Objective
To investigate the effect of dynamic balance training with center of pressure (COP) games using visual biofeedback of COP movement in stroke patients. Method: Thirty-eight stroke patients were randomly assigned to the static or dynamic balance training group, or control group. Static group received weight-shift training with visual biofeedback of weight distribution bar. Dynamic group received dynamic balance training using COP games. Each training session lasted 30 minutes, 3 times in a week during 3 weeks. Control group received traditional rehabilitation only. The ability of balance control was assessed using posturography by total path distance, frequency of sway, and COP weight-spectrums during standing, and during presentation of virtual moving surround. Total patherror was also assessed during sine curve and dynamic circle trace test.Results: In static group, there were significant improvement in the total path distance during comfortable standing and path error during sine curve tracing. In dynamic group, significant improvements were found in the path error during sine curve and dynamic circle tracing. Conclusion: Dynamic training group showed more improvement in dynamic balance ability, whereas static group showed more changes in the static balance ability. The visual biofeedback training is more specified for balance rehabilitation in stroke patients. (J Korean Acad Rehab Med 2004; 28: 515-522)

Objective
We developed the Cognitive Perceptual Assessment for Driving (CPAD) to assess the driving ability of people with acquired brain injury. To find out the usefulness of this tool as a screening test for safe driving, we compared it with the Cognitive Behavioral Driver's Inventory (CBDI). Method: Subjects were 101 people with acquired brain injury who had driven a car before the injury. Each subject was evaluated with CPAD and CBDI. CPAD consisted of 8 tasks and 10 variables. We calculated CPAD score using 10 variables and compared CPAD with CBDI result and score. Results: The average CPAD score was 49.65⁑7.97. According to CBDI test, the number of CBDI passing group was 36, borderline group was 27, and failing group was 38. CPAD variables and score showed significant correlation with CBDI score (p＜0.05). There was significant difference in CPAD variables and score among the 3 groups (p＜0.05). Conclusion: CPAD can be a useful tool for assessing the driving ability of the people with acquired brain injury. (J Korean Acad Rehab Med 2004; 28: 523-531)

Objective
This study was designed to investigate the effect of arm sling on static balance of hemiplegic patients. Method: 23 hemiplegic stroke patients were evaluated. Subjects rested about for twenty minutes in sitting position before examination. Balance was examined by Mediance^Ⱂ (Human-Tech Inc, Korea) for 30 seconds in three conditions (no-sling, with cuff-type arm sling and with Kang's Multi support). The order of examination was randomly selected. These tests were repeated for three times. Balance was represented as weight asymmetry and postural sway. Results: There was no significant difference in weightasymmetry between no sling group and cuff-type arm sling group, but with Kang's Multi-support group, weight asymmetry was significantly decreased compared to no-sling group and cuff-type arm sling group. Postural sway was identical with no-sling group, cuff-type arm sling group and Kang's Multi-support group. Conclusion: Kang's Multi-support was helpful to reduce weight asymmetry compared with no-sling or cuff-type sling, and to improve standing balance of hemiplegic patients. (J Korean Acad Rehab Med 2004; 28: 532-536)

Objective
To investigate the oxygen consumption and temporospatial data according to types of cerebral palsy (CP) and to offer the basic information about the energy expenditure during gait in adults with CP. Method: Thirty-six adults with CP (11 spastic diplegia, 10 spastic hemiplegia, 15 athetoid type) and 24 healthy subjects were participated in this study. The parameters of energy expenditure were evaluated by KB1-C Oxymeter and temporospatial parameters during 8 meter walking were collected using Vicon 370 motion analyzer.Results: Single support time was significantly decreased and double support time was significantly increased in CP spastic diplegia, compared with controls (p＜0.05). Oxygen rate and oxygen cost were significantly higher in CP spastic diplegia than CP atheoid or controls. Conclusion: We could identify that oxygen consumption and temporospatial data of CP spastic diplegia was significantly different from athetoid or normal controls. (J Korean Acad Rehab Med 2004; 28: 537-541)

Objective
To identify change of the radiologic indicators known to reflect height of medial longitudinal arch between with and without foot orthosis on flatfoot in children with cerebral palsy. Method: 15 children with cerebral palsy, which were diagnosed as pes planus by bio-mechanical examination and foot print test, were participated in this study. Initial radiologic study (foot anteroposterior and lateral view with standing position) had been done with shoe only and then second radiologic study with shoe and foot orthosis as same method. 3 months after, third radiologic study were performed with shoe only. Radiologic indicators were measured at each radiologic studies. Radiologic indicators measured at intial study were compared with both second andthird study. Results: In comparing initial radiologic study with second, consistently changed radiologic indicators toward corrective direction were calcaneometatarsal angle, navicular height, arch height ratio, arch height angle, talometatarsal angle in anteroposterior view. The other five indicators were variable in increase or decrease of change. There were no interval changes of radiologic indicators comparing at initial study with third study. Conclusion: Calcaneometatarsal angle, arch height ratio, arch height angle, and talometatarsal angle were consistently changed, simply measurable radiologic indicators for evaluation of pes planus in children with cerebral palsy. (J Korean Acad Rehab Med 2004; 28: 542-548)

Objective
To evaluate whether 7 radiographic angles make a useful method for analysing foot deformities in children with cerebral palsy, and to assess with changes in angles after 2 years with orthoses or operations. Method: The talocalcaneal, talus-first metatarsal, and calcaneus-fifth metatarsal angles on the AP radiographs and the talocalcaneal, tibiotalar, talus-first metatarsal, and talohorizontal angles on the lateral radiographs were measured in 183 cerebral palsied. Seven angles were analyzed according to the clinical types, spasticity, ambulation, and age. One hundred three feet were followed up for 2 years with application of orthoses or operations. Results: The frequencies of higher range in AP talocalcanealangle were 24.4% in spastic diplegia. The increased frequencies for abnormal range increased as the grade of spasticity. Non-ambulator group had many frequencies of lower range in AP talocalcaneal angle. The age of 8∼9 years showed high peak in the frequency of abnormal range. After 2 years, the frequencies of normal range were increased in groups with orthoses or operations. Conclusion: The radiographic angles were a useful method for observing feet of the children with cerebral palsy. If the appropriate interventions for feet were applied, the normal frequencies of radiographic angles were increased after 2 years. (J Korean Acad Rehab Med 2004; 28: 549-558)

Objective
To evaluate the cardiac function and to explore the importance of the evaluation of cardiac function in patients with Duchenne muscular dystrophy (DMD). Method: Thirty-nine patients with DMD without any symptoms of heart problems underwent physical examinations and cardiac monitoring including the arterial carbon dioxide (CO₂) screening. Thirty one patients underwent pulmonary function test. Results: Among 39 patients 27 showed abnormal electrocardiographic findings such as ventricular hypertrophy, ischemic change, atrial hypertrophy, T wave inversion, sinus tachycardia and ST elevation. 24 patients showed abnormal echocardiographic findings such as abnormal ejection fraction, dilated cardiomyopathy (DCMP), filling abnormality of left ventricle, global hypokinesia and reduced systolic function. 17 patients showed low ejection fraction (below 59%) and 4 of them were diagnosed as DCMP. There were significant correlations between age and ejection fraction (r=⁣0.552, p＜0.01), between functional level and ejection fraction (r=⁣0.607, p＜0.01) and between vital capacity and ejection fraction (r=0.547, p＜0.01). However, ejection fraction showed no significant correlations with arterial CO₂. Conclusion: Routine evaluation of the cardiac function, at least from 10 years of age, and proper treatment following early diagnosis of heart problems were necessary in patients with DMD, because they possibly have been severely affected by cardiac problems without any clinical symptoms. (J Korean Acad Rehab Med 2004; 28: 559-564)

Objective
The aim of this study was to investigate the suitability of the Revised version of the Korean Spinal Cord Independence Measure (KSCIM-R), which is a functional evaluation tool for spinal cord injury. Method: Thirty patients with spinal cord injury were enrolled. The KSCIM was modified to as KSCIM-R. Inter- rater reliability and relative sensitivity of KSCIM-R were evaluated by two raters, biweekly. Results: The Kappa coefficient of the various individual tasks in the KSCIM-R ranged between 0.71 and 0.95 (mean: 0.82), which was higher than the previous version, KSCIM. High correlations were found between the total KSCIM-R scores of the paired raters (r=0.95, p＜0.01), and between KSCIM-R scores and total FIM scores (r=0.90, p＜0.01). The KSCIM-R detected all the functional changes detected by FIM total scoring, however the FIM missed changes in 16 (16%) of 102 sequential test batteries, which was detected by KSCIM-R total scoring. Conclusion: These results demonstrated that the KSCIM-R is reliable and more sensitive than the FIM and KSCIM in reflecting the functional changes of SCI patients. (J Korean Acad Rehab Med 2004; 28: 565-573)

Objective
To investigate the correlation between the severity of paralysis and hand sympathetic skin response (SSR) in patients with Bell's palsy and to evaluate the clinical utility of hand SSR as a predicting factor of prognosis. Method: Twenty patients with Bell's palsy and twenty normal controls were recruited. The severity of paralysis was graded according to House-Brackmann Facial Grading Scale (H-B FGS), and percent degeneration of Nasalis was determined by Facial Nerve Conduction Study (FNCS). Results: The difference of hand SSR amplitude between affected and unaffected side was significant (p＜0.05).There was significant correlation between H-B FGS and the difference of hand SSR amplitude (p＜0.05). There was significant correlation between percent degeneration and the difference of hand SSR amplitude (p＜0.05). There were significant correlations between the difference of hand SSR amplitude at 5 days and percent degeneration at 9 and 14 days (p=0.026, p=0.001). Conclusion: The difference of hand SSR amplitude between affected and unaffected side was useful for the indication of the severity of paralysis. And, hand SSR would be useful for an early prognostic predictor in Bell's palsy. J Korean Acad Rehab Med 2004; 28: 574-578)

Objective
The purpose of this study was to investigate the associated symptom aggravating factors and epidemiologic characteristics in patients with neck and back pain. Method: The demographic characteristics and the total number of patients who visited the Department of Rehabilitation Medicine, Yong-dong Severance Hospital for the management of neck and back pain were evaluated. A total of 2800 patients sampled from this group of patients and the possible influential factors such as symptom aggravating factors were evaluated. The back school attendants were analyzed for the effectiveness of education on prevention and management of neck and back pain. Results: The most common age group with neck and back pain were 5th decade (21.4%) and 6th decade (24.8%). The proportion of patients in acute stage were increased yearly. Of the aggravating factors, sports injury, driving and weight gain increased annually. In patients with neck pain, aggravation by typing and computer work was remarkable. The patients with desk type of job were increased each year and the patients in teenage group were also increased annually. Conclusion: Understanding of the current epidemiologic characteristics and the influential factors will be helpful for providing objective standards for assessment, management and preventioin of neck and back pain. (J Korean Acad Rehab Med 2004; 28: 579-585)

Objective
To study gait patterns of patients with chronic lumbosacral radiculopathy, and to investigate whether gait parameters can reflect functional deficit in relation to the level of lumbosacral radiculopathy. Method: Conventional physical examinations and three- dimensional gait analysis were performed on 24 patients with chronic lumbosacral radiculopathy (twelves with L5 and twelves with S1 radiculopathy) who were diagnosed by electrophysiologic study and magnetic resonance imaging study, and 12 healthy control subjects. Temporospatial, kinematic and kinetic parameters of patients were compared with those of the control group. Results: In patients with lumbosacral radiculopathy, walking velocity, stride length, ratio of single support time todouble support time and range of pelvic obliquity were less than control group. Increased double support time, decreased maximal hip extension angle, decreased ankle plantar flexion angle during preswing phase and decreased maximal ankle plantar flexion moment were noted in S1 radiculopathy patients compared with control group. Decreased pelvic rotational range and decreased ankle dorsiflexion moment were specific in L5 radiculopathy patients compared with control group. Conclusion: Using three-dimensional gait analysis, we could identify specific gait parameters to reflect functional deficit related to the level of lumbosacral radiculopathy. (J Korean Acad Rehab Med 2004; 28: 586-591)

Objective
To identify the range of the precise locations of the motor points of biceps brachii and brachialis muscles in relation to bony landmarks. Method: Nine upper limbs of five male cadavers were dissected. The number and location of the motor points from the musculocutaneous nerve to biceps brachii and brachialis muscles were identified in relation to the bony landmarks. Bony landmarks were coracoid process and lateral epicondyle of the humerus. The length of the arm was defined as the distance from the apex of the coracoid process to the lateral epicondyle of humerus. The locations of the motor points were expressed as the percentage ratio ofthe length from the coracoid process to the motor points in relation to the length of the arm. Results: First proximal motor points of the long head, short head of biceps brachii, and brachialis were located in 47.5⁑5.6%, 53.0⁑4.6%, 64.3⁑3.4% and second proximal points of them were 51.8⁑2.9%, 57.7⁑3.5%, 68.5⁑4.4% respectively. Conclusion: The identification of the locations of motor points related to the bony landmarks would increase the accuracy and ease of the motor point blocks to elbow flexors such as biceps brachii and brachialis muscles. (J Korean Acad Rehab Med 2004; 28: 592-595)

Objective
To compare the clinical usefulness of the posterior superior iliac spine (PSIS) with that of iliac crest (IC) for identifying the lumbar vertebral level. Method: Lumbar spine level was identified by the line connecting bilateral upper margin of iliac crests in the antero-posterior lumbar X-rays of 120 patients. Assumed IC level and assumed PSIS level were compared by 3 examiners' palpation in 60 patients. A marker was taped on assumed IC level and assumed PSIS level by 4 examiners and the postero-anterior lumbar X-rays was taken in randomly distributed 50 patients.Results: IC intersection line was ranged from the L4 spinous process to the L5-S1 interspinous process in all patients. Inter- examiner agreement of palpation was significantly greater in PSIS than IC level (p＜0.05). The marker indicating assumed IC level was higher than true IC level in all patients and was higher than L3-4 interspinous process in 8%. Conclusion: We may use PSIS level for assumption of the lumbar vertebral level to compensate for the limitation of iliac crest palpation, but at the same time keep in the mind the variarity of the PSIS level. (J Korean Acad Rehab Med 2004; 28: 596-600)

Objective
To determine the Korean adult standard of mean length and depth from spinous process which is palpable landmark of back to each facet joint. Method: The horizontal line was made between the posterior end of each facet joint, and the rectangular line was made on the horizontal line at the level of spinous process, respectively. We measured the length from the point of intersection to the posterior end of each facet joint (SFL), and the depth from the tip of spinous process to the point of intersection (SFD). All parameters were measured in 30 volunteers (Exp. 1) using computed tomography and in 30 cadavers (Exp. 2). Results: The lower lumbar spine revealed the longer SFL (p＜0.01). SFD was significantly increased from L1-L2 to L3-L4 facet joints, but significantly decreased in L5-S1 facet joint compared to L4-L5 facet joint (p＜0.01). There was no significant difference in laterality, gender, and viability (Exp. 1 and Exp. 2)(p＞0.05). There was no correlation with height and weight, either (r＜0.04). Conclusion: We measured the standard for SFL and SFD in Korean. We suggest that these results will be useful in clinical practice including blind approach of spinal intervention to the facet joints. (J Korean Acad Rehab Med 2004; 28: 601-605)

Objective
To evaluate the relationship between body mass index (BMI) and foot parameters. Method: We examined 1,107 feet of 872 volunteers (male: 325, female: 547) with 3D foot scanner (Nexcan^Ⱂ, K & I, Korea). The relations of BMI and foot parameters were analyzed by partial correlation analysis with adjusted height. We classified subjects into 4 groups by BMI; low-weight (＜18.5 kg/m²), normal-weight (18.5∼22.9 kg/m²), over- weight (23.0∼24.9 kg/m²) and obesity (＞25 kg/m²) group. The relations of these groups and foot parameters were analyzed by univariate ANOVA with fixed height. Results: Instep point length, ball width and girth, waist, instep height and girth, and vamp height showed a positive relation to BMI (p＜0.01). However, foot parameters related to longitudinal length and medial longitudinal arch had no significant relation to BMI (p＜0.01). Ball width and girth, waist, instep height and girth, vamp height were significantly highest in obesity group compared to the other groups (p＜0.05). However, foot parameters related to longitudinal length and medial longitudinal arch showed no significant difference between these 4 groups (p＞0.05). Conclusion: This study showed that BMI was positively related to height, width, girth of foot. But, BMI had no significant relation to length of foot, and medial longitudinal arch. (J Korean Acad Rehab Med 2004; 28: 606-612)

Schwartz-Jampel syndrome is a rare autosomal recessive disorder characterized by clinical myotonia, persistent spontaneous activity, and skeletal dysplasia (short stature, pigeon breast, micrognathia etc.). We experienced an eleven- year-old girl complaining of gait disturbance and motor weakness of both legs. She was operated for umblical hernia at the age of two and for congenital hip dislocation at the age of six. She displayed short stature, short neck, microstomia, micrognathia, pigeon breast, and calf musclehypertrophy. Her muscle strength was fair to good grade in both legs. Percussion- and exercise-induced myotonia was observed. Her cognitive function was below-average intelligence. Serum creatine kinase was elevated three to four times of normal level. Routine motor and sensory conduction studies were normal and continuous electrical myotonic discharges were detected in all examined muscles. Clinically, her symptom was non-progressive for three years. (J Korean Acad Rehab Med 2004; 28: 613-617)

The epidural lipomatosis is the unusual result of fat deposition in the extradural space of spinal canal, and most cases are associated with the chronic systemic steroid treatment. Symptoms related to spinal stenosis are postulated to result from spinal cord and nerve root compression. MR imaging is the first choice of the investigation method. Patients with acute progressive symptoms are best treated surgically, while others with stable symptoms can initially be treated medically with immediate tapering of their steroid dose. We reported one case of lumbar spinal stenosis induced by epidural lipomatosis receiving chronic steroid treatment. Surgical treatment could not be performed because of the poor general condition. Rehabilitation care and nonoperative therapy were effective in improving symptoms in lumbar epidural spinal stenosis induced by epidural lipomatosis. (J Korean Acad Rehab Med 2004; 28: 618-621)

Multiple symmetric lipomatosis is a rare disorder characterized by massive fatty deposits arranged symmetrically around the neck, shoulder, abdomen and back. It is typically associated with high alcohol consumption and a high prevalence of peripheral neuropathy. The pathogenesis of the syndrome is still unknown, but mitochondrial abnormality or metabolic abnormalities are occasionally found in the affected patients. In our patient, clinical and electrophysiologic signs of a generalized peripheral sensorimotor neuropathy and a multiple bilateral lumbosacral radiculopathywere observed. Sural nerve biopsy demonstrated many small unmyelinated fibers with complete loss of axoplasm and a extensive loss of myelinated fibers. Lipoma biopsy demonstrated non-capsulated mature adipose cells in the subcutaneous tissue. Serum lipid studies were normal. MERRF point mutation of mitochondrial DNA were negative in blood. We reported a case of multiple symmetric lipomatosis and peripheral polyneuropathy with the review of literature. (J Korean Acad Rehab Med 2004; 28: 622-626)

Primary synovial osteochondromatosis is a disorder characterized by the formation of multiple intra-articular osteocartilaginous bodies. Clinical symptoms are not specific, which makes the diagnosis difficult. Magnetic resonance imaging is useful in the diagnosis of synovial osteochondromatosis of the hip, especially in cases in which ossified bodies are not present. Synovial osteochondromatosis tends to be progressive but self-limiting and the optional treatment is controversial. We described two patients with primary osteochondromatosis of hip who presented with symptoms and signs of single joint arthropathy of hip. (J Korean Acad Rehab Med 2004; 28: 627-630)