Objective
To investigate the changes of motor and soma-tosensory evoked potentials found in focal cerebral cortical ischemia induced by endothelin-1 (ET-1), one of the common models of cerebral infarct in rats. Method: A total of twenty Sprague-Dawley rats were studied. Focal cerebral cortical ischemia was induced by steterotaxic injection of ET-1 into forelimb region of cerebral cortex. Pellet retrieval test, motor evoked potential (MEP), and somatosensory evoked potential (SEP) were compared before and after cerebral ischemia. The location and extent of cerebral ischemia were confirmed histologi-cally. Results: Success rate of pellet retrieval test decreased significantly after induction of cerebral ischemia, demon-strating sensorimotor deficit in the contralateral forelimb. The latency and amplitude of MEP did not changed significantly despite weakness of forelimb. However, SEP showed reversal of the positive peaks. Conclusion: The results suggest that the changes of MEP and SEP in focal cerebral cortical ischemia are different from those in cerebral ischemia by large artery occlusion. When evaluating MEP and SEP in focal cerebral ischemia model, interpretation of evoked potentials should be cautious. (J Korean Acad Rehab Med 2009; 33: 147-153)

Objective
To evaluate the characteristics of the motor evoked potentials (MEPs) and the cortical topography of swallowing muscles in healthy subjects. Method: Fourteen healthy subjects were enrolled. Their mean age was 31 years. Transcranial magnetic stimulation was applied to left and right motor cortices in turn and contralateral electromyographic recordings were done from orbicularis oris, masseter, submental and infrahyoid muscles during resting. The scalp sites of maximal response and the lowest stimulus output which elicited motor evoked potential (MEP) of these muscles were recorded. The onset latency and peak-to-peak amplitude of MEP were measured for each muscle. Results: Most of the maximal MEPs of swallowing muscles were evoked within 9~17 cm lateral and 1~5 cm anterior from Cz and they showed interhemispheric symmetry. In submental and infrahyoid muscles, the threshold of right cortical excitability was significantly lower than that of left cortical excitability. The latency of the left submental MEP was statistically shorter than that of right submental MEP. Conclusion: These results demonstrated that the cortical representation of swallowing muscles displays interhemis-pheric symmetry. In addition, we suggest that submental and infrahyoid muscles have right cortical dominant tendency. (J Korean Acad Rehab Med 2009; 33: 154-158)

Objective
To evaluate the effects of transcutaneous elec-trical nerve stimulation (TENS) applied at lower extre-mity for standing balance in patients with hemiplegia. Method: Twenty-two hemiplegic patients were tested while standing on balance trainer under eight stimulation modes (No TENS, bilateral TENS, hemiplegic TENS, and una-ffected TENS. These four conditions were applied both with and without vision). All patients were able to stand inde-pendently more than five minutes. TENS was applied with pulse width 200µs, frequency of 100 Hz, amplitude set at the sensory detection threshold of each patients. TENS was applied thirty seconds for each stimulation modes, and res-ting period was 10 minutes. Postural sway was determined during the testing period by the sum of anterior-posterior (AP) center of pressure (COP) sway, medio-lateral (ML) COP sway, and total sum of COP sway. Also postural sway was determined by proportion of time of COP in three circles, which semidiameters are 10 mm, 20 mm, 30 mm each. Results: When patients were applied with TENS eyes closed at the unaffected lower extremity, AP, ML, and total sum of COP sway decreased significantly. Conclusion: In hemiplegic patients with independent standing, TENS application at the unaffected leg over five minutes can be helpful standing balance enhancement. (J Korean Acad Rehab Med 2009; 33: 159-164)

Objective
To measure the foot force and contact area distribution between the paretic and nonparetic sides during static and dynamic weight-bearing states, and to determine their relationship with BMD (bone mineral density). Method: Sixteen stroke patients (mean age=63.5±7.46 years) were included and BMDs of bilateral femurs were evaluated. Foot force and total foot contact areas were measured using the F-scan insole system. All values were expressed in ratio of paretic versus nonparetic sides. Results: The paretic side showed significantly smaller values in BMD, foot force and total contact area than the nonparetic sides (p<0.05). Femoral BMD ratio correlated significantly with dynamic weight bearing force ratio (r=0.58, p<0.05) and time elapsed since stroke as well (r=-0.17, p<0.05), while it did not correlate with either static weight-bearing force ratio (r=0.25, p>0.05), or total contact area ratio during both dynamic and static weight-bearing state (r=0.23, r=0.12, p>0.05). Multiple regression analysis showed that dynamic weight-bearing force ratio and time elapsed since stroke were independently related to BMD ratio (t=3.25, p<0.001 and t=-4.89, p<0.001). Conclusion: The present study showed that foot force differences in the dynamic weight- bearing state significantly correlated to post-stroke BMD while foot contact area in both the static and dynamic weight-bearing state did not correlate to post-stroke BMD. (J Korean Acad Rehab Med 2009; 33: 165-171)

Objective
To find the characteristics of stroke in colorectal cancer patients. Method: We retrospectively analyzed 32 patients of stroke in colorectal cancer who were operated from January 2001 to December 2002 by reviewing their charts and brain CTs or MRIs. The type, risk factor, localization and origin of stroke and the stage of colorectal cancer were analyzed. Results: The mean age was 69.2 years. TNM stage II (41%) was the most common. Twenty-three cases were ischemic stroke, four were hemorrhagic stroke and the others were unidentified. Diabetes (63%), hypertension (53%), cardiac disease (19%), and family history of stroke (9%) were ob-served in patients. The main cause of ischemic stroke was arterial thrombosis, and lacunar and middle cerebral infarc-tion were more common in ischemic stroke. Conclusion: Several common risk factors between colorectal cancer and stroke were observed, and these risk factors are associated with the atherosclerosis of cerebral vascular system. To reduce the incidence of cerebrovascular disease and colorectal cancer, we may need to control those risk factors. (J Korean Acad Rehab Med 2009; 33: 172-176)

Objective
To investigate a characteristics of short physical performance battery (SPPB) in some Korean rural commu-nity and to obtain a preliminary data of SPPB in Korea. Method: A total of 488 persons aged 22 to 82 with no disability, interviewed and administered a SPPB and a balance test using Mediance. Subjects were divided into 3 groups with high (less than 6 points), medium (7 to 9 points) and low (10 to 12 points) risk groups according to SPPB score. Lower extremity performance was measured using SPPB including assessment of standing balance, a timed 4-m walk, and timed test of rising 5 times from a chair. Chronic condition were ascertained as self-report of past disease history. The relationship between general cha-racteristics of subjects, self-report of past history of disease, limb load asymmetry, postural sway and SPPB score were statistically analyzed. Results: In a multivariate analysis, older age, lower educa-tional background and high body fat mass were associated independently with poor performance. In a multivaria-teanalysis of subjects aged 60 or older, older age, lower educational background and history of hypertension were associated independently with poor performance. Conclusion: These findings should be considered in planning specially tailored intervention for disability prevention in this subgroups. And this study provides the preliminary evidence that a SPPB is a useful tool in evaluating Korean elderly who are not disabled but have poor lower extremity performance. (J Korean Acad Rehab Med 2009; 33: 177-185)

Objective
To find out whether electrical stimulation affects intracellular signaling mechanisms that link the biochemical and mechanical events of smooth muscle contraction. Method: A total of 31 adult Sprague-Dawley female rats were divided into 3 groups: control group, spinal cord injury (SCI) only group, and spinal cord injury with elec-trical stimulation (SCI+ES) group. Complete spinal cord transec-tion was performed surgically at T10 cord level. The electrode for electrical stimulation was implanted into sacral spinal cord region (S2-4). Electrical stimulation was applied 4 hours per day from the day of operation. Results: In SCI+ES group, the weights of fecal pellet were significantly higher from the 3rd day of post-operation to the 6th day than the SCI only group. The numbers of pERK 1/2 immunoreactive cells significantly increased in all colon segments of the SCI+ES group but had decreased in the SCI only group. Western blot showed the stronger bands of phosphorylated ERK1/2 in all colon segments and also phosphorylated caldesmon in mid or distal colon segments in the SCI+ES group. Conclusion: These results suggest that electrical stimulation to sacral plexus region activate phosphorylation of ERK1/2 and caldesmon which leads to improvement of bowel fun-ction by promotion of secretion or motility in the colon. (J Korean Acad Rehab Med 2009; 33: 186-193)

Objective
To quantify activities of bulbocavernosus reflex (BCR) using root mean square (RMS) value of motor unit action potentials in power spectrum analysis. Method: Twenty-six male patients with spinal cord injury were studied. The BCRs were evaluated by one examiner. The patients were assigned into absent, hypoactive and normal reflex groups according to the degree of BCR acti-vity. The electrophysiological activities of the BCRs were evaluated by the RMS value of the motor unit action poten-tials in power spectrum analysis recorded from the bulbo-cavernosus muscle using concentric needle electrode. Results: The BCR by clinical examination was absent in 6 patients, hypoactive in 10 patients and normal in 10 patients. RMS values of absent, hypoactive and normal BCR groups were 15.1±3.6 uV, 26.7±13.2 uV and 36.3±4.8 uV, respec-tively. RMS values of three groups were significant different (p=0.028) and showed significant correlation (r=0.714, p= 0.005). Conclusion: There was strong correlation between RMS value of motor unit action potentials of bulbocavernosus muscle and degree of BCR activities estimated by clinical examination in patients with spinal cord injury. (J Korean Acad Rehab Med 2009; 33: 194-197)

Objective
To compare the therapeutic effects between ra-diofrequency thermocoagulation and phenol motor branch block in treatment of spasticity of child with cerebral palsy. Method: Thirteen patients with spastic cerebral palsy were randomly divided into two groups. One group received percutaneous selective radiofrequency thermocoagulation on tibial nerve motor branch and the other group received phenol motor branch block to the gastrocnemius muscle. Therapeutic effects were assessed before and after treatment for 6 months in each group. The severity of ankle spasticity was assessed with the modified Ashworth scale (MAS), the modified Tardieu scale (MTS), and the passive range of motion (PROM) of ankle joint. Results: In both groups, the MAS and MTS decreased, and radiofrequency thermocoagulation group showed more signi-ficant reduction of the spasticity (p<0.05). There was a significant increase in PROM on knee flexion and extension in a radiofrequency thermocoagulation group (p<0.05). Conclusion: Percutaneous selective radiofrequency thermo-coagulation could be a treatment option for relieving the localized spasticity of ankle in spastic cerebral palsy with little adverse effect. (J Korean Acad Rehab Med 2009; 33: 198-204)

Objective
To evaluate the capsular stiffness of the gleno-humeral joint by measuring the slope of pressure- volume curves generated during intra-articular hydraulic distension (IHD) and analyze its correlation with clinical variables and outcomes in terms of limitation of range of motion (LOM) and severity of pain. Method: IHD with real-time intra-articular pressure mo-nitoring was performed for 53 patients with adhesive capsulitis and the capsular stiffness was measured from pressure-volume curves by calculating the slope of elastic deformation region. LOM, measured by LOM score and sum of ROMs (range of motion), and degree of pain, measured by visual analog scale (VAS), were evaluated before and after IHD: three days (3D) and one month (1M) after IHD. Results: In patients with stiffer capsules, LOM and pain were severe before IHD (Pearson's correlation coefficient (r)= 0.291, -0.348, 0.381 and p=0.065, 0.026, 0.014 for LOM score, sum of ROMs and VAS, respectively. By this order, henceforth). On 3D follow up, the correlation between the stiffness and LOM or pain was maintained (r=0.291, -0.348, 0.381 and p=0.065, 0.026, 0.014). The improvement of LOM score on 3D follow up was less as the capsules were stiffer (r=-0.368, p=0.023). On 1M follow up, LOM remained severer in stiffer capsules whereas pain did not (r=0.372, -0.402, 0.183 and p=0.039, 0.025, 0.342). Conclusion: The stiffness of the glenohumeral joint capsule, measured from the slope of pressure-volume curves during IHD, showed significant correlation with the severity of LOM and pain in patients with adhesive capsulitis of shoulder. (J Korean Acad Rehab Med 2009; 33: 205-214)

Objective
To assess the accuracy and confidence of the glenohumeral joint injection using an anterior approach in cadavers. Method: Eight shoulders from six cadavers were placed supine with arm abduction and external rotation. A single physiatrist performed all the ultrasonography guided injection using an anterior approach. A twenty-one gauge needle was placed into shoulder and intraarticular position was verified by small injection of blue dye. And then the anatomic dis-section was done. Results: Seven out of eight (87.5%) were judged to be accu-rately placed by the anatomic section. In one case, the needle tip was placed in supraglenoid space. In one of the seven accurate cases, the needle traversed the long head tendon of biceps muscle. Confidence of the injections was 87.5%. Conclusion: Ultrasonography guided glenohumeral injection using an anterior approach was efficient and safe. (J Korean Acad Rehab Med 2009; 33: 215-218)

Objective
To compare ultrasonography guided versus blind approach in a randomized trial examining the efficacy of suprascapular nerve block in patients with non-specific shoulder pain. Method: A total of 20 patients with shoulder pain lasting for more than 1 month were included in this study. After 1:1 randomization, patients were included either in the blind group (n=10) or in the ultrasonography guided group (n=10) of suprascapular nerve block. All patients were evaluated before and after treatment, in terms of shoulder pain and disability index (SPADI) and nerve conduction study. Results: Significant improvements were seen in all pain scores and disability after both types of nerve block, with no significant difference in the improvement of pain and disability between the two approaches. However, amplitude changes of nerve conduction study were larger in ultrasono-graphy guided approach than blind approach. Conclusion: This study suggests ultrasonography guided approach of suprascapular nerve block could place the needle closer to the nerve compared to blind approach. (J Korean Acad Rehab Med 2009; 33: 219-224)

Objective
To investigate symptom prevalence, risk factor, and relationship between job stress and health-related quality of life in visual display terminal (VDT) workers with low back pain. Method: 5,005 people aged from 28 to 59 without neck or upper extremity pain, were enrolled and their general characteristics, working period, personal history like smoking, drinking, type of leisure and average housework time were collected via a questionnaire survey. The job stress and the health-related quality of life were measured by using the Korean Occupational Stress Scale (KOSS) and the Korean Short Form Health Survey-36 (KSF-36) respectively. The relationship between general characteristics, working period, personal history, KOSS score, and KSF-36 score were statistically analyzed. Results: The average age of questionnaire respondents was 43.4 years old. Twenty-seven and ninety-one (2,791) VDT workers responded to have experienced low back pain in past 1 year. The symptom prevalence was 58.2%. The KOSS score of all VDT workers was higher than reference range. There were moderate negative correlations between KOSS score and subscale score of KSF-36 like vitality, mental health, and mental component summary in all groups. In a multivariate analysis of all subjects, younger age, female, type of leisure except sports activity, and feeling of body loading were independently associated with low back pain of VDT workers. Conclusion: This study provides the basic data about the relationship between job stress and health-related quality of life of VDT workers as well as risk factors of low back pain in VDT workers. (J Korean Acad Rehab Med 2009; 33: 225-236)

Objective
To evaluate the validity of Sharp-Purser test in the assessment of anterior atlantoaxial subluxation in rheu-matoid arthritis patients. Method: We assessed the validity of the Sharp-Purser test in 38 rheumatoid arthritis patients who were subjected to stabilization surgery. All patients were evaluated using manual laxity test and re-evaluated radiologically. Results: In 31 out of 38 patients (81.6%) Sharp-Purser test was positive in spite of anterior displacement of C1 over C2 on radiograms, while the tests were negative in 7. Among those 7 patients with negative test, 4 (10.5%) were acute cases and 3 (7.9%) were chronic cases with high grade hypomobile slip. Among the 31 patients with positive Sharp-Purser test, ADI (atlantodental interval) was 4 mm in 4 patients, 5 mm in 9, and greater than 5 mm in 18 patients. Among the 7 patients with negative Sharp-Purser test, ADI was 4 mm in 4 patients and greater than 5 mm in 3 patients. Conclusion: Our results show that the Sharp-Purser test is a useful clinical examination to diagnose atlantoaxial insta-bility. (J Korean Acad Rehab Med 2009; 33: 237-241)

Thalamic infarction is frequently bilateral due to the nature of the vascular supply to the thalamic region, and is usually caused by cardiogenic embolism or emboli originating from the proximal basilar or vertebral artery. But there have been no reported case of bilateral thalamic ischemic injury. A 25-year old man was in coma after committing suicide, hanging his neck. MRI showed bilateral pulvinar ischemic injury. He showed disturbance in recent memory, cal-cula-tion, and had bilateral hemianopsia, transcortical motor ap-hasia, intentional tremor, proprioceptive sensory dysfunction. He was treated with progressive physical therapy for ambulation, repeated stimuli with TENS for proprioception, given donepezil 5 mg and cognitive training for improve-ment of cognition. After discharge, he was able to walk independently at outdoors, and could do all activities of daily living by himself. All motor and sensory functions of upper and lower extremities were recovered except tremor and dynamic standing balance dysfunction. (J Korean Acad Rehab Med 2009; 33: 242-245)

Hypoglossal nerve injury is an uncommon complication following endotracheal intubation. A transoral procedure in-cluding endotracheal intubation may result in hypoglossal nerve compression at the lateral margin on the hyoid bone and inner mandibular margin at the tongue base. A 50-year- old patient undergoing rotator cuff repair developed a tran-sient unilateral postoperative hypoglossal nerve injury follo-w-ing uncomplicated endotracheal intubation for general ane-s-thesia. The following day the patient complained of diffi-culty with tongue movement and buccal manipulation of food, and had slurred speech. An electrophysiologic assess-ment confirmed a diagnosis of unilateral hypoglossal nerve palsy. The symptoms resolved spontaneously and completely by 6 weeks. The possible etiology of the injury is discussed, and related literatures are reviewed. (J Korean Acad Rehab Med 2009; 33: 246-248)

Atopic myelitis is defined as myelitis of unknown cause with either hyperIgEaemia and mite antigen-specific IgE positivity or coexistent atopic diseases such as atopic der-matitis, allergic rhinitis, and bronchial asthma. Atopic mye-litis was shown to preferentially affect young males and the cervical spinal cord. We report a rare case of atopic myelitis which occurred in a child. A 13-year-old male had typical history of atopic dermatitis. He developed paresthesia and numbness of both upper extremities with the upper limb muscle weakness. The magnetic resonance imaging scans showed localized inflammation in the cervical cord. The cerebrospinal fluid findings were normal and oligoclonal immunoglobulin G bands were absent. Treatment with intra-venous methylprednisolone obtained clinical improvement. The location of the lesion in the cervical cord on the magnetic resonance imaging and the past history of atopic dermatitis should be suggestive of atopic myelitis. (J Korean Acad Rehab Med 2009; 33: 249-251)

Dysphagia can be caused by various mechanisms such as impaired tongue movement, delayed swallowing reflex, decreased pharyngeal peristalsis, incomplete closure of epi-glottis and cricopharyngeal dysfunction. Cricopharyngeal muscle, forming the upper esophageal sphincter, acts as a muscular sling between the pharynx and the esophagus. Normally, it closes constantly at rest and opens during laryngeal elevation through active relaxation on the one hand and passive traction by the antero-cephalad laryngeal movement on the other. If its incoordination or hypertonicity happens, dysphagia can develop. Cricopharyngeal muscle dysfunction is caused by various situations such as neuro-muscular diseases, postoperative changes and stroke, parti-cularly after brainstem stroke. We report a case of isolated dysphagia caused by failure of active relaxation of crico-pharyngeal muscle without aspiration after left lateral me-dullary lacunar infarction. (J Korean Acad Rehab Med 2009; 33: 252-254)