Objective: To investigate the functional recovery following the transplantation of human embryonic stem (hES) cells into an injured rat spinal cord. Method: Sprague-Dawley rats were subjected to the spinal cord injury (SCI) using the New York University impactor. The rats were randomly allocated into three groups of 12 rats each, one media-treated and two hES cell-transplanted groups (5×10³/5Ռl, 2×10⁴/5Ռl). The hES cells were transplanted 1 week after a SCI. Results: The hES cells transplanted into the rats were found to promote the hind limb performance 8 weeks after transplantation. In the electrophysiological study, the transplanted rats showed significantly shortened latencies and increased amplitudes of motor and somatosensory evoked potentials, compared to the media-treated rats. In the spinal cord of the hES cell-treated group, the pathological findings including the glial scar formation and degenerative changes were attenuated and the human Tau protein-positive cells were identified in the vicinity of the necrotic cavity and in the white matter. Conclusion: These results suggest that the transplantation of hES cells might play a role in promoting the functional recovery after a SCI. (J Korean Acad Rehab Med 2008; 32: 491-500)

Objective: To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) applied over the left prefrontal cortex on the enhancement of verbal working memory in healthy persons. Method: High frequency (10 Hz) rTMS was applied over the left prefrontal cortex with the intensity of 100% resting motor threshold (RMT). A 3-back verbal working memory task was administered before, during (after applying 500 and 1,000 pulses, respectively), and 30 minutes after real or sham rTMS. Results: Real rTMS, compared with sham stimulation, significantly improved working memory performance. Accuracy of response increased significantly after applying 1,000 pulses of real rTMS (p＜0.05). This effect maintained for 30 minutes after completion of stimulation (p＜0.05). The error rate and reaction time did not change with rTMS. There was no noticeable side effect during or after rTMS. Conclusion: 1,000 pulses of 10 Hz rTMS administered to the left prefrontal cortex with the intensity of 100% RMT have positive impact on verbal working memory in healthy persons. Further study is necessary to address this effect of rTMS in patients with cognitive dysfunction. (J Korean Acad Rehab Med 2008; 32: 501-505)

Objective: To investigate the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex on sensory and pain perception. Method: We measured the current perception threshold and the pain tolerance threshold with Neurometer^Ⱂ CPT/C in 14 healthy subjects (eleven males and three females, mean age: 25.0 years). Threshold testing was evaluated prior to, immediately after, 30 min after and 60 min after rTMS. The stimulation parameters were a frequency of 10 Hz and a field intensity of 100% of the active motor thresholds. Stimuli were provided in trains of 100 pulses, followed by a 50s rest period, 10 trains were applied in the session, resulting in 1,000 pulses in total. Results: The current perception thresholds of 5, 250, 2,000 Hz were significantly increased immediately, 30 min after rTMS (p＜0.05) and no effects at all were noticed after sham rTMS. The pain tolerance thresholds of 5, 250 Hz were significantly increased immediately, 30 min after rTMS and the pain tolerance threshold of 2,000 Hz were significantly increased immediately, 30 min, 60 min after rTMS (p＜ 0.05). No effects at all were noticed after sham rTMS. Conclusion: After high frequency rTMS over the primary motor cortex, we found that the current perception thresholds and the pain tolerance thresholds of 5, 250, 2,000 Hz were significantly increased. (J Korean Acad Rehab Med 2008; 32: 506-511)

Objective: To investigate whether combined somatosensory evoked potential (SEP) and motor evoked potential (MEP) would provide more reliable data in predicting hemiplegic upper limb function in subjects with an acute stroke. Method: We enrolled 59 subjects (34 males; mean age, 56.7 years) with stroke involving the middle cerebral artery (MCA) territory. The SEP and MEP were recorded within a month from the onset time of the stroke. Simultaneously, the manual function test (MFT) and the self-care in functional independence measure (Fsc) were selected for evaluation (MFT-Initial and Fsc-Initial). The MFT and Fsc were assessed every other week until improvement was no longer observed (MFT-Final and Fsc-Final). The subjects were divided into two groups according to SEP and MEP results. With the results from the two methods combined, the subjects were divided into three groups: responses in both, responses in only one, and responses in none. Data were analyzed to find the correlation of MFT or Fsc with the results of SEP and MEP combined and individually. Results: Both SEP and MEP had a correlation with MFT- Initial and MFT-Final, but not with Fsc-Initial and Fsc-Final (p＜0.05), whether combined or not. However, combining the SEP and MEP resulted in a stronger correlation with MFT-Initial and MFT-Final. Conclusion: Combining SEP and MEP is a more effective means to detect the recovery of motor weakness for hemiplegic upper limb in stroke subjects, although SEP or MEP alone has a correlation with recovery as well. (J Korean Acad Rehab Med 2008; 32: 512-517)

Objective: To investigate the effects of intramuscular low frequency electrical stimulation on shoulder pain in hemiplegic patients. Method: Twenty five hemiplegic shoulder pain patients were divided into two groups. For experimental group, we inserted stainless steel acupuncture needle on the motor points of supraspinatus, infraspinatus, trapezius and middle deltoid muscle and applied intramuscular electric stimulation (4 Hz, unsymmetric spike pulse, 2.0 ms of pulse width) for twenty minutes, three sessions a week, in total 10 sessions. For control group, we applied transcutaneous electrical nerve stimulation for twenty minutes. Visual analog scale(VAS), passive range of motion of shoulder joint, and Korean version of modified Barthel index (K-MBI) were measured before and after the treatment. Results: The VAS of experimental group significantly decreased from 7.23±0.83 to 3.04±1.52, while control group showed a slight decrease from 7.50±0.70 to 5.64±0.74. The experimental group showed significant improvement compared to the control group (p＜0.05). In the experimental group, there were significant improvements in motion of abduction from 103.6±20.5 to 134.0±32.3 and external rotation from 60.0±19.6 to 68.6±19.7 (p＜0.05) even though there were no significant differences between the two groups. Conclusion: Intramuscular low frequency electrical stimulation improved pain as well as the range of motion. This could be used for the treatment of hemiplegic shoulder pain. (J Korean Acad Rehab Med 2008; 32: 518-526)

Objective: To investigate the correlation between the pulse pressure (PP) and functional outcome in acute middle cerebral arterial (MCA) ischemic stroke. Method: We reviewed the medical records of 52 first-ever hemiplegic MCA ischemic stroke patients (age 61.5±9.7 years; 35 men, 17 women). Functional outcomes were evaluated with Korean-modified Barthel index (K-MBI), functional independence measure (FIM), Korean-national institutes of health stroke scale (K-NIHSS), and Korean-mini mental state examination (K-MMSE) on 3 days and 3 months after the onset of stroke in all the subjects. The PP was measured six times within initial 24 hours after stroke onset and then the highest PP was selected for the analysis. Results: The degree of PP elevation revealed the significant correlations with male gender, over the age of 55 years, diabetes mellitus, and current smoking history, respectively (p＜0.05). In TOAST (Trial Org 10172 in Acute Stroke Treatment) classification, the large artery atherosclerosis group showed significantly the higher PP rather than the other groups (p＜0.05). There were inverse correlations between the PP and each of FIM and K-MBI scores on 3 months after stroke onset (p=0.000, 0.009; r=−0.479, −0.358). There was an inverse correlation between the PP and the change of FIM (p=0.000, r=−0.532). Conclusion: The PP within initial 24 hours after stroke onset revealed significant correlation with functional outcome. The management for the proper PP gives the favorable effect on the functional outcome in acute MCA territory ischemic stroke. (J Korean Acad Rehab Med 2008; 32: 527-532)

Objective: To determine the incidence of peripheral neuropathy occurring in post-acute spinal cord injury patients. Method: We retrospectively reviewed the distribution of involved nerves in 94 spinal cord injury patients (men: 77, mean age: 45.2 years) who underwent electrodiagnostic studies at an early stage of rehabilitative therapy between March 1999 and June 2007 and looked for the existence of peripheral neuropathy according to the injured area (cervical/ thoracolumbar cord). Results: The incidence of peripheral neuropathy observed on electrodiagnostic studies was 38.3% (36/94). Twenty-one (46.7%) of 45 patients with injured cervical cords exhibited peripheral neuropathy, and 15 (30.6%) of 49 thoracolumbar cord injury patients exhibited peripheral neuropathy; hence, tetraplegia had a higher incidence. The most commonly involved nerve was the peroneal nerve (24 cases), followed by the median nerve (9 cases) and the ulnar nerve (9 cases). Conclusion: The incidence of peripheral neuropathy observed in electrodiagnostic studies was high in spinal cord injury patients at the initiation of intensive rehabilitative therapy. The incidence of peripheral neuropathy in cervical cord injury patients was higher than that seen in thoracolumbar injury patients. Active education and training concerning appropriate bed positioning are necessary for spinal cord injury patients at an early stage after injury to prevent peripheral neuropathy. (J Korean Acad Rehab Med 2008; 32: 533-536)

Objective: To investigate the disability identity and life satisfaction according to the severity of disability in the spinal cord injured persons resident in the community. Method: The subjects of this national wide study were 397 spinal cord injured persons resident in the community. We investigated their disability identity, life satisfaction, depression, social integration and social support. The questionnaire included the newly developed disability identity scale to evaluate the disability identity, that consisted of five sub-scales (personal worth, self-acceptance with the disabled, individual civil right, common cause and external barriers) and 23 questions. The subjects were divided into four groups according to severity of disability: motor complete tetraplegia, motor incomplete tetraplegia, motor complete paraplegia and motor incomplete paraplegia. Results: The scores of life satisfaction, depression and social support were not different according the four groups. However the disability identity scale of the motor incomplete paraplegia was lower than motor complete tetraplegia or motor complete paraplegia (p＜0.05). The sub-scale score of the personal worth and self-acceptance were lower in less severely disabled persons. As the disability identity scale was higher, social integration (r=0.478, p=0.000), and social support (r=0.465, p=0.000) were moderate and the depression was negative (r=−0.252, p=0.000). Conclusion: Less severely disabled persons showed lower disability identity. Disability identity scale was significantly correlated with higher social integration, higher social support and lower depression score. The newly developed disability identity scale will be a useful tool for the evaluation of the psychological status and planning the rehabilitation strategy for spinal cord injured persons. (J Korean Acad Rehab Med 2008; 32: 537-543)

Objective: To evaluate erectile dysfunction in patients with spinal cord injury and the relationship between patient's subjective answers and the results of objective tests regarding erectile dysfunction. Method: Twenty-one male patients with erectile dysfunction after spinal cord injury were administered with nocturnal penile tumescense and rigidity testing (NPTR) using Rigiscan^Ⱂ over 2 consecutive nights. NPTR using Rigiscan^Ⱂ at second night was performed after oral administration of sildenafil 50 mg. Answer of the global efficacy question (GEQ) after oral administration of sildenafil 50 mg and the parameters of NPTR were compared. Results: After oral administration of sildenafil 50 mg, number and duration of erectile episodes, and duration of rigidity greater than 60% on NPTR improved significantly (p＜ 0.05). Sixteen out of seventeen patients (94.1%) who showed improved nocturnal erection after oral administration of sildenafil 50 mg answered that they had an improved erectile function after sildenafil. All four patients (100%) who showed no improvement in nocturnal erection after sildenafil answered that their erectile function was not improved after oral administration of sildenafil 50 mg. Conclusion: We expect NPTR using Rigiscan^Ⱂ might be useful for the evaluation of erectile dysfunction in men with spinal cord injury. (J Korean Acad Rehab Med 2008; 32: 544-548)

Objective: To explore accuracy and validity of a VO₂max prediction equation of the multistage model using by modified Bruce protocol submaximal exercise test in healthy subjects. Method: Thirty three healthy subjects (age: 44.0±12.9) were recruited. VO₂max was measured during treadmill by direct gas analysis from a maximal incremental test. VO₂max was then predicted from multistage model equation with age, measured oxygen consumption and heart rate during a maximal incremental treadmill test. And the predicted VO₂max values from equation were compared with the measured VO₂max values. Results: The predicted VO₂max values and the measured VO₂max values were highly correlated (r=0.9, p＜0.001). The predicted VO₂max values (2,285.3±536.0 ml/min) were not significantly different from the measured VO₂max values (2,285.5±598.5 ml/min). Conclusion: In healthy subjects, the multistage model equation offers a fairly accurate VO₂max prediction. Therefore the equation can be used in the estimation of VO₂max at modified Bruce protocol in an aerobic exercise program. (J Korean Acad Rehab Med 2008; 32: 549-552)

Objective: To investigate the distribution of pain and associated factors and to understand treatment and prevention of Kendo related pain. Method: Ninety three Kendo players were given an account of questionnaire. Age, career, class, weekly practice time, daily warm-up exercise, daily cool-down exercise, pain existence, distribution of pain, diagnosis of pain origin, method of pain control, period of most pain and injury occurrence were investigated and analyzed. Results: The mean age was 29.3 years and mean career was 25.8 months. Sixty-four out of ninty-three Kendo players had musculoskeletal pain. Foot was the most common area of pain complaints (25%), which were followed by wrist (17.2%), ankle and heel (15.4%), knee (14.1%) in order of prevalence. Univariate analysis indicated increased occurrence of pain was correlated with age, career, class and warm-up exercise. As the causes of pain, tennis elbow, herniated lumbar disk, plantar fascitis and torsion of ankle were common. Conclusion: Musculoskeletal pain related to Kendo was found highly frequent and involved in whole body. Foot, ankle and heel were the most common area of pain and the cause of pain was various. (J Korean Acad Rehab Med 2008; 32: 553-557)

Objective: To investigate the analgesic effect of high frequency repetitive transcranial magnetic stimulation (rTMS) on the experimental human muscle pain and its underlying mechanism. Method: Twenty healthy Korean volunteers participated in this study. The acute muscle pain was induced by infusion of hypertonic saline (5%) into the left extensor carpi radialis longus (ECRL) muscle. During the hypertonic saline injection, 10 Hz rTMS were applied on the hot spot of left ECRL. The changes of visual analogue scale (VAS) of muscle pain and motor evoked potential (MEP) were measured from the start of saline injection to 70 minutes after the start of stimulation. At 90 minutes after the first stimulation, the subjects completed the Korean version of the McGill Pain Questionnaire (MPQ). The sham stimulation was applied with the same method as rTMS experiment. Results: In rTMS, the VAS of muscle pain was significantly decreased from 2.5 minutes and continued until 3 minutes after the last rTMS. While the amplitude of MEP was significantly increased, the latency of MEP was significantly decreased after the start of rTMS and the effect on MEP continued until 5 minutes after the last rTMS. The quality of pain experiment by rTMS and sham stimulation showed no difference in MPQ. Conclusion: The present results suggested that 10 Hz rTMS over primary motor cortex decreased the perception of muscle pain and increased the excitability of corticospinal pathway. (J Korean Acad Rehab Med 2008; 32: 558-563)

Objective: To define the ultrasonographic findings of the median nerve within the carpal tunnel and to verify the differences of the median nerve according to age, sex and the wrist in the normal Korean adults. Method: We studied 152 hands of 76 normal Korean adults who had no symptoms of carpal tunnel syndrome such as hand numbness, pain, dysesthesia or hand weakness. All subjects were examined with a real-time ultrasonography. We evaluated the flattening ratio (FR) and cross-sectional area (CSA) of the median nerve within the carpal tunnel. Results: The CSA of the median nerve was 6.44±0.02 mm² (at distal radioulnar joint), 6.34±0.02 mm² (at pisiform) and 6.31±0.02 mm² (at hamate). The FR at distal radioulnar joint is 2.36±0.02, at pisiform is 2.33±0.01 and at hamate is 2.33±0.01. Men have a larger cross-sectional area and flattening ratio of the median nerve than women. The older group over age 50 years has a smaller cross-sectional area and flattening ratio than the younger group. There were differences between men and women in body mass index (BMI) as well as between the older and the younger. There was also a linear relationship with CSA and FR in weight and height. Conclusion: The ultrasonographic finding of the normal Korean adult's median nerve in the carpal tunnel were different according to age and sex. Weight, height and BMI might be important factors to bring different results according to race, sex and age. (J Korean Acad Rehab Med 2008; 32: 564-569)

Objective: To compare the effects of spinal stabilization exercise against with lumbar extensor strengthening exercise. Method: Sixty patients with chronic low back pain were enrolled into the study and randomly classified into three groups. Groups were treated with spinal stabilization exercise (Group 1), lumbar extensor strengthening exercise using a MedX machine (Group 2), or with a combination program (Group 3) for 8 weeks. Patients were not given any other treatment modalities. Isometric peak torque of the lumbar extensors, pain rating score (PRS), Medical Outcomes Study Short Form-36 (SF-36) score, and the Oswestry low back pain disability questionnaire (OLBPD-Q) were assessed at 0, 4, and 8 weeks of exercise. Results: 1) After 8 weeks, all groups showed incremental improvements in maximal isometric torque of the lumbar extensors and exhibited improvement in SF-36, PRS, and OLBD-Q scores (p＜0.05). 2) There were no significant differences in the degree of improvement among the three groups after 8 weeks of exercise. 3) The percentage of patients with scores of good or excellent in Group 3 was higher than in Groups 1 and 2 according to all evaluation tools. Conclusion: In the treatment of chronic low back pain, all exercise groups showed decreased pain, improved quality of life, and increased lumbar extensor strength regardless of the exercise type employed. We suggest that exercise programs in general are effective for the treatment of chronic low back pain and a combination exercise program seems to be most beneficial. (J Korean Acad Rehab Med 2008; 32: 570-575)

Objective: To determine if physical factors (age, sex, weight, foot length) affected anteroposterior and intersidal weight- bearing pattern on footplate in standing posture and duration of stance phase at walking. Method: Participants were 578 healthy adults (250 men, 328 women). All participants were tested by Gaitview^Ⱂ (Alfoots, Seoul, Korea) which measure anteroposterior, intersidal weight-bearing pattern on foot plate and duration of stance phase at walking. Measurements were analyzed to find any relations among physical factors (age, sex, weight, foot length), anteorposterior, intersidal weight-bearing pattern and stance phase. Results: The age, weight, foot length had no specific relations to anteroposterior weight-bearing pattern (r＜0.2, p＜0.05). Men had greater weight-bearing pattern on forefoot than women (p＜0.01). The higher the age, the more midstance and the more delayed stance phase was noted (r＞0.4, p＜0.01). Conclusion: There was a significant correlation between sex and anteroposteior weight-bearing pattern. And there was a positive relation between age and stance, midstance phase. (J Korean Acad Rehab Med 2008; 32: 576-581)

The developing brain is highly plastic and thus brain lesions during development interfere with the innate development of architecture, connectivity and mapping of functions and trigger modifications in structure, wiring and representation. Unilateral inhibition of the sensorimotor cortex during development results in a sparse contralateral projection from this cortex and retention of a greater number of ipsilateral projections from the more active cortex. We report a patient with bilateral cerebral lesions. She had mild hemiparesis. Transcranial magnetic stimulation to the less affected hemisphere elicited bilateral motor evoked potentials of the first dorsal interossei and ipsilateral responses revealed shorter onset latencies and larger peak to peak amplitude than contralateral response, implying a greater ipsilateral than contralateral projection. This observation indicates direct ipsilateral corticospinal projections from the less affected brain hemisphere. (J Korean Acad Rehab Med 2008; 32: 582-585)

Autonomic dysfunction is a common manifestation in Guillain-Barre syndrome (GBS), but it rarely persists. We report a case involving a 22-year-old man who presented with glove-and-stocking type sensory loss, symmetric weakness, urinary distension, orthostatic hypotension, decreased perspiration, and the syndrome of inappropriate secretion of antidiuretic hormone. He was subsequently diagnosed as having GBS with autonomic failure that persisted for more than six months, despite regaining muscle strength. Orthostatic hypotension progressively improved after rehabilitation and administration of midodrine and fludrocortisone. Extensive evaluation and management should be performed in patients with GBS because severe autonomic dysfunction is a major source of disability. (J Korean Acad Rehab Med 2008; 32: 586-590)

Chromosome 18p deletion syndrome is one of the most frequent autosomal abnormalities with more than 150 reported cases in the world and 7 reported cases in South Korea. Frequent clinical features of 18p deletion syndrome include intellectual disability, growth retardation, and dysmorphic features including ptosis. To the best of our knowledge, sensorineural hearing loss has not been reported in the 18p deletion syndrome until now. A case with sensorineural hearing impairment associated with hypoplasia of bilateral cochlear nerves is presented in this paper. The sensorineural hearing impairment seen in this case could be related with deleted gene(s) located in the short arm of chromosome 18 or be an independent feature unrelated with 18p deletion. Further case reports are required in order to better define the relation between sensorineural hearing loss and the 18p deletion syndrome. (J Korean Acad Rehab Med 2008; 32: 591-594)