to achieve a standard living equal to that of their citizens. Non-government organizations can assist Governments by formulating needs, suggesting suitable solutions and providing services complementary to those provided by Governments. This article looks into the current position of the policies for persons with disabilities in our society and reviews the main tasks of disability policies including social, employment, educational and medical security, and the social integration. Especially, as a physiatrist, the policy tasks of medical security for the disabled persons is emphasized. (J Korean Acad Rehab Med 2003; 27: 157-163)
Method: The subjects were twenty-four stroke patients receiving rehabilitation therapy who could maintain sitting posture independently. These patients were randomly divided into a control and an experimental group. The ability of static postural balance control with the modified Clinical Test Sensory Interaction Balance (mCTSIB) and the weight bearing test was measured before and after the balance training. The ability of dynamic postural balance control was measured with the limit of stability (LOS) test and the rhythmic weight shift test. Motor assessment scale (MAS) and modified Barthel index (MBI) were also checked for measuring the effects.
Results: There was significant improvement in both abilities of static and dynamic postural balance control in the experimental group that had visuo-perceptual biofeedback training using the Balance Master (p＜0.05). MAS and MBI scores after the training showed a bigger increase in the experimental group than in the control group.
Conclusion: The visuo-perceptual biofeedback sitting balance training using the Balance Master was considered to be more effective than the conventional training in the stroke patients. (J Korean Acad Rehab Med 2003; 27: 164-172)
Method: 16 hemiplegic patients who could walk without assistive devices were included in this study. We used insole foot-pressure system to measure weight bearing ratio of both feet during walking. We assessed walking speed and pressure ratio during straight or circular walking at their comfortable gait speed.
Results: Pressure ratio of affected foot showed negative correlation with walking time irrespective of walking direction. Pressure ratio of affected foot and walking time during circular walking to the affected side was significantly higher and slower respectively than that to the intact side.
Conclusion: Asymmetrical weight bearing of both feet during walking is highly correlated with walking ability in hemiplegic patients and pressure ratio of affected foot may be simple and useful determinant of walking ability. (J Korean Acad Rehab Med 2003; 27: 173-177)
Method: We performed a prospective study on 1370 cases of stroke consecutively admitted to the hospital from June, 2001 to May, 2002 during hospitalization by medical records and questionaire.
Results: The highest incidence of the stroke was noted in the group of 60 years of age. The proportion of stroke subtypes were infarct (75.2%), intracranial hemorrhage (21.2%), and subarachnoid hemorrhage (3.6%). Sixteen percents of patients arrived over 24 hours after onset of stroke. The seasonal incidence was in order of frequency of spring, winter, autumn, and summer. The highest occurrence of the stroke was noted in May. The onset time of stroke was highest between 7：00 am and 8：00 am. Risk factors in stroke by the order of frequency were hypertension (61.1%), abnormal EKG at admission (45.5%), hyperlipidemia (38.3%), smoking (36.6%), previous stroke history (24.7%), and diabetes mellitus (24.7%). The common complications during hospitalization were pneumonia (7.6%), gastritis (5.6%), depression (4.8%), and hepatitis (4.6%).
Conclusion: Although the results of this study obtained from one local hospital in Korea, they are valuable as basic epidemiologic data of stroke for the prospective community- based study in the future. (J Korean Acad Rehab Med 2003; 27: 178-185)
Method: We retrospectively reviewed the videofluoroscopic findings of 83 dysphagia patients with various underlying conditions. We used 2 cc of diluted barium as thin viscosity food, 2 cc of yoplait as medium viscosity food, and 2 cc of semiblended gruel diet as thick viscosity food. We assessed the presence of aspiration and the amount of residue in valleculae and pyriform sinus with 3 grade scales.
Results: Aspiration was more frequently observed in thin viscosity (32.5%) than medium (6.0%) or thick viscosity (8.4%) (p＜0.05). Vallecular residue was more abundant in thick viscosity than medium, and in medium viscosity than thin (p＜0.05). Pyriform sinus residue was more abundant in thick viscosity than thin viscosity (p＜0.05).
Conclusion: We conclude that thickened food may make more pharyngeal residue after swallow in dysphagia patients with weak pharyngeal constriction. Therefore the texture, another property of food, needs to be further studied. (J Korean Acad Rehab Med 2003; 27: 186-191)
Method: Thirty-nine adults with CP were participated. They took the radioopaque markers for 3 successive days. Then, abdominal X-ray was taken on the fourth day. The 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 ESHAⰒ Food Processor. Then, daily intakes of the nutrients were compared with Recommended Dietary Allowance of Korean Nutrition Society.
Results: Colon transit time were more than 2 times delayed in adults with CP as compared with those of normal controls. Colon transit time was significantly prolonged in non- functional ambulators (p＜0.05). Colon transit time tended to be delayed in subjects with spastic type, but not related with the degree of cognitive function. On the evaluation of daily nutrients intake, several nutritional factors were inadequate in adults with CP.
Conclusion: Adults with CP had the problems in colonic motility and nutritional intake. Also, delayed colon transit time was significantly related with poor mobility, and possibly related with spasticity. (J Korean Acad Rehab Med 2003; 27: 192-197)
Method: Thirteen adults with CP were participated in this study. Nine of these thirteen subjects had urological symptoms. The urological history taking, urine analysis, urine culture, voiding cystourethrography (VCUG) and urodynamic study were done.
Results: The urinary incontinence was the most common presenting symptom. All subjects without urological symptoms showed normal urodynamic findings. Eight of the subjects who had urological symptoms had abnormal findings on urodynamic study. All subjects showed normal findings on voiding cystourethrography. Based on urodynamic findings, six subjects were treated with anticholinergic drug and five (83.3%) of these subjects showed improvement of their urological symptoms.
Conclusion: Many adults with CP might have the problems in urination. Our study showed that many symptomatic subjects had abnormal urodynamic findings and much of these urological symptoms was improved with proper treatment. These adults with CP would, therefore, benefit from proper assessment and treatment, expecially in the subjects who have urological symptoms. (J Korean Acad Rehab Med 2003; 27: 198-203)
Method: Eighty-six adults with CP and 146 age matched controls participated in this study. Psychological health status of all participants was evaluated by the interview and questionnaire including Beck Depression Inventory (BDI), Brief Symptoms Inventory (BSI) and Affect Balance Scale (ABS).
Results: Depressive symptom on BDI was common in adults with CP. Study group showed significantly higher scores in BSI and lower scores in ABS compared with the control group (p＜0.05). Employment, severity of disability and health perception were significantly related to the psychological health status in adults with CP (p＜0.05).
Conclusion: This study revealed that psychological problems were greater in adults with CP, compared with the controls. Psychological health status in adults with CP was related to employment, severity of disability and health perception. Therefore, active medical and social interventions for providing employment, minimizing disability and improving health perception will be helpful for enhancing their psychological health. (J Korean Acad Rehab Med 2003; 27: 204-209)
Method: We performed the BSID-II for children with delayed development who were diagnosed as CP or global developmental delay (GDD). The characteristics of mental developmental index (MDI) and psychomotor developmental index (PDI) of BSID-II were evaluated and sensitivity and specificity of BSID-II in the diagnosis of CP were studied.
Results: While both MDI and PDI were decreased similarly in the GDD, PDI were significantly more decreased than MDI in the CP. The CP with hemiplegic pattern showed high MDI and PDI compared to those with the other patterns. When abnormal PDI defined as lower than 85 was used as a diagnostic criteria of CP, sensitivity and specificity were 0.88 and 0.41. When abnormal PDI defined as 13 and higher than MDI was used, sensitivity and specificity for the diagnosis of CP were 0.50 and 0.84.
Conclusion: The characteristic findings of BSID-II in the CP could be used as a supportive diagnostic measurement. We should interpret carefully in the children with hemiplegic pattern because they had a near normal MDI and higher PDI than functional status of hemiplegic limbs. (J Korean Acad Rehab Med 2003; 27: 210-214)
Method: Seventeen paraplegic men were enrolled for the study. Isometirc and isotonic strength and dynamic endurance levels for wheelchair propulsion were measured using BTE work simulator. Neurological and demographical characteristics of patients were collected by personal interviews and direct examinations.
Results: The spinal cord injured level showed a significant correlation with dynamic endurance (r=0.503, p＜0.05) but not with the isometric and isotonic strength. The total duration of wheelchair use showed a significant correlation with the isotonic strength (r=0.497, p＜0.05), but not with the isometric strength and dynamic endurance. The age and outdoor activities or exercise time during one week showed no significant correlation.
Conclusion: Spinal cord injured level positively correlated with dynamic endurance. Both cardiorespiratory effect and trunk balance may influence this correlation. The total duration of wheelchair use wasn't correlate with dynamic endurnace. It seems to be more advisable trunk balance training goes with dynamic endurance training in rehabilitation program. (J Korean Acad Rehab Med 2003; 27: 215-219)
Method: The subjects were 50 healthy adults (mean age, 45.6 years) without the clinical signs and symptoms of peripheral neuropathy. All subjects underwent electrodiagnostic evaluation of the following sensory nerves in lower limbs: superficial peroneal, sural, proximal sural, lateral dorsal cutaneous branch of sural nerve (LDSN), and medial plantar. Examined late responses included: tibial F-wave, peroneal F-wave, and H-reflex recorded from the soleus muscle.
Results: No response rates of sensory nerve conduction studies such as superficial peroneal, sural, proximal sural, LDSN, and medial plantar nerves were 2%, 0%, 0%, 24%, and 18%, respectively. No response rates of late responses such as tibial F-wave, peroneal F-wave, and H-reflex were 0%, 2%, and 8%, respectively. And no response rates were significantly correlated with age (p＜0.05).
Conclusion: No response rate of sensory and late responses of lower limbs are relevant to age increments, the results should be considered for an early diagnosis of peripheral neuropathy in the lower limbs of old population. (J Korean Acad Rehab Med 2003; 27: 220-223)
Method: The subjects were 10 healthy volunteers. The study was composed of 3 sessions: first session, baseline evaluation; second session, RES with a intensity for proprioceptive stimulation on tibial nerve at the right ankle for 3 different duration of 30 minutes, 1 hour, and 2 hours; third session, repeat of baseline evaluation after RES (post- RES evaluation). The baseline evaluation include somatosensory evoked potential study with stimulation of right tibial nerve and compound muscle action potential (CMAPs) of tibial nerve recorded at abductor hallucis and H reflex. The amplitude of each study were measured and compared between baseline evaluation and post-RES evaluation using Kruscal-Wallis test.
Results: There was no significant change in amplitudes of SSEP, CMAP and H reflex between baseline evaluation and post-RES evaluation of 30 minutes, 1 hour and 2 hours.
Conclusion: This study suggests that chronic repetitive proprioceptive afferent nerve stimulations could not modulate primary somatosensory cortex in healthy subjects. However, we could not rule out the limitations of sensitivity of somatosensory evoked potential study. (J Korean Acad Rehab Med 2003; 27: 224-227)
Method: A cross-sectional area and a flattening ratio of the median nerve, and a cross-sectional area of the carpal tunnel were measured in neutral, maximally flexed (Phalen's test), and maximally extended (reverse Phalen's test) positions in 59 wrists of 30 normal subjects.
Results: The cross-sectional area of median nerve was significantly decreased in maximal flexion (p＜0.01), and in maximal extension (p＜0.01). The mean flattening ratio of median nerve was revealed significant change in maximal flexion (p＜0.01), and in maximal extension (p＜0.01). The mean cross-sectional area of the carpal tunnel was significantly decreased in maximal flexion (p＜0.01), and in maximal extension (p＜0.01), with comparing to neutral position, respectively.
Conclusion: Phalen's test reveals higher degree of irritation to median nerve. The high-resolution ultrasonography is suggested as an available tool for the screening and follow up aid-test for the CTS. (J Korean Acad Rehab Med 2003; 27: 228-231)
Method: We used 15 mdx and 15 control mice. To grade exercise loading, control and mdx mice were divided into free-living, exercise and immobilization groups. Free-living and exercise groups were further divided into steroid-treated and sham-treated groups to evaluate the effect of steroid administration. We measured the apoptotic changes using in situ DNA nick-end labling (TUNEL), DNA fragmentation assay and western blots for Bcl-2 and BAX.
Results: With TUNEL method, the largest number of myonuclei became positive in sham-treated exercise group while apoptosis was significantly reduced in steroid-treated exercise group in mdx mice. Steroid-treated free-living group showed higher rate of apoptotic change than sham-treated free-living group. With western blots for Bcl-2 and BAX, the value of BAX/Bcl-2 ratio was highest in sham-treated exercise group and among free living mdx mice, it was higher in steroid-treated group than sham-treated one.
Conclusion: Apoptosis can be minimized in free living condition while exercise loading or immobilization can cause apoptotic change in muscular dystrophy animal model. Steroid administration induces apoptosis in free living muscle and it alleviates apoptotic damage caused by exercise loading in mdx mice. (J Korean Acad Rehab Med 2003; 27: 232-239)
Method: Seventeen patients with lumbar discogenic pain who have not received other interventional procedures were studied. After confirmation of needle placement into the discs by C-arm fluoroscopy, discogram was done. And 40 mg of triamcinolone and 0.5 cc of 2% lidocaine were injected into the nucleus. Correlation between degeneration and Visual Analogue Scale (VAS) was analyzed. The effects of steroid injection were evaluated using VAS and limitation of lumbar flexion at pre-injection, 1 week post-injection, 1 month post-injection, and 3 months post-injection. Changes over time were assessed statistically using ANOVA and chisquare.
Results: Correlation between degeneration and VAS was high (r=0.7). The averages of VAS reduced significantly from 6.1⁑1.6 at pre-injection, to 2.4⁑1.8 at 1 week post- injection, to 1.8⁑1.2 at 3 months post-injection, respectively (p＜0.05). The number of group of highly or moderately limited lumbar flexion was decreased from 10 at pre- injection to 4 at 1 day post-injection. Fourteen of 17 patients (82.4%) had a successful outcome reporting at least 50% reduction between pre and 3 months post-injection in VAS.
Conclusion: Intradiscal steroid injection was an effective treatment for patients with lumbar discogenic pain. (J Korean Acad Rehab Med 2003; 27: 240-244)
Method: 52 tendinitis cases were evaluated by physical examination, Cyriax selective tension technique, simple X-ray and the high-resolution realtime ultrasonography. And clinical diagnosis of tendinitis was confirmed when symptom was relieved after the local lidocain injection to suspected site of tendinitis. The ultasonographic results were compared to clinical diagnosis and ultrasonographic findings were investigated.
Results: The distribution of clinical tendinitis was as follows; 15 extensor carpi radialis tendinitis, 12 supraspinatus tendinitis, 9 subscapular tendinitis and etc. Clinical diagnosis was matched with ultrasonographic results in 38 cases out of 52 (73.1%). The ultrasonographic findings of tendinitis were as follows; 31 hypoechogenicity, 14 thickening, 13 hypervascularity, 12 irregular margin and etc.
Conclusion: The ultrasonography is useful in diagnosis of tendinitis and can provide the exact lesion site of tendinitis. Also it can be used for differential diagnosis of acute or chronic tendinitis. (J Korean Acad Rehab Med 2003; 27: 245-249)
Method: Thirty-one breast cancer patients who had undergone curative surgery were randomly assigned to an exercise group (n=16) and a non-exercise group (n=15). Exercise therapy was consisted of aerobic activity such as bicycle ergometer for 30 minutes, twice a day, five times each week for 2 weeks. The venous blood samplings were obtained on postoperative days 1, 7 and 14. NKCA was assayed by cytotoxic response against K562 cells. The venous blood samplings were obtained on postoperative days 1, 7 and 14. NKCA was assayed by cytotoxic response against K562 cells.
Results: The baseline study did not show any statistical difference between exercise group and non-exercise group. Mean NKCA of day 7 decreased in both groups compared with that at postoperative day 1 (p＜0.05). At day 14, the difference of the mean NKCA between two groups was not significant, but the mean NKCA of the exercise group without metastasis demonstrated a significant increase compared with that of the non-exercise group without metastasis (p＜0.05).
Conclusion: This study suggested that early moderate exercise had a beneficial effect on the function of NK cells in early stage of breast cancer patients after curative surgery. A further study will be needed to evaluate long-term effect of exercise on NK cell. (J Korean Acad Rehab Med 2003; 27: 250-254)
Method: Sixty healthy adult men performed five maximal isokinetic knee extension-flexion contractions in each of two contralateral leg stabilization conditions at different angular velocities. In the "Front condition", the test was done with a bar in front of the ankle joint of the non-testing leg. In the Fix condition", the non-testing leg was strapped and induced reciprocally to perform isometric contractions with respect to the testing leg. From the measured values, we calculated the strength difference ratio ([Peak Torque (PT) of "Fix condition"-PT of "Front condition"]⁓100/PT of "Front condition") at each angular velocity.
Results: By comparing the extensor strength, greater PTs were measured at the "Fix condition" in all tested angular velocities (p＜0.01). For the flexor, the PTs of both conditions were similar. The strength difference ratio decreased as angular velocity increased (r=0.48, p＜0.01) in the extensor.
Conclusion: We could infer the crossed extension-flexion reflex is more apparent in the lower angular velocity than in higher one. (J Korean Acad Rehab Med 2003; 27: 255-259)
Method: Medical records of 119 hospitalized patients with cancer who received the consultation base rehabilitation program from January 1999 to December 2000, were reviewed. Karnofsky Performance Status scale (KPSS) was used as a functional measurement.
Results: The most common primary cancer referred for the consultation base rehabilitation program was a lung cancer (16.8%), followed by brain cancer (10.9%) and hepatic cancer (9.2%). Spine was the most common metastatic site (72.7%). Strengthening (47.2%) and range of motion exercises (39.6%) were commonly prescribed rehabilitative procedures in the cancer patients with no metastasis and bracing (45.5%) was the most common cause for consultation in the cancer patients with metastasis. A significant functional improvement was observed between the initial (mean=58.4%) and final assessments (mean=65.2%) on KPSS (p＜0.01) in the cancer patients with no metastasis. However, the cancer patients with metastasis did not show a significant functional improvement.
Conclusion: Significant functional gains were observed in cancer patients who received the consultation base rehabilitation program. (J Korean Acad Rehab Med 2003; 27: 260-264)
Method: We did the recognition survey using 12-item self administrated questionnaire over 2 months in 2001. The questionnaires were sent to 613 physiatrists. Eighty-eight physiatrists of the 613 completed the questionnaires.
Results: Eighty-three of 88 completed the questionnaires were performing their procedure under roentgen environment. The mean procedure time per week was 2.1 hours. Their common procedures doing under roentgen environment were as follows: swallowing videofluoroscopic study (60.2%), voiding cystourethrography (49.3%), arthrography (37.3%), epidurography 25.3%, and so on. 8.5 % of the 83 physiatric interventionists wore the radiation dosimeter and received regular assessment of radiation safety. 62.7% of the participants were wearing one piece apron, and 24.1% wore one piece apron and thyroid shield. Of the radiation related symptoms, fatigue was most common.
Conclusion: We concluded that the special concern and education program to reduce radiation risk are required because of gradual increase of radiation exposure for physiatrists and lack about recognition of radiation exposure. (J Korean Acad Rehab Med 2003; 27: 265-268)
Method: Medical records of the 108 patients with stroke, spinal cord injury and traumatic brain injury were reviewed after the discharge from acute rehabilitation care. The demographic factors, socioeconomic status, disease characteristics and functional status of the patients were evaluated to investigate the affecting factors to the discharge destinations.
Results: Discharge destinations were subdivided into homes 67 (62%), transfer to other hospitals 31 (29%) and transfer to oriental medicine hospitals 10 (9%). The Functional independence measure (FIM) score, length of rehabilitation care, type of payment, operation and diagnosis significantly influenced discharge destinations (p＜0.05). The patients who were transferred to other hospital showed significantly lower FIM score and longer length of rehabilitation care compared with patients who were discharged to home or transferred to oriental medicine hospital (p＜0.05).
Conclusion: The FIM score, length of rehabilitation care, type of payment, operation, and diagnosis significantly influenced the discharge destinations of patients after rehabilitation. It is necessary to increase the subacute or chronic rehabilitation facilities for the case of patients with severe physical disabilities. (J Korean Acad Rehab Med 2003; 27: 269-274)
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