Objective: The purpose of this study is to present the epidemiological data on patients with a stroke admitted to the severance hospital, Yonsei University College of Medicine (YUMC) and to investigate the significant risk factors of stroke.

Methods: We reviewed medical records of 532 patients with a stroke admitted to the hospital of from 1992 to 1996 retrospectively.

Results: The incidence was highest in the sixth decade. Ischemic stroke (64.3%) was more common than a hemorrhagic stroke (35.7%) and the thrombotic infarction was the leading type (28.3%) of all kinds of stroke. Middle cerebral arterial territory was the most commonly involved site for the thrombotic and embolic stroke. Of the intracerebral hemorrhages, basal ganglia (48.4%) was the most commonly involved site with was followed by the thalamus (24.2%), lobar (19.3%), and cerebellum (6.5%). In subarachnoid hemorrhages, the aneurysm was most frequently located in the middle cerebral artery (34.4%). The possible contributing factors of stroke were hypertension, hypercholesterolemia, cigarette smoking and diabetes mellitus. The common complications during hospitalization were the frozen shoulders, depression, pneumonia, reflex sympathetic dystrophy (RSD), and hydrocephalus.

Conclusion: This study showed the changing trends of stroke in its distribution of subtypes. Multicenter prospective study using stroke registry would be required for the determination of national epidemiologic trends.

Objective: This study was designed to investigate whether the stroke occurrence is influenced by the seasonal and diurnal changes and also to know if the seasonal factor affects the functional outcome of stroke patients.

Method: We analyzed the epidemiologic, etiologic, and clinical data collected from the chart reviews in 824 stroke patients who were admitted to the Asan Medical Center from April 1995 to May 1997.

Results: The highest incidence of the stroke was noted in the group of 60 years of age with the ratio of male to female, 1.27 : 1. The occurrence rate of ischemic stroke (60.4%) was higher than that of hemorrhagic stroke (34.9%) or other type stroke (4.7%).

The highest occurrence of stroke was noted during the months of January and November. The seasonal preference was winter and autumn followed by summer and spring. The onset of stroke was relatively high between 6:00 am and 6:00 pm with regard to the diurnal variance. The functional improvement was not significantly affected by the seasonal change.

Conclusion: The stroke occurred more in winter and autumn than in other seasons. And the functional recuperation was not influenced by the seasonal variation. A further multicenter prospective study using stroke registry would bring more precise and valuable informations.

Objective: To determine the differences of the tendon reflex responses (TRR) between medial and lateral heads of gastrocnemius muscles in healthy subject and spastic patients.

Method: The TRR of medial and lateral heads were evaluated in 20 healthy subjects and 20 spastic hemiplegic patients. From 5 repeated trials on each subject, the shortest latency and duration, and the largest peak-to-peak amplitude of TRR were chosen for the representative value.

Results: 1. The evoked potentials by tendon reflex in medial head of gastrocnemius demonstrated significantly higher amplitude than in the lateral head of gastrocnemius in patients (P＜0.05) and the evoked potentials in lateral head of gastrocnemius demonstrated significantly higher amplitude than in the medial head of gastrocnemius in healthy patients (P＜0.05). 2. Mean latency of the evoked potentials by a tendon reflex in both heads of gastrocnemius in the spastic patients and healthy subjects were not significantly different (P＞0.05). 3. Mean duration of the evoked potentials by a tendon reflex in both heads of gastrocnemius in spastic patients and healthy subjects were not significantly different (P＞0.05).

Conclusion: These results indicate that the medial head of gastrocnemius is activated more than the lateral head of gastrocnemius by a tendon reflex in recording evoked potentials of the spastic patients.

Objective: To determine the relationship of the Mini-Mental State Examination (MMSE) scores to the functional improvement of the brain-injured patients with a traumatic brain injury or cerebrovascular accident.

Method: Thirty patients who were admitted to a rehabilitation hospital for their initial brain injury were retrospectively studied. Subjects were administerd a MMSE as cognitive assessment and a Functional Independence Measure (FIM) and Modified Barthel Index (MBI) as functional assessment upon referral for the rehabilitation and at discharge.

Results: MMSE scores, FIM scores and MBI scores at discharge increased significantly compared to the scores at the start of rehabilitation. The changes of MMSE scores significantly correlated with the changes of FIM scores and MBI scores in 30 brain injured patients (p＜0.001). Among the subitems of FIM, the social cognition, communication, self care, and sphincter control were strongly correlated with the MMSE scores.

Conclusion: We conclude that the MMSE can be a relevant predicting factor for the changes of functional status of brain-injured patients from a inpatient stroke rehabilitation and post brain- injury rehabilitation.

Objective: To investigate and compare the vibratory inhibition of H-reflex in the subjects with and without brain injury.

Method: H-reflex and the vibratory inhibition of H-reflexes were evaluated in thirty two limbs in subjects without brain injury and twenty two limbs in the brain injury patients. The maximal amplitudes of H-reflexes were recorded before and while vibrating the Achilles tendon. The ratio of the two trials (vibratory maximal H-reflex amplitude / previbratory maximal H-reflex amplitude) was defined as 'H-reflex vibratory inhibition'. H-reflex vibratory inhibition was correlated to the spasticity (Asworth scale).

Results: The mean values of H-reflex vibratory inhibition were 0.5361⁑0.0373 in the control group and 0.7539⁑0.0543 in the brain injured group. There was a significant difference between two groups. H-reflex vibratory inhibition tends to increase as the spasticity increases.

Conclusion: The vibratory inhibition of H-reflex was significantly decreased in the brain injured patients than in the controls. We conclude that the H-reflex vibratory inhibition can be used in the evaluation of the spasticity.

Objectives: To investigate the outcome of preterm infants and the prevalence of cerebral palsy and to examine the relevance between clinical risk factors, ultrasonographic abnormalities and the development of cerebral palsy.

Methods: From January, 1993, to December, 1994, we selected and followed up 437 cases of survived preterm infants born in Seoul National University Hospital. Clinical risk factors such as gestational age, birth weight, maternal complications, birth asphyxia, and neonatal sepsis were evaluated. Sequential ultrasonographic observations were done at the interval of 7 or 10 days. Ultrasonographic abnormalities could be classified into periventricular echodensity, periventricular leukomalacia (PVL) including cystic PVL, intraventricular hemorrhage, ventriculomegaly and brain atrophy. Diagnosis of the cerebral palsy was confirmed after the follow up more than 2 years after birth, and the correlations of ultrasongraphic abnormalities with clinical types and severities of cerebral palsy were analyzed.

Results: Twenty one cases (4.8%) among survived infants were diagnosed as a cerebral palsy. The prevalence of cerebral palsy was 20% in infants with less than 32 weeks of gestation, and 1.4% after 34 weeks. The prevalence of cerebral palsy was 12% in infants with less than 2000 g of birth weight, while, 0.4% in more than 2000 g of birth weight. Mother's age, primiparaty, and history of abortion did not influence the prevalence of cerebral palsy, but preterm labor, preterm rupture of membrane, severe birth asphyxia, neonatal sepsis, and respiratory distress syndrome were significantly relevant to the increased prevalence of cerebral palsy. Fifty six percents (18/32) of PVL (100% of cystic PVL) and 53% (7/13) of third grade IVH progressed to a cerebral palsy. Without PVL, third grade IVH had no explicit correlation with a cerebral palsy. Multiple logistic regression analysis of clinical risk factors and ultrasonographic abnormalities revealed that PVL is a determinant and independent risk to the cerebral palsy. Most cases turned out a spastic diplegia. The cases with cystic lesions especially showed the worse clinical outcomes.

Conclusion: Four point eight percents of survived preterm infants developed a cerebral palsy. The existence of PVL was the most important risk factor among the perinatal problems and ultrasonographic abnormalities.

Objective: To evaluate the pattern of developmental delay of language and to correlate the language with other developmental areas in cerebral palsy children.

Method: Sequenced Inventory of Communication Development (SICD) was studied in 31 children with cerebral palsy of age ranging from 11 months to 48 months. Korean Denver Developmental Screening Test (DDST) was also performed in 18 children simultaneously.

Results: On SICD, 10 children (32.3%) showed the receptive language delay and 13 children (41.9%) showed the expressive language delay. Among 15 spastic quadriplegic children, 40% showed the delay of receptive language development, 53.3% showed the delay in expressive language development. Among 10 spastic diplegic children, 30% showed the delay of both receptive and expressive language development. One spastic right hemiplegic child showed a delay of expressive language development, but 4 left hemiplegic children showed the normal language development. One hypotonic cerebral palsy child showed a delay of both receptive and expressive language development.

The expressive language was delayed more than the receptive language.

SICD correlated highly with the language sector of DDST. And both SICD and DDST language sectors correlated with the other sectors of DDST (personal-social, fine motor-adaptive, gross motor), especially with the fine motor sector (r=0.912, 0.918, 0.976, p＜0.001).

Conclusion: There is a considerably high incidence of developmental delay of language in cerebral palsy children, especially among spastic quadriplegic children.

The early evaluation and treatment for the developmental delay of language need to be included in a general rehabilitation program for the cerebral palsy children.

Objective: To find out the characteristics of gait maturation process in Korean normal children.

Method: Three dimensional kinematic gait analysis using Vicon 370 system from Oxford Metrics Company was performed for 72 children (33 females) without known gait anomalies aging between one and six years old. The data were compared with those from 41 normal adults which were collected previously using the same method, and with those from study by Sutherland et. al.

Results:

1. The initial heel contact, initial flexion wave of the knee joint during the early stance phase and reciprocal arm swing were found before the age of 3.5.

2. Pelvic motion in transverse plane, hip joint motion in all the three planes, knee joint motion in coronal plane, and ankle joint motion in transverse plane remained greater than those of Caucasian children of Sutherland et. al.

3. Single stance period remained shorter than that of Caucasian children.

4. Internal rotation of hip joint and varus motion of the knee joint remained greater than those of Caucasian children.

Conclusion: The difference between Korean and Caucasian children were

1. Development of muscles' ability which stabilize the large leg joints during gait seems slower among Korean children than Caucasian children.

2. These differences are probably from the anthropometrical characteristics of Korean and Caucasian growing children. Also, the different definition of angle systems between the Korean and Caucasian data might case some erroneous effect on the interpretation of result.

Objective: To evaluate the changes of dermatomal SEP (DSEP) in children with a spastic cerebral palsy (CP) after the selective posterior rhizotomy (SPR).

Method: The subjects were 14 spastic CP children, with the age from 3 to 6 years old, who underwent SPR. DSEPs were studied at the L2-3, L4, L5, S1 dermatomes bilaterally, pre and postoperatively. Postoperative DSEPs were interpreted by the changes of latency, amplitude and waveforms.

Results: 1) All children were spastic diplegia except one who was a spastic hemiplegia. 2) Preoperative DSEPs were flat or severely distorted in 40 of 112 waveforms (34.5%). 3) Postoperative DSEP latencies were no change in 39.3%, improved in 17.9%, and worsened in 25.6% respectively. Amplitudes were no change in 30.8%, improved in 38.5%, and worsened in 13.7% respectively. Waveforms were no change in 64.1%, improved in 22.2%, and worsened in 8.5% respectively. There was no statistical difference of postoperative changes of the 3 categories according to the root levels.

Conclusion: The results showed that the preoperative DSEPs were abnormal in 34.5% suggestive the lesions of CP being more widespread than strictly involving the motor system. This study confirmed that the most SEPs unchanged by the SPR. A further study for the relationship of postoperative DSEP changes and clinical findings such as functional impairment would be needed.

Objective: To quantify the effect of botulinum toxin A injection, by the compound muscle action potential (CMAP) measure from the gastrocnemius muscles (GCM) and to compare them with the clinical data.

Methods: Seventeen legs of 10 cerebral palsy (CP) children were studied with botulinum toxin A injection on the motor points of their GCM. Each GCM was injected up to 6 units of the botulium toxin A per kilogram of the body weight. The CMAP were measured at the motor points of GCM with the surface electrodes on the post-injection day 1, day 3, day 7, 2 weeks and at 1 month then monthly thereafter for 6 months. Physician rating scale (PRS) and the angle of passive ankle dorsiflexion were evaluated at the same time.

Results: The amplitude and the area of the CMAP decreased from post-injection day 1 to 3 months. The most pronounced decrement was seen at 2 weeks post-injection (p＜0.05). The most pronounced increase of the dorsiflexion angle and PRS were seen at 1 and 2 months post-injection, respectively (p＜0.05).

Conclusion: The compound muscle action potential measure can be used for the neurophysiological quantification of the effect of botulinum toxin A, especially for the superficial muscles of extremities.

Objects: To investigate the effect of anti-diuretic hormone (ADH) on nocturnal polyuria in spinal cord injured patients.

Methods: Eleven quadriplegics, seven paraplegics, and nine normal person participated in this study. Quadriplegics and paraplegics ranged from A to C grades according to the ASIA classification. All participants were independent in activities of daily living on wheelchair level. Their intake and output were measured at every 6 hours for 24 hours. The level of ADH was measured by the radioimmunoassay method.

Results: 1) Urine output from midnight to 6:00 A.M. was increased in quadriplegics, but not in paraplegics. 2) ADH at 6:00 A.M. and midnight was decreased in quadriplegics than in controls. No significant change of ADH level was noted in paraplegics. 3) Serum osmolality was higher in quadriplegics than in controls at 6:00 A.M. and midnight.

Conclusion: This study indicates that the nocturnal polynuria in spinal cord injured patient is partly due to a decreased ADH.

Objective: To know the effect of intrathecal baclofen on increased muscle tone, spasm and ambulation.

Methods: Six patients with a severe chronic spasticity were evaluated with 10∼75 ㄍg of intrathecal baclofen infusion. Two patient were infused more than two times (25 ㄍg, 50 ㄍg, 75 ㄍg). After each bolus infusion, an assesment was done for the patient's Ashworth score, spasm score, reflex score, peak eccentric torque by Cybex 6000 system^Ⱂ, H/M ratio, subjective feeling of walking and the gait analysis.

Results: Spasticity decreased from the mean prebolus Ashworth score of 3.4 to mean postbolus Ashworth score of 1.4 and the pre- and postbolus mean reflex score were 3.9 and 1.6 respectively for a minimum of 4 hours. All patients showed that spasms disappeared, and the peak eccentric torque and H/M ratios also decreased. For the bipedal locomotion, all patients improved in their gait speed, step length, and maximal knee flexion angle, but only two patients improved in their subjective ambulatory functions. These two patients could control the spastic limbs voluntarily and walk independently at the prebolus stage. Four patients had more difficulty in gait because of the subjective weakness of extensor muscles of the lower extremities.

Conclusion: Intrathecal baclofen decreased the spasticity, and spasm effectively in patients who had failed the conservative treatment with medication and physical therapy.

Objective: To describe the videofluoroscopic findings of quadriplegic patients with dysphagia and to assess the predisposing factors of dysphagia in quadriplegic patients.

Method: Six quadriplegic patients with a dysphagia within 3 months from the injury were included in this study and videofluoroscopic evaluations for both lateral and AP views were performed and evaluated.

Result: A variety of swallowing deficits that involve both oral and pharyngeal phases were detected in the videofluoroscopic study.

The presumed predisposing factors of dysphagia were a surgical stabilization of cervial vertebrae, inadequate neck extension due to cervical orthosis, history of mechanical ventilation, cervical traction, tracheostomy state and cranial nerve injury.

Conclusion: When there are symptoms that suggest a swallowing problem such as a frequent reflex coughing and voice change in quadriplegic patients, videofluoroscopic study will help to prevent the pulmonary complications and to determine the successful swallowing strategies.

Objective: To determinate the reference values of residual latencies of motor nerves and to evaluate the early diagnostic value of residual latency.

Method: The subjects were 129 diabetes mellitus patients and 60 controls with no known neurological disorders. The patients were divided into two groups based on the conventional nerve conduction study: Group 1, 75 patients without neuropathy; Group 2, 54 patients with neuropathy. The group 2 patients were subdivided into 4 sub- groups on the basis of conduction velocity and residual latency of the median nerve. Residual latencies were measured in all subjects and glycosylated hemoglobin percentages (HbA1c) were measured in the diabetes patients. In group 2, each nerve conduction parameter was correlated with the duration of diabetes and HbA1c. The duration of diabetes, HbA1c, and amplitude of median nerve response were compared between the subgroups of group 2 patients.

Results: Motor residual latencies obtained from the controls were 1.93⁑0.28 msec, 1.53⁑0.24 msec, 2.46⁑0.43 msec, 2.21⁑0.53 msec in median, ulnar, deep peroneal and posterior tibial nerves, respectively. In group 1, motor residual latencies of median & deep peroneal nerves were significantly delayed compared with those of the controls. In group 2, motor residual latencies of median, ulnar, deep peroneal and posterior tibial nerves were significantly delayed more than those of the controls and group 1.

In group 2, increased HbA1c correlated to the decreased conduction velocities of median, deep peroneal, posterior tibial nerves but not to the residual latencies.

In the subgroup of group 2 (2-D), the nerve involved more distally showing lower compound muscle action potential and higher HbA1c.

Conclusion: Residual latency measurement can be a useful diagnostic method for the early detection of diabetic neuropathy.

Objectives: To analyze the motor evoked potential (MEP) responses to a degree of voluntary contraction and stimulus intensity and to suggest the standardized optimal stimulation for MEP responses.

Methods: MEPs induced by a cortical stimulation were elicited at the thenar muscles in 15 normal subjects during the rest and gradual voluntary contraction, using the 10% of maximal voluntary contraction (MVC), 30%, 50%, and MVC. During rest and during each contraction, excitability threshold at rest (RET) and at contraction (CET) were determined. Consecutive stimuli were applied, according to the intensity of ratio increment (110% to 150% of excitation threshold).

Results: The RET showed a remarkable decrease (57.1⁑8.2% → 47.4⁑8.7%) after the voluntary contraction (P＜0.05). Shortening of latency reached the saturation level with 10% of MVC, irrespective of stimulus intensity. Amplitude reached a saturation level at 30% of MVC with 62.7% intensity of maximal output, which is equal to 140% intensity of its CET, and to 110% of RET. MEP amplitude at rest and at 10% of MVC were influenced by the excitation threshold (P＜0.05), but those at above 30% of MVC were not related.

Conclusion: The procedure for optimal facilitation for the MEPs is as follows; for minimal latency of MEPs, minimal contraction (10% of MVC) with RET intensity is enough. For maximal amplitude of MEPs, moderate contraction (30% MVC) with 110% intensity of RET is adequate.

Objective: Most spinal cord injured patients suffered form various autonomic dysfunction. The purpose of this study is evaluation of sympathetic skin response (SSR) and R-R interval variability (RRIV) as a method of autonomic function test in spinal cord injured patients.

Method: Thirty-six spinal cord injured patients were enrolled in this study. SSR was recorded in the palm and sole by electrical stimulation of right median nerve and RRIV during rest, deep breathing and Valsalva maneuver for 1 minute.

Results: The higher level of spinal cord injury, the higher rate of the abnormal sympathetic skin response in the palm and sole and more reduced values of Valsalva ratio (p＜0.05). The parameters of sympathetic skin response and R-R interval variability were not correlated with injury severity of spinal cord and their autonomic symptoms.

Conclusion: Evaluation of SSR and RRIV could be helpful methods to evaluate autonomic function in the spinal cord injured patients.

Objectives: To investigate the effects of topical anesthetic ointment (lidocaine 2.5%⁢prilocaine 2.5%) to the pain during electromyographic examination

Method: Thirty-two adults without known neurological disorders were studied. The needle Electromyography (EMG) of flexor carpi radialis (FCR) muscle and the motor and sensory conduction studies of median nerve were performed after the application of topical anesthetic ointment in one upper extremity and compared to the other side upper extremity without anesthesia. The intensity of pain was assessed with the Visual Analog Scale (VAS) and the characteristics of pain was evaluated with the modified short-form McGill pain questionnaire.

Results: The VAS score of the needle EMG of FCR muscle in the anesthetized side was significantly lower to that of the non-anesthetized side (P＜0.01). And the characteristics of pain were shooting (10 cases, 31.3%), or throbbing (6 cases, 18.8%) in the anesthetized side and dull (13 cases, 40.6%), or numb (7 cases, 21.9%) in the non-anesthetized side. The VAS scores of the sensory and motor nerve conduction study of median nerve were not significantly different in both sides.

Conclusion: The application of topical anesthetic ointment decreases the intensity and changes the characteristics of pain during the needle EMG.

Objective: The dorsomedial cutaneous nerve (DMCN) to the great toe is a branch of the medial dorsal cutaneous nerve, which originates from the superficial peroneal nerve. The objective of this study is to standardize the electrodiagnostic technique, and to investigate the usefulness of dorsomedial cutaneous nerve (DMCN) conduction study in patients with peripheral neuropathy.

Method: Sixty two legs in 31 normal adults and 56 legs in 28 patients with the clinical signs and symptoms as well as electrodiagnostic evidences of peripheral neuropathy were evaluated with the DMCN conduction study. The stimulating electrode was placed over the lateral 1/3 between medial and lateral malleoli and the active electrode was placed over 12 mm medial and 10 mm proximal to the extensor hallucis longus tendon over the 1st metatarsophalangeal joint.

Results: The mean values of DMCN conduction study in normal adults were 2.95⁑0.47 msec for onset latency, 3.58⁑0.43 msec for peak latency, 6.67⁑2.87μV in amplitude, and 12.96⁑1.17 cm for distance from active electrode to stimulation point. There were statistically significant differences between normal and patients groups in all parameters except the distance.

Conclusion: A method for DMCN conduction study was introduced which could be used as a valuable technique for the early evaluation of peripheral neuropathy.

Objectives: To determine the effect of facilitation on H reflex side-to-side amplitude ratio and to determine the effect of averaging under the assumption that an averaging could further stabilize the amplitude ratio in a facilitated condition.

Method: FCR H reflex amplitude ratios of direct and averaged potentials were measured in fifty asymptomatic subjects under three conditions, during rest, during a constant 5 pound isometric contraction under the hand-dynamometer monitoring, and during a moderate constant isometric contraction under the electromyographer's verbal guidance.

Results: The lower limits of the amplitude ratios that encompass 97.5% of subjects by the percentile method under three conditions were as follows; (1) during the rest (n=37); 0.47 (direct) and 0.50 (average), (2) during the constant 5 pound isometric contraction under the hand- dynamometer monitoring; 0.47 (direct) and 0.48 (average), and (3) during the moderate constant isometric contraction under the electromyographer's verbal guidance; 0.48 (direct) and 0.46 (average), respectively.

Conclusion: There seems to be no definite effect of facilitation and averaging on H reflex amplitude ratio. H reflex amplitude ratio measured in facilitated condition without averaging is still useful for the diagnosis of unilateral radiculopathy.

Objective: To evaluate the effect of a transrectal probe on the opening of internal urethral sphincter.

Method: Twenty-five patients with a neurogenic bladder dysfunction were included in this study. For the transrectal ultrasonography (TRUS), a transrectal probe was inserted into the rectum before the bladder was filled. Internal urethral sphincter opening was investigated during the filling and voiding phases. The bladder was emptied and the probe was introduced intrarectally after the bladder filling for the investigation of internal urethral sphincter opening. Twelve subjects underwent an additional cystometry for the recording of maximal intravesical pressure with and without transrectal probe.

Results: There was no significant difference in the sensitivity of TRUS for the opening of internal urethral sphincter with insertion of the probe before or after the bladder filling. There was no significant change of the maximal intravesical pressure with or without the probe in the rectum.

Conclusion: The results demonstrate that transrectal probe for TRUS does not cause a reflex effect on the opening of internal urethral sphincter.

Objective: The purpose of this study is to evaluate the effects of a self-stretching exercise on the pressure threshold of myofascial trigger point.

Method: We examined the changes of pressure threshold in 66 patients with myofascial trigger points before and after a self-stretching exercise of shoulder girdle and also tested the visual analogue scale (VAS) of the subjective pain intensity. The self-stretching exercise of shoulder girdle includes a stretching exercise of four muscles in shoulder girdle simultaneously, including upper trapezius, levator scapulae, infraspinatus, rhomboideus major and minor, which is followed by 1) a sitting position, relaxed, 2) lateral bending of neck to contralateral side, 3) forward and downward stretching of ipsilateral arm with protrusion of scapula and internal rotation of arm maximally to the contralateral foot. Each stretching motion is maintained for 30 seconds.

Results: The results of the patients experiencing unilateral or bilateral myofascial neck and shoulder pain showed that the pressure threshold of trigger point increased in response to the self-stretching exercise as assessed by a pressure algometer. Also visual analogue scale (VAS) decreased in response to the self-stretching exercise.

Conclusion: We conclude that the self-stretching exercise of shoulder girdle is an effective method for the simultaneous stretching of upper trapezius, levator scapulae, infraspinatus, rhomboideus major and minor.

Objective: To identify the precise locations of the motor branches and motor points of hamstring and triceps surae muscles to the bony landmarks.

Method: Twenty-eight limbs of 14 adult cadavers were anatomically dissected. The adult cadavers were selected randomly without regard to gender and age. The cadravers which were unable to obtain a neutral position or which received a trauma to the posterior thighs or the lower legs were excluded from the study. The number and location of the motor branches and motor points from sciatic nerve to each hamstirng muscles and from tibial nerve to each triceps surae muscles were identified related to the bony landmarks. Bony landmarks were ischial tuberosity, medial and lateral epicondyles of femur, and medial and lateral malleolli of tibia. The length of femur was defined as the distance from the ischial tuberosity to the intercondylar line of femur and the length of lower leg was defined as the distance from the intercondylar line of femur to the intermalleolar line of tibia. The locations of the muscular branches and the motor points were expressed as the percentage of the length of femur and lower leg.

Results: One muscular branch from the sciatic nerve to the semimembranosus muscle and from the posterior tibial nerve to the soleus muscle, and one or two muscular branches to the biceps femoris, semitendinosus, and semimembranosus, medial gastrocnemius, lateral gastrocnemius and soleus muscle were located at 23.0⁑5.7%, 21.0⁑10.5%, 25.0⁑10.3% of the femur from the ischial tuberosity and 2.0⁑6.2%, 4.0⁑3.3% and 10.0⁑3.3% of the lower leg from the intercondylar line of femur. There were one to four motor points in the hamstring and triceps surae muscles. The motor points of biceps femoris, semitendinosus and semimembranosus were located at 33.0⁑7.8%, 28.0⁑14.5% and 48.0⁑19.0% of the femur. The motor points of the medial gastrocnemius, lateral gastrocnemius and soleus were located in 5.0⁑0.6%, 10.0⁑3.0% and 18.0⁑4.3% of the lower leg below the intercondylar line of femur.

Conclusion: The identification of the locations of muscular branches and motor points related to the bony landmarks from this study would increase the accuracy of the motor branch blocks or motor point blocks to the hamstrings and triceps surae muscles.

Objective: To assess the jumper's knee for the symptoms and diagnostics by MRI and ultrasonography in basket ball players.

Method: Twenty knees of 10 basketball players with chronic knee pain were assessed by the history taking, physical examination and diagnosis by magnetic resonance imaging and ultrasonography. Their average age was 17.4 years. Stanish classification is used for grading the symptoms of jumper's knee.

Results: Nine proximal patellar tendons were diagnosed as jumper's knees (45%) and 11 distal tendons were diagnosed as jumper's knees (55%). In ultrasonographic findings, average proximal patellar tendon thickness was 4.5 mm⁑1.2 mm, and distal patella tendon thickness was 7.1⁑1.1 mm. Sensitivity was 63% (12/19) and specificity was rated as 100% (21/21). By the MRI findings, sensitivity was rated as 32% (6/19) and specificity was rated as 90% (16/21). Study between the patient's clinical severity level by Stanish classification and thickness of patellar tendon showed no significant correlation (＜0.5).

Conclusion: The ultrasonography to be more convenient and easier as a diagnostic method for the jumper's knee than MRI.

Objective: To know the clinical features of overuse injury in performing musicians and to evaluate related factors that may affect the overuse injury and playing related pain.

Methods: Eighty professional musicians and music college students were examined during 1 year. All were examined by a history taking, physical examination, radiologic exam and if needed electromyography. Nonparametric Sperman's correlation were used for the statistic analysis and 5 interval grading system, visual analog scale for pain, and stress, criteria of joint hypermobility were used for various measurements.

Results: Fifty four men were studied in 3 music colleges and a professional orchestra. Frequency of symptom was 46.3%. The string players were most frequently affected (65%), whereas the wind instrument players were least frequently affected (11.5%). The most commonly affected site was the hand and wrist (54.2%) followed by the spine. Patients were divided by the severity into 5 groups and among them the grade 1 was most common (29.6%). No significant correlation was seen between the practice hours per week but a significant correlation was noted between the stress and playing related pain. Joint hypermobility plays an important role in music playing which is dependent on the kind of instruments.

Conclusion: Incidence of the overuse injury in musicians is high in Korea and the prevention and early treatment are essential for the good outcome of overuse syndrome.

Objective: We designed this study to evaluate muscle tone by using a biomechanical method and to provide data for the future studies about muscle tone.

Method: We evaluated 29 subjects without known neuromuscalar diseases using the biomechanical method. Both plantar flexors of each subject were passively stretched by isokinetic dynamometer from 30^oplantar flexion position to 10^odorsiflexion position. Peak eccentric torque (PET) and torque threshold angle (TTA) were calculated at angular velocity of 10^o/sec, 90^o/sec and 300^o/sec. Regression lines from torque/position curve at 10^o/sec and 300^o/sec were considered an intrinsic stiffness index (ISI) and total stiffness index (TSI). Stretch reflex threshold speed (SRTS) was defined as the minimum speed of plantar flexion movement in which EMG reflex activity in plantar flexor muscles is induced.

Results: The mean of TTA was higher in 10^o/sec than in 300^o/sec. The means of ISI and TSI were 0.11⁑0.08, and 0.18⁑0.04. The mean of SRTS was 125.2⁑48.3^o. No statistical difference in each parameter was found according to the side or gender.

Conclusion: ISI, TSI, PET, TTA and SRTS using a biomechanical method are thought to be useful parameters for the quantitative assessment of muscle tone change of ankle plantar flexors.

Objective: The purpose of this investigation was to document the isokinetic performance deficiencies of the invertor and evertor muscles of chronically sprained ankles.

Method: Eversion/Inversion testing was performed by a Cybex 6000 isokinetic dynamometer at the speeds of 60^o/sec and 120^o/sec on 17 subjects who had unilateral chronic ankle sprain. Values were compared between the involved and uninvolved sides.

Results: The inversion peak torque deficits between the involved and uninvolved extremities were significantly greater than eversion deficits at 60^o/sec and 120^o/sec. Evertor/Invertor peak torque ratios of involved sides at 60^o/sec were significantly greater than uninvolved sides.

Conclusion: We conclude that chronic ankle sprains associate an ankle invertor weakness rather than an evertor weakness. Ankle invertor weakness might be resulted from a disuse atrophy and painful ankle inversion. Further prospective study is needed to determine the relationship between the invertor weakness and the chronic ankle sprain.

Objective: The purpose of this study was to investigate a correlation between the muscle strength of trunk and bone mineral density (BMD) in women.

Method: A total of 218 healthy women participated in the study. Their age ranged from 26 to 72 years. Dual X-ray absorptiometry was used to measure the BMD of lumbar spine and the trunk muscle strength was assessed by a Cybex NORM^TM system. Under the standard criteria of World Health Organization for the dual X-ray absorptiometry analysis, we divided spine T-score into three groups(group 1: osteoporosis, group 2: osteopenia, and group 3: normal).

Results: The data revealed a siginificant correlation (r=⁣0.455, p=0.0001) between the age and BMD of lumbar spine. Trunk extensor muscle strength revealed 56.27⁑18.08 Nm (mean⁑SD) in osteoporosis group, 72.84⁑21.69 Nm in osteopenic group, and 77.90⁑22.28 Nm in normal group. Trunk flexor muscle strength was 82.73⁑23.30 Nm in osteoporosis group, 86.00⁑19.77 Nm in osteopenic group, and 98.91⁑18.29 Nm in normal group.

Conclusion: These results indicated that the trunk extensor muscle was weaker than the flexor muscle in osteoporotic group. As the bone mineral density reduced, the strength of both trunk extensor and flexor decreased. However the weakness of trunk flexor occurred at the earlier stage of osteoporosis than the weakness of trunk extensor.

Hand rehabilitation is essential to restore the maximal functional capacity of a patient after the injuries of hand or upper extremity, such as a fracture, tendon tear, crushing, or amputation. To achieve the purpose, hand rehabilitation should begin shortly after the completion of surgery. Especially after the replantation, functional recovery can be achieved by a careful inpatient evaluation providing a proper treatment, detecting problems, and updating treatment programs, and arranging discharge and follow-up cares by a hand rehabilitation team.

We report our experience of a successful hand rehabilitation of patient with a replantation surgery after the complete right forearm amputation. A comprehensive approach and systematized treatment programs are important for a hand rehabilitation.

We report a case of Eosinophilia- Myalgia syndrome with central nervous system (CNS) involvement following ingestion of the essential amino acid, tryptophan. The Eosinophilia- Myalgia syndrome can be diagnosed when there is a severe myalgia and peripheral eosinophilia in the absence of other diseases causing eosinophilia. This condition has been associated with the ingestion of the tryptophan in many cases, but the amount and duration of ingestion have been yet to be elucidated. Although many cases have been reported, few cases involved the CNS.

We present a 28 year- old male who complained of a severe myalgia and disorientation after taking the taken tryptophan for 2 weeks. Thorough examination revealed the peripheral eosinophilia, vasculitis on brain MRI, abnormal VEP, and muscle atrophy on muscle biopsy. Symptoms improved with the steroid pulse after discontinuation of the tryptophan.

Benign focal amyotrophy (BFA) is a limited form of anterior horn cell disease with variable benign clinical appearance. Clinical symptoms of cold-sensitive BFA have been described but electrodiagnostic workup on these symptoms has not been done. A 28-year-old man suffering from cold-sensitive weakness and coordination disturbance of a hand underwent electrodiagnostic study while the subject was exposed to the cold. According to this study, the BFA with cold sensitivity may be classified as one type of BFA which can be confirmed by electrodiagnostic study.