Objective
The purposes of this study were to investigate the findings of various diagnostic tools for shoulder pain in hemiplegic patients and to compare the results of each diagnostic tool.

Method: Sixty shoulders in hemiplegic patients with shoulder pain were evaluated by physical examination, visual analogue scale, plain X-ray, arthrogram, ultrasonography and 3-phasic bone scan.

Results: The subluxation of shoulder on X-ray was found in 45 patients. The abnormal findings of arthrogram were 39 patients and the most common finding was adhesive capsulitis. The abnormal findings of ultrasonography were 45 patients and the most common finding was supraspinatus tendinitis. In cases of shoulder subluxation on X-ray, many cases were associated with supraspinatus tendinitis on ultrasonography and with adhesive capsulitis on arthrogram. In comparison with the arthrogram and ultrasonography, partial and complete rotator cuff tear findings show consistency. And patients with adhesive capsulitis on arthrogram show significantly high incidence of biceps tendinitis finding on ultrasonography.

Conclusion: In hemiplegic patients with shoulder pain, the ultrasonography is more valuable and useful as an invasive diagnositc method for the evaluation of rotator cuff tendinitis especially when there is subluxation in X-ray and adhesive capsulitis in physical examination. (J Korean Acad Rehab Med 2003; 27: 293-299)

Objective
To investigate the clinical characteristics, risk factors and complications of stroke patients and their effect on the patient's functional outcomes at discharge.

Method: We performed a prospective study during hospitalization on 1,250 consecutive acute stroke patients discharged from Dong-Eui Hospital from June 2001 to May 2002. Glasgow outcome scale, status of upper extremity involved and status of ambulation were used to evaluate functional status.

Results: The variables of clinical characteristics identified as significant in functional status at discharge were the presence of occupation, interval between onset and visit to hospital arrival, type of first treatment after stroke, type of caregiver, type of stroke and location of infarction and intracranial hemorrhage. Positive functional outcomes were significantly related to a younger age, male, small amount of hemorrhage and short length of hospital stay. Among risk factors of stroke, abnormal ECG findings at admission and presence of previous stroke were negative prognostic factors. The complications influencing stroke outcome negatively were pneumonia, depression, urinary tract infection, myocardial infarction and recurrence of stroke in hospitalization.

Conclusion: The results of this study should be considered during acute management and rehabilitation of stroke patients and are valuable as basic data of functional outcome after stroke. (J Korean Acad Rehab Med 2003; 27: 300-308)

Objective
The purpose of this study was to investigate the factors associated with motivation for rehabilitation in stroke patients and to identify the relationship between their motivation and functional outcome.

Method: Subjects were 23 stroke patients who admitted to rehabilitation wards. Volitional Questionnaire (VQ) for assessing patients' motivation, personal and environmental variables, modified Barthel index (MBI), Beck depression inventory (BDI), minimental status examination (MMSE) and neurobehavioral cognitive status examination (NCSE), visual reaction time (VRT) and auditory reaction time (ART) were obtained at 1 week after admission, and then MBI was measured again after 4 weeks.

Results: VQ score was not related to the personal and environmental variables, but significantly related to BDI, MMSE, NCSE, VRT, ART, follow up score of MBI 4 weeks later and MBI gain.

Conclusion: Motivation was more associated with neuropsychological status than personal or environmental factors and significant factor of functional outcome. Therefore, physicians and physiotherapists should attempt to promote motivation of their patients during rehabilitation. (J Korean Acad Rehab Med 2003; 27: 309-313)

Objective
To identify interhemispheric differences of facilitation of motor evoked potentials (MEPs) from the affected and unaffected hemispheres after stroke and to correlate the differences with their motor functions.

Method: MEPs induced by cortical stimulation were obtained at both thenar muscles in 28 post-stroke patients. Motor cortex was stimulated with 110% and 130% intensity of threshold during rest, minimal and moderate voluntary muscle contraction. We analyzed the MEP amplitude or area in 130% threshold intensity at rest (Rmax) and on moderate contraction (Fmax). The ratio of Fmax in both hemispheres (interhemispheric facilitation ratio, FR) and the ratio of Fmax to Rmax (facilitation index, FI) were also analyzed. Pinch strength, Brunnstrom stage, and Jebsen hand function test were included evaluating their motor functions.

Results: MEPs could not be evoked in cases whose Brunnstrom stage of hand was under 3. In response group, amplitude and area of Fmax of unaffected side were significantly larger than those of affected side (p＜0.05). FR showed good correlation with clinical findings evaluating motor functions (p＜0.05). In cases of FR ＞ 0.5, FI of unaffected side was significantly greater than that of affected side (p＜0.05).

Conclusion: We suggest to use FR and FI as useful parameters for evaluation of hand function in post-stroke patients. (J Korean Acad Rehab Med 2003; 27: 314-319)

Objective
The purpose of this study was to identify the effect of EMG-triggered electrical neuromuscular stimulation for recovery of hemiplegic arm function.

Method: EMG-triggered electrical stimulation was applied to the extensor digitorum communis (EDC) of 8 chronic hemiplegics who showed no functional changes for more than 3 months. Stimulation was started when the amplitude of processed EMG signal from the same muscle exceeded the preset threshold. The therapeutic effect was evaluated by kinesiologic and clinical methods before and after 4 weeks. Quantitative EMG from EDC, excursion of second metacarpophalangeal joint, and functional measurements were used. We also evaluated cognitive and perceptual effect on recovery of arm function.

Results: Subjects treated with EMG-triggered electrical stimulation showed significant gain in amplitude of quantitative EMG and excursion sum during maximal exertion comparing to those of pre-treatment (p＜0.05). There was also an decrease of spasticity after treatment. But functional, perceptual and cognitive outcome were not changed significantly (p＞0.05).

Conclusion: These results suggest that EMG-triggered electrical stimulation might be an effective therapeutic modality to improve motor function of the hemiplegic arm of chronic brain injured patients. (J Korean Acad Rehab Med 2003; 27: 320-328)

Objective
The purposes of this study were to analyze the problems and to suggest the methods for improvement of the current Disability Grading Guide (hereinafter called CDGG) for the disabled after stroke when compared with the previous Disability Grading Guide (hereinafter called PDGG).

Method: Thirty-five registered disabled persons after stroke were evaluated by two physiatrists to assess the grades of disability according to CDGG and PDGG, which were in use. The evaluations of disabled persons for the grading were done by the physiatrists through house-visit and at the hospital according to CDGG (hereinafter called CDGG-visit and CDGG-OPD) and PDGG (hereinafter called PDGG-grade). These re-evaluated disability grades were compared with the initial disability grades recorded in their disability registries.

Results: There was a low level of agreement between the registered grade and the re-evaluated grades; however, there has shown a high level of agreement amongst the re-evaluated grades. The degree in the registered grade was evaluated upward compared to the degree in other reevaluated grades.

Conclusion: The difference degree between CDGG and PDGG of established was insignificant; however, a new candidate who wants to be evaluated using CDGG has possibilities of facing unfairness when compared to the disabled people with relatively higher registered degrees. (J Korean Acad Rehab Med 2003; 27: 329-334)

ated disability grades were compared with the initial disability grades recorded in their disability registries.

Results: There was a low level of agreement between the registered grade and the re-evaluated grades; however, there has shown a high level of agreement amongst the re-evaluated grades. The degree in the registered grade was evaluated upward compared to the degree in other reevaluated grades.

Conclusion: The difference degree between CDGG and PDGG of established was insignificant; however, a new candidate who wants to be evaluated using CDGG has possibilities of facing unfairness when compared to the disabled people with relatively higher registered degrees. (J Korean Acad Rehab Med 2003; 27: 329-334)

Objective
To evaluate the effects of hyperbaric air therapy (HAT) on cerebral perfusion for children with cerebral palsy.

Method: The protocol for HAT consisted of consecutive 10 days in which a child and his/her caregiver were held in 1.3 atm hyperbaric air chamber for 60 minutes per one day. Nine children with cerebral palsy underwent ^99mTc-HMPAO single-photon emission computed tomography (SPECT) before and after HAT. The change of regional cerebral blood flow (rCBF) was evaluated by subtraction analysis using statistical parametric mapping.

Results: Average gestational age and birth weights were 34.0⁑5.1 months, and 2.3⁑1.2 kg, respectively. Two spastic quadriplegics, four spastic diplegics, two spastic hemiplegics, and one ataxic child were enrolled. In 3 out of 9 children, rCBF change was demonstrated; increased perfusion in right cerebellar hemisphere in child with diffuse brain atrophy and increased perfusion in diffuse cerebral cortex in child with left frontal leukoencephalopathy and decreased perfusion of right frontal cortex in child with right frontal leukoencephalopathy.

Conclusion: These findings suggest that HAT may recruit less excitable neurons that was of functionally silent in motor cortex, previously. However, increased rCBF following HAT protocol could not be ruled out whether the result of learning effects or HAT. (J Korean Acad Rehab Med 2003; 27: 335-339)

Objective
Using diffusion tensor MRI (DTI), to investigate the microstructural abnormality of corticospinal tract in the cerebral palsied children with periventricular leukomalacia on conventional MRI and to recognize the clinical usefulness of DTI.

Method: Seven patients were studied. DTI was peformed using 1.5T MR scanner (Vision Plus, Siemens, Erlangen, Germany) and fractional anisotropies of corona radiata, posterior limbs of internal capsules, and cerebral peduncles of midbrain in both hemisphere were calculated.

Results: The fractional anisotropy was significantly decreased in all corona radiata, posterior limbs of internal capsules, cerebral peduncles of midbrain in six patients except one hemiplegic patient, compared with that of control group. In in the hemiplegic patient, the fractional anisotropy was reduced only in affected hemisphere. In addition, the fractional anisotropy tended to be also increased as gross motor function measure (GMFM) score was increased.

Conclusion: We believe that DTI may be efficient in evaluating microstructural abnormality on the motor pathway of brain and helpful in providing prognosis of clinical findings in cerebral palsied children with periventricular leukomalacia. (J Korean Acad Rehab Med 2003; 27: 340-343)

Objective
To evaluate the effect of stretching therapy of neurogenic bladder in spinal cord injured patients.

Method: Twelve spinal cord injured patients who had neurogeic bladder manifested with urinary incontinence resistant to oral and intravesical anticholinergic instillation treatment were selected. Oxybutynin solution was instillated via foley catheter and the catheter was clamped until incontinence occur. This was performed twice a day for 7 days. The urodynamic studies were compared before and after therapy. Total volume of daily incontinence and total volume of daily fluid intake were also monitored.

Results: After stretching therapy, median maximal bladder capacity increased from 190.08 to 457.17 ml (p＜0.01), mean bladder compliance increased from 8.46 to 18.85 ml/cmH₂O (p＜0.01), mean reflex volume increased from 148.75 to 252.17 ml (p＜0.05), mean maximal detrusor pressure decreased from 52.17 to 28.29 cmH₂O (p＜0.01), mean clinical maximal capacity increased from 277.50 to 537.50 ml (p＜0.01), and mean daily incontinent volume decreased from 508.33 ml to 20.83 ml (p＜0.01). No significant correlation was found between the duration since onset of injury and the urodynamic finding.

Conclusion: This study proved that stretching therapy of bladder was an effective method in spinal cord injured patients who had neurogenic bladder with uncontrolled incontinence with conventional therapy. (J Korean Acad Rehab Med 2003; 27: 344-348)

Objective
To investigate the incidence, time of onset, and risk factors of deep vein thrombosis asssociated with heterotopic ossification in patients with spinal cord injury.

Method: The medical records of 201 patients with spinal cord injury were reviewed. Duplex ultrasound and/or venography were used for the diagnosis of deep vein thrombosis and 3 phase bone scan and/or plain radiologic studies were used for the diagnosis of heterotopic ossification.

Results: Whereas the incidence of heterotopic ossification and deep vein thrombosis in this population were 10.0% and 4.5%, respectively, 55.5% of the individuals with deep vein thrombosis developed heterotopic ossification. The overall incidence of coexistence of deep vein thrombosis and heterotopic ossification was 2.5%. The significant difference between the occurrence of heterotopic ossification and deep vein thrombosis in this SCI population reached statistical significance (Fisher's exact test p＜0.005).

Conclusion: The results of this study suggest that there exists an association between the occurrence of deep vein thrombosis and heterotopic ossification following SCI. (J Korean Acad Rehab Med 2003; 27: 349-354)

Objective
To assess the usefulness of the somatosensory evoked potentials in correlating with various clinical features and in predicting the functional outcome in patients with stroke.

Method: The subjects were 57 patients with first stroke. Somatosensory evoked potential study was performed at the time of transfer to the rehabilitation department. Data of somatosensory evoked potential with median and tibial nerve stimulations were obtained and classified as normal (group 1), abnormal (group 2), and no response group (group 3). Modified Barthel index (MBI), motor and sensory functions were evaluated at the time of transfer and discharge.

Results: MBI score was statistically different among the 3 groups based on the findings of median and tibial nerve SSEP at the time of transfer, but not different at the time of discharge. Motor function was statistically different among the 3 groups at the time of transfer and discharge. Sensory function was statistically different among the 3 groups at the time of transfer, but not different at the time of discharge.

Conclusion: Even though SSEP study reflects the functional status of the patients and correlates well with the findings of brain image, it has limitation in predicting outcome of the patients with stroke. (J Korean Acad Rehab Med 2003; 27: 355-360)

Objective
This study was to evaluate the correlation of clinical symptoms and physical signs with electrodiagnostic findings in carpal tunnel syndrome (CTS), and to increase the usefulness of clinical symptoms and physical signs in the diagnosis of CTS.

Method: We prospectively identified 322 hands from 172 subjects clinically from 5 tertiary hospitals. All subjects completed 6 clinical symptoms and 6 physical signs including 3 provocative tests. Each symptoms and signs were divided motor and sensory symptoms and signs, and the correlation between symptoms and signs and the results of motor and sensory conduction studies and needle electromyography were evaluated. The sensitivity and specificity of each valuable symptoms and signs for electrodiagnostic results were also assessed.

Results: Tingling sensation, nocturnal pain, worsening, and Phalen sign were correlated with motor conduction study, and falling tendency, abductor pollicis brevis weakness and atrophy, tingling sensation, hypoesthesia, and Tinel and Phalen signs were correlated with needle electromyography. The Phalen sign had the best sensitivity and specificity for median motor conduction study, and the best sensitive physical sign for needle electromyography.

Conclusion: Motor and sensory symptoms and signs were not correlated with motor and sensory conduction studies, but motor symptoms and signs were correlated with needle electromyography. The Phalen test was the most useful evaluating tool to diagnose CTS. (J Korean Acad Rehab Med 2003; 27: 361-368)

Objective
To compare the degree of improvement of conduction block in carpal tunnel syndrome (CTS) between the patients who received operation and those who received conservative treatment.

Method: Subjects included 33 hands of 27 CTS patients who received operation (operation group) and 20 hands of 17 patients who were managed conservatively (non-operation group). Median antidromic sensory responses were recorded with wrist and palm stimulation. The criterion for conduction block was more than 50% drop of baseline to negative peak amplitude of sensory nerve action potential with wrist stimulation compared to palm stimulation. The degree of conduction block was measured before and after treatment, and the improvement of conduction block was compared between the two groups.

Results: The degrees of conduction block were 59.9⁑14.3% in operation group and 60.5⁑14.5% in the non-operation group at initial evaluation. The improvements of conduction block were 32.1⁑15.1% (5∼58.9%) in operation group and 7.8⁑19.8% (⁣27.3∼36.7%) in non-operation group after treatment and the difference was statistically significant.

Conclusion: The results suggest that operative treatment may be useful even in patients with carpal tunnel syndrome with conduction block. (J Korean Acad Rehab Med 2003; 27: 369-373)

Objective
To analyze the degree of injury and patterns of recovery according to the severity and degree of ischemia-reperfusion.

Method: Fifty-three rats were divided into 2 groups by degree of ischemia using ultrasonography. Each group was subdivided into 1 and 3-hours ischemia groups. Baseline recordings were performed, and ligation of the femoral vessels were done. Reperfusion process was done. Nerve conduction study (NCS), Sciatic Function Index (SFI) and histologic study were used.

Results: NCS parameters of the less than 3 hours incomplete insult group showed normal value. More than 1 hour of complete insult induced peripheral nerve injury. On first day and week, amplitude of NCS was small in 3-hour group. Muscle fiber diameter was less in 3-hour group. Although NCS parameters did not reach normal values on 4th week, 3-hour group showed smaller amplitudes. SFI returned to normal level at 4th week. Reperfusion injury was observed by electromyography.

Conclusion: Less than 3 hours of partial ischemia/ reperfusion did not result in any form of injury whereas more than 1 hour of complete insult resulted in peripheral nerve injury with greater injury seen in 3 hour insult group. Neurological recovery was not achieved at 4 th week, and the more severe the ischemia, the poorer was the recovery. (J Korean Acad Rehab Med 2003; 27: 374-381)

Objective
Caveolae are the microdomain of the plasma membrane that have been implicated in signal transduction and caveolin is a principal component of the caveolae. Caveolin-3, a family of caveolin related protein, is expressed only in muscle tissue. Here we examined the expression of caveolin-3 in the course of myobalst differentiation and within the muscle tissue.

Method: L6 cell, rat skeletal myoblast, was cultured in the low mitogen medium and caveolin-3 expression was observed both by immunocytochemistry and western blot analysis. Localization of caveolin-3 within the muscle tissue was investigated and compared to that of dystrophin. Results: While caveolin-3 was not expressed in the proliferating myolast, caveolin-3 was expressed in the differentiated myoblast. Caveolin-3 and dystrophin were co-expressed in the membrane of muscle tissue and integrated density of caveolin-3 was elevated in the area of muscle injury. In the Duchenne muscular dystrophy, caveolin-3 was expressed in the membrane of muscle tissue, but dystrophin was not.

Conclusion: Caveolin-3 was induced during the myobalst differentiation and its expression was increased during the muscle regeneration. Caveolin-3 was physically associated with dystrophin as a complex, but not absolutely required for the biogenesis of dystrophin complex. (J Korean Acad Rehab Med 2003; 27: 382-387)

Objective
To analyze the clinical and electrodiagnostic findings of patients with failed back surgery syndrome after lumbar disc operation.

Method: We investigated 28 patients with back and/or lower limb pain and weakness who were underwent lumbar spine operation. Seven patients who had undergone surgery due to spinal infection or fracture were excluded. Twenty-one patients included 7 female and 14 male patients with ages 20∼63 years, and the mean age was 44.4 years. The following data were evaluated: clinical symptoms, neurological examination, duration from operation to first visit, preoperative diagnosis, operation number and site, electrodiagnostic studies, radiologic studies (simple radiographs, epidurography, CT, MRI), and psychological evaluations (SCL-MPD).

Results: The time of the visit after the operation varied between one month and 15 years (mean 48.5 months). Electrodiagnostic study revealed lumbar radiculopathy in 18 patients and the most common level was at the fifth lumbar root. All eight patients who undergone epidurography showed filling defect or indentation. Psychologic evaluations were performed on five patients and they revealed high scores in depression and somatization.

Conclusion: Clinical and electrodiagnostic findings of lumbar radiculopathy, abnormal epidurographic findings and psychological results after lumbar disc operation were related to the causes of failed back surgery syndrome. (J Korean Acad Rehab Med 2003; 27: 388-393)

Objective
To survey characteristic patterns and speculate psychologic factors of the patients with low back pain associated with industrial injury or traffic accidents.

Method: Nineteen low back pain patients after traffic (12 cases) or industrial (7 cases) accidents were compensation insurance status. 40 controls were low back pain patients without compensation insurance status. All had been evaluated with an electrodiagnostic study. Pain drawings and symptom check list for minor psychiatric disorder (SCL- MPD) were assessed to speculate the characteristics of the psychologic factors.

Results: In the electrodiagnostic study patients with compensation insurance status had segmental radiculopathy in 5 cases (26.3%) and controls in 18 cases (45.5%). Pain drawings classified as Ransford scores were abnormal in 14 cases (73.7%) of the patients and in 9 cases (24.3%) of the controls. Visual inspection of the pain drawings classified as non-indicative were 12 cases (63.2%) of the patients and 13 cases (31.3%) of the controls. SCL-MPD showed higher somatization, depression and phobic-anxiety scores than the controls.

Conclusion: Pain drawing and SCL-MPD are available for screening of the psychological factors and management for low back pain of compensation insurance stauts. (J Korean Acad Rehab Med 2003; 27: 394-398)

Objective
To determine whether the area and the shape of the vertebral body endplate in the magnetic resonance image (MRI) findings were risk factors for the development of symptomatic herniated lumbar intervertebral disc.

Method: Sixty patients of low back pain with the age below 60 were enrolled. They didn't have spondylolisthesis or the history of spine surgery. MRI films of these patients were reviewed. Anteroposterior and transverse diameter of endplates, height of vertebral body and intervertebral discs were measured. The relation of these data and intervertebral disc herniation, body weight, height, body mass index (BMI) were statistically studied.

Results: Patients' weight, BMI, the vertebral body area and the shape of the endplate were related to disc herniations. Furthermore, the larger and circular vertebral body was observed in the patients with disc herniation. In the patients with lower back pain, men were diagnosed disc herniations of the MRI finding more than women.

Conclusion: In anatomical aspect, the area and the shape of the vertebral body at the endplate level were important factors contributing to the development of disc herniations at L4-L5 and L5-S1. (J Korean Acad Rehab Med 2003; 27: 399-403)

Objective
The purpose of this study was to evaluate the reliability of patient pain drawings using a 3-dimensional (3D) virtual human body system.

Method: Pain drawings were collected from thirty-four patients with various types of musculoskeletal pain. On the first clinic visit, patients were instructed to draw in their pain areas on a diagram depicting the body (P1). The examining physiatrist, blinded to the patients drawing, also drew in the pain areas on a separate diagram based on thorough history taking (D). After 2 to 9 days without treatment, patients repeated their pain drawings (P2). A second physiatrist input each of the pain drawings into the Pain Chart System (PCS), for comparison of pain distribution sites and areas among the three drawings. The weighted-sum of comparison algorithms was calculated for similarity determinations between drawings.

Results: The similarity values between P1 and P2, and P1 and D were 0.63±0.18 (mean±S.D.) and 0.62±0.18 (mean±S.D.), respectively, reflecting a high reliability of pain drawings.

Conclusion: High test-retest and inter-individual reliability of successive pain drawings suggest that pain drawings may be a useful tool to describe the painful sites. (J Korean Acad Rehab Med 2003; 27: 404-409)

Objective
Clinical application of Functional Electrical Stimulation (FES) was limited due to the muscle fatigue phenomenon. This study was undertaken to find an electrical stimulation frequency, which optimally improves muscle endurance in spinal cord injured rabbit.

Method: Fifteen rabbits were experimentally spinal cord injured at the T10 or T11 spinal cord level. Three kinds of stimulation frequency (10, 20, 40 Hz) and sham control stimulation were applied to the tibialis anterior muscle of each four group for 1 hour per day, for 2 weeks. Muscle fatigue index and peak torque were measured during electrical stimulation, and proportion of the type I muscle fiber was measured at ATPase (pH 9.4) staining.

Results: Complete paraplegia was obtained in all 12 rabbits. Muscle fatigue index and peak torque were not changed after 2 weeks of electrical stimulation in all four groups. The proportion of the type I muscle fiber was reduced in all four groups after 2 weeks. However, 40 Hz stimulation group showed less decline in proportion of type I muscle fiber than control or 10 Hz group.

Conclusion: High frequency electrical stimulation applied at an early stage of spinal cord injury is more effective in preserving muscle endurance than low frequency stimulation. (J Korean Acad Rehab Med 2003; 27: 410-417)

OBJECTIVE
Postural control ability is one of determinant factors of falls in older adults. The purpose of this study was to determine if age affected postural control measures in Balance Master system. METHOD: Forty-four healthy adults (22 men, 22 women) were divided into two groups; younger (20 to 29 years) and older (60 to 69 years) groups. All participants were tested by Balance Master system. A total 5 measurements were analyzed to determine the difference between older and younger group. RESULTS: Older adults demonstrated wider area of sway (o) under condition (eye closed on foam surface) in mCTSIB, low directional control (%) in slow front/back rhythmic weight shift, and low on-axis velocity (o/sec) in fast front/back rhythmic weight shift (p<0.05). Right/ Left weight symmetry (%) during sit to stand was significantly higher in older groups (p<0.05). Wider area of turn sway (o) and longer turn time (sec) during step/ quick turn were demonstrated in older groups (p<0.05). CONCLUSION: The results showed that the postural control ability measured by Balance Master system was reduced in the older adults. Further studies should be carried out to correlate this reduction with the falls in healthy elderly.

Objective
To measure the lumbar segmental range of motion (ROM) with 3-dimensional motion analysis system and compare the results with radiologic ROM measurements.

Method: Ten healthy adult volunteers were included. We attached surface markers at the corresponding skin surface of each lumbar vertebral bodies and measured lumbar segmental ROM in flexion-extension, right bending, left bending, axial rotation with 3-D motion analysis. We compared some of the results with radiologic segmental ROM measurements.

Results: In 3-D motion analysis, segmental ROM of flexion and extension, right bending, left bending, right rotation, left rotation were, respectively: 10.1^o, 45^o, 3.5^o, 1.7^o and 1.9^o (L1-L2); 17.9^o, 6.2^o, 5.1^o, 1.4^o and 1.1^o (L2-L3); 15.0^o, 7.2^o, 4.9^o, 2.1^o and 1.1^o (L3-L4); 14.9^o, 5.8^o, 4.6^o, 1.7° and 1.6° (L4-L5); 10.6^o, 4.9^o, 3.8°, 2.6° and 0.8° (L5-S1). There was no statistically significant difference in segmental ROM between 3-D motion analysis measurements and radiologic measurements except L5-S1 right bending, L2-L3 and L5-S1 left bending. No statistical significant difference in lumbar flexion and bending ROM was found between two methods.

Conclusion: 3-D motion analysis is a useful method when measuring the lumbar segmental range of motion and it has an advantage to analyze segmental lumbar motion with three directions simultaneously. (J Korean Acad Rehab Med 2003; 27: 424-432)

Objective
To compare the plantar peak pressure of diabetic patients without neuropathic and ischemic symptoms to normal subject wearing diabetic shoes and to compare the plantar peak pressures of P.W. minor (B) shoes to Apex (A) shoes.

Method: Thirty three normal subjects and fourteen diabetic patients were participated. Plantar peak pressures in shoes were measured by pedar^Ⱂ during a comfortable gait wearing two types of diabetic shoes, respectively. A shoes and B shoes were used in this study. Plantar pressure was analyzed by pedar C-expert program at T0 (whole foot), M1 (heel), M2 (midfoot), M3 (1st, 2nd metatarsal area), M4 (3rd, 4th, 5th metatarsal area), M5 (great toe), M6 (2nd, 3rd toe area) and M7 (4th, 5th toe area) zones respectively.

Results: Plantar peak pressures of diabetic patients without neuropathic and ischemic symptom were not different from normal subjects. In normal subjects, plantar peak pressure of B shoes were lower than A shoes at both T0, M3 and M5 zones and left M6 and M7 zones. Plantar peak pressures of A shoes was lower than B shoes at both M2 zones. In diabetic patients plantar peak pressures of B shoes was lower than A shoes at right M4 and left M5 zones.

Conclusion: There was no sgnificant difference between plantar peak pressures of normal subjects and diabetic patients without neuproathic and ischemic symptom. B shoes were better than A shoes to reduce plantar peak pressure. (J Korean Acad Rehab Med 2003; 27: 433-437)

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a frequent complication of severe head trauma. Fluid restriction is treatment choice of SIADH in patients with traumatic brain injury (TBI), but fluid restriction is limited because they need sufficient calories. We described a patient who, on the four months after a head injury, presented with deterioration of consciousness, which coincided with the development of the SIADH, and which rapidly reversed with the correction of the hyponatremia by demeclocycline with minimal fluid restriction. We suggest that SIADH should be included in the differential diagnosis of deterioration of consciousness during the recovery period of the patients suffering from head injury because unexpected clinical deterioration may often have a reversible cause. Also, demeclocycline will be useful, which allows for increased fluid liberalization and for provision of adequate calories, in the treatment of the SIADH in patients with TBI. (J Korean Acad Rehab Med 2003; 27: 438-441)

We wanted to report three cases of bruxism who were intractable to conventional management such as dental protection or medication but responded to motor point blocks (MPB) with botulinum toxin-A (BTX-A) on mastication muscles. Untreated, bruxism causes unfavorable complications of masseter hypertrophy, headache, temporomandibular joint destruction, and furthermore total dental wear and malnutrition. Our three patients had no previous history of bruxism or any neuromuscular disorder. They were presented with decreased cognitive function and severe bruxism about 6 months after brain injury. We managed the patients with MPB of BTX-A on each masseter and temporalis muscles. Bruxisms were markedly improved about 2 weeks after MPB without any complications. On follow-up 6 months after MPB, two of three patients remained free of bruxism and another patient revealed attenuated bruxism with decreased severity and frequency. Therefore, we think that MPB with BTX-A could be considered as a treatment option for severe bruxism in brain-injured patients. (J Korean Acad Rehab Med 2003; 27: 442-445)

We present four pediatric cases examined by diffusion tensor MRI (DTI) to investigate microstructural abnormalities of brain related to their neurologic disability and motor weakness, following absence of any remarkable lesion on the motor pathway in conventional MRI. DTI is a relatively novel MR technique that enables investigation of the orientation and integrity of white matter fiber tracts of the brain in vivo. Case 1, 2 and 3 had suffered from cerebral palsy and case 4 had developed left hemiparesis

after a traumatic brain injury. Conventional brain MRI presented no specific abnormality in case 1 and 2, a focal encephalomalacia in the left anterior thalamus in case 3, and contusional hemorrhages in the left temporal and parietal lobes in case 4. But DTI disclosed microstructural abnormalities on descending motor pathway including the posterior limb of the internal capsule or the cerebral peduncle of the midbrain in all cases. (J Korean Acad Rehab Med 2003; 27: 446-450)

The spontaneous spinal epidural hematoma is rare, but the severe and permanent motor disability underlines its importance. The clinical picture begins with a local spinal and radicular pain but some hours or days later progressive neurologic symptoms develop. The standard treatment for spinal epidural hematoma has been a prompt surgical evacuation. We reported two cases of spontaneous spinal epidural hematoma which had no underlining conditions. The neurological deficit progressed to complete paraplegia despite of an early operation in one case of hematoma located in T2,3 level, whereas another case in T10 to L2 level showed complete paraplegia at the initial evaluation but good functional recovery after the operation. The outcomes seemed to be dependent mainly on the location of hematoma in the spinal cord. So early diagnosis and prompt surgical treatment are critical to the patient with hematoma located in the upper thoracic level and progressive neurological deficit. (J Korean Acad Rehab Med 2003; 27: 451-454)

A mother-in-law and a daughter-in-law suffered chronic low back pain and they were injected epidural steroid on same day. Eleven days after injection, the daughter-in-law showed weakness of right lower extremity and lost filling sensation of bladder. Radiologic findings of Magnetic Resonance Imaging for lumbar spine revealed epidural abscess encompassing from L1 to sacral spine. After emergency surgical procedure and antibiotics therapy, the symptoms and the signs disappeared. Seven days after injection, the mother-in- law was diagnosed as pyogenic arthritis of right knee joint and then epidural abscess. Although the surgical procedure for right knee joint and antibiotics therapy were done, the epidural abscess didn't disappear. Moreover, surgical procedure for the epidural abscess couldn't be done due to septic condition, which was the cause of death. We report two cases of epidural abscess showing the importance of early management and serious end result. Prevention of these complication through extreme caution is needed. (J Korean Acad Rehab Med 2003; 27: 455-458)