Objective
To develop a new scoring system for Jebsen Hand Function Test (JHFT) and test validity of the new score scale in stroke patients. Method: JHFT and the modified Barthel index upper extremity subtest (MBI-U) were performed on a total of 210 stroke patients at a tertiary university hospital. Based on JHFT raw data, scores were calculated from the existing scoring system and the new one. Validity of scores from each system was evaluated by comparing each score with the MBI-U score. Floor effects of both scoring system were compared. Results: In all the seven subtest items of JHFT, the floor effect of the new scoring system was far lower than that of the existing one. Pearson correlation coefficient between the score from the new scoring system and the MBI-U score was 0.4880 (p＜0.0001, n=210). Conclusion: 'New score scale' -a scoring system for JHFT based upon new criteria- was presented. New score scale for JHFT has reduced floor effect and is valid in stroke patients. (J Korean Acad Rehab Med 2007; 31: 623-629)

Objective
To determine the relationship between cognitive-perceptual function and functional independence in stroke patients. Method: Thirty-three patients (16 male, 17 female) with first ever ischemic stroke were enrolled. Their mean age was 60.4 years and the mean post-onset duration was 8.1 months. Subjects underwent detailed cognitive assessment including digit span test, line bisection test, Albert test, Wechsler nonverbal memory scale, Korean Hopkins verbal learning Test, Rey complex figure test, and trail making test A. Their functional outcomes were assessed using Functional Independence Measure (FIM) and Modified Barthel Index (MBI). Results: Among the cognitive subtests, Wechsler nonverbal memory scale, Albert test, and Rey complex figure test scores had significant correlation with both FIM and MBI scores. Patients with right hemispheric stroke showed significantly lower scores in line bisection test and Rey complex figure test than those with left hemispheric stroke patients. Conclusion: Visuospatial perception and nonverbal memory functions seemed to be two most important cognitive- perceptual domains for functional recovery of stroke patients. (J Korean Acad Rehab Med 2007; 31: 630-635)

Objective
To evaluate the effect of neuromuscular electrical stimulation (NMES) therapy on swallowing dysfunction in patients with chronic (more than 6 months) dysphagia caused by stroke. Method: A total of 16 patients with stroke-caused swallowing disorders based on a videofluoroscopic swallowing study (VFSS) were treated with NMES for two weeks. NMES was applied to the skin over the anterior neck muscles for one hour a day. Swallowing function was evaluated by the functional dysphagia scale using the VFSS, clinical dysphagia scale and the American Speech-Language Hearing Association National Outcomes Measurements System Swallowing Scale (ASHA NOMS scale) before and after electrical stimulation. Follow up VFSS was performed one month after intervention. Results: After completing ten treatment sessions, aspiration, reflex coughing and the total score in the clinical dysphagia scale were significantly decreased (p＜0.05). There was also a significant improvement in the ASHA NOMS scale (p＜ 0.05). Regarding the functional dysphagia scale, the residue in the valleculae and piriformis sinus, and total scores were significantly decreased (p＜0.05). Specifically, the scores of the pharyngeal phase were mainly decreased as compared to that of the oral phase. In addition, these effects were maintained one month after the intervention as measured with functional dysphagia scale. Conclusion: After ten sessions of NMES, we found improvement in dysphagia parameters in chronic dysphagia patients. Specifically, residue in the valleculae and piriformis sinus, and a parameter of the pharyngeal phase were significantly improved. (J Korean Acad Rehab Med 2007; 31: 636-641)

Objective
To clarify the issues about the importance of hyperglycemia in the acute stage of stroke as a poor predictor of clinical outcome, we analyzed the relationship between the glucose level in admission and clinical outcome in the acute stroke patients. Method: Twenty-five patients with sudden onset of acute stroke with focal neurological deficit were included in this study. Clinical assessments consisted of the National Institutes of Health Stroke Scale (NIHSS) for neurological impairment and the Korean modified Bathel index (KMBI) for functional status. NIHSS and K-MBI were assessed at admission and at discharge. Plasma glucose level was measured at admission in all patients. Acute hyperglycemia at admission was defined as fasting plasma glucose level more than 140 mg/dl. Statistical analysis were used to compare variables and clinical outcome scores between the normoglycemic and hyperglycemic groups. Results: For the patient with hyperglycemia at admission, the odds ratio for neurological improvement decreased (Ղ=-0.604) and the odds ratio for functional improvement decreased (Ղ=-0.553). However, control of the glucose level during the acute stroke was not significantly related to neurological and functional recovery (p＞0.05).Conclusion: In patients with acute stroke, hyperglycemia at admission was associated with neurological and functional impairments. Therefore, we expect that strict control of hyperglycemia during the acute stroke would improve clinical outcomes. (J Korean Acad Rehab Med 2007; 31: 642-648)

Objective
To determine the effects of concentric isokinetic knee strength training on gait, balance and health related quality of life in chronic stroke patients. Method: Fifteen patients with chronic stroke participated in this study. All subjects were community ambulators and trained using Biodex System 3 isokinetic dynamometer three times a week for 6 weeks. The training program consisted of concentric isokinetic strengthening of both knee extensors and flexors. Peak torque of knee extensors and flexors, walking performance (temporospatial parameter of gait and stair climbing time), balance (overall balance index, anterior/ posterior index and medial/lateral index) and health-related quality of life measure (36-item short form health survey, SF-36) were evaluated before and after training period. Results: Muscle strength improved significantly after training. Walking speed, stride length and stair climbing time improved significantly after training. Balance indices and SF-36 score also improved significantly after training. Conclusion: Gain in muscle strength appeared to be transferred to functional improvement. Therefore, isokinetic resistance training program would be one of the effective rehabilitation programs for chronic stroke survivors. Further investigations are required for long-term effect and development of strength-specific resistance training program. (J Korean Acad Rehab Med 2007; 31: 649-654)

Objective
To evaluate the effect of arm ergometry exercise training on the cardiovascular system and sensorimotor function in the early stroke patients. Method: 19 stroke patients without cardiac disease were randomly assigned to exercise training group (9 patients) and control group (10 patients). The time interval between the onset of stroke and exercise training was 20 days. The training group subjects were trained three times a week for 30 minuts by arm ergometry and conventional rehabilitation during 4 weeks. Exercise intensity was prescribed at 30% to 60% of heart rate reserve. Control group were trained only conventional rehabilitation. Exercise test with arm ergometry was performed before and after 4 weeks training period. To evaluate sensorimotor function, Fugl-Meyer score of upper extremities was measured before and after 4 weeks training period. Results: In training group, heart rate at rest decreased after 4 weeks training significantly. However, improvement of peak oxygen uptake was not significant. After 4 weeks, the difference of Fugl-Meyer score are correlate the difference of peak oxygen uptake. Conclusion: Early aerobic exercise training in stroke patients may improve resting heart rate and sensorimotor function. (J Korean Acad Rehab Med 2007; 31: 655-660)

Objective
To investigate the relationship between the independence levels of ADL and the function of affected and unaffected hands using Modified Barthel Index (MBI) and Jebsen Hand Function Test (JHFT) at subacute and chronic stages of stroke. Method: Retrospective review was performed including unilateral stroke patients who had been admitted and evaluated with MBI and JHFT before discharge and 6 months after stroke onset. Correlations between sub-MBI related to hand function and JHFT were analyzed. Results: Thirty-one patients with dominant hemispheric lesion and 13 patients with non-dominant hemispheric lesion were included in this analysis. The evaluation was performed at 43.2±28.0 days post-stroke before discharge and followed at 200.0±46.1 days post-stroke. MBI scores and the JHFT scores of affected hand were significantly increased in both groups. At the time of discharge, both groups showed significant correlations between MBI scores and the JHFT scores of unaffected hand, but at 6 months post-stroke, significant correlations were found between MBI scores and the JHFT scores of dominant hand. Improvement of the 'stacking checker' item was significantly correlated with improvement of MBI in both groups. Conclusion: In subacute stage, MBI reflects the function of unaffected hand, but in chronic stage, it rather reflects the function of dominant hand. The results suggest that rehabilitation concerning hand function may need different approach according to the lesion laterality. (J Korean Acad Rehab Med 2007; 31: 661-667)

Objective
To compare gait parameters of patients with idiopathic Parkinson's disease (IPD) during obstacle crossing with those of healthy control subjects. Method: Conventional physical examinations and three- dimensional gait analysis were performed on 16 patients of IPD with stage 2∼3 of the Hoehn and Yahr disease rating scale, and 11 healthy control subjects during stepping over the obstacle. Temporospatial, kinematic and kinetic parameters of patients were compared with those of the control group. Results: In patients with IPD, walking velocity was slower and stride length were shorter than control group. Decreased post-obstacle distance of the lead limb and increased pre-swing time of the lead and trail limbs were noted in IPD patients compared to control group. Many significant modifications of kinematic and kinetic parameters were detected in IPD patients compared to control group during obstacle crossing. Conclusion: Using three-dimensional gait analysis, we could identify specific modifications of gait parameters in IPD patients during obstacle crossing. These modifications may reduce or increase the risk of a falling in IPD patients. (J Korean Acad Rehab Med 2007; 31: 668-676)

Objective
To evaluate sniff nasal inspiratory pressure (SNIP) in patients with amyotrophic lateral sclerosis (ALS), to analyse the relationship between SNIP and other pulmonary function test and to verify the usefulness of SNIP in patients with ALS. Method: Twenty-eight patients with ALS able to follow command were studied. SNIP and maximal inspiratory pressure (MIP) were measured using respiratory pressure meter in sitting position. Forced vital capacity (FVC) and peak cough flow (PCF) were evaluated using spirometer and peak flow meter respectively. The relationship between SNIP and other pulmonary function parameters were analysed.Results: The mean value of SNIP was -20.7 cmH₂O (21.7% predicted) and the mean value of MIP was -16.3 cmH₂O (8.0% predicted). SNIP correlated with MIP (r=0.776, p= 0.000). When expressed absolute value, SNIP was higher than MIP in twenty-one of the twenty-eight patients with ALS. Difference of SNIP and MIP was 4.4 cmH₂O and it was statistically significant (p=0.001). SNIP and MIP correlated with FVC. SNIP and MIP correlated with PCF as well.Conclusion: SNIP in patients with ALS is useful method to assess inspiratory muscle strength in addition to MIP. (J Korean Acad Rehab Med 2007; 31: 677-682)

Objective
To determine the clinical utility of flexor carpi radialis (FCR) H-reflex with and without facilitation in the diagnosis of 7th cervical radiculopathy. Method: Thirty-four subjects (27 men, 7 women) participated in this study showed symptoms and signs suggesitive of cervical radiculopathy and every subject had single herniated cervical disc on MRI study. All participants underwent electrophysiologic study including routine nerve conduction study (NCS), electromyography (EMG), FCR H-reflexes with and without facilitation in both arms. Abnormal parameters for FCR H-reflex were 1) side to side latency difference more than 1.0 msec, 2) absence of FCR H-reflex in one side, 3) side to side amplitude ratio below 33% for without facilitation and 22% for facilitation. If the subjects had at least one of the three abnormal parameters, we concluded as having abnormal FCR H-reflex. Results: In the FCR H-reflex without facilitation group, we were not able to elicit FCR H-reflex in both arms in 17 subjects. Among the 17 subjects with elicited FCR H-reflex, 7 had abnormal FCR H-reflex (C7 root; 4, other roots; 3). In the FCR H-reflex with facilitation group, FCR H-reflex was obtained in 32 subjects, 13 out of the 32 showed abnormal FCR H-reflex (C7 root; 6, other roots; 7). The sensitivity and specificity of FCR H-reflex without facilitation in the diagnosis of 7th cervical radiculopathy were 67%, 73%, with facilitation it were 50%, 65%. Conclusion: Even though FCR H-reflex without facilitation is superior in its sensitivity and specificity, low elicitabiliy is the factor that limits its clinical utility. FCR H-reflex with facilitation with its good elicitability, seems to be a useful adjunctive method to routine NCS and EMG examination in the diagnosis of 7th cervical radiculopathy. (J Korean Acad Rehab Med 2007; 31: 683-688)

Objective
To verify the efficacy of 6cm segmental nerve conduction study in ulnar neuropathy at the elbow (UNE). Method: Ulnar nerve conduction studies were performed unilaterally in twenty five asymptomatic healthy adult volunteers and twenty five symptomatic patients with UNE. Twenty five symptomatic patients with UNE were diagnosed by standard ulnar nerve conduction studies, and needle EMG study. In the same healthy controls and patients groups, 6 cm and 10 cm segmental study were then performed at the elbow. The sensitivity and specificity of 6 cm segmental study were compared with those of 10 cm segmental study in these patients. Results: The sensitivity and specificity came out to be 76% and 92% for the 6 cm segmental study and, 52% and 96% for the 10 cm segmental study. Conclusion: The sensitivity of 6 cm segmental NCS was much higher compared with 10 cm segmental NCS, whereas the specificity was similar in both tests. For screening of the UNE, 6 cm segmental NCS seems to be a more efficacious test. (J Korean Acad Rehab Med 2007; 31: 689-693)

Objective
To examine the effect of cold spray (Ethyl chloride) on reducing pain during needle electromyography (EMG). Method: Seventy-six adults, who had experienced needle electromyographic examination, were studied. They were randomly assigned to either experimental or control group. In experimental group, cold spray was applied to needling point of examining muscles before each needle examination. In control group, needle examination was performed without pre-treatment. The intensity of pain was assessed by the Visual analogue scale (VAS) and Verbal rating scale (VRS). Denial to re-examination was evaluated after EMG study. Results: The VAS, VRS and denial to re-examination were significantly lower in experimental group (p＜0.05). Conclusion: The application of cold spray before needle examination decreased the intensity of pain and denial to re-examination. (J Korean Acad Rehab Med 2007; 31: 694-698)

Objective
To verify the reproducibility of nerve conduction studies, identify the most reproducible parameters and evaluate the acceptable ranges of parameters for patients with diabetic neuropathy. Method: Motor and sensory nerve conduction studies with F waves were studied in the median, ulnar, peroneal, tibial and sural nerves on two occasions. Fifty patients diagnosed with diabetes were assigned to an intra-rater reproducibility group (n=30) and another group (n=20) to an inter-rater reproducibility group; not in sequence. Twenty-two healthy volunteers were randomly assigned to an intra-rater reproducibility group as controls. Results: In the control group, the median motor distal latency (r=0.968) was the most reproducible parameter. For the intra-rater examinations in patients with diabetes, the ulnar F wave (r=0.977) was the most reproducible parameter. For the inter-rater examinations in patients with diabetes, the median sensory latency (r=0.986) was the most reproducible parameter. The differences in the values, in repeated studies, were not statistically significant for both the intra-rater and inter-rater groups. Conclusion: The nerve conduction study is an objective and highly reproducible test. F waves and other nerve conduction parameters were reproducible in patients with diabetic neuropathy. In repeated nerve conduction studies the parameters identified out of the acceptable ranges would be of great value in the evaluation of patients with diabetic neuropathy progression. (J Korean Acad Rehab Med 2007; 31: 699- 704)

Objective
To evaluate the association between neuralgic pain distribution and the severity of carpal tunnel syndrome (CTS). Method: Pain drawings using computerized pain chart system were collected from 131 patients (213 hands) with CTS. The presence and severity of CTS were determined by means of median motor and sensory nerve conduction studies. The severity was divided into 3 classes on the basis of electrophysiological findings: mild (93 hands), moderate (70 hands) and severe (50 hands). The similarities between pain drawing patterns and median nerve dermatome in the hands were evaluated. The pain distributions of the palmar and dorsal sides of each five fingers, palm and dorsum of hand were also evaluated.Results: There were no significant differences in similarity values of pain distribution among the groups of CTS hands divided by severity: similarity values were 0.22±0.14 in mild CTS patients, 0.24±0.16 in moderate CTS patients and 0.27±0.14 in severe CTS patients. In the CTS patients, the pain drawings showed relatively frequent distributions in the palmar side of 2^nd to 4^th fingers. Conclusion: There was no significant correlation between pain drawing patterns and severity of CTS. The pain drawings of patients with CTS indicate distribution to be most frequent in the palmar side of 2^nd to 4^th fingers. (J Korean Acad Rehab Med 2007; 31: 705-710)

Objective
To evaluate the effect of low-energy extracorporeal shock wave therapy (ESWT) in refractory calcifying epicondylitis. Method: Twelve patients (1 man, 11 women, mean age 49), who suffered from refractory medial or lateral epicondylitis (mean duration 22 months) with sonographically verified calcification, were included. Subjects were classified according to radiologic and sonographic findings of calcification. Visual analogue scale (VAS) at rest and activities of daily living (ADL) as well as Nirschl score were evaluated before and 3 months after low-energy (0.06∼0.12 mJ/mm², 1,500∼ 2,000 shocks) extracorporeal shock wave therapy (ESWT). Sonographic changes and Roles and Maudsley score were assessed 3 months after ESWT. Results: VAS at rest and ADL as well as Nirschl score were significantly decreased (p＜0.05) after ESWT. Roles and Maudsley score was "Good" in six patients (50%), "Acceptable" in 3 (25%) and "Poor" in 3 (25%) after 3 months. In sonographic classification, "Fragmented type" was observed in five (42%), "Nodular" in 3 (25%), "Small" in 4 (33%). All of eight radiologically positive patients (67%) showed sonographic changes of calcification including one complete resorption (8%), 3 disintegration (25%) and 4 decrease of size or number (33%). All of four radiologically negative patients (33%) were "Small type" and did not show any change of calcification on sonography. Conclusion: Low-energy ESWT can help the clinical improvement and resorption of calcification in refractory calcifying medial or lateral epicondylitis. Radio-opaque calcification may be a good indicator of resorption of calcification on sonography after low-energy ESWT. (J Korean Acad Rehab Med 2007; 31: 711-717)

Objective
To investigate the response of back muscle, the flexion moment and the kinematic change of lumbar spine during sudden upper limb loading between expected and unexpected conditions. Method: 23 healthy young subjects (13 male and 10 female, mean age 26.6±3.3) were recruited. We measured the latency of paraspinal muscle contraction (erector spinae and lumbar multifidus), flexion moment of lumbar spine, and kinematic change of lumbar spine during sudden upper limb loading by using surface EMG system, motion analysis system, and force platform. 6 trials with 3 eye opened and 3 eye closed were performed randomly. Results: The latency of paraspinal muscle contractions was significantly slower during eyes closed condition than during eyes opened condition after sudden upper limb loading (p＜0.05). The flexion moment and the flexion change of lumbar spine increased significantly during eyes closed condition compared with eyes opened condition (p＜0.05). Conclusion: The response of paraspinal muscle was significantly slower and the flexion moment and the flexion change of lumbar spine was higher during unexpected condition than during expected condition after sudden upper limb loading. Therefore, the spinal stability is more decreased during unexpected condition than expected condition. (J Korean Acad Rehab Med 2007; 31: 718-724)

Objective
To assess the effect of knee osteoarthritis (OA) and unilateral total knee arthroplasty (TKA) on balance. Method: Fifteen patients with bilateral knee OA and fifteen patients with unilateral TKA and fifteen healthy adults were assessed by computerized dynamic posturography. The posturography test was performed 3 times at 6 different simulated conditions. We evaluated anteroposterior sway of center of gravity and strategy score of OA group, TKA group and healthy adults group. We compared the equilibrium scores of each group with normal data reported previously. We also compared strategy scores of each group.Results: Patients with bilateral knee OA and unilateral TKA showed lower equilibrium scores than normal one at the condition 4, 5, 6. But patients with unilateral TKA did not show significant equilibrium score difference as compared with bilateral knee OA patients. Patients with bilateral knee OA and unilateral TKA showed significantly lower strategy scores than normal one at the condition 4, 5, 6 (p＜0.05). But patients with unilateral TKA did not show significant strategy score difference as compared with bilateral knee OA patients. Conclusion: Patients with bilateral knee OA showed deficit of dynamic postural control due to proprioceptive dysfunction. And TKA did not affect proprioceptive change in knee osteoarthritis. (J Korean Acad Rehab Med 2007; 31: 725-729)

Objective
To know the characteristics of muscle strength and tendon diameter of rotator cuff in the elite thrower and correlation between both parameters. Method: Twenty-four elite throwers (male 16, female 8) without pain and injury were included. Dominant hand was right side in all subjects. Thickness and width of rotator cuff except teres minor were measured with ultrasonography. Concentric strengths of shoulder internal (IR) and external rotators (ER) were measured with isokinetic device. Results: There was no difference between dominant and nondominant shoulder in tendon diameter except that thickness and width of dominant infraspinatus were greater than nondominant. ER/IR peak torque ratio was about 1.0 in both sides. There were significant correlations between subscapularis thickness and IR strength, infraspinatus width and ER strength, supraspinatus thickness and ER strength, supraspinatus width and ER strength, infraspinatus thickness and IR strength, infraspinatus width and IR strength in nondominant side, and subscapularis thickness and ER strength in dominant side.Conclusion: It is possible that external rotation peak torque is increased in elite thrower. Muscle strength could not be expected by tendon diameter except nondomiant subscapular thickness and infraspinatus width. This study will be the basis of the next study about elite thrower. (J Korean Acad Rehab Med 2007; 31: 730-734)

Objective
To evaluate the clinical efficacy of the quantitative bone scintigraphy in shoulder adhesive capsulitis (AC). Method: Twenty-six AC patients and age-matched 18 healthy controls underwent bone scintigraphy. For the quantitative analysis, region of interest (ROI) was drawn over each gleno-humeral joint area, excluding coracoid process, acromion and acromio-clavicular joint. We obtained the uptake ratios of affected side to unaffected side from anterior and posterior image respectively. Additionally, mean uptake ratios were calculated from both anterior and posterior ROI count. Reference values for each uptake ratio were obtained from 18 healthy controls. Clinical stages of the patients were determined according to the history and physical examination including range of motion under sonographically guided intra-articular anesthesia (Hannafin's stage). Quantitative measurements were analyzed according to Hannafin's stage and clinical findings. Results: Uptake ratios for the patients were significantly higher than the controls (p＜0.05). Sensitivities of the anterior image and mean uptake ratio were 81 % and 62% respectively. All 7 patients with abnormal findings in posterior image were stage II. Ninety-four percent in stage I and II showed abnormal mean uptake ratio. Nocturnal pain was associated with increased uptake ratio, particularly mean uptake ratio (p＜0.05).Conclusion: The findings of quantitative bone scintigraphy correlated with the clinical diagnosis, nocturnal pain and Hannafin's stage. Thus, the quantitative bone scintigraphy may be helpful in the diagnosis of shoulder AC. Additionally, mean uptake ratio and posterior image may contribute to clinical staging of AC (i.e. stage I, II and stage II respectively). (J Korean Acad Rehab Med 2007; 31: 735-741)

Objective
To investigate the usefulness and indications of arthrosonography by testing if the new technique could provide additional information on the degrees of rotator cuff tears when compaired to the findings of conventional ultrasonographic examinations. Method: Thirty six patients, who were identified to have partial or full-thickness rotator cuff tears by conventional ultrasonography, were included. Intraarticular injection of 15 ml of fluid was performed via posterior approach under ultrasound-guidance, which was followed by arthrosonography. Results: Among 26 patients with partial-thickness tear which was detected by the conventional ultrasonography, eight were identified to have full-thickness tears by the arthrosonography. Although the difference was not significant, the grade 3 partial-thickness tear in the conventional sonography had a higher rate of being identified as full- thickness tear in the arthrosonography than the grade 2 partial-thickness tears. The size of partial-thickness tear was increased after instillation of fluid in the arthrosonography. Conclusion: Arthrosonography would be useful in differentiating partial- and full-thickness tears. When a tear of the rotator cuff tendon, especially a grade 3 partial-thickness tear, is detected in the conventional sonographic examination, an obscured full-thickness tear should be suspected and subsequent arthrosonographic procedure could be administered to clarify the extent of the lesion. Moreover, arthrosonography might be helpful in detecting partial-thickness tears by making them appear larger after instillation of fluid. (J Korean Acad Rehab Med 2007; 31: 742-749)

Objective
To compare the effect of pharmaceutic agents which were used in trigger point injection and to establish a relationship between ultrasonographic change in injected muscle and post-injection soreness by a double blinded study. Method: Twenty-seven patients who were diagnosed as myofascial pain syndrome with their trigger point in upper trapezius muscle were recruited. They were assigned to four groups by age and sex: lidocaine injection (n=8), normal saline injection (n=6), 20%dextrose injection (n=6), and BTX-A injection (n=7). One physiatrist palpated a trigger point at upper trapezius muscle and injected blinded agents with same volume (1 ml). Ultrasonography for injected muscle was done by 2 weeks after injection. Visual analog scale was evaluated up to twenty three weeks. Results: Mean score of visual analog scale was decreased in all groups. Among the four agents, 0.5% lidocaine and BTX-A showed significant decrement in visual analog scale (p＜0.05). Ultrasonographic depth of muscle was increased in BTX-A and 20% dextrose injected group at the end of injection (p＜0.05). There were no significant different treatment effect in four pharmaceutic agents. Conclusion: In all four groups, trigger point injection showed therapeutic effect for myofascial pain syndrome. Among the four agents, 0.5% lidocaine and BTX-A could reduce pain significantly up to twenty three weeks. Mechanical pressure on muscle fiber was thought to be one of the causes of post-injection soreness. (J Korean Acad Rehab Med 2007; 31: 750-755)

Objective
To evaluate the effect of height and tilt adjustable keyboard tray on work-related musculoskeletal pain in visual display terminal (VDT) workers. Method: Twenty-one VDT workers, who had myofascial pain in upper trapezius (UTZ) and extensor carpi radialis longus (ECRL) or brevis (ECRB) during VDT work, were randomly assigned to a control (n=10) that used conventional keyboard or experimental group (n=11) that used height and tilt adjustable keyboard tray. A pretest assessed the visual analog scale (VAS), pain threshold of UTZ and ECRL or ECRB, and grip and tip pinch strength as well as upper extremity function index (UEFI). Post-test was conducted 1 month later. Additionally, differences in working posture between the two groups were evaluated. Results: For the UTZ, the decrease of VAS (p＜0.05) and increase of pain threshold (p＜0.01) in experimental group were significantly greater than control group after 1 month. Increase of right grip strength (p＜0.01) and UEFI (p＜ 0.05) in the experimental group were significantly larger than control group. Experimental group showed lower keyboard height (p＜0.01) and smaller elbow angle (p＜ 0.01) as well as more anterior tilted keyboard angle (p＜ 0.01) than the control group. Conclusion: Application of height and tilt adjustable keyboard tray seems to affect the working posture, thus reduce the work-related musculoskeletal pain of UTZ as well as enhance the strength of right grip strength and upper extremity function in VDT workers. Additionally, anterior keyboard tilting may help to reduce wrist extension in low keyboard height which contributes to decreasing UTZ muscle tension. (J Korean Acad Rehab Med 2007; 31: 756-761)

Objective
To investigate the changes of BMD (bone mineral density), biochemical bone markers and lipid profiles after combination therapy of low dose estrogen (0.3 mg) and intermittent fluoride (monofluorophosphate) in postmenopausal osteopenia. Method: We studied 61 women with postmenopausal osteopenia from March 2002 to May 2005. Group I (n=30) was treated with low dose estrogen (0.3 mg), fluocalcic^Ⱂ (monofluorophosphate 100 mg+calcium 500 mg), and calcium (500 mg). Group II (n=31) was treated with standard dose estrogen (0.625 mg) and calcium (1,000 mg). BMD at the lumbar spine and femur, osteocalcin, deoxypyridinoline, and lipid profiles were measured at baseline and 2-year after treatment. Results: 1) Average postmenopausal periods were 2.8 years and 3.1 years in Group I and II, respectively. 2) BMD increased significantly in two groups, and BMD in group I increased significantly more than that in group II. 3) Deoxypyridinoline decreased significantly in two groups, and there was no significant difference between the two groups. 4) Total cholesterol and LDL cholesterol decreased significantly in two groups. Conclusion: Combination therapy with monofluorophosphate and low dose estrogen in postmenopausal osteopenia was more effective than standard dose estrogen therapy to prevent postmenopausal osteoporosis. (J Korean Acad Rehab Med 2007; 31: 762-766)

Objective
To evaluate the effects of stretching exercise on the head speed of golf club and driving distance. Method: 58 male golfers (20 professionals, 22 amateurs, 16 beginners) were included in the study. They carried out stretching exercise programs related to muscles of trunk, upper and lower extremities for 5 and 30 minutes. The head speed of golf club and driving distance were measured before and after the stretching exercise. The effects of stretching exercise programs on the head speed and driving distance were assessed. Results: The head speed increased significantly in amateur and beginner groups after 30 minutes' stretching. In professional group, the head speed increased significantly after 5 minutes' stretching, but no more increment was found after 30 minutes' stretching. Driving distance increased significantly in all groups after 5 minutes' stretching. After 30 minutes' stretching, much more increment was found compared to 5 minutes' stretching.Conclusion: Sufficient stretching exercise program before golf swing can increase the head speed of club and driving distance. We recommend stretching exercise to improve golf performance. (J Korean Acad Rehab Med 2007; 31: 767- 771)

Crossed aphasia refers to language disturbance induced by unilateral right hemisphere (non-language dominant) injury in right-handed people who had no previous history of brain damage. Crossed aphasia occurs in less than 2 percent who developed a aphasia. We report a case of a 49-year-old right handed man with language disturbance after right middle cerebral infarction. He showed nonfluent crossed aphasia with Gerstman syndrome such as right-left disorientation, finger agnosia, acalculia and agraphia, but not with apraxia and neglect. At 7 weeks after onset, language function indicated improvement in spontaneous speech and at 19 weeks after onset, improvement in spontaneous speech, comprehension, repetition, naming and reading. (J Korean Acad Rehab Med 2007; 31: 772-775)

Kümmell's disease is a rare disorder defined as delayed avascular necrosis of a vertebral body after minor trauma. Diagnosis is based on clinical presentation of delayed onset back pain and kyphosis after minor trauma, and on intravertebral vacuum cleft in radiologic examination. Vertebroplasty or surgical management is necessary to the patients with risks of vertebral collapse or cord compromise, but we experienced a successful result after active conservative management to a patient with severe vertebral collapse and mild spinal cord compression without myelopathy. A 76-year old woman had back pain and gait disturbance 7 weeks after fall down. X-ray and MRI showed a vacuum cleft in T12 vertebra. We treated her conservatively with bed rest and immobilization followed by gradual weight bearing with thoracic-lumbar-sacral orthosis. Back pain and gait disturbance was improved after conservative management, and the improvement was maintained until 8 months after fall down. (J Korean Acad Rehab Med 2007; 31: 776-780)