantar nerve conduction study was performed in order to look for the possibility of tarsal tunnel syndrome according to Saeed and Gatens in cerebral palsy with spastic diplegia. Twenty-one control subjects aged from 2 to 13 and 31 patients from 3 to 13 years of age were studied. Mean conduction velocity of medial plantar nerve showed significant delay in patients as 39.8±10.6m/sec compared with the control subjects as 45.3±3.9m/sec and that of lateral plantar nerve was also delayed significantly in patients as 40.3±11.2m/sec compared with the control subjects as 45.8±4.3m/sec.

But the mean amplitude of medial plantar nerve was not significantly different between patients as 24.4±12.5uV and the control as 27.6±14.3uV and that of lateral plantar nerve also was not significantly different, either. There was no compound nerve action potentials that was not evoked in controls but in 2 cases of patients those were not evoked. The longer the years of walking, the more decreased amplitude of medial and lateral plantar nerves in cerebral palsy with spastic diplegia.

In conclusion, pes valgus in cerebral palsy may cause stretch or local compression of medial and lateral plantar nerves, resulting in decreased conduction velocity and amplitude of compound nerve action potentials.

Optimal stimulus parameters in functional electrical stimulation, which can minimize muscle fatigue and can achieve effective muscle contraction were determined to restore the motor function in atrophied muscles caused by central nervous system injury. Fatigue index of muscle contraction was measured from 2 min of tetanic contraction in T6 spinal cord injured Sprague-Dawley rats.

In control rats, the soleus muscle was classified into slow muscle and the medial gastrocnemius muscle was fast muscle according to their mechanical property of contraction. Optimal parameters of electrical stimulation for slow muscle were 20Hz, 0.2ms square pulse. For fast muscle, 40Hz, 0.3ms square pulse was optimal to reduce muscle fatigue. The atrophied soleus and medial gastrocnemius muscles by spinal cord injury showed significantly decreased muscle weight and tension, however, optimal parameters of electrical stimulation were the same as those of control rats. All of these findings suggest that optimal parameters in electrical stimulation which restore the motor function of atrophied muscle should be 20Hz, 0.2ms in slow muscle and 40Hz, 0.3ms in fast muscle.

Pyrexia is one of the most common complications in myelopathic patients. This study was designed to investigate the incidence and characteristics of fever in patients who suffered myelopathy stemming from traumatic or nontraumatic causes and to find the occurrence of the fever especially caused by urinary tract infection in the management of the myelopathic bladder. 81% among the 86 myelopathic patients who had admitted in Seoul National University Hospital ultimately experienced febrile episodes. There was no difference in the incidence of pyrexia between the traumatic and the nontraumatic spinal cord injury patients. The neurologic level of the cord lesion did not affect the incidence of pyrexia. 78% of the fever occurred within the first 30 days of the hospital stay. Urinary tract infection and pneumonia manifested themselves as high fever, while thermoregulatory dysfuction that prevailed in quadriplegia above T6 level showed mild fever. The most frequent causes were UTI, atelectasis, thermoregulatory dysfunction, decubitus ulcer. The pyrexia caused by UTI was more common in the foley indwelling group and suprapubic cystostomy group than in clean intermittent catheterization group and catheter free voiding group.

Impotence is one of the most common complications of spinal cord injury but its assessments were not satisfactory yet. In order to evaluate penile erection pattern exactly and to use the results as the basic contents of sexual counselling in spinal cord injured patients, we conducted four erection studies to 16 spinal cord injured patients. We excluded the patients who have psychologic, vascular, and endocrinologic diseases and local perineal injury.

Tectile-stimulated and vibratory-induced erection were measured to assess local penile response and nocturnal penile erection, audiovisually-stimulated erection were measured by Rigiscan to assess autonomic function.

We concluded as follows;

1) Vibratory-induced erection was the most effective method for penile erection especially in patients with upper motor neuron lesion.

2) Normal rigigram findings of nocturnal penile erection were observed in patients with incomplete upper motor neuron lesion.

3) VIbratory-induced and audiovisually-stimulated erection were not effective in almost all patients.

Dermatomal sensory examinations have been done usually for the patients with thoracic spinal cord lesion because there is no optimal method of motor evaluation, clinically. And also it is difficult to define the level of the thoracic lesions, electrodiagnostically. Intercostal somatosensory evoked potentials (SEPs) are easy to elicit and can evaluate the focal lesion from the intercostal nerve to the cortex through the thoracic cord. The purpose of this study was to determine the clinical usefulness of intercostal SEPs in the thoracic cord lesions.

Intercostal SEPs were achieved by the third(T3), fifth(T5), seventh(T7), and ninth(T9) intercostal nerve stimulation.

We examined 20 healthy controls and 10 patients with thoracic spinal cord lesions. In controls, the mean P1 latencies were 22.98±1.56msec for the third intercostal SEPs (T3),24.57±1.73msec for the fifth intercostal SEPs (T5), 27.72±2.07msec for the seventh intercostal SEPs (T7), and 28.07±3.34msec for the ninth intercostal SEPs (T9). The mean N1 latencies for T3, T5, T7 and T9 were 30.84±1.63msec, 32.68±2.09msec, 33.65±1.98msec and 35.76±2.66msec, respectively. The P1 and N1 latencies were increased gradually from T3 to T9 segment one by one. The P1-N1 amplitudes in controls for T3, T5, T7 and T9 were 1.65±0.78uV, 1.30±0.57uV, 1.37±0.60uV and 1.39±0.59uV, respectively. The inconsistency of waveforms or no response at certain level was the most important finding in the patients with thoracic cord lesions.

In conclusion, the intercostal SEPs study is a complementary examination to evaluate the thoracic cord lesions in addition to clinical and electromyographic examinations. But it can not be applied below T9 level because of the inherent anatomic limitations of the method.

Sexual concerns are an important part of the rehabilitation of the spinal cord-injured patients. Spinal cord injuries in men often alter the ability to have erections or ejeculation and the individual suffering such injury must not only cope with devastating physical disability but also accommodate a new sexual self. So, we evaluated the sexual function of 5 spinal cord-injured male with Rigiscan^Ⱂ that measures concurrent penile tumescence and rigidity noninvasively and objectively. In this study, it was found that reflexogenic erections occured in all 5 patients and psychogenic erection occured only a patient with lower motor neuron lesion. Because all patients had experience of reflexogenic erection, they are looking for further successful sexual life. But, indeed, anyone didn't showed sufficient duration of penile rigidity required for coitus. The results indicate that objective evaluation and proper management of sexual dysfunction is prerequisite for accommodation of new sexual life.

The H-reflex has been used clinically to study diagnosis of the S1 radiculopathy. But only latency difference was used diagnostic criteria because of technical consistencies and the lack of normative data of the amplitude and the side to side difference.

In most of previous study groups, gastrocnemius muscle was used in evaluation of H-reflex. But in this study, we used soleus muscle in evaluation of H-reflex in order to establish more simple and more objective method of S1 radiculopathy diagnosis.

The H-reflex in the soleus muscle was evaluated in one hundred subjects(forty healthy subjects, thirty eight subjects having L5 radiculopathy and twenty two subjects having S1 radiculopathy).

An analysis of the regression of H-latency on height produced formula: H latency (ms)=11.24+0.12×Height(cm). Mean difference of H-latency was 1.07±0.44 ms in control group,1.18±0.34 ms in L5 radiculopathy group, 1.34±0.38 ms in S1 radiculopathy group(p<0.05). Mean difference of H-amplitude was 1.24±0.97 mV in control group, 1.22±0.84 mV in L5 radiculopathy group, 1.47±0.91 mV in S1 radiculopathy group(p<0.05). When we defined S1 radiculopathy as the latency over mean latency in control group+2SD, the sensitivity was 69.8%, specificity was 91.3%. And when we also defined S1 radiculopathy as the side to side H reflex latency difference over 1.5 ms, the sensitivity was 61.2%, specificity was 83.9%. In conclusion, the latency, latency difference & the amplitude difference of H reflex recording from soleus muscle are valuable tools in helping to diagnosis S1 radiculopathy.

This article is a research for electrical neuropathy of 37 patients who were proven to peripheral neuropathy by the high voltage electrical current. The subjects included 37 male patients between 11 and 53 years of age who were admitted to Hangang Sacred Hospital from February 1991 to August 1995. Most of them were injured by high tension current of 22900 Volt, A.C.. Total body surface area(TBSA) of burn was 16.97% average and the depth was revealed 2nd to 3rd degree of burn. We excluded the pre-existing lower motor-neuron abnormality such as diabetes or alcoholism. The electrodiagnosis was carried out on the median, ulnar, peroneal and tibial nerves.

The results were as follows;

1) The ulnar nerve was the most frequently injured nerves by electrical burn and follows the median, peroneal, tibial nerves.

2) The hand was the most frequent entrance sites of electicity in 89.2% of cases, the feet were the most frequent exit sites of electrical current in 67.6% of cases. And 45.9% of nerve injuries were occurred at exit sites of electricity.

3) The pathway of current flow was classified into several types such as `Cross', `Hemi', `Upper', `X', `Y', `Local' and `Mixed' types. The `Cross' and `Hemi' type were the most common pathways in 24.3%.

4) The `Upper' type and the left hand entrance type injury revealed the highest incidence of the cardiac conduction abnormalities. And the sinus bradycardia was revealed the most common abnormality.

According to the several results, peripheral neuropathy and cardiac complication were closely related to the type of current, the current pathway, the entrance and exit site of electrical injury. These results may be helpful in the early detection of complication which is crucial of the electrical burn patients to return to maximal functional and productive life-style.

A retrospective study was performed on 98 patients with myasthenia gravis diagnosed at the Department of Rehabilitation Medicine, Gospel Hospital, Kosin University and Department of Rehabilitation Medicine, College of Medicine, Hanyang University from January 1988 to December 1995.

The purpose of this study was to examine the findings of EMG and Tensilon test according to the clinical pictures of myasthenia gravis and to determine correlation and reliability of EMG and Tensilon test.

Women were affected more frequently than men, with a ratio of 1.8:1 and there were peaks of incidence in their 3rd and 4th decades. According to modified Osserman's classification, group I was 26 patients, group IIa was 36 patients, most common, group IIb was 15 patients, group III was 15 patients and group IV was 6 patients. Thymoma was found in 22 patients(22.4%), and thymectomy was performed in 12 patients among them.

In Tensilon test, performed in 74 patients, 64 patients(86.5%) revealed positive response and in EMG test, performed in 51 patients, 36 patients(70.6%) revealed positive response. 36 patients were performed both Tensilon test and EMG test and 33 patients(91.7%) revealed positive response on either Tensilon or EMG test.

On the basis of this study, it is necessary to perform both EMG and Tensilon test for diagnosis of myasthenia gravis.

It is important to consider the effect of physical the rapeutic modalities on the autonomic nervous system(ANS) because pain pathway and the ANS pathway are interrelated each other. There are controversies between researchers about the effect of transcutaneous electrical nerve stimulation(TENS) on the ANS and not much is known about the effect of interference current therapy(ICT) on the ANS. Our purpose is to evaluate the effect of TENS and ICT on the ANS with skin temperature and sympathetic skin response(SSR).

We applied high frequency(100Hz) TENS, low frequency(10Hz) TENS, and ICT(1000Hz) for 20 minutes on right forearm area of 25 normal young men. Skin temperature was measured before the treatment and at 5 minutes' interval. SSR was measured before and after the treatment.

Both the high and low frequency TENS showed no change in skin temperature and SSR. ICT showed delayed latency and decreased amplitude in SSR and there was slight amount of decrease in skin temperature, which was statistically nonsignificant. The changes in SSR after ICT disappeared after the cessation of the treatment.

In conclusion, 1) TENS has no effect on ANS. 2) ICT causes changes in SSR but the effect disappears after the cessation of treatment.

The purpose of the study was to provide a guideline for the measurement of instantaneous axis of rotation (IAR) in the lateral bending and to compare the position and translation of IAR of normal persons and the patients with disc herniation. The X and Y axes were considered to be as the follows; X axis was a extension line passing bilateral the most upper margin of superior iliac crest, and Y axis was a perpendicular line to X axis passing L5 spinous process. 25 normal individuals and 24 patients with disc herniation were included in this study. There was no significant difference of the position and lateral translation of IAR of L2 vertebra body between in normal and patient groups. The results suggest that the support of the muscles and orientation of the facet joints of the lumbar spine would prevent a instability of the motion segments.

Low back pain(LBP) is a significant problem in today's society, with lifetime incidence rate reported between 50% and 90%. Many factors associated with LBP are reported. Among the causes, aberrations of posture may play a role in the development of LBP. Many investigators have assessed the curvature of spine in standing posture. But whether LBP is associated with lumbar hyperlordosis or hypolordosis is controversial.

Objective of the study was to evaluate static standing posture aberrations in chronic and acute LBP patients in comparison with healthy individuals. The sample including 98 subjects recruited to the following three groups: acute, chronic and control. Lumbar lordosis, thoracic kyphosis, lumbosacral angle and center of gravity(C.O.G.) were measured using skeletal analysis system and balance scan.

Chronic LBP patients exhibited a decreased lumbar lordosis, thoracic kyphosis, lumbosacral angle and backward displacement of C.O.G. compared to control group. Acute LBP patients exhibited a decreased lumbar lordosis, lumbosacral angle, increased thoracic kyphosis, and backward displacement of C.O.G. compared to control group.

We concluded that initially the lumbar hyperlordosis may result in LBP and thoracic and lumbar hypolordosis followed.

We retrospectively analysed the features and the functional outcome of the thoracolumbar vertebral fractures(TLVF) in geriatric patients who were admitted to Anam hospital between 1991 to 1994. The investigation included the cause, type and level of fracture, and neurologic deficits. Also, the concomitant osteoporosis, length of hospital stay and ambulation status at the time of discharge were included. The geriatirc group, age above 65 years old, was 41 out of total 199 patients with TLVF.

The most common cause of vertebral fracture was "spontaneous"(19 cases) followed by "slip" down(13 cases). The majority of the cases did not show any neurologic deficit except for one case. Osteoporosis as the underlying causes in the radiologic study appeared 77.1% in geriatric and 26% in the young age group. At the time of hospital release 38 cases of geriatric patients were able to ambulate independently with or without walking aids. We conclude that with proper diagnosis and managements of vertebral fractures including the underlying cause of osteoporosis would be able to attain the independent mobility and successfully return to the community life.

The spinal SEPs can be used to evaluate conduction along the somatosensory pathway and, in particular, the transit time from the arrival at the spinal cord to the initiation of the cortical potentials.

In this study, we have recorded cervical spinal evoked potentials over the upper, middle, and lower cervical spine and the scalp in normal adults using the median, ulnar, and musculocutaneous nerve stimulation.

The latencies and the amplitudes of spinal evoked potentials over the upper, middle, and lower cervical spine are 12.92±0.93msec & 1.19±0.58μV, 12.86±0.86msec & 1.18±0.44μV,12.86±0.80msec & 1.21±0.50μV for the median nerve, 13.63±1.33msec & 0.71±0.26μV, 13.53±1.17msec & 0.86±0.43μV, 13.51±1.13msec & 0.90±0.49μV for the ulnar nerve, and 12.41±1.10msec & 0.88±0.30μV, 12.37±1.06msec & 0.97±0.43μV, 12.36±1.08msec & 1.02±0.49μV for the musculocutaneous nerve. We established average values for the cervical spinal evoked potentials in normal Korean adults, and these will be a data base for the further studies about it.

There are no statistically significant differences in the latency and amplitude of cervical evoked potentials between the upper, middle, and lower levels.

Cognitive evoked potentials or Event-related potentials(ERPs) reflects a variety of cognitive functions. ERPs includes a late positive wave P300 or P3, and earlier waves N100, P200, and N200. To evaluate the cognitive function of normal children, through this study we found normal values and age-related correlations of auditory event-related potentials (ERPs) using the conventional 'oddball' paradigm in 60 normal children of 6 and 15 years of age.

The results were as follows.

1) The average latencies of N100, P200, N200, and P300 was 127.40±31.01, 196.02±31.93, 251.61±321.91, 343.84±34.79 msec. The average amplitudes of P300 was 12.06±5.17μV.

2) ERPs(N100, P200, N200, P300) latencies and P300 amplitudes at Fz, Cz, and Pz had no significant difference between male and female children, and they also had no significant difference among sites of recording.

3) There were significant negative correlations between ERPs latencies and age during childhood(P<0.001)

4) The amplitude of P300 had no significant correlation with age

In conclusion, we should consider changes in latencies according to age when we determined latencies of cognitive evoked potentials in children.

It is known that other than well known distal peripheral nervous system complication, diabetes can affect, though rarely, the central nervous system. There have been a number of studies concerned with somatosensory evoked potentials (SEPs) in patients after stroke. Most of these studies have, however, paid attention to the relationship between anatomical location of the lesion and SEPs. Only a few have discussed the relationship among conduction delays in distinct parts of somatosensory pathways, especially in the central nervous system for diabetic patients with stroke.

The purpose of this study was to compare the latencies and amplitudes of SEPs between 2 groups of stroke patients with and without diabetes mellitus and to evaluate the mechanism of showing abnormal SEPs in stroke patients with diabetes mellitus.

Fifty stroke patients who had no history or findings suggestive of diabetes mellitus, thirty diabetic stroke patients, twenty diabetics, and fourteen age-matched controls were studied by SEPs with stimulation of the median nerve at the wrist and recorded from Erb's point, second cervical vertebra, and scalp referenced to FPz. In stroke patients who were diabetic, N9, N13, and N20 latencies were very likely to be increased and N9-N20 conduction time was also prolonged. In stroke patients with the lesion involving somatosensory pathway whether or not diabetic, scalp recorded N20 potentials were of low amplitude even though the amplitude is more reduced in diabetic patients.

These findings suggests that prolonged peripheral and central conduction time in diabetic stroke patients is most likely due to diabetes mellitus rather than the stroke itself, even though the scalp recorded potential of low amplitude can be shown also.

Intraoperative somatosensory evoked potentials(SEPs) are widely used for the early detections of cerebral ischemia during temporary occlusive procedures of the parent vessels in aneurysm surgery. Somatosensory evoked potentials in response to median nerve stimulation were monitored during 20 aneurysm procedures. Base line SEPs were obtained shortly after the induction of general anesthesia and were recorded continuously during the operation. Absolute latency and cortical SEP amplitude were subsequently determined. Statistical analysis confirmed that there were significant changes in latency and amplitude of cortical SEP after aneurysm clipping during the course of operation.

The false positive and false negative rate were 5% and 15%, respectively, where SEP latency increased by more than 10% or SEP amplitude decreased by more than 50% after the time of anesthetic induction. Monitoring of the SEPs during intracranial aneurysm surgery can help the surgeon in the management of proximal vessel control and reduce the morbidity of aneurysm operation.

The reaction time tests were thought to be relatively simple and sensitive tools to evaluate the level of arousal and concentration. The purpose of the study was to investigate the normative data of simple reaction time test in Korean people.

60 normal subjects in 3 age groups were tested on visual and auditory reaction times. Mean reaction time was 258msec in visual reaction time test and 234msec in auditory reaction time test. Mean reaction times were prolonged in older age group. False key rates(errorness key pressing in the absent of target stimuli) were 0.005 in visual reaction time test and 0 in auditory reaction time test. Missing key rates(no response for above 2 seconds since target stimuli start) were 0.002 in visual reaction time test and 0.002 in auditory reaction time test.

It was concluded that the reaction time test is simple to conduct in clinical setting and error rates can also be used as evaluative indices.

Transcranial magnetic stimulation of human motor cortex during voluntary muscle contraction produces motor evoked potentials followed by a transient electromyographic silent period(SP). SP has been known to `inhibitory' effects of cortical activity.

We evaluated SP in abductor pollicis brevis muscle in 21 healthy adults(male: 11, female: 10) who have no neurological signs and symptoms.

SP in relation to sex, recording site (right-left difference), height, magnetic stimulation intensity, and voluntary muscle contraction were studied.

We concluded as follows

1) The SP of male subjects was significantly longer than that of female subjects.

2) There was no significant difference of SP according to recording site and height.

3) The SP was significantly prolongated with increasing magnetic stimulation intensity.

4) There was no significant difference of SP duration between maximal and submaximal voluntary muscle contraction.

This study was to investigate the blood pressure and heart rate response to isokinetic contraction at the knee joint. The subjects(n=30) performed unilateral knee extension/flexion contraction at 60°/sec(4repitition), 180°/sec(4repitition) and 180°/sec(20repitition).

The heart rate and blood pressure were measured at rest and following contraction completion at immediate, 1 and 3 minutes. In response to isokinetic contraction, heart rate was increased significantly(p<0.01). The mean increment ratio for heart rate was meaningful different in all test methods(p<0.01). In addition, increment ratio for systolic blood pressure notable increased in 180°/sec(20 repitition) compared with 180°/sec(4repitition)(p<0.01). Findings from the present study suggest that cardiovascular stress(the increase in heart rate and blood pressure associated with isokinetic contraction is proportional to amount of total work.

The purpose of this study was to assess the correlation between patellar shape and knee pain and to determine the effectiveness of quadriceps setting exercise for the relief of knee pain. The lateral radiographs of the 34 patients with knee pain and 44 control group were analyzed with respect to patellar shape by computing the ratio of patellar length to the length of the articular surface(morphology ratio). The 34 patients performed quadriceps setting exercise daily for 12 months.

Pain disability index was scored by patients at the beginning and at the end of the 12-month exercise. Three types of patellae were established by morphology ratio. A significantly larger portion of type II and type III patellae was found in patients with knee pain. After 12-month quadriceps setting exercise significant decrement of pain disability index was noted. In conclusion patellar shape in the sagittal plane can provide useful information to the clinician about patients with knee pain.

This study was performed to establish the normal values of the relaxation index and angular velocity through the pendulum test on the knee joint using an electrogoniometer. Fifty normal subjects participated in the study. The age ranged from 21 to 67 years old with 25 males and 25 females. Each subject was placed in a supine position and the electrogoniometer was attached to their knee joint. The leg was then dropped and the knee was allowed to swing passively.

The relaxation index was 1.678±0.090. The first angular velocity was 3.873±0.622 rad/s and the second angular velocity was 3.076±0.551 rad/s. There was no difference in parameters according to age or gender.

For more precise measurement of spasticity, analysis of the electromyographic signals recording simultaneously with pendulum test would be needed.

The purpose of this study was to establish the normal values of tendon reflex in adults. Patellar and Achilles tendon reflex tests were performed in 50 normal adults using electric reflex hammer. The compound muscle action potentials(CAMP) were obtained on rectus femoris muscle for patellar tendon reflex and soleus muscle for Achilles tendon reflex. From 10 repeated trials of each subject, the shortest latency and the largest peak-to-peak amplitude of CAMP were chosen for representative value.

The results were as follows:

1) Mean values of latency and amplitude were 17.35±1.56msec, 1.55±0.75mV for patella tendon reflex, 30.97±2.99msec and 2.60±1.98mV for Achilles tendon reflex.

2) There were no significance in the side-to-side differences (P>0.05).

3) The age and the height of subjects showed significant correlation with the latency of patellar and Achilles tendon reflex (P<0.001).

We believe our result can be used as a guideline researches regarding the tendon reflex in lower extremities

The majority of stroke patients present that upper extremity of hemiplegic limb is weaker than lower extremity. However, there is a sizeable group of stroke patients with weakness affecting more predominantly lower extremity than upper extremity. This study designed to determine the incidence, anatomical lesions, and functional outcomes of stroke patients with lower extremity weakness.

The result are as follows:

1) Among 129 stroke patients, 6 cases(4.7%) present predominant lower extremity weakness.

2) The anatomical lesions of these cases are anterior cerebral artery infarction in 3 cases, corona radiata infarction, internal capsular infarction, and pontine lacunar infarction in 1 case respectively. There is correlation between somatotopic area of cortex or corticospinal tract corresponding to lower extremity and lower extremity weakness.

3) Functional Independence Measure(FIM) scores of lower extremity weakness at the beginning of rehabilitation are not significantly different from those of classic stroke patients with dominant upper extremity weakness. FIM scores of lower extremity weakness group at the time of discharge are higher than those of upper extremity weakness group.

This study indicated that the infarcts involving internal capsule and brain stem corresponding to somatotopic organization of lower extremity presented the weakness of lower extremity as seen in the patients of anterior cerebral artery territory. The results are based on relatively small, as yet, population of stroke. And therefore a further study is necessary to provide a conclussive data.

Traumatic brain injury occurs with high frequency and is the leading of brain damage in previously healthy young people. Persisting disability after traumatic brain damage usually comprised both mental and physical handicap.

Cognitive, intellectual, and emotional problems also appear to be more persistent and social and vocational disablities than physical disabilities.

The clinical observation was made with 50 cases which had organic brain syndrome after traumatic brain injury and investigated the cognitive and emotional disturbance of patients with lateralized and localized cerebral lesions by KWIS(Korean Wechsler Intelligence Scale) and MMPI(Minnnesota Mutltiphasic Personality Inventory).

The results were as follows:

1) Eighteen cases(36%) were in their 4th decade and the males were more frequent than the females.

2) The most common cause of traumatic brain injury was traffic accident(88%).

3) The most common type of traumatic bain injury was intracranial hematoma.

4) The organic brain syndrome was more frequent in operative subjects.

5) The most common area of traumatic brain injury were temporal(26%) and frontal(22%) and frontotemporal(16%).

6) The clinical manifestation of organic brain syndrome were memory disturbance (88%), headache(68%), dizzness(68%), anxiousness(56%), disorientation(50%), insomnia (48%), nervousness(48%).

The result of this study suggest that the earlier diagnosis and recognition of organic brain syndrome could reduce psychiatric symptoms. In KWIS and MMPI, left brain damaged groups showed mainly verbal dysfunction and tendency for thought disturbance.