Objective: To know the usefulness of the Modified Mini- Mental State Exam (3MS) as a screening test of cognitive function after stroke and the relationship between the 3MS with clock drawing task (CDT) and the 3MS with visual scan task (VST) in view of visual neglect and functional outcome.

Method: We studied 17 patients with unilateral hemisphere stroke [7 right hemisphere stroke (RHS), 10 left hemisphere stroke (LHS)] who have a mean age of 59.4 years and a mean hospital stay of 34.3 days on final examination. None of them had the previous history of mental illness or the previous stroke attack. We performed the MMSE, 3MS, VST and CDT at the first week of onset of stroke and at discharge.

Results: 1) 3MS was a valuable screening test of cognitive function like MMSE (p＜0.05) in both RHS and LHS groups. 2) VST was a valuable screening method of unilateral neglect in patients with normal 3MS (p＜0.05). 3) CDT was also valuable screening method of unilateral neglect in patients with normal 3MS (p＜0.05). 4) 3MS with CDT showed no significant correlation with FIM score (p＞0.05).

Conclusion: We think that 3MS is a valuable screening test of cognitive function after stroke. VST and CDTs are valuable screening tools in estimating unilateral neglect after stroke. But 3MS with CDT is not well correlated with functional outcome. (J Korean Acad Rehab Med 2002; 26: 237-242)

Objective: This study was to investigate the relationship between genotype of Apolipoprotein E (Apo E) and severity of disability after brain injury as well as serum lipid profile.

Method: One hundred thirty-five brain injured patients (mean age 54.6⁑16.7 years, 90 male and 45 female) were enrolled. There were 34 patients with ischemic Stroke, 61 hemorrhagic stroke, and 40 traumatic brain injury. Apo E genotype was determined by polymerase chain reaction and polyacrylamide gel electrophoresis. The serum concentrations of total cholesterol, triglyceride, and HDL-cholesterol were measured. The outcome of brain injury was assessed by functional independence measure (FIM) scores.

Results: Most frequent Apo E genotype was E 3/3 (72%). In hemorrhagic stroke patients with ε4 allele, FIM score at admission was significantly lower than that of the patients without ε4 allele (p＜0.05). In traumatic brain injury patients with ε4 allele, FIM score change was significantly smaller than that of patients without ε4 allele (p＜0.05). The level of total serum cholesterol was lower in the ischemic stroke patients who have ε2 allele in comparison with the patients without that allele.

Conclusion: The presence of ε4 allele is considered to have relationship with the severity of disability and functional outcome in the patients with brain injury. (J Korean Acad Rehab Med 2002; 26: 243-248)

Objective: The objective of this study is to assess whether the patients with dysphagia, who must take fluid thickener and dysphagia diet, have adequate fluid and calory intake.

Method: Fifteen patients with dysphagia were participated in this study. In all of them, dysphagia was documented by videofluoroscopy and viscosity modification was recommended. The amount of fluid and calory intake was measured for 3 consecutive days during taking thickened fluid and dysphagia diet. serum sodium, blood urea nitrogen (BUN) and creatinine (Cr) level were measured.

Results: Fourteen of 15 patients with dysphagia took adequate fluid and calory. In thirteen of 14 patients, BUN/Cr ratio and serum sodium were within normal limit. In one of 14 patients, BUN/Cr ratio was elevated due to excessive protein intake. One of 15 patients with dysphagia took the fluid and calory under the standard. Her BUN/Cr ratio was 27.2. But this patient took more fluid and nutrition day after day. At 3rd day after measurement, she took adequate fluid and calory.

Conclusion: Sufficient fluid and calory could be supplied with fluid thickener and dysphagia diet. But physician should observe carefully whether dysphagic patient consume adequate amount of fluid and calory. (J Korean Acad Rehab Med 2002; 26: 249-253)

Objective: To investigate the status and basic demand of community based stroke-disabled for rehabilitation program development in an urban area.

Method: The subjects were 46 residencial stroke disabled over 6 months after disease onset. Two teams (composed of one physiatrist and one nurse, respectively) visited patient's home, and evaluated physical and functional status and surveyed for the status and basic demand of community based rehabilitation.

Results: Forty two patients (91.3%) received primary medical care after onset of the stroke, and twenty two patients (47.8%) received rehabilitation therapy. The most common reason for not having received rehabilitation therapy was poor economic state. University hospital was the most common place of their rehabilitative management. Mean score of Modified Barthel Index (MBI) was 60.7. Mean score of Craig Handicap Assessment and Reporting Technique (CHART) was 223 and economic self-sufficiency scale presented the lowest score as 6.5⁑4.6. The desire of patients for rehabilitation and welfare service was rehabilitation management and the desire of subjects for the government and society was warrant for livelihood.

Conclusion: We concluded that rehabilitation program utilizing common resource such as areal university rehabilitation team and facilities of community health center should be developed. (J Korean Acad Rehab Med 2002; 26: 254-267)

Objective: The purpose of this study was to determine the ability of Mini Mental Status Examination (MMSE) and Motor Free Visual Perception Test (MVPT) to predict driving outcome in subject with brain damage.

Method: Fifteen brain damaged subjects were administered for this study. Fourteen subjects had brain damage due to stroke and only one subject had traumatic brain injury. All subjects were evaluated with MMSE and MVPT. We used total score for each tests. Subjects were also evaluated in driving simulator that measured their operational responses to filmed driving situation. Correlation between neuropsy-chological tests score and driving simulator score were analyzed.

Results: 1) By average score, MMSE score was 26.6 and MVPT score was 23.7. Driving simulator score was average 30.1. 2) There was good correlation between MVPT score and driving simulator score (r=0.675, p＜0.01). 3) There were no correlation between MMSE and driving simulator score nor between MMSE and MVPT score.

Conclusion: MVPT can be used as screening test for identifying person who are not ready to drive after getting brain damage. (J Korean Acad Rehab Med 2002; 26: 268-272)

Objective: This study was designed to evaluate the correlation of periventricular leukomalacia (PVL) on brain MRI and Denver II and Capute developmental test.

Method: Thirty children with PVL on brain MRI showing delayed development were included. The severity of PVL was graded as localized/generalized lesion in three fields; periventricular hyperintensity in T2 weighted image (PVHI in T2WI), reduced volume of cerebral white matter (RV of CWM), ventriculomegaly with periventricular wall irregularity (VM with PVWI). Development quotients were obtained by Denver II and Capute test, and assessed according to the severity of PVL.

Results: Although language, fine motor-adaptive, personal- social scale of Denver II and cognitive-adaptive and clinical linguistic and auditory milestone of Capute test had little correlation with severity of PVL, gross motor developmental scale assessed by Denver II had a certain degree of correlation with severity of PVL which was not significant statistically. The gross motor developmental scale of the nineteen preterm births had a significant correlation with VM with PVWI, but the other developmental scales still had no significant correlation with PVL.

Conclusion: As for the children with delayed development the degree of motor development was a significant predictor of the PVL on brain MRI, but those of language and cognitive development were not. (J Korean Acad Rehab Med 2002; 26: 273-278)

Objective: To determine the effective and safe dose of Dysport^Ⱂ (one of the commercial botulinum toxins) for relieving the spasticity of calf muscle in cerebral palsy.

Method: Twenty spastic cerebral palsy children (34 limbs) were randomly assigned to a high dose (HD; 16 Unit/ kg/limb) injection group and low dose (LD; 8 Unit/kg/limb) injection group. Locomotor rating scale (LRS) and parameters of 3 dimensional gait analysis including ankle dorsiflexion angle at stance phase (MADA), maximal dynamic gastrocnemius (MDGL) and soleus length (MDSL) were assessed before, 4 weeks after, and 12 weeks after injection.

Results: Mean LRS, MADAs, MDGLs and MDSLs were significantly increased both 4 and 12 weeks after injection in HD group. In LD group, LRS, MADAs, MDGLs and MDSLs showed some improvement but they were statistically insignificant. The high dose had no adverse effect except the mild and transient weakness, which was tolerable to the cerebral palsy patients.

Conclusion: The present study demonstrated the high dose injection of Dysport^Ⱂ was more effective than the low dose injection to relieve the spasticity of calf muscle in cerebral palsy. (J Korean Acad Rehab Med 2002; 26: 279-284)

Objective: The aim of this study was to identify factors influencing the degree of neurological injury, show the natural course of recovery, and evaluate the relationship between degree of neurological injury and functional recovery from traumatic central cord syndrome.

Method: We reviewed 15 patients retrospectively and investigated their demographic and treatment data. Initial ASIA motor scales and functional recovery at 4 weeks and 8 weeks after injury were analyzed.

Results: The age of patients showed significant correlation with degree of neurological injury (r=⁣0.55145, p＜0.05) while mechanism of injury, surgical intervention and gender difference showed no correlation. Only 2 patients (13.3%) ambulated independently at initial period but subsequently 13 patients (86.7%) at 8 weeks. The number of patients who independently voided increased from 2 (13.3%) to 11 (73.3%) during the 8 weeks. Early ASIA motor score differed significantly according to the degree of functional recovery of bladder and ambulation in 4 weeks, 8 weeks after injury (p＜0.05).

Conclusion: Only the age of patients related to the initial neurologic severity. Most patients regained their bladder and ambulatory functions considerably within 8 weeks, and the degree of early neurological injury by ASIA motor scale reflected the degree of functional recovery in 4 and 8 weeks after injury. (J Korean Acad Rehab Med 2002; 26: 285-291)

Objective: The aims of this study is to determine the influence of the imbalance between sympathetic and parasympathetic nervous input to colon transit control in spinal cord injured patients and the effect of the anticholinergic medication for neurogenic bladder on colon transit time.

Method: Eighty-six patients with cervical and thoracic cord injury were enrolled. The colon transit time (CTT) according to the severity and lesion of injury and also the administration routes of oxybutynin were compared by independent t-test.

Results: Total CTT was 56.7 hours, with right CTT 16.9 hours, left CTT 21.3 hours and rectosigmoid CTT 18.5 hours. The rectosigmoid CTT of the patients with the lesion at T6 or below were prolonged than that of the patients with the lesion above T6 (p＜0.05). According to administration route of oxybutynin, instillation group showed more shortened rectosigmoid CTT than oral route group (p＜0.05).

Conclusion: The imbalance between parasympathetic and sympathetic outflow from the spinal cord has play an important role in colon transit control of spinal cord injured patients. The management of neurogenic bowel and bladder considering colon transit time is needed for the effective management of spinal cord injured patients. (J Korean Acad Rehab Med 2002; 26: 292-298)

Objective: To evaluate the effectiveness of conservative treatment for the vesicoureteral reflux (VUR) in spinal cord injured patients.

Method: Twelve spinal cord injured patients were diagnosed as VUR which was graded as the International Classification System by voiding cystourethrography (VCUG). They received conservative treatment including clean intermittent catheterization, administration of anticholinergics and intravesical oxybutynin instillation therapy. Pre-treatment urodynamic studies and VCUG were compared with follow-up studies after conservative treatment. The results of follow-up VCUG were graded as controlled or remained group.

Results: After conservative treatment, VUR was controlled in 8 patients (67.0%) and remained in 4 patients (33.0%). On urodynamic studies after conservative treatment, mean maximal bladder capacity increased from 225.0 to 370.6 ml (p＜0.05), mean bladder compliance increased from 12.1 to 31.5 ml/cmH₂O (p＜0.05), mean maximal detrusor pressure decreased from 63.8 to 21.8 cmH₂O (p＜0.05) in controlled group. But in remained group, there was no significant difference between pre & post-treatment. There was singnificant difference in change ratio of maximal detrusor pressure between two groups (p＜0.05).

Conclusion: This study showed 67.0% controlled rate of VUR by VCUG with improved urodynamic parameters after conservative treatment. We conclude that VUR can be effectively managed by the conservative method in spinal cord injured patients. (J Korean Acad Rehab Med 2002; 26: 299-305)

Objective: To evaluate the effect of oral sildenafil citrate (Viagra^Ⱂ) on erectile dysfunction following spinal cord injury.

Method: Seventy nine male patients with erectile dysfunction after spinal cord injury, who were free from contraindications, received 50 mg of sildenafil. Visual-analogue erection scale (VAES) was used to evaluate the rigidity of penis before and after the medication. In addition, the duration of erection and side effects of sildenafil were evaluated.

Results: Mean VAES score showed a statistically significant increase after the medication from 5.6 to 7.5 (p=0.000). The mean duration of erection also increased from 3.4 minutes to 27.1 minutes after medication (p=0.000). Sixty seven patients (84.8%) reported improved erection with 50 mg of sildenafil and sixty one patients (77.2%) reported rigid erection enough for sexual intercourse. Ten patients (12.7%) reported side effects: facial flushing (3), dizziness (2), headache (2), chest pain (2), and palpitation (1).

Conclusion: This study demonstrated that sildenafil is an effective medication in treating erectile dysfunction after spinal cord injury. (J Korean Acad Rehab Med 2002; 26: 306-310)

Objective: To evaluate safely the driving ability of the handicapped with developed driving simulator in the virtual environment and to investigate clinical usefulness.

Method: A real car was remodeled for realism and equipped it with hand control device for driving of the handicapped. The subjects were 10 normal people with driving license and 15 patients with thoracic or lumbar spinal cord injury who had driving experience. 5 driving skills were measured (average speed, steering stability, centerline violation, traffic signal violation, and time taken in driving) in various road conditions. The normal participants manipulated the gas pedal and the brake by their foot while the patients did with their hands. After they finished to drive the whole course, they answered the questions ("How realistic the driving simulator seems to you" and "How much your fear reduced")

Results: 1) Four driving skills measured between two groups (normal vs. handicapped) were not significantly different (p＞0.05). 2) In 4 kinds (start road, speed limit road, sharp curve road and left turn) of the road conditions, the average speed of the patients group was significantly different from the normal group (p＜0.05). 3) Eleven patients (73%) reported that their driving fear was reduced and the score of "how realistic" question was 51.5% in average.

Conclusion: This developed driving simulator will be able to be used for one of the programs for evaluating and training the driving skill of the handicapped and need to enhance the reality of driving simulator. (J Korean Acad Rehab Med 2002; 26: 311-315)

Objective: To determine whether there is a difference in nerve conduction studies depend on the body mass index (BMI) of subjects

Method: Twenty normal healthy volunteers were enrolled for the study. A routine usual sensory and motor nerve conduction study and a sensory nerve conduction study using the near nerve needle technique were performed. BMI was calculated as weight (kg) divided by height (m) squared. In order to evaluate the effect of BMI on the various measurements of the nerve conduction study, one-way analysis of variance (ANOVA) was used.

Results: The sensory nerve amplitudes of median, ulnar and sural nerves correlated significantly (p＜0.05) with BMI. However, no correlation was noted between BMI and sensory nerve amplitude by near nerve needle technique. There was no statistical differences noted in the measurements of latency of examined motor and sensory nerves neither the velocity of examined motor nerves.

Conclusion: In clinical practice, the effect of BMI should be taken into account when the interpretation of abnormal sensory nerve study has to be soli. (J Korean Acad Rehab Med 2002; 26: 316-320)

Objective: To find useful parameters in biomechanical assessment of spasticity.

Method: Knee extensor muscles of 60 limbs of 47 patients which showed clinical spasticity were stretched by isokinetic dynamometer. Stretch was done with the velocities of 60^o/sec, 120^o/sec, 180^o/sec, 240^o/sec. Four parameters [torque onset angle (TOA), peak torque angle (PTA), peak eccentric torque (PET), peak eccentric torque area (PETA)] were measured at each stretch velocity. Then, regression analysis was performed in relationship between each parameter and strech velocity. We analysed the correlation between the slope of each parameter in regression equation and clinical Modified Ashworth Scale (MAS).

Results: The slope of TOA and PTA had negative value so that they showed the decreasing trend of their value according to increasing velocity. On the other hand the slope of PET and PETA had positive value which meant that those parameters increased according to increasing velocity. The slope of PET and PETA were correlated statistically. The higher the MAS score was, the larger value of slope of PET, PTEA were noted.

Conclusion: Peak eccentric torque and Peak eccentric torque area are thought to be useful parameters in biomechanical assessment of spasticity. (J Korean Acad Rehab Med 2002; 26: 321-326)

Objective: To examine the relation of shoulder adhesive capsulitis and local bone loss to affected limb.

Method: Twenty-nine patients with the adhesive capsulitis of the shoulder were studied. For reference, 29 patients, without history of injury or disease in the upper limbs, were randomly selected. Areal bone mineral density (BMD) was measured from the proximal humerus, distal humerus and forearm of upper limbs using a Prodigy^Ⱂ (Lunar, USA). The BMD of the affected side versus the unaffected were compared.

Results: The reference group: no significant difference between the mean BMDs in the right and left upper limb. The adhesive capsulitis group: 1) The mean BMD in the proxi-mal humerus of the affected upper limb was significantly lower than the unaffected limb (0.85 g/cm² vs 0.88 g/cm²; p＜0.05). 2) No significant difference between the mean BMDs in the distal humerus of the affected and unaffected limb (1.10 g/cm² vs 1.10 g/cm²). 3) No significant difference between the mean BMDs in the forearm of the affected and unaffected limb (0.82 g/cm² vs 0.82 g/cm²).

Conclusion: In patients with adhesive capsulitis of the shoulder, the mean BMD of the affected limb, compared with the unaffected side, was significantly lower in the proximal humerus. But distal humerus and forearm showed no significant side-to-side differences. (J Korean Acad Rehab Med 2002; 26: 327-331)

Objective: The purpose of this study was to evaluate the effects of the prolotherapy on the healing of the tendon tissue and the proliferation of fibroblasts in the injured Achilles tendons.

Method: The tendons of twenty eight Sprague-Dawley rats were transected at 2 mm above the calcaneal insertion in the right Achilles tendon and sutured. Then they were allocated randomly into two groups: prolotherapy group and control group. We injected 20% dextrose 0.1 ml on injured tendon area of prolotherapy group immediately after transection. After 2 and 4 weeks, the diameters of tendons were measured on both the injured and uninjured tendon. The number of fibroblasts and the ratio of fibroblast to fibrocyte on the injured tendon tissues were measured by the image analyzer.

Results: The diameters of the injured tendons of the prolotherapy group were not significantly different with that of the control group. However, the number of fibroblasts and the ratio of fibroblast to fibrocyte in the prolotherapy group showed significantly larger and more increased than the control group (p＜0.05).

Conclusion: This result showed the additional regeneration effect of the prolotherapy on the healing of the injured tendon tissue. Therefore, the prolotherapy would be an effective treatment on the tendon injury. (J Korean Acad Rehab Med 2002; 26: 332-336)

Objective: To investigate the diagnostic validity of doppler ultrasonography (US) and impedance plethysmography (IPG) using photoplethysmography for evaluation of varicose vein of the lower extremities.

Method: One hundred sixty-six limbs in 83 consecutive patients with varicose vein were included. Venous reflux and deep venous lesions were assessed by doppler US. Venous filling time was evaluated using IPG. Diagnostic capabilities of two methods were analyzed using Receiver Operating Characteristic (ROC) curve.

Results: Doppler US identified superficial venous reflux in sixty-nine of 119 limbs with varicose vein and no abnormalities in 34 of 47 normal limbs (sensitivity, 58%; specifi-city, 75%). IPG demonstrated superficial venous insufficiency in 75 of the affected limbs and normal refill time in 38 of the normal limbs (sensitivity, 63%; specificity, 81%). Sensitivity was increased to 82% when both tests were used together. Area under the ROC curve was 0.66 in doppler US, 0.72 in IPG, and 0.76 in both tests. Deep venous lesion was found in 31 limbs using the both tests; 15 limbs with doppler US and 18 limbs with IPG.

Conclusion: IPG was more superior to doppler US in diagnosing venous insufficiency. The combination of both tests provided more accurate diagnostic information in assessing venous valvular function. (J Korean Acad Rehab Med 2002; 26: 337-341)

Objective: The purpose of this study was to examine the changes of cardiopulmonary response and serum lipid level after backward walking training in healthy male college students.

Method: Subjects were ten healthy male college students. Maximal heart rate and VO_2max were determined for each subject by administering a Bruce treadmill exercise test after backward walking training during eight weeks. Wilcoxon signed rank test was used to evaluate the changes of the backward walk training.

Results: The study showed that maximal heart rates were 163.7 beat/min in pre-training and 175.8 beats/min in post- training; in contrast, resting heart rates were 72 beat/min in pre-training and 67 beat/min in post-training. The maximal oxygen consumptions were 2111 ml/min in pre-training and 2521 ml/min in post-training. There were significant differences (p＜0.05) in maximal heart rate, heart rate ratio of maximal heart rate (% HR), oxygen consumption, and oxygen consumption ratio of maximal oxygen consumption (% VO_2max) between the pre and post-training. The HDL cholesterol level was 42.8 mg/dl in pre-training and 58.0 mg/dl in post-training. There was significant increased of HDL cholesterol in post-training.

Conclusion: We concluded that 5 km/hr backward walk training for eight weeks was an effective exercise program to increase in aerobic capacity of the male college students. (J Korean Acad Rehab Med 2002; 26: 342-346)

Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovulation induction agents used for patients with ovulatory dysfunction. It's pathogenesis is uncertain, although increased capillary permeability with extravasation of fluid into the abdominal cavity is most likely suggested. Early features of the syndrome include nausea, vomiting, diarrhea, ascites, pleural effusion, and ovarian enlargement. In severe cases, increased viscosity with hemoconcentration, hypovolemia, oliguria, coagulopathy, and thromboembolism may appear, and eventually develop to cerebral infarct. We experienced a case of cerebral infarct caused by OHSS with antiphospholipid antibody syndrome after using an ovulation induction agent, and we present this rare case with the review of literature. (J Korean Acad Rehab Med 2002; 26: 347-351)

Roberts syndrome is a rare genetic disorder characterized by pre- and postnatal growth retardation, symmetrical limb defects and craniofacial anomalies. A report is given on a 5 year old male child showing the following anomalies; bilateral aplasia of distal humerus, radius, ulnar and 5th mid-phalanx of hand, cleft palate, hypertelorism and craniosynostosis, pronated foot with genu valgus. We report one case of Roberts syndrome with review of literature. (J Korean Acad Rehab Med 2002; 26: 352-354)

A 75-year-old woman presented a cauda equina syndrome with epiconus involvement from the compression fractures of T12, L1, and L3 vertebrae as a result of fall accident. Cystometrogram performed at three months after the injury showed a small bladder capacity and low compliance. Anticholinergic medications including intravesical instillation of oxybutynin solution failed to increase the bladder capacity or lower the intravesical pressure. Bladder distension therapy using normal saline infusion with a volume surpassing the previous measured maximal bladder capacity was per-formed. The procedures were repeated four times per day. At the fifth day of the distension therapy, the patient complained of acute low abdominal pain and gross hematuria. The cystogram revealed the extraperitoneal bladder rupture. The patient was treated successfully with antibiotics and continuous urinary drainage through the Foley catheter for 14 days. We report a case of extraperitoneal bladder rupture during the bladder distension therapy. (J Korean Acad Rehab Med 2002; 26: 355-357)

Myokymia is a clinical phenomenon characterized by undulating, vermicular, rippling and wavelike movements spreading across the muscle surface. Facial myokymia is an unusual complication of brainstem hemorrhage. It tends to occur in brainstem tumor or multiple sclerosis. We report a 51-year-old man with continuous facial and neck myokymia after brainstem hemorrhage, who revealed focal myokymic discharges in face, neck and pharyngolaryngeal muscles innervated by cranial nerve V, VII, X, and XI. After injection of 20∼80 units of Botulinum toxin type A (Dysport^Ⱂ) to the left orbicularis oris, mentalis, mylohyoid and posterior belly of digastric muscles, amplitude of continuous myokymic discharges was markedly reduced. We recommend Botulinum toxin injection as a very effective therapeutic method in managing focal movement disorders. (J Korean Acad Rehab Med 2002; 26: 358-362)