Objective: To investigate the effects of botulinum toxin on the mechanical hyperalgesia, electrophysiology and motor functions in the persistent muscle pain rat model. Method: A secondary mechanical hyperalgesia in the bilateral hindpaws of Sprague-Dawley rats was produced by the repeated injections of acidic saline into gastrocnemius. Botulinum toxin A (BTX-A(4): 4 U/kg, BTX-A(7): 7 U/kg) was administrated into same muscle 24 hours after a second injection of saline. The mechanical hyperalgesia was measured with withdrawal threshold to von Frey filament. The grade of muscle paralysis was evaluated with electrophysiology and the locomotor performance using inclined plane board. Results: The mechanical hyperalgesia was significantly decreased from 5 days to 2 weeks in BTX-A(7) group in the injected side. The dose-dependent decreased amplitude of compound muscle action potential and reduced prevalence of endplate noise from the first day of botulinum toxin injection lasted for 4 weeks in both gastrocnemius. The maximum angle maintained at initial position on the inclined plane board did not change. Conclusion: Local muscular injection of botulinum toxin A reduced ipsilateral hyperalgesia dose-dependently in per- sistent muscle pain rat model without motor deficit. The antinociceptive mechanism of botulinum toxin might act at a local or peripheral rather than a systemic or central effect due to ineffectiveness of contralateral hyperalgesia. Clini- cally, botulinum toxin A might be useful for the treatment of local and referred pain of muscle origins. (J Korean Acad Rehab Med 2008; 32: 1-8)
Objective: To investigate the benefit of electrical stimulation for dysphagia caused by stroke. Method: Ten consecutive stroke patients with dysphagia for 3 months or more were enrolled in this study and assigned to one of the two group (electrical stimulation group or sham group) according to randomization table. Five patients were allocated to electrical stimulation group and 5 patients to sham group. One patient in the sham group dropped out because of transfer to other hospital. Electrical stimulation with a maximal tolerable intensity was applied on both digastric muscles and both thyrohyoid muscles for 1 hour, 5 days a week for 4weeks in electrical stimulation group. Sham group received electrical stimulation in same condition except stimulation intensity of 1 mA. Clinical dysphagia scale, functional dysphagia scale and kinematic analysis of hyoid bone movement were assessed at baseline (before treatment), 2 weeks later (during treatment), 4 weeks later (after treatment). Results: The clinical dysphagia scale decreased in both group, of which the difference was not statistically significant. The functional dysphagia scale decreased significantly in the electrical stimulation group. The electrical stimulation group revealed greater improvement in clinical dysphagia scale and functional dysphagia scale compared to sham group. Conclusion: Electrical stimulation therapy with a maximally tolerable intensity to digastric and thyroid muscles might be effective in chronic stroke patients with dysphagia. (J Korean Acad Rehab Med 2008; 32: 9-14)
Objective: To investigate the effect of computer-based cognitive rehabilitation on unilateral spatial neglect in stroke patients. Method: Twenty four stroke patients (7 men, 17 women) who had unilateral spatial neglect were recruited. Patients were randomly assigned to either case or control group. Case group received both classical neglect stimulation therapy (attention and compensation training) and computer-based cognitive rehabilitation, but control group received only classical neglect stimulation therapy. The effect of therapy was assessed with star cancellation test, line bisection test, MVPT (motor-free visual perception test), and MBI (modified Barthel index). Results: Four weeks after the therapy, both group showed significant improvement in star cancellation test, line bisection test, MVPT, and MBI. But there was no statistically significant difference between control and case group with each evaluation tool after 4 weeks treatment (p＞0.05). Conclusion: Computer-based cognitive rehabilitation has no additional benefit to the treatment of hemi-spatial neglect in stroke patients. (J Korean Acad Rehab Med 2008; 32: 15-19)
Objective: To assess the effect of motivation for treatment and to find out causes of dropping out from treatment in performing the constraint-induced movement therapy (CIMT). Method: Forty six stroke patients were treated with CIMT for 2 weeks. Prior to and after treatment, Fugl-Meyer motor assessment (FMA), Wolf motor function test (WMFT), box and block test (BBT), and 9 hole peg test, motor activity log (MAL) were performed, and for the evaluation of treatment motivation, motivation score (MS) was assessed in 24 patients. Results: After 2 weeks of CIMT treatment, the mean value of FMA increased by 15.1%, WMFT by 19.5%, BBT by 35.8%, the time of 9 hole peg test decreased by 20.2%, and the "How well" sub-score of the increased MAL was 59.6% (p＜0.05). Larger improvement of FMA score was observed in patients with high MS (p＜0.05). Twelve out of 46 patients were dropped, 5 patients (18.5%) among 27 right side hemiplegic patients and 7 patients (38.9%) of 19 left side hemiplegic patients gave up the treatment in the middle, and the MS score of the quitted patients (35.3 point) was lower than that of patients who did not quit (40.5 point) (p＜0.05). Conclusion: After 2 weeks of CIMT treatment, larger improvement of movement capacity was observed in patients with high motivation. Among patients with low treatment motivation and old age, many patients were dropped out during CIMT. (J Korean Acad Rehab Med 2008; 32: 20-25)
Objective: To suggest the standard tool for the selection of exercise stress tests (EST) by analysis of the initial evaluation factors affecting EST. Method: Twenty-two hemiplegic patients carried out treadmill, arm and bicycle ergometer ESTs. Treadmill EST using modified Harbor protocol was performed without taking off AFO. The velocity of the arm and bicycle ergometer was set in 50 rpm, and the resistance was increased up to 5 W at each stage. Each EST was completed at 80% of maximal heart rate. Results: Brunnstrom stage of lower extrimity, Medical Research Council (MRC) scores [hip flexor, knee extensor, finger flexor] and standing balance of twelve patients completing treadmill EST were superior to those of failed group (p＜0.05). Twelve patients completing bicycle ergometer EST showed significant differences in MRC scores [hip flexor, knee extensor] and sitting balance (p＜0.05). Brunnstrom stage of lower extremity hip flexor and knee extensor power contributed mostly to the completion of treadmill EST (p＜0.01). The completion of bicycle ergometer EST was mostly dependent on hip flexor and knee extensor power (p＜0.01). Conclusion: For bicycle ergometer EST, hip flexor and knee extensor power should be higher than 3 and 4, respectively. Treadmill EST can be suggested when Brunnstrom stage of lower extremity, hip flexor and knee extensor power are above 4, 4 and 3, respectively. The completion rate of treadmill EST can be increased when standing balance ability and Brunnstrom hand score higher than 4 and 2, respectively. (J Korean Acad Rehab Med 2008; 32: 26- 31)
Objective: To investigate the effectiveness of pulmonary rehabilitation program on functional improvement in patients with spinal cord injury and the difference between tetraplegics and paraplegics. Method: Twenty one patients without previous history of pulmonary pathology were recruited for this study. Fourteen patients were tetraplegic (12 males, 2 female; mean duration of disease, 42.2±7.9 days; mean age, 52.7±3.4 years old), seven patients were paraplegic (6 males, 1 female; mean duration of disease, 48.8±6.3 days; mean age, 42.1±3.7 years old). All patients received pulmonary rehabilitation composed of respiratory muscles strengthening exercise, positive inflation exercise, and breathing exercise with BreatherⰒ for 30 minutes a session, twice a day, five days per week for 4 weeks. We evaluated arterial blood gas analysis, pulmonary function test (PFT), modified Borg scale (MBS), Spinal Cord Independence Measure (SCIM), and Functional Independence Measure (FIM) as outcome measures at the beginning and 4 weeks after treatment. Results: After the pulmonary rehabilitation program, both of PaO2 and SaO2 increased in tetraplegia and paraplegia groups. MBS improved at rest and on exercise in both of paraplegia and tetraplegia groups (p＜0.05). FEV1 and FVC increased in both groups (p＜0.05). Both SCIM and FIM scores increased in both groups (p＜0.05). The difference of the improvement ratio of PFT, MBS and functional scales between tetraplegia and paraplegia groups was not significant. Conclusion: It is suggested that pulmonary rehabilitation program would be useful to improve the functional improvement including of pulmonary function and subjective dyspnea scale in both of tetraplegia and paraplegia groups. (J Korean Acad Rehab Med 2008; 32: 32-37)
Objective: To assess the necessity of extra rounds of urine culture when symptom of urinary tract infection (UTI) is developed from asymptomatic bacteriuria in spinal cord injury patients. Method: A total of 226 patients who took a urine culture at least twice during their stay and did not show symptoms of UTI at the admission were chosen. We then divided them into two groups: the one with patients who showed symptoms of UTI, and the other with ones who did not. Follow-up urine culture was performed when patients had symptoms of UTI or after one month from admission. Results: 1) Of the 226 patients, 60 patients showed symptoms of UTI, while 166 patients did not. 2) From the UTI group, there were 38 (63.3%) patients whose organism from their urine culture changed. From the non-UTI group, 79 (47.6%) patients saw their organism from their urine culture changed. 3) From the UTI group, there were 31 (56.4%) patients whose organism was more resistant to the antibiotics. From the non-UTI group, there were 80 (68.4%) patients whose organism was more resistant to the antibiotics. Conclusion: If UTI occurs in spinal cord injury patients, new organism might be detected in urine culture. Therefore, we should choose the proper antibiotics based on results of follow-up urine culture performed when the patients had symptoms of UTI. (J Korean Acad Rehab Med 2008; 32: 38-44)
Objective: To evaluate the effect of midodrine, an Ձ1 agonist, on symptom and hemodynamic response during standing and arm bicycle ergometer exercise in patients with cervical cord injury. Method: Twelve cervical spinal cord injury patients with orthostatic hypotension symptoms and post-exercise hypo- tension were enrolled. They were positioned on a 90°standing frame for 3 minutes. After 15 minutes of resting on supine position, 5 minutes of arm bicycle ergometer exercise was done. These tests were done without midodrine initially, but, with 5 mg midodrine on the next day. Heart rate, self-perceived presyncope score (PPS), systolic and diastolic blood pressure were measured before, during and after the exercise. Results: With 5 mg midodrine, the decrease of systolic and diastolic blood pressures after 3 minutes' standing was significantly smaller than without midodrine (p＜0.05). PPS was also significantly decreased with midodrine on standing frame test. Arm ergometer exercise induced less systolic blood pressure decrease and better PPS on immediate and 5 minutes after exercise with midodrine (p＜0.05). The change of diastolic blood pressure and heart rate was not significant after the exercise with midodrine. Conclusion: In cervical spinal cord injury patients with orthostatic and post-exercise hypotension, 5 mg midodrine significantly improved the symptoms and the systolic blood pressures. (J Korean Acad Rehab Med 2008; 32: 45-50)
Objective: To investigate the current condition of education and vocation of patients with muscular dystrophy in Korea and to identify the factors determining their educational and vocational status. Method: This study included 129 patients with muscular dystrophy. Functional level of patients was evaluated by modified Barthel index (MBI). The current condition of education and vocation of patients was evaluated by self-reports. The mean age of the patients was 23.5 years and 84.5% were men. Results: Education duration of patients was 11.8 years, similar to that of general Korean population. University graduation rate of patients was 29.8%, which is higher than average rate of general Korean population. The unemployment rate of patients was 77.4%, which is much higher than average rate of general Korean population. Education duration was correlated with the onset age of disease symptom and with the functional level at the end of education period. The vocational status was related with education duration and functional level. The factor which influenced most negatively on maintaining education and vocation was physical limitation. Conclusion: For muscular dystrophy patients with physical limitation, equal opportunities and environment for exercising their ability should be secured with the specific policies and regulations, which consider their physical disabilities and interconnect educational field with vocational field. (J Korean Acad Rehab Med 2008; 32: 51-55)
Objective: To determine the therapeutic effect of paratendinous injection of aprotinin, a polyvalent inhibitor of inflammatory proteolytic enzyme, in patients with shoulder tendinitis. Method: Thirty patients with shoulder tendinitis diagnosed with ultrasonography were included. Patients were assigned to one of two groups at random to receive paratendinous injection. One group received a paratendinous aprotinin 1.5 ml and 1% lidocaine 2 ml injection of shoulder 2∼5 times at 1 week apart. The other group received a paratendinous injection one time with mixture of triamcinolone 40 mg and 1% lidocaine 2.5 ml. The effect of treatment was assessed with the visual analogue scale (VAS), and the patients' life activities were assessed with the Western Ontario rotator cuff (WORC) index. Results: The VAS of the two groups showed improvement at 1 week (aprotinin group: 2.9±0.7, triamcinolone group: 3.7±1.2) and 4 weeks (aprotinin group: 2.1±1.0, triamcinolone group: 2.4±1.0) after injection compared with pre- injection status (aprotinin group: 8.6±1.3, triamcinolone group: 8.2±1.3)(p＜0.01) and the WORC index of the two groups showed improvement at 1 week (aprotinin group: 36.5±7.8, triamcinolone group: 53.2±12.3) and 4 weeks (aprotinin group: 33.4±6.2, triamcinolone group: 31.4±8.8) after injection compared with pre-injection status (aprotinin group: 116.2±29.1, triamcinolone group: 123.5±37.0)(p＜ 0.01). There was no significant difference in the improvement of the VAS scores and WORC index between the two groups. Conclusion: The short term effect of paratendinous aprotinin injection in patients with shoulder tendinitis was as good as triamcinolone injection, although more frequent injection was necessary. (J Korean Acad Rehab Med 2008; 32: 56-61)
Objective: To identify the optimal site for piriformis muscle injection, using easily detectable sacroiliac joint as a landmark, under fluoroscopic guidance. Method: We examined the anatomic relationships of the sciatic nerve, piriformis muscle and sacroiliac joint in 18 buttocks from 9 cadavers. The distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve, and the width of the sciatic nerve at that point were measured. We assessed the depth of the piriformis muscle and the sciatic nerve using ultrasonography in asymptomatic controls. Results: The mean distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve was 15.7±3.4 (12∼22) mm laterally and 16.5±4.1 (10∼25) mm caudally. The mean width of the sciatic nerve at that point was 15.4±3.7 (12∼22) mm. Ultrasonographic findings revealed the mean distance as 4.48±0.49 cm from the skin to the surface of the piriformis muscle and as 5.68±0.62 from the skin to the surface of the sciatic nerve. Conclusion: The most optimal injection site for piriformis syndrome was located 15.6±3.4 (12∼22) mm laterally and 16.5±4.1 (10∼25) mm caudally from the inferior margin of the sacroiliac joint. (J Korean Acad Rehab Med 2008; 32: 62-66)
Objective: To assess the clinical usefulness of ultrasonography for the diagnosis of mild and very mild carpal tunnel syndrome. Method: Ultrasonographic evaluation was performed in 39 hands of 29 patients with mild and very mild carpal tunnel syndrome according to Bland's neurophysiologic grading scale. Controls included 41 hands of 34 subjects without electrophysiologic evidence of carpal tunnel syndrome. Ultrasonographic findings were evaluated quantitatively with regard to the cross-sectional area, the flattening ratio, the swelling ratio of the median nerve, and palmar displacement of the flexor retinaculum. The analysis of differences between controls and patients group were done by independent t-test. Cut-off values using receiver operation characteristic, were calculated. Results: Patients had significantly increased cross sectional area and flattening ratio of the median nerve at proximal carpal area, palmar displacement of the flexor retinaculum at proximal carpal area. A critical value of equal or higher to 8.5 mm2 for cross-sectional area at the pisiform level showed a sensitivity 79.5%, a specificity of 95.1%, which had most diagnostic value compared with the value of cross-sectional area at the distal radius level, flattening ratio at the pisiform level and palmar displacement. Conclusion: Ultrasonography was useful in the diagnosis of mild and very mild carpal tunnel syndrome. (J Korean Acad Rehab Med 2008; 32: 67-72)
Objective: To investigate the clinical applicability of the somatosensory evoked potentials (SEPs) study in early detection of diabetic neuropathy, and compare the results in different degrees of the disease. Method: The study was performed retrospectively with prospective data collection. The Toronto clinical scoring system was taken as well as nerve conduction study, needle electromyography, and SEPs study with median and posterior tibial nerve stimulations in thirty-eight diabetic patients and twenty non-diabetic adults. The subjects were divided into the non-neuropathy group and the neuropathy group, and the latter was divided into three subgroups (suspected, probable, and definite) according to the degree of neuropathy. Statistical analysis was performed with height and age-related correction of reference values of the latency of SEPs with posterior tibial nerve stimulation. Results: The Toronto clinical scoring system showed concordance with the degree of the diabetic neuropathy (p＜0.05, correlation coefficient=0.827). SEPs study with posterior tibial nerve stimulations showed statistically significant latency delay, not only in the neuropathy group, but also in the non-neuropathy group, compared with the non-diabetic group (p＜0.05). Moreover, the latency delay was noted in proportion to the degree of the diabetic neuropathy within the neuropathy group. Interpretation of the data with height and age-corrected reference values of latency of posterior tibial SEPs had stronger correlation. Conclusion: The SEPs study is useful in the early diagnosis of diabetic neuropathy. However, application of the SEPs to clinical use needs to go through height and age correction. (J Korean Acad Rehab Med 2008; 32: 73-79)
Objective: To determine the prevalence of denervation potentials from the foot intrinsic and the lumbosacral paraspinal muscles in asymptomatic persons in Korea. Method: Nerve conduction studies were performed in 80 asymptomatic persons at sural, peroneal and tibial nerves. We excluded 15 persons with abnormal values of nerve conduction studies. In our study, 36 males and 29 females participated and the mean age of subjects was 52.9 years. We checked denervation potentials from unilateral lumbosacral paraspinal (L4-S1) and foot intrinsic muscles (abductor hallucis and extensor digitorum brevis muscle) by needle EMG. Results: The prevalence of denervation potentials from foot intrinsic muscles was 3% (2 cases out of 65 asymptomatic subjects). Denervation potentials consisting of a positive sharp wave were seen from the abductor hallucis muscle. No subjects showed any denervation potentials from the lumbosacral paraspinal muscles in our study. Abnormal X-ray findings were seen in subjects who had denervation potentials from the foot intrinsic muscles. Conclusion: The prevalence of denervation potentials from the foot intrinsic and the lumbosacral paraspinal muscles in asymptomatic person was not as high as previously reported. (J Korean Acad Rehab Med 2008; 32: 80-83)
Objective: To determine optimal stimulation site for median motor conduction study, we compared fixed distance (7 cm proximal to the recording electrode) stimulation method and distal wrist crease stimulation method. Method: Nerve conduction studies were performed in 65 hands of 36 healthy adults without neurologic abnormality. Median motor responses were recorded from abductor pollicis brevis (APB) with the stimulations at the point 7 cm proximal to the recording electrode and at the distal wrist crease. The distal latencies and onset-to-peak amplitudes were measured and compared between two techniques. The distal latencies were also compared to that of ulnar compound muscle action potential (CMAP) obtained with fixed distance stimulation (7 cm proximal to the recording electrode). And we measured median nerve actual length from distal wrist crease to APB muscle motor point by anatomic dissection of 12 hands. Results: The distal latencies of median CMAP to APB with 7 cm fixed distance stimulation and distal wrist crease stimulation were 2.91±0.37 ms and, 2.75±0.41 ms respectively. The differences were statistically significant. The distal latency of ulnar CMAP was 2.50±0.32 ms. Differences in distal latencies between ulnar CMAPs and not only 7 cm fixed distance median stimulation but also distal wrist crease median stimulation were also statistically significant. The mean length of median nerve from distal wrist crease to APB motor point was 5.91±0.77 cm. Conclusion: We suggest that the median motor nerve conduction study using distal wrist crease stimulation was an easier and more rapid procedure than fixed distance median motor nerve conduction study. (J Korean Acad Rehab Med 2008; 32: 84-88)
Objective: To assess the clinical value of digital infrared thermal imaging (DITI) as an indicator for successful lumbar epidural block in patients with lumbar radiculopathy. Method: Ten patients having lumbar radiculopathy with low back pain and unilateral radicular leg pain participated in this study. The DITI was taken before and 20 minutes after lumbar epidural block. Visual analog scale (VAS) and straight leg raising (SLR) test were done before taking DITI. Temperatures were measured over 39 sectors of both lower extremities. Temperature differences of the affected and the sound side were compared between before and after lumbar epidural block. Correlation between the temperature differences and two variables, the VAS and SLR were assessed. Results: There were the relative increase of temperature in DITI after lumbar epidural block, especially in posterior part of sector 7, posterior upper lateral thigh, sector 8, posterior upper middle thigh, sector 14, medial popliteal area, sector 15, posterior upper lateral calf, and sector 18, posterior middle medial calf. In posterior 15th sectors, the relative increase of temperature had a positive correlation with improvement of VAS score, and in 18th sector, it is positively correlated with improvement of SLR. Conclusion: It seems that the relative increase of temperature differences after lumbar epidural block is positively correlated with improvement of VAS and SLR in specific sectors, posterior 15th and 18th each. DITI may be useful as an objective indicator of successful lumbar epidural block. (J Korean Acad Rehab Med 2008; 32: 89-94)
Objective: To identify the risk factors for secondary lymphedema after breast cancer surgery. Lymphedema, a sequelae of breast cancer therapy, changes functional abilities and may affect a patient's psychosocial adjustment and overall quality of life. It is generally underreported and undertreated. Method: Six hundred two patients who had undergone breast cancer surgery between January 2000 and December 2005 were examined. The circumferences of the upper extremities were measured and lymphedema was defined as difference of greater than 2cm between the affected and normal arms. The effects of age, body mass index, diabetes, hypertension, side of tumor, sugery method, radiotherapy, chemotherapy, TNM stage, involvement of axillary lymph nodes, menopausal state and laboratory findings on the development lymphedema were investigated and analyzed by t-test, chi-square test and multiple logistic regression analysis. Results: 121 out of 602 patients had lymphedema. Those patients with lymphedema had a higher body mass index. Univariate analysis indicated an increased occurrence of lymphedema due to those with body mass index, radiotherapy, T2 stage, N3 stage and axillary lymph node invasion. Multivariate analysis revealed that body mass index and radiotherapy were independently associated factors for lymphedema after breast cancer surgery. Conclusion: The patients who had radiotherapy or BMI greater than 25 must be considered as potential candidates to have lymphedema after breast cancer surgery. Therefore, these patients should be informed during the follow-up period about this morbidity, the preventive measure, and the treatment. (J Korean Acad Rehab Med 2008; 32: 95-99)
Objective: To evaluate the clinical usefulness of ICF (International Classification of Functioning, Disability and Health) through correlation among existing functional evaluation tools and examined environmental factors affecting its function. Method: One hundred eight persons with disabilities living in Seoul were randomly selected according to disability severity categories. Functional Independence Measure (FIM), modified Barthel index (MBI) and ICF were examined and subjects were interviewed by trained rehabilitation doctors and occupational therapists. We compared correlation between these three functional measurements. We coded environmental factors affecting function. That was used in second level of 74 ICF items. Results: The average of FIM, modified Barthel index, capacity and performance scores of ICF was 112.76, 92.97, 5.74 and 3.19. There was a statistical correlation among FIM, Barthel index, and ICF. The facilitator chapters among ICF's environmental factors were support and relationships (51.9%), attitudes (45.8%) in order. Most facilitated second level domains among the 68 items were immediate family (66.77%) and health professionals (52.8%). The most barrier chapters in ICF were product and a technology (19.5%), environment changes (15.5%) in order. Most barrier second level domains were design, construction and technology of buildings for public use (37%) and assets (37.0%). Conclusion: ICF correlates with the existing functional evaluation tool and can facilitate management of activity and participation by linking the result with the environmental factors, which may exacerbate or minimize them. (J Korean Acad Rehab Med 2008; 32: 100-105)
Lee, Bum Suk , Kim, Wan Ho , Kim, Eun Soo , Kang, Se Young , Kim, Myung Soo , Ahn, Mi Ra , Moon, Nam Ju , Lee, Kwang Sun , Lee, Jin Yong , Park, Jong Hyock , Kim, Yoon , Kim, Yong Ik
Objective: To compare the disability grades previously evaluated and registered, with the re-evaluated ones for individuals with disability living in Seoul.Method: Thee hundred and eleven people with disability living in Seoul were selected by the hierarchical systematic extraction method. Their disability grade was re-evaluated in the otolaryngology, ophthalmology, rehabilitation outpatient clinic or via home visit. And the disability level of each person was evaluated by the Korean Activities of Daily Living (K-ADL). Results: Two hundred and twenty nine people with disability were re-evaluated on their disability grades. One hundred and thirty four (58.5%) cases had the same disability grade as initially evaluated. Thirty three cases were re-adjusted to a higher disability grade and sixty two cases to a lower grade. The K-ADL scores of people with brain lesion and spine/spinal cord injury were higher than those of other type of disability, which indicated a higher level of disability. Conclusion: When disability grades were re-evaluated, discrepancy rate was 41.5%. For proper management in the process of disability registration, it is imperative to implement a policy, which ensures the re-evaluation of the disability grade at a regular interval, the clear guidelines for grading as well as the competency of the evaluators. (J Korean Acad Rehab Med 2008; 32: 106-111)
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) has been reported rarely in systemic lupus erythematosus (SLE). We report a case of a 33 year-old woman who was diagnosed as SLE 2 years ago and presented with both feet and hands tingling sensation over 2 months. She also showed clinical features of areflexia, elevated CSF protein, and demyelination in the nerve conduction study. Her lower limb weakness and ataxic gait gradually progressed. Her symptoms which had shown minimal improvement to immunoglobulin therapy responded to immunosuppressant treatment. (J Korean Acad Rehab Med 2008; 32: 112-115)
Poststroke depression is very common and has been reported in as many as 40∼50% of poststroke patients. The fluoxetine is one of the most frequently prescribed drugs for the treatment of poststroke depression. This serotonin selective reuptake inhibitor, known as generally safe and well tolerated drug, has been recently reported to induce mania. We report a case of fluoxetine-induced mania. A 64 year-old male, who has taken 10 mg of fluoxetine daily due to poststroke depression, presented elevated mood, hyperactivity, regressed behavior, excessive planning, sleep deterioration, and talkativeness abruptly. We were suspicious of fluoxetine- induced manic state and discontinued immediately fluoxetine without prescription of mood stabilizer. His symptoms had been ceased over two weeks. (J Korean Acad Rehab Med 2008; 32: 116-118)
The true neurogenic thoracic outlet syndrome (TOS), one type of the TOS, has vague and controversial clinical symptoms, so a variety of diseases can mimic the presentation of TOS, especially ulnar neuropathy or cervical root lesion. For most patients with TOS, common practice is to offer a course of conservative treatment, but its kinds are not enough and pain is too severe to do that in the chronic state. We experienced a case of true neurogenic thoracic outlet syndrome with distinctive clinical symptom and abnormal electrodiagnostic findings. The symptom was not controlled by conservative management including oral medication or physical therapy. So we injected type A botulinum toxin (BotoxⰒ) in the scalene and pectoralis minor muscles with ultrasonography guide. After 2 weeks, the pain decreased in visual analogue scale nine to four, and the compliance to physical therapy was improved. The result appeared to demonstrate that botulinum toxin injection may be helpful in controlling symptoms and making the patient adapt in physical therapy in the difficult case to management by any other methods. (J Korean Acad Rehab Med 2008; 32: 119-122)
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