Surface Mapping of Motor Points in Biceps Brachii Muscle

OBJECTIVE: To localize the site of motor points within human biceps brachii muscles through surface mapping using electrophysiological method. METHOD: We recorded the compound muscle action potentials of each lattice of the biceps brachii in 40 healthy subjects. Standardized reference lines were made as the following: 1) a horizontal reference line (elbow crease) and 2) a vertical reference line connecting coracoid process and mid-point of the horizontal reference line. The Compound muscle action potentials were mapped in reference to the standardized reference lines. The locations of motor points were mapped to the skin surface, in the ratio to the length of the vertical and the half of the horizontal reference lines. RESULTS: The motor point of the short head of biceps was located at 69.0+/-4.9% distal and 19.1+/-9.5% medial to the mid-point of horizontal reference line. The location of the motor point of the long head of the biceps was 67.3+/-4.3% distal and 21.4+/-8.7% lateral. The motor point of the short head of the biceps was located more medially and distally in the male subjects compared to that in the female (p<0.05). CONCLUSION: This study showed electrophysiological motor points of the biceps brachii muscles through surface mapping. This data might improve the clinical efficacy and the feasibility of motor point targeting, when injecting botulinum neurotoxin in biceps brachii.

Surface Mapping of Motor Points in Biceps Brachii Muscle

OBJECTIVE: To localize the site of motor points within human biceps brachii muscles through surface mapping using electrophysiological method. METHOD: We recorded the compound muscle action potentials of each lattice of the biceps brachii in 40 healthy subjects. Standardized reference lines were made as the following: 1) a horizontal reference line (elbow crease) and 2) a vertical reference line connecting coracoid process and mid-point of the horizontal reference line. The Compound muscle action potentials were mapped in reference to the standardized reference lines. The locations of motor points were mapped to the skin surface, in the ratio to the length of the vertical and the half of the horizontal reference lines. RESULTS: The motor point of the short head of biceps was located at 69.0+/-4.9% distal and 19.1+/-9.5% medial to the mid-point of horizontal reference line. The location of the motor point of the long head of the biceps was 67.3+/-4.3% distal and 21.4+/-8.7% lateral. The motor point of the short head of the biceps was located more medially and distally in the male subjects compared to that in the female (p<0.05). CONCLUSION: This study showed electrophysiological motor points of the biceps brachii muscles through surface mapping. This data might improve the clinical efficacy and the feasibility of motor point targeting, when injecting botulinum neurotoxin in biceps brachii.

Cortisol Awakening Response and Nighttime Salivary Cortisol Levels in Healthy Working Korean Subjects

PURPOSE: Cortisol awakening response (CAR) and nighttime cortisol levels have been used as indices of adrenocortical activity. However, population-based statistical information regarding these indices has not been provided in healthy subjects. This study was carried out to provide basic statistical information regarding these indices. MATERIALS AND METHODS: Cortisol levels were measured in saliva samples collected immediately upon awakening (0 min), 30 min after awakening and in the nighttime on two consecutive days in 133 healthy subjects. RESULTS: We determined the mean [standard deviation (SD)], median (interquartile range) and 5th-95th percentile range for each measure and auxiliary indices for CAR, i.e., the secreted cortisol concentration within 30 min of awakening (CARscc) and absolute and relative increases in cortisol level within 30 min of awakening (CARi and CARi%, respectively). We also determined these values for auxiliary indices derived from nighttime cortisol level, i.e., the ratio of cortisol level 30 min after awakening (CA30 min) to nighttime level (CA30 min/NC), as well as absolute and relative decreases in cortisol levels from CA30 min to nighttime (DCd and DCd%, respectively). We found no significant differences in cortisol level for any time point or in auxiliary indices between collection days, genders and ages. CONCLUSION: The provided descriptive information and statistics on the CAR and nighttime cortisol level will be helpful to medical specialists and researchers involved in hypothalamus-pituitary-adrenal axis assessment.

Salivary Cortisol and DHEA Levels in the Korean Population: Age-Related Differences, Diurnal Rhythm, and Correlations with Serum Levels

PURPOSE: The primary objective of this study was to examine the changes of basal cortisol and DHEA levels present in saliva and serum with age, and to determine the correlation coefficients of steroid concentrations between saliva and serum. The secondary objective was to obtain a standard diurnal rhythm of salivary cortisol and DHEA in the Korean population. MATERIALS AND METHODS: For the first objective, saliva and blood samples were collected between 10 and 11 AM from 359 volunteers ranging from 21 to 69 years old (167 men and 192 women). For the second objective, four saliva samples (post-awakening, 11AM, 4PM, and bedtime) were collected throughout a day from 78 volunteers (42 women and 36 men) ranging from 20 to 40 years old. Cortisol and DHEA levels were measured using a radioimmunoassay (RIA). RESULTS: The morning cortisol and DHEA levels, and the age-related steroid decline patterns were similar in both genders. Serum cortisol levels significantly decreased around forty years of age (p < 0.001, when compared with people in their 20s), and linear regression analysis with age showed a significant declining pattern (slope= -2.29, t= -4.297, p < 0.001). However, salivary cortisol levels did not change significantly with age, but showed a tendency towards decline (slope= -0.0078, t= -0.389, p=0.697). The relative cortisol ratio of serum to saliva was 3.4 - 4.5% and the ratio increased with age (slope=0.051, t=3.61, p < 0.001). DHEA levels also declined with age in saliva (slope= -0.007, t= -3.76, p < 0.001) and serum (slope= -0.197 t= -4.88, p < 0.001). In particular, DHEA levels in saliva and serum did not start to significantly decrease until ages in the 40s, but then decreased significantly further at ages in the 50s (p < 0.001, when compared with the 40s age group) and 60s (p < 0.001, when compared with the 50 age group). The relative DHEA ratio of serum to saliva was similar throughout the ages examined (slop = 0.0016, t = 0.344, p = 0.73). On the other hand, cortisol and DHEA levels in saliva reflected well those in serum (r = 0.59 and 0.86, respectively, p < 0.001). The highest salivary cortisol levels appeared just after awakening (about two fold higher than the 11 AM level), decreased throughout the day, and reached the lowest levels at bedtime (p < 0.001, when compared with PM cortisol levels). The highest salivary DHEA levels also appeared after awakening (about 1.5 fold higher than the 11 AM level) and decreased by 11AM (p < 0.001). DHEA levels did not decrease further until bedtime (p=0.11, when compared with PM DHEA levels). CONCLUSION: This study showed that cortisol and DHEA levels change with age and that the negative slope of DHEA was steeper than that of cortisol in saliva and serum. As the cortisol and DHEA levels in saliva reflected those in serum, the measurement of steroid levels in saliva provide a useful and practical tool to evaluate adrenal functions, which are essential for clinical diagnosis.

Salivary Cortisol and DHEA Levels in the Korean Population: Age-Related Differences, Diurnal Rhythm, and Correlations with Serum Levels

PURPOSE: The primary objective of this study was to examine the changes of basal cortisol and DHEA levels present in saliva and serum with age, and to determine the correlation coefficients of steroid concentrations between saliva and serum. The secondary objective was to obtain a standard diurnal rhythm of salivary cortisol and DHEA in the Korean population. MATERIALS AND METHODS: For the first objective, saliva and blood samples were collected between 10 and 11 AM from 359 volunteers ranging from 21 to 69 years old (167 men and 192 women). For the second objective, four saliva samples (post-awakening, 11AM, 4PM, and bedtime) were collected throughout a day from 78 volunteers (42 women and 36 men) ranging from 20 to 40 years old. Cortisol and DHEA levels were measured using a radioimmunoassay (RIA). RESULTS: The morning cortisol and DHEA levels, and the age-related steroid decline patterns were similar in both genders. Serum cortisol levels significantly decreased around forty years of age (p < 0.001, when compared with people in their 20s), and linear regression analysis with age showed a significant declining pattern (slope= -2.29, t= -4.297, p < 0.001). However, salivary cortisol levels did not change significantly with age, but showed a tendency towards decline (slope= -0.0078, t= -0.389, p=0.697). The relative cortisol ratio of serum to saliva was 3.4 - 4.5% and the ratio increased with age (slope=0.051, t=3.61, p < 0.001). DHEA levels also declined with age in saliva (slope= -0.007, t= -3.76, p < 0.001) and serum (slope= -0.197 t= -4.88, p < 0.001). In particular, DHEA levels in saliva and serum did not start to significantly decrease until ages in the 40s, but then decreased significantly further at ages in the 50s (p < 0.001, when compared with the 40s age group) and 60s (p < 0.001, when compared with the 50 age group). The relative DHEA ratio of serum to saliva was similar throughout the ages examined (slop = 0.0016, t = 0.344, p = 0.73). On the other hand, cortisol and DHEA levels in saliva reflected well those in serum (r = 0.59 and 0.86, respectively, p < 0.001). The highest salivary cortisol levels appeared just after awakening (about two fold higher than the 11 AM level), decreased throughout the day, and reached the lowest levels at bedtime (p < 0.001, when compared with PM cortisol levels). The highest salivary DHEA levels also appeared after awakening (about 1.5 fold higher than the 11 AM level) and decreased by 11AM (p < 0.001). DHEA levels did not decrease further until bedtime (p=0.11, when compared with PM DHEA levels). CONCLUSION: This study showed that cortisol and DHEA levels change with age and that the negative slope of DHEA was steeper than that of cortisol in saliva and serum. As the cortisol and DHEA levels in saliva reflected those in serum, the measurement of steroid levels in saliva provide a useful and practical tool to evaluate adrenal functions, which are essential for clinical diagnosis.

A View on Oriental Medicine

No abstract available.

Current Status of Alternative Medicine

The ultimum goal of eliminating diseases and maintaining normal health is same both in western medicine, oriental medicine and alternative medicine. At the present time, the western medicine tends to take more scientific technological approach in their practice while the oriental medicine still maintain more humanistic approach. 5000 year old traditional medicine still challenges the 21 century scientific modern medicine in the field of clinical practices. The "disease-oriented" western medicine classify the human condition as "diseased and non-diseased" states. In the mean time the "health-oriented" oriental medicine classify it into "healthy and unhealthy" states. For the maintenance of normal health, five principles are emphasized. They are (1) eat right, (2) move right, (3) sleep right, (4) breathe right, and (5) mind right. To reverse an unhealthy condition back to normal healthy state, the methods of (1) natural substance therapy, (2) exercise therapy, and (3) stimulation therapies including acupuncture, moxibustion, finger pressure, and cupping techniques. In order to eliminate the diseases, four distinct approaches namely (1) chemical, (2) physical, (3) psychological, and (4) surgical treatments are utilized. Recent international trend of globalization has brought an information explosion and transcultural exchange of science, technology, arts and medicine. There are so many different kinds f traditional medicine, hidden popular folk medicine, and various less recognized techniques and theories of healing arts. Some are originated in oriental culture while others are originated in western culture. Experts of western medicine claim that only those informations clarified or proven by the objective and scientific methodology can be recognized as a part of western (orthodox or conventional) medicine. All kinds of traditional medicines, folk medicines, and many other fragments of medical techniques and theories are collectively labelled as "alternative medicine or complementary medicine". In western countries, the oriental medicine is included in the alternative medicine, but in Korea the oriental medicine is not included in the alternative medicine since both western medicine and traditional Korean medicine are considered to be the official conventional medicine. There are clear evidence that the western medicine, oriental medicine, and alternative medicine all are complimentary to each other. If and when all the complimentary components existing in various healing arts together in one medicine, a new integrated comprehensive wholistic medicine can be produced.

A Trial of Diagnostic Program Using a Computer for Unilateral Visual Neglect

OBJECTIVE: To confirm the merit of a newly-developed computer system that detects gaze in diagnosing unilateral visual neglect syndrome. METHOD: The subjects were 20 normal adults and 2 left hemiplegic patients with prominent unilateral visual neglect. The 'line bisection' test and the 'star cancellation' test were performed, and their modified forms of tests-the 'center scanning in vacant 2-dimension space' and the 'one object scanning' among 25 different objects were also performed on a table with right hand and on a computer monitor with head motion. RESULTS: Normal subjects didn't show difference in line bisection and center scanning tests. However, center scanning time was shorter in the methods that used a computer. By comparing horizontal shifting in the line bisection test and the center scanning test, the center was more shifted toward left side than in the line bisection test when the tests were performed using a computer. Duration to perform the star cancellation was longer than to perform the one object scanning test. It took 3 minutes for each subject to obtain the results from the line bisection and the center scanning on papers, whereas the results from the tests with a computer were displayed at the moment of marking by the subjects. By the results from the patients, the marked centers were deviated toward right side and longer duration was needed to perform the tests in comparison with normal subjects. CONCLUSION: Visual perception can be changed by dimension even in normal adults, and the program using a computer that was developed in this study has merit especially by shortening the testing time. However, continuous study is needed for practical use of this program in the patients with unilateral neglect.

Unipue Problems in Korea in Usage of Western Medical Instruments by Oriental Medical Practitioners

No abstract available.

The Analysis of Sit-to-Stand Motion in Stroke Patients

OBJECTIVE: The ability to get up from a chair is an important component in maintaining independence and a prerequisite for upright mobility for stroke patients. The purpose of this study was to compare the sit-to-stand movement in stroke patients with that in healthy adult. METHOD: Twenty-three stroke patients and thirty-seven young healthy subjects were included in this study. Subjects sat on an adjustable chair with their feet on force plates and performed the standing up movement at a self-paced, comfortable speed. The study patients were tested barefoot. The changes in joint angle, maximal moment, power, and ground reaction force in lower limb were calculated using 3 dimensional motion analyzer throughout the sit-to-stand transfer. RESULTS: The mean time needed was significantly longer in stroke patients than in young healthy subjects. Pelvic tilting and hip flexion angle at initial and final angle were significantly greater in stroke patients than in young healthy subjects. Maximal momentum, power and change of ground reaction force in ankle joint were significantly lower in stroke patients than in young healthy subjects. Hip external rotation angle at standing point showed significant correlation with maximal hip external rotation and slow walking speed during the comfortable walking. CONCLUSION: We concluded that the analysis of sit-to-stand movement in stroke patients may provide a useful guide for gait recovery and training.

Sleep Apnea Syndrome and Prognosis in Stroke Patients

OBJECTIVE: The purpose of this study was to evaluate the prognostic value of sleep apnea syndrome in stroke patients by polysomnography. METHOD: Fifteen patients with ischemic stroke were studied with polysomnography. Medical history, sleep history, location of stroke, and severity of neurological deficit were recorded. Patients were observed by physician for evidence of snoring and excessive daytime sleepiness. Functional abilities were measured with the use of the Modified Barthel Index (MBI). To evaluate the autonomic nervous system, heart rate variability (HRV) study was done. RESULTS: Mean SaO2 during polysomnography was 88.2%, and mean recording time was 321 minutes. Apnea types were obstructive, mixed, and central. Respiratory Distress Index (RDI) correlated with functional outcome and mean SaO2. HRV study showed no significant changes under the orthostatic stress in apnea patients. CONCLUSION: We concluded that the sleep apnea syndrome could be a prognostic factor in rehabilitation outcome of stroke.

Effect on Diarrhea of Dietary Soluble Fiber Added to Nasogastric Tube-Fed Formulas in Stroke or Traumatic Brain Injury Patients

OBJECTIVE: The purpose of this study was to investigate the effect of dietary soluble fibers added to nasogastric tube-fed formulas and to compare the difference of the degree of diarrhea according to the amount of dietary soluble fibers in stroke or traumatic brain injury patients for comprehensive rehabilitative management. METHOD: Fifty-two stroke or traumatic brain injury patients fed by nasogastric tube due to dysphagia were included. They received fiber-free formulas for the first 30 days and then they were randomly assigned to three groups, including the control (fiber-free) group, moderate fiber (3.5 gm fiber/L) group and high fiber (7 gm fiber/L) group. Each group received their respective formulas for the next 30 days. We compared diarrhea score and frequency. RESULTS: In the control group, the degree of diarrhea was not changed with time. In the moderate and high fiber groups, daily diarrhea score and monthly diarrhea frequency were low compared to the control group (p<0.05). Also, the incidence of pseudomembraneous colitis was low in fiber groups. CONCLUSION: We concluded that adding dietary soluble fibers to nasogastric tube-fed formulas may be helpful to reduce the diarrhea and the development of pseudomembraneous colitis. The proper fiber amount will be determined through the following more case studies.

The Effects of Epidural Steroid Injection in the Management of Low Back Pain

OBJECTIVE: Several kinds of steroids had been used epidurally for the treatment of low back pain, but there were few available medical reports as to the effects of each steroid. The purposes of this study were to evaluate the effects of epidural steroid injections and to investigate the factors affecting the results. METHOD: Forty four backache patients were randomly assigned to one of three groups: Group 1, epidural saline as a control group(n=12); Group 2, epidural triamcinolone and 1% lidocaine(n=13); Group 3, epidural dexamethasone and 1% lidocaine(n=19). The effects of epidural injections were measured by pain self-assessment scale(pain score) and Rubin scale(success rate). RESULTS: The pain scores of steroid groups after one to seven days after the injections were significantly lower than those of the control group(p0.05) between two steroid groups. The overall success rate of the steroid groups was 68.8%. Although there were no statistically significant differences between the steroid groups with respect to sex, age and duration, the younger age group seemed to respond better to the treatment. CONCLUSION: We founded that epidural steroid injection could be a valuable adjunct to the management of low back pain but its effective duration was relatively short. Physicians should keep in mind that comprehensive treatment including rest, medication, physical therapy, exercise and education ought to be provided for the better clinical results.

Assessment of Autonomic Function in Stroke Patients by Power Spectral Analysis of Heart Rate Variability

OBJECTIVE: To evaluate the effects of orthostatic stress with a head-up tilt on the autonomic nervous system and to determine how a cerebral stroke influences the cardiac autonomic function, using the power spectral analysis(PSA) of heart rate variability(HRV). METHOD: We studied 11 stroke patients with a left hemiplegia and 14 patients with a right hemiplegia. Their hemispheric brain lesions were confirmed by the MRI. The ECG and respiration signals were recorded at the tilt angle of 0o and 70o for 5 minutes under the condition of frequency controlled respirtaion(0.25 Hz). Data were compared with the age- and sex-matched 12 healthy controls. RESULT: In a control group, the normalized high frequency power showed a significant decrease during the head-up tilt(p0.05). Compared with the right hemiplegia and control groups, the left hemiplegia group was associated more with a reduced low and high frequency power and showed no significant changes under the orthostatic stress. CONCLUSION: PSA of HRV can identify the reduced cardiac autonomic activity in stroke patients, with a greater reduction in the left hemiplegia group than in the right hemiplegia group, which may cause a high risk of cardiac arrhythmias and sudden death.

Auto-Lock and Motorized Device for the Knee Joint of Long Leg Brace; Development and Performance Test

OBJECTIVE: To develop and evaluate a new orthotic device for the knee to improve the ambulation patterns in paraplegic patients. METHOD: The new orthotic device combined a high torque servo motor with a bail-lock knee joint, and a its wireless controller adopting open-loop control system. The device was tried in a paraplegic volunteer for two months, simultaneously with the conventional long leg brace. RESULTS: The new device could keep the orthotic knee joint exended during the stance phase, and allow the sequential flexion and extension of the joint during the swing phase. The new orthotic device provided both longer step length(p<0.05) and fewer cadence(p<0.05) maintaining the same walking speed. Also, a circumduction during the swing phase reduced, and the posture of the trunk became straighter. The stride time and the double support period became longer(p<0.05), and the magnitude of the shift of pelvic center increased(p<0.05). CONCLUSION: The new orthotic device for the knee was developed and evaluated in a paraplegic volunteers who had failed to use the functional electrical stimulation. The results were satisfactory with a probable lower energy efficiency with the new orthosis. Further study for verification of the results seems to be necessary.

Recent Epidemiologic Trends of Stroke

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.

Shoulder Subluxation in Hemiplegia: Comparison of Therapeutic Effects of Four Different Types of Slings

The purpose of this study is to compare the effectiveness of the Rolyan, hemisling, remodified Bobath, and the newly designed triangular Bobath slings. Sixteen patients with a shoulder subluxation were evaluated by the simple shoulder AP X-rays with and without slings. The hemisling was applied with the elbow flexed at 90 and 120 degrees. The radiologic evaluation for the detection of shoulder subluxation was done by measuring the vertical and horizontal displacement on a plain AP view. The mean value of vertical displacement without a sling application was 5.21 cm which was reduced to 4.30 cm by a triangular Bobath sling application and 4.32 cm by a hemisling application at 120degrees elbow flexion. These two slings significantly corrected the vertical displacement, but other were not. In nine of sixteen patients, the triangular Bobath sling was the best sling for the vertical correction. All slings except a hemisling increased the horizontal displacement even though it was not statistically significant. The triangular Bobath sling improved the discomfort of the axilla better than the remodified Bobath sling. The results support that the triangular Bobath sling was the best among 4 slings for the correction of shoulder subluxation, although a reduction in lateral displacement and an improvement in applicability need to be explored further.

Clinical Value of a New Self Assessment Method of Pain

To evaluate the clinical value of a new self assessment method of pain, so called pain rating score(PRS), we performed the visual analogue scale, verbal rating scale, McGill pain questionnaire, and PRS on 60 patients with complained neuro-musculo-skeletal pain. The results showed that the reliability of PRS was very high. The PRS was a simple, easy, and comprehensive method to assess the pain for its intensity, frequency, duration, and aggravating factors. The PRS was very sensitive for the change of pain. Based on the above results we have concluded that, the new self assessment method of pain, pain rating score(PRS), is a valuable and useful clinical method which is simple, easy to perform and comprehensive.

Assessment of Autonomic Nervous Function in Young Adults by Power Spectral Analysis of Heart Rate Variability

The powers of the low-frequency(LF) and high-frequency(HF) components characterizing heart rate variability (HRV) appear to reflect, in their reciprocal relationship, changes in the state of the sympatho-vagal balance occurring during orthostatic stress with head-up tilt. We studied 24 healthy volunteers (median age, 23.1 years) who were subjected after a rest period to a series of passive head-up tilt steps chosen from the following angles: 0 degree. 15 degrees, 30degrees, 45degrees, 70degrees, and 90degrees under the condition of frequency controlled respiration(0.25Hz) in order to get data of the Korean young adults. During head-up tilt, heart rate and normalized low frequency power(LF(N : 0.05-0.15 Hz) of HRV showed significant increase(p=0.000), but normalized high frequency power(HFN : 0.2-0.3 Hz) and total power showed progressive decrease(p=0.000, p<0.01 respectively). Male showed significantly higher LF(N and lower HFN than female at tilt table angle 0degree(p<0.01). Power spectral analysis of HRV appears to be capable of providing a noninvasive quantitatibve evaluation of graded changes in the state of the sympatho-vagal balance.

Correlation of Visual Perceptual Dysfunction with Brain Lesion in Stroke Patients

Visual perceptual dysfunction in stroke patients causes a failure in activties of daily living and learning. Therefore, the correct diagnosis and remediation of visual perceptual dysfunction are important. Since the mechanism of visual perception is not well studied, it is difficult to treat visual perceptual dysfunction effectively. In this study, we tried to correlate visual perceptual dysfunction with anatomical lesion of brain for the use of visual perceptual training. We assesed the visual perception and the brain lesions of fiftroke patients, with Motor-Free Visual Perception Test(MVPT), and brain computerized tommography respectively. The visual responses of contralateral side of the lesions were diminished. The raw score of MVPT was low in patients with lesions in both parietal and, right temporal lobes. The right parietal lobe lesions correlated with tests for figure-ground and visual closure, and the left parietal lobe lesions with visual processing time. The result suggests that the right parietal lobe has an important role in visual perceptions. The right temporal, and the left parietal lobes as well as the subcortex of both hemisphere also has significant roles in visual perceptions.