Development in motor skills and abnormal movement patterns in developing child are clearly observed and easily identified by the parents. Motor delay and movement disorder are common presentations for children with developmental disorders. Therefore, assessment for motor development and movement disorder become the major developmental focus of early in life. Physical examination has been considered as a key element for identifying developmental motor disorder. Traditionally, development of tone, primitive reflexes, postural reaction and motor milestone are commonly used as the evaluation tools for early identification of children at high risk for developmental disorder. Recently the assessment of the quality of general move-ments was introduced as a new form of neuromotor assessment of young infant. Therefore, clinical usefulness of the assessments for detecting neurological dysfunction was briefly reviewed in this paper. As well, there are a lot of movement disorders shown in child. The movement disorders can be separated into transient, paroxysmal and chronic ones according to their evolution. Since the knowledge of the movement disorders in each category enables us to understand the evolution of movement disorders, avoid unnecessary tests and treatments, and also give the proper information to the parents, the movement disorders were briefly reviewed in this paper. (J Korean Acad Rehab Med 2006; 30: 545-553)

Objective
To find most effective pressure relief method in wheelchair seated spinal cord injured patients and to evaluate effectiveness of trunk lateral bending, trunk pulling and trunk forward flexion methods in practical environment Method: Twenty spinal cord injury patients were included in this study. After 5 cm air-filled cushion (ROHO^Ⱂ) was placed on wheelchair seat, patients were seated on wheelchair with neurtal position and interface pressure of buttock was measured by X-sensor 4.0 system. Patients took a posture lateral bending, trunk pulling, forward flexion methods. Mean and maximal pressure of buttock were measured at each pressure relief methods. Results: Mean and maximal pressure of buttock were reduced by 90^o trunk forward flexion (p＜0.05). In trunk lateral bending method, pressure was reduced in non-weight bearing side of buttock, but pressure was highly elevated in weight bearing side. In trunk pulling method, pressure was elevated in both weigth bearing and non-weight bearing side. Conclusion: 90^o trunk forward flexion method can be recommended to wheelchiar seated spinal cord injured patients for pressure relief of buttock. (J Korean Acad Rehab Med 2006; 30: 554-559)

Objective
Deep vein thrombosis (DVT) is one of the most common complications of acute spinal cord injury (SCI). It is well known that the incidence of DVT in post-acute SCI patients decreases to a level similar to that in the general population. The aim of this study was to evaluate the blood coagulation status and the possibility of DVT occurrence in post-acute SCI patients. Method: Twenty-three SCI patients (SCI group) were included in this study. Ten patients having spinal fracture with no evidence of SCI were used as the control group. Coagulation status was examined using factor VIII antigen, factor VIII procoagulant, fibrinogen, D-dimer, protein C, and protein S in both groups. Duplex ultrasonography was performed for the diagnosis of DVT. Results: Prevalence of the abnormally decreased protein S level was significantly high in the SCI group (87%) than in the control group (30%). Prevalence of the abnormally increased F VIII:Ag, F VIII:C, and fibrinogen levels in the SCI group were significantly high in the SCI group (p＜0.05). Conclusion: We conclude that post-acute SCI patients may have hypercoagulability. Proper physical prevention and thromboprophylaxis should be considered in post-acute SCI patients because they have relatively higher risk of thromboembolic complication. (J Korean Acad Rehab Med 2006; 30: 560-564)

Objective
To observe motor recovery after spinal cord injury (SCI) by time and impact strength in minocycline administration rat. Method: Forty Sprague-Dawley rats were divided into four groups according to minocycline administration and damage heights. Rats in first group were damaged in 2.5 cm heights, and injected with minocycline. In second group, minocycline was not injected. Rats in third group were damaged in 5 cm heights, and injected with minocycline. In fourth group, rats were damaged in 5 cm and minocycline was not injected. Rats received injury by the force-calibrated weight drop device and first and third groups injected minocycline 90 mg/kg immediately after injury and injected 45 mg/kgevery 12 hours. Motor recovery was determined by the Basso-Beattie-Bresnahan (BBB) locomotor rating scale at 1st, 7th, 14th, 21st, and 28th day after injury. Results: The BBB scores were significantly higher in first and third groups as compared to second and fourth groups after injury. There was significant change of BBB scores in first group as compared to third. Conclusion: After injury, BBB scores were significantly higher in minocycline treated rats as compared to the control. Minocycline might have beneficial effects on the recovery cascade after SCI. (J Korean Acad Rehab Med 2006; 30: 565-570)

Objective
The intrarectal pressure can make error during urodynamic study and can decrease the accuracy of detrusor pressures. The purpose of this study was to investigate the incidence and cause of the error in measurement of recral pressure. Method: Forty-eight patients with spinal cord injury were enrolled. With the patients in the lithotomy position, catheter was placed into the bladder and the rectum, then urodynamic testing began by infusion of normal saline (20∼30^oC) via urethral catheter. The errors by measurement of rectal pressure during urodynamic study were recorded. According to the position of patients and spasticity of hipflexors, difference of rectal pressure was investigated. Results: The error rate of intrarectal pressure during urodynamic study was 41%. Intrarectal pressure was higher in lithotomy position than in lateral lying position. According to modified Ashworth scale of hip flexors, intrarectal pressure in grade 0 was significantly lower than grade 1, 1.5 and 2 (p＜0.05). Conclusion: There was significant errors in measuring of the intravesical pressure during urodynamic study. These factors might be posture, spasticity of hip flexors, and expelling of the catheter in urodynamic study. (J Korean Acad Rehab Med 2006; 30: 571-574)

Objective
To know whether nerve conduction study (NCS) could predict later development of carpal tunnel syndrome (CTS) in asymptomatic hands of the patients with unilateral CTS. Method: Thirty four patients with unilateral CTS were studied. Subjects were divided into groups with or without the delay of latency, based on the results of initial NCS of asymptomatic hands. After follow up for more than 6 months clinically and electrodiagnostically, the development of CTS in initially asymptomatic hands was compared between groups. Results: At follow up, CTS was diagnosed in 83% of the subjects in the group with motor latency delay at first study, while it was diagnosed in 32% of the subjects in the group without motor latency delay. In the group with sensory latency delay at first study, CTS was diagnosed in 78% of subjects at follow up, whereas only 19% of the subjects developed CTS in the group without sensory latency delay. The incidence of CTS at follow up was significantly higher in the group with motor or sensory latency delay at first study. Conclusion: In unilateral CTS, latency delay in motor or sensory NCS of asymptomatic hands may suggest a greater risk of later development of CTS. (J Korean Acad Rehab Med 2006; 30: 575-579)

Objective
The purpose of this study was to examine the factor influencing the improvement of symptoms and change of electrophysiologic findings of patients after carpal tunnel release. Method: We examined 16 patients (27 hands) who underwent carpal tunnel release operation after diagnosed with carpal tunnel syndrome by the electrodiagnostic study from March 2000 to February 2001. Nerve conduction tests and visual analogue scale were performed pre-operateively and 1 month and 3 years post-operatively. We also performed a correlation study to measure the improvements of symptoms with the patient's age, duration of symptoms, and severity of works. Results: The improvement of visual analogue scale had no correlation with the age, severity of work and visual analogue scale at pre-operation. However, there was significant relationship between the improvement of visual analogue scale and duration of symptom. Conclusion: These findings suggest that the benifits of the carpal tunnel release operation were influenced by the patient's duration of the symptoms. The longer the symptoms were experienced, the improvements of the symptoms were reduced. (J Korean Acad Rehab Med 2006; 30: 580-583)

Objective
To assess long term outcomes of aggressive rehabilitative treatment on canalicular sequestered lumbar disc herniations Method: Clinical outcomes of twenty four patients with sequestered disc herniation with symptomatic radicular pain were evaluated prospectively and longitudinally for one year. All patients received aggressive rehabilitative treatment including transforaminal epidural steroid injection, pelvic stabilization exercise, physical therapy, and back school. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry Disability Index (ODI) for back pain before treatment, posttreatment one, three, six, and twelve months. After twelve months, we categorized patients' satisfaction. Four patients were dropped out. Results: The averages of VAS for lower extremity and back pain reduced significantly from 6.6 and 5.8 at pretreatment to 0.7 and 0.9 at 12 months posttreatment, respectively (p＜0.001). The averages of ODI reduced significantly from 73.5% at pretreatment to 22.3% at posttreatment 12 months (p＜0.001). Sixteen of twenty patients (80.0%) were satisfied with their current status posttreatment 12 months. Conclusion: Sequestered disc herniations could be treated successfully by aggressive rehabilitative treatment. Clinical improvement was achieved from posttreatment one month and persisted for twelve months. Operation might be delayed until aggressive rehabilitation treatment fail to treat sequestered disc herniations. (J Korean Acad Rehab Med 2006; 30: 584-589)

Objective
To investigate the change of blood glucose and cortisol levels after three consecutive epidural steroid injections Method: Fifteen patients with low back pain and radiating pain were included. Three consecutive epidural injections were performed weekly. The serum glucose, insulin and cortisol levels were measured 30 minutes before the 1st injection and at 24 hours and l week after each injection. Results: There were significant changes in the result of glucose and insulin levels at 24 hours after each injection (p＜0.05), but no signigicant changes at 1 week compared with pre-injection level. The cortisol level significantly decreased at 24 hours after 1st injection and did not return to pre-injection level at 1 week after 1st injection (p＜0.05). There were no further increases in the glucose and insulin levels and no further decrease in the cortisol level after each of the three consecutive injections. Conclusion: Three consecutive epidural injections at 1 week interval seems to be as safe procedure. But significant suppression of cortisol kept on for 1 week, so it should be taken into account when patients with previous epidural injection undergo major stress. (J Korean Acad Rehab Med 2006; 30: 590-594)

Objective
To determine stability parameters in clinical balance tests and posturography that can assess age-related changes in posture control sensitively Method: Thirty nine healthy elderly people over 60 years old and twenty young controls were recruited. Elderly people were subdivided into 3 groups by age (aged 60∼69, 70∼79, over 80). Subjects were evaluated with clinical balance tests and posturography. In posturography, center of pressure (COP) parameters were obtained as total path distance, sway area, mean frequency of sway in comfortable standing. Visual feedback system (VFS) was added to posturography and then subjects were asked to move their COP into the target circle on monitor with active movement on force plate. In VFS, time to get in the circle, total path of deviation, time in the circle were measured. Results: Time in the circle assessed by posturography with VFS showed significant difference between age groups (p＜0.05). Significant correlations between time in the circle and clinical balance tests were also found (p＜0.01). Conclusion: A posturography with VFS was considered to have clinical usefulness in sensitive evaluation of age-related change of balance control in healthy elderly people. (J Korean Acad Rehab Med 2006; 30: 595-603)

Objective
It was aimed to evaluate the nutritional status of geriatric stroke patients admitted to a convalescent and rehabilitation hospital and the clinical usefulness of the mini-nutritional assessment (MNA) to identify malnutrition in elderly stroke patients. Method: We performed a nutritional evaluation using the MNA questionnaire, anthropometric, haematological, and biochemical parameters in 30 stroke patients. Malnutrition was defined if there were abnormalities in at least one of the following parameters: serum values of albumin and transferrin, hemoglobin and total lymphocytes in blood, and body mass index. The sensitivity, specificity, and predictive values of MNA for malnutrition were assessed.Results: The mean age of patients was 69.5 years and mean body mass index was 22.8 kg/m². The prevalence of malnutrition was 46.7% while malnutrition or risk of malnutrition by MNA was 80%. The sensitivity, specificity, and positive/negative predictive values of MNA for malnutrition were respectively 92.9%, 31.3%, 54.2%, and 83.3% with a cutoff point lower than 23.5. There was a significant difference of hemoglobin value between malnourished and nourished group (p＜0.05). Conclusion: Malnutrition was common in geriatric stroke patients. MNA was a useful screening tool to exclude nourished geriatric patients. (J Korean Acad Rehab Med 2006; 30: 604-610)

Objective
The purpose of this study is to translate the Berg Balance Scale (BBS) to the Korean version (K-BBS) and to evaluate its reliability. Method: With the agreement of Katherine Berg, the original editor of the BBS, two physiatrists and three physical therapists had translated the English version of BBS into Korean (K-BBS). This was back-translated into English by a Korean-American physiatrist fluent in English. After a 2- hour K-BBS education course, the video recorded K-BBS of 18 stroke patients were reviewed by nine examiners (four physiatrists and five physical therapists) to assess the inter- rater and the intra-rater reliability. Kendall's correlation co-efficient and Pearson's correlation coefficient were computed to assess the intra-rater and test-retest reliability, respectively. Results: The inter-rater reliability was 0.97 at 2 separate evaluations with an interval of 10 days (p＜0.05). The intra- rater reliability was 0.95 (p＜0.05) in the physiatrist group and 0.97 (p＜0.05) in the physical therapist group. Conclusion: We recommend that the Korean version of the Berg balance scale is a reliable instrument to be used in balance assessment of stroke patients. (J Korean Acad Rehab Med 2006; 30: 611-618)

Objective
To investigate the association between type 2 diabetes mellitus and bone mineral density (BMD), the relationship between the duration of type 2 diabetes and BMD, and the effect of diabetic microangiopathies on BMD. Method: 52 men, aged 55∼65 years, with type 2 diabetes and 52 men without diabetes were studied and matched by age and body mass index (BMI). The slit-lamp examinations and the nerve conduction studies were used for diagnosing diabetic retinopathies and diabetic peripheral polyneuropathies, respectively. The densitometric studies were carried out in the L1, L2, L3, L4 and total lumbar vertebra, the femoral necks, the trochanters, and total hips using a DEXA densitometer. Results: Diabetic men had BMDs similar to those of the control group. There is no relationship between the duration of diabetes and BMD. BMDs at the trochanters in subjects with diabetic microangiopathies were reduced in comparison with those without diabetic microangiopathies (p＜0.05). Conclusion: The densitometric studies may be helpful to diabetic men with microangiopathies, especially with other osteoporotic risks. (J Korean Acad Rehab Med 2006; 30: 619-625)

Objective
To analyze gender differences in adult foot shape with 3D foot scanner Method: Subjects included 1,107 feet of 872 healthy volunteers (male: 325, female: 547) without foot deformity. Total 23 foot parameters (foot length, inside joint length, outside joint length, ball girth, ball width, grading point length, vamp height, vamp length, waist girth point length, waist point length, waist height, waist girth, instep girth point length, instep point length, instep height, instep girth, short heel girth, long heel girth, throat opening, vamp waist angle, waist instep angle, instep-vamp height ratio, instep- ball girth ratio) were measured with 3D foot scanner. Uni-variate t-test was used to assess significant differences between men and women for each foot parameter, standardized to stature and foot length. Results: For a given stature, 20 of 23 foot parameters were greater in men than women (p＜0.05). For a given foot length, 13 of 23 foot parameters were greater in men than women (p＜0.05). Conclusion: This study demonstrated that female feet were different from male feet in a number of shape characteristics. These differences should be taken into account in the manufacture of women's shoes. (J Korean Acad Rehab Med 2006; 30: 626-631)

Objective
To evaluate sniff nasal inspiratory pressure (SNIP) in patients with Duchenne muscular dystrophy (DMD), to analyse the relationship SNIP and other pulmonary function test and to verify the usefulness of SNIP in patients with DMD. Method: Twenty-seven patients with DMD who were able to follow commend were studied. Among them two patients were unable to perform maximal inspiratory pressure (MIP) mesurement. SNIP and MIP were measured using respiratory pressure meter in sitting position. Forced vital capacity (FVC) and peak cough flow (PCF) were evaluated using spirometer and peak flow meter respectively. The relationship between SNIP and other pulmonary function parame-ters were analysed. Results: The mean value of SNIP was ⁣44.9 cmH₂O (41.6% predicted) and the mean value of MIP was ⁣32.9 cmH₂O (43.9% predicted). SNIP was correlated with MIP. When expressed absolute value, SNIP was higher than MIP in 23 of the 25 patients with DMD. SNIP and MIP were correlated with FVC. SNIP and MIP were correlated with PCF as well. Conclusion: SNIP in patients with DMD is useful method to assess inspiratory muscle strength in addition to MIP and more easier to perform than MIP. (J Korean Acad Rehab Med 2006; 30: 632-638)

Objective
To evaluate the clinical importance of effusion in bicipital tendon sheath and the change of ultrasonographic findings according to the treatment. Method: Thirty patients with hemiplegia, clinically diagnosed as adhesive capsulitis in hemiplegic shoulder, were investigated. To confirm the location and existence of effusion and to measure the largest diameter and cross sectional area (CSA) of bicipital tendon sheath, the longitudinal and transverse scan of the shoulder were used. Each patient was treated with a series of three intraarticular injections with triamcinolone under ultrasonographic guidance. After each intraarticular injection, the diameter and CSA of bicipital tendon sheath, and passive range of motion of the affected shoulder were measured and compared to the unaffected side. Results: The initial ultrasonographic examination showed increased amount of effusion in the affected bicipital tendon sheath compared to the unaffected side (p＜0.01). After intraarticular injection, the amount of effusion was decreased (p＜0.01) and passive range of motion of the shoulder was increased (p＜0.05). Conclusion: The ultrasonographic evaluation of effusion in the bicipital tendon sheath, and interval change of effusion according to the treatment, can be useful tool for diagnosis and follow-up of adhesive capsulitis in hemiplegic shoulder. (J Korean Acad Rehab Med 2006; 30: 639-645)

Objective
The aims of this study were to refer descriptive statistics of the disability duration in musculoskeletal injured patients in the automobile accidents. Method: The authors chose 469,319 injured patients in traffic accidents as subjects that met inclusion criteria with 8 representative Abbreviated Injury Scale (AIS) comparable with 4th edition of Korean standard classification of diseases. Mean, standard deviation, mode, median, maximum and minimum of 8 representative AIS code were calculated. Results: Mean disability duration for minor cervical sprain was 18.8 days, that of moderate cervical disc herniation was 56.2 days, that of serious cervical disc herniation was 141.5 days, that of minor lumbar sprain was 21.2 days, that of moderate lumbar disc herniation was 53.5 days, that of serious lumbar disc herniation was 128.1 days, that of sprain of 3 major joint in lower limb without desmorrhexis was 24.0 days, and that of dislocation or desmorrhexis of 3 major joint in lower limb was 101.2 days. Conclusion: Disability duration of the representative musculoskeletal diseases comparable to AIS code in 4th edition of Korean standard classification of diseases was presented and this study can be utilized as a basic recommended disability duration of automobile injured persons. (J Korean Acad Rehab Med 2006; 30: 646-654)

Objective
To evaluate the effect of electrical stimulation on muscle strength, muscle bulk and envelope amplitude. Method: Twenty right handed healthy men and women (8：12) volunteered to be subjects whose mean age were 25.5⁑2.8 years. Left thenar muscle was stimulated at 40 Hz frequency for 20 minutes, every weekday for 2 weeks. Maximal tip pinch power of first and second finger, and cross sectional area of abductor pollicis brevis were assessed before and after electrical stimulation in both hands. Results: Maximal tip pinch power increased in bilateral hands. The thickness and cross sectional area of both thenar muscles were increased, but they were significant only in left side. Envelope amplitude increased significantly in left thenar muscle at maximal voluntary contraction, and showed a tendency to increase in right side at each percent of 10, 30, 50, 100 and in left side at 10, 30, 50% maximal voluntary contractions. Conclusion: The electrical stimulation on unilateral muscle induced the increment of bilateral muscular strength. The neural factor and muscle hypertrophy are responsible for the increased strength of the stimulated muscle and the increase in the nonstimulated muscle strength is related to the cross-training effect and adaptation effect. (J Korean Acad Rehab Med 2006; 30: 655-660)

Dystonia is an abnormal movement characterized by sustained muscle contractions, frequently causing twisting and repetitive movements or abnormal postures. Torsion dystonia is characterized by torsion spasms of muscle contraction, which distorts the limbs and trunk into dystonic postures. We present a case of a patient with torsion dystonia who was recalcitrant to oral medication or even surgical operations. This patient was treated with motor point block using 5% phenol solution. Using electromyographical guidance, phenol was injected into the paraspinal and upper extremity muscles, respectively. He showed reduction of dystonia and improvement of functional abilities. Motor point block using phenol can be considered as a tool of the management for patients with torsion dystonia. (J Korean Acad Rehab Med 2006; 30: 661-664)

Myotonic dystrophy is the most common autosomal dominant myopathy in adults. It is a disorder with multisystemic clinical features affecting the skeletal muscle, the heart, the eye, and the endocrine system. We experienced a 45-year- old myotonic muscular dystrophy male patient who developed cerebral infarction without well-known risk factors. He had typical haRchet face and ptosis with atrophy of gastrocnemius muscles. Typical myotonic discharge and severe affected myotonic dystrophin gene were shown. Right side motor weakness, sensory change and aphasia were developed after attack. We investigated all the possible risk factors of cerebral infarction. However, we could not find any well-known risk factors. Only abnormal left ventricular relaxation, one of cardiac problems in myotonic muscular dystrophy was shown. We think that his cerebral infarction may be related with the cardiac problem related with myotonic muscular dystrophy. (J Korean Acad Rehab Med 2006; 30: 665-669)

Since being introduced by Gauderer et al. in 1980, percutaneous endoscopic gastrostomy (PEG) has proved to be a safe and effective procedure that has become a popular way to establish long term enteral feeding in situations where oral intake is not possible. Indications of PEG are broad, with a few exceptions such as total obstruction of pharynx or esophagus and poor transillumination conditions. In those cases, percutaneous radiologic gastrostomy (PRG) or surgical gastrostomy is feasible. We reported a case of percutaneous radiologic gastrostomy (PRG) in locked-in syndrome patient. (J Korean Acad Rehab Med 2006; 30: 670-673)