In Korea, the need of medical care is high in persons with disabilities. But the health care system, especially the continuum of long-term rehabilitation care for the persons with disabilities is not well established. Under the General Agreement on Trade in Services (GATS), the pressure to open up the health care market has been increased in Korea. This article examines the health care system of developed countries (USA, UK and Japan) with review of the health policies, laws, income security and pensions, payment systems, medical rehabilitation facilities, and home health services for the persons with disabilities.And this article also discusses the process of the health care market opening in Korea, the debating issues, the implications for the domestic medical market, and the matter of concern in rehabilitation medicine field. In the viewpoint of the rehabilitation medicine, the transitional services and home health services for the persons with disabilities should be prepared, and the public health should be expanded as the social network of the persons with disabilities, before the health care market is fully opened up. (J Korean Acad Rehab Med 2004; 28: 195-203)

Objective
The aim of this study is to evaluate the change of esophageal acidity when feeding via nasogastric tube is replaced by via percutaneous endoscopic gastrostomy (PEG) tube. Method: Fourteen patients with brain injury participated in the study. 24-hour pH monitoring was performed during nasogastric tubal feeding. After PEG tube insertion, 24-hour pH monitoring was followed up. There was no difference in medication affecting to esophageal acidity in same patient at both pH monitorings. The results of pH monitorings analyzed with Wilcoxon signed rank test. Results: The total time below pH 4.00 was 135.43⁑190.69 minutes for the patients with nasogastric tube and 25⁑42.74 minutes for PEG tube (p=0.013). The numbers of acid reflux was 42.07⁑47.03 and 21.93⁑22.77 respectively (p＝0.074). Of the 14 patients, 9 had acid reflux in nasogastric tubal feeding, which was improved in all 9 patients after PEG. Of the 14 patients, 5 had no acid reflux in nasogastric tubal feeding but 3 of the 5 developed new acid reflux in PEG tubal feeding. Conclusion: Percutaneous endoscopic gastrostmy tube feeding was better for acid reflex control. But careful observation is needed after PEG because PEG can develop new acid reflux. (J Korean Acad Rehab Med 2004; 28: 204-207)

Objective
The aims of this study was to evaluate the effects of visible light therapy for the stroke patients. Method: Thirty stroke patients were enrolled and classified into two groups, experimental (n=19) and control group (n=11). Control group received conventional rehabilitation therapy. Experimental group received additional light therapy with red light (intensity 962 lux, wave length 620 nm) on wrist, elbow, and shoulder joint area (diameter 10 cm) at the same time, 3 times per day, 20 minutes per session, 5 days per week, for 2 weeks. All patients were assessed their paralytic upper extremity functions using manual muscle testing, two point discremination test (2-PD), Semmes-Weinstein monofilament test, and modified Ash-worth scale. To evaluate neurophysiological effects of light therapy, sympathetic skin response, thermography, and doppler ultrasound on radial artery were performed. Results: Compared to the control group, the experimental group significantly improved in the 2-PD test, Semmes- Weistein monofilament test, and the hand grip power. Neurophysiologic parameters showed no significant difference between experimental and control groups. Conclusion: Visible light therapy maybe used as an effective therapeutic modality for improving hand function of stroke patients. Further studies are required to define the mechanism of effects on paralytic extremity of visible light. (J Korean Acad Rehab Med 2004; 28: 208-213)

Objective
Bone mineral loss in the upper extremity of hemiplegic patients can increase the prevalence of fractures that interrupt the rehabilitation program and lower the level of activity. The aim of this study was to investigate any difference between the affected and unaffected forearm's bone mineral density (BMD) and evaluate the relationship between several clinical variables and osteoporosis of hemiplegic forearm. Method: Sixty-seven hemiplegic patients (42 males, 25 females, mean age 55.2 years) were enrolled. The BMD of radius was measured using dual energy X-ray absorptiometry in 67 hemiplegic subjects. Results: The BMD of affected forearm was significantly lower than unaffected side (p＜0.05). The reduction of BMD in the hemiplegic forearm well correlated with duration of hemiplegia, self care of functional independence measure score, complex regional pain syndrome-type 1 (CRPS-1) (p＜0.05). But, there was no correlation between BMD and modified Ashworth scale, muscle power of wrist extension. Conclusion: Hemiplegic forearm had high prevalence of osteoporosis like lower extremity. Therefore, increasing level of ADL and early detection of CRPS-1 was necessary for prevention of osteoporosis of forearm. (J Korean Acad Rehab Med 2004; 28: 214-219)

Objective
To investigate the actual driving state of the brain injured who had received driver training program. Method: We conducted a follow up survey with 64 brain injured who had received driver training program at the National Rehabilitation Center. 29 subjects were first attempting to obtain a license (First obtaining group) while 35 subjects were trying to re-obtain a license after being handicapped (Re-obtaining group). The contents of the survey were compared between first obtaining group and re-obtaining group, and between hemiplegic side. Results: 41 subjects obtained license in regard to the total 64 subjects in which 39% of theses were actually driving.Licensed rate was 55% for first obtaining group and 71% for re-obtaining group. Driving rate was 56% for first obtaining group and 28% for re-obtaining group. Comparing to hemiplegic side, left hemiplegics (54%) showed a tendency to have higher rate of accident than right hemiplegics (0%) without statistical significance. Conclusion: Licensed rate of the brain injured was 64%, and driving rate and accident rate were 39% and 38%, respectively. Left hemiplegics, especially, had a higher rate of accident than right hemiplegics. (J Korean Acad Rehab Med 2004; 28: 220-225)

Objective
It is known that spinal cord injury (SCI) in adult men may result in sex hormonal changes. To investigate this change, we compared sex hormone levels of male SCI patients, uninjured normal, and infertile subjects. Method: Serum levels of follicular-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone were determined in 67 male SCI patients, 20 uninjured normal men and 39 idiopathic infertile men. One-way analysis of variance (ANOVA) procedures were performed with a significance level of 0.05. Results: Compared with normal and infertile control groups, SCI patients had lower levels of testosterone and higher levels of prolactin. FSH levels of SCI patients were only lower than those of infertile controls. LH levels of SCI patients showed no significant difference. Compared with hormone levels of acute SCI patients, those of chronic SCI patients showed a tendency to increase in FSH, LH and testosterone, and a tendency to decrease in prolactin. Etiology of injury, completeness of injury and voiding method for neurogenic bladder did not influence the sex hormone levels in SCI patients. Conclusion: In our study, male SCI patients showed sex hormonal abnormalities of hypothalamo-pituitary type. And elevated serum prolactin level might influence hormonal changes and sexual dysfunction in male SCI patients. (J Korean Acad Rehab Med 2004; 28: 226-231)

Objective
To evaluate the electrophysiologic findings of the dorsal ulnar cutaneous nerve (DUCN) in ulnar neuropathy at the elbow and to correlate the sensory nerve action potential (SNAP) amplitude of DUCN to those of ulnar compound muscle action potential (CMAP) and SNAP. Method: The subjects were 39 patients diagnosed as ulnar neuropathy at the elbow. Electrophysiologic classification consisted of 3 groups: conduction block (CB); conduction block and axonal degeneration (CBAD); axonal degeneration (AD). Findings of DUCN conduction study were evaluated according to the electrophysiologic classification. The amplitude of DUCN was correlated to those of CMAP and SNAP. Results: The DUCN conduction study was normal in all cases of CB (4 cases), but was abnormal in 21 cases of CBAD (23 cases) and in 10 cases of AD (12 cases). Even in the cases with AD, 4 cases showed normal DUCN potentials. Correlations of DUCN to ulnar SNAP and CMAP were r=0.48, (p＜0.01) and r=0.33, (p＜0.05), respectively. Conclusion: Findings of DUCN may be related to the fasc icular involvement of the ulnar nerve at the elbow. Although it is possible for the DUCN to be spared in ulnar neuropathy at the elbow, electrophysiologic measurement of the DUCN response remains useful, but only in those cases where it is abnormal, which suggests the lesion to be at a more proximal site. (J Korean Acad Rehab Med 2004; 28: 232-235)

Objective
To obtain the sensory thresholds of the feet from healthy adult using Semmes-Weinstein monofilaments. Method: Twenty male and twenty female volunteers aging from 24 to 38 years old were selected. There were no known medical conditions associated with decreased foot sensation and history of previous injury to the foot. The subjects were blindfolded with the leg resting on a chair as 14 plantar and 5 dorsal locations were tested on each foot. Each site on the foot had the Semmes-Weinstein monofilaments applied to it first, in an order of increasing stiffness, then repeated in decreasing order. A positive threshold response was recorded when the subject could feel the filament and could accurately locate where on the foot the stimulus had been applied. Results: The mean sensitivity for all sites was 3.41⁑0.17. Sensation in the plantar surface of greater toe, 5th toe, arch, and dorsal surface of 1st web space, 3rd toe at the metatarsophalangeal joint level, 5th metatarsal head were the most sensitive. The least sensitive regions were the heel pad, lateral plantar midfoot, and medial and lateral heel. Conclusion: Normal data of sensory threshold using Semmes-Weinstein monofilament could be used for the early detection of peripheral neuropathy or loss of protective sensation. (J Korean Acad Rehab Med 2004; 28: 236-239)

Objective
This study was performed to investigate the effect of experimental muscle pain on the stretch reflex through electrophysiologic measuring of H-reflex and ankle tendon reflex. Method: Muscle pain was produced by the continuous infusion of 5% hypertonic saline into the soleus and tibialis anterior muscles respectively in the fourteen healthy, male volunteers. Control was made with infusion of 0.9% isotonic saline. H-reflex and ankle tendon reflex were recorded at the soleus before, during and 30 minutes after infusion of saline. Results: The amplitude of ankle tendon reflex increasedsignificantly during soleus and tibialis anterior muscle pain by the infusion of hypertonic saline as compared with those of before and after injection. But the H-reflex showed no significant changes during the infusion in either muscles. Conclusion: These results have demonstrated a muscle pain increased the amplitude of the stretch reflex without a corresponding increase of the H-reflex amplitude. One explanation could be an increased dynamic sensitivity of the muscle spindles during muscle pain caused by an increased firing of the dynamic γ-motor neurons. (J Korean Acad Rehab Med 2004; 28: 240-246)

Objective
This study was conducted to assess the effect of percutaneous vertebroplasty in the patients with chronic osteoporotic compression fracture at the thoracic and the lumbar vertebra. Method: Twelve patients with chronic osteoporotic compression fracture of thoracic and lumbar vertebra were engaged in this study. Treated levels were from the ninth thoracic vertebra to the fifth lumbar vertebra. Effects were assessed on the first day, 1 month after treatment and the last follow up (average 164 days after vertebroplasty; range 60 days to 302 days) by visual analogue scale (VAS), McGill pain questionnaire (MPQ), and compression ratio of vertebral body. Complication rate was assessed. Results: Significant improvement by VAS and MPQ was noticed on the first day, 1 month after treatment and the last follow up. Further vertebral height loss was not noticed on follow-up. Conclusion: Percutaneous vertebroplasty can be an effective treatment method in patients with chronic back pain due to osteoporotic compression fracture at the thoracic and the lumbar vertebra. (J Korean Acad Rehab Med 2004; 28: 247-252)

Objective
To evaluate the effect of systemic and appropriate rehabilitation after menisectomy. Method: We reviewed the medical records of 13 patients who had been in rehabilitation program after menisectomy. We measured the range of motion of the knee joint, pain intensity by visual analogue scale (VAS) score, the difference of thigh circumference between normal and menisectomied legs, and strength of flexors and extensor of the knee and functional tests before and after rehabilitation. Results: Range of motion, VAS score, thigh circumference, strength of flexors and extensors of the menisectomied knee were significantly different before and after rehabilitation. Knee flexion angle increased from 76.9^o to 135^o and kneeextension angle increased from ⁣10.8^o to 0^o. VAS score decreased from 4.3 to 0.9. The difference of thigh circumference decreased from 2.80 to 0.44 cm. The torque of flexors increased from 82.88 to 120.05 Nm and that of extensors increased from 97.83 to 149.77 Nm at 60 degrees/ sec. Twelve out of 13 players performed functional activities and returned to sports successfully after systemic rehabilitation. The average duration of rehabilitation was 16.6 weeks. Conclusion: We suggested that systemic and appropriate rehabilitation after the menisectomy was needed for successful return to sports. (J Korean Acad Rehab Med 2004; 28: 253-258)

Objective
To determine the relation of Radiographic Scoring System and Scoliosis Research Society-22 (SRS-22), a revised form of health-related quality-of-life (HRQL) questionnaire in idiopathic adolescent scoliosis patients. Method: A patient group was made up of 41 adolescents who were diagnosed as idiopathic scoliosis. A control group of 17 persons with Cobb's angle ＜10^o was established. To evaluate psychosocial condition, SRS-22 was used to collect the data on both patient and control group. Roentgenographic study was conducted to obtain the Radiographic Deformity Score and evaluate the curve pattern. Results: Pain, self image/appearance, mental health and total score of SRS domains were found to be significantly different between patient and control group (p＜0.05). Radiog raphic Deformity Score was positively correlated with pain and self image of SRS domains (p＜0.05). However, the pattern of curve was found to be not correlated with SRS score. Conclusion: We could evaluate a psychologic condition of idiopathic adolescent scoliosis using Scoliosis Research Society-22 (SRS-22) health-related quality-of-life (HRQL) questionnaire. The more severe spinal deformity, it had the more negative influence on psychologic conditions in idiopathic adolescent scoliosis patients. Therefore, the clinician who is managing idiopathic adolescent scoliosis patients should consider their psychosocial conditions. (J Korean Acad Rehab Med 2004; 28: 259-264)

Objective
This study was conducted to analyze the psychological factors which influence myofascial pain syndrome and to evaluate whether the electromyographic study on the myofascial trigger point in shipyard workers satisfied the diagnostic criteria of myofascial pain syndrome. Method: We studied 61 patients who were employed in the shipbuilding industry and diagnosed myofascial pain syndrome. We investigated them using the Minnesota Multiphasic Personality Inventory (MMPI) and the visual analogue scale (VAS) and also obtained spontaneous electrical activity (SEA) by electromyographic study on myofascial trigger point.Results: Mean VAS of subjects was 5.88. On the MMPIprofile, the patients scored highest in psychopathic deviate, and then in hypochondriasis, depression and hysteria, in that order. The correlation of the VAS with results of electromyographic study and with the MMPI were not significant. In the electromyographic study, 19 patients out of 61 (31%) showed initial positive deflection on spontaneous electrical activities. Conclusion: This study suggested that considering the psychosocial aspect of myofascial pain syndrome, as well as organic aspects in hard manual labor such as shipyard work might be useful for treatment. (J Korean Acad Rehab Med 2004; 28: 265-269)

Objective
The purpose of this study was to investigate the prevalence and risk factors of the foot pain in university freshmen and one year follow-up study.Method: The subjects were interviewed about the prevalence and risk factors of the foot pain, which were followed up one year later.Results: In a total of 1,784 subjects, the prevalence of the foot pain was 22.3% with 17.4% in men and 27.6% in women. The foot pain in the groups was significantly associated with gender, the height of heels, the size of shoes, the recent change of shoes, trauma, change in weight, the shoe type at present and the daily walking distance. There was no significant relation between foot pain and the other parameters, such as body mass index, change of the shoe type or change in height. One hundred and fifty seven subjects were reevaluated after one year. The prevalence of the foot pain was 30.6% with 25.4% in males and 34.9% in females.Conclusion: The prevalence of the foot pain was 22.3% in university freshmen and 30.6% in one year follow up study, and was significantly associated with shoe problems and lifestyles. (J Korean Acad Rehab Med 2004; 28: 270-280)

Objective
The purpose of this study was to evaluate the beta blocker effect on excercise ability and hemodynamics after cardiac rehabilitation program (CRP).Method: Thirty-two patients with coronary artery disease were divided into two groups: 16 patients in the beta blocker group and 16 patients in the control group. CRP with aerobic exercise was done for 6 weeks. Before and after CRP, a symptom limited graded exercise test was done.Results: The maximal exercise time and the maximal oxygen uptake were significantly higher, and the percentage of maximal oxygen uptake and the rating of perceived exertion were significantly lower after CRP as compared to those parameters before CRP in both groups (p＜0.05). There were no significant differences in above parameters between the beta blocker and control groups (p＞0.05). The submaximal heart rate and submaximal rate pressure product (RPP) were significantly lower after CRP as compared to those before CRP in both groups (p＜0.05). After CRP, the maximal heart rate and the submaximal RPP were significantly lower in the beta blocker group than in control (p＜0.05).Conclusion: A beta blocker can be widely used in CRP without having a negative effect on exercise capacity in the patients with coronary artery disease. (J Korean Acad Rehab Med 2004; 28: 281-287)

Nonaka myopathy (NM) or distal myopathy with rimmed vacuoles was an autosomal recessive muscle disease with preferential involvement of the tibialis anterior and sparing quadriceps muscles in young adulthood. Patients with NM usually showed slightly elevated serum creatine kinase (CK) levels and characteristic rimmed vacuoles in muscle biopsy. Recently, the UDP-N-acetylglucosamine-2-epimerase/N-ace- tylmannosamine kinase (GNE) gene was identified as theidentified as the causative gene for NM. Here we reported a NM patient carrying homozygous mutations (V572L) of the GNE gene. To the best of our knowledge, this was the first report of genetically confirmed NM in Korea and NM should be included in the differential diagnosis of slowly progressive weakness of distal legs. (J Korean Acad Rehab Med 2004; 28: 288-291)