Objective
To investigate the analgesic effect of needle electrical stimulation (NES) according to the electrode placement in acute arthritic rat model. Method: Male Sprague-Dawley rats (120 rats, 250⁑50 g) were injected with a mixture of 3% carrageenan and 3% kaolin into the right knee joint. Rats were randomly assigned into one of four groups: Group I, control group (n=30); Group II, arthritic limb-induced control group (n=30); Group III, NES application group on the ipsilateral arthritic limb (n=30); Group IV, NES application group on the contralateral arthritic limb (n=30). We applied the NES (2 Hz, 200μs, 20 min) to group III and IV. We assessed the change of paw withdrawal latency (PWL) and the immunoreactivity of c-fos by immunohistochemistry at baseline, 4, 8, 12 and 24 hours after induction of arthritis. Results: NES was more effective in Group III and IV than group II 8 hours after the induction of arthritis (p＜0.001) based on the results of PWLs and c-fos immunoreactivity. The analgesic effects of Group III were greater than those of group IV (p＜0.001). Conclusion: Contralateral NES on arthritic limb reduced pain in arthritic rat model as effectively as ipsilateral NES. (J Korean Acad Rehab Med 2007; 31: 143-149)

Objective
To assess neurotoxicity of intrathecal restorative fluid leakage in the course of the intradiscal restorative fluid injection. Method: Twenty male Sprague-Dawley rats, body weight range of 300∼350 gm, were divided randomly into four groups. Control group, group A (mixed solution of glucosamine hydrochloride 5%, chondroitin sulfate 5%, and bupivacaine hydrochloride 2%), group B (glucosamine hydrochloride 8%, chondroitin sulfate 2%, and bupivacaine hydrochloride 2%) and group C (glucosamine hydrochloride 16%, chondroitin sulfate 2%, and bupivacaine hydrochloride 2%). The behavioral test for cold allodynia (tail flick test) was conducted 1 day prior to the injection and 7 days postoperatively. Histopathologic evaluation was performed using light microscopy by a neuropathologist. The severity of nerve and cord injury were graded according to injury scoring system. Results: Each group showed no significant difference in sensory function test using tail flick test before and after intrathecal restorative fluid injection. Cold allodynia was not showed statistically significant difference among the group. Histological examination showed statistically significant difference between control group and group B, group C, and between group A and group B, C in both cord and root. Conclusion: Intrathecal injection of restorative fluid shows neurotoxic changes in roots and spinal cord in histopathologic studies. Although same ingredients of restorative solution, the different concentration of the ingredients revealed different neurotoxicity. (J Korean Acad Rehab Med 2007; 31: 150-156)

Objective
To evaluate the characteristics of cognitive dysfunction in the stroke patients with basal ganglia and thalamic lesion. Method: We studied 24 stroke patients (＜3 months after onset) with thalamus or basal ganglia lesion, retrospectively. Patients were divided into 3 groups according to the brain lesion (group 1, basal ganglia; group 2, thalamus; group 3, both area). Results of cognitive function tests including Mini-Mental State Examination, Neurobehavioral Cognitive Status Examination and detailed test of attention, memory and executive function using Computerized Neuropsychological Test were compared between groups. Results: Most of the patients showed abnormal performance in all domains of cognitive function regardless of location of the lesion. Impairment in stroop test and trail making test was prominent, suggesting executive dysfunction. Attention and verbal memory were impaired, too. Group 3 showed most severe cognitive dysfunction in all domains although statistically not significant. There were no significant differences between group 1 and group 2. Conclusion: All domains of cognitive function were impaired in basal ganglia or thalamic stroke, especially in executive function. There were no significant differences in cognitive dysfunction between basal ganglia and thalamic groups in this study. (J Korean Acad Rehab Med 2007; 31: 157-161)

Objective
To evaluate autonomic function in stroke patients and to explore the relationship between patient's subjective symptoms and the results of objective tests regarding autonomic dysfunction. Method: Twenty stroke patients and 27 controls were recruited. Autonomic function was accessed by subjective checklist and by objective tests such as sympathetic skin response (SSR) and blood pressure (BP) response to positional change and to sustained hand-grip. Motor function was classified using the Brunnstrom stages: Group 1, stage 1 and 2; Group 2, stage 3 and 4; Group 3, stage 5 and 6. Results: Seventy percent of patients had subjective changes in autonomic function after stroke. 50% and 65.5% of patients revealed autonomic insufficiency by BP response tests and SSR, respectively. More than half of the patients who didn't have any subjective changes in autonomic function revealed autonomic insufficiency by objective tests. Group 1 of Brunnstrom stage in upper extremity showed significantly longer SSR latencies (p＜0.05) and lower amplitudes than the controls (p＜0.05). Group 1 and 2 of Brunnstrom stage in lower extremity showed significantly longer SSR latencies (p＜0.05) and lower amplitudes than the controls (p＜0.05). Conclusion: Although stroke patients don't complain any subjective symptoms of autonomic dysfunction, they need to undergo objective autonomic function evaluations such as SSR and BP responses. (J Korean Acad Rehab Med 2007; 31: 162-168)

Objective
To find out the clinical features of central post-stroke pain (CPSP) and how somatosensory evoked potentials (SEPs) are affected in patients with CPSP. Method: One hundred and one patients with stroke who showed normal results in nerve conduction study, were enrolled. SEPs were evoked by electrical stimulation of the median and tibial nerves. The results of the SEPs in the CPSP group were compared with those in the non-CPSP group. Brain SPECT (single photon emission computed tomography) was examined and thalamic involvement in SPECT was compared between the groups. Results: Seventeen patients met the diagnostic criteria of CPSP. Nine patients showed normal findings in SEP. Abnormal findings in SEP were not related to the development of CPSP, but those who showed no response in SEP had significantly higher chance of developing CPSP. Thalamic involvement in SPECT was found in thirteen patients with CPSP, but was not related to the development of CPSP. Conclusion: Stroke patients who showed severe abnormality in SEP seem to be more likely to have CPSP. Therefore, SEP is thought to be helpful in the prediction of CPSP. (J Korean Acad Rehab Med 2007; 31: 169-175)

Objective
To evaluate and quantify the postural instability in patients with Parkinson's disease (PD) using computerized posturography. Method: Twenty subjects with PD group (10 men, 10 women) and 20 control group (10 men, 10 women) were matched for age and sex. Average Hoehn-Yahr stage of PD group was 2.3⁑0.3. Sensory dysfunction, voluntary motor impairments and functional limitation were measured by determining the subject's response to reduced or altered sensory and voluntary motor control of balance. Results: PD subjects demonstrated wider area of sway (^o) under eye closed condition in modified sensory organization test and lower directional control (%) in right/left rhythmic weight shift (p＜0.05). No significant difference was observed for sit to stand. Wider area of turn sway (^o) and longer turn time (sec) during left step/quick turn were demonstrated in PD subjects (p＜0.05). Conclusion: Computerized posturography shows that sensory dysfunction scores, voluntary motor impairment scores and functional limitation test scores were reduced in patients with PD. (J Korean Acad Rehab Med 2007; 31: 176-181)

Objective
To investigate the changes of sperm quality by taking adrenergic agonist in spinal cord injured (SCI) males treated by repeated electro-ejaculation. Method: Twenty-six SCI males were induced three times to ejaculate with rectal probe electrical stimulation, and then semen analysis for their antegrade and retrograde ejaculates was performed, at weekly interval, while they either took pseudoephedrine (Sudafed^Ⱂ) for 2 weeks or no medication as a control. Results: Before pseudoephedrine medication, there was no significant difference in sperm quality between two groups. However, after 2 weeks' medication, SCI males taking pse-udoephedrine showed increased semen concentration, motile sperm count and sperm motility of the antegrade ejaculates compared to control group, although there was no difference in any parameter of the retrograde ejaculates. Moreover, sperm motility of the antegrade ejaculates significantly improved after 2 weeks' medication compared with those at the baseline. Conclusion: Pseudoephedrine, a sympathomimetic adrenergic agonist, may potentiate the improvement of sperm quality in SCI males undergoing repeated electro-ejaculation for short periods. (J Korean Acad Rehab Med 2007; 31: 182- 187)

Objective
To investigate the life of persons with C4 tetraplegia in the community residence. Method: This study was designed as a personal interview survey using the questionnaires for the general characteristics, Craig Handicap Assessment and Reporting Technique (CHART), Diener's satisfaction with life scale, and Rosenberg self esteem scale. The subjects were 15 persons with C4 tetraplegia. Results: Among 15 persons, six were married, three of them were married after the injury. Five persons reported being employed, thirteen persons used computers. The number of cases for remodeling their houses were 13. Twelve persons reported being 'glad to be alive'. Their Diener's satisfaction of life scale was 16.6 (slightly dissatisfied). Rosenberg self esteem scale was 23.3. The CHART showed the following scores: physical independence 46, mobility 56, occupation 30, social integration 89, and economic self sufficiency 68. Diener's satisfaction with life scale of the subjects were significantly correlated with that of their caregiver (p=0.006). Conclusion: The life of the individual with C4 tetraplegia in the community was more active than expected, considering their substantial physical limitation. Therefore, appropriate post-discharge planning should be included in inpatient rehabilitation program for the C4 tetraplegics. (J Korean Acad Rehab Med 2007; 31: 188-195)

Objective
To investigate the relationship between variables measured by sliding rehabilitation machine and gait parameters in hemiplegic stroke patients. Method: Thirty-two patients with hemiplegia due to stroke were included in this study. Maximal inclinations of sliding rehabilitation machine where each patient could extend their knee and plantarflex their ankle, and the ratio of the load in affected lower limb to total body weight were measured. Clinical parameters such as functional ambulation classification, 10 meter walking time, timed up and go test, Berg balance scale, modified Barthel index, and manual muscle test were evaluated. We investigated correlations between variables measured by sliding rehabilitation machine and gait parameters using Pearson test. Results: Maximal inclination of sliding rehabilitation machine and the ratio of the load in affected lower limb to total body weight were significantly correlated with almost all measured clinical parameters. Conclusion: Sliding rehabilitation machine could be a useful and objective method to measure the closed kinetic chain strength and function of affected lower limb including gait in patients with hemiplegia due to stroke. (J Korean Acad Rehab Med 2007; 31: 196-201)

Objective
There is increasing interest in growth hormone (GH) replacement therapy to improve quality of life (QoL) of elderly with age-related decline in GH level (somatopause). The aim of this study was to evaluate the effect of GH replacement on the QoL in patients with somatopause. Method: A prospective study of 56 adults with somatopause was conducted. They were replaced with a GH over a 6-month period. QoL was assessed by using three self-rating questionnaires: the Nottingham Health Profile (NHP), the Psychological General Well-Being Index (PGWBI) and the Assessment of Growth Hormone Deficiency in Adults (AGHDA). Results: Significant impairment in QoL as measured by NHP, PGWBI and AGHDA were noted in patients with somatopause compared with age and sex matched normal population (p＜0.05). There was significant improvement in QoL after 6-month of GH replacement (p＜0.05). Conclusion: Six months GH replacement induced an improvement in the QoL of patients with somatopause. (J Korean Acad Rehab Med 2007; 31: 202-206)

Objective
To compare the effects of raloxifene alone with a combination of raloxifene and fluoride in postmenopausal osteoporosis on bone mineral density, bone turnover and lipid profiles, at 2 year. Method: Fifty two women with postmenopausal osteoporosis (T-score＜2.5) were studied. Subjects were divided into two groups; Group I (n=23), treated with raloxifene and fluoride, and Group II (n=29), treated with raloxifene alone. Bone mineral density (BMD) at the lumbar spine and femur, osteocalcin, deoxypyridinoline and lipid profiles were measured at baseline and 2 years after treatment. Results: BMD at the lumbar spine was increased in two groups, and BMD in Group I was increased more than that in Group II. Osteocalcin was increased in Group I, and was decreased in Group II. Deoxypyridinoline was decreased in two groups. Total cholesterol and LDL cholesterol were decreased in two groups, but HDL cholesterol and triglyceride showed no significant change in two groups. There were no significant differences between two groups in lipid profiles. Conclusion: The combined therapy with raloxifene and low- dose intermittent fluoride was more effective in postmenopausal women with osteoporosis than raloxifene alone, which would not influence on positive effect of raloxifene for lipid metabolism. (J Korean Acad Rehab Med 2007; 31: 207-212)

Objective
To establish the envelope amplitude-activity and number of small segments (NSS)-activity clouds of normal adults using the interference pattern of quantitative electromyography (EMG). Method: Healthy adults whose ages were from 20 to 59 years old participated in this study. Using quantitative EMG of the biceps brachii, vastus medialis, and tibialis anterior muscle, the interference patterns were analyzed. The interference patterns were measured at three to five different force levels, ranging from minimum to maximum, and recorded at least 20 epochs at each muscle. Results: The envelope amplitude-activity and NSS-activity ratio of the biceps brachii, vastus medialis, and tibialis anterior muscles were obtained in males and females. The establishment of normal clouds of gender related envelope amplitude-activity and NSS-activity were obtained. Conclusion: By using the above normal clouds of envelope amplitude-activity and NSS-activity, automatic interference pattern analysis may contribute to early diagnosis and detection of progress of myopathy and neuropathy. (J Korean Acad Rehab Med 2007; 31: 213-219)

Objective
To investigate the differences in clinical and radiologic features between HLA-B27 positive ankylosing spondylitis (AS) and HLA B27 negative AS. Method: Ninety-nine consecutive patients who were suspected as AS in initial diagnostic process were studied. HLA-B27 was examined with microlymphocytotoxicity method in all patients. A radiologist and a physiatrist re- read plain pelvis radiographies of all patients. Difference in onset age and C-reactive protein (CRP) depending on HLA B27 status and an association between HLA B27 status and clinical and radiologic features were tested. Results: Sacroiliitis (≥bilateral grade 2) was identified in 63 of 77 patients with HLA B27 and 7 of 22 patients without HLA B27 through the re-reading process. Ten percent of definite AS was HLA B27 negative AS. Five of 22 patients without HLA B27 were diagnosed as diffuse idiopathic skeletal hyperostosis. There was a significant association between sacroiliitis (≥bilateral grade 2) and HLA B27 (p＜0.05) in re-reading process. No significant difference was found in onset age, and CRP depending on HLA B27 status. No significant association was noted between HLA B27 and gender, clinical and radiologic features. Conclusion: HLA B27 is useful in diagnosing AS in patients with clinical features of AS and sacroiliitis (≥unilateral grade 1). None of clinical and radiologic parameters are associated with HLA B27 status. It does not make difference in onset age of AS. To make a more concrete conclusion, a study of a much larger number of HLA B27 negative AS patients will be necessary. (J Korean Acad Rehab Med 2007; 31: 220-227)

Patients with ankylosing spondylitis are more susceptible to spine fractures than healthy people. Because of their underlying back pain, vertebral fracture induced pain is not easily controlled by bed rest, physical therapy and medications. Thus, new treatment methods should be introduced. We report a 63 year-old man with ankylosing spondylitis who fell down 4 weeks ago and suffered a fracture of T6 spine. He complained of a mid thoracic pain. Although he was treated with bed rest, physical therapy, second-line bisphosphonate agents, the pain persisted. Therefore, intravenous zoledronate which was approved for palliative treatment of bone metastases in patients with breast cancer, 4 mg was administrated. The severity of pain was decreased by half within 2 days and sustained over 4 weeks. (J Korean Acad Rehab Med 2007; 31: 228-231)

The stiff-man syndrome is a rare and disabling disorder, characterized by muscle rigidity with superimposed painful spasms involving axial and limb musculature. The clinical symptoms are continuous contraction of agonist and antagonist muscles caused by involuntary motor-unit firing at rest and spasms precipitated by tactile stimuli, passive stretch, volitional movement of muscles, startling noises and emotional stimuli. The cause of stiff-man syndrome is unknown but an autoimmune pathogenesis is suspected. The presence of antibodies against glutamic acid decarboxylase, the association of the disease with other autoimmune disorders, and the presence of various autoantibodies contribute to the assumption. The stiff-man syndrome is clinically elusive, but potentially treatable and should be considered in patients with unexplained stiffness and spasms. Drugs that enhance GABA neurotransmission, such as diazepam and baclofen, provide modest relief of clinical symptoms. We described three patients with clinical and electrophysiologic feature of stiff-man syndrome. (J Korean Acad Rehab Med 2007; 31: 232-237)

Akinetic mutism is a clinical syndrome in which the patient is unable to speak (mutism) or move (akinesia). Various brain lesions can induce akinetic mutism. We attended a 71-year-old woman who presented with akinetic mutism caused by bilateral anterior cerebral artery infarction. The patient improved after the administration of levodopa combined with carbidopa, in response to visual and verbal stimuli. Increased verbal output and spontaneous motor activities were also noted. Levodopa may be helpful to the treatment of akinetic mutism. (J Korean Acad Rehab Med 2007; 31: 238-242)

On chromosome Xp21 region, several genes such as glycerol kinase (GK) gene, adrenal hypoplasia congenita gene and Duchenne muscular dystrophy gene are located contiguously. Xp21 contiguous gene deletion syndrome involves the glycerol kinase gene deletion together with the adrenal hypoplasia congenita and/or Duchenne muscular dystrophy gene. The clinical features of a patient with a Xp21 contiguous gene deletion syndrome are sum of each disease, psychomotor retardation and lethargy for glycerol kinase deficiency, hyperpigmentation and salt wasting dehydration for congenital adrenal hypoplasia and muscular weakness and hypotonia for Duchenne muscular dystrophy. We experienced and reviewed two cases of Xp21 contiguous gene deletion syndrome with literatures. (J Korean Acad Rehab Med 2007; 31: 243-247)

We experienced a patient who developed a cerebral air embolism after subclavian venous catheter removal. The patient underwent gastric antrectomy under impression of gastric cancer. After surgery, right subclavian venous catheter was removed while the patient was kept in supine position for 15 minutes. When he changed to sitting position, he became agitated and O₂ saturation was dropped to 72%. Immediately 100% O₂ was administered via air mask. Computed tomography of brain showed multiple focal air densities in the cerebral vessels. Three days after the event, he slowly regained consciousness with persistent left hemipareis. After rehabilitation, he was able to walk with quadcane and gained functional improvement. (J Korean Acad Rehab Med 2007; 31: 248-251)

Neuropathic arthropathy is a chronic and progressive disease of bone and joints. One of the most common causes of neuropathic arthropathy is syringomyelia. Syringomyelia associated with Arnold-Chiari I malformation has been well documented in many reports. We report a case of 76 year-old woman presented with the right elbow joint pain and stiffness. Her symptom was caused by neuropathic arthropathy associated with Arnold-Chiari I malformation and syringomyelia. The purpose of this paper is to emphasize that neuropathic arthropathy requires the evaluation of central nervous system to assess for occult causal lesion. (J Korean Acad Rehab Med 2007; 31: 252-256)

The diagnosis of thoracic outlet syndrome (TOS) is sometimes confused by its nonspecific symptoms and various etiologies. Moreover, the paths of involving nerves and arteries are highly diverse. We report a 35 year-old man who had numbness and coldness in his left upper extremity with no improvement to medical therapy. The electrophysiologic studies were normal. Radial artery pulse was absent and the thermography revealed markedly reduced temperature below the left mid-forearm. The arteriography showed compression of the left subclavian artery between the clavicle and the 1st rib with aneurysmal change proximal to the compression. Occlusion of the left brachial artery and collateral arteries were also observed. Under the diagnosis of vascular TOS, 1st rib resection was performed and his symptoms were relieved. Vascular TOS may be considered in cases of upper limb paresthesia. (J Korean Acad Rehab Med 2007; 31: 257-260)

Trauma is one of the causes of lymphedema. However, we usually do not consider it as a cause of the lymphedema, thus, we often fail to take care of the patients properly. We report a patient with post traumatic lymphedema and the result of complex decongestive therapy, and reviewed the clinical, lymphoscintigraphic findings and treatment. (J Korean Acad Rehab Med 2007; 31: 261-264)