Recently the numbers of persons with disabilities and aged are rapidly increasing every year. And the scope of persons with disabilities is much more diversified. According to the recent report of the desire for the persons with disabilities, it is noted that medical rehabilitation service is most insufficient. But compared to the numbers and needs of persons with disabilities, the numbers of medical rehabilitation facilities are still much insufficient. The important factors to be considered in rehabilitation hospital are accessibility, comprehensiveness, quality, continuity and efficiency. In Korea, the current conditions of medical rehabilitation service are as follows: 1) increase of medical rehabilitation demand, 2) shortage of rehabilitation hospital beds, 3) insufficient medical rehabilitation insurance system, 4) absence of continuum care, 5) accessibility problem etc. Considering these aspects, the government is planning to build the regional rehabilitation center each district and meet the need for persons with disabilities by the second five-year plan of the welfare for persons with disabilities. Finally I suggest some a plans to establish medical service provision system for the disabled. First of all, regional rehabilitation center should be established in each province, so as to provide better and comprehensive medical services to the disabled. Second, medical services in public and private health sector should be expanded. Third, the need for the community rehabilitation committee that links the hospital and the community should be emphasized. (J Korean Acad Rehab Med 2004; 28: 1-6)

Objective
To compare functional outcome of posterior circulation (PC) stroke with middle cerebral artery (MCA) stroke. Method: We reviewed retrospectively 2,226 records of stroke patients admitted to our hospital from June 1992 to October 2001, and selected PC stroke patients as a case with exclusion criteria; the presence of other neurological disease, the history of previous stroke, or multiple brain lesions. Also, we considered MCA stroke patients matched to a case as a control. 28 patients were selected as a case and 24 patients as a control. We compared FIM gains and efficiencies. Results: Self care FIM efficiency (0.56⁑0.45) of PC stroke was higher than that (0.43⁑0.24) of MCA stroke and sphincter FIM efficiency (0.04⁑0.10) of the former was lower than that (0.10⁑0.11) of the latter. But, we couldn't detect any difference in cognitive (0.09⁑0.14 vs. 0.14⁑0.14), motor (1.10⁑0.71 vs. 0.87⁑0.51), and total FIM efficiency (1.20⁑0.73 vs. 1.02⁑0.60). Conclusion: Our study shows the functional outcome of PC stroke previously reported as controversial or rather poor result is favorable like that of MCA stroke, under active rehabilitation intervention. And so we think that comprehensive rehabilitation management is needed for functional regain even in patients with PC stroke. (J Korean Acad Rehab Med 2004; 28: 7-12)

Objective
To investigate chronological change of uninvolved hand function in hemiplegic patients and to assess any correlation between the improvement in Jebsen hand function test (JHFT) and modified Barthel index (MBI) and between the improvement in hand power and modified Barthel index. Method: JHFT, MBI and hand power measurement were done twice on twenty hemiplegic patients. Initial test were done after 36.5⁑18.2 days from onset and follow-up interval were 28.2⁑7.2 days. Results: We could find statistically significant time shortening in JHFT (p＜0.01) and power increment (p＜0.05) of uninvolved hands. None of MBI was normalized except for feeding. Majority were not normalized in JHFT. Patients who improved in stacking checkers in JHFT and in lateral pinch power showed improvement in total MBI score. But any correlation between the improvement in other items of JHFT and each items of MBI and between the improvement in hand power and each items of MBI were not found. Conclusion: Not normalized uninvolved hand function of the majority in the follow-up test proved the necessity of active rehabilitation on the uninvolved hand in acute stage. Generally there was no correlation between the improvement in JHFT and MBI, and between the improvement in HP and MBI. (J Korean Acad Rehab Med 2004; 28: 13-19)

Objective
To determine whether insufficient weight- bearing on the hemiparetic side has a correlation with the degree of stiff-knee gait in hemiplegic patients. Method: Fifty hemiplegic patients were included. In all patients, 3-dimensonal gait analysis and static and dynamic foot pressure measurements were taken. The degree of stiff-knee gait was evaluated using the peak knee flexion angle and the knee flexion slope at toe-off in hemiplegic limb. The degree of weight-bearing was evaluated using the percentage of hemiplegic foot pressure and pressure-time integration on the non-hemiplegic side. Results: The static and dynamic mean pressure ratios and pressure-time integration ratio were statistically correlated with peak knee flexion angle and knee flexion slope (p＜0.01). Conclusion: As a result, insufficient weight-bearing had a correlation with the degree of stiff-knee gait in hemiplegic patients. Insufficient weight-bearing should be further investigated to determine whether it is one of the characteristic findings of stiff-knee gait, or another cause of stiff-knee gait. (J Korean Acad Rehab Med 2004; 28: 20-25)

Objective
The purpose of this study was to compare the reduction of shoulder subluxation radiologically using two types of extension arm sling. Method: Fifteen patients with a hemiplegic shoulder subluxation were studied. Two types of extension sling (forearm cuff type and humeral cuff type) were applied for the shoulder subluxation. On the shoulder X-ray, three parameters were measured: vertical distance (VD), horizontal distance (HD), and joint distance (JD). Results: The mean values of the VD, HD, and JD of hemiplegic shoulder without a sling were 2.00⁑0.69 cm, 2.69⁑0.45 cm, and 1.53⁑0.56 cm, respectively, which were reduced to 1.00⁑0.43 cm, 2.61⁑0.46 cm, and 0.80⁑0.37 cm by a forearm cuff type and to 1.80⁑0.83 cm, 2.60⁑0.45 cm, and 1.33⁑0.66 cm by a humeral cuff type. A forearm cuff type showed corrective effect in VD and JD, but a humeral cuff type did not in any of three parameters. When compared with nonhemiplegic side, there was no significant difference in VD and JD with a forearm cuff. But a humeral cuff showed significant difference in all parameters. So a forearm cuff type showed corrective effect this time. Conclusion: A forearm cuff type extension arm sling was a more effective orthosis for the reduction of the hemiplegic shoulder subluxation than a humeral cuff type extension arm sling. (J Korean Acad Rehab Med 2004; 28: 26-30)

Objective
The purpose of this study was to investigate the effects of video feedback training for the parents of autistic spectrum disorder children. Method: Ten Autistic spectrum disorder children and their mothers participated in this training. Twenty minutes play times were videotaped including free play time and chosen play time. After one session, watching videotape, the researcher analyzed the relation of the children and their mother and had a feedback training with the mother of child. Results: The child's responses to the mother's start actions had significant differences (p＜0.05). The language responses of children increased in the organized environment of chosen play. Language responses increased but negative actions and no responses reduced when mother encouraged child centered play rather than mother engaged in children's play directly. In log sector model, mother's responses according to the play type had meaningless difference (p＜0.05). But in division analysis mother's responses to child's start action had meaningful difference in pre/post treatment and play type. Conclusion: The effects of video feedback training of autistic spectrum disorder children's parents were positive. Through this investigation the interaction and the communication with autistic spectrum disorder children and their parents are influenced positively. (J Korean Acad Rehab Med 2004; 28: 31-40)

Objective
To evaluate the influence of the length of the median nerve in the diagnosis of carpal tunnel syndrome (CTS). Method: Inching test of median sensory nerve using TenElectrodes was performed in 114 hands of 68 CTS patients and 68 hands of 34 controls. The abnormal cut-off values of 1-cm, 2-cm, 3-cm, 4-cm, 5-cm, 6-cm, and 7-cm segment studies were calculated as the maximal conduction delay per centimeter (maximal CD/cm)⁢SD⁓2 for each segment in controls. Based on such values, the sensitivity of each segment study in the CTS group and the specificity in controls were obtained. Results: In controls, mean CD/cm was 0.20⁑0.08 ms, and maximal CD/cm was 0.26⁑0.08 ms in the segment between 2 and 3 cm distal to distal wrist crease. With the abnormal cut-off value set at 0.26 ms, the sensitivity of the 1-cm segment study was 98.5% in CTS. The sensitivities of the 2-cm through 7-cm segment studies were 93.9%, 93.9%, 92.4%, 92.4%, 92.4%, and 90.9%, respectively. Conclusion: These suggest that studies of longer nerve segments tend to lower the sensitivity of the test because the inclusion of the unaffected segments in calculation attenuates the effect of conduction delay at the site of the lesion. (J Korean Acad Rehab Med 2004; 28: 41-47)

Objective
To investigate the effect of distant muscle contraction on the sensory and motor nerve conduction and F-wave studies. Method: During isometric contraction (10%, 25% and 50% of maximal voluntary contraction) of dominant hand using hand held dynamometer, sensory nerve action potentials (SNAPs), compound muscle action potentials (CMAPs) and F-waves were examined on contralateral upper and ipsilateral lower extremities in 20 healthy adult subjects. SNAPs of median and sural nerves, CMAPs and F-waves of median and tibial nerves were recorded with submaximal and supramaximal intensity stimulation. Results: At submaximal stimulation the amplitudes and areas of median and sural SNAPs and median nerve CMAPs were significantly increased during distant muscle contraction (p＜0.05). Distant muscle contraction did not effect on the parameters of SNAPs and CMAPs at supramaximal stimulation. The latencies of F-waves were significantly shortened and amplitudes of F-waves were increased during distant muscle contraction (p＜0.05). Especially the amplitudes of F-waves were significantly positive correlated with the level of muscle contraction (p＜0.05). Conclusion: SNAPs and CMAP were augmented by the distant muscle contraction only submaximal stimulation. Due to facilitation, the distant muscle contraction should be considered during routine F-wave studies. (J Korean Acad Rehab Med 2004; 28: 48-53)

Objective
To reveal the pattern of involvement of the peroneal and tibial division in the sciatic nerve injury according to the locations and etiologies. Method: Fifty-four patients with sciatic nerve injuries were investigated. The relative involvement of peroneal dominant (PD) and tibial dominant (TD) were determined by needle electromyography, and the locations and etiologies of sciatic nerve injury were evaluated. Fifteen patients were followed up and the prognostic factors were investigated. Results: The peroneal division was more severely affected in thirty-three cases (59.3%), tibial division was more in thirteen cases (24.1%), and there were nine cases (16.7%) equally affected. Fracture was the most common cause of sciatic nerve injury, and TD was common in case of pelvic fracture while PD was common in the lesions below the hip joint. Younger person, responsiveness of sensory nerve conduction and fracture were the factors of better improvement while pattern of involvement (TD/PD) was not. Conclusion: The sciatic nerve injuries affected the peroneal division greater than the tibial division, but in case of pelvic fracture it affected the tibial division greater than the peroneal division. The relative fixation and anatomical difference of peroneal nerve was thought to be the cause of those differences. (J Korean Acad Rehab Med 2004; 28: 54-58)

Objective
This study was designed to evaluate the contribution of anatomical factors to the stimulation intensity needed for functional electrical stimulation (FES) of shoulder girdle muscles, especially the supraspinatus. Method: Anatomical dimensions, including the length of the arm and scapular spine, were measured in twenty three normal subjects. Depth and thickness of the supraspinatus and trapezius muscle were measured ultrasonographically. FES was applied for supraspinatus muscles, and the minimal intensity required to induce contraction was recorded. Correlations of intensity with the anatomical dimensions were investigated statistically. Results: The thickness of the supraspinatus muscle and the length of the scapular spine showed statistically significant correlations with the minimal intensity for FES of supraspinatus muscles. No other anatomical measurements showed significant correlation. Conclusion: The intensity required for FES was affected by the thickness and length of muscles, rather than other anatomical variables. The results of this study suggest that one of the major factors contributing to the determination of the intensity of FES is the size of muscles. If the intensity could be estimated before stimulation, based on the size of muscle, unnecessary discomfort of the patients would be avoided. (J Korean Acad Rehab Med 2004; 28: 59-63)

Objective
To verify the effect of low energy laser irradiation (LELI) on the regeneration of injured sciatic nerve of the rat by showing the functional improvement and the elevated immunoreactivities (IRs) of growth-associated protein 43 (GAP-43). Method: Twenty rats, which had standardized compression injuries to the sciatic nerves, received the calculated LELI therapy immediately after the nerve injury and four consecutive days. The functional status was evaluated by sciatic functional index (SFI), and GAP-43-IRs was evaluated by immunohistochemistry and RT-PCR. Results: The SFI was recovered in LELI rats faster than in the control group. Although expression of GAP-43 in the injured sciatic nerve was increased both in the LELI and control groups, the intensities of GAP-43-IRs were much greater in LELI treated group at 1 and 3 weeks after nerve injury. Both SFI and GAP-43-IRs reached the same level at 5 weeks after the nerve injury. Conclusion: LELI enhanced the neural regeneration after experimentally induced sciatic nerve injury at the early stage of recovery. Considering the effect of LELI on nerve regeneration was not fully explained until now, this study could suggest the meaningful explanation on the mechanism of LELI effectiveness on neural regeneration. (J Korean Acad Rehab Med 2004; 28: 64-70)

Objective
The usage of mechanical ventilator has been an issue in advanced stage of most neuromuscular diseases. The patients experience hypoventilation symptoms and usually die from pulmonary complications at last. Besides traditional invasive mechanical ventilation, non-invasive intermittent positive pressure ventilation (NIPPV) has provided an alternative treatment option. We evaluated the effects of NIPPV. Method: We applied NIPPV method to the patients with advanced neuromuscular disease who were hospitalized due to ventilatory failure, who visit our outpatient clinic due to hypercapnic symptoms, or who showed hypercapnia on a routine follow-up. To evaluate ventilatory status, blood gas tensions were analyzed by the arterial blood gas analysis and/or pulse-oxymeter and capnometer. Overnight pulse- oxymeter monitorings were done whenever necessary. Results: Thirty patients were managed with NIPPV successfully. In five cases, invasive IPPV with tracheostomy at admission was switched to NIPPV. Three patients who had been intubated to receive IPPV were transferred to NIPPV without being tracheostomized. Conclusion: NIPPV can be used safely and effectively as an alternative method of ventilatory support for the patients with advanced neuromuscular disease who show ventilatory failure. It would relieve symptoms and signs of hypoventilation and prevent the acute respiratory muscle decompensation, if applied before overt ventilatory failure. (J Korean Acad Rehab Med 2004; 28: 71-77)

Objective
To evaluate the utility of manual lymph drainage (MLD) during lymphoscintigraphy (LS) in predicting the effect of complex physical therapy (CPT). Method: Forty seven patients were included in this study. MLD was done for 30 minutes after one hour LS image was obtained. 24 patients were followed up for 3∼6 months. According to one hour LS image, patients were assigned to visible lymph node or lymphatic vessel group (Either group) and invisible lymph node and lymphatic vessel group (Neither group), and also according to LS changes after MLD, good and poor response group. The limb volume was checked before, and immediately after CPT, and at 1 month and 3∼6 months after CPT. The treatment response was evaluated by percent volume reduction (PVR). Results: There were no significant differences in volume reduction between Either group and Neither group. Otherwise, good response group showed significantly greater volume reduction after CPT than poor response group. Mean PVR in the good response group was 37.02% immediately after CPT, 41.2% at 1 month after CPT, and 47.4% at 3∼6 months after CPT. Mean PVR in the poor response group was 19.22% immediately after CPT, 13.0% at 1 month after CPT, and 5.21% at 3∼6 months after CPT. Conclusion: LS changes after MLD reflected the effects of CPT more accurately than one hour LS image. (J Korean Acad Rehab Med 2004; 28: 78-82)

Objective
The aim of this study was to investigate the prevalence of spinal deformities such as scoliosis, thoracic kyphosis and lumbar lordosis in Korean elementary school students. Method: Five hundred forty Korean elementary school students were preliminary screened for spinal deformities by physical examinations and the three dimensional skeletal analysis system. The study time and pain regions were investigated in sitting on chairs that commonly used in Korean elementary school. Results: The prevalence of scoliosis, thoracic kyphosis and lumbar lordosis were 9.8%, 18.7% and 23.1%. There was a significant difference in study time between spinal deformity group and control group (p＜0.01). In spinal deformity group, pain regions were low back (45%), posterior neck (23%), buttock (21%) and shoulder and elbow joints (11%). Conclusion: The spinal deformities showed high prevalence in elementary school students assessed by the three dimensional skeletal system analyser. The long term follow-up evaluation and confirmative radiographic study will be necessary to assess curve progression in spinal deformity group. (J Korean Acad Rehab Med 2004; 28: 83-87)

Objective
To compare the ultrasonographic findings of chronic lateral epicondylitis of elbow with partial tear of common extensor tendon before and after prolotherapy. Method: The subjects were 12 cases of chronic lateral epicondylitis with partial tear of common extensor tendon, which were confirmed by ultrasonography. We examined the common extensor tendon with ultrasonography at initial visit. After injecting 15% dextrose solution monthly for five times, follow up ultrasonography was performed one month after last injection. Results: Before prolotherapy, every case had anechoic focus without normal fibrillar pattern, which represented partial tear of tendon. Seven cases showed focal or diffuse hypoechoic foci with loss of normal fibrillar pattern of tendon, which represented tendinosis. After prolotherapy, initial anechoic foci were changed to smaller size with diffuse fibrillar pattern inside in 6 cases, to the same the sized hypoechoic foci with diffuse fibrillar pattern inside in 2 cases. And a few fibrillar pattern were seen within the initial anechoic focus in 1 case and most of anechoic foci were filled with fibrillar pattern except small anechoic foci in 3 cases. Conclusion: Prolotherapy can help the recovery process of chronic lateral epicondylitis. And ultrasonography can be a useful method to evaluate the therapentic effect of lateral epicondylitis. (J Korean Acad Rehab Med 2004; 28: 88-93)

Objective
To compare the foot pressure of the insole with medial longitudinal arch support and metatarsal pad and insole with medial longitudinal arch support only. Method: Thirty three normal subjects participated in this study. Insole were fabricated by Hana-meditec company after shaping the subjects' foot. The left insole had only medial longitudinal arch support and right insole had medial longitudinal arch support with metatarsal pad. Bare foot pressure were measured by EMED system^Ⱂ during comfortable gait. Shoes were manufactured by Osan University. Foot pressure in the shoes was measured by PEDAR system^Ⱂ during comfortable gait. Plantar pressure were analyzed by PEDAR C-expert program at T0 (whole foot), M1 (heel), M2 (midfoot), M3 (1st and 2nd metatarsal area), M4 (3rd, 4th and 5th metatarsal area), M5 (great toe), M6 (2nd and 3rd toes area), and M7 (4th and 5th toes area) zone. Results: Right bare foot plantar peak pressure was identical with left side. Right plantar peak pressure with metatarsal pad in shoes was lower than left side with medial longitudinal arch support only at M1, M2 and M4 zone. Conclusion: For reducing the plantar peak pressure, the insole with medial longitudinal arch support and metatarsal pad were better than the insole with medial longitudinal arch support only. (J Korean Acad Rehab Med 2004; 28: 94-97)

Objective
To provide a perspective on the recent trends in the etiologies and levels of lower limb amputations in Korea. Method: Medical records of 284 patients discharged from Seoul National University Hospital between 1990 and 1999 who had amputation related procedure codes were reviewed. Data were used to calculate ratios of congenital anomaly, trauma related, tumor related, diabetes related, and vascular insufficiency related amputations, and ratios of each level of amputations. Trends over time were examined by comparing data from 1990 to 1994 with those from 1995 to 1999 using chi square tests. Results: Dysvascular amputations accounts for 53.5% of lower limb loss in recent 10 years, and tumor (18.9%), congenital anomaly (14.5%), and trauma (6.1%) ranked the next common etiologies. The proportion of dysvascular amputations since 1995 was found to be significantly greater than the ratio before 1995 (p＜0.05), and the ratio of amputations secondary to congenital anomaly was lower (p＜0.05). There was no significant change in the level of amputations. Conclusion: Over recent 10 years, the risk of amputation secondary to dysvascular conditions has been increased, which warrants further investigations and efforts to improve our management of amputees. (J Korean Acad Rehab Med 2004; 28: 98-103)

Sensory neuronopathy (sensory ganglionitis), believed to be caused by an autoimmune attack against the dorsal root ganglia, has been recently linked with antiganglioside antibodies (anti-GD 1b). We present a case of idiopathic sensory neuronopathy with a positive anti-GD 1b IgG. The patient showed functional improvement with the use of gabapentin and immediately showed a resumption of symptoms when its use was stopped. Currently there is no proven therapy for sensory neuronopathy and the effect of immunosuppressive and intra venous immunoglobulin has been reported with mixed results. Also, there has been no research yet on the use and effect of gabapentin in sensory neuronopathy. This case shows that gabapentin alleviated neuropathic pain and tingling sensation in sensory neuronopathy. The authors believe that gabapentin modulated the voltage dependent calcium channels in the dorsal root ganglion and that this led to overall clinical and functional improvement. The curative or relieving effect of gabapentin in sensory neuronopathy still needs more research in the future. (J Korean Acad Rehab Med 2004; 28: 104-108)

Osteoarthritis of the knee is a common cause of disability in the aging population. Traditional nonoperative treatment options include exercise, physical therapy, weight reduction, nonsteroidal antiinflammatory drugs, analgesics and corticosteroid injection. In recent years, intra-articular injection of hyaluronate-derived products has gained popularity as a palliative modality for the treatment of osteoarthritis of the knee. The common adverse reaction are mild pain or swelling at the site of injection that may occur up to 20% of patients. Severe local inflammation, warmth and joint effusion are rare and no systemic complication have been reported, to our knowledge. We presented one case in which synovial inflammation was observed following intra- articular injection of the knee. (J Korean Acad Rehab Med 2004; 28: 109-112)