Objective
To evaluate usefulness of quantitative measurement of three phase bone scintigraphy in assessing the complex regional pain syndrome (CRPS) after stroke using reference value in healthy adults. Method: Twenty nine stroke patients with CRPS and 15 stroke patients without CRPS underwent three phase bone scintigraphy (TPBS). Uptake ratio was calculated by isotope count of affected side divided in isotope count of unaffected side in each phase. Reference value was obtained in 13 healthy adults. The sensitivity and specificity of quantitative measurement of TPBS was assessed. Results: In the all phases of hand, uptake ratios of the CRPS group were significantly higher than non-CRPS group(p＜0.05). There was no significant difference in the delayed phase of shoulder between the CRPS group and the non- CRPS group. In the delayed phase of hand, sensitivity and specificity of quantitative measurement of TPBS were 82.8% and 86.7%, whereas those of qualitative interpretation by nuclear physician were 65.5% and 66.7%, respectively. Conclusion: Quantitative measurement of TPBS was more sensitive and more specific than qualitative interpretation by nuclear physician in assessing the CRPS after stroke. Quantitative measurement of TPBS may be helpful in detecting CRPS after stroke. (J Korean Acad Rehab Med 2005; 29: 337-342)

Objective
Dysphagia is one of the important determinants of the prognosis for various diseases. Clinical dysphagia scale (CDS) was developed to screen dysphagia after stroke. We aimed to reevaluate this scale with comparison to the videofluoroscopic swallowing study (VFSS) findings. Method: Retrospective chart reviews were completed on 677 dysphagic patients undergoing the VFSS from July 2000 to January 2004. CDS was evaluated by a physiatrist before the VFSS. Functional dysphagia scale, new VFSS scale, and American Speech-Language-Hearing Association National Outcome Measurement System swallowing scale (ASHA NOMS scale) were evaluated based on the VFSS. The correlations between CDS and these VFSS scales were studied. In 118 patients, followed up for more than 6 months, the initial CDS were analysed with the follow-up VFSS findings. Results: CDS was correlated with the VFSS findings and also correlated in disease groups other than stroke (p＜0.05). CDS was different significantly between the aspiration, penetration, and normal group classified on the simultaneous VFSS but not on the VFSS after more than 6 months (p= 0.102). Conclusion: We confirmed that CDS was a quantitative clinical tool responding the VFSS findings well and was adoptable to any dysphagic patients irrespective of the causal disorders. (J Korean Acad Rehab Med 2005; 29: 343-350)

Objective
To evaluate the blood level of IGF-1 (insulin- like growth factor-1) and IGFBP-3 (insulin-like growth factor binding protein-3) in patients with post-acute stage brain diseases, and to investigate the relationship between IGF-1/ IGFBP-3 blood level and functional status in patients with post-acute stage brain diseases. Method: Initial IGF-1/IGFBP-3 blood levels of 32 patients with post-acute stage brain disease were obtained and various functional indices, including modified Barthel index (MBI), functional ambulatory category (FAC), and Jebsen hand function test (JHFT), were assessed initially and at discharge. Results: The IGF-1 blood level was normal in 23 patients and decreased in 9. The IGFBP-3 blood level was normal in 20 patients and increased in 13. The initial IGF-1/IGFBP- 3 levels were associated with the change of MBI score during admission (p＜0.05, r²=0.214/p＜0.05, r²=0.213). There was a correlation between IGF-1/IGFBP-3 levels and JHFT score only on the unaffected side at discharge (p＜0.05, r²=0.278). There was no relation between IGF-1/IGFBP-3 levels and the change of JHFT score on either side during admission. Conclusion: Initial IGF-1/IGFBP-3 blood level check can be a useful method to anticipate functional improvement of patients with post-acute stage brain disease. (J Korean Acad Rehab Med 2005; 29: 351-358)

Objective
The purpose of this retrospective study was to evaluate the incidence of deep vein thrombosis (DVT) in spinal cord injury (SCI). Method: We analyzed the incidence of DVT and factors that alter its risk in 263 SCI patients. The injury status of each SCI subject was categorized as either motor complete or motor incomplete and either quadriplegic or paraplegic. The cause of injury was categorized as either traumatic or nontraumatic. Duplex ultrasound was performed in the clinically DVT suspected patients. No patient had been started on anticoagulant prophylaxis prior to diagnosis of DVT. Results: Fifteen patients (5.7%) had a diagnosed DVT and one patient (0.4%) had a diagnosed pulmonary embolism. Motor complete lesion and quadriplegic status were better predictors of DVT than motor incomplete lesion and paraplegic status. Cause of injury and existence of spasticity were not statistically correlated with the incidence of DVT. Accuracy of clinical diagnosis was 45.4%. All cases of the diagnosed DVT was located proximal veins (iliac and femoral veins). Ten of 15 DVTs (66.6%) were detected earlier than 2 months after SCI. Conclusion: Incidence of DVT in SCI patients were 5.7%. Motor complete lesion and quadriplegic status were suggested as significant predictors of DVT in SCI patients. (J Korean Acad Rehab Med 2005; 29: 359-364)

Objective
The purpose of this follow-up study was to evaluate the status of standing and gait for the paraplegics at their home after discharge. Method: A medical doctor interviewed 93 paraplegics by spinal cord injury, who visited the outpatient clinic of the National Rehabilitation Hospital, or who were admitted for the follow up urologic evaluation. Results: Out of 93 paraplegics, 90 patients had done a standing exercise in hospitals, but 42 patients continued a standing exercise after discharge. Seventy-nine patients had done a gait exercise in hospitals, but only 24 patients continued a gait exercise after discharge. Seventy-five patients were prescribed KAFO (Knee-Ankle-Foot orthosis), but only 11 patients used the KAFO continuously after discharge. The reasons to stop using KAFO were loss of motivation, lack of time, no helper, difficulties with wearing orthoses, and etc. The continuous using rates of other standing or exercise equipments were higher than that of KAFO. Conclusion: Many paraplegics had done gait training and had been prescribed KAFO in hospitals. But only 14.7% of them had used KAFO for any purpose after discharge. We believe that more careful consideration and explanation are needed to each patient. We think that standing or exercise equipments are good alternatives. (J Korean Acad Rehab Med 2005; 29: 365-370)

Objective
To evaluate the renal function by investigating the relationship among serum cystatin C, serum creatinine, creatinine clearance and the average of bilateral ERPF (effective renal plasma flow) ratio of the MAG3 renal scan for the spinal cord injured patients. Method: Seventy-one spinal cord injured patients who admitted to our department were evaluated from January 2004 to October 2004. Blood samples and 24-hour urine of all the subjects were collected for measuring serum cystatin C, serum creatinine and creatinine clearance. MAG3 renal scan was done for 47 subjects. Regression analysis and Pearson's correlation methods were utilized for statistical analysis. Results: There was significant correlation between 1/cystatin C and creatinine clearance (p＜0.001) and the correlation coefficient between 1/cystatin C vs. creatinine clearance (R= 0.552) was bigger than that between 1/creatinine and creatinine clearance (R=0.329). The reciprocal of cystatin C was positively correlated with the average of bilateral ERPF ratio of MAG3 renal scan (p=0.01), while there was no significant correlation between 1/creatinine and the average of bilateral ERPF ratio. Conclusion: Measurement of serum cystatin C is a useful and convenient method for the evaluation of renal function in spinal cord injured patients. (J Korean Acad Rehab Med 2005; 29: 371-376)

Objective
To categorize the spinal cord injury level and American Spinal Injury Association (ASIA) impairment scale into functional classification of shooting and to give information about shooting sport for the disabled to medical staffs, and to remind importance of sports activities for rehabilitation. Method: Seventy nine spinal cord injured players were classified into each functional classes by two international classifier. During the classification process, demographic data such as age, sex, duration, injury type and questions including attitude toward disabled shooting or benefits or difficulties from shooting were collected by interview. Results: Functional classes of players were closely related to injury level and ASIA impairment scale. Average dura-tion of shooting experience of men (8.01 years) was significantly different from that of women (5.29 years)(p＜0.05). Self-motivated (39.3%) and disabled friends (21.5%) were leading motive providers followed by medical staff (20.2%), other shooting player or coach (12.7%), family (6.3%). Promoting self confidence (32.5%) was number one benefit from shooting and followed by making friends (22.1%), increasing independence (18.3%), and increasing in social participation (12.7%). Conclusion: We report the functional classification result of spinal cord inured player and we found that sports activities promote social activities and help to develop self confidence. (J Korean Acad Rehab Med 2005; 29: 377-382)

Objective
An electromyographic examination is often utilized to confirm the diagnosis of suprascapular neuropathy in patients with shoulder pain and dysfunction. The purpose of this study was to compare two recording methods (surface and monopolar needle electrode recordings) for the evaluation of suprascapular nerve. Method: Twenty-two healthy subjects were tested with each method. Differences between the recording methods were compared for compound muscle action potential (CMAP) latencies and amplitudes. And the parameters obtained from two recording methods were correlated. Results: The mean age was 43.6⁑12.4 years (range: from 23 to 72 years old). The surface recordings appeared to give a more reproducible latency and amplitude of CMAP of the infraspinatus. The surface recorded CMAP latency and amplitude were 2.58⁑0.46 ms, and 12.6⁑2.7 mV, respectively. Those of the needle electrode recording were 2.49⁑0.41 ms and 27.6⁑6.55 mV, respectively. The two recordings were significantly correlated in latency (r=0.876, p＜0.05) and amplitude(r=0.484, p＜0.05). Conclusion: Considering the invasiveness of study and compliance of the patient, the surface electrode recording may be prudent for the convenient assessment and follow up studies in suprascapular nerve conduction study. (J Korean Acad Rehab Med 2005; 29: 383-386)

Objective
To evaluate changes of the parameters of the compound muscle action potentials (CMAPs) in repetitive stimulation test of the distal segment after section of the rat sciatic nerve. Method: Twenty rats (Sprague-Dawley, 400∼450 gm) were used. Under anesthesia, one side of sciatic nerve at the 1 cm distal to the ischial tuberosity was sectioned. Following section the proximal end of the distal segment of the nerve was fixed to adjacent muscle by suture. An active stimulating wire electrode was placed at 1 cm distal to the proximal end of the distal segment. Recording electrodes were mounted at the soleus subcutaneously. Recordings of the repetitive stimulation of the sciatic nerve from the soleus were obtained at 4-hours intervals until complete conduction absence. Results: Mean time of complete absence of the CMAPs in the distal segment after section of the sciatic nerve was 70.0 ⁑12.5 hours. There was no significant change in the amplitude or area of the CMAPs in low rate or high rate repetitive stimulation. Conclusion: Our results suggested that sufficient amount of acetylcholine was released in response to repetitive stimulation after nerve section in the rat. (J Korean Acad Rehab Med 2005; 29: 387-391)

Objective
Through a animal study using rats, we investigated whether abnormal spontaneous activities (ASAs) could be observed in the radiculopathies of biochemical and mechanical model. Method: A total of 30 Sprague-Dawley male rats were randomly assigned into sham, nucleus pulposus (NP) and ligation groups. In the sham group, the right L4 and L5 nerve roots were exposed by laminectomies. In the NP group, nucleus pulposus was transplanted onto nerve roots from tail. In the ligation group, exposed nerve roots were ligated by silk ligatures. All rats were evaluated by mechanical allodynia, motor paresis, and the needle electromyography (EMG) examination. Results: Mechanical allodynia was observed on the 4th and 7th postoperative days in NP and ligation groups. Motor paresis was observed only in the ligation group. The needle EMG showed ASAs on the 4th postoperative day, but decreased in incidence and amount on the 7th postoperative day in the NP and ligation groups. Conclusion: The ASAs can be observed by the biochemical action of nucleus pulposus as well as the mechanical compression. The results of this study may help explain the discrepancy between radiologic and electrodiagnostic findings. (J Korean Acad Rehab Med 2005; 29: 392-397)

Objective
To evaluate the effects of patella taping on pain and disability in symptomatic knee osteoarthritis (OA). Method: Using a within-subjects study design, 54 patients were tested under three conditions in random order: untaped, wearing therapeutic knee tape and wearing control knee tape. Outcome measure was pain as measured by visual analogue scale and disability as measured by walking speed, timed up and go test, and step test. Results: The therapeutic tape significantly reduced pain, when compared with the control and untaped conditions (p＜0.05). Also significant improvement in disability was ob-served on timed up and go test and step test in therapeutic tape compared with the control and untaped conditions (p＜0.05). But there was no significant difference on walking speed among three conditions (p＞0.05). A significant association between change of pain in stairs and lateral patellofemoral joint space was evident (r=0.503, p＜0.05). Conclusion: Therapeutic knee tape is a simple, inexpensive strategy that increases the treatment options for therapists and patients in the conservative management of knee OA. (J Korean Acad Rehab Med 2005; 29: 398-405)

Objective
To evaluate the effects of proliferant by injecting blood into the articular cartilage defect. Method: The patella of rabbits were dislocated laterally and 2 mm circular and 2 mm depth full-thickness defect was made in the articular cartilage. We injected 0.2 cc autologous blood to the right defect and normal saline to the left one at 1 week after operation for six times with a 1 week interval. After injection for six weeks, the articular cartilage defect were obtained and stained with H-E and S-100. Results: The surface of the saline-injected group was easily distinguishable from the surrounding articular cartilage. But the blood-injected group had similar appearance to the surrounding cartilage, with the margin of the defect barely discerptible. Strong S-100 stained immune cartilage cells were observed in the blood-injected group. Conclusion: The repairing process of the injured articular cartilage using autologous blood was shown to be much better than that of saline-injected group although the observation period was short and the number of animal was small. So we found that autologous blood effectively repaired osteochondral defects. (J Korean Acad Rehab Med 2005; 29: 406-412)

Objective
To investigate the changes of intraarticular temperature in the knee according to the application methods of cold jet-stream and to find the more effective method which reduces the intraarticular temperature. Method: Fifteen healthy subjects were examined. We recorded both skin and intraarticular temperature of the knee for 120 minutes. We compared two different cooling methods using ⁣30^oC cold jet-stream by CRAis^Ⱂ (Century, Korea). The first was the intermittent cold jet-stream application method (ICA) which applied cold jet-stream to the knee joint every other minute for 5 minutes and the second was the continuous cold jet-stream application method with infrared (CCAI) for 5 minutes. Results: In ICA, the intraarticular temperature maximally dropped as 1.7⁑0.6^oC (p＜0.01) and it took 28.7⁑18.9 minutes. Intraarticular temperature dropped 0.6⁑0.5^oC after 2 hour (p＜0.05). In CCAI, the intraarticular temperature maximally dropped as 2.8⁑0.7^oC (p＜0.01) and it took 38.0⁑24.6 minutes, intraarticular temperature after 2 hour dropped as 1.36⁑0.75^oC (p＜0.05). According to the two methods, CCAI showed more reduction in the lowest and after 2 hour intraarticular temperature compared with ICA in the knee joint (p＜0.05). Conclusion: CCAI is better for reducing the intraarticular temperature than ICA. (J Korean Acad Rehab Med 2005; 29: 413-418)

Objective
We examined the effect of low power laser irradiation (LPLI) on the proliferation and differentiation of PC12 nerve cells. Method: After seeding 4⁓10⁵ PC12 nerve cells each in the 24 well-culture dishes, we cultured them for 6 days with RPMI1640 media. LPLI (650 nm, 5 mW, 5 sec) was applied for 1 day, 2 days and 3 days (1, 2 and 3-day-LPLI groups) consecutively. For the degree of proliferation of PC12 nerve cells, we compared the total cell number at 6th day after LPLI by MTT cell proliferation assay. For the degree of differentiation, we compared the length of neurite out- growth and the expression of RT97 at 6th day after adding nerve growth factor on each group. Results: The total cell numbers were increased significantly after LPLI, but those increments were not significant among 1, 2, and 3-day-LPLI groups. The numbers of the differentiated PC12 nerve cells and the expressions of RT97 were diminished serially according to the number of days of LPLI. Conclusion: We conclude that LPLI increased the proliferation and decreased the differentiation of PC12 nerve cells. We could suggest that single or short-term use of LPLI on the injured nerve should be helpful for enhancing the neural regeneration in vivo. (J Korean Acad Rehab Med 2005; 29: 419-423)

Objective
Virtual reality (VR) has been thought to have great usability to enhance cognitive functions. This study was designed to evaluate the efficacy of a VR program which was developed to improve cognition of the elderly. Method: After developing a VR program, we set special input units and a large projection type monitor for the elderly. The VR program simulated 17 different house-hold tasks. Thirty elderly persons including 9 mild-dementia and 21 none-dementia were involved and were randomly divided into two groups. Fifteen were belonged to the training group and the other 15 belonged to the control group. The training group subjects underwent this VR program for 4 weeks by 3 times a week. Cognitive function change was assess by neuropsychological test scores before and after training period. Results: In the training group, scores in attention and immediate and delayed auditory memory tests were improved after training. However the control group didn't show any changes. And most subjects of the training group enjoyed this program. Conclusion: VR based cognitive training is a useful method to enhance cognitive functions for the elderly. (J Korean Acad Rehab Med 2005; 29: 424-433)

A 59 year-old female patient suffered from complex regional pain syndrome in left hemiplegia, was managed to stellate ganglion block (SGB) with 5 ml of 1 % lidocaine. The SGB was performed twice previously, with no side effects. And the third SGB was done in the same manner after negative aspiration testing. Two minutes later, she developed respiratory difficulty with increased blood pressure. Immediately airway management was performed by mask ventilation with oxygen. But ten minutes later, she developed respira-tory arrest with unconsciousness and intubation was performed. Soon she recovered spontaneous respiration and the blood pressure returned to the former level. Despite taking all precautions during SGB, complications such as respiratory arrest and hypertension may occur even in the hands of an experienced physician. Therefore, before starting SGB, all resuscitation drugs and equipment must be ready for use in case any emergency develops. (J Korean Acad Rehab Med 2005; 29: 434-437)

Cervical dystonia is the most common form of local dystonia encountered in a movement disorders clinic. Rotatocollis is involuntary contraction of sternocleidomastoid and contralateral splenius muscles resulting in twisting of the head clockwise or counterclockwise on the axial plane. We injected phenol solution into the affeced muscle or nerve branch in two patients with rotatocollis. There was significant improvement in neck movement and position. Phenol block may offer an easy and inexpensive alternatives for patients with cervical dystonia. (J Korean Acad Rehab Med 2005; 29: 438-440)