Objective: To estimate the self-esteem and to understand the psychosocial needs of people with cerebral palsy(CP).

Method: Thirty-seven adult CP with age from 19 to 30 years and 24 controls with age from 19 to 33 years were evaluated for their self-esteems. The self-esteem was estimated by the standardized Korean-version of manual which was originally developed by Fitts(1965).

Results: The CP group scored significantly lower than the control group on 5 items of the physical self-esteem, personal self-esteem, self identity, self satisfaction, and self behavior among the 14 self-esteem items. Males scored higher than females on the personal self-esteem and self behavior. Personal self-esteem score was higher with the increasing age. The type of CP and the independent gait had no influence on the positive self.

Conclusion: The differences on self-esteem between CP and control group suggest the needs of psychosocial support for the adults with cerebral palsy.

Objective: To evaluate the effects of orthostatic stress with a head-up tilt on the autonomic nervous system and to determine how a cerebral stroke influences the cardiac autonomic function, using the power spectral analysis(PSA) of heart rate variability(HRV).

Method: We studied 11 stroke patients with a left hemiplegia and 14 patients with a right hemiplegia. Their hemispheric brain lesions were confirmed by the MRI. The ECG and respiration signals were recorded at the tilt angle of 0^o and 70^o for 5 minutes under the condition of frequency controlled respirtaion(0.25 Hz). Data were compared with the age- and sex-matched 12 healthy controls.

Result: In a control group, the normalized high frequency power showed a significant decrease during the head-up tilt(p＜0.05), whereas the normalized low frequency power showed a significant increase(p＜0.05). But for the left and right hemiplegia groups, there were no significant changes of normalized high and low frequency power under the orthostatic stress(p＞0.05). Compared with the right hemiplegia and control groups, the left hemiplegia group was associated more with a reduced low and high frequency power and showed no significant changes under the orthostatic stress.

Conclusion: PSA of HRV can identify the reduced cardiac autonomic activity in stroke patients, with a greater reduction in the left hemiplegia group than in the right hemiplegia group, which may cause a high risk of cardiac arrhythmias and sudden death.

Objectives: The biomechanical assessment of spasticity has been developed recently, but not standardized yet for the test procedures and parameters of measurement. This study was designed for the development of standardized method of the biomechanical assessment of spasticity using the isokinetic dynamometer.

Method: The plantar flexor muscles of both ankles were stretched from 40^o plantar flexion to 20^o dorsiflexion using the isokinetic dynamometer at the angular velocities of 15^o, 30^o, 60^o, 90^o, 120^o, 180^o, and 300^o per second. Three parameters, peak eccentric torque(PET), torque threshold angle(TTA), and angle at peak torque(PTA) were analysed.

Results: PET increased and TTA decreased significantly in the involved side. The side to side difference of PET and TTA increased in the patient group with more spasticity. The side to side difference of PET increased, but the side to side difference of TTA decreased with the increase in the angular velocity.

Conclusions: The isokinetic dynamometer is useful in the assessment of the spasticity of ankle plantar flexor of hemiplegic patients. PET and TTA are useful parameters. The faster angular velocities seemed to be more appropriate for the analysis of torque values and the slower angular velocities seemed to be more appropriate for the analysis of thresholds.

Objective: This study was designed to measure the range of normal values of the diaphragmatic latency, central motor conduction time and the extent of right-left agreement after a magnetic stimulation and to measure the parameters of diaphragmatic activity after magnetic stimulation in stroke patients and to compare them with the results of pulmonary function test (PFT).

Method: In seventeen healthy adults and sixteen well-cooperated stroke patients, a magnetic stimulation with 90 mm circular coil (Magstim 200) on cerebral cortex during inspiration and on C7 spinous process, and a transcutaneous electric stimulation of phrenic nerve were performed. An active electrode was attached at 5 cm superior to the tip of the xiphoid process, a reference electrode at chestwall along the midclavicular line at the lower margin of rib cage, and a ground electrode at sternum. Pulmonary function test was checked in the stroke patients.

Results: The latencies of magnetically evoked Compound muscle action potential (CMAP) were 15.1 ms on cortical stimulation, 7.7 ms on cervical stimulation and the central motor conduction time (CMCT) of diaphragm was 7.4 ms in a control group. Normal limits of each parameter were 17.7 ms, 8.9 ms and 9.8 ms in 95% CI and right-left difference of each parameter was not found. In stroke patients, twelve patients showed delayed CMCT or unevokable CMAP, and among them eleven patients showed restrictive pattern in PFT. Patients with delayed CMCT or unevokable CMAP had significantly high risk of restrictive pulmonary dysfunction.

Conclusions: We measured the normal values of evoked response of the diaphragm for cortical and cervical stimulation. In stroke patients, those with delayed CMCT or unevokable CMAP for diaphragm showed higher incidence of restrictive pulmonary dysfunction. Motor evoked potentials of the diaphragm could be used to detect the respiratory dysfunction of central origin.

Objective: Our study was designed to evaluate the clinical value of pulse oximetry for the detection of aspiration in a stroke patient with dysphagia at bedside.

Methods: Thirty two acute stroke patients with dysphagia were devided into two groups according to the presence or absence of aspiration. And controls was selected among the inpatients without a neurological disease and an evidence of dysphagia. We assessed the dysphagia by a neurological examination, fiberoptic examination of vocal cord and videofluoroscopic swallowing study(VFSS). And the oxygen saturation of tissue blood flow(SpO₂) was measured, while VFSS was performed by swallowing the barium sulfate fluid for three times.

Results: The clinical findings of dysphagia were not exactly correlated with the VFSS. There was no significant difference of the resting SpO₂ among three groups, but the mean SpO₂ fell more in the patients with aspirations(⁣2.73%) than in the controls(⁣0.11%) or the patients without aspirations(⁣0.33%). Mean SpO₂ fell more in the patients with aspiration of larger amount, but the change of SpO₂ was not statistically significant.

Conclusions: We conclude that the pulse oximetric measurement of SpO₂ is useful as a screening test for the assessment of aspiration and the efficacy of swallowing training.

Objective: The aim of the study is to evaluate the changes of the respiratory patterns associated with swallowing in the brain-injured patients.

Method: Twenty brain-injured patients(6 bulbar lesions, 14 pseudobulbar lesions) and fifteen normal subjects were selected for this study. Each subject swallowed 5cc of water for ten times in a upright sitting position and a submental electromyography recording and respirography by pneumobelt on mid-abdomen were recorded simultaneously.

Results: 1) Most swallows occured during the late expiratory phase in both brain-injured patients and controls.

2) In brain-injured patients, the incidence of swallowing during inspiration was significantly higher than the controls(p＜0.05).

3) In brain-injured patients, the postdeglutitive inspiration was significantly higher than the controls(p＜0.05).

4) In patients with a bulbar lesion, the postdeglutitive inspiration was significantly higher than patients with a pseudobulbar lesion(p＜0.01).

5) Postdeglutitive swallowing relatively correlates with the abnormalities in clinical findings and Video Fluoroscopic Swallowing Study(VFSS) findings.

Conclusion: The respiratory patterns associated with the swallowing in brain-injured patients were different from that of the normal adults and the postdeglutitive inspiration could be the most valuable predictor of the aspiration.

Objective: The purposes of this study were to estimate the incidence and complications of the tracheostomy and after decannulation, and to compare the functional outcomes between tracheostomy and non-tracheostomy groups in the severe traumatic brain injury (TBI) patients.

Method: One hundred and fifteen severe TBI patients were included in this study and the functional outcomes were measured by the Functional Independence Measure (FIM) scores retrospectively.

Results: The incidence of tracheostomy was 45.2% and the average duration of tracheostmy was 69.7 days. Twenty seven complications associated with the tracheostomy (51.9%) were reported and a pneumonia was the most common complication. Fourteen complications (26.9%) were reported after the decannulation and a tracheal granuloma was the most common complication. Complications mostly occurred during the first two weeks of tracheostomy. The duration of rehabilitation treatment for the patients with tracheostomy was longer than the patients without tracheostomy. TBI patients with tracheostomy had significantly lower initial and discharge FIM scores, FIM gain, and FIM efficiency than the patients without tracheostomy.

Conclusion: The complications of tracheostomy were mostly occurred early in the acute stage. Functional outcomes were lower in severe TBI patients with tracheostomy, thus early comprehensive and aggressive rehabilitation treatments would be necessary.

Objectives: To investigate the correlation of the initial Computerized Tomography(CT) findings of the brain and the functional outcome, and to suggest the initial CT findings as a functional outcome predictor in the traumatic brain injured(TBI) patients.

Methods: Thirty-nine TBI patients were included in this study. Subjects were divided into groups of non-focal or focal TBI, and with or without a depressed skull fracture according to their initial brain CT findings.

Results: The non-focal TBI patients were not significantly different from focal TBI patients in the days from onset to rehabilitation, rehabilitation stay, and initial FIM score. However their outcome in FIM gain and FIM efficiency significantly worse than focal TBI patients. The TBI patients with a depressed skull fracture were not significantly different from the patients without a depressed skull fracture in the days from onset to rehabilitation, rehabilitation stay, and intial FIM score. However their outcomes were significantly worse than patients without a depressed skull fractrue in FIM efficiency.

Conclusion: The initial brain CT findings were generally useful for the prediction of functional outcomes in TBI patients.

Objective: To find out the motor recovery in stroke patients according to the presence of diaschisis.

Method: Computed tomography (CT) and/or magnetic resonance imaging (MRI) scan and single photon emission computed tomography (SPECT) study were performed on a consecutive series of 98 inpatients from July 1995 to August 1996. Among them 42 stroke patients were included in this study with cerebellar, pontine, and bilateral hemispheric lesions excluded.

Results: The types of diaschisis were crossed cerebellar diaschisis (CCD) (36 cases), thalamocortical diaschisis (6 cases), striatocortical diaschisis (5 cases), and capsulocortical diaschisis (1 case). And the functional recovery scale improved from 37.5 points to 53.0 points by the motricity index and from 41.2 points to 68.8 points by the MBI score. Only the motricity index showed a significant inverse correlation with the asymmetry index in CCD.

Conclusion: Although other types of diaschisis were found, the most frequent type was CCD. The lower the asymmetry score was the lower motricity index. Therefore, CCD could be a prognostic factor for the motor recovery.

Objective: To investigate the functional facilitation effect on an affected side of spastic hemiplegic cerebral palsy by immobilizing the intact side with a cast.

Method: Five hemiplegic cerebral palsies, who had been treated by general rehabilitation therapy during previous 6 months and showed no functional improvement were studied. Their intact arms were immobilized by scotch short arm casts for 6 weeks. And, the therapeatic effects of this method were evaluated by the Box and Block Test of manual dexterity, Erhardt Developmental Prehension Assesment and Brain Perfusion SPECT.

Results: 1. Box and Block test: Before the cast immobilization method, hemiplegic cerebral palsies could transfer a mean of 5.4⁑3.36 cubic rods from one to the other side, and after the treatment a mean of 8.0⁑1.41 cubic rods with the affected arm.

2. Erhardt Developmental Prehension Assesment: Before the treatment, the grasp motion of round rod, cubic rod, and button suited in a mean of 5.1⁑3.0 months, and after the treatment, suited in a mean of 8.2⁑0.66 months.

3. Brain Perfusion SPECTs did not change before and after the cast immobilization method.

4. There was no adverse effect resulting from the cast immobilization method on an intact side.

Conclusion: We concluded that the cast immobilization method on an intact side could be a new beneficial rehabilitation method for the treatment of spastic hemiplegic cerebral palsies.

Objective: To establish the normal values of the transcranial doppler sonography in healthy Korean adults according to the increasing age and sex.

Method: We examined 68 healthy adult volunteers who had no history of diabetes mellitus, hypertension, cerebrovascular disease or other neurological illness. The study included 54 subjects from whom good doppler signals from the middle, anterior, and posterior cerebral arteries could be obtained. Mean blood flow velocity (MBFV), Resistance index (RI), and Pulsatility index (PI) were analyzed by Angiodine 2 Doppler System operating at 2 MHz frequency.

Results: MBFV significantly decreased with the increasing age in the middle, anterior and posterior cerebral arteries (p＜0.05). There was a significantly decreased MBFV of the middle cerebral artery in the 4 th, 5 th, 6 th, and 7 th decades compared to the 3 rd decade (p＜0.05). RI and PI were significantly increased with the increasing age (p＜0.05). MBFV of the female subjects were greater than the male subjects (p＞0.05). There was no significant difference in the RI and PI between the male and female subjects.

Conclusion: We suggest that the transcranial doppler sonography can be used as one of the useful screening tools for the diagnosis of cerebrovascular diseases.

Objective: To investigate the ambulatory status and its contributing factors in eighty one patients with spina bifida, and to obtain informations about the actual state and the problems of their orthotic uses for the lower limbs.

Method: Eighty one spina bifida patients above thirty months of age who registered to the Myelomeningocele Clinic of Seoul National University Hospital were investigated through the telephone interviews and the retrospective reviews of the medical records by a physiatrist.

Results: About one half of 81 spina bifida patients had problems in their ambulation. It was significantly influenced by the neurological level, the type of spina bifida, the contractures and deformities of the lower limbs, and presence of hydrocephalus. The deformity of hip and the neurological level were revealed to be the most important factors contributing to their state of ambulation by the multiple linear logistic analysis(p＜0.01). Forty patients had used the lower limb orthoses of which the ankle-foot-orthosis was most frequently used. The satisfaction and compliance of the patients, however, were not high and the most common complaint of the parents was a skin wound from the use of orthoses.

Conclusion: The neurological level and the deformity of hip were the two most important contributing factors to the ambulation of the spina bifida patients. Early detection of the neurological level and an adequate prescription of the lower limb orthoses should be stressed for the management of ambulation in spina bifida patients.

Objective: To investigate the correlations of neurological level, BCR and urodynamic study (UDS) in the spinal cord injury(SCI) patients, we analyzed the results of BCR and UDS fundings.

Method: The sujects were twenty-four patients with SCI who were beyond 3 months following the SCI. According to the level of injury, the patients were divided into 3 groups: above T10 level, 7; T10 to L2 level, 8; below L2 level, 9. Electrophysiological BCR test and UDS were performed in all patients.

Results: The results showed a significant correlation between the BCR test and level of injury, however there was no correlation between the UDS and level of injury, nor between the detrusor function and BCR test. The results might be from a differential recovery of the somatic and autonomic nervous system.

Conclusion: As a part of comprehensive evaluation for the bladder function in the SCI patients, we recommend both the bulbocavernosus reflex test and urodynamic study. Further neurophysiological research would be needed to understand the urodynamic findings which did not correlate with the level of SCI.

Objective: To explore the diagnostic value of the nerve conduction study in the dorsal nerve of penis before and after erection.

Method: Nineteen subjects with a confirmed psychogenic impotence were studied for the superficial peroneal and sural sensory nerve conductions, bulbocavernous reflexes (BCR), tibial and pudendal somatosensory evoked potentials (SEP), and conduction studies of the dorsal nerve of penis. Sixteen subjects with normal findings had repeat studies after an injection of Prostaglandin E1.

Results: Erection helped to obtain a dorsal penile sensory potentials in 18.8% of the 16 subjects. The mean conduction velocity of the dorsal nerve of penis increased significantly from 33.8⁑9.3 m/sec to 48.4⁑12.8 m/sec. The mean sensory amplitude of the dorsal nerve of penis increased significantly from 1.7⁑1.0 ㄍV to 2.8⁑1.4 ㄍV. There was no significant difference in the BCR latency and the pudendal SEP (latency and amplitude) before and after erection.

Conclusion: Erection helps to obtain the sensory potentials of the dorsal nerve of penis when it is technically difficult to obtain and increases the conduction velocity as well as amplitude of the dorsal nerve of penis. However it does not affect the BCR latency and pudendal SEP.

Objective: The aim of present study is to obtain the reference values of motor and sensory nerve conduction study (NCS) of the median nerve and to re-assess the values of criteria for abnormal findings in the electrophysiological diagnosis of Carpal tunnel syndrome (CTS).

Method: Median and ulnar NCS were performed in 62 neurologically healthy adults as controls and 142 patients with CTS. Reference values of the median and ulnar NCS were obtained from the controls and the criteria for the diagnosis of CTS were made. Sensitivities of diagnostic criteria were calculated.

Results: The criteria included 7 items: (1) A 5-cm short segment study through carpal tunnel, ≥1.3 msec; (2) median motor latency (8 cm), ≥4.0 msec; (3) median sensory latency (14 cm, onset), ≥3.0 msec; (4) median sensory nerve action potential amplitude (baseline to peak), ≤20 uV; (5) ratio of median to ulnar motor latency, ≥1.5; (6) ratio of median to ulnar sensory latency, ≥1.2; (7) ratio of median to ulnar sensory amplitude, ≤0.6. The order of the highest to lowest sensitivity were as follows: a 5-cm short segment study, median sensory latency, median motor latency, ratio of median to ulnar sensory latency, and ratio of median to ulnar motor latency. Approximately 65% of the patients met all the 7 diagnostic criteria and 95% of the patients met 3 or more.

Conclusion: The criteria proposed in this study would enhance the diagnostic sensitivity for the CTS.

Objective: To assess the abnormal spontaneous activities in needle electromyography (EMG) according to the type of herniated lumbar disc and anteroposterior the diameter of dural sac in magnetic resonance imaging (MRI).

Method: We performed the MRI on 120 patients with low back pain (LBP) and measured the midline anteroposterior diameter of dural sac in a MRI axial view. Fifty patients with a disc protrusion or extrusion in MRI were reviewed for the clinical findings on physical examination and assessed for the abnormal spontaneous activities (ASA) in needle EMG.

Results: Seventy cases with a normal finding in MRI did not have differences in a dural sac diameter regardless their age or sex. Fifty cases with a protrusion or extrusion in MRI showed that the dural sac size decreased more in an extrusion than in a protrusion, and more in a paracentral type than in a central type. The incidence of ASA in a needle EMG increased more in an extrusion than in a protrusion, and more in a paracentral type than in a central type. The incidence also increased according to the decrement of a dural sac diameter. The incidence of ASA were 100% in a group with both motor and sensory signs, 94% in a group with a motor sign, 86% in a group with a sensory sign, 26% in a group without motor or sensory sign.

Conclusion: We concluded that the abnormalities in needle EMG must be correlated with the direction of herniated lumbar disc and anteroposterior diameter of the dural sac in MRI as well as clinical findings.

Objective: The purpose of this study was to determine the reliability and usefulness of the lateral femoral cutaneous nerve conduction study by comparing the modified Ma's method (method I) with the method proposed by Spevak and Prevec (method II) and to develop a standard value of the Korean normal adult by the method II.

Method: Twenty-nine healthy adults were examined for the lateral femoral cutaneous nerve conduction by both methods bilaterally. The nerve was stimulated 1 cm medial to anterior superior iliac spine (ASIS) in the method I and 8 cm distal to ASIS in the method II. The sensory nerve action potential was recorded with 8 cm long strip electrodes placed on the thigh 17 cm distal to ASIS in the method I and 33 cm distal to ASIS in the method II.

Results: 1) Among 58 extremities, a sensory nerve action potential was detected in 52 extremities (89.7%) by the method I and in 57 extremities (98.3%) by the method II without a significant difference between both methods. 2) The mean distal latency was 3.41 msec by the method I and 4.56 msec by the method II. 3) The mean amplitude was 7.24 ㄍV by the method I and 6.63 ㄍV by the method II without a significant difference between both methods. 4) The mean conduction velocity was 50.9 m/sec by the method I and 55.2 m/sec by the method II without a significant difference between both methods.

Conclusion: According to the study, both methods are compatible and reliable for the examination of lateral femoral cutaneous nerve except for a significant difference in a mean conduction velocity.

Objective: To investigate the conduction velocity of sympathetic skin response(SSR) in normal adults.

Method: The latency of SSR was measured in 41 normal healthy subjects by the simultaneous recordings from three sites of the hand. And we also measured the distance and conduction time between the recording sites of the hand. The conduction velocity of SSR was calculated by dividing the distance by conduction time.

Results: The SSR was obtainable in all subjects from three sites of the hand. The mean latencies of SSR recorded from wrist, midpalm and index finger were 1.29, 1.40 and 1.54 seconds respectively. And the mean latency showed a significant increase from wrist to index finger(p＜0.05). The conduction velocity of the SSR from wrist to index was 0.57 m/sec, and segmental conduction velocities from wrist to palm and palm to index were 0.62 and 0.66 m/sec respectively. The conduction velocity of SSR in the distal segment was slightly faster than in the proximal segment with no statistical significance.

Conclusion: The conduction velocity of SSR by the simultaneous recordings at two or more sites of the hand can be easily obtained and offers a useful parameter along with the amplitude and latency of SSR.

Objective: To evaluate the usefulness of cutaneous silent period(CSP) in assessing the pain sensory function mediated by the Aδ fiber in diabetic polyneuropathy and to define the proper CSP parameter and method.

Method: We studied 18 diabetic polyneuropathy patients and 20 age-matched healthy subjects. CSPs were recorded in the abductor pollicis brevis muscle and soleus muscle with the surface electrodes and a painful electrical stimulation was given to the mixed nerves(median and tibial nerve) and cutaneous nerve(ulnar and superficial peroneal nerve). Onset latency, end point and duration of CSP were compared between two groups. CSP parameters correlated with the motor and sensory nerve conduction parameters in diabetic polyneuropathy patients.

Results: CSP onset latency and end point were significantly delayed in diabetic polyneuropathy patients for both mixed nerve and cutaneous nerve stimulations. There was no difference in CSP duration between two groups. CSP onset latency was shortend and duration was prolonged in mixed nerve stimulation due to an antidromic collision, which showed a cutaneous nerve stimulation as the propor method. There was no correlation between the CSP parameters and motor and sensory nerve conduction parameters. In 3 cases, the CSPs were unable to the evoked despite the sensory nerve action potential was normally evoked. This suggests that the CSP would give an information about the Aδ fiber function than the large myelinated fiber.

Conclusion: This study indicates that the CSP is a useful supportive electrophysiologic study to assess the Aδ fiber function in diabetic polyneuropathy. The CSP onset latency and cutaneous nerve stimulation are the useful parameter and method for the CSP.

Objective: To investigate the possibility of volume conduction in the superficial radial sensory nerve conduction study in patients with a complete radial nerve injury.

Method: In patients with a complete radial neuropathy, a superficial radial sensory nerve conduction study was carried out by an antidromic and orthodromic methods. Antidromic technique was carried out by increasing stimulus intensity gradually. Median palmar cutaneous nerve conduction study was also carried out by an antidromic method.

Results: When the stimulus intensity was significantly higher than the optimal technique, a median palmar cutaneous nerve action potential was evoked instead of the superficial radial nerve action potential. This is a volume conducting potential which occurrs following a high intensity stimulus.

Conclusion: Superficial radial sensory conduction study must be carried out by an optimal stimulus intensity and an orthodromic method to eliminate the effect of volume conduction.

Objective: To evaluate the sensitivity and specificity of each parameter including the distoproximal ratio(D/P ratio) in median nerve conduction.

Method: Median motor and sensory nerve conduction studies were performed in 48 patients(66 hands) with the clinically diagnosed carpal tunnel syndrome and 33 control(46 hands).

Sensory nerve conduction was measured from index finger both antidromically and orthodromically, and from middle finger orthodromically.

Orthodromic sensory nerve conduction velocity was measured in the median nerve between the middle finger and palm and between the palm and wrist. These figures were used to calculate the ratio of distal to proximal conduction.

Results: The sensitivity of each parameter was 47.0% to 74.2% with control mean⁑2SD as reference value. The sensitivity of distoproximal ratio was 74.2%.

The sensitivity of each parameter was 76.1% to 90.9% with the predictive value method. The highest diagnostic yield was obtained with the distoproximal ratio(90.9%).

Conclusion: Normal limits should be derived from acceptable statistical analysis. Segmental study of median sensory nerve conduction velocity with calculation of the distoproximal ratio is a sensitive parameter for the diagnosis of mild to moderate carpal tunnel syndrome.

Objective: To confirm the clinical utility of diaphragmatic needle electromyography (EMG) in patients with respiratory dysfunction.

Method: Needle electorode was inserted into the muscle just above the lower costal margin between anterior axillary and medial clavicular lines. Case 1 who showed no response bilaterally in a phrenic NCS and a complete denervation of the diaphragm on needle EMG was unable to be weaned off from the ventilator. Case 2 who showed normal electrodiagnostic findings was successfully weaned off from the ventilator. Case 3 who showed a respiratory insufficiency from organophosphate intoxication had normal electrodiagnostic findings and was able to be successfully weaned off from the ventilator with a psychiatric support.

Result: We ruled out the possibility of lack in central respiratory drive and weaned off patients from the ventilator, based on a normal firing pattern of motor unit potentials.

Conclusion: Phrenic nerve conduction study (NCS) alone is not sufficient to find out the nature of respiratory dysfunction. Needle EMG of the diaphragm can be helpful in determining the pathogenesis, but its utility has been limited due to its potential risks. However we have confirmed that the needle EMG of diaphragm is a safe and easy study to perform and can provide a valuable information in the evaluation and management of respiratory dysfunction.

Objective: To investigate the electrophysiologic and histopathologic changes of the prheral nerve from hyperthermal nerve injury and to observe the difference of these changes according to the level of temperature and the duration of heat application.

Method: The experimental rats (Sprague-Dawley) were divided into four groups according to the degree of temperature and the duration of heat application : Group 1, 43^oC for 15 min; Group 2, 43^oC for 30 min; Group 3, 45^oC for 15 min; Group 4, 45^oC for 30 min. A segment of 5 mm of the sciatic nerve was exposed and treated in vivo with local hyperthermia using a thermostatically controlled heating unit.

For the electrophysiologic examination, both sciatic nerve conduction study and needle electromyographic examination were performed immediately before, and at 1 day, 3 days, 1 week, 2 weeks, and 4 weeks after the hyperthermia. For the histopathologic study, a sciatic nerve biopsy was performed at 1 day, 1 week, 2 weeks, and 4 weeks after the hyperthermia and the changes were investigated under the light microscopic and electronmicroscopic examinations.

Results: In experimental groups, the compound muscle action potentials (CMAPs) showed a significant reduction compared to the control group (p＜0.05). Amplitudes of CMAPs following the heat application to the nerve were inversely related with the degree and duration of hyperthermia. A significant recovery of CMAPs was observed at 4 weeks after the hyperthermia in all experimental groups. The motor conduction latencies, however, did not show any significant changes. The needle electromyography of the gastrocnemius began to reveal fibrillation potentials on the 3rd day after the hyperthermia and continued to appear until the second week and then completely disappeared at 4 weeks after the hyperthermia. The histopathologic findings began to show the degeneration of axon and myelin within 24 hours and a remarkable regeneration at 4 weeks after the hyperthermia.

Conclusion: The results revealed that the hyperthermia of peripheral nerve within the range of 43∼45^oC for 15∼30 min is likely to cause a significant acute, but not necessarily permanent nerve injury, and the severity of nerve injuries is related to the temperature and duration of heat applications. Whether the results can be clinically applied to human beings would require further exploration.

Objective: To analyze the diagnostic value of digital infrared thermographic imaging(DITI) and to compare the therapeutic effects of lidocaine injection(LI) and dry needling(DN) in the treatment of myofacial pain syndrome(MPS) by using the DITI and visual analogue scale(VAS).

Method: After 20 minutes adaptation time, 41 patients with MPS and 15 controls undertook DITI. LI and DN were randomly given in the trigger points of the patient group and to either side of the upper trapezius muscle in the controls. The effects of treatment were immediately assessed by measuring the temperature difference(ΔT) of the involved area and the corresponding area on the opposite side of the body using the DITI and VAS. Follow up assessments of VAS, change of VAS, ΔT and change of ΔT were performed 1, 3, 5 and 7 days after the treatment, respectively.

Result: 1) The sensitivity and specificity of hot spots for TrP were 78.1% and 73.3 %, respectively. 2) ΔT and VAS continuously declined for 7 days after the treatment as compared to before the treatment in groups Ia (n= 16, ΔT＞0.6℃, LI) and Ib (n=16, ΔT＞0.6℃, DN). 3) ΔT and VAS ware not statistically different for groups Ia and Ib. 4) There was no statistically significant correlation between ΔT and VAS in both groups I and Ib.

Conclusion: These data suggest that DITI can be used as one of the valuable tools for the evaluation of trigger points. No significant difference noted in the therapeutic effects of LI and DN for MPS.

Objective: To investigate the regional differences of skin blood flow and to evaluate the effects of foot temperature on the severity of neuropathic pain and to predict the development of plantar foot ulceration by measuring of the temperature variations on the plantar surface of feet in the diabetic patients.

Method: We measured the temperature variations on plantar surface of the feet in controls (n=18) and diabetic patients with(n=20) or without(n=23) polyneuropathy. The surface temperature from the 3rd metatarsal head(MTH), greater toe(GT), heel, medial and lateral longitudinal arch(LA) was measured by Digital Infrared Thermographic Imaging(DITI).

Results: The mean foot temperature of diabetic patients with polyneuropathy was significantly increased compared to controls or diabetic patients without polyneuropathy(p＜0.001). The surface temperature readings of the GT, medial LA and the 3rd MTH tended to be increased in controls and patients with polyneuropathy. The mean plantar surface temperature was significantly increased according to the duration of diabetes mellitus(DM)(p＜0.05).

Conclusion: The results suggest that DITI provides a diagnostic modality in the prediction of neuropathic foot and increased risks of foot ulcer development in the diabetic patients.

Objective: To investigate the torque curves and heart rate responses to isometric, eccentric and concentric isokinetic exercises with a maximal voluntary contraction of the right knee and elbow joints in 30 healthy men(26.6⁑2.2 years).

Method: Subjected performed the eccentric and concentric isokinetic exercises with 10 repetitions at 60^o/sec, while performing the isometric exercises at a joint angle of 60 degrees for the same period of time with Cybex 6000. Peak torque, angle of peak torque, and total work were measured and the flexor-to-extensor ratios of peak torque were calculated.

Heart rates were recorded simultaneously at rest and immediately after the exercise, and the time required to return to the resting heart rate level was also recorded for each exercise session.

Results: Peak torque and total work for the eccentric exercise were significantly higher than those for the concentric exercise(p＜0.01) of the knee and elbow joints. Eccentric peak torques for flexors and extensors of the knee joint occurred at a significantly longer muscle length than the concentric peak torques(p＜0.01).

Flexor-to-extensor ratios of a peak torque of the knee joint between the eccentric and concentric isokinetic exercises did not show a significant difference.

Torques at a joint angle of 60 degrees were highest in the eccentric isokinetic exercise, followed in the order by isometric, and then concentric isokinetic exercises of the knee joint(p＜0.01), and concentric torque at a joint angle of 60 degrees was significantly lower than those of the eccentric and isometric exercises of the elbow joint.

The increase in heart rate and the time of returning to the resting heart rate level were independent of the size of the contracting muscle mass and the types of exercise. The increment ratio for the heart rate was 70.4⁑23.6%.

Conclusion: In conclusion, the response of heart rate to the exercise is not influenced by the contracting muscle mass or the types of exercise in a short duration of maximal voluntary contraction, implying that special precautionary measures are not required for the isometric, eccentric and concentric isokinetic exercises.

Object: To find out the anatomical changes of adhesive capsulitis of the shoulder by the ultrasonography.

Method: We examined 20 patients with a adhesive capsulitis of the shoulder. Ultrasonographic findings were analysed by a radiologist who measured the synovium thickness of anterior, posterior and axillary plane and coracohumeral ligament length of the shoulder.

Results: Synovium thickness of the shoulder was measured with a mean value of 1.4⁑0.3 mm in the anterior plane, 1.4⁑0.4 mm in posterior plane and 1.8⁑0.5 mm in axillary plane of the unaffected sides and a mean value of 1.7⁑0.5 mm in the anterior, 1.8⁑0.4 mm in posterior and 3.2⁑1.0 mm in axillary planes of the affected sides. Coracohumeral ligament length was measured with a mean value of 27.8⁑7.9 mm in the unaffected side and 26.3⁑8.1 mm in the affected side.

Conclusion: The characteristic appearance of the adhesive capsulitis of the shoulder by ultrasonography was an increased synovium thickness in the axillary plane compared to the unaffected side. This study demonstrates that the ultrasonography is a valuable tool for the evaluation and follow up for the adhesive capsulitis of shoulder.

Objective: To evaluate the effects of stellate ganglion block(SGB) in adhesive capsulitis of the shoulder which was not treated with other procedures and therapeutic exercise.

Method: Fifty patients with adhesive capsulitis of the shoulder were assessed by the shoulder range of motion(ROM) and visual analogue scale before and in 30 minutes after the SGB without other procedures and therapeutic exercise.

Results: In 30 minute after the SGB, the shoulder ROM increased 11^o in flexion, 14^o in abduction, 8^o in internal rotation, and 6^o in external rotation and visual analogue scale decreased (P＜0.05). The changes of shoulder ROM after the SGB were not significantly related to duration of the adhesive capsulitis of shoulder, except in flexion.

Conclusion: The stellate ganglion block can be another effective method for the patients with adhesive capsulitis of the shoulder.

Objective: To evaluate the clinical usefulness of ultrasonographic measurement of the sternocleidomastoid muscle(SCM) in congenital muscular torticollis.

Method: We studied nine patients(5 males, 4 females) who were diagnosed as a congenital muscular torticollis. We measured the thickness of SCM muscles bilaterally by the ultrasonography and obstetric caliper under sedation, before and after conservative treatment.

Results: Before the treatment, thickness of the SCM muscle was significantly thicker in the lesion side than non-lesion side(p＜0.05). There was significant changes in thickness of the lesion side from the values of the before- to thoses of after-treatment(p＜0.05). Both the difference of thickness and the ratio between lesion and non-lesion side significantly decreased after the treatment(p＜0.05). Obstetric caliper measurement showed no significant changes in the difference of thickness and the ratio between the lesion and non-lesion sides after the treatment.

Conclusion: Ultrasonographic measurement of the thickness of SCM in congenital muscular torticollis was easily applicable, objective, and reliable, thus was an affordable method for both diagnosis and evaluation of the treatment effect.

Objective: To determine whether muscle fatigue affects knee joint proprioception.

Method: Thirty healthy subjects (18 male and 12 female) with an average age of 22.1 years were selected for this study. Angular errors were measured to test propriocetive function in the knee joint. In a sitting position, the subject's dominant leg was passively positioned to the 45^o knee flexion stimulus point for 2∼4 second, while the subject concentrated on this position, the leg was passively returned to the 90^o flexion position, afterward the subject was asked to duplicate the stimulus point actively. The difference, in degrees between the stimulus point and the reproduced point is an angular error. All subjects were blindfolded and underwent proprioception measurement before and after the muscle fatigue. Isokinetic exercises performed at 180 degree/sec on the Cybex Orthotron II(Cybex, a division of Lumex, Inc. USA) were used to induce the muscle fatigue. All subjects performed an isokinetic exercise with their dominant leg. Exercise was continued until 50% of the initial peak torque was reached. When the subjects were fatigued to less than 50% of the initial peak torque, the isokinetic exercises were discontinued. Then we immediately retested the proprioception using the same method.

Results: The mean and standard deviation of the angular error increased from 2.79⁑1.17^o to 6.40⁑3.42^o after muscle fatigue.

Conclusion: The proprioception significantly decreased after the muscle fatigue(p＜0.001). This result suggests that the muscle fatigue must be considered when an injured professional athlete a patient with fatigable disease is set in a rehabilitation program. Further studies are required to determine the physiological mechanisms of the role of muscle fatigue for the decreasing proprioception.