Objective
To determine whether transplanted human adipose tissue derived stem cells (hATSCs) can survive and increase the amount of proteoglycans in degenerated intervertebral disc. Method: Lumbar disc degeneration was induced in thirty New Zealand white rabbits by injection of chondroitinase ABC^Ⱂ. After 2 weeks, hATSCs were transplanted in degenerated disc in hATSCs group. Control group received phosphate buffered saline. The histologic grading and height of disc were measured at 2, 4, and 8 weeks after transplantation. The viability of donor cells was identified by using β-Actin gene polymerase chain reaction (PCR). Results: 4 and 8 weeks after hATSCs transplantation, the histologic grading showed significantly high score in hATSCs group (p＜0.05), but the amount of proteoglycans was not significantly different between the two groups. The change of disc height was not significantly increased in hATSCs group. In the β-Actin gene PCR analysis, positive signal in the hATSCs group was observed. Conclusion: hATSCs transplantation may be useful in decelerating disc degeneration in experimental models and provide new hopes for treatment of degenerative disc disease in humans. (J Korean Acad Rehab Med 2007; 31: 269-277)

Objective
To see whether anodal direct current (DC) polarization of the inferior parietal cortex (IPC) and the primary sensorimotor area (SM1) in corticobasal degeneration (CBD) patients leads to improvement of praxia and finger motion. Method: Twelve patients with CBD were enrolled. This single blind crossover study had three arms, anodal DC to IPC, anodal DC to SM1, and shame polarization on occipital area. DC was delivered for 40 minute at 2 mA with 25 cm2 sponge electrodes. Before and 20 min after the start of polarization, we performed the test of oral and limb apraxia (TOLA), finger tapping frequency, and grooved pegboard test. Results: The total score of TOLA was increased 5.4±2.3% after anodal DC to IPC. The scores of limb apraxia and picture gesture subtests of TOLA, not of oral apraxia subtest, increased significantly after anodal DC to IPC compared to sham DC polarization (p＜0.05). In anodal DC to SM1 group, the finger tapping frequency increased 15.5±14.1%, which was significantly greater than in sham group (p＜0.05). Conclusion: These results showed beneficial effects of anodal DC polarization on apraxia and hand function in CBD patients. In addition, these effects for apraxia and hand movement were dependent on their stimulation sites of brain. (J Korean Acad Rehab Med 2007; 31: 278-282)

Objective
To develop a Korean version of Modified Barthel Index (K-MBI) for subjects with stroke and to test the reliability and validity of K-MBI. Method: Six senior physiatrists translated the 5th version of MBI into K-MBI and we administered K-MBI to 30 subjects with stroke. Fifteen different examiners working at the 5 different university hospitals evaluated video-recorded examination cases independently to test the reliability and validity of K-MBI. We analyzed intra- and inter-rater reliabilities of the K-MBI by the Kendall's coefficient of concordance and Spearman's correlation coefficients, respectively. Cronbach's alpha coefficient was used for assessing internal consistency of the K-MBI and Spearman's correlation between the K-MBI and Brunnström stage was employed to evaluate the validity of the K-MBI. Results: The intra-rater reliabilities of physiatrists, resident physicians of rehabilitation medicine and occupational therapists were 0.93∼1.00, 0.87∼0.99, and 0.97∼1.00 (p＜ 0.01), respectively. The inter-rater reliabilities were 0.93∼0.98 (p＜0.01) and Cronbach's alpha was 0.84 (p＜0.01) as the internal consistency reliability of K-MBI. For construct validation study, each item of K-MBI had significant correlation with total score of K-MBI (r=0.54∼0.78, p＜ 0.01). Conclusion: The K-MBI is a reliable and valid instrument for measuring functional status of subjects with stroke. (J Korean Acad Rehab Med 2007; 31: 283-297)

Objective
To identify the usefulness of laryngeal reflex cough test (LRCT) as screening test for aspiration, especially silent aspiration, in stroke patients with dysphagia. Method: Gag reflex (GR), 3-oz water swallow test (WST) and LRCT were performed in 70 stroke patients with dysphagia and their results were compared with those of videofluoroscopic swallowing study (VFSS). Laryngeal reflex cough was induced with the nebulized 20% l-tartaric acid, which irritates the mucosa of laryngeal vestibule. Diagnostic values such as sensitivity, specificity, predictive values, accuracy of each test for detecting aspiration and silent aspiration shown in VFSS were evaluated. Results: 37 out of 70 patients (53%) showed subglottic aspiration or supraglottic penetration in VFSS. Sensitivity and specificity of LRCT to diagnose aspiration on VFSS were 16% and 88%, respectively. Positive and negative predictive value, and accuracy were 60%, 48%, and 50% respectively. Sensitivity and specificity of GR and WST for detecting aspiration were 46%, 73% and 43%, 82%. In 28 patients (40%), VFSS revealed aspiration without cough (silent aspiration). Sensitivity and specificity of LRCT for detecting silent aspiration were 14% and 78%, whereas those of GR and WST were 50%, 67% and 50%, 78%. By combining of all tests sensitivity for detecting aspiration and silent aspiration were 76% and 92%. Conclusion: LRCT showed inadequate sensitivity and predictive values in predicting the risk of aspiration and silent aspiration. Combining LRCT with GR and WST improved sensitivities for detection of aspiration and silent aspiration. (J Korean Acad Rehab Med 2007; 31: 298-304)

Objective
To determine risk factors of orthostatic hypotension in ischemic stroke patients. Method: In 98 ischemic stroke patients, blood pressure and heart rate were measured after resting in the supine position for 10 minutes and again after standing for one minute. Presence of orthostatic hypotension was correlated with age, gender, body mass index, laboratory findings, diabetes mellitus, anti-hypertensive use, side of involved hemisphere, smoking and K-MBI (Korean Modified Barthel Index). Results: 30 out of 98 patients had orthostatic hypotension. Those patients with orthostatic hypotension were older in age and had a higher average blood pressure, heart rate and plasma creatinine. On the other hand, body mass index, K-MBI and serum sodium levels were lower in the orthostatic hypotension group. Multivariate analysis revealed that age, body mass index, anti-hypertensive use and smoking were independently associated with orthostatic hypotension. Conclusion: Old age, low BMI, anti-hypertensive use, smoking were risk factors of orthostatic hypotension in the ischemic stroke patients. Patients in the higher risk categories should receive regular monitoring of blood pressure in order to detect orthostatic hypotension and prevent its complications. (J Korean Acad Rehab Med 2007; 31: 305-309)

Objective
To investigate the effect of simulated stiff knee on the gait parameters. Method: Twenty healthy male adults were recruited. The temporospatial, kinematic & kinetic parameters and energy consumption were analyzed under three different conditions which were free gait, fixed knee flexion in neutral position and limited knee flexion to 30 degrees using knee orthosis. Results: When knee flexion was fixed in neutral position, the cadence and walking speed significantly decreased, and the step time, step width, O2 cost significantly increased compared to free gait. When knee flexion was limited or fixed in neutral position, the kinematic and kinetic parameters in pelvis, hip, knee and ankle joints significantly changed compared with free gait. Conclusion: Simulated stiff-knee may affect not only knee joint but also pelvis, hip and ankle joints with increased energy consumption. These findings help us to understand the compensatory mechanism and energy conservation of stiff-knee gait. (J Korean Acad Rehab Med 2007; 31: 310-316)

Objective
To investigate the effect of slow walking speed on the gait. Method: Twenty healthy young male subjects were recruited. The temporospatial data, kinematic and kinetic data in sagittal plane at two different walking speed (2 km/hr, 4 km/hr) were obtained through three dimensional analyzer with the force plate, and compared these parameters at slow gait speed to those at normal gait speed. Results: The cadence and step length decreased significantly and double support time increased significantly (p<0.05) at slow speed compared to at normal speed. The most peak angle of hip, knee and ankle joint decreased, maximal ankle dorsiflexion angle in stance phase increased significantly at slow speed compared to at normal speed (p＜0.05). The most maximal extension and flexion moment and power in sagittal plane decreased compared to at normal speed (p＜ 0.05). Conclusion: The results of this study demonstrate that only slow walking speed without any pathology may change the temporospatial, kinematic and kinetic parameters of gait, and these results may be useful to interpret the data of gait analysis in the disabled persons with slow walking speed. (J Korean Acad Rehab Med 2007; 31: 317-323)

Objective
To investigate the effect of laterally wedged insole on static balance of patients with degenerative osteoarthritic knees. Method: Eighteen female patients were diagnosed with medial compartment knee degenerative osteoarthritis (OA) based on symptoms and simple X-rays. Patients were studied while they stood wearing shoes with the 5 degrees or 10 degrees lateral wedged insoles compared with a bare foot. Patients chose a comfortable stance with feet spread apart, slightly turned outwards, and were asked to look straight ahead at a fixed point in a quiet room. Postural sway and weight load asymmetry were recorded while the patients were standing on two adjacent force platforms during a 30 second trial. Results: Postural sway and weight load asymmetry for 30 seconds were not significantly changed by wearing laterally wedged insoles with varying elevations (p＞0.05). Conclusion: The degree of the postural sway and weight load asymmetry for 30 seconds with the insole were not affected by the tilt of the lateral wedge. (J Korean Acad Rehab Med 2007; 31: 324-328)

Objective
To evaluate the anatomic course of the lateral antebrachial cutaneous nerve (LABCN) and medial antebrachial cutaneous nerve (MABCN) in the forearm. Method: We dissected 29 upper extremities of 16 cadavers for LABCN and 20 upper extremities of 15 cadavers for the MABCN. We measured the distance (BT_L) between the biceps tendon (BT) and LABCN on the intercondylar line. The BT is the point at which biceps tendon crosses intercondylar line. The distance (L12) between LABCN and the point of 12 cm distal to BT on the line between BT and radial artery at wrist was measured. The distance (ME_M) between MABCN and medial epicondyle on the intercondylar line was measured. M8 and M10 are the distances between MABCN and the points 8 cm and 10 cm distal to BT on the line from BT to mid-point of flexor carpi radialis and palmaris longus at the wrist respectively. Results: BT_L and L12 were 1.4±3.7 mm and 4.4±3.7 mm respectively. ME_M, M8 and M10 were 28.6±6.9 mm, 18.9±8.9 mm and 18.3±8.2 mm respectively. The thickness of LABCN and MABCN was 19.1±4.9 mm and 13.2±4.2 mm respectively. Conclusion: The LABCN was emerge just lateral to biceps tendon at the elbow and ran down to radial artery. The anatomic course of MABCN was variable at the elbow and forearm. (J Korean Acad Rehab Med 2007; 31: 329-332)

Objective
To establish turns-amplitude, activity-envelope amplitude and activity-number of small segements (NSS) clouds of normal early teens using interference pattern. Method: Forty four healthy early adolescence from 11 to 15 years old participated in this study. The interference patterns were analyzed using quantitative electromyography of the biceps brachi and tibialis anterior muscles. The interference patterns were measured at 3 to 5 different force levels ranging from minimum to maximum and turns, mean amplitude, activity, envelope amplitude, NSS were analyzed. By turns/amplitude, activity/envelope amplitude and activity/ NSS ratio, normal clouds of gender related each parameters were obtained. Results: The turns-amplitude, activity-envelope amplitude and activity-NSS ratio of the biceps brachii and tibialis anterior muscles were obtained. Normal clouds of gender related turns-amplitude, activity-envelope amplitude and activity-NSS for each muslces were established. Conclusion: By using normal cloud patterns of turns- amplitude, activity-envelope amplitude and activity-NSS, automatic interference pattern analysis may contribute to diagnose neuromuscular disease in early adolescent patients. (J Korean Acad Rehab Med 2007; 31: 333-340)

Objective
To investigate diagnostic usefulness of dermatomal somatosensory evoked potentials (DSEP) in the evaluation of lumbar radiculopathy using stimulation intensity lower than conventional stimulation intensity. Method: Fifty-seven patients with low back pain were studied with DSEP and needle electromyography (EMG). The radiculopathy was diagnosed by lumbar MRI or operative findings. The DSEP study was performed with stimulation intensity of 1.0×, 1.5×, 2.5× sensory threshold, respectively. We compared the sensitivity and specificity of DSEP and needle EMG in the evaluation of L5 radiculopathy. Results: Radiological and operative findings revealed unilateral herniated disc and L5 root compression in 38 patients (66.7%). Nineteen patients had no significant L5 root compression. The sensitivity and specificity of abnormality were 68.4% and 78.9% in 1.0× sensory threshold stimulation; 71.1%, 78.9% in 1.5× sensory threshold stimulation; and 44.7%, 84.2% in 2.5× sensory threshold stimulation, respectively. Whereas they were 55.2% and 100% in needle EMG. Conclusion: DSEP using low stimulus intensity showed higher sensitivity in the diagnosis of L5 radilculopathy, and DSEP might provide additional diagnostic usefulness in the evaluation of patients with suspected L5 radiculopathy. (J Korean Acad Rehab Med 2007; 31: 341-345)

Objective
To evaluate the effect of the air stacking exercise on maximal insufflation capacity (MIC) and peak cough flow (PCF) in patients with neuromuscular diseases. Method: Two hundred twenty nine neuromuscular patients with vital capacity (VC) below 50% of the predicted normal value were initially evaluated for VC, MIC, PCF, and assisted PCF (APCF). After the first evaluation, these patients were instructed to carry out air stacking exercise periodically, and were re-evaluated after one year. Results: Forty seven patients were capable of performing air stacking exercise on regular basis, at least twice a day for one year. Among these patients, MIC increased in 28 patients from 1345.4 ml to 1572.9 ml on average (p＜0.05), while it decreased in 19 patients from 1740.0 ml to 1325.3 ml on average (p＜0.05). In the increasing MIC group APCF increased from 244.6 L/min to 278.1 L/min (p＜ 0.05). In the decreasing MIC group, every value decreased significantly. Conclusion: Air stacking exercise was shown to be capable of increasing MIC and APCF despite the reduction in VC and PCF in patients with neuromuscular diseases. (J Korean Acad Rehab Med 2007; 31: 346-350)

“Mirror-writing” is the simultaneous process of reversing individual letters and composing word strings in reverse direction. It is reported that the lesions which cause “mirror-writing” are left parietal lobe, left basal ganglia, right supplementary motor area, left supplementary motor area, left cingulate gyrus, and left angular gyrus. To explain this phenomenon, several theories have been proposed such as the motor, the visual dominance, the supplementary motor area, the visio-spatial, the visual word- form, the hemisaptial factor or directional and the reflected graphemic representation hypotheses. With reviewing some of literatures, we present a case of “mirror- writing” of posterior corpus callosum lesion which is not included in the aforementioned those. (J Korean Acad Rehab Med 2007; 31: 351-355)

Central pontine myelinolysis is a demyelinating disease of central pons. Nocturnal polyuria is defined as increased urination during nighttime with a nocturnal fraction exceeding from 20% to 33%. We have experienced nocturnal polyuria developed in two patients with central pontine myelinolysis. In these cases, serum antidiuretic hormone and urine osmolality were lower at nighttime than daytime. It suggests that nocturnal polyuria is caused by abnormal diurnal variation of antidiuretic hormone. In the first case, nocturnal polyuria was recovered spontaneously and also follow up brain MRI showed decreased signal intensity in pons. In the second case, nocturnal polyuria was improved after the treatment of intranasal desmopressin. It appeares that central pontine myelinolysis can cause nocturnal polyuria due to the interruption of antidiuretic hormone pathway. The symptom of nocturnal polyuria can be treated by desmopressin. (J Korean Acad Rehab Med 2007; 31: 356-360)

We experienced a case of adult-onset Still's disease with dysphagia of soft tissue origin. A 38-year-old woman was admitted for intermittent high spiking fever, diffuse pain and swelling on anterior neck with dysphagia. Physical examination revealed a thin woman with trismus, board-like hardness of anterior neck, hepatomegaly, and erythematous evanescent rash on leg. Neck CT displayed bilateral cervical lymphadenopathy with soft tissue swelling, and tonsilitis. Chest and abdomen CT showed the inflammatory changes of multiple organs. Laboratory evaluation revealed neutrophilic leukocytosis, slightly increased alanine transaminase, negative antinuclear antibody and rheumatoid factor, and increased inflammatory markers. Skin, liver, colon, and pleural biopsy demonstrated the chronic inflammation. Videofluoroscopic swallowing study revealed laryngeal penetration with large amount residue in vallecular space and pyriform sinus, and incomplete cricopharyngeal relaxation. Gradual improvement in anterior neck pain and pulmonary edema and the decrease of effortful and multiple swallowing were observed with high dose steroid therapy. (J Korean Acad Rehab Med 2007; 31: 361-365)

We presented a case which showed clinical improvements after fabricating new ortho-prosthesis to a patient with severe leg length inequality. He was 51 years old and had developed the leg length inequality on the right due to osteomyelitis that he experienced when he was seven. He had been using the orthosis fabricated by a private orthotic shop for more than twenty years from his twenties. We prescribed a new ortho-prosthesis composed of patellar tendon bearing ankle foot orthosis combined with endoskeletal shank and dynamic SACH foot. With this new ortho-prosthesis, there were significant improvements in initial abnormal gait patterns of excessive knee flexion at mid-stance and decreased maximal knee flexion peak at swing phase in the kinematic parameters on transverse plane. And step width, step length and step time were also improved. He got pain relief and improvement of gait endurance. (J Korean Acad Rehab Med 2007; 31: 366-370)

Seven hemiplegic stroke patients suffering elbow flexor spasticity were selected for musculocutaneous nerve (MN) blocks. The MN was identified at the proximal 1/3 area on anteromedial surface of upper arm at supine position. An injectable monopolar EMG needle electrode was inserted into MN under real time ultrasonography. The 7% phenol solution was injected 0.2 ml at a time into MN until biceps brachii and brachialis muscle contractions were completely blocked at a maximum of 5 mA electrical stimulation. The total dose of injected phenol solution was 1.2∼2.2 ml. We examined modified Ashworth scale (MAS) of elbow flexor and elbow angle at the standing position. In all the subjects, MAS was decreased and elbow angle was increased after nerve block. Ultrasonography guidance makes it exact to identify MN and to inject neurolytic solution to target. It can lead minimal complications by using the least dosage of neurolytic drug. (J Korean Acad Rehab Med 2007; 31: 371-374)

Psoriasis, whose symptom is shown in around 1∼3% American people, is a chronic and inflammatory skin disease. There are many treatments for pustular and erythrodermic psoriasis and oral retinoid which is a synthetic derivative of vitamin A is the most popular drug of them. Acitretin called as the second generation retinoid is a kind of active retinoid metabolite, which shows some drug toxicities in hepatic, skeletal and cardiovascular systems including atherosclerosis after a long term use. Even though that, we have just one case which has ever reported on acitretin-associated thrombotic stroke so far. We report a case on a patient who has multiorgan thrombotic occlusions resulted from longstanding psoriatic treatments by using acitretin for five years. This patient suffers from lots of complications such as superior mesenteric artery thrombosis, small cerebellar infarctions, cerebral infarction, acute renal failure concomitant with both small renal infarctions and atherosclerosis obliterans in his two legs. (J Korean Acad Rehab Med 2007; 31: 375-379)