Objective: To investigate the relationship between activities of daily living (ADL) dependence and psychological parameters in the adult hemiplegic stroke patients.

Methods: The subjects were total 122 stroke patients who underwent rehabilitation therapy. Patients were surveyed with questionnaires for anxiety, stress, and depression. Cognitive functions were assessed by mini-mental status examination and their ADL functions were evaluated by modified Barthel index. The correlation between ADL function and psychological parameters was statistically analyzed by Pearson's correlation test.

Results: Results were as follows: The average stress score of stroke patients was 76.7 which was relatively high. Fourty-seven percent of stroke patients suffered from depression, and it was more frequent in the left hemiplegics. As the result of the Pearson's correlation test, ADL function is closely correlated with intrapersonal stress level, but not with the level of anxiety or depression. The cognitive function has correlation with intrapersonal stress level, but not with depression.

Conclusion: Understanding of the relationship between psychological status and ADL function in the stroke patients will be helpful to the physician for conducting efficient rehabilitation of these patients.

Objective: To determine the optimal therapeutic range of serum carbamazepine concentration in agitated brain injured patients.

Methods: Five traumatic brain injured patients exhibiting agitated behavior were treated with carbamazepine during acute rehabilitation. Carbamazepine dose was increased from 400 mg to 1600 mg gradually and blood samples were analyzed for serum carbamazepine concentration. The presence and degree of posttraumatic agitation was measured by the Agitated Behavior Scale (ABS) developed by Corrigan. Therapeutic serum concentration of carbamazepine was defined as serum carbamazepine concentration at a point of time maintaining the ABS scores below 21.

Results: After carbamazepine therapy, ABS score was changed from 36.2 to 19.8 and the therapeutic serum concentration of carbamazepine was 10.18 ug/ml on average. Experienced adverse effects were drowsiness, gastrointestinal trouble, slurred speech, headache, leukopenia, abnormal liver function test, hair loss, skin rash, and double vision. But most of these adverse effects were mild, transient, and reversible with an adjustment in dosage or rate of dosage increase.

Conclusion: In the agitated brain injured patient, success in controlling the agitated behavior requires raising the dose of carbamazepine to high serum concentration levels above 10 ug/ml, as long as adverse effects do not intervene. Therefore we suggest that the therapeutic range of serum carbamazepine concentration for agitated brain injured patients is above 10 ug/ml.

Objective: To evaluate the effect of a contralateral shoe-lift and ipsilateral leather outsole on the energy consumption in hemiplegic gait.

Method: Ten hemiplegic patients who could walk independently were enrolled. Using portable ergospirometer (K4b², Cosmed, Italy), quantitative evaluation of oxygen consumption under varying shoes conditions was done: 1) regular shoes 2) a half-inch shoe-lift on the sound side 3) a half-inch shoe-lift on the sound side and leather outsole on the plegic side. The evaluation distance was 20 meter on comfortable walking speed.

Results: The oxygen consumption was significantly decreased after the application of shoe-lift compared with regular shoes (p＜0.01), and the oxygen consumption was least with the application of shoe-lift and leather outsole (p＜0.05). This effect was prominent in subject with poor muscle power in hemiplegic lower extremity. The walking speed was also increased with shoe-lift and leather outsole (p＜0.05).

Conclusion: The results of this study demonstrate that proper shoes modification can reduce the energy consumption in hemiplegic gait and can lead to more efficient functional ambulation.

Objective: Reflex sympathetic dystrophy (RSD) is a syndrome of post-traumatic neuropathic pain in association with dystrophic changes and signs of sympathetic overactivity. Pain following spinal cord injury occurs frequently, but RSD is not usually considered as one of the common sources of pain. There have only been a few reports of RSD in spinal cord injured patients, although this condition is well-known in the painful upper extremity of hemiplegia due to stroke. The purpose of this study was to investigate the rate of occurrence, characteristic clinical features and more objective evaluation tools for the diagnosis of RSD in cervical cord injured patients.

Method: Thirty-two cervical cord injured patients were evaluated for hand pain, swelling, vasomotor changes and dystrophic skin or nail changes. The patients were evaluated with studies such as three phase bone scintigrathy, digital infrared thermographic imaging (DITI) and plain roentgenograms of the hands.

Results: Eighteen patients (56.3%) were diagnosed as RSD based on the clinical symptoms and findings of three phase bone scintigraphy. Characteristic symptoms were hand pain, edema and dystrophic skin or nail changes, in the order of frequency. In patients with spasticity of the upper extremity, the incidence of RSD was higher than in patients without spasticity.

Conclusion: We should consider RSD as a cause of upper extremity pain in cervical cord injured patients. This will lead to early diagnosis and treatment of the condition and it will be helpful in preventing various complications.

Objective: Anemia had been reported to be one of the common complications in the spinal cord injured patients. The purposes of this study were to investigate the incidence of anemia, its relating factors and efficacy of rehabilitation therapy in the acute spinal cord injured patients.

Method: A retrospective study was performed in the 103 acute spinal cord injured patients. We monitored serum hemoglobin, serum hematocrit, serum albumin and protein and change of the weight in the acute spinal cord injured patients at our rehabilitation department.

Results: The incidence of anemia was 62.1% (64/103). According to the level of injury, the incidence of anemia was 65.2% in cervical cord injury, 62.5% in thoracic cord injury and 46.2% in lumbar cord injury. The incidence of anemia was not different significantly by the severity of injury. The relating factors of anemia were urinary tract infection, pressure sore, acute bleeding, pneumonia, hypoalbuminemia, hypoproteinemia. Among these, hypoproteinemia was statistically related to anemia. The efficacy of functional independence measure (FIM) was significantly lower in the anemic group.

Conclusion: Therefore we should concern about the prevention and treatment of anemia in the spinal cord injured patients.

Objective: To verify the effectiveness of nerve block to the femoral nerve (motor branch of rectus femoris) for stiff-legged gait in spastic patients and to identify factors which influence its effect.

Method: EMG-guided femoral nerve (motor branch of rectus femoris) block by 2% lidocaine and/or 5% phenol was performed on 33 patients with stiff-legged gait: 22 were spastic hemiplegia after stroke; 10 were spastic paraparesis; 1 was spastic diplegia. Subjective improvement in gait performance was evaluated. Pre- and post-block comparisons were made by objective parameters, including gait speed and sagittal knee kinematics.

Results: Twenty five of all subjects showed subjective improvement in gait performance and significant differences of pre- and postblock gait data after nerve block by 2% lidocaine. Eighteen of 19 patients who had activity of rectus femoris alone at swing phase showed subjective improvement in gait performance and significant differences of pre- and postblock gait data after this procedure. Twenty two of 25 patients with sufficient strength of hip flexor showed the same result as the above. There were no significant differences between the subgroups depending on the degree of the quadriceps spasticity. 5% phenol block for more long-term effect also showed significant increase in knee flexion at swing phase in these 25 patients.

Conclusion: Femoral nerve (motor branch of rectus femoris) block can be a effective treatment modality for stiff-legged gait. Sufficient strength of hip flexor muscle, rectus femoris activity without activities of vastus muscles at swing phase on dynamic EMG are the factors which predict the favorable outcome in this procedure. But, diagnostic block with lidocaine is a mandatory to predict its effect in clinical practice.

Objective: To determine the effect of cold air therapy on relieving spasticity, the optimal intramuscular temperature, and the duration of spasticity relief.

Method: Twenty-three 4 months old Korean white rabbits weighing 2 to 3 kg were used. After posterior laminectomy at thoracolumbar junction, the spinal cord was completely transected. After spasticity occurred, cold air was applied to the triceps surae muscles for 30 minutes at three different intramuscular temperatures (32.5, 30, and 25^oC). Spasticity was measured pre-treatment, immediately following treatment, after 30 minutes, and after 60 minutes. Clinical parameters (muscle tone, deep tendon reflex, ankle clonus, and Babinski's sign) and electrophysiologic parameters (F/M ratio and H/M ratio) were measured.

Result: Muscle tone and Babinski's sign significantly decreased immediately following treatment in the 32.5^oC group, immediately following treatment and after 30 minutes in the 30^oC and 25^oC group. Deep tendon reflex and ankle clonus significantly decreased immediately following treatment in the 32.5^oC group, immdiately following treatment, after 30 minutes in the 30^oC group, immediately following treatment, after 30 minutes and after 60 minutes in the 25^oC group. The F/M ratio and H/M ratio were not significantly affected in the 32.5^oC group but decrease immediately following treatment in the 30^oC and 25^oC groups. Compound motor unit action potentials were not evoked in 6 out of 16 cases (37.5%) in the 25^oC group, resulting in blockage of conduction.

Conclusion: To relieve spasticity with cold air therapy, the intramuscular temperature should be maintained at 30^oC. The duration of spasticity relief lasted from 30 minutes to one hour after cold air therapy.

Objectives: Six cases of tardy ulnar neuropathy caused by cubitus varus deformity are presented. Clinical features and electrodiagnostic study of six cases were analysed to understand the mechanim of nerve palsy and the usefulness of electrodiagnostic study.

Methods: Electrodiagnostic study and elbow flexion test were performed and elbow varus angle, internal rotation angle of shoulder, biceps and brachioradialis muscle activities were measured in 6 patients

Results: Decreased ulnar nerve motor conduction velocities in the elbow segment was shown in 5 patients. Prolonged distal latency and reduced amplitude of ulnar sensory nerve action potentials were shown in one patient. Needle electromyography showed large amplitude motor unit action potentials in ulnar innervated forearm or hand muscles. The mean values of varus angle and internal rotation angle of humerus were 21^o, and 28^o, respectively. Brachioradialis showed relatively higher activity than biceps brachii in the early phase of elbow flexion. Three patients underwent surgery and showed immediate symptom relief.

Conslusion: Tardy ulnar nerve palsy in cubitus varus thought to be caused by internal rotation of distal segment of humerus, stretching of ulnar nerve, snapping of the medial head of triceps on ulnar nerve and anterior transposition and compression of ulnar nerve. The three dimensional corrective osteotomy could be the most efficient treatment to restore the anatomic alignment of the elbow joint.

Objective: We investigated the useful electrodiagnostic indicators and the extent of retrograde degeneration (RD) in carpal tunnel syndrome (CTS).

Method: We measured median mixed nerve action potentials (MMNAP) in 26 CTS and 37 normal hands by recording at the elbow and stimulating 0, 3, 6 and 9 cm proximal to the distal wrist crease. The 3 MMNAP parameters such as amplitude, latency and conduction velocity were compared between CTS and control group. The most useful indicator was compared between subgroups of CTS (mild and severe) and control group.

Results: The amplitudes of all MMNAPs in CTS group, except stimulating 9 cm proximal to the wrist (MA9), were significantly smaller than those in control group (p＜0.05). MA9 in severe CTS subgroup, not mild subgroup, was significantly smaller than that in control group (p＜0.05). CTS and control group were not significantly different in the MMNAP latencies, except stimulating 9 cm proximal to the wrist (p＜0.05), and in the MMNAP conduction velocity, except stimulating in 0 cm to 3 cm segment proximal to the wrist.

Conclusion: The amplitude of MMNAP in forearm can be the most useful indicator of RD in CTS, and the conduction velocity, a less useful indicator. We believe that RD progresses as the severity of CTS increases, and dose beyond 9 cm proximal to the distal wrist crease.

Objective: To determine whether electrophysiologic findings of mild diabetic neuropathy in elderly patients is due to age or diabetic mellitus itself.

Method: Electrophysiologic examination was performed in patients with diabetes mellitus and in normal control subjects over the age of 60. Electrophysiologic results of 55 diabetic neuropathy patients and the normal control subjects were compared.

Results: 1) Effect of age or diabetes mellitus on the electrophysiologic parameters: In normal controls over 60 years of age the motor and sensory parameter demonstrated a significant difference compared to those under 60. In diabetic patients, motor and sensory parameters demonstrated a significant difference compared to the control group.

2) Interaction of age and diabetes mellitus: Concerning the effect of age, significant differences were observed in amplitude in both motor and sensory responses. Regarding the effect of diabetes, significant differences were observed in latency or velocity in the motor and sensory nerves compared to the control group.

Conclusion: Eletrophysiologically, prolonged latency is the result of the diabetic process, whereas decreased amplitude is thought to be due to the effect of age. In diagnosing mild diabetic neuropathy in elderly patients, we should consider the differential effects of age itself and diabetes mellitus.

Objective: To demonstrate a conduction block of the median nerve at the flexor retinaculum (FR) in carpal tunnel syndrome (CTS), comparison of potentials obtained with stimulation of median nerve at the wrist and the palm may be required.

Method: To determine the severity and incidence of conduction block in patients with CTS, seventy hands of neurologically healthy adults (mean age, 48 years) as control, and seventy hands of patients with CTS (mean age, 51 years) were tested. We performed median motor and middle finger recorded antidromic sensory conduction study with stimulation of the wrist and palm of a distance of 5 cm. The negative peak spike duration and baseline to peak amplitude of the compound muscle action potential (CMAP), and sensory nerve action potential (SNAP) with wrist and palm stimulations were measured. From these values, the wrist to palm duration ratio and amplitude ratio were obtained.

Results: The criteria of median motor nerve conduction block were a wrist to palm amplitude ratio of less than 0.7 and a wrist to palm duration ratio of less than 1.13. The criteria of median sensory conduction block were a wrist to palm amplitude ratio of less than 0.61 and a wrist to palm duration ratio of less than 1.33. In the patient group, 10 hands (14.3%) showed motor conduction block and 12 hands (17.1%) showed sensory conduction block and 3 hands (4.3%) showed both. The wrist to palm amplitude ratios of CMAP and SNAP in the patient showing conduction block were 0.6⁑0.1, and 0.4⁑0.2, respectively. There was no correlation between palm CMAP or SNAP amplitude and respective wrist to palm ratios.

Conclusion: Comparison of the amplitude and duration of CMAP or SNAP obtained with stimulation of both wrist and palm may be able to differentiate between conduction block and axonal degeneration. These values may be useful in planning treatment and predicting outcome.

Objective: To determine the reference values for the diagnosis of isolated entrapment neuropathies of medial and lateral plantar nerve and inferior calcaneal nerve distal to the tarsal tunnel.

Method: The subjects were neurologically healthy 30 adults (15 males, 15 females). Distal motor nerve conduction study of medial and lateral plantar nerves and inferior calcaneal nerve was performed. The recording muscles for medial and lateral plantar nerves and inferior calcaneal nerve were flexor hallucis brevis, flexor digiti minimi brevis, and abductor digiti minimi pedis, respectively. The stimulation was done at distal and proximal to the tarsal tunnel to differentiate the tarsal tunnel syndrome and the entrapment neuropathy of distal to the tarsal tunnel. The distance of recording and distal stimulation site was fixed to 10 cm for medial and lateral plantar nerves. The skin temperature was maintained 33^oC or above. The proximal latency, distal latency, peak to peak amplitude, conduction velocity and residual latency were measured. The reference values were obtained by 95 percentile values.

Results: The reference values for the diagnosis of isolated entrapment neuropathies of medial plantar nerve, lateral plantar nerve and inferior calcaneal nerve distal to tarsal tunnel are as follows.

1) Medial plantar nerve: distal latency, ＞ 4.3 msec; side to side difference, ＞ 0.7 msec

2) Lateral plantar nerve: distal latency, ＞ 4.1 msec; side to side difference, ＞ 0.6 msec

3) Latency difference of medial and lateral plantar nerve: ＞ 0.7 msec

4) Inferior calcaneal nerve: distal latency, ＞ 4.3 msec; distal peak latency, ＞ 7.2 msec; side to side difference of distal onset latency, ＞ 1.5 msec; side to side difference of distal peak latency, ＞ 0.8 msec; residual latency, ＞ 3.0 msec

Conclusion: The distal motor nerve conduction method used in this study and the reference values could be used to differentiate entrapment neuropathies of medial and lateral plantar nerve and inferior calcaneal nerve distal to the tarsal tunnel from tarsal tunnel syndrome.

Objective: To find the developing features of H reflex by the gradual increase of stimulation intensity, to evaluate the variability of each H reflex latency, and to verify the consistency of the side-to-side difference of bilateral H reflex latencies in normal population.

Method: Fifty normal persons (100 limbs) were studied. H reflexes were elicited using standardized technique from Braddom and Johnson.

Result: H reflex developed in the stimulation intensity at which M response was not evoked in 46 of total 100 limbs. The latency difference between the longest and shortest in each ipsilateral evoked potential was 0∼2.1 ms (mean 0.65±0.44 ms). In the side-to-side latency difference between the variously evoked H waves, the mean value of maximal one was 1.28±0.63 ms (0.4∼2.6 ms), and the mean value of the minimal one was 0.24±0.35 ms (0∼1.5 ms). The mean side-to-side latency difference between the H waves of maximal amplitudes was 0.69±0.46 ms (0.1∼1.6 ms), and the mean side-to-side difference between the shortest latencies was 0.61±0.53 ms (0∼2.1 ms). Among these findings the latency difference of the maximal amplitude was observed in 47 cases with 0∼1.5 ms, in 3 cases with more than 1.5 ms.

Conclusion: In diagnosing the S1 radiculopathy with the side-to-side latency difference it will be reasonable to use the latency of maximal amplitude or the shortest latency as diagnostic tool, and reevaluation will be needed with the diagnostic criteria of 1.5 ms latency difference.

Objective: To establish the reference values of the sensory conduction for all the digits in the hand, conduction studies were performed using the standard technique.

Method: One hundred hands of fifty neurologically healthy adults with mean age of 45 years (range, 23∼69) were tested. Depending on ages, the 50 adults were devided into three groups: group 1, 20∼45 years old; group 2, 46∼60 years old; group 3, 61∼ years old. Antidromic sensory nerve conduction techniques using a fixed distance were performed. The onset latency and baseline to peak amplitude of the sensory nerve action potentials (SNAPs) were measured. During the test, the skin temperature of the hand was maintained at 34^oC or above. These variables from SNAPs were compared according to age, gender, side, and recording digits.

Results: Comparison of the median and ulnar SNAPs between age groups revealed longer onset latency and smaller amplitude in the elderly group. The amplitude of SNAPs was larger in females than in males and the left side than the right side. Comparison of the latencies and amplitudes between the second and third digits showed no significant difference statistically. Also, the latencies and amplitudes of the median and ulnar nerves recorded from the fourth digits showed no significant difference statistically.

Conclusion: Based on these results, the reference values for sensory conductions from all the digits were obtained. These values would be helpful in evaluation of CTS or unspecified finger pain or upper extremity neuropathy.

Objective: To evaluate the effect of clonidine on the experimental neuropathic pain model and to observe whether neuropathic pain is related to the sympathetic nervous system in this model by reversal of allodynia with administration of epinephrine.

Method: The neuropathic pain was produced by unilateral transection of the superior caudal trunk innervating the rat's tail. Tail withdrawal responses based on mechanical (withdrawal frequency to bending force of von Frey hair 2.0 g) and the thermal (withdrawal latency to tail immersion in a 4^oC or 40^oC water with a cut-off time of 15 seconds) stimuli were used. Experiments were performed two weeks after surgery when neuropathic pain had fully been developed. Experimental group by administration of clonidine was examined by tail withdrawal responses at Day 1, Day 3 and Day 5. After one week of wash-out period, reversal of allodynia by administration of epinephrine was examined by the same test.

Results: Clonidine significantly decreased the frequency of withdrawal with the mechanical stimuli compared with control (P＜0.01), but did not significantly decrease with the cold or warm stimuli. Epinephrine tended to aggravate the mechanical allodynia, but it was not significant compared with the control.

Conclusion: Clonidine may relieve mechanical allodynia in neuropathic pain, but the mechanism of neuropathic pain that is related to the sympathetic nervous system in this experimental model may be unreliable.

Objective: Hyaluronic acid is a naturally occurring glycosaminoglycan which, by virtue of its viscosity, elasticity and other theological properties, acts as lubrication and shock absorbing fluid in joints. In addition to its lubrication and cushioning properties, hyaluronic acid has been associated with in vitro anti-inflammatory activity and possible disease-modifying effect in animals. The purpose of this study was to evaluate the effect of intraarticular injection of hyaluronic acid or steroid on the healing of the experimental degenerative osteoarthritis and the therapeutic synergism between the hyaluronic acid and steroid.

Method: 48 rabbits with experimental osteoarthritis produced by extension immobilization of knees were treated with hyaluronic acid and/or steroid and then assessed clinically, radiologically, scintigraphically and histopathologically at pre and post treatment.

Results: The hyaluronic acid treated group had more favorable results than other groups but the results were not statistically significant. The steroid treated group did not have significant change in comparison to the control group. Therapeutic synergism between hyaluronic acid and steroid was not found.

Conclusions: The results of this study indicate that the intraarticular injection of hyaluronic acid may be effective for the treatment of patients with osteoarthritis.

Objective: To evaluate the efficacy of intraarticular injection of hyaluronic acid and steroid in adhesive capsulitis of shoulder.

Method: Thirty-nine patients with adhesive capsulitis of shoulder were assigned at random to receive intraarticular injection into the glenohumeral joint. The treatment groups were divided into three: group A, triamcinolone 1 ml and 1% lidocaine 3 ml and normal saline 25 ml; group B, hyaluronic acid 2 ml and 1% lidocaine 3 ml and normal saline 25 ml; group C, hyaluronic acid 2 ml and 1% lidocaine 3 ml. The same physical therapy program was carried out for all patients. Pain was assessed by visual analogue scale (VAS) and range of motion (flexion, abduction, internal rotation and external rotation) was measured before injection, and at 30 minutes, 1 week and 2 weeks after injection.

Results: The shoulder range of motion (ROM) and VAS of three groups were all improved at 30 minutes, 1 week and 2 weeks after injection compared with those of preinjection, but there was no significant difference in ROM and VAS among three groups.

Conclusion: We concluded that intraarticular injection of hyaluronic acid would be a good treatment method in adhesive capsulitis of shoulder, specially in patients with risk of steroid use.

Objective: The purpose of this study is to evaluate the effects of the cold air application on the subjective pain threshold of knee joint pain.

Method: We recorded the changes of the pain threshold in 60 patients before and after cold air application who complaint of knee joint pain. Patients were divided into 3 groups randomly with each 20 patients and each group received cold air application for 30 seconds, 1 minute, 3 minutes. Cold air of CRAis (Kyung-won Century, Korea) was applied to the anterior portion of the knee with a temperature of ⁣30^oC. The changes of the pain threshold was estimated by visual analogue scale.

Results: In 30 seconds treating group, VAS score was lowered 2.25±1.16 and 2.26±1.13 immediately after, and 30 minutes after cold air application, respectively (P＜0.05). In 1 minutes treating group, VAS score was lowered 1.65±2.58 and 2.41±2.59 immediately after and 30 minutes after cold air application, respectively (P＜0.05). In 3 minutes treating group, VAS score was lowered 1.94±1.80 and 2.10±2.3 immediately after and 30 minutes after cold air application, respectively (P＜0.05). The VAS score was lowered significantly after cold air application in all groups, but there's no significant correlation between change of VAS score and cold air application time. In group with initial VAS score greater than 5, the VAS score was more decreased after cold air application.

Conclusion: Cold air application for 30 seconds using CRAis machine is useful treatment method for knee joint pain.

Objective: To evaluate the efficacy of epidural injections of hypertonic saline, steroid and local anesthetics in patients with low back pain and sciatica.

Method: Retrospective study of 325 patients with low back pain and sciatica. Group I, 261 patients, were treated with epidural injection of steroid (Depo-medrol^Ⱂ) weekly for 2 weeks and local anesthetics (lidocaine and bupivacaine) daily via epidural catheter. Group II, 64 patients, were treated with epidural injection of hypertonic saline for three successive days and same method of group I via epidural catheter. The efficacy was assessed with Visual Analog Scale (VAS) on the day of pre- and post- (2weeks later) epidural injection.

Results: (1) VAS score changes from pre- to post-epidural injections were from 6.1⁑3.6 to 3.6⁑1.8 (p＜0.05) in Group I and from 6.2⁑1.6 to 2.6⁑1.4 (p＜0.05) in Group II. (2) VAS score decrease of Group II was more than that of Group I (p＜0.05).

Conclusion: Epidural injections of hypertonic saline, steroid and local anesthetics are effective for patients with low back pain and sciatica in the short term, and more effective than that of steroid and local anesthetics, but prospective long-term follow up studies will be necessary in the future.

Objective: The purpose of this study is to evaluate the effects of cold air application on the pressure threshold of myofascial trigger points.

Method: The 60 patients with myofascial trigger points in unilateral infraspinatus muscle were divided into 3 groups with equal number and cold air was applied using CRAis (Kyung-won Century, Korea) for 1, 3 and 5 minutes. We examined the changes of pressure threshold in myofascial trigger points before, immediately after and 30 minutes after cold air application. Also we examined the changes of pressure threshold of contralateral infraspinatus muscles.

Results: 1) The pressure threshold of trigger point in infraspinatus muscle were increased immediately and 30 minutes after the cold air application as assessed by the pressure algometer (p＜0.05).

2) There was no significant correlations in the changes of pressure threshold among 3 groups after the cold air application (p＞0.05).

3) There was no significant correlations among the age, the body mass index and the changes of pressure threshold in myofascial trigger points (p＞0.05).

Conclusion: We conclude that the cold air application is a effective method for treatment of myofascial trigger points.

Objective: The purposes of this study were to observe the radiographic changes of lumbar facet joints by magnetic resonance imaging (MRI) in conservatively and operatively treated groups of patients with herniated intervertebral disc, and to compare the biomechanical effects to lumbar facet joints according to the treatment methods

Method: The patients composed of 20 conservatively treated control group and 40 operatively treated group who had disc herniation at lower lumbar spine. Follow-up MRIs were performed in order to assess the radiographic changes of intervertebral disc and lumbar facet joints, such as disc degeneration, lumbar facet joint angle and tropism in either treatment groups individually.

Results: There are significant increase in lumbar facet joint angle in operatvely treated group at the level of both L4/5, right L5/S1 compared to that of conservately treated group, but the disc degeneration and facet joint tropism were not changed after treatment in both groups. There's no relationship between treatment period and each parameters.

Conclusion: The radiographic biomechanical lumbar facet joint changes on MRI seems to be related to degenerative change of lumbar facet joint in operatively treated group with a lumbar disc herniation. Therefore, careful selection of optimal operation time and criteria would be important.

Objective: To evaluate outcomes of treatment of hallux valgus and its associated foot deformities with shoe and insole modification

Method: We present the short-term follow-up of 32 symptomatic hallux valgus deformities in 20 patients. The patients were all female and 32 to 77 years in age at the time of modification of shoe and insole. Twenty patients were evaluated on an average of 4 weeks following their shoe and insole modification. Hallux valgus angles and first-second intermetatarsal angle were evaluated as well as the range of motion of the first metatarsophalangeal joint and patient's satisfaction. Outcome was measured using changes in visual analogue scale (VAS) on twenty occasions during 4 weeks.

Results: Hallux valgus was commonly associated with the lesser (2nd∼5th) toe deformity (21 cases, 65.5%), pes planus (12 cases, 37.5%), Achilles tightness (12 cases, 37.5%) and great toe pronation (10 cases, 31.5%). The result obtained was highly significant (p＜0.002), suggesting that the shoe and insole modification were as effective in reducing the level of pain due to hallux valgus and its associated foot deformities.

Conclusion: The shoe and insole modification can be an effective treatment of reducing pain of hallux valgus and its associated deformities.

Objective: Aims of this study are to assess the activities of daily living (ADL) for disabled persons in some rural communities using an appropriately developed ADL scale and to analyse the relationship between severity of impairment and ADL score.

Method: ADLs of 98 disabled persons in two myeons of Kyunggido were assessed from May 1996 to August 1997. The newly developed ADL index composed of eight basic ADL (B-ADL) and two instrumental ADL (I-ADL) parameters were used. Impairment defined by the National Reparation Law was divided into a severely disabled group, grades 1 to 6 and a mildly disabled group, graded 7 to 14. Correlations between the impairment grade of each body part and the assessed ADL score were studied.

Results: 1) The most dependent ADL item of ten ADL parameters was performance in the public office (37.8%) and, the most independent ADL item was feeding (98.0%). 2) With severe impairment of the upper or lower limb, all ADL scores except for feeding were significantly low (p＜0.05). In addition, with severe hearing impairment, scores of performance in public office were accessed low (p＜0.05). 3)With severe lower limb impairment, average scores of I-ADL and B-ADL were low (p＜0.05). 4) With severe language impairment, the average I-ADL score was also low (p＜0.05).

Conclusion: The task of performance in the public office was the most difficult ADL item for disabled persons. All ADL parameters except feeding were affected for disabled persons with lower or upper limb impairment. We think this pilot study may be used to develop more appropriate ADL scales for community based rehabilitation in the future.

Objective: To evaluate peripheral hemodynamics using the doppler ultrasound in the diabetic patients.

Method: We measured mean blood flow velocity (MBFV), resistance index (RI), pulsatility index(PI) in the dorsalis pedis artery (DPA), posterior tibial artery (PTA), and radial artery (RA) from 18 normal controls (n=36), 17 diabetes patients without neuropathy (n=34), and 21 diabetes patients with neuropathy (n=42) by use of Angiodine 2 Doppler system operating at 8 MHz frequency.

Results: MBFV of all the examined arteries increased significantly in the diabetes with neuropathy in comparison to controls and the diabetes without neuropathy (p＜0.05). RI and PI of DPA and PTA decreased significantly in the diabetes with neuropathy in comparison to controls and diabetes without neuropathy (p＜0.05). The blood flow velocity profile was changed from triphasic to monophasic pattern in the diabetes with neuropathy in DPA and PTA.

Conclusion: The Doppler ultrasound is considered as a useful tool for screening change of peripheral blood flow in the diabetic patients with neuropathy.

Objective: To determine the correlation between osteoporosis and the related factors through retrospective study.

Method: Data from 1002 patients (834 women and 168 men) were analyzed through medical records [bone mineral density (BMD), age, height (Ht), body weight (BW), body mass index (BMI), and the accompanying conditions]. BMD of lumbar spine (L1-4) and femur (neck, Ward's triangle, trochanter, and shaft) were measured using dual energy x-ray absorptiometry (DEXA) and were correlated with age, Ht, BW, BMI, and accompanying diseases, and fracture incidence.

Results: 1) BMD of lumbar spine and femur neck in women significantly correlated with age and that of lumbar spine in men significantly correlated with BMI, Ht, BW. 2) The accompanying conditions in osteoporosis were diabetes mellitus (5.9%), Cushing syndrome (3.7%), oophorectomy (2.8%), hyperthyroidism (2.6%), and chronic renal failure (1.0%). 3) Fracture sites and their incidences were single spine (4.89%), multiple spine (2.99%), and femur (2.0%). 4) Mean BMD and T-score in fracture group was 0.687±0.16 g/cm², ⁣3.51±1.3 in lumbar spine and 0.578±0.14 g/cm², ⁣2.70±1.1 in femur, respectively.

Conclusion: Osteoporosis is a major public health problem among the elderly, demanding effective strategic approach for prevention and treatment. We concluded that further studies of male osteoporosis are required.

Objective: 1. To determine the difference of scapulohumeral rhythm (SHR) between the affected and unaffected side in hemiplegic patients. 2. To discover the influencing factors on altered scapulohumeral rhythm of affected side in hemiplegic patients.

Method: Fifteen hemiplegic subjects, 18 to 54 years of age, participated in this study.

Subjects were divided into two groups according to muscle tone on the basis of modified Ashworth scale (MAS). Plain X-ray of the shoulders were taken in neutral, 90 degree abduction, and full elevation of the arm in both affected and unaffected side. The arm angle, scapula angle, and glenohumeral angle were recorded for each individual in each of the three positions.

Result: In the unaffected shoulders of hemiplegic patients, the mean values of SHRs from neutral to the 90^o and from neutral to the 180^o were 1：1.82 and 1：2.12, respectively. In the affected shoulders, the mean values of SHRs between 0∼90^o abduction and 0 to full abduction were 1：2.35 and 1：2.25, respectively. The mean value of SHRs from neutral to 90 degree of affected side was significantly decreased than unaffected side in the low tone group and increased in the high tone group (p＜0.05). In addition, the SHRs of hemiplegic shoulders were significantly increased in the high tone group than the low tone group (p＜0.05).

Conclusion: Spasticity tends to result in decreased motion of scapula, which alters the SHR. A glenohumeral-to-scapulothoracic ratio of hemiplegic shoulder could be affected by spasticity and presence of subluxation.

In 1965 Gillespie reported a new syndrome of bilateral aniridia, cerebellar ataxia, and oligophrenia (mental retardation). This new syndrome was named Gillespie syndrome. Since then only 17 cases of Gillespie syndrome have been reported in UK, Brazil, Ireland, Belgium, Australia, and US. A case of Gillespie syndrome was not reported in Korea.

A 4 year-old girl has triad of Gillespie syndrome, which are partial aniridia, cerebellar ataxia and mental retardation. We confirmed this with ophthalmologic examination, brain MRI, and developmental delay. We report the typical manifestation of Gillespie syndrome in a 4 year-old girl with the brief review of literature.

Distortion of vowels in dysarthria associated with amyotrophic lateral sclerosis can be detected at the perceptual, physiological, and acoustical levels of analysis. Sound spectrography was used to analyse the formants of vowels which reflect position and space of articulatory organs. We analyse status and progression of dysarthria in 54 year old women with amyotrophic lateral sclerosis using sound spectrography. Target formant frequencies were measured from select words containing the vowels /a/, /e/, /i/, /o/, /u/. Results revealed that dysarthric patient exhibited smaller vowel space areas and less systematic changes in vowel spaces for pronouncing different vowels in comparison with normal control. Changes of vowel formants in sound spectrographic analysis reflected progression of dysarthric symptom in this patient. We conclude that acoustic analysis of vowels using sound spectrography is a useful tool to visualize and quantitatively analyse the severity and progression of dysarthria due to paralytic articulatory organ.