Objective
To investigate the function of sympathetic nervous system in patients with first-ever unilateral stroke by measuring hand sympathetic skin response (SSR) and the relationship between sympathetic dysfunction and motor function. Method: Eighteen patients with first-ever unilateral stroke and eighteen normal controls were recruited. The differences of hand SSR amplitude and latency between affected and unaffected side were investigated. Motor function was classified according to the Brünnstrom stage and activities of daily living were evaluated by modified Barthel Index (MBI) and Functional Independence Measure (FIM). Orthoe- static hypotension (OH) was evaluated and graded. Results: The difference of the amplitude of hand SSR between affected and unaffected side was increased in stroke patient group (p＜0.05). There was significant correlation between Brünnstrom stage and the difference of hand SSR amplitude (p＜0.05). There were significant correlations between MBI, FIM and the difference of hand SSR amplitude (p＜0.05). There was significant correlation between OH and the difference of hand SSR amplitude (p＜0.05). Conclusion: Evaluation of hand SSR could be useful methods to evaluate central autonomic dysfunction and motor dysfunction. (J Korean Acad Rehab Med 2006; 30: 207-212)

Objective
To identify the etiology of hemiplegic shoulder pain by ultrasonographic and clinical examinations and to determine the correlation between ultrasonographic findings and clinical factors in patients with hemiplegic shoulder. Method: Seventy hemiplegic patients with shoulder pain or without shoulder pain were enrolled. All of patients were evaluated by ultrasonography. We analyzed clinical factors including visual analogue scale (VAS) of hemiplegic shoulder pain, shoulder subluxation measured by plain X-ray, shoulder manual muscle test (MMT), passive range of motion (PROM) of the shoulder joint and complex regional pain syndrome (CRPS). Results: 51.0% of patients with shoulder pain showed ab-normal ultrasonographic findings, while 9.5% of patients without shoulder pain. Those with abnormal ultrasonographic findings had significantly decreased shoulder PROM in flexion, abduction, external rotation and internal rotation and more severe subluxation of hemiplegic shoulder (p＜0.05). Conclusion: After investigating the hemiplegic shoulder through ultrasonography, painful hemiplegic shouder had high incidence of abnormal ultrasonographic characteristics. Ultrasonography is more worthwhile and useful as an primary diagnostic method, especially when there is severe shoulder subluxation and the limitation of PROM of shoulder in hemiplegic patients. (J Korean Acad Rehab Med 2006; 30: 213-218)

Obejctive: This study was proposed to evaluate the electrophysiologic changes in motor evoked potentials (MEPs) and silent period after paraspinal electrical stimulation near caudal area of the spinal cord in stroke patients. Method: Electrical stimulation was applied to T12 paraspinal area using interferential current therapy (80∼100 Hz) in 18 stroke patients. The amplitude and latency of cortical motor evoked potential and duration of silent period were measured before and after the electrical stimulation. Results: The amplitude of MEPs in affected side was lowcompared with unaffected side. The duration of silent period was variable in affected side. The duration of silent period was increased after the electrical stimulation in stroke patients (p＜0.05). Changes of the amplitude and latency of MEPs were not significant. Conclusion: These results mean that the central inhibitory mechanism affecting the silent period is activated by a certain electrical stimulation near caudal area of the spinal cord in stroke patients. (J Korean Acad Rehab Med 2006; 30: 219-224)

Objective
To find correlations between the deletion of dystrophin gene and cognitive status in Duchenne muscular dystrophy (DMD). Method: Cognitive abilities of 49 DMD children with dystrophin deletion were tested. Korean Wechsler Intelligence Scale for children was used to evaluate the cognitive status in DMD. Gene deletion was classified into two groups according to the location of the rearrangement (proximal region: central and 3' region of the gene). Results: Molecular study by multiplex PCR (Polymerase Chain Reaction) of dystrophin exons was performed to identify 49 deletions in the 110 DMD patients. 13 out of 49 DMD were mentally impaired. In patients with distal dele-tions, total IQ (Intelligence Quotient) score was lower than the those with proximal deletions; which was not statistically significant. And the difference of the verbal and performance intelligence scale was not statistically significant. But comparisons of molecular and neuropsychological features showed that deletions localized in the central and 3' regions of the gene were preferentially associated with the mental impairement. Conclusion: We concluded that deletions in the distal portions of the gene were more related to the mental retardation, although deletions with variable locations might lead to cognitive impairments. (J Korean Acad Rehab Med 2006; 30: 225-229)

Objective
This paper aims at investigating the fitness of available computer mouse interfaces to each level of cervical spinal cord injury (SCI) patients ranging from C4 to C7. Method: Several commercially available computer mouse interfaces were selected for performance evaluation. They were head pointer, touch screen, button mouse, big-ball mouse, and mouse pad. Usual mouse with rubber pad was also tested for the C6-C7 SCI patients. The performance of each interface was evaluated in terms of average click rate of moving target box and patient's satisfaction. Results: The results that the touch screen and the head pointer were superior to other interfaces in terms of clickrate. However, in terms of the satisfaction ratio, C4-C5 SCI patients preferred the head pointer and C6-C7 SCI patients preferred the big-ball mouse. The difference in click rate and satisfaction ratio was attributed to the convenience of the interface, i.e., the necessity and type of orthosis when using the mouse interface. Conclusion: The results showed that the patients' preference was determined mainly by the convenience. Therefore, the convenience of the interface must be fully considered in the design and selection of computer interface for the SCI patients. (J Korean Acad Rehab Med 2006; 30: 230-235)

Objective
To help cardiopulmonary rehabilitation and prevention of cardiovascular disease in spinal cord injured patients. Method: Twenty spinal cord injured patients were divided into 3 groups according to level of injury - cervical, thoracic and lumbar level groups. Exercise stress test was initiated at a velocity of 1.5 mph for 1 minute and was increased 0.5 mph for each subsequent minute. To evaluate blood lipid profiles, we measured total cholesterol, HDL (high density lipoprotein)-cholesterol, LDL (low density lipoprotein)-cholesterol and triglyceride levels in the fasting state. Results: Oxygen consumption, oxygen consumption ratio ofmaximal oxygen consumption and minute ventilation were significantly higher in the thoracic and lumbar cord level groups compared to the cervical cord level group (p＜0.05). There was a significant difference between all 3 groups in respect to total duration of exercise (p＜0.05). The HDL- cholesterol level showed significant correlation with total exercise time (p＜0.05). Conclusion: Cardiopulmonary evaluation by specialized wheel chair system in spinal cord injured patients may be more safe and accurate method compared to the previous examination. (J Korean Acad Rehab Med 2006; 30: 236-240)

Objective
To evaluate the relationship between the electrophysiologic findings and the ultrasonographic findings of the ulnar neuropathy around the elbow. Method: We examed 20 elbows with the ulnar neuropathy around the elbow and 22 healthy elbows. We measured the cross-sectional area (CSA) and the diameters of the long, short axis of the ulnar nerve at the swollen portion and the compressed portion by ultrasonography. Results: The CSA, diameters on the longitudinal and transverse view of the swollen portion of the ulnar nerve of the patients group was larger than that of the control group (p＜0.05). The decrement of conduction velocity across the elbow was ⁣0.54⁑5.74 m/s in the control group and 18.60⁑10.45 m/s in the patients group (p＜0.05). There was no significant correlation between the decrement of the nerve conduction velocity across elbow and the decrement of CSA (r=0.346, p＞0.05). There was significant correlation between the decrement of the nerve conduction velocity across elbow and the increment of the diameter on the swollen portion on the longitudinal and transverse view (r=0.541, 0.466, p＜0.05, respectively). Conclusion: The difference of diameter between swollen and compressed portion of the ulnar nerve on the ultrasonography was correlated with the conduction velocity decrement on the electrophysiologic study. (J Korean Acad Rehab Med 2006; 30: 241-246)

Objective
To compare the difference of bone mineral density (BMD), biochemical markers, and lipid profiles according to dosage of estrogen on combined therapy with estrogen and alendronate in postmenopausal osteoporosis. Method: We studied 81 women with postmenopausal osteoporosis (T-score＜2.5) from March 2002 to February 2005. Subjects were divided in two groups; Group I (n=36), treated with low dose hormone therapy (HT) (0.3 mg estrogen/1.25 mg MPA (Medroxyprogesterone acetate)) and alendronate, and Group II (n=45), treated with standard dose HT (0.625 mg estrogen/2.5 mg MPA) and alendronate. BMD at the L-spine and femur, osteocalcin, deoxypyridinoline, and lipid profiles were measured at baseline and 1 year after treatment.Results: BMD at the L-spine increased significantly in two groups and BMD at the femur increased but showed no statistical differences. Deoxypyridinoline and osteocalcin decreased significantly in two group. Total cholesterol and LDL (low density lipoprotein) cholesterol decreased significantly in two groups, no significant difference was observed between two groups in BMD, osteocalcin, deoxypyridinoline, and lipid profiles. Conclusion: We concluded that combined therapy with low dose estrogen and alendronate in postmenopausal osteoporosis showed similar therapeutic effect provied by combined therapy of standard dose estrogen and alendronate. (J Korean Acad Rehab Med 2006; 30: 247-253)

Objective
To assess the static balance under the virtual moving surround (VMS) in healthy young and elderly adults. Method: There were twenty four healthy young adults and thirty nine healthy elderly aged 60 and older. Each group was tested with forceplate during quite standing with eyes opened, closed and under the VMS for static balance. The VMS was stimulated with a head-mounted display (HMD). The parameters for static balance were total sway path distance and area. Results: All static balance parameters of healthy elderly were significantly increased in all conditions when comparedwith parameters of young adults. In the young adults and elderly, total sway path distance and sway area were significantly different under the VMS. In the healthy elderly, total sway path distance and sway area were significantly increased under the VMS as much as eyes closed . Conclusion: In the healthy adults, the VMS could provoke the significant postural sway during static standing. VMS can be used as a tool to evaluate and treat of the patients with static balance dysfunction. (J Korean Acad Rehab Med 2006; 30: 254-260)

Objective
To assess effectiveness of resting hand splints to prevent contracture, maintain functional position and minimize spasticity in early stroke patients. Method: Subjects were hemiplegic patients with stroke less than one month. Both splint and control groups participated in individual motor training and upper limb stretching exercise. The subjects of the splint group wore resting hand splints for maximum of 12 hours each night for 4 weeks. Measurements of edema by measuring circumference of the third phalanx, pain at hemiplegic upper extremity using visual analog scale, spasticity at the wrist graded by the modified Ashworth scale, passive range of motion at the wrist with goniometer, and functional hand use with themanual function test (MFT) were made. All measurements were taken during standard rehabilitation at the beginning and end of a 4-week treatment period. Results: Before treatment, the circumferences of the splint and control groups were 6.7⁑0.5 cm and 6.7⁑0.8 cm, respectively. After 4 weeks, both were 6.8⁑0.6 cm and 6.8⁑0.8 cm, which showed no significant differences between the groups. The effects of splinting were statistically nonsignificant between control and splint groups for all measurements. Conclusion: An overnight splint-wearing regimen for early stroke patients may not produce clinically beneficial effects. (J Korean Acad Rehab Med 2006; 30: 261-265)

Objective
To find the most effective lever-point to manufacture the rocker-outsole. Method: Ten healthy men were participated. Metatarsal-bar, 12⁓1⁓0.5 cm, was clung to the outsole of shoes. In the first experimental-group, we set the center of the metatarsal- bar to an imaginary line which across the center of the 1st metatarsal head with that of the 5th metatarsal head. In turns, we experimented the other groups as moved the center of the metatarsal-bar 0.5 cm backwards, each naming 2nd, 3rd, 4th group. Plantar peak pressures were measured at T0 (whole foot), M1 (heel), M2 (midfoot), M3 (1st, 2nd metatarsal area), M4 (3rd, 4th, 5th metatarsal area), M5 (great toe), M6 (2nd, 3rd toe) and M7 (4th, 5th toe). Results: There was significant decrease in the peak pressure of M3 in the first experimental-group, which the center of metatarsal-bar was set to an imaginary line. Conclusion: In the first experimental-group, there was significant decrease in the peak pressure of M3. Therefore, the lever-point of rocker-outsole should be set to an imaginary line which connects the center of the 1st metatarsal head with that of the 5th metatarsal head. (J Korean Acad Rehab Med 2006; 30: 266-270)

Objective
To analyze and evaluate the quality of the Korean web sites of medical information about degenerative osteoarthritis. Method: The search term 'degenerative osteoarthritis' was entered into five popular Korean web search engines. The web sites for the first 20 matches generated by each search engine were grouped by author and evaluated by DISCERN instrument, certification standard of internet health information by Korean Academy of Medical Sciences (KAMS instrument), and guidelines and items for evaluation of internet health information by Chung and Park (Chung & Park Instrument). Results: Of the 100 sites identified, only 44 were unique and included in the analysis. Eight sites were commercial and each 21, 5, 3, 7 sites were authored by physician, public institute, oriental medical doctor and others, respectively. By DISCERN instrument, there was a significant difference in total score, reliability of publication and overall quality rating. By KAMS instrument, there was a significant difference in total score, reliability, and content. By Chung & Park instrument, there was a significant difference in total score, objectivity, accuracy, credibility and authority. Conclusion: The quality of degenerative osteorarthritis information on the internet varied greatly. Web sites authored by public institutes and physicians were ranked higher than others. (J Korean Acad Rehab Med 2006; 30: 271-281)

We reported a 56-year-old man who presented with vagus nerve injury after deep laceration in the neck. During being treated the neck insult, he was performed pyloplasty and vagotomy and used total parenteral nutrition due to peptic ulcer perforation and panperitonitis. He suffered from swallowing difficulty and underwent percutaneous endoscopic gastrostomy placement. As formerly, recurrent gastroesophageal reflux symptoms and gastric feeding intolerancewere developed. We fixed a transgastrostomal jejunal tube in jejunum through the gastric stoma. The gastroeophageal reflux and feeding intolerance did not recur. After 30 days later, jejunal tube was removed, nutritional support was replaced by gastric tube. We were able to provide a temporary nutritional bridge with percutaneous endoscopic gastrojejunostomy placement for patients who suffered from dysphagia. (J Korean Acad Rehab Med 2006; 30: 282-285)

Gabapentin has been accepted worldwide as a novel antiepileptic drug with a favourable tolerability profile. Although its exact mode of action is not known, it is recently widely used to manage symptomatic treatment of neuropathic pain syndromes. It has few side effect profiles and it is known not to be associated with liver injury. But we experienced a case of liver injury associated with gabapentin. A 44-year-old man was hospitalized because of seizure caused by septic shock. He complained of tingling sensation and burning pain on his both legs. Gabapentin was prescribed to control his symptoms. An increase of serum aminotransferases was detected after gabapentin therapy, and immediately after stopping it, aminotransferase level normalized. (J Korean Acad Rehab Med 2006; 30: 286-288)

To date, very few cases with intraneural ganglion cyst of the peroneal nerve has been reported. The common symptoms include localized pain and various degrees of motor and sensory deficits. Though electrodiagnostic study has been useful in lesion localization, recent imaging studies, such as ultrasonography and magnetic resonance imaging, should be used in establishing differential diagnosis and extent of a lesion preoperatively. Treatment can be achieved by microsurgical removal of the cyst. We had a 74 year old female with right foot drop for 3 months and we diagnosed that she had intraneural ganglion of the peroneal nerve using physical examination, electrodiagnostic study, ultrasonography, and magnetic resonance imaging. Although there was no specific symptom on the left side, there was a similar lesion like that of right intraneural ganglion, that was detected by ultrasonography. However, the patient's neurologic symptoms have not improved after operation. (J Korean Acad Rehab Med 2006; 30: 289-293)