Objective: To evaluate the effect of computer-assisted cognitive rehabilitation program on cognitive function of the patients with brain injury.

Method: Twenty seven subjects with brain injury (23 males, 4 females) were enrolled and classified into two groups, experimental and control group. There was no significant difference between two groups in age and postonset duration. Control group received conventional rehabiliation therapy including physical and occupational therapy. Experimental group received additional computer- assisted cognitive training using PSS CogRehab software (USA, 1995), 3 times per a week, 30 minutes per session, for 4 weeks. The PSS CogRehab software consisted of foundation, memory, visual spatial and problem solving categories with 45 indivisualized training programs. These

45 programs are arranged according to the degree of difficulty. All patients were assessed their cognitive function using Computerized Neuropsychological Test (Mirae engineering, 1999) before treatment and at 1 month after treatment.

Results: Before the treatment, two groups showed no difference in their cognitive function. After 1 month treatment, the experimental group showed significantly higher performance in forward digit span, forward visual span, auditory continuous performance test and visual controlled continuous performance test than control group (p＜0.05).

Conclusion: Computer-assisted cognitive training would be useful as a additional tool of cognitive rehabilitation in patients with brain injury. (J Korean Acad Rehab Med 2002; 26: 1-8)

Objective: To evaluate the influence of aphasia on the cognitive screening test in stroke patients with unilateral cerebral hemispheric lesions.

Method: We evaluated 51 hemiplegic patients with unilateral cerebral hemispheric lesions using CT or MRI. We divided the subjects into three groups according to the presence of aphasia and motor weakness: right hemiplegic patients with aphasia, right hemiplegic patients without aphasia, and left hemiplegic patients. Functional Independence Measure (FIM), Mini-Mental Status Examination (MMSE) and Neurobehavioral Cognitive Screening (NCSE) Tests were applied in all patients.

Results: No differences were observed in motor FIM scores between three groups. Total FIM and cognitive FIM scores

of the right hemiplegic patients with aphasia were lower than those of the other two groups. MMSE and several sub-items of NCSE (orientation, attention, comprehension, repetition, naming and calculation) showed the same results. But the mean scores of memory, similarity, and judgement items in NCSE were higher in the left hemiplegic patients than the right hemiplegic patients. No differences were observed in the construction score.

Conclusion: All three cognitive screening tests used in this study were remarkably influenced by the ability of the language function of the patients. Lack of adequate items to detect right cerebral hemispheric lesions were also noticed. (J Korean Acad Rehab Med 2002; 26: 9-13)

Objective: To evaluate the colonic motility and nutrients intake in children with spastic cerebral palsy (CP) and to compare the results with those of normal children.

Method: Thirty-eight children with spastic CP were participated in this study. They took the radioopaque markers for 3 successive days. Then, abdominal X-ray was taken on the fourth day. Total and segmental colon transits were estimated by the simplified assessment of a single-film technique by Metcalf et al. The amounts of nutrients intake for 3 days were recorded and nutritional factors were analyzed by ESHA^Ⱂ Food Processor. Then, daily intakes of the nutrients were compared with Recommended Dietary Allowance of the Korean Nutrition Society.

Results: Total and segmental colon transit time were more

than 2 times delayed in children with spastic CP as compared with those of normal controls. Total colon transit time was significantly prolonged in quadriplegic and non-ambulatory children (p＜0.05). On the evaluation of daily nutrients intake, most of nutritional factors were inadequate in children with spastic CP.

Conclusion: The children with spastic CP had the problems in colonic motility and nutritional intake. Also, delayed colon transit time was significantly related with poor mobility. Therefore, early intervention for these problems will be required in spastic CP, especially quadriplegic and non- ambulatory children. (J Korean Acad Rehab Med 2002; 26: 19-25)

Objective: To investigate the prevalence and contributing factor of musculoskeletal pain in preadolescent children.

Method: Four hundreds and four primary school students without history of trauma or serious medical conditions were investigated. Self-reported questionnaire and physical examination were done.

Results: One-week and 1-year overall pain prevalence were 25.9% and 33.7%, respectively. Prevalence of wide spread pain (WSP) was 7.2% and that of myofascial pain syndrome (MPS) was 7.9%. Prevalence of overall pain and MPS was

higher in the 6th grade students than the 4th grade. WSP was more frequent in girls than boys. Joint hypermobility, physical fitness, body mass index and life style including computer use, regular exercise and satisfaction to desk-chair did not affect pain prevalence.

Conclusion: Musculoskeletal pain was common in preadolescent children. Age and sex rather than physical state or life style seem to be the contributing factors to pain prev- alence. (J Korean Acad Rehab Med 2002; 26: 26-31)

Objectives: To provide proper standards of handicapped driver's ability test in Korea and evolve new driving aids.

Method: Thirty-six cervical cord injured persons (C5∼C7) were evaluated with Baltimore Therapeutic Equipment work simulator to which a straight handle was attached. The isotonic torque on a straight handle was measured during forward and backward movement and isometric torque was measured at neutral position. Analysis of variance (ANOVA) was used to compare torque among three groups (C5∼C7).

Results: The forward and backward torque of C7 tetraplegics was significantly higher than that of C6 tetraplegics

(p＜0.05). All of 12 persons with C5 tetraplegia could not pass the test. Only 1 out of 12 persons with C6 tetraplegia and all of 12 persons with C7 tetraplegia could pass the test. But 9 out of 12 persons with C5 tetraplegia and all of 12 persons with C6 tetraplegia could operate brake and accelerator with servo-hand control.

Conclusion: All of the C5 tetraplegics and 92% of the C6 tetraplegics could not pass the handicapped driver's ability test of Korea. Therefore it is necessary to evolve driving aids for the C5 and C6 tetrapleigics and to modify this test. (J Korean Acad Rehab Med 2002; 26: 32-36)

Objective: The purpose of this study is to develop an experimental spinal cord injury spasticity model using rabbits and to evaluate a quantitative spasticity measure.

Method: After an general anesthesia, 19 rabbits out of total 24 rabbits were laminectomized posteriorly and the spinal cords contused with 15 g⁓20 cm weight drop around 11th and 12th thoracic cord. After two weeks, behavioral analysis and clinical measurements of hindlimb spasticity were assessed. After that, rabbits' triceps surae was dissected and the length-tension plot was obtained by stretching it 5 mm, 2 mm/sec. And then the stiffenss of stretch reflex was determined from the length-tension plot. The stiffness of stretch reflex of the five normal control group was measured.

Results: 1) The measure was possible among 15 out of 19 spinal cord injured rabbits. One out of 19 rabbits was died

from urinary infection. Two rabbits was died from intraop-

erative bleeding at 2 weeks. Another one was excluded from the measurement due to joint contracture. 2) All of 15 rabbits showed clinical spasticity of hindlimb in 2 weeks. The spasticity was increased after the 4th day. 3) On the length-tension plot, the stiffness of stretch reflex of 15 rabbits significantly increased more than that of 5 normal group. 4) The total stiffness is correlated with the deep tendon reflex of knee and muscle tone of ankle. The stiffness of stretch reflex is weakly correlated with the deep tendon reflex of knee, digital hyperreflexia and ankle clonus.

Conclusion: The experimental spinal cord injury model and the quantitative spasticity measure method would contribute to measure the effect of the new therapy of spasticity more accurately, and to establish a principle of the new therapy. In addition, the study is expected to contribute to establish pathophysiology of spasticity. (J Korean Acad Rehab Med 2002; 26: 37-45)

Objective: Nerve conduction study of palmar cutaneous branch of median nerve is infrequently evaluated in spite of its importance because of perceived technical difficulties. This study reports the different nerve conduction responses of palmar cutaneous branch of median nerve by change of stimulation site.

Method: Conduction study of palmar cutaneous branch of median nerve was performed in 42 normal individuals stimulated at the site of 7 cm proximal to the recording electrode. Results were compared to those of stimulated at the site of 10 cm proximal to the recording electrode with t-test by SPSS 7.5.

Results: Values of conduction study stimulated at the site of 10 cm proximal to the recording electrode were 2.37⁑0.48 msec (mean⁑SD) for peak latency, 15.67⁑8.31μV for amplitude and 34.52⁑5.97 mA for supramaximal intensity.

Those values stimulated at 7 cm proximal were 1.72⁑0.33 msec for peak latency, 24.48⁑11.41μV for amplitude and 12.82⁑2.18 mA for supramaximal intensity. Amplitude stimulated at the site of 7 cm was significantly larger than that stimulated at the site of 10 cm (p＜0.01). Supramaximal intensity stimulated at the site of 7 cm was significantly smaller than that stimulated at 10 cm (p＜0.01).

Conclusion: The different stimulation site influences on the nerve conduction study of the palmar cutaneous branch of median nerve. Conduction study of palmar cutaneous branch of median nerve with stimulation at 7 cm proximal is a more reliable and convenient method compared to 10 cm proximal in respect of larger amplitude and smaller supramaximal intensity. (J Korean Acad Rehab Med 2002; 26: 46-49)

Objective: To assess the axonopathy and demyelination neuropathy according to the electrophysiologic severity in diabetic neuropathy.

Method: Electrophysiologic data of 246 patients who had been diagnosed with diabetic neuropathy was obtained and classified into suspected, possible, and definite groups by the criteria of our laboratory. Nerve conduction study was performed in the median, ulnar motor and sensory nerves, peroneal and tibial motor nerves, and sural nerve. Statistics were done with the results from the median motor and sensory, tibial motor and sural nerves. According to the severity of diabetic neuropathy, correlation and Chi-square analysis between amplitudes and latencies were performed.

Results: Frequencies of diabetic neuropathy according to

electrophysiologic severity were as follows: 24 cases of suspected, 141 cases of possible, and 81 cases of definite neuropathy. The correlation ratios between amplitude and latency were ⁣0.41∼⁣0.79 (p＜0.05) in the definite group of all the nerves examined, and below 0.3 in the suspected and possible groups. By Chi-square analysis, amplitude reduction was the predominant finding in the suspected and possible groups.

Conclusion: In the early stage of diabetic neuropathy, axonopathy might be the preceding pathogenesis, while with progression of diabetic neuropathy, axonopathy and demyelination may coexist. (J Korean Acad Rehab Med 2002; 26: 50-54)

Objecive: To evaluate the neurophysiological changes after intramuscular botulinum toxin A (BTX-A) injection in normal adults.

Method: Nine subjects were studied by electrophysiological measurements before and after the injections. BTX-A (5 IU, Botox^Ⱂ, Allergen, USA) was injected in the extensor digitorum brevis (EDB) muscles. Thereafter, electrophysiological measurement was followed up during 6 months.

Results: The compound muscle action potential (CMAP) amplitude of injected EDB muscle decreased significantly for 8 weeks, a maximal decrement at 4 weeks after in-

jection. CMAP peak area changes over time were nearly identical to those of CMAP peak amplitudes. The first/fourth amplitude change of CMAP with 3-Hz repetitive nerve stimulation decreased significantly for 8 weeks and the amplitude following post-exercise activation increased significantly after injection. There were no significant changes in F-wave amplitude and latency.

Conclusion: Serial electrophysiological measurements after intramuscular BTX-A injection into EDB provide useful information for the neurophysiological change after injection. (J Korean Acad Rehab Med 2002; 26: 55-60)

Objective: We tried to make real time observation of the ulnar nerve with elbows in an extended and flexed state at 100 degrees.

Method: We examined 58 elbows of 29 healthy volunteers. The participants were symptomless and showed normal conduction across the elbow. The transducer was applied between the line connecting medial epicondyle and olecranon. We measured the distances between the center of nerve, medial epicondyle, olecranon, skin, and investigated the flattening ratio with elbows extended. Afterwards, we repeated the measurement with the elbows flexed at 100 degrees. We classified the position of the nerves into three groups according to the flexed position. We used the Okamoto classification.

Results: The distance between nerve and skin, between nerve and medial epicondyle was 0.57⁑0.11 cm, 0.83⁑0.15 cm, with the elbow extended. But with the elbow flexed, the distance decreased to a value of 0.45⁑0.11 cm, 0.64⁑0.25 cm, respectively. The flattening ratio was 0.52⁑0.13 at extension, and 0.31⁑0.11 at flexion. Subluxation and dislocation of the ulnar nerve were seen in 20.7% and 5.2% respectively. With the elbow flexed, the ulnar nerve moved anteromedially and superficially in the dislocated group.

Conclusion: With the elbow flexed, the ulnar nerve moves superficially and medially, and the flattening ratio is greater when the elbow is extended. (J Korean Acad Rehab Med 2002; 26: 61-66)

Objective: To investigate the relationship between commonly used radiologic parameters and occurrence of low back pain (LBP) through prospective study using pre-employment radiologic examination in high risk workplace.

Method: One hundred and fifty four male workers in high risk workplace were evaluated. Lumbar lordosis, lumbosacral angle, lumbar gravity line and lumbar disc height- related parameters were measured using simple radiologic films of lateral lumbosacral view taken during pre-employment medical check. Relationship between occurrence of LBP during post-employment period with a mean 1.7⁑1.0 years and radiologic parameter was investigated.

Results: Lumbar lordosis, lumbosacral angle and lumbar disc height were not significantly correlated to the occurrence of LBP. Amount of anterior shift of lumbar gravity line did not showed correlation to occurrence of LBP, but subjects with posterior displacement of lumbar gravity line showed significantly low rate of occurrence of LBP.

Conclusion: These results suggest that commonly used radiologic parameters are not so useful to predict occurrence of LBP in high risk workers. The possibile preventive effect of posterior shift of lumbar gravity line seems to be worth further researching. (J Korean Acad Rehab Med 2002; 26: 67-72)

Objective: The goal of this study is to investigate the effect of subacromial bursa injection of hyaluronate in patients with adhesive capsulitis of shoulder.

Method: Fifty nine patients with adhesive capsulitis of shoulder were injected with hyaluronate (Hyruan^Ⱂ, LG chemical) 2.5 ml to subacromial bursa once a week for 5 weeks and randomly selected twenty eight patients among them were injected with Depomedrol^Ⱂ 20 mg only at first week. The effect of hyaluronate injection was evaluated by pain (Visaul analogue scale), night pain, range of motion of shoulder, functional activities of daily living and patient's self satisfaction at preinjection, every week after first injection until 5th week, 8th and 12th week.

Results: Visual analogue scale and night pain were signi-

ficantly decreased at 5th and 12th week compared with preinjection status. The range of motion of shoulder and functional activities of daily living significantly improved at 5th week and 12th week. Eighty eight percent (N=52) of patients reported as a little improved, improved or much improved at 5th week. No significant serious side effect of injection was found until 12th week.

Conclusion: Hyaluronate injection into subacromial bursa decreased pain and improved shoulder range of motion. It also improved functional activities of daily living of patients with adhesive capsulitis. So it is effective and safe for those patients, especially who cannot receive corticosteroid intraarticular injection. (J Korean Acad Rehab Med 2002; 26: 73-80)

Objective: The purpose of this study is to evaluate the effect of visible light therapy for the management of somatic pain.

Method: Subjects consisted of 42 patients with pain and were divided into two groups; control (n=22) and experimental (n=20) groups. Control group received conventional physical therapy only, while experimental group received additional light therapy with blue light (light intensity 4080 lux, wave length 581 nm, distance from lamp 5 cm). Intensity of pain was assessed by visual analogue scale (VAS) and McGill pain questionnaire. Sympathetic skin response was measured to assess the status of autonomic nervous system. VAS and McGill pain questionnaire were administered before treatment and at 1 day, 2 days, 3 days, 1 week, and 2 weeks after treatment. Sympathetic skin response were performed before and 2 weeks after treatment.

Results: 1) In both experimental and control groups, VAS became significantly lower at two weeks after treatment compared to pretreatment scale (p＜0.05). 2) McGill pain questionnaire showed significantly lower scores two weeks after treatment compared to pretreatment score, only in experimental group (p＜0.05). 3) Experimental group showed significantly lower McGill pain questionnaire score than control group at two weeks after treatment (p＜0.05). 4) Latency and amplitude of sympathetic skin response showed no significant difference between experimental and control groups.

Conclusion: Visible light therapy can be used as an effective therapeutic modality for the management of symptomatic pain in combination with conventional physical therapy. (J Korean Acad Rehab Med 2002; 26: 81-85)

Parry-Romberg syndrome is characterized by slowly progressive but self-limited atrophy of the facial subcutaneous fat, which can be followed by wasting of associated skin, cartilage, connective or ocular tissue, muscle and bone. The possible etiologies of Parry-Romberg syndrome are infection, immunological, trauma, sympathetic innervation, hereditary and cranial vascular malformation. The major features of this syndrome, which have been reported previously, are

atrophy of the soft tissues on one side of the face with

hyperpigmentation of the overlying skin and various neurologic findings, including migraine-type headache, trigeminal neuralgia and focal epilepsy. We describe the improvement of functional level related to Parry-Romberg syndrome in a child who presented the unilateral neurologic deficits and epilepsy with intracranial vascular dysplasia after comprehensive rehabilitative management. (J Korean Acad Rehab Med 2002; 26: 90-93)

Multiple system atrophy (MSA) is an idiopathic neurodegenerative disorder involving many neuronal structures. It is a heterogeneous system disorder affecting extrapyramidal, cerebellar and autonomic nervous system. Only a minority of MSA patients are diagnosed before reaching the full blown stage. Its autonomic features like orthostatic hypotension, vocal cord paralysis are directly related to mortality.

Up to now, rehabilitation of MSA patients had been rarely reported. Early, proper diagnosis and comprehensive rehabilitation for their heterogeneous clinical features are important. We experienced 54 year old hemiplegic paient who overlaps MSA. He showed some improvement in ADL and cerebellar symptoms after comprehensive rehabilitation programs. (J Korean Acad Rehab Med 2002; 26: 94-98)

Emery-Dreifuss muscular dystrophy(EDMD) is a very rare, has never reported in Korea, relatively benign muscle disorder caused by defects of emerin.

The clinical triad include 1) early contracture of the elbows, Achilles tendons, and postcervical muscles, 2) progressive weakness and atrophy in a humeroperoneal distribution, and 3) cardiomyopathy characterized by conduction defect. Heart block is a frequent cause of death.

The detection of this disorder is important because insertion of a cardiac pacemaker can be life saving. As emerin was not found in biopsies from patients affected by EDMD and

most mutations in EDMD are null, the immunohistochemical diagnosis can be easily performed by detection the absence of emerin.

We report a 14-year-old boy with slowly progressive scapuloperoneal muscle weakness and atrophy, and contracture of the Achilles tendons, elbows and postcervical muscles. Muscle biopsy showed marked atrophy of myofiber and increased intermysial fibrosis and immunohistochemical study showed emerin deficiency. (J Korean Acad Rehab Med 2002; 26: 99-103)

Intrathecal administration of methotrexate is one of the standard therapies in the acute lymphocytic leukemia (ALL). Spinal puncture and tapping for intrathecal administration of methotrexate is considered as a routine procedure but this procedure carries risks of spinal hematoma in ALL patients. Spinal hematoma after spinal puncture is an uncommon

condition, but it can occur more often in patients with thrombocytopenic or coagulation disorder. We report 4 year-4 month-old boy of ALL with spinal hematoma leading to paraplegia following lumbar puncture for intrathecal methotrexate treatment. (J Korean Acad Rehab Med 2002; 26: 104-107)

Pelizaeus-Merzbacher disease (PMD) is an X-linked recessive disorder characterized by dysmyelination of the central nervous system (CNS) caused by mutations in the proteolipid protein (PLP) gene. PLP is located at Xq22 and its mutation result in abnormal expression or production of PLP, the most abundant protein in CNS myelin. We present a case of PMD in the 7-year-old boy with nystagmus, ataxia, spastic quadriplegia and severe psychomotor delay. His brain MRI revealed totally dysmyelinated white matter

involving entire supratentorial region, atrophic change, and overaccumulation of the iron in both basal ganglia. He also showed soft-tissue contractures of the hip adductors, associated hip dislocations and equinovarus foot deformities due to severe spasticity of lower extremities. Orthopaedic surgery was performed on both hips. Antispastic medication and physical therapy were maintained for reduction of spasticity. We report this case with the review of literatures. (J Korean Acad Rehab Med 2002; 26: 108-112)

Organophosphate is known to damage both the peripheral and central nervous system. We report a case of organophosphate-induced peripheral polyneuropathy with myelopathy. A 46 years old woman who had ingested a large amount of insecticide (organophosphate) was transported to our hospital. Following medical treatment, she was transferred to the Department of Rehabilitation Medicine 1 month later. Upon admission to rehabilitation medicine, the patient was quadriplegic with markedly decreased muscle tone and strength. Electrodiagnostic examination revealed low amplitude of sensory nerve action potential (SNAP), unevokable compound muscle action potential in distal muscles and abnormal spontaneous activities with needle

electromyography, which were compatible with peripheral polyneuropathy. Three months later, motor and sensory function of upper extremities were normalized. The muscle tone of lower extremity increased to Ashworth grade II. Follow-up electrodiagnostic examination revealed normalization of SNAP and disappearance of spontaneous activities, but somatosensory evoked potential which were initially normal, revealed prolonged P40 latencies in the lower extremities. These electrophysiological findings were thought to result from the spinal cord lesion and correlated with clinical findings. We diagnosed the patient as peripheral polyneuropathy with delayed myelopathy induced by organophosphate. (J Korean Acad Rehab Med 2002; 26: 113-116)