Objective
To reconfirm the relationship between the Fos expression and the pulsed radiofrequency which very few articles have reported. Method: Thirty-four male Sprague-Dawely rats were enrolled: 8 for lumbar 3rd dorsal root ganglion (DRG) stimulation, 4 for L3 and L4 DRGs, 5 for C5 and C6 DRGs, 8 for sham L3 DRGs, 5 for sham L3 and L4 DRGs, and 4 for sham C5 and C6 DRGs. Without laminectomy, each lumbar DRG was stimulated with PRF for 2 minutes 2 times with 42°C. Sham group was stimulated with PRF electrode but without any stimulation. Three hours after the stimulations, spinal cord was thin sectioned for immunohistochemistry and Fos expression was calculated. Individual sections were digitized with 4096 gray levels using a computer assisted image analysis system. With laminectomy, cervical DRGs was stimulated with the same method of lumbar DRGs. Sham stimulation was applied to the sham group. Results: No significant difference of Fos expression was observed on dorsal horn of rat in operated site, 3 hours later after operation, between the PRF and sham group in lumbar DRGs and the PRF and sham groups in cervical DRGs. Conclusion: The expression of Fos was not significantly related with the cervical and the lumbar DRGs stimulation with PRF. (J Korean Acad Rehab Med 2007; 31: 387-393)

Objective
To examine the repeatability and the reproducibility of a new evaluation system for seated postural control. Method: A total of 30 healthy volunteers (12 male, 18 female, mean age 25.1±3.4) participated in this study: 15 for repeatability and 15 for reproducibility study. We invented a new device for the assessment of seated postural control. The device was consisted of unstable platform, force plate, frame, safety harness, monitor and computer. Force plate on unstable platform measured the center of pressure (COP) of subject. COP maintaining time, COP moving time and COP sine curve trace were recorded. Each subject was tested three times with an interval of 3 days between the test sessions. The intraclass correlation coefficients (ICC) were calculated. Results: There were no significant differences between male and female in each parameter. There were no significant differences in COP maintaining time, COP moving time and COP sine curve trace when tested repetitively. ICC for both the repeatability and the reproducibility showed good to excellent reliability for all variables (ICC, 0.60∼0.99) except posterior and right-posterior moving time. Conclusion: This newly designed system for seated postural control using unstable platform proved to be a reliable tool. It may be a useful method to assess the seated postural control. (J Korean Acad Rehab Med 2007; 31: 394-399)

Objective
To investigate the clinical usefulness of the Korean version of Berg balance scale (K-BBS) by obtaining the cutoff value for the activities related to ambulation in subjects with stroke. Method: We measured the K-BBS and checked the activities related to ambulation in 52 subjects with stroke every other week. The activities related to ambulation were composed of 4 stages, including independent sitting, independent sit to stand, independent gait with Q (quad) cane and independent gait without any assistance. Data were analyzed by ROC (Receiver operating characteristic) curve technique to obtain each cutoff value of the K-BBS representing for the individual activities. Results: The ROC analysis showed that each activity matched the following cutoff values: independent sitting, 5; independent sit to stand, 18; independent gait with Q cane, 25; and independent gait without any assistance, 34. Conclusion: The K-BBS would be a useful instrument to tell the degrees of the activities related to ambulation and the cutoff values could be helpful for judging the assistance level for ambulation in patients with stroke. (J Korean Acad Rehab Med 2007; 31: 400-403)

Objective
To determine whether the rehabilitation desire of stroke patients in post-acute rehabilitation facilities was suitable to objective parameters, and to figure out the discharge plan after post-acute rehabilitation facilities. Method: 107 stroke patients in post-acute rehabilitation facilities were included. In order to identify rehabilitation desire, interviews were conducted among patients or their family members in a direct line. Discharge plans of patients after post-acute rehabilitation facilities were surveyed. All participants completed demographic measures, Mini Mental Status Examination (MMSE), Korean Modified Barthel Index (K-MBI) and International Classification of Functioning, Disability and Health (ICF) core set for patients with neurological problems in post-acute rehabilitation facilities to determine the influences on rehabilitation desire. Results: Most (81.3%) of the patients desired more intensive rehabilitation service and 65 patients (60.7%) purposed to get physical therapy focused on motor recovery. Only 24 patients (22.4%) planned home discharge, most (67.3%) of them did re-admission. Conclusion: The desire of patients in post-acute rehabilitation facilities would have a tendency of hospital staying for motor recovery in large percentage of patients. Rehabilitation desire and goal were not affected by the affected side and onset duration. Social support and extended educational program for rehabilitation for the patients and their relatives should be performed to overcome these problems. (J Korean Acad Rehab Med 2007; 31: 404-409)

Objective
To compare the radiological corrective effect for shoulder subluxation among GivMohr & other slings in hemiplegic patients. Method: Fifteen hemiplegic patients with flaccid upper limb were included. The vertical distance (VD), horizontal distance (HD) & joint distance (JD) on the plain AP views of the shoulders were measured. GivMohr sling was compared with 2 conventional slings, which were forearm cuff type extension sling and Bobath sling, in the effects of correction. Results: The mean values of VD and JD of hemiplegic shoulder increased compared to unaffected side, but those of HD was not different between them. In Bobath sling, VD was significantly reduced and HD was not changed. However, JD was increased as other studies. GivMohr sling and forearm cuff type extension sling showed corrective effect in VD and JD (p＜0.05). When compared with these two slings, there were no significant differences in VD and JD. Conclusion: The results show that GivMohr sling reduces shoulder subluxation as other slings. This new sling is helpful for patients with flaccid upper limbs to reduce shoulder subluxation. (J Korean Acad Rehab Med 2007; 31: 410-416)

Objective
To compare the therapeutic effects between stellate ganglion block and steroid therapy in post-stroke complex regional pain syndrome. Method: In this controlled study, thirty-eight patients with post-stroke complex regional pain syndrome were randomly divided into two groups. One group received a total of five repeated stellate ganglion block every three days and the other group received an oral corticosteroid therapy. Therapeutic effects were assessed before treatment, after fifteen days and thirty days in the each group and evaluated via volume of the involved hand, circumference of the middle finger, shoulder and hand pain score. Results: In both groups, hand edema and circumference of middle finger were decreased after fifteen days and thirty days of treatment. However, the stellate ganglion block group showed more significant improvement in mean change of hand edema and circumference compared to the steroid therapy group. The hand and shoulder pain were also decreased significantly after fifteen days in both groups. In stellate ganglion block group, patients' pain kept decreased even after thirty days had passed since the treatment. However, in the other group who got the steroid therapy, there was no further decrease from the fifteenth day after the therapy. Conclusion: Although both treatment were effective in relieving symptoms of post-stroke complex regional pain syndrome, the stellate ganglion block was more effective. However, further controlled study is required. (J Korean Acad Rehab Med 2007; 31: 417-422)

Objective
To investigate the usefulness of the oxygen uptake efficiency slope (OUES) in the evaluation of cardiorespiratory fitness of the stroke patients. Method: 25 stroke patients who could walk independently were included in this syudy. The symptom-limited graded treadmill test was performed to assess cardiovascular fitness. During the test, minute ventilation (VE), oxygen consumption (VO₂), carbon dioxide production (VCO₂), respiratory exchange ratio (RER) and anaerobic threshold (AT) were measured through respiratory gas analysis. A linear relationship was established between the oxygen consumption and the logarithmic transformation of minute ventilation. From this linear relationship, we obtained a slope that represented the OUES. OUES values were obtained from data corresponding to 75% (OUES₇₅), 90% (OUES₉₀) and 100% (OUES₁₀₀) of the exercise duration. Results: The differences among OUES₇₅, OUES₉₀ and OUES₁₀₀ groups were not statistically significant and these three groups were highly correlated to each other. Maximal oxygen consumption (VO_2max) was positively correlated with OUES₇₅ (r=0.723), OUES₉₀ (r=0.762), OUES₁₀₀ (r=0.809) and AT (r=0.696), respectively (p＜0.01). Conclusion: OUES is considered to be the valuable submaximal index to evaluate the cardiorespiratory fitness of stroke patients who can not reach maximal exercise. (J Korean Acad Rehab Med 2007; 31: 423-426)

Objective
To report an overall survey of the application state of non-invasive intermittent positive pressure ventilator (NIPPV) in patients with neuromuscular diseases who were managed successfully in this hospital. Method: To estimate current state of NIPPV application, chart review and telephone survey were performed in neuromuscular patients who applied NIPPV successfully from March 2001 to January 2006 in this hospital. Results: Among 161 patients who once tried NIPPV, 100 patients applied NIPPV successfully. The composition was 66 patients with myopathy, 20 patients with amyotrophic lateral scoliosis, 6 patients with spinal muscular atrophy, 3 patients with cervical cord injury, and 5 patients with other neuromuscular diseases. Among them, 12 patients who had undertaken tracheostomy were switched into NIPPV, however 3 ALS paients who had first applied NIPPV successfully were taken tracheostomy later. Conclusion: NIPPV is an equally effective and safe tool for ventilatory support, which can be used as an alternative method of invasive ventilatory support for patients with advanced neuromuscular diseases. We assume that more neuromuscular patients can improve their quality of life, and prolong their life span through application of NIPPV. (J Korean Acad Rehab Med 2007; 31: 427-433)

Objective
To evaluate the usefulness of the mental component summary (MCS) from the short form 36-item health survey (SF-36) as a screening test for depression in patients with chronic musculoskeletal pain and identify the optimal cut-off value that predicts a positive depression score measured by the center for epidemiological study depression survey (CES-D). Method: This study was designed as a questionnaire survey. 502 patients who visited our outpatient clinics due to chronic musculoskeletal pain were evaluated. They completed the SF-36 and the CES-D. The correlation between the MCS score from the SF-36 and the CES-D was identified, and also the cut-off value of the MCS score was determined with ROC curves used the CES-D as the standard measure for depression. The MCS scores were compared according to age, sex, duration of diseases, diagnosis, and the presence of depression. Results: The mean overall score of CES-D and the MCS score were 17.5±10.2, 52.2±16.4 respectively. The MCS scores negatively correlated with the CES-D (γ=-0.879, p＜0.01). There were no significant differences of the MCS scores in each group according to age, sex, duration of diseases, and diagnosis (p＞0.05). However, patients with depression had significantly lower MCS scores than patients without depression (p＜0.05). The cut-off value was 42.4 with 88.1% of sensitivity and 92.6% of specificity. Conclusion: The MCS scores would be useful screening test for depression with cut-off value of 42.4 that predicts the closest result of the CES-D. (J Korean Acad Rehab Med 2007; 31: 434-439)

Objective
To investigate the diagnostic value of magnetic resonance imaging (MRI) in early detection of sacroiliitis, to identify risk factors of early sacroiliitis, and to propose a diagnostic algorithm for early ankylosing spondylitis (AS). Method: Twenty-nine consecutive patients with inflammatory back pain (IBP) and unclear sacroiliitis (unilateral grade 2≥sacroiliitis in plain radiography (PR) based on modified New York criteria) were studied. Clinical features of spondyloarthropathy, HLA B27 positivity, and MR image set of the sacroiliac (SI) joints were obtained. Two radiologists interpreted MR images independently to diagnose definite sacroiliitis. An association between sacroiliitis in MRI and each clinical and laboratory feature was assessed with linear logistic regression analysis. Post-test probability was determined with sensitivity/specificity of clinical and laboratory features. Results: MRI showed definite sacroiliitis in sixteen patients. The most frequently noted finding was erosion and high signal intensity lesion within the joint cavity in gadolinium enhanced T1-weighted images. Unilateral grade 2≥sacroiliitis in PR was the only significant risk factor of definite sacroiliitis in MRI. When unclear sacroiliitis in PR, more than one clinical feature of spondyloarthropathy, and HLA B27 were found, probability of AS was 83% in a proposed diagnostic algorithm. Conclusion: MRI of the SI joints can detect sacroiliitis in more than half of patients with IBP and unclear sacroiliitis in PR. Unilateral grade 2≥sacroiliitis in PR was a risk factor of definite sacroiliitis in MRI. A diagnostic algorithm for early detection of AS is proposed. (J Korean Acad Rehab Med 2007; 31: 440-446)

Objective
To evaluate and compare protein expression profiles of synovial fibroblasts using proteome analysis in swine knee injuries with joint instability, during early post-traumatic arthritis (PTA) development. Method: Experimental PTA was induced by transection of the anterior cruciate ligament (ACL) in swine left knee joints. After sacrifice at 8 weeks, cartilage and synovium obtained from both knee joints were prepared for histopathologic examination. Cultured synovial fibroblasts were processed for 2-dimensional electrophoresis and mass spectrometric analysis. Histopathologic examination showed overt arthritic changes that supported the development of early PTA. Results: Proteome analyses led to the identification of more than 1,500 protein spots and of 11 differently expressed protein spots. Of those, six proteins were down-regulated (cytoskeletal β actin, cofilin-1, destrin, Rho GDP dissociation inhibitor α, and unnamed protein product), and five proteins were up-regulated (α-B crystallin, smooth muscle protein 22-α, and cytoskeletal β actin) in ACL-transected synovial fibroblasts. That is, proteins related to cellular organization and signal transduction are down-regulated, and those related to cell rescue, defence, and stress are up-regulated. Conclusion: These results may suggest that joint instability contributes to the development of PTA and is one of the major etiologic factors of PTA. In addition, this suggests that the proteome analysis of synovial fibroblasts is a useful approach in examining a joint after an injury and can be used to understand the pathogenesis of PTA. (J Korean Acad Rehab Med 2007; 31: 447-456)

Objective
To investigate the physical function of Korean elderly by age and gender and to assess the impact of declined physical function on their quality of life. Method: The Korean Longitudinal Study on Health and Aging (KLoSHA) is designed as a populationbased prospective cohort study on health and aging of Korean elderly aged 65 years and over. In one city among the central metropolitan area for one year, 1,000 subjects includeing a simple random sample and an oldest-old subpopulation participated in baseline study. All subjects are older than 65 years (76.3±14.8, 65∼98 years). We surveyed their general characteristics and symptoms related physical function and examined physical function, functional disabilities, balance function and quality of life with standardized assessment tools. Results: The strengths of quadriceps were preserved over the functional level, but BMI was significantly reduced according to age irrespective of sex. Physical function and quality of life were consistently decreased according to age in female elderly, especially over 80 years. On the contrary, male elderly under 85 years preserved their physical function. In 85∼89 year group, they showed the remarkable disabilities related to musculoskeletal conditions or pain and decrease of balance. Elderly people had greater disabilities and lesser confidence for balance, lower quality of life irrespective of sex. Conclusion:Significant gender differences in Korean elderly were found in the patterns of functional decline. Physical dysfunctions and disabilities are main factors lowering quality of life. (J Korean Acad Rehab Med 2007; 31: 457-465)

Objective
To determine the normal values of flexor carpi radialis (FCR) H-reflex without facilitation, with facilitation and with facilitation & averaging. And to compare the three methods. Method: The FCR H-reflex was tested in 60 healthy people. 1) H-reflexes was recorded in the FCR muscle without facilitation. 2) H-reflexes was recorded in the FCR muscle with facilitation and facilitation was carried out by contracting the FCR muscle with 1 kg of weight. 3) FCR H-reflex was tested by repetitive stimulation with facilitation and the multiple responses were averaged. Results: Without facilitation, FCR H-reflexes were elicited only in 24 people out of 60 people and with facilitation, FCR H-reflexes were elicited in all 60 people. The mean latencies and amplitudes of the three methods were measured and normal limits of latency difference and amplitude ratio were calculated. In the FCR H-reflex without facilitation, with facilitation and with facilitation & averaging, the normal limits of latency difference were 1.0 msec, 1.0 msec, 1.1 msec and normal limits of amplitude ration were 0.37, 0.22, 0.57. Conclusion: FCR H-reflex with facilitation and with facilitation & averaging might be useful in the clinical diagnosis. (J Korean Acad Rehab Med 2007; 31: 466-471)

Objective
To investigate the effectiveness of motor point blocking using 70% alcohol for the treatment of spasticity in patients with cerebral palsy. Method: 16 patients with spastic cerebral palsy were injected at both hip adductor muscles with 70% alcohol. The severity of spasticity was assessed with the modified Ashworth scale (MAS) of adductor muscles, and the passive range of motion (PROM) of hip abduction. MAS and PROM were measured before, immediately after, and 1 and 3 months after the motor point block. Satisfaction of caregivers was also checked 3 months after the procedure. Results: The MAS prior to the motor point block and at 3 months after the procedure were 4.44±0.62 and 3.63±1.16. The PROM before motor point block and at 3 months after the procedure were 21.81±14.14° and 32.81±12.37°. 11 out of 16 (68.8%) caregivers reported high satisfaction. Conclusion: Motor point block with 70% alcohol to the hip adductor muscles could be a safe and cost-effective procedure for relieving the localized spasticity of hip adductor muscles in spastic cerebral palsy. (J Korean Acad Rehab Med 2007; 31: 472-477)

Eosinophilic fasciitis is a rare disorder which can markedly affect the quality of life in individual patients by disabling joint mobility. Eosinophilic fasciitis causes symmetrical pain, swelling and contracture of the extremities. A definite diagnosis of eosinophilic fasciitis is usually based on histopathologic examination. Hematologically, patients with this disease often have hypergammaglobulinemia and eosinophilia. However, these abnormalities are not specific to this disease and do not correlate with the severity of eosinophilic fasciitis. Although this disease shows good response to systemic steroids, no generally accepted and effective treatment modality has been available. Physical treatment of contracture includes passive, active assistive and active ROM, depending on the condition of the patient, usually after the application of deep or superficial heat. Therapeutic ultrasound is commonly used for contracture. We encountered a case of rehabilitation for an eosinophilic fasciitis localized on the left lower extremity. (J Korean Acad Rehab Med 2007; 31: 478-481)

Candida species inhabit the skin and mucous membranes of healthy individuals with low virulence, and osteomyelitis due to Candida is very rare. However, incidence of invasive candidal infection is increasing by intravenous drug use, broad spectrum antibiotics, and indwelling central venous catheter. A 63 year old man with cervical pain radiating to left scapula and upper extremity, who had undergone an appendectomy followed by broad spectrum intravenous antibiotics therapy for 3 weeks, visited outpatient clinic. The results of electrophysiologic study was compatible with left C6 and C7 radiculopathy, and cervical MRI and bone scan findings were suggestive of osteomyelitis. Pathologic findings of tissue biopsy showed bone destruction with acute and chronic nonspecific inflammation, and tissue culture and staining revealed Candida famata. (J Korean Acad Rehab Med 2007; 31: 482-485)

Diabetic thoracic polyradiculopathy is an unusual cause of severe, chronic abdominal pain in patient with diabetes mellitus of variable duration. The diagnosis can be made by careful history taking, physical examination and paraspinal and abdominal muscle electromyography. Since there are so many diseases that cause similar abdominal pain, it is hard to diagnose diabetic thoracic polyradiculopathy. A 41-year-old female patient with diabetes mellitus had been taken to the department of internal medicine due to unexplained chronic left upper quadrant abdominal pain. Upper gastrointestinal endoscopy, abdominal computed tomography, urologic and gynecologic examinations had been done but failed to find the cause of abdominal pain. We diagnosed chronic abdominal pain of the patient as diabetic thoracic polyradiculopathy confirmed by electromyography and report this case with a brief review of the related literatures. (J Korean Acad Rehab Med 2007; 31: 486-489)

The obturator externus bursa has been described as a potential bursa between the tendon of the obturator externus muscle and the posterior hip capsule. Although pathologic involvement of the iliopsoas bursa by intraarticualr hip disease has been extensively described, obturator externus bursa has not been fully investigated. We describe a patient who presented with hip pain and limited range of motion. Her magnetic resonance imaging of pelvis revealed an enhancing cystic lesion that extends inferomedially displacing obturator externus muscle and mild synovitis of the right hip. She was diagnosed as having obturator externus bursitis, and after symptomatic treatment pain and limited range of motion disappeared. The obturator externus bursa is a potential communication of the hip joint, can be a site of disease spread from the hip joint, and can be identified with magnetic resonance imaging. (J Korean Acad Rehab Med 2007; 31: 490-492)