Objective
To investigate which outcome measurements are useful for detecting functional changes after therapeutic approach to delayed motor impairment in an animal model of Huntington's disease (HD). Method: R6/2 transgenic mice received intraventricular injections of adenoviral BDNF/noggin (AdB/N), AdBDNF, AdNull (n=15 each) at 4 weeks of age. Untreated R6/2s and wild-type mice were also recruited as controls. Motor performance was measured using rotarod analysis and locomotor activity test at regular intervals until preterminal age of 13 weeks. Results: On constant speed rotarod testing, AdB/N-treated R6/2s exhibited a delayed disease progression after post- operative 6 weeks. AdB/N also ameliorated general locomotor activity deficits. One min-rotarod analysis showed a delayed motor impairment in AdBDNF group at preterminal age compared with AdNull and untreated controls, which was not shown in 3 min and 5 min-rotarod. Accelerating rotarod paradigm was not superior to constant speed. Partial therapeutic effects on locomotor activities were detected in total 60 min-monitoring, but not in 30 min- or 10 min- monitoring. Conclusion: Appropriate behavioral testing and outcome measurements should be selected to detect the treatment effect to slow functional deterioration in HD. (J Korean Acad Rehab Med 2007; 31: 503-511)

Objective
To evaluate changes of the spinal cord conductivity by investigating the cortical somatosensory evoked potentials (SEPs) after angular rotations of the cervical spine in the rats. Method: Ten rats (Sprague-Dawley, 300∼350 gm) were used. The trunk and head were fixed in the instrument for measuring rotational angles of the cervical spine. P1 latencies and P1-N1 amplitudes of the SEPs were obtained by stimulation of the posterior tibial nerve at the left hind paw. Thin scalp needle electrodes were placed subcutaneously at the 3 mm posterior to the vertex and nasion. We measured the parameters of the potentials at each 10o angular loading and compared the values measured immediately with those 5 minutes after each rotation. Results: P1 latencies were 19.9±5.5 msec at rest, 20.1±5.8 msec at 90o, 20.5±5.8 msec at 100o, 21.2± 6.2 msec at 120o and 21.7±6.1 msec at 130o, which were significantly prolonged above 100o rotational loadings (p＜0.05). The potentials disappeared at 140∼170o in some rats. The P1 latencies were prolonged according to increasing of the head rotational angles, however, P1-N1 amplitudes were not significantly decreased until absence of the potentials. There was no significant difference of the P1 latencies and P1-N1 amplitudes between potentials recorded immediately after rotational loading and at 5 minutes after rotation. Conclusion: P1 latencies of the SEPs according to the head rotation were significantly prolonged over 100o loadings in the rats. This result suggested possible impairment of the spinal cord conductivity over 100o rotational loading of the cervical spine in the rat. (J Korean Acad Rehab Med 2007; 31: 512-515)

Objective
To investigate the relationship between cognitive impairment and 1H magnetic resonance spectroscopy (1H MR spectroscopy) in patients with subarachnoid hemorrhage (SAH) caused by rupture of middle cerebral artery (MCA) aneurysm. Method: 1H MR spectroscopy was performed in 6 patients with SAH after rupture of MCA aneurysm and in 20 controls. Image-guided localized 1H MR spectra were obtained from left parietal white matter (PWM). The cognitive status was evaluated using the Mini Mental Status Examination (MMSE), and the scores were correlated with N- acetyl aspartate/creatine (NAA/Cr), choline/creatine (Cho/ Cr), and myoinositol/creatine (mI/Cr) metabolic ratios. Results: NAA/Cr was significantly lower, and Cho/Cr was higher in SAH patients than in controls in the left PWM (p＜0.05). NAA/Cr in the left PWM was correlated with MMSE (p＜0.05), but Cho/Cr and mI/Cr in the left PWM was not correlated with MMSE (p＞0.05). Conclusion: 1H MR spectroscopy could be helpful in the evaluation of cognitive impairment in SAH. (J Korean Acad Rehab Med 2007; 31: 516-520)

Objective
To evaluate the effects of growth hormone on metabolism and quality of life of spinal cord injured patients. Method: Thirteen chronic spinal cord injured patients without metabolic and psychologic disorders except growth hormone deficiency were included in the study. They were randomly divided into two groups. Seven patients received growth hormone and six patients received distilled water as control. Before and after 6 months' administration, we measured Adult Growth Hormone Deficiency Assessment (AGHDA) and Psychological General Well-Being Index (PGWBI) for assessing quality of life. Bone mineral density (BMD), osteocalcin, urine deoxypyridinoline, % lean body mass, % body fat, body mass index (BMI) and lipid profile were also examined for assessing metabolic states. Results: The AGHDA score decreased significantly from 6.7±2.9 to 3.9±2.1 (p＜0.05), and the PGWBI score increased significantly from 81.7±14.8 to 88.7±8.7 (p＜0.05) in growth hormone treatment group. There were no significant differences in control group. Other values about metabolic states were not significantly different in all groups. Conclusion: Growth hormone was effective on improving quality of life in spinal cord injured patients, but there was no positive effect on metabolic values for short-term therapy. (J Korean Acad Rehab Med 2007; 31: 521-528)

Objective
To evaluate clinical relevance of airway hyperresponsiveness (AHR) in subjects with chronic spinal cord injury (SCI) by investigating the prevalence of asthma-like symptoms. Method: Two hundred twelve patients with SCI responded to the modified questionnaire of International Study of Asthma and Allergic disease in Children (ISSAC). Among them, 28 patients underwent a methacholine bronchial provocation test to measure AHR. Results: The prevalence of AHR was significantly higher in subject with chronic cervical SCI compared with that in subjects with chronic thoracic or lumbar SCI (73.3% vs. 23.1%, p=0.023). In tetraplegics, the prevalence of wheezing during last 12 months, post-exercise wheezing, sleep disturbance due to nocturnal cough or wheezing, and dust-induced breathlessness were 40.0%, 37.8%, 33.3%, and 31.1% respectively, which were significantly higher than paraplegics and general population in Korea (p＜0.05, p=0.001, 0.013, 0.002, 0.004 respectively). Conclusion: AHR in subjects with chronic cervical SCI might be a cause of symptomatic airway disturbances such as wheezing, cough, and breathlessness. (J Korean Acad Rehab Med 2007; 31: 529-534)

Objective
To evaluate the prevalence of drooling in children with cerebral palsy and to determine their parents' needs for adequate treatment. Method: 107 children with cerebral palsy who attended to the pediatric rehabilitational treatment center were investigated whether they had the problems related with drooling. For the children with drooling, the severity of drooling was measured with subjective and objective measurement tools, and the types of cerebral palsy were classified. The parents answered to the questionnaire for several problems caused by drooling and whether they wanted treatment for drooling or not. Results: 25 (23%) out of 107 children with cerebral palsy had drooling problems. 16 (64%) of them were spastic quadriplegic, which was the most common type. Parents of 17 (68%) drooling children had much uncomfortable feeling to drooling, and of 21 (84%) parents wanted treatment. In 21 (84%) children, their therapists felt difficulties during their treatment sessions due to drooling. Conclusion: 23% of children with cerebral palsy in rehabilitation clinic had drooling and most of their parents wanted treatment for drooling. (J Korean Acad Rehab Med 2007; 31: 535-540)

Objective
To obtain clinical usefulness of knee extension- flexion exercise by comparing the exercise indexes between treadmill exercise and knee extension-flexion exercise and to collect reference of exercise indexes using knee extension-flexion exercise. Method: Sixty four young healthy subjects participated in two modes of exercise. Subjects performed exercise using isokinetic dynamometer in one leg knee extension-flexion exercise and treadmill running using Bruce protocol in treadmill exercise. We recorded oxygen consumption, heart rate during rest and exercise. Results: When comparing exercise indexes using treadmill exercise, we obtained relative exercise indexes using knee extension-flexion exercise, male 15.96%, female 15.77% in work rate, male 48.46%, female 52.53% in peak oxygen consumption, male 73.57%, female 80.82% in peak heart rate, male 65.97%, female 65.20% in oxygen pulse, male 56.07%, female 62.50% in peak tidal volume, male 82.56%, female 82.53% in peak respiratory rate, male 47.79%, female 49.48% in peak minute ventilation. In dynamic variables, we obtained male 266.82%, female 292.98% in ratio increase in oxygen consumption to increase in work rate. Conclusion: Knee extension-flexion exercise showed enough response to evaluate cardiorespiratory function through low work rate. Therefore knee extension-flexion exercise may be used for an exercise tolerance test in patients who cannot perform established exercise tolerance test. (J Korean Acad Rehab Med 2007; 31: 541-546)

Objective
To evaluate the prevalence and characteristics of anemia in the long distance runners. Method: Subjects included 61 long distance runners and 40 control. The 61 subjects averaged 39.9±4.5 years of age. Long distance runners has been training for at least 6 months. Hemoglobin, iron, total iron binding capacity, reticulocyte count, peripheral blood smear, urine hemosiderin were evaluated. WHO criteria cut off value of hemoglobin for the diagnosis of anemia was used, 13 g/dl in men and 12 g/dl in women. Iron deficiency was defined as the percent transferrin saturation less than 15. The percent transferrin saturation was calculated by dividing the serum iron level by the total iron-binding capacity. Results: Anemia occurred in only 2.0% and 9.0% of the male and female long distance runners respectively and other laboratory findings supported diagnosis of iron deficiency anemia. The percentage of iron deficiency anemia was lower than normal control. Iron deficiency was evident in 6.0% and 18.1% of the male and female long distance runners respectively. Conclusion: Recreational long distance runners were at no greater risk for developing a frank anemia than the non-exercising population. (J Korean Acad Rehab Med 2007; 31: 547-551)

Objective
To investigate whether mean F-wave latency is a useful electrodiagnostic test in diabetic patients. Method: We examined the diagnostic usefulness of mean F-wave latency, motor nerve conduction velocity (MCV), and amplitude of compound motor nerve action potential (CMAP) of the tibial and peroneal nerves, and of sensory nerve action potential (SNAP) amplitude of the sural nerve in 51 diabetic patients. Results: For the tibial and peroneal nerves, the Z-scores of the mean F-wave latency were significantly larger than those of the MCV and of the amplitude of the CMAP. Conclusion: Mean F-wave latency is a sensitive measure for the detection of diabetic polyneuropathy and should be included in electrophysiological studies of diabetic patients. (J Korean Acad Rehab Med 2007; 31: 552-556)

Objective
To acquire normal values of nerve conduction study of the superficial radial sensory nerve (SRN) distal branches to the second web space (2 WEB) and second digit (2 DIG) and compare them with the results of the conventional method. Method: Forty-three healthy adult subjects (25 males, 18 females) were included. Nerve conduction study was performed in both hands. Superficial radial sensory responses were obtained with 2 recording montages: 1) antidromic stimulation, recording electrode placed between the 2nd and 3rd metacarpals with stimulation 10 cm proximally on the lateral forearm (2 WEB); 2) orthodromic stimulation, stimulation at the second digit with recording 10 cm proximally at the snuff box (2 DIG). Each stimulation was performed twice, and onset latency, peak latency, and sensory nerve action potential (SNAP) amplitude (baseline-to- peak) were measured. Correlations between the values and body mass index (BMI), sex, and finger circumference were tested statistically. Results: The age of the subjects was 36.0±10.4 years (range, 23∼64 years), and the BMI was 22.6±2.8 kg/m2. The onset latency, peak latency and SNAP amplitude of the 2 WEB response were 1.7±0.1 ms, 2.2±0.2 ms, and 24.6± 8.2μV, respectively. The onset latency, peak latency and SNAP amplitude of the 2 DIG response were 1.6±0.2 ms, 2.2±0.2 ms, and 15.2±6.0μV, respectively. A statistically significant difference was observed between male and female subjects for both 2 WEB and 2 DIG responses. Weak correlations were found between the nerve conduction values and BMI, sex, and finger circumference. Conclusion: Sensory nerve action potentials can be successfully obtained from the distal branches of the superficial radial nerve. (J Korean Acad Rehab Med 2007; 31: 557-561)

Objective
To investigate the type of upper limb dysfunctions and to determine major dysfunctions influencing on the quality of life (QoL) in the early phase after mastectomy. Method: Among the female patients with mastectomy after diagnosed as breast cancer followed by chemotherapy and/or radiation therapy, 38 patients who had shoulder pain or arm edema were selected. Visual analog scale (VAS) for pain at rest and during activity, range of motion of shoulder and arm circumference were measured. Disabilities of Arm, Shoulder and Hand (DASH) and Short form-36 v2 questionnaire were used to assess the functional disability and health-related QoL. Results: Lymphedema (31.6%), limitation of motion (31.6%) and shoulder pain (26.3%) were major dysfunctions. Patients who had limited motion showed more severe dysfunctions. The cases with shoulder pain showed low level of QoL in mental component. VAS during activity and activity of daily living (ADL) domain of DASH were major impact factors on QoL related to physical functioning. In mental component, social domain of DASH was the most influencing factor on QoL. Conclusion: Pain during activity, limited ADL and social activity were major problems lowering QoL in patients with breast cancer. The proper managements for these problems is needed. (J Korean Acad Rehab Med 2007; 31: 562-567)

Objective
To investigate usefulness of surface electromyography (sEMG) for the pain evaluation in the patients with temporomandibular myofascial pain dysfunction syndrome (TM-MPDS). Method: Twenty unilateral TM-MPDS patients (10 males, 10 females, duration of disease 6.6±5.6 months, age 28.5±3.0 years) and twenty healthy controls (10 males, 10 females, age 30.1±6.2 years) were recruited for this study. The patients were treated with trigger point injection therapy and cryotherapy once a week, and ultrasound thermotherapy four times a week for 2 weeks. Active electrodes were attached on temporalis and masseter muscles with reference electrode on chin and ground electrode on forehead. All of subjects were instructed to clench teeth for 5 seconds after full relaxation. For temporalis and masseter muscles, the amplitudes of clenching-EMG activities were obtained and the mean value of five biting cycles was calculated on both sides. sEMG, visual analog scale (VAS) and asymmetry index (AI) were assessed before and 2 weeks after treatment. Results: For temporalis and masseter muscles, the amplitudes of affected side-EMG activity significantly decreased, and the AI of the patient group significantly increased compared with those of the control group (p＜0.05, p＜ 0.05). The AI of the patient group significantly decreased after treatment (p＜0.05, p＜0.05). Higher AI in masseter muscle before treatment was significantly correlated with lower VAS after treatment (r=-0.487, p＜0.05). Conclusion: It is suggested that sEMG would be useful for diagnosing and evaluating the pain in TM-MPDS. (J Korean Acad Rehab Med 2007; 31: 568-573)

Objective
To verify the effect of thermo-undulation therapy on the patients with chronic low back pain. Method: 115 patients with back pain (mean age: 51.2 year-old; male, female: 46, 69) were recruited. Experimental group (n=85) was subjected to thermo-undulation therapy for 30 minutes, once a day, five days a week during eight weeks and control group (n=30) was administered with sham procedure. Before and after the therapy, range of motion (ROM) the spine and flexibility of lower extremity muscles were evaluated with goniometry. The functional status was measured by Roland Morris disability questionnaire and quality of life was measured by the SF-36 (36-Item Short Form Health Survey Instrument) and SF-12 scales. The STAI-6 (Spielberger State-Trait Anxiety Inventory) was used for anxiety. We checked the intensity of pain by visual analog scale (VAS) and evaluated the effect of far-infrared ray with Digital Infrared Thermographic Imaging (DITI) technique. Results: After therapy, the scores of muscle flexibility, spine ROM, VAS, Roland Morris disability questionnaire, SF-36, SF-12 and STAI-6 showed a tendency to improve in experimental group (p＜0.05), but no significant differences compared with control group (p＞0.05). Only the temperature differences of experimental group by DITI were significantly lower than those of control group (p＜0.05). Conclusion: Thermo-undulation therapy may be an adjuvant therapy for chronic low back pain. (J Korean Acad Rehab Med 2007; 31: 574-581)

Objective
To compare the scar formation and hand function between moist exposed burn ointment (MEBO) treatment and conventional skin graft in full thickness hand burns. Method: Prospective comparative study was done between MEBO treatment group and conventional skin graft group. Full thickness burn wound scars on dorsal hand were compared. Scars were assessed with the Vancouver scar scale and other objective measurement tools such as pigmentation, erythema, pliability, transepideramal water loss, thickness and perfusion. Hand function was evaluated by the Jebsen hand function test and Michigan Hand Function Questionnaire. Results: Vancouver Scar scale showed significantly better scores in the MEBO group than in the conventional skin graft group. Scar thickness and transepidermal water loss were greater in the MEBO treatment group whereas pigmentation value was greater in the conventional skin graft group. There was no significant difference in the hand function between the two groups. Conclusion: MEBO application could be an alternative treatment to conventional skin graft treatment in full thickness hand burn wounds. In the future, more studies are yet to come how MEBO treatment may affect the skin condition of the burn injuries. (J Korean Acad Rehab Med 2007; 31: 582-589)

Objective
To assess the short-term clinical effect of a new spinal decompression device (DRX-3000) combined with transforaminal steroid injection (TFI) in comparison with TFI only in patients with lumbar herniated intervertebral disc (HIVD) Method: Fourty-one patients diagnosed as lumbar intervertebral disc herniation were recruited and divided into two therapeutic groups. Eighteen patients were treated with DRX-3000 combined with TFI. Twenty-three patients were treated with only TFI. The visual analogue scale (VAS), straight leg rasing test (SLR), radiating pain, Oswestry Disability Index (ODI), sitting tolerance, standing tolerance and sleeping tolerance were measured before treatment and 4 weeks after treatment. Results: VAS, radiating pain, sitting tolerance and ODI were significantly improved after treatment in all patients (p＜0.05). SLR and sleeping tolerance were significantly improved in combined treatment group and standing tolerance were significantly improved in TFI group after treatment (p＜0.05). After treatment, degree of VAS decrease was larger in combined treatment group than TFI group(p＜0.05). Conclusion: Spinal decompression with TFI was more effective than only TFI in patients with lumbar HIVD in a short period. (J Korean Acad Rehab Med 2007; 31: 590-595)

The clinical impact of severe hypoglycemic brain insult is ranged from alterations of mental status to profound coma and death. However, the exact mechanism of hypoglycemic brain insult is not well known yet. We report a case of a 75-year-old female with diabetes, who developed dementia after a severe hypoglycemic event. Diffusion-weighted magnetic resonance imaging detected an increased signal intensity in the splenium of corpus callosum. After 6 days, follow-up MRI (T2 weighted imaging) revealed irreversible signal abnormalities in the splenium of corpus callosum. Also, SPECT (Single Positron Emission Computed Tomography) and PET (Positron Emission Tomography) revealed decreased cerebral functions in left parietal, temporal and occipital lobes. This case brings up better understanding for the extent and mechanism of hypoglycemic brain insult. (J Korean Acad Rehab Med 2007; 31: 596-601)

De Quervain's disease is the most common form of tenosynovitis, which causes disability in daily living and occupational activity. Anatomical variations in the first extensor compartment including separate comparment influenced the effects of treatment. A 45-year-old woman had severe pain on wrist and suffered in activity of daily living after motor vehicle accident. She had swelling and tenderness upon the radial styloid process, and more aggravated pain by Finkelstein's maneuver test. The magnetic resonance imaging (MRI) scans showed severe peritendinous edema within the synovial sheath, increased signal intensity within the tendons. Also, the images revealed a thickened septum between abductor pollicis longus and extensor pollicis brevis. Corticosteroid was injected on both sides of the septum. We report a case of definite septum of de Quervain's disease via MRI scans. (J Korean Acad Rehab Med 2007; 31: 602-605)

Tuberculosis can affect the sacroiliac joint. The involvement has been reported in up to 10 percent of patients with osteoarticular tuberculosis. The onset is usually insidious, and early diagnosis requires a high index of clinical suspicion. Lack of awareness of this presently uncommon form of infection often leads to diagnostic delay and increased morbidity. Early diagnosis and proper treatment with anti-tuberculous medication could obtain a satisfactory functional outcome. We report a case of tuberculous sacroiliitis in a 21 year-old male patient including his clinical presentation, radiographic features and outcome of medical treatment. (J Korean Acad Rehab Med 2007; 31: 606-608)

We report our therapeutic experience in a patient with complex regional pain syndrome (CRPS) related to brachial plexitis. A 16-year-old female suffered from excruciating burning pain and allodynia abruptly developed on left shoulder. Cervical MRI was normal. Electrodiagnostic findings were compatible with acute brachial plexopathy. Hand swelling, dystrophic color change, desquamation, and anhidrosis were displayed. Three-phase bone scan revealed increased radio-uptake on left upper extremity. The course of the disease was slowly progressive with wax and wane pattern. Pain became gradually intractable to all therapeutic modalities and medications. She gradually improved with long-term multimodal pain management. After 2 years of disease-free period, CRPS recurred and the extent was more severe than the first attack. We tried oral mexiletine, risedronate, high dose multi-vitamin, and leukotriene modulator which were effective in reducing pain and allodynia. Hand swelling gradually subsided and functional regain was obtained. (J Korean Acad Rehab Med 2007; 31: 609-615)