OBJECTIVE: We studied the clinical utility of surface electromyography (SEMG) for the assessment of chronic low back pain (CLBP). METHOD: We compared electrical activity from electrodes placed on the 16 lumbar paraspinal areas between 25 CLBP patients and 25 control subjects in static neutral standing posture and dynamic flexion-reextension state. The CLBP patients and the control subjects were matched for age, gender, and body mass index (BMI) to adjust for any confounding effects. We analyzed amplitudes and areas of electrical activity on lumbar paraspinal muscles in neutral standing posture and dynamic flexion-reextension state. RESULTS: In the static neutral posture, there are increased amplitudes of electrical activity in CLBP compared with controls (p<0.01). In the dynamic flexion-reextension state, area ratio of electrical acitivity during the extension state to electrical acitivity during flexion state are significantly decreased in CLBP compared with controls (p<0.01). The presence of lumbar radiculopathy or the severity of LBP is not well correlated with the electrical acitivity on SEMG. The sensitivity and the specificity of SEMG are 72% and 80% respectively. CONCLUSION: These results indicate that SEMG is a useful method for the assessment of CLBP.
Body Mass Index ; Electrodes ; Electromyography* ; Humans ; Low Back Pain* ; Paraspinal Muscles ; Posture ; Radiculopathy ; Sensitivity and Specificity

OBJECTIVE: Multiple factors including age, sex, habituation, refraction, cooperation and technical variables are associated with P100 latency of Visual evoked potential (VEP). So we tried to evaluate the P100 latency of visual evoked potential according to refraction. METHOD: We studied 28 patients (12 males, 16 females) with myopia. Subjects were divided into 3 groups (mild, moderate, severe myopia) according to refraction and we evaluated the results of VEP studies. RESULTS: Mean values of refraction and latency (P100) of naked eyes were -4.27 D, 103.95 msec. and those of corrected eyes (in glasses) were -0.25 D, 100.59 msec. Respectively, in mild, moderate and severe myopia, the each P100 latency of naked eyes were 101.27 msec, 102.59 msec, 107.99 msec and those of corrected eyes were 98.33 msec, 100.58 msec, 102.19 msec respectively (p<0.05). There was significant negative correlation between refraction and P100 latency in myopia. CONCLUSION: Our results suggested that there were significant changes in VEP (P100 latency) according to refraction. In performing the VEP study, we should consider the refraction and visual acuity.
Evoked Potentials, Visual* ; Humans ; Male ; Myopia* ; Visual Acuity

OBJECTIVE: To assess the correlation between the risk categories of diabetic foot screening test by 5.07 Semmes- Weinstein monofilament and the findings of standard nerve conduction studies of upper and lower extremities. METHOD: We studied 74 patients who were consulted to our department to rule out the diabetic neuropathy. We classified the patients to 4 risk groups by foot screening test using 5.07 Sememes-Weinstein monofilament, and performed the standard nerve conduction studies of upper and lower extremities. The risk categories of foot screening tests were compared to the findings of the nerve conduction studies. RESULTS: When the risk category becomes higher, there were more delay in latencies (motor and sensory potentials of median and ulnar nerve, sensory potentials of sural and superficial peroneal nerve, median and peroneal F-wave), slower conduction velocities (median, ulnar, peroneal, posterior tibial nerve) and lower amplitudes (motor and sensory potentials of media and ulnar nerve, peroneal and posterior tibial nerve, sural nerve) (p<0.05). Except for the amplitude of ulnar nerve and the latencies of peroneal and ulnar nerve, there were significant differences in the nerve conduction study data between the risk group 3 and the risk group 0 (p<0.05). CONCLUSION: We confirmed that the risk category of diabetic foot screening test by Semmes-Weinstein monofilament can meaningfully reflect the severity of diabetic neuropathy. We also suggest that it is necessary to pay attention to the nerve conduction study in the patients with history of foot ulcer.
Diabetic Foot* ; Diabetic Neuropathies ; Foot ; Foot Ulcer ; Humans ; Lower Extremity ; Mass Screening* ; Neural Conduction* ; Peroneal Nerve ; Tibial Nerve ; Ulnar Nerve

OBJECTIVE: The comparison of nerve conduction parameters of each laboratory is difficult because those are influenced by many factors. This study was performed to provide comprehensive normative nerve conduction parameters of median nerve by using a meta-analysis. METHOD: We searched MEDLINE between year 1965 to 2000. Among them we selected 7 articles that provided the mean, standard deviation and sample size of median nerve conduction study and estimated the reference value of median nerve conduction parameters using a meta-analysis. RESULTS: The distal latency of median motor nerve was measured at 8 cm proximal to motor point of abductor pollicis brevis and the distal latency of median sensory nerve was measured at 14 cm proximal to interphalangeal joint of 2nd or 3rd finger. Mean of distal onset latency, amplitude, and conduction velocities of median motor nerve were 3.46 msec, 11.12 mV, and 57.10 m/sec, respectively. Mean of onset distal latency, peak distal latency, and amplitude of median sensory nerve conduction study were 2.72 msec, 3.34 msec, and 37.29 mV, respectively. CONCLUSION: Meta-analysis can summarize large quantity of studies and can maximize subject numbers, it can provide reference value approximate to the normal one. So this value can be used in interpretation of the reference value of each laboratories.
Fingers ; Joints ; Median Nerve* ; Neural Conduction ; Reference Values* ; Sample Size

OBJECTIVE: To provide informations on contributing factors analysis for the driving status in spinal cord injured people through basic statistics from an analysis of the survey results. METHOD: The survey was administered to 121 spinal cord injured persons with no evidence of head injury. Subjects were divided to driver group and non-driver group and compared to their general charateristics, neurologic characteristics, status of activity of daily living (ADL). Logistic regression was used to analyze contributing factors for the driving status. RESULTS: Forty-four (36.4%) of 121 respondents were driving and among them male drivers were 35 (79.6%). The average age and the age at the time of injury were lower in the driver group than non-driver group. Among complete lesions, C7 was the highest level who could drive independently. The mean score of ADL was significantly higher in the driver group than non-driver group. The significant factors that affect the driving of spinal cord injured persons were sex, age, age at the time of injury, Frankel type, motor score, jobs after their injury, compensations for their accidents, means of ambulation, sports activities, and ADL status. Especilly significant factors were age at the time of injury, means of ambulation, ADL status. CONCLUSION: We suggested that the driver training should be an essential part of the rehabilitaion program for the spinal cord injured people to maximize their quality of life in the community.
Activities of Daily Living ; Craniocerebral Trauma ; Surveys and Questionnaires ; Humans ; Logistic Models ; Male ; Quality of Life ; Spinal Cord Injuries* ; Spinal Cord* ; Sports ; Walking

OBJECTIVE: To analyze the factors influencing the capacity of cough, the relationships between maximal respiratory pressure, lung compliance, capacity of cough, and assisted cough techniques were evaluated in tetraplegics. METHOD: The vital capacity (VC) in seated and supine position, maximum insufflation capacity (MIC), maximum inspiratory (MIP) and expiratory (MEP) pressure in seated position were measured. Unassisted and assisted peak cough flow (PCF) at two different conditions (a volume assisted method by the mechanical insufflation [PCFmic] and the manual assistance by abdominal compression [MPCF]) were evaluated in 44 tetraplegic patients. RESULTS: The mean value of VC in supine was greater than that of seated position (p<0.01). The MICs of the subjects were significantly higher than VCs in a same position (<0.01). Both volume and manual assisted method showed significantly higher PCF than unassisted PCF (p<0.01). MIP (r=0.53) correlated with UPCF as well as MEP (r=0.68), although MEP was better correlated with UPCF. CONCLUSION: Generally the therapists apply manual pressure only to increase capacity of cough, which assist the expulsive phase. The results of this study showed that both inspiratory and expulsive phases should be assisted to enhance the effectiveness of cough.
Compliance* ; Cough* ; Humans ; Insufflation ; Lung Compliance ; Respiratory Muscles* ; Supine Position ; Vital Capacity

OBJECTIVE: To evaluate the effectiveness of local intramuscular botulinum toxin type A injection in patients with congenital muscular torticollis. METHOD: Six patients (mean age, 13.3 months) with congenital muscular torticollis who did not respond to physical therapy were participated with the informed consent of their parents. Twenty-five to fifty Speywood units of Dysport (Beaufour Ipsen, France) were injected into the palpated mass of the sternocleidomastoid muscle. The angle of tilt and range of motion of the neck in sitting position were obtained before and after injection. The size of the mass within the sternocleidomastoid muscle was measured with ultrasonogram. RESULTS: Satisfactory improvement of 3 parameters at post- injection 6-month follow-up was achieved in all patients. The tilting angle and range of motion of the neck to rotation were normalized in 5 patients. The size of the mass within the sternocleidomastoid muscle was decreased significantly with ultrasonographic evaluation. CONCLUSION: Local intramuscular BTA injection might be effective for patients with congenital muscular torticollis who do not respond to conservative management.
Botulinum Toxins* ; Botulinum Toxins, Type A* ; Follow-Up Studies ; Humans ; Informed Consent ; Neck ; Parents ; Range of Motion, Articular ; Torticollis* ; Ultrasonography

OBJECTIVE: To reveal basic mechanism regarding the swallowing difficulty in stroke and inflammatory myopathy patients, and to compare this with normal persons. METHOD: Five volunteers without any swallowing problems, three inflammatory myopathy patients and five stroke patients with swallowing difficulty and a similar movement of the hyoid bone were included in this study. Videofluoroscopic swallowing studies were performed in all subjects, and their videofluoroscopic motions were analyzed through 2-dimensional motion analysis using the APAS (Ariel Performance Analysis System). RESULTS: The motions of the hyoid bone and the epiglottis of the inflammatory myopathy patients were much smaller than those of the volunteers but their pattern was similar to the volunteers. Although the difference in the displacement of the hyoid bone and epiglottis between the stroke patients and volunteers was low, the movement pattern between them was different. During an excursion of the hyoid bone, there was an interruption in its motion, which may be due to the spasticity of the cricopharyngeal muscle. CONCLUSION: In inflammatory myopathy patients, the cause of the dysphagia is a weakness of the swallow-related muscles but in stroke patients, spasticity of the upper esophageal constrictor muscle, i.e. the cricopharyngeal muscle, may be another cause. Relieving the spasticity of the cricopharyngeal muscle as well as strengthening of the swallow-related muscles should be considered when treating stroke patients with dysphagia.
Deglutition Disorders* ; Deglutition* ; Epiglottis ; Humans ; Hyoid Bone ; Muscle Spasticity ; Muscles ; Myositis ; Stroke ; Volunteers

OBJECTIVE: To evaluate the benefits of cold and warm stress Digital Infrared Thermographic Imaging (DITI) for detecting Reflex Sympathetic Dystrophy (RSD) in stroke patients compared with conventional non-stress DITI. METHOD: Twenty-three stroke subjects with clinical RSD and fifteen stroke subjects without RSD underwent stress and non-stress DITI. Stress DITI study was performed by continuously imaging both hand dorsum for 30 minutes while immersing an sound side lower limb in cold and warm water bath. The cold and warm water bath were kept at 12.0+/-1.4degrees C and at 37.0+/-1.4degrees C respectively. RESULTS: The sensitivity and specificity of conventional non- stress DITI were 82.6% and 80.0% when side to side temperature difference was more than 1degree C. The sensitivity and specificity of cold stress DITI test were improved to 95.7% and 93.3%, those of warm stress DITI test to 86.9% and 86.7%. CONCLUSION: This study indicates that cold stress DITI study may be helpful method in identifying the RSD, which is not detected by conventional non-stress DITI test.
Baths ; Hand ; Humans ; Lower Extremity ; Reflex Sympathetic Dystrophy* ; Reflex* ; Sensitivity and Specificity ; Stroke* ; Thermography ; Water

OBJECTIVE: To assess the frequency of traumatic basal ganglia hemorrhage (TBGH) and its functional recovery in traumatic brain injury (TBI). METHOD: Three hundred two patients with TBI were retrospectively analyzed via the medical records and radiologic findings. The subjects were divided into 4 groups according to the brain lesions: extraaxial lesion (subdural hemorrhage, epidural hemorrhage, subarachnoid hemorrhage), intraaxial lesion (diffuse axonal injury, white matter hemorrhage, gray matter hemorrhage), mixed lesion, and TBGH. Statistical comparison of cause, severity and prognosis between groups. RESULTS: Mean age was 41.6 years old. The most common lesion of TBI was extraaxial lesion. The most common cause was falls (47.5%). The incidence of TBGH group was 4.7%. Although TBGH group was of longer duration of hospital stay and lower GCS than the other brain lesions, there was no significant difference in GOS score. TBGH with extraaxial or mixed lesion was of lower GCS and GOS score compared with TBGH itself or TBGH with intraaxial lesion. CONCLUSION: The associated cerebral lesion, but not TBGH itself, could be considered to be an important factor in determining severity and recovery of TBI.
Axons ; Basal Ganglia Hemorrhage* ; Basal Ganglia* ; Brain ; Brain Injuries* ; Hemorrhage ; Humans ; Incidence ; Length of Stay ; Medical Records ; Prognosis* ; Retrospective Studies ; Subarachnoid Hemorrhage