Spinal cord injury (SCI) often results in devastating neurological dysfunction. Therefore many of the SCI patients suffer with physical disabilities or social handicaps. Many obstacles have been known to affect adult spinal cord regeneration and functional recovery. However, scientific knowledge of the central nervous system (CNS) development and post-injury responses including pathophysiology of SCI has been expanded recently, which might produce potential promising therapies for this condition. These are as followed; (1) pharmacological neuroprotective agents, (2) administration of exogenous neurotrophic factors or augmenting intraneural cyclic AMP, (3) inhibition of nonpermissive environment of the injured spinal cord, (4) cellular transplantation, and (5) rehabilitation interventions with body- weight supported treadmill therapy and functional electrical stimulation. In addition, the precise evaluation of functional improvement or gait is also important in rehabilitation of SCI patients. Various evaluation tools have been developed and introduced in order to estimate a degree of improvement properly. (J Korean Acad Rehab Med 2008; 32: 603-611)

Objective: To investigate the effects of functional magnetic stimulation (FMS) on the functional recovery in a rat model of spinal cord injury (SCI). Method: Forty-five Sprague-Dawley rats (200∼250 grams, female) were used. Rats were laminectomized and the T9 segment of spinal cord was contused using New York University (NYU) spinal impactor. Ten gram weight rod was dropped from a height of 25 mm to produce moderately contused spinal cord injury model. The animals were randomly assigned to 2 groups: one exposed to FMS (FMS group) and the other not exposed to FMS (non-FMS group). Transcranial functional magnetic stimulation was noninvasively applied for 4 weeks. To compare the results between FMS group and non-FMS group, motor functions were evaluated with the Basso, Beattie, and Bresnahan (BBB) locomtor rating scale and inclined plane test, and somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) were also recorded. Results: There was a significant difference in locomotor recovery between FMS group and non-FMS group (p＜0.05). Measurement of MEP was also indicated that amplitude of MEP in FMS group is larger than that in non-FMS group. Conclusion: These results indicate that FMS may have beneficial effects on motor recovery after spinal cord injury and the benefits of FMS could be an additional non-invasive therapeutic method for clinical trials in patients with spinal cord injury. (J Korean Acad Rehab Med 2008; 32: 612- 618)

Objective: To introduce the technique of the ultrasound- guided selective nerve root injection in the lower cervical spine and to evaluate its accuracy and distribution patterns of injections. Method: Thirty-one patients with the cervical radiculopathies (C5 to C7) from cervical disc herniation were enrolled in this study. Targeted nerve root image was obtained and the needle was introduced to its dorsal surface under the ultrasound guidance. Then 2 ml of contrast media was injected which was followed by fluoroscopic image. The accurate injection was defined as the contrast media placed over the neural foramen along the targeted nerve root. Results: 24 of 31 (77.4%) procedures were assesed to be accurately placed and there was no significant complication. The accuracy of injection was lower at the C7 nerve root (70.0%) than other nerve roots. In all cases, large amount of back flow to the brachial plexus and spread to the adjacent nerve roots were observed. Conclusion: In the lower cervical spines, ultrasound-guided selective nerve root injections might be considered as a radiation free, safe and available method. (J Korean Acad Rehab Med 2008; 32: 619-623)

Objective: To evaluate the effect of functional electrical stimulation (FES) on the motor function and gait in children with cerebral palsy. Method: Sixteen ambulant children (8 females, 8 males) with diplegic (n=12) or hemiplegic (n=4) cerebral palsy participated in this study. All were randomly assigned to either the FES (n=8) or control (n=8) group. Both groups received physical therapy based on neurodevelopmental technique for 20 minutes a day, 5 days a week for a period of 6 weeks. The FES group was treated with additional neuromuscular electrical therapy over quadriceps, hamstring, and ankle dorsiflexor on affected legs. Modified Ashworth scale, active range of motion of affected ankle and knee joints, motricity index for strength, gross motor function measure (GMFM), and gait analysis were performed before and after treatments. Results: The strength of lower limbs, section of D (standing), E (walking-running-jumping) and total of GMFM, and maximal range of motion of knee from sagittal kinematic data improved significantly in FES group (p＜0.05). In FES group, change values of before and after treatments to the strength of lower limbs, and section of D and total of GMFM were significantly improved compared to control group (p＜0.05). There was no serious side effect. Conclusion: This study suggests that FES in children with cerebral palsy may be a safe and beneficial therapeutic technique in improving the leg strength and gross motor function. However, we could not find any superior changes then control in gait kinematics of FES group. (J Korean Acad Rehab Med 2008; 32: 624-631)

Objective: To investigate that neurogenesis in the subventricular zone (SVZ), which is already known as neurogenic area where neural stem/progenitor cells persist, and the striatum, which is non-neurogenic area, might be induced by voluntary exercise (VEx) or environmental enrichment (EE), and compare the extent of the neurogenesis with untreated controls. Method: Total 12 C57BL/6 mice, 2∼3 months old, were recruited as follows; voluntary wheel runner, EE and control. For 2 weeks, VEx group was housed in rat cage (48×26 cm) with 2 running wheels with 3∼4 animals/cage, and EE group was housed in the living condition of huge cage (86×76 cm), social interaction (13∼14 mice/cage) and objects such as toys, tunnels and running wheel, whereas control group was placed in the standard cage (30×18 cm). Results: VEx and EE tended to increase the densities of mitotic marker BrdU^＋ cells in SVZ and striatum. They also exhibited more BrdU^＋ cells (/mm³) into the striatum, even though they did not show statistical significance. Moreover, EE group showed significant increment of the newly generated neurons coexpressed with BrdU^＋ and ՂIII-tubulin^＋ (/mm³) in SVZ and striatum as compared to those of controls. Conclusion: Voluntary physical exercise and EE induced cell proliferation and neurogenesis in both SVZ and striatum. Characteristically, EE could significantly induce neurogenesis in striatum, non-neurogenic area as well as SVZ, typical neurogenic area. Therefore, this strategy might be used to activate neural regeneration in various central nervous system diseases. (J Korean Acad Rehab Med 2008; 32: 632-636)

Objective: To investigate the correlation between functional evaluation scales and cognitive evoked potentials (CEPs) in chronic stroke patients. Method: Ten chronic stroke patients with middle cerebral arterial infarction (age 53.6±15.7 years, 5 men, 5 women, duration 210.5±143.2 days) were recruited. Korean mini- mental status examination (K-MMSE) scores of the subjects were ranked between 15∼24 points and the grades of Rancho Los Amigos level of cognitive function of the subjects were VI or VII. They received physical therapy using neuro-developmental technique and cognitive rehabilitation twice a day, 5 times a week, for total 4 weeks. Before and after the treatment, cognitive function tests including K- MMSE, Loewenstein occupational therapy cognitive assessment (LOTCA) and motor-free visual perception test (MVPT) and functional ability tests including functional independence measure (FIM) and Korean version of National Institutes of Health stroke scale (K-NIHSS) were done and CEPs were recorded. Results: The scores of K-MMSE, LOTCA, MVPT, FIM and K-NIHSS showed significant improvement, respectively (p＜0.05). The P300 latencies significantly decreased from 420.2±34.8 msec to 391.5±36.4 msec (p＜0.05). There were significant correlations between the percentage of change of P300 latencies and each percentage of change of K-MMSE, LOTCA and MVPT (r=0.863, p=0.001; r=0.745, p=0.013; r=0.806, p=0.005). There were significant correlations between the percentage of change of P300 latencies and each percentage of change of FIM and K-NIHSS (r=0.758, p=0.011; r=0.743, p=0.014). Conclusion: The CEPs would be a useful method for reflecting the effect of neuro-cognitive rehabilitation treatment and predicting the functional recovery in chronic stroke patients. (J Korean Acad Rehab Med 2008; 32: 637-643)

Objective: To compare the characteristics between geriatric depression scale (GDS), Hamilton depression rating scale (HDRS) and post-stroke depression scale (PSDS) in the aspect of diagnosis and severity assessment for post-stroke depression. Method: 45 post-stroke patients were included for this study. Subjects were classified through DSM-IV criteria into three different groups; depression-free, minor depression and major depression. GDS, HDRS, PSDS were also assessed in all subjects simultaneously. Three depression assessment scales were compared between groups based on DSM-IV criteria, and the sensitivity and specificity using cut-off value were analyzed. Results: All scales showed the significant differences between depression group and depression-free group. GDS showed higher sensitivity and specificity than HDRS and PSDS and GDS showed the significant difference between minor depression and no depression group, but other scales did not. HDRS and PSDS in major depression group showed the significant differences compared with minor depression group (p＜0.05), but GDS did not. Conclusion: GDS may be more useful to identify the presence of depression compared to GDRS and PSDS. However, to measure the severity of depression, HDRS and PSDS may be more useful than GDS. (J Korean Acad Rehab Med 2008; 32: 644-650)

Objective: To evaluate the effects of pamidronate on post- stroke reflex sympathetic dystrophy (RSD). Method: Twenty four subacute stroke patients who fulfilled Kozin's criteria of RSD were enrolled in this study. Mixed with 500 ml of 5% glucose saline, 60 mg of pamidronate was intravenously administered daily for 3 consecutive days to make total dose of 180 mg. Clinical scores of the pain and swelling and the circumference of the middle finger were measured just before, 1 and 2 weeks after the injections. Three phase bone scintigraphy and bone densitometry (BMD) were performed before and 2 weeks after pamidronate injections. Results: Clinical scores of the pain and swelling and the circumference of the middle finger improved significantly after pamidronate injections. The ratio of radioisotope uptake decreased in both blood pool and delayed phase images. BMD of ultradistal radius of the involved arm significantly increased after pamidronate injections. Eleven subjects developed fever or myalgia. Two subjects could not complete the injections due to severe allergic skin reaction. Conclusion: The intravenous pamidronate injection could be an effective therapeutic tool for post-stroke RSD. (J Korean Acad Rehab Med 2008; 32: 651-656)

Objective: To identify the etiology of hemiplegic shoulder pain by magnetic resonance (MR) arthrography. Method: The study included seventy-four hemiplegic patients with shoulder pain. After several physical examinations, all patients had fluoroscopically guided injection by a physiatrist with a maximum of 12∼15 ml of contrast agent. Then T1-weighted, T2-weighted and fat-suppressed T1-weighted images were taken at the oblique coronal plane. In addition, fat-suppressed T1-weighted images were obtained at the oblique sagittal and oblique coronal plane. Results: Except for the 9 patients who did not finish the study, the mean age of the participants was 61.5±8.9 years and mean duration of the cerebrovascular accident (CVA) was 15.7±9.7 weeks. The findings were as follows: 40% supraspinatus tendinitis, 30.8% superior labrum anterior to posterior (SLAP) lesion, 29.2% adhesive capsulitis, 24.6% supraspinatus partial tear, 23.1% biceps tendinitis, 13.8% supraspinatus full thickness tear, 7.7% infraspinatus partial tear. The SLAP lesion had significant statistic relationship with biceps tendinitis (p＜0.05) but not with rotator cuff lesion. Conclusion: We found that causes of hemiplegic shoulder pain were various. The prevalence of the SLAP lesion was high (30.8%). We recommend the MR arthrography when the hemiplegic shoulder pain does not improve by conventional therapy or the cause of the pain is uncertain. (J Korean Acad Rehab Med 2008; 32: 657-663)

Objective: To consider the utility of non-invasive positive pressure ventilation (NIPPV) support during percutaneous gastrostomy procedure in amyotrophic lateral sclerosis (ALS) patients with severe respiratory insufficiency and weight loss. Method: Percutaneous gastrostomy was performed in 25 ALS patients with forced vital capacity (FVC) below 50% of predicted normal value. NIPPV was applied to all these patients during the procedure. To estimate the utility of NIPPV application during gasrtostomy tube placement, safety and procedure related complications were investigated. Results: Percutaneous endoscopic gastrostomy (PEG) was performed successfully in 21/25 patients (84%). Percutaneous radiologic gastrostomy (PRG) was performed to the rest. FVC_P (predicted value of FVC) in seated position were 1,239.1 ml (32.1%) in PEG-successful group and 1,065.0 ml (26.8%) in PEG-failed group, respectively. All the patients tolerated the use of NIPPV successfully and there were no respiratory complications with the procedure. There were no major complications and procedure-related mortality in all the patients. Conclusion: NIPPV support during percutaneous gastrostomy tube placement could make the procedure possible in ALS patients with very low vital capacities. (J Korean Acad Rehab Med 2008; 32: 664-667)

Objective: To evaluate the usefulness of ultrasonographic (US) examination in patients with knee osteoarthritis (OA) and determine US findings associated with pain and functional status. Method: 45 patients with primary knee OA classified by the American College of Rheumatology (ACR) criteria were recruited. The severity of pain and functional status were measured by Lequesne index and Western Ontario and McMaster Universities Osteoarthritis Scores (WOMAC). All patients underwent US examination of their knees and plain radiography for Kellgren and Lawrence (KL) grade. Results: Even in mild OA cases (KL G1, 2), patients had evidence of distended suprapatellar pouch (effusion) (32%), synovial thickening (12%), cartilage degeneration (32%) and medial capsular distension (72%). The severity of pain and functional status were found to be correlated with following US findings: amount of suprapatellar effusion (Ճ=0.514, p＜0.01), degree of synovial thickness (Ճ=0.520, p＜0.01), cartilage degeneration grade (Ճ=0.594, p＜0.01), length of medial capsular distension (Ճ=0.426, p＜0.01). However, the length of medial and lateral osteophytes, size of Baker's cyst, and clinical parameter such as age, disease duration and BMI score were not correlated with the severity of pain and functional status in OA patients. Following multiple regression analysis, the amount of effusion, synovial thickness and length of medial capsular distension were correlated with Lequesne and WOMAC functional status score (Ճ²=0.635, p＜0.05). Conclusion: Ultrasonographic assessment was useful for diagnosing knee OA. The severity of pain and function were highly associated with the amount of suprapatellar effusion, degree of synovial thickness, the length of medial capsular distension and grade of cartilage degeneration. (J Korean Acad Rehab Med 2008; 32: 668-681)

Objective: To evaluate the quality of life and psychologic status in parents of children with cerebral palsy (CP). Method: We studied 94 parents of children with cerebral palsy (case) and 60 parents of normal children (control). The functional level of CP was determined based on the gross motor functional classification system (GMFCS), and type of CP was classified by clinical features. We collected the data through questionnaires obtained from the parents, which consisted of Short Form Health Survey-36 (SF-36), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Family APGAR score. The data were statistically analyzed. Results: The mean scores of SF-36 in parents of CP children was significantly lower than controls (60.09＜67.38, p＜ 0.001). BDI (p＜0.001) and BAI (p=0.002) scores of parents of CP children were significantly higher than control group, and familial APGAR score was lowered in the CP group compared to the control group. There were no differences in the scores of SF-36 in parents according to the severity of CP (p=0.844). Conclusion: The quality of life of parents of children with CP was significantly lower than that of control parents. Also psychologic status and familial function were poorer in parents of CP. It is necessary to evaluate and support for parent's psychologic status and quality of life in the comprehensive rehabilitation of CP. (J Korean Acad Rehab Med 2008; 32: 682-688)

Objective: To find out whether the footprint test was significant as a screening test in hallux valgus (HV) patients. Method: The standing AP radiography and the static footprint were performed on 26 general patients, 52 feet total, ranging in age from 15∼70 years. As markers of the footprint test, the angles that we want to measure were designated as H and H' angles. Results: The HV angle on plain radiography correlated significantly to the H angle of the footprint test (r=0.75), and presented as HV angle=1.012H＋2.723. The HV angle on plain radiography inversely correlated significantly to the H' angle (r=−0.56) and presented as HV angle=−0.731H' ＋90.953. Conclusion: The footprint test could be used as a screening test for hallux valgus prior to plain radiography. HV angle in standing AP radiograph could be predicted by measuring the H and H' angle on the static footprint. Supplement studies on variable factors such as age, gender, etc. are required for further study. (J Korean Acad Rehab Med 2008; 32: 689-692)

Objective: To investigate the frequency of tarsal tunnel syndrome (TTS) in the diabetic neuropathy patients. Method: Electrodiagnostic study was performed to diagnose diabetic neuropathy and tarsal tunnel syndrome (TTS) in 56 patients (male 25, female 31) with diabetes mellitus. The frequency of combined TTS in diabetic neuropathy patients was calculated. Results: Out of 56 diabetic patients, 52 patients were diagnosed as diabetic peripheral neuropathy. The frequency of concomitant TTS was 22 cases in 52 diabetic patients with diabetic neuropathy. Conclusion: In diabetic neuropathy group, the frequency of TTS was higher than general population. (J Korean Acad Rehab Med 2008; 32: 693-697)

Objective: To examine pressure pain threshold (PPT) on several skeletal muscles in upper extremity, trunk, and lower extremity by using electronic pressure algometer and to evaluate it's interrater reliability, reproducibility, difference between gender and dominance, correlation with body mass index, and comparison among each muscles. Method: Forty healthy adults (male 27, female 13) were examined by two raters and reexamined in the same order after a rest of 10 minute. PPT at the splenius capitis, upper trapezius, infraspinatus, lumbar paraspinal muscle, extensor carpi radialis, vastus medialis, and gluteus medius muscles of both side was measured by medical electronic algometer. Rate of force application was approximately 2 lb/sec. Body mass index (BMI) was estimated from the individual's body weight by the square of their height. Results: There were no statistical differences of PPTs at all muscles between two raters, between two test with time interval, and between dominant and nondominant side, respectively. PPT in man was higher than female at all muscles. There was significant correlation between BMI and PPT at lumbar paraspinal muscle, vastus medialis, and gluteus medius only in male. PPT was highest at lumbar paraspinal muscle and lowest at splenius capitis. Conclusion: Electronic pressure algometer is a reliable tool for evaluation of PPT which has high interrater reliability and high reproducibility and is not affected by dominance and location of muscles. Therefore, it is a useful clinical tool to compare PPT before and after treatment and to study the mechanism of musculoskeletal pain research program. (J Korean Acad Rehab Med 2008; 32: 698-702)

Objective: To establish reference values for the femoral condylar cartilage thickness and to observe the cartilage clarity and sharpness between different age groups of healthy Koreans employing a ultrasonographic scanner. Method: 105 healthy volunteers from the ages of twenties to the fifties, without clinical signs of osteoarthritis were recruited for the study. Cartilage thickness at both intercondylar notch, medial condylar and lateral condylar area were obtained with 12 MHz linear transducer, in supine position under maximum flexion of the knee joints. Cartilage sharpness and clarity were also recorded in grade between 0 to 3. Results: The thickness of cartilage significantly decreased with the increment of age (p＜0.05) and the cartilage of the man was much thicker than woman (p=0.000). Grade of the sharpness and clarity was not different between age groups and the checked grade was mostly grade 1 and there was no grade 3. Conclusion: This study defines standard reference values of femoral condylar cartilage for musculoskeletal ultrasonography to prevent misinterpretation of thinning of cartilage thickness in difference age groups and sex. With these findings, we can specify the range of normal degenerative change of femoral condylar cartilage. (J Korean Acad Rehab Med 2008; 32: 703-710)

Objective: To investigate the mean values and correlations between the rotational profiles of bilateral lower extremities in Korean elderly men. Method: 100 lower extremities were examined for the rotational profiles of bilateral lower extremities with radiographic examination. Results: The mean values of femoral anteversion, axial rotation of the knee joint, proximal and distal tibial torsion, bimalleolar axis (BMA), and Q angle were 8.72°, 0.19°, 34.53°, 26.25°, 20.97°, 5.65°. In Korean elderly men, the result of tibial torsion and Q angle was smaller than the results of other studies, and the bilateral differences were detected in the measured profiles of lower extremities, except axial rotation of the knee joint. However, all profiles represented a positive correlation between right and left lower extremities. The correlation between proximal tibial torsion and BMA had a positive correlation, But the femoral anteversion and tibial torsion had no correlations among the profiles in Korean elderly men. Conclusion: We suspected that Korean elderly healthy men have reduced tibial torsion and more genu varus alignment, and the rotational profiles of lower extremities showed side to side difference, but there were symmetrical tendency. It will be helpful in assessing the evaluation, treating, researching of the musculoskeletal problem in Korean elderly people. (J Korean Acad Rehab Med 2008; 32: 711-718)

Objective: To determine the effects of isometric hip adduction and abduction on the activity of vastus medialis obliquus (VMO) and vastus lateralis (VL) during semisquat and squat exercise. Method: Thirty healthy male subjects without history of knee pain were recruited. Subjects performed a traditional exercise combined with hip adduction and abduction during semisquat and squat exercise. A total of 3 repetitions lasting 6 seconds each were executed following two-minute intervals. The EMG signals were collected from VMO and VL of the dominant leg. The data were normalized to the maximal isometric voluntary contraction of VMO and VL at 90° of knee flexion using isokinetic dynamometer and analysed in terms of their RMS values. Results: The activity of both VMO and VL was significantly greater during both semisquat and squat exercise with hip adduction and abduction than without hip adduction and abduction. The VMO/VL ratio was significantly greater. The squat exercise produced significantly greater VMO and VL activity than the semisquat exercise, regardless of hip position. However, there were no significant differences in VMO/VL ratio between semisquat and squat exercise. Conclusion: Combining isometric hip adduction using theraband during semisquat exercise produced higher VMO/ VL ratio through more selective VMO activation and could be easy and effective rehabilitation program in patellofemoral pain syndrome. (J Korean Acad Rehab Med 2008; 32: 719-725)

Incidence of cardiac tumor is low among all tumors, but cardiac myxoma is a frequent benign tumor of the heart. Though cardiac myxoma has the classic triad (obstructive cardiac signs, embolism and constitutional manifestations), cardiac investigations may not be performed until the presence of cerebral embolism or cardiac problems, as in the case reported here. It is the reason that constitutional symptoms like myalgia, muscle weakness, arthralgia, fever and weight loss may be overlooked in the absence of any history of cardiac problems or may be confused as other specific immunological diseases. We present a case of a 26-year-old woman whose clinical manifestations of left atrial myxoma were multiple arthralgia, fever caused by constitutional symptoms, hemiplegia and aphasia caused by embolic cerebral infarction. (J Korean Acad Rehab Med 2008; 32: 726-729)

Spinal subdural hematoma (SDH) is a rare cause of acute spinal cord compression. In most cases, these lesions are observed in association with lumbar puncture or spinal anesthesia, coagulation defect, or an underlying vascular malformation. The use of anticoagulant drug is recommended in managing deep vein thrombosis, acute myocardiac infarct, or acute cerebral infarct. But the risk of bleeding in major organs still exists and is increased by the use of multiple anticoagulants and the intensity of anticoagulation. The risk of spinal hematoma is increased in anticoagulated patients who undergo lumbar puncture or spinal anesthesia. But to dates, there are extremely rare cases of spontaneous spinal SDH occurring in patients with anticoagulant therapy when spinal instrumentation is not also being used. With reviewing some of literatures, we present a case of acute spontaneous spinal SDH developed whilereceiving anticoagulant therapy for treating acute cerebral infarct. (J Korean Acad Rehab Med 2008; 32: 730-733)

The prevalence of self-mutilation behavior after spinal cord injury is not known. However, self-biting of fingers after spinal cord injury is a rare phenomenon. We report a case of 51-year-old man self-biting of fingers, resulting in multiple finger amputation following C5 complete spinal cord injury. We believe this to be the first Korean report of multiple finger amputation due to self-biting following spinal cord injury. The mutilative self-biting was related to depression and central pain of upper extremity. After operation for tendon transfer of brachioradialis to extensor carpi radialis brevis, his feeding skills and driving skills on electric-powered wheelchair had been improved, and then, his self-biting of fingers had been diminished. The patient has been temperate in self-biting behavior after administration of gabapentin. In our case, functional improvement of upper extremity by functional surgery and central pain relief by gabapentin provided attenuation of mutilative self-biting behavior. (J Korean Acad Rehab Med 2008; 32: 734-736)