Method: Forty two chronic stroke patients were enrolled and classified into two groups, experimental and control group. The experimental group took CIT for 2 weeks. CIT consisted of restraint of the unaffected upper extremity with massive training of the affected upper extremity. The motor function of patient's upper extremity was assessed by Manual Function Test (MFT) and Jebsen Hand Function Test before treatment, at 2 weeks and at 8 weeks after the treatment.
Results: The withdrawal rate was 46.7% during CIT period. There was substantial significant improvements in MFT and Jebsen Hand Function Test after 2 weeks of treatment in the experimental group (p＜0.05). The effects in the experimental group were maintained at 6 weeks after cessation of the treatment.
Conclusion: CIT is considered to be an effective treatment for motor function of the chronic hemiplegic upper extremity motor function, and will be useful as an additional therapeutic tool. (J Korean Acad Rehab Med 2003; 27: 813-818)
Method: 20 hemiplegic patients (right: 10, left: 10) were evaluated LSST in resting position at three different points (T2-Superior Angle, T3-Scapular Spine, T7-Inferior Angle) in three times of the both shoulder. Muscle power of shoulder, Brunnstrom stages, spasticity, subluxation degrees using X-ray studies and ROM pain degrees using Visual Analog Scale (VAS) were also evaluated to examine the clinical correlation.
Results: This study showed the evidence of positive correlation with LSST and shoulder subluxation, ROM pain degrees using VAS at T7-inferior angle (p＜0.05), and negative correlations with LSST with shoulder abduction muscle power and Brunnstrom stage. But, there were no correlations with shoulder spasticity and hemiplegic side.
Conclusion: This study provided LSST can be a useful predictor of shoulder subluxation and it supposed that the glenoid fossa on the affected side was upward rotated compared to the unaffected side. (J Korean Acad Rehab Med 2003; 27: 819-823)
Method: Twenty-one subjects with chronic stroke were participated in this study. All subjects were indoor ambulators. The hemiplegic knee flexors and extensors of the experimental group (n=11) were trained eccentrically using Cybex 770 dynamometer 3 times a week for 6 weeks. Conventional rehabilitation treatment was administrated to the control group at the same duration and frequency as the experimental group. Total peak torque, total work and functional parameters were measured before and after training.
Results: Significantly higher mean percent changes of peak torque and total work were observed in the experimental group compared to the control group at all eccentric angular velocities tested. Functional parameters also showed significant improvements in the gait speed, a timed stair climb up and down, and sit-to-stand time compared to the control group (p＜0.05).
Conclusion: The isokinetic eccentric strengthening training of knee extensors and flexors in patients with chronic hemiplegia were useful in strengthening the affected leg and functional improvement. (J Korean Acad Rehab Med 2003; 27: 824-829)
Method: Fifty subjects with brain injury were enrolled and classified into two groups, experimental (n=25) and control group (n=25). Control group received conventional reha bilitation therapy including physical and occupational therapy. Experimental group received additional computer- assisted cognitive training using CogRehabKⰒ software consisted of 10 level-completing programs, 3 times per week, 30 minutes per session, for 4 to 6 weeks. All patients were assessed their cognitive functions using Seoul Computerized Neuropsychological Test (SCNTⰒ, Maxmedica, 2001), minimental status examination (MMSE), digit span, and Wechsler memory scale before and after treatment. Functional independence measure and geriatric depression scale were also applied for evaluation of functional and mood status.
Results: Before the treatment, two groups showed no difference in their cognitive functions. After 4 to 6 weeks of treatment, the experimental group showed significantly higher performance in forward digit span, forward visual span, auditory continuous performance test, and visual continuous performance test in CNT and MMSE than control group (p＜0.05).
Conclusion: We conclude that the CogRehabKⰒ may be useful as an additional tool for the cognitive rehabilitation in patients with brain injury. (J Korean Acad Rehab Med 2003; 27: 830-839)
Method: Subjects were 89 patients with aneurysmal SAH who were undergone craniotomy and clipping of aneurysm. We evaluated the relationship between the incidence of seizure and the use of antiepileptic drug. And we sought to identify putative risk factors associated with seizure after SAH.
Results: Ten patients (11.2%) had one or more epileptic seizures. One patient had only preoperative seizure and nine patients including four patients who had prehospital or preoperative seizure developed seizures during follow up after surgery. All but two of these nine patients were receiving an antiepileptic drug at the time of seizure. Blood samples for antiepileptic drug plasma levels were taken more than once in 81 patients. Of total blood samples, therapeutic serum levels were achieved in 73.5% of the seizure group and in 68.6% of the no-seizure group (p＞0.05). Drug- related side effects occurred in 22.5% (20/89). Significant risk factors for seizure included early seizure (4/5) and rebleeding after surgical clipping of aneurysm (2/3).
Conclusion: We think that the preventive effect of anticonvulsant drug on late seizure is unclear in patients with aneurysmal SAH. (J Korean Acad Rehab Med 2003; 27: 840-844)
Method: The subjects comprised 113 patients with cerebral palsy in Holt Ilsan Home. We performed the previous medical history review, the physical examination, and investigated the functional independency with modified Barthel index. Result was compared between over the 20-years-old age group and the younger age group.
Results: Patients in older age group had more contractures of one or more joints in 67.4%, subluxations in 19.0% and dislocations in 8.1%. The modified Barthel index scores of older age group was significantly higher than juvenile group, and significantly lower within mixed type and quadriplegic type group. Patients in older age group with microcephaly were significantly lower than those with hydrocephalus or seizure, and those without microcephaly, hydrocephalus, or seizure were significantly higher.
Conclusion: These results showed that older-aged cerebral palsy in rehabilitation had more musculoskeletal complications and higher functional status than the younger group. The musculoskeletal complication and associated disease like microcephaly significantly affected the activities of daily living. Therefore, a detailed long-term follow-up study with more medical attention is needed. (J Korean Acad Rehab Med 2003; 27: 845-849)
Method: The study included 27 children with hemiplegic cerebral plasy and 12 normal control group who were taken Bell-Thomson's view x-ray for measuring of leg length. The patient group was divided into the group with LLD and the group without LLD. Then we evaluated the relationship between the rate of leg length shortening (LLS) and clinical factors.
Results: Of the total 27 cerebral palsy children, 18 children (66.7%) had LLD, whose average rate of LLS was 2.0 percent. Nine children didn't have LLD, whose average rate of LLS was 0.6 percent. There was no specific relationship between the rate of LLS and the age, muscle power or spasticity, but there was negative correlation between the rate of LLS and the score of gross motor functional measure (GMFM).
Conclusion: It is necessary to define the LLD in children with hemiplegic cerebral palsy by the rate of LLS and to be concerned about the LLD due to its possible correlation with poor functional outcome. (J Korean Acad Rehab Med 2003; 27: 850-854)
Method: Eighteen children with spastic diplegic cerebral palsy participated in this study. Gait patterns on sagittal plane were studied before and at average 3.5 years after SPR. Kinematic and temporospatial data were obtained by the VICON 370 system.
Results: The spasticity of hip adductor and ankle plantarflexor were improved significantly after SPR. The maximal angle of pelvic tilt, ankle dorsiflexion angle at initial contact, peak ankle dorsiflexion angle during stance phase, at toe-off and during swing phase, mid-range point of flexion-extension motion on ankle were significantly improved after SPR. The temporospatial data tended to improve after SPR at long-term follow up.
Conclusion: The SPR reduced spasticity and the gait patterns were improved in children with spastic diplegic cerebral palsy at long-term follow up. (J Korean Acad Rehab Med 2003; 27: 855-861)
Method: The subjects comprised 83 patients with CP. We analyzed the brain MRI findings such as periventricular leukomalacia (PVL), brain atrophy, infarction or hemorrhage, basal ganglia lesion, migration anomaly and delayed myelination with consideration of clinical subtypes of CP.
Results: Of the 83 MRI findings, 69 abnormalities (83.1%) were the followings; PVL in 47 cases{17 spastic diplegics (SD), 17 spastic quadriplegics (SQ), 5 spastic hemiplegics (SH), 4 atonic or hypotonic quadriplegics, 2 ataxic quadriplegics and 2 mixed quadriplegics (MQ)}, brain atrophy in 6 cases (3 SQ, 1 SD, 1 SH and 1 MQ), infarction or hemorrhage in 7 cases (5 SH and 2 SQ), migration anomaly in 2 cases (1 SQ and 1 SH), delayed myelination in 3 cases (2 SQ and 1 SH) and basal ganglia lesion in 4 cases (3 MQ and 1 atonic quadriplegic). 33 cases of 47 PVL and 2 cases of 6 brain atrophy were preterm CPs. There was no difference in severity of CP between preterm and fullterm CPs.
Conclusion: The results of this study would be helpful in estimating the brain lesions in various clinical subtypes of CP. (J Korean Acad Rehab Med 2003; 27: 862-867)
Method: Fourty-one patients with CP underwent MRI and SPECT of the brain. The patients were divided into 5 groups. Group 1 was for the cases with normal findings on MRI and SPECT, group 2 for abnormal on MRI but normal on SPECT, group 3 for normal on MRI but abnormal on SPECT, group 4 for abnormal findings on both MRI and SPECT with same abnormal lesion and group 5 for abnormal findings on both MRI and SPECT but with different abnormal lesion.
Results: In group 2, periventricular leukomalacia (PVL) and cortical atrophy were shown on MRI. In group 3, decreased blood flow at cerebellum was shown on SPECT. In group 4, brain atrophy on MRI and the decreased blood flow at the same site on SPECT were shown. In group 5, 15 of 22 cases with PVL on MRI and decreased blood flow at cerebellum, thalamus, basal ganglia and the cortical areas were shown.
Conclusion: Brain SPECT was more sensitive in the detection of cerebellum, thalamus and cortical blood flow abnormality. MRI was more sensitive in demonstration of white matter lesion. (J Korean Acad Rehab Med 2003; 27: 868-874)
Method: 34 spinal cord injured male patients were participated in this study. We measured the maximal detrusor pressure, compliance of detrusor, involuntary detrusor reflex and urethral pressure by urodynamic study. And we induced ejaculatory stimulation by vibratory (FerticareⰒ) and electrical stimulation (SeagerⰒ) and analyzed the sperm volume, the concentration, the total sperm count, the motile sperm count and motility. Analysis of variance (ANOVA) and paired t-test were used to compare sperm quality among groups of urodynamic parameters.
Results: Semen quality such as sperm concentration, sperm volume, motile sperm count was significantly (p＜0.05) better in patients with low maximal detrusor pressure, high detrusor compliance, normtonic urethral pressure than with high maximal detrusor pressure, low detrusor compliance, hypertonic urethral pressure, regardless of involuntary detrusor reflex.
Conclusion: The proper management of neurogenic bladder for improving semen quality in spinal cord injured male patients may be needed for better pregnant outcomes. (J Korean Acad Rehab Med 2003; 27: 875-879)
Method: To determine the baseline differences, thirty three patients were classified into two groups: cord injured level above T9 and from T9 to L2. And thirteen patients were included in follow-up study to evaluate the effects of 4 weeks electrical stimulation.
Results: There was no significant difference in the baseline colon transit time on two groups. After electrical stimulation, the left and rectosigmoid transit time was more improved in lower level injured group comparing with upper level injured group. In the rectoanal manometry the mean resting anal pressure, mean squeezing pressure, high pressure zone, and threshold of rectoanal inhibitory reflex were increased after the electrical stimulation on two groups. And the mean squeezing pressure on T9-L2 injured patients was significantly increased (p＜0.05).
Conclusion: The elecrical stimulation to the sacral dermatomes increased the mean squeezing pressure of rectoanal manometry more significantly on the T9-L2 injured patients than the group of spinal cord injured level above T9. However, there was no statistically significant difference in the colon transit time before and after the electrical stimulation between two groups (J Korean Acad Rehab Med 2003; 27: 880-885)
Method: Fifteen subjects who had participated in 4 weeks small group counselling and twenty subjects, who had participated in simple sexual rehabilitation education were enrolled among among spinal cord injury couples. Direct interview was conducted. Visual analogue scale, Time trade off, Hospital anxiety and depression, and Beck depression inventory were used as quality of life indexes. Sexual Interest, Activity and Satisfaction was used as a sexual adjustment measure.
Results: The sexual adjustment index was very significantly positively correlated with all 4 indexes of the quality of life. The couples of the small group counselling had significantly higher sexual adjustment index than the simple education group. Satisfaction for small group counselling was also higher.
Conclusion: To improve the quality of life for spianl cord injury couples, sexual adjustment level must be improved. Systematic sexual rehabilitation program such as small group counselling may be better solution than simple sexual rehabilitation education program. (J Korean Acad Rehab Med 2003; 27: 886-893)
Method: The subjects were included 26 patients with spinal cord injury and 22 healthy men. We measured serum osteocalcin and urine deoxypyridinoline (DPYD) in 2 hours after awakening and measured BMDs in lumbar vertebrae, femur, and distal forearm in patients and control group. The patients were 21 men, 5 women, mean age 43.2⁑14.3 years, and mean duration 28.3⁑45.0 months, who were divided by injury level and injury severity respectively.
Results: The biochemical markers of bone metabolism in patients group had significant differences comparing to control group (p＜0.05). The urine DPYD and BMDs in femur showed significantly negative correlation with the duration of spinal cord injury (p＜0.05).
Conclusion: In patients with spinal cord injury, urine DPYD and BMDs in femur had significant correlation with the duration of injury. But, the injury level and injury severity had no significant correlation with the markers of bone metabolism and BMDs. (J Korean Acad Rehab Med 2003; 27: 894-898)
Method: Thirteen cases with stage IV pressure ulcers (according to the National Pressure Ulcer Advisory Panel, 1989) were enrolled for the study. Seven cases were treated with Ulmus and 6 cases were treated with wet gauze as a control group. The sizes and stages of pressure ulcers were evaluated every 2 week for 12 weeks.
Results: After 12 weeks, the size of pressure ulcers decreased from 78.17⁑47.77 cm3 to 8.14⁑13.17 cm3 (mean⁑S.D., n=7) in Ulmus treated group, whereas from 62.10⁑40.89 cm3 to 36.69⁑36.23 cm3 (mean⁑S.D., n=6) in wet gauze treated group. The size of pressure ulcers decreased more significantly (p＜0.05) in Ulmus treated group than wet gauze dressed group. Among seven cases treated by Ulmus, 2 cases completely healed, 3 cases improved to stage II, and 2 cases remained to stage IV, whereas among 6 cases treated by wet gauze, 1 cases improved to stage II, 1 case to stage III, and 4 cases remained to stage IV.
Conclusion: Ulmus was more effective in management of pressure ulcers than wet gauze. We suggest that Ulmus can be used as a useful method of conservative treatment for the stage IV pressure ulcers. (J Korean Acad Rehab Med 2003; 27: 899-905)
Method: The sixty eight patients with documented CTS in outpatient clinic from January, 2000 to June, 2001 were included (9 male, 59 female, averaged age 50.0⁑8.8 years). We evaluated the severity of symptom, functional status of ADL with the Levine' questionnaire, and clinical severity with 3 kinds of examination (thenar atrophy, sensory change, and Phalen's test). The electrodiagnostic severity was classified according to Stevens' classification and compared with the severity of symptom, functional status, and clinical severity.
Results: The electrodiagnostic severity was classified into three degrees. Five patients (7.4%) were classified into mild degree, 32 patients (47.1%) moderate degree, 31 patients (45.6%) severe degree. The average of severity of symptom scores were 28.4⁑8.5, 31.8⁑7.4, and 31.8⁑9.1 respectively, and there was no significant difference (p＞0.05) between the groups. Functional status scales were 14.2⁑6.7, 15.6⁑5.4 and 18.9⁑7.0 respectively and no significant difference (p=0.07) but there was a tendency that the severer was electrodiagnostic severity, the more decreased functional status scale. The clinical severity showed a significant correlation with the electrodiagnostic severity (p＜0.05).
Conclusion: The electrodiagnostic severity has a significant correlation with the clinical severity, but not with the severity of symptom, the functional status in CTS. (J Korean Acad Rehab Med 2003; 27: 906-911)
Method: Subjects were 22 patients with AVF in patients with CRF and 10 controls without AVF in patients with CRF. We studied nerve conductions, and compared the findings in the arms with fistula and without fistula, and the arms in controls.
Results: In ulnar motor nerve conduction study, the amplitude in fistula side was lower than non-fistula side, but the conduction velocity in non-fistula side was lower than fistula side. In radial motor nerve conduction study, the distal latency in non-fistula side was more delayed than that in fistula side. There were no statistical significancies between fistula side and non-fistula side in the other nerve conduction study parameters in arms. And there was no statistically different incidences of carpal tunnel syndrome in both sides. Comparing with controls, conduction velocities of ulnar and radial motor nerves and peak latencies of ulnar and radial sensory nerves were more delayed in both sides.
Conclusion: There were no significant local effects of arteriovenous fistula on nerve conductions in patients with chronic renal failure. (J Korean Acad Rehab Med 2003; 27: 912-916)
Method: Twenty healthy adult volunteers (male 10, female 10) participated in this study. The oropharyngeal swallowing was investigated using electrophysiologic method of Ertekin's. Simultaneous recording of surface electromyographic potentials at submental muscles and laryngeal movement using piezoelectric sensor was performed during swallowing. The 2, 5, and 10 cc of water at 90-degree upright and 30-degree flexed head positions were used for evaluation. We recorded five parameters; swallowing reflex time, total duration, amplitude and rise time of SM muscle contraction, and laryngeal relocation time.
Results: The mean swallowing reflex time of 2 cc water at upright and flexed neck positions were 489⁑86.7, 462.1⁑70.7 msec, respectively. There were no significant differences in swallowing reflex time, total duration, amplitude and rise time of submental muscle contraction, and laryngeal relocation time among various conditions (p＞0.05). Only ampli tude of submental muscle was lower in female than male subjects regardless of volume and neck position (p＜0.05).
Conclusion: The water volume and position changes of head and neck did not influence on electrophysiologic parameters of swallowing in healthy adults. (J Korean Acad Rehab Med 2003; 27: 917-921)
Method: Ten subjects were investigated using either 20 Hz or 1 Hz rTMS. To reduce inter-individual variability, we explored same subject in one week interval with different frequency. TMS was conducted with intensity of 90% of motor threshold. The effect of rTMS with EMG amplitude evoked in First Dorsal Interossei by TMS. Test motor evoked potentials were evaluated with intensity of 110% of motor threshold before rTMS, during the interval and immediately, 5 minutes, 20 minutes after the end of train.
Results: The analysis showed a significant decrease of cortical excitability after 1 Hz rTMS and an increase after 20 Hz rTMS. In low-frequency, Motor Evoked Potential (MEP) amplitude decreased quickly after initial 300 pulses stimulation. In high-frequency, there were some variation of individual MEP in the response to rTMS. The changes of MEP amplitude after 1200 stimulation continued until 20 minutes.
Conclusion: These results provided basic evidence of rTMS for modulation of cortical excitability and could be further applied in patients group. (J Korean Acad Rehab Med 2003; 27: 922-927)
Method: From July, 2001 to June, 2002, twelve patients who had calcaneal fractures with persistent foot pain and paresthesia were included in our study. We examined electromyography for medial and lateral plantar nerve, inferior calcaneal nerve, also evaluated types of calcaneal fracture and severity of pain and disability with nerve injury.
Results: The intraarticular types were 13 cases, extraarticular type was 1 case and communited types were 2 cases. In the electromyographic findings, the 9 cases were diagnosed as neuropathy. In a cases with neuropathy, 8 persons complained over moderate degree of pain and all persons complained over moderate degree of walking disability. However one of three persons without neuropathy complained over moderate degree of walking disability. So disability tended to be more severe in cases with neuropathy.
Conclusion: We think that neuropathy associated with calcaneal fracture is a cause of aggravation of pain and walking disability, and electromyography for nerves of foot will be needed in the calcaneal fracture. (J Korean Acad Rehab Med 2003; 27: 928-934)
Method: One millimeter of three proliferant solutions (20% dextrose water-group A, 5% dextrose water mixed with NaCl-group B, NaCl solution-group C) with the same osmolarity (1,110 mOsm) was injected around the right Achilles tendon of each rat, whereas the left was not injected to be used as control. After six weeks of injection, the injected tendons and controls were obtained. The transverse diameter of gross specimen, the count of fibroblasts on light microscope, and the findings of cross- sectional analysis using electron microscope were compared.
Results: Overall, transverse diameter and the count of fibroblasts increased in the injected specimens compared to controls, however, their significant differences were demonstrated only for the two groups injected with dextrose containing solutions (p＜0.05). However, A and B groups did not show significant differences in all parameters investigated. On electron micrograph, fibril diameters of solution- injected tendon consisted of either extremely large or small sizes with the limited intermediate sizes.
Conclusion: Although high osmolar solution could increase the transverse diameter and fibroblast counts, however, dextrose-containing solution was much more effective as a proliferant solution. (J Korean Acad Rehab Med 2003; 27: 935-940)
Method: We retrospectively reviewed the medical records and radiographs of all patients with idiopathic scoliosis seen in our institution from March, 1997 to February, 2002. Inclusion criteria in this study included a diagnosis of adolescent idopathic scoliosis, with no history of back pain before brace prescription, with Cobb's angle 15-degree or more. All subjects were educated to do scoliosis correction exercise, educated for correct posture, and to wear the orthosis over 22 hours per day, even during sleeping.
Results: Forty-nine subjects were reviewed, treated with the orthosis. We found that pain regions occurring after institution of modified Boston orthosis were chest wall (contacting with pad), lower back, neck and pelvis orderly. We also found that aggravation of Cobb's angle in patients with pain more than without pain, but any disease was not found in the former.
Conclusion: There were no serious conditions with the patients who had the pain after institution of the modified Boston orthosis, but the pain was often associated with curve progression in adolescent idiopathic scoliosis patients. (J Korean Acad Rehab Med 2003; 27: 941-945)
Method: Sixty patients with knee osteoarthritis were enrolled and divided into the control (n=30) and wedge (n=30) groups. The control group received only conventional therapy for 5 weeks, while the wedge group took lateral wedges with 4 mm height in additional to the same conventional therapy. Intensity of pain and funtional activity were assessed by Western Ontario and Mac-Master Universities Osteoarthritis index (WOMAC index) and Lequesne´s index. Scanogram was measured to assess femorotibial angle change. WOMAC index, Lequesne's index and scanogram were measured before and 6 months after the therapy.
Results: For the wedge group, WOMAC index and Lequesne's index were significantly lower at the six month follow up compared to the initial indices (p＜0.05). The femorotibial angle showed no significant change in both groups.
Conclusion: Lateral heel and sole wedges can be used as an effective therapeutic modality for long term management of knee osteoarthritis in combination with conventional therapy. (J Korean Acad Rehab Med 2003; 27: 946-951)
Method: The sagittal kinematic and temporospatial data of ramp and level walking were obtained by a motion analyzer for ten healthy young adults.
Results: Compared with the values of level walking, the range of motion of ankle at all degrees for up-hill walking and the ROM of hip at 20o down-hill and all degrees for up-hill walking were significantly different (p＜0.05). The peak dorsiflexion of ankle at 20o of up-hill and at 20o down-hill walking increased significantly (p＜0.05) and peak plantar flexion of ankle at all degrees of up-hill walking increased significantly (p＜0.05). The peak flexion of knee at 20o of up-hill walking increased significantly (p＜0.05) and peak extension of knee at 20o of up-hill and down-hill walking also increased significantly (p＜0.05). The peak flexion angles of hip at all degrees for up and down-hill walking were significantly different (p＜0.05) and peak extension angles of hip at 10o of up-hill walking increased significantly (p＜0.05). The temporospatial data showed no significant difference.
Conclusion: Ramp walking showed a different kinematic gait pattern. So, this study may be useful to evaluate the effect of gait training on the ramp and pathologic gait patterns. (J Korean Acad Rehab Med 2003; 27: 952-957)
Method: Three dimensional gait analysis was performed in 19 unilateral below-knee amputees and 20 controls. Measured gait parameters were temporal parameters and kinematic and kinetic parameters at hip, knee and ankle joints. Gait parameters obtained from amputated limbs were compared with those of sound limbs and control group.
Results: There were no significant differences in temporal parameters among 3 limbs. In amputated limbs, degree of knee flexion and knee extension moment in stance phase were less than sound limbs and control group. In addition, timing of peak knee extension moment occurred later. Also, timing of ankle plantar flexion in loading response and preswing phase occured later, and degree of ankle plantar flexion in preswing phase were less in amputated limbs compared to other limbs. Peak plantar flexion moment in amputated limbs were less than sound limbs, but not than control group.
Conclusion: This study suggested that most significant gait abnormalities in unilateral below-knee amputees were observed at the knee and ankle joint in amputated limbs. (J Korean Acad Rehab Med 2003; 27: 958-963)
Method: Thirty eight healthy subjects and twenty seven pes cavus cases were evaluated by radiologic measurements. We evaluated the criteria for longitudinal arch curve by measuring the calcaneal pitch, talocalcaneal angle, talometatarsal angle, metatarsal angle and navicular height I and II.
Results: By comparing the pes cavus with the control group, no significant differences in the talocalcaneal angle, metatarsal angle and navicular height I and II were found. Whereas we found a significant difference between the talometatarsal angle and calcaneal pitch. Talometatarsal angle is more sensitive and specific compared to the calcaneal pitch.
Conclusion: In diagnosis of idiopathic pes cavus, talometatarsal angle is more reliable in the diagnosis of pes cavus. The ultimate diagnostic value of talometatarsal angle in pes cavus is 6o. (J Korean Acad Rehab Med 2003; 27: 964-967)
Method: Epidural block with blind approach has been done for the patients who suffered from lower back pain with radiating pain due to spinal disorders. Conventional blind approaches using the glass syringe (control group) and the newly invented instrument (experimental group) were applied to each 30 patients, respectively. Epidurography was used for the confirmation to conclude success or not.
Results: Two cases were failed in the control group. One case showed injected contrast media in the interspinal ligament, another case revealed dura-puncture. But there was no failure in the experimental group. The mean time from skin-penetration to epidurography was 299.7⁑13.6 second in control group and 184.0⁑16.3 second in experimental group. The mean time from changing to glass syringe (control group) or epidural detector (experimental group) to epidurography was 146.0⁑14.0 second in control group and 60.0⁑7.0 second in experimental group. The time for epidural block was much less in experimental group (p＜ 0.001).
Conclusion: This newly invented epidural detector could make the epidural block easier, safer, and faster. We suggest this instrument is useful complementary method for spinal epidural procedure. (J Korean Acad Rehab Med 2003; 27: 968-973)
Method: Fourteen iliolumbar ligaments of seven human cadavers were dissected and measured distance from the lumbar spinous process to the iliolumbar ligament and vertical depth of iliolumbar ligament from the skin surface.
Results: All 14 iliolumbar ligaments were originated at the L5 transverse process and inserted in anterior surface of the iliac crest. Direct distance from lumbar spinous process to the origin siteof the iliolumbar ligament was 7.67⁑0.39 cm (distance from the spinous process to presumed skin point of the termination site of the ligament, 6.71⁑0.4 cm). Vertical depth from skin surface was 3.94⁑0.57 cm to the origin site of the iliolumbar ligament, and 3.67⁑0.54 cm to the termination site of the iliolumbar ligament.
Conclusion: The iliolumbar ligament was deep seated anatomical structure in the lumbosacral region. Superficial landmark of the lumbar spinous process may be useful in approach to iliolumbar ligament. (J Korean Acad Rehab Med 2003; 27: 974-977)
Method: We retrospectively reviewed the clinical characteristics and VFSS findings in thirteen patients with esophageal cancer and stricture. Videofluoroscopic parameters of oral, pharyngeal, and esophageal phases were measured. Patients were divided into three groups according to their diseases: Group A, esophageal cancer with esophagectomy (5 patients); Group B, esophageal cancer with non-operative treatment (3 patients); and Group C, esophageal stricture with surgical treatment (5 patients).
Results: Group A had vocal cord palsy (VCP) after esophagectomy, and all patients showed poor laryngeal closure and aspiration during swallowing. Group B received radiation therapy prior to VFSS and showed poor laryngeal closure and high pharyngeal residue with aspiration during and after swallowing. Group C received esophagectomy with anastomosis of lower gastrointestinal tract (stomach, jejunum, colon). Most had VCP and showed high pharyngeal residue, stricture of upper esophageal sphincter, and poor oral control with aspiration during and after swallowing.
Conclusion: Characteristics of dysphagia on VFSS were poor laryngeal closure in operated esophageal cancer patients. In patients of non-operated esophageal cancer and esophageal stricture, high pharyngeal residue and poor laryngeal closure were characterized. (J Korean Acad Rehab Med 2003; 27: 978-983)
Method: The patient population consisted of 93 patients undergoing video fluoroscopic swallowing study (VFSS) to evaluate the risk of aspiration. The voice analyses were performed before and after VFSS using a portable recorder and voice analysis. The parameters included Average Fundamental Frequency (Fo), Relative Average Perturbation (RAP), Shimmer Percent, Noise to Harmonic Ratio (NHR), and Voice Turbulence Index.
Results: The patients were divided into two groups according to VFSS findings, non-aspiration group (including patients without vocal cord contact) and aspiration group (including patients with vocal cord contact). In comparing the differences of acoustic parameters before and after VFSS, all parameters except Fo were significantly different (p＜0.05). When the cut-off point was set to 0.3, the RAP was the most significant parameter given that the sensitivity was 0.911 and the specificity was 0.979. Combining RAP and NHR, the sensitivity was 1.000 and the specificity was 0.771.
Conclusion: Voice analysis is a very convenient and effective diagnostic tool in clinically evaluating the risk of aspiration. (J Korean Acad Rehab Med 2003; 27: 984-989)
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