The population enjoying ski had increased since 1970's in Korea. Recently, that of snowboarders has increased rapidly among young population. Patterns of injuries are somewhat different between two sport activities. The most commonly injured region is knee among skiers and wrist among snowboarders. Head injury, spinal injury, and abdominal injury are not so common but a few serious injuries had been reported in Korea. To prevent or minimize injuries, proper pre-seasonal training including muscle strengthening, proper selection of equipments, and instruction for both sport technique and protection for safety are important. Also primary care for the injured as well as delivery system for seriously injured population should be established. (J Korean Acad Rehab Med 2005; 29: 553-556)

Objective
The response of the pharyngeal phase during swallowing is influenced by various factors including viscosity, shape, firmness, fracturability, and cohesive power. These factors affect the pharyngeal phase simultaneously, but little research has been conducted into their individual effects on the pharyngeal phase. This study investigated the relationship between controlled viscosity and pharyngeal transit time (PTT). Method: The subjects were 81 patients with naso-gastric tube due to brain dysfunction. PTT was assessed by video- esophageal fluoroscopy and the viscosity of the processed starch by Brookfield viscometer. High viscosity was defined as a controlled viscosity of 12% and 9%, medium viscosityas a controlled viscosity of 7.5%, 6%, and 4.5%, and low viscosity as a controlled viscosity of 3%, 1.5%, and 0% (liquid viscosity). Results: PTT was prolonged with increasing viscosity in the experimental group. There were no significant differences between PTT of the experimental and control groups at any viscosity. Aspiration prevalence was 1.85%, 7.82%, and 22.22% in the high, medium, and low viscosity groups, respectively, and the three prevalences showed significant differences. Conclusion: PTT showed a tendency to be prolonged with increasing food viscosity in the experimental group. (J Korean Acad Rehab Med 2005; 29: 557-562)

Objective
To investigate the relationship between National Institute of Health Stroke Scale (NIHSS) and motor evoked potential (MEP) after stroke, measured by transcranial magnetic stimulation (TMS). Method: Forty six subjects with the middle cerebral artery ischaemic/hemorrhagic stroke were examined with NIHSS and TMS. According to the responsiveness of MEP in the affected muscles, subjects were divided into 2 groups: Group I consisted of 26 subjects responsive to TMS of the affected hemisphere and group II, 20 subjects unresponsive to TMS. NIHSS score was expressed as a sum of NIHSS total score, NIHSS arm and leg subscore. Results: The resting motor threshold (rMT) and the ampli-tude of MEP in group I were 75.1% and 13.5 uV, respectively. Although NIHSS leg subscore was no statistical difference between two groups, NIHSS total score and NIHSS arm subscore in group I were statistically lower than those in group II. In group I, the rMT had a correlation with NIHSS total score and NIHSS arm subscore (r=0.39, r=0.49, p＜0.05), but did not with NIHSS leg subscore (r=0.07, p＞0.05). Conclusion: The NIHSS has relationship with cortical neurophysiological changes in the affected cerebral cortex in stroke. Therefore, it would be a useful tool to evaluate the status of motor function of hemiplegic stroke. (J Korean Acad Rehab Med 2005; 29: 563-567)

Objective
To evaluate the level of depression, anxiety and quality of life in primary caregivers for the severe stroke patients. Method: We studied a sample of 44 severe stroke patients and their primary caregivers. Functional status of the severe stroke patients was evaluated by Modified Barthel Index (MBI). We collected the data through interviewing the caregivers and using the Beck Depression Inventory (BDI), State- Trait Anxiety Inventory (STAI), Ego-strength scale, Short Form Health Survey-36 (SF-36) and Family APGAR (Adaptation, Partnership, Growth, Affection and Resolve) score. Results: The average level of depression in caregivers was low. The mean socres of STAI were 41.5 for state anxiety and 44.3 for trait anxiety, respectively. Ego-strength scale was significantly inversely related to BDI score and trait anxiety inventory score, but positively related to SF-36 score. The most influencing factor for the SF-36 score was the BDI score. Conclusion: Primary caregivers for the home-bound severe stroke patients demonstrated a lower level of quality of life, especially mental health, general health and vitality component. Community based rehabilitation should more focus on the evaluation and support for caregiver's psychologic status and their quality of life. (J Korean Acad Rehab Med 2005; 29: 568-577)

Objective
To evaluate exercise capacity of subacute stroke patients with nonambulatory exercise stress test and to determine whether reduced exercise efficiency is associated with functional performance. Method: Experimental design was prospective and observational study. Eighteen patients with moderate to severe impairment after recent stroke performed exercise stress test by repeated knee flexion and extension exercise using isokinetic dynamometer. Work rate, oxygen consumption, heart rate were assessed during exercise stress test. The dynamic response, the ratio of change in oxygen uptake to change in work rate, was measured for correlation with FIM (Functional Independence Measure) scores. Occupational therapist recorded FIM scores on the day of transfer to inpatient rehabilitation unit and on discharge. Age-matched healthy group also performed exercise stress test in same settings. Results: The patients group who had similar dynamic response with age-matched healthy group showed higher FIM scores than the patients group having higher dynamic response. Conclusion: Nonambulatory exercise stress test could be effectively used in subacute stroke patients and the ratio of change in oxygen uptake to change in work rate was a useful variable to reveal low exercise efficiency in subacute stroke patients who had a abnormal skeletal muscle metabolic capacity. (J Korean Acad Rehab Med 2005; 29: 578-583)

Objective
To determine the diagnosis and investigate the clinical features of children with language delay. Method: One hundred seventy-eight children who were referred to the Developmental Delay Clinic for the evaluation of suspected language delay were prospectively enrolled. Multidisciplinary assessment was done by a physiatrist, pediatric neurologist and pediatric psychiatrist. All patients took speech evaluation, full battery of cognitive assessment and hearing test. Results: The common diagnoses of children with language delay were mental retardation (MR), specific language impairment (SLI) and autism spectrum disorder (ASD) in the order of frequency. The early developmental history showed delay of acquisition of motor milestone in MR group. The brain magnetic resonance image (MRI) and single photon emission computerized tomography (SPECT) findings couldn't help to distinguish the brain pathology in SLI, MR and ASD. The result of speech evaluation showed more severely involved in ASD and MR rather than SLI. Conclusion: In the clinical assesment and management of the children with language delay, the comprehensive assessment which includes cognition and personal-social area as well as language itself would be helpful for the understanding and setting up the therapeutic plan of these children. (J Korean Acad Rehab Med 2005; 29: 584-590)

Objective
Ossification of the posterior longitudinal ligament (OPLL) is a degenerative disorder of the spine which is related to cervical compressive myelopathy. We studied patients with central cord syndrome (CCS) to explore the implication of OPLL on clinical features and functional outcomes of CCS. Method: A retrospective study was conducted on 26 patients with CCS between 1998 and 2003. Demographic characteristics, mechanisms of injury, neurological impairments, main functional outcomes, and complications were identified. Clinical features and outcomes were compared between OPLL and non-OPLL group. Results: Twenty patients with CCS had OPLL (12/17 with traumatic and 8/9 with non-traumatic CCS). The initial ASIAObjective: Ossification of the posterior longitudinal ligament (OPLL) is a degenerative disorder of the spine which is related to cervical compressive myelopathy. We studied patients with central cord syndrome (CCS) to explore the implication of OPLL on clinical features and functional outcomes of CCS. Method: A retrospective study was conducted on 26 patients with CCS between 1998 and 2003. Demographic characteristics, mechanisms of injury, neurological impairments, main functional outcomes, and complications were identified. Clinical features and outcomes were compared between OPLL and non-OPLL group. Results: Twenty patients with CCS had OPLL (12/17 with traumatic and 8/9 with non-traumatic CCS). The initial ASIAmotor score of OPLL and non-OPLL patients was 67.8 and 65.3 and, at discharge, 82.8 and 78.5. There were no significant differences in gait, bladder management, length of stay, discharge disposition, and major complications between OPLL and non-OPLL group. Among OPLL patients, non- traumatic CCS patients showed higher ASIA motor score at discharge and had a tendency of better functional outcome than traumatic CCS patients. Conclusion: OPLL was commonly observed in CCS patients. Mechanism of injury rather than the presence of OPLL was a significant determinant of clinical features or functional outcomes of CCS. (J Korean Acad Rehab Med 2005; 29: 591-597)

Objective
To compare abductor digiti minimi (ADM) recording with first dorsal interosseous (FDI) recording for the localization of ulnar neuropathy at the elbow. Method: The subjects were consisted of 28 patients of ulnar neuropathy at the elbow. The subjects were divided into 3 groups: focal demyelination; focal demyelination and axonal degeneration; axonal degeneration. Compound muscle action potentials were recorded from both ADM and FDI muscles and ulnar nerve was stimulated at the wrist, 2 cm distal and 8 cm proximal to the medial epicondyle. Focal demyelination were analyzed into conduction block and/or conduction slowing. Results: Conduction block was observed in 13 out of 28patients (46%) with FDI recording and 11 out of the 28 patients (39%) with ADM recording. Conduction block was found solely with FDI recording in 3 patients, whereas 1 patient showed conduction block with ADM recording only. Concomitant segmental motor conduction slowing was observed in 11 out of 13 patients with FDI recording and in 6 out of 11 patients with ADM recording. Conclusion: Measurements to the FDI had a higher yield of abnormality than the ADM. In some patients, only one recording muscle showed abnormal findings. Therefore, it may be useful to record from both muscles to localize ulnar neuropathy at the elbow. (J Korean Acad Rehab Med 2005; 29: 598-601)

Objective
The purpose of this study was to observe clinical characteristics and electrodiagnostic findings of idiopathic facial palsy and to follow up beyond 1 year after onset. Method: From February 2002 to July 2003 the authors analyzed 103 cases that could be followed up after 1 year since diagnosed as idiopathic facial palsy by electrodiagnostic study which was performed at approximately 2 weeks after the onset time. The patients were classified by House- Brackmann (H-B) facial nerve grading system on their first visits and followed up by telephone interview using H-B system. Treatment method, age, sex, medical history and symptoms were noted. In addition, the blink reflex, nerveconduction study and needle electromyography (EMG) were done. Results: When degree of degeneration (% degeneration) was greater than 90% at approximately 2 weeks after the onset or motor unit action potentials were not detected in at least one among the four tested muscles, patients did not gain satisfactory facial function after 1 year. Conclusion: Methods related to prognosis of idiopathic facial palsy were compared with side to side evoked potential amplitude and needle EMG. This methods would be helpful to explain its prognosis. (J Korean Acad Rehab Med 2005; 29: 602-607)

Objective
This study aims at evaluating the usefulness of the electrodiagnostic study (EDx) and the magnetic resonance imaging (MRI), which are performed before surgical operation of brachial plexus injury. Method: We reviewed 57 cases of brachial plexopathy diagnosed with surgical findings. EDx and MRI were performed to the patients before surgery. Based upon intraoperative findings, we evaluated the occurrence of preganglionic root injury and subsequently each injured spinal root level. Results: EDx and MRI for preganglionic root injuries showed 92.1% and 78.9% of diagnostic sensitivity and 63.2% and 42.9% of diagnostic specificity, respectively. The followings were about each injured spinal root level. EDx showed that the sensitivities of C5, C6, C7, C8, T1 were 91.4%, 91.4%, 92.6%, 96%, 95.8%, and their specificities were 59.1%, 59.1%, 56.7%, 68.8%, 66.7%. MRI showed that the sensitivities were 47.4%, 57.9%, 58.3%, 75%, 66.7%, and their specificities were 57.1%, 71.4%, 78.6%, 85.7%, 85.7%. Conclusion: As for preganglionic brachial plexopathy, EDx was more useful than MRI to diagnose preganglionic root injury and determine the level of injured spinal root. (J Korean Acad Rehab Med 2005; 29: 608-613)

Objective
Lateral femoral cutaneous nerve (LFCN) conduction study is an objective measure for the diagnosis of meralgia paresthetica. Sensory nerve action potential of LFCN is not frequently evoked because of anatomical variations around inguinal area. The purpose of this study is to support the diagnosis of meralgia paresthetica by considering anatomical variations of LFCN in Korean adult cadavers. Method: Eighteen lower limbs of total nine adult cadavers were studied. Men were five and women were four. The points that LFCN or the main branch of LFCN met the imaginary line from anterior superior iliac spine (ASIS) to pubic tubercle and to lateral border of patella were recorded,respectively and distances from ASIS to those points were measured. Results: The distance from ASIS to the point that LFCN or the main branch of LFCN met the imaginary line from ASIS to pubic tubercle and to lateral border of patella was respectivlely 1.36⁑0.68 cm (minimal 0.2, maximal 3.0) and 10.74⁑5.68 (minimal 3.3, maximal 20.1) cm. There was no significant distance difference between men and women. Conclusion: This study showed anatomic variations of LFCN around ASIS and femoral part. This knowledge may help LFCN conduction study for the diagnosis of meralgia paresthetica. (J Korean Acad Rehab Med 2005; 29: 614-618)

Objective
We designed this study to investigate the relationship among lumbar disc herniation, vertebral endplate area and shape, and lumbar and sacral parameters. Method: 78 experimental patients with low back pain and 27 controls were enrolled. Experimental patients were divided into group A with low back pain without trauma and lumbar disc herniation and group B with low back pain due to lumbar disc herniation without trauma. Controls had low back pain due to recent trauma but no previous history of back pain and lumbar disc herniation. We reviewed MRI (magnetic resonance image) films of these patients with anteroposterior and transverse diameter of endplates, lumbarlordosis angle, and sacral angle. The relationship of these data and sex, age, body weight, height, intervertebral disc herniation, low back pain were statistically studied. Results: Patients' sex, age, body weight, height, vertebral endplate area and shape, lumbar and sacral parameters were not related to disc herniation. But the more circular vertebral shape was, the larger lumbar lordosis angle was. And the larger lumbar lordosis angle was, the less sacral angle was. Conclusion: There were no relationships between the development of disc herniation at L4-5, L5-S1 and the shape of the vertebral body at the endplate level. (J Korean Acad Rehab Med 2005; 29: 619-623)

Objective
To evaluate effect of comprehensive rehabilitation treatment after reconstruction of anterior cruciate ligament (ACL). Method: We reviewed the medical records of 10 patients who had been in rehabilitation program after reconstruction of ACL. 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 reconstructed legs, strength of flexors and extensors of the knee, and functional test before and after rehabilitation. Results: The range of motion, VAS score, thigh circumference, strength of flexors and extensors of reconstructed knee were significantly improved after rehabilitation. The knee flexion angle increased from 86.5^o to 135^o and knee extension angle increased from ⁣9.61^o to 0^o. VAS score decreased from 3.8 to 1.2. The thigh circumference just above patella decreased from 38.6 cm to 36.5 cm. The torque of flexors increased from 66.2 N·m to 128.7 N·m and that of extensors at 60^o/sec increased from 110.5 N·m to 201.2 N·m. 8 out of 10 players returned to sports successfully after systemic rehabilitation. Conclusion: We suggested systemic and appropriate rehabilitation after ACL reconstruction for successful return to sports. (J Korean Acad Rehab Med 2005; 29: 624-629)

Objective
To suggest a safer and easier technique of suprascapular nerve block by assessing anatomical relationship of the suprascapular notch from a view point of surface anatomy. Method: Fourteen shoulders of seven cadavers were dissected in prone position. The scapular notch was exposed and the articular branch of suprascapular nerve was observed. The length and depth of spine, height and relative position of scapular notch were measured for all of the specimen. Results: The length of the spine was 11.45⁑0.72 cm. The injection point was measured as relative position of scapular notch on the spine. The ratio between distance from medial border of the spine to injection point and from the injection point to posterior angle of acromion was 1.89⁑0.2：1. The depth of the spine, which was defined as the shortest vertical distance from the injection point to the scapula was 2.69⁑0.43 cm, and the vertical distance from this contact point to the base of the scapular notch, e.g. the height of the scapular notch, was 1.18⁑0.1 cm. Conclusion: We expect we could perform suprascapular nerve block easily and safely with suggested surface landmarks and measured data in this study. (J Korean Acad Rehab Med 2005; 29: 630-634)

Objective
Because bone metabolic changes progress from initial stage of stoke, early prevention and treatment have been important. Isoflavone has been proved to be effective in post-menopausal osteoporosis. Therefore the authors used a stroke rat model and evaluated the effects of isoflavone on bone metabolism from initial stage of stroke. Method: Female Sprague-Dawley rats were randomly divided into 2 separate groups; a stroke without isoflavone supplement group and stroke with isoflavone supplement group. The bone mineral density (BMD) in 4th and 5th lumbar vertebrae were measured at the day before stroke, 11th and 18th days after the stroke. The BMD in excised distal femur and proximal tibia and the maximum load offemur neck and tibia shaft were measured at 18th days after the stroke. Results: On the 18th day after stroke, BMD of stroke with isoflavone group was significantly higher than that of stroke without isoflavone group in 4th and 5th lumbar vertebrae and distal femur. The maximum load of stroke with isoflavone group was significantly higher than that of stroke without isoflavone group in femur neck. Conclusion: The results suggested that isoflavone supplement in stroke rat had beneficial effect on bone metabolism from the initial stage of stroke. (J Korean Acad Rehab Med 2005; 29: 635-639)

Objective
To evaluate the dynamics of autonomic nervous activity at rest and immediately after maximum exercise using heart rate variability (HRV) in coronary artery disease (CAD) and to assess the long-term effect of exercise. Method: Time and frequency domain of HRV was measured in 18 normal subjects, 37 CAD patients with percutaneous transluminal angioplasty and 10 CAD patients with coronary artery bypass graft at rest and 1 hour after peak graded treadmill exercise. Nineteen CAD patients were exercised with moderate intensity during 4 month and HRV was measured. Results: At rest, the standard deviation of the NN interval (SDNN) and low frequency was significantly lower in bothCAD groups than in normal subjects. At recovery stage after maximum exercise, low frequency and low frequency/high frequency ratio was significantly lower in both CAD groups than in normal subjects. SDNN at recovery stage in normal subjects remained significantly below the baseline. There was no significant change in HRV after long-term exercise even though maximum oxygen uptake had improved. Conclusion: This study demonstrated the reduced control of autonomic nervous activity in CAD patients at rest and immediately after peak exercise. There was no change in HRV after long-term exercise. (J Korean Acad Rehab Med 2005; 29: 640-646)

Objective
Nowadays half body bathing (H-bath) became popular with increasing interests of health and well-being. H-bath is expected to be beneficial and safe as well as conventional whole body bathing (W-bath). However, there has been no formal report on the safety and effectiveness of H-bath. Therefore, this study tried to evaluate and compare the cardiovascular response during H-bath and W-bath in patients with or without cardiovascular disease. Method: 17 subjects with at least one cardiovascular risk factor and 15 subjects without any cardiovascular risk factor took H-bath while 22 healthy control group without any cardiovascular risk factor took W-bath. Changes of skin and oral temperature as well as hemodynamic responses (systo-lic blood pressure, diastolic blood pressure, heart rate) were measured. Results: Increasing of systolic blood pressure and heart rate in H-bath was statistically lowered compared to W-bath as time goes by in bathing (p＜0.05). There were no significant difference in patients with and without cardiovascular disease. Conclusion: Heart rate, temperature, systolic blood pressure showed a more gradual increase during H-bath than during W-bath. We propose that H-bath could be a more safe and compliant method of cardiac rehabilitation in patients with cardiovascular disease. (J Korean Acad Rehab Med 2005; 29: 647-653)

Objective
To investigate the kinematic and kinetic characteristics of stair ascent in patients with knee osteoarthritis. Method: Twenty patients with knee osteoarthritis and twenty healthy controls were recruited. The kinematic and kinetic data were obtained through a three dimensional motion analyzer. The kinematic and kinetic data during stair ascent were compared between two groups. Results: The total required time of stair ascent was significantly longer in the osteoarthritis group than that of the control group (p＜0.05). In comparison with the control group, the angle of maximal pelvis anterior tilting, minimal and maximal hip flexion and minimal knee flexion were significantly increased (p＜0.05). However, the angle of knee flexion and ankle dorsiflexion at initial contact were significantly decreased in the osteoarthritis group (p＜0.05). The maximal moment and power of knee extension and ankle plantarflexion were significantly decreased in the osteoarthritis group (p＜0.05). Sixteen patients (80.0%) in the osteoarthritis group showed flexion arc after initial contact. "W" sign was shown in 16 patients (80.0%). Conclusion: We found the unique kinematic and kinetic patterns during stair ascent in patients with knee osteoarthritis, and that knee osteoarthritis influence not only kinematic and kinetic patterns of knee but also those of hip and ankle. (J Korean Acad Rehab Med 2005; 29: 654-661)

Objective
To investigate the effect of cervical orthosis upon swallowing and the differences of bracing effect between normal people and spinal cord injured patients. Method: 12 normal adults and 32 cervical cord injured patients who were wearing one of the three common cervical orthoses (soft neck collar, Philadelphia brace, and Minerva brace) were recruited. Swallowing function was evaluated by videofluoroscopic swallowing study (VFSS) without cervical bracing for the baseline data and with cervical bracing to compare with baseline data. The parameters observed were oropharyngeal diameter, initiation point of swallowing, hyoid bone movement, laryngeal penetration, aspiration,and residual volume after swallowing. Results: Cervical orthoses decreased oropharyngeal diameter, reduced hyoid bone movement, increased residual volume, and changed initiation point of swallowing. Minerva brace revealed to give more influence than other braces. Normal adult group and patient group showed no difference in cervical bracing effect. Conclusion: Attention should be paid to swallowing function when cervical bracing is needed because cervical bracing itself can increase the risk of aspiration. (J Korean Acad Rehab Med 2005; 29: 662-668)

We reported a 32-year-old man diagnosed as Bickerstaff's brainstem encephalitis with Guillian-Barre syndrome. After plasmapheresis, his consciousness and respiratory function and motor strength improved. He was discharged without rehabilitation treatment and could perform activities of daily living independently on wheel chair level. For reducing cocontraction of lower extremity muscles, neuromuscular reeducation using EMG biofeedback was performed after admission. After a month of treatment, gait pattern was improved. He received rehabilitative managements such aspool therapy with gait training and improved to 4/5 grade at proximal lower extremities, but the endurance and the quality for his walking was poor because of the cocontraction of muscles in lower extremities. EMG biofeedback for the neuromuscular reeducation leading to each muscle's isolated movements was done. After 2-month rehabilitation, he could walk over 20 meters even level independently without walking aids. This case could be a good model for the effective neuromuscular reeducation. (J Korean Acad Rehab Med 2005; 29: 669-672)

Lesch-Nyhan syndrome is a rare X-linked recessive metabolic disorder characterized by developmental delay, hyperuricemia, choreoathetosis, spasticity, mental retardation, and compulsive self-injurious behavior. This disorder results from a complete deficiency of the purine salvage enzyme, hypoxanthine-guanine phosphoribosyltransferase (HGPRT). This syndrome is often misdiagnosed to cerebral palsy and clinical manifestations are usually related to the degree of enzyme deficiency. Complete HGPRT deficiency presents with severe specific neurologic manifestation and nephrolithiasis leading to fatal kidney damage. This report highlighted the importance of clinical awareness leading to early diagnosis and therapy for prevention of the self mutilation and renal failure, even if we couldn't inhibit the progression of neuro-psychotic symptoms. (J Korean Acad Rehab Med 2005; 29: 673-677)

Subacute combined degeneration is a disease of spinal cord involving the posterior and lateral columns due to vitamin B₁₂ deficiency. We experienced a 56-year-old man suffering subacute combined degeneration, characterised by dysesthesia and disturbance of deep sensation such as position sense,proprioception and vibration sense in the lower extremities, and ataxic gait. We reported one patient with subacute combined degeneration of the cord in association with pernicious anemia resulting from inactivation of intrinsic factor by it's antibodies. (J Korean Acad Rehab Med 2005; 29: 678-680)

Both hypothyroidism and hyperthyroidism can display signs and symptoms of neuromuscular dysfunction overshadowed by primary disease. Whatever the mechanism by which the thyroid affects muscles and nerves, prompt diagnosis and restoration of normal thyroid function leads to resolution of most neuromuscular symptoms. Therefore patients with thyroid dysfunction should be questioned for musculoske-letal complaints and referred to a specialist if necessary. Thyroid disorders should be considered as one of the causes in patients presenting musculoskeletal manifestation. We described four patients with thyroid disorders who presented with musculoskeletal manifestations. (J Korean Acad Rehab Med 2005; 29: 681-685)