Objective
To asses the prevalence of urinary difficulty and the relationship of urinary difficulty and type of brain lesion from multicenter prospective epidemiologic study. Method: 394 patients including outpatients and inpatients who visited from multicenter department of rehabilitation medicine from January 2008 to June 2008 were evaluated. Study based on international prostate symptom score (IPSS) and Quality of life (QoL) score were assessed, and the correlation between the two indexes was analyzed. Results: 140 patients (35.5%) complained urinary difficulty as patient's main symptom, while IPSS score was 13.7 showing above moderate symptom at 77.5%. For patients complained urinary difficulty, the average of quality of life score was 3.1. Among stroke, 37% of infarction and 34% of hemorrhage complained urinary difficulty while 40% of traumatic brain injury did. Patients with ACA infarction reported urinary difficulty most frequently. Nocturia (71%), frequency (53.3%), incomplete emptying (30%) were the most frequent symptoms. Sixty-six patients (46%) complaining urinary difficulty were taking medications and anticholinergics were most widely used (75%). Scores of IPSS and QoL according to type and site of brain lesion didn't show meaningful difference while QoL score correlated significantly with IPSS score (p＜0.05). Conclusion: Among all the brain lesion patients, 35.5% complained urinary difficulty while IPSS and QoL score according to type and site of brain lesion didn't show meaningful difference. Urinary difficulty affects the life quality of brain lesion patients. (J Korean Acad Rehab Med 2010; 34: 115-119)

Objective
To find out the changes of the family structure and familial total income of Korean patients with the brain disorders and associated factors. Method: A total of 1,903 patients with brain disorders in Korea were enrolled and drew up the questionnaires about their socioeconomic state and family supports, including pre- and post-disorder family structure, compositions of their family income, and employment of caregivers. Results: A 38.2% of subjects experienced the change in numbers of cohabiting family, decrement in 30.3% and increment in 7.9%. Prior to brain disorders, 48.6% of patients earned their living by themselves, but only 2.8% did after brain disorders. Separation and divorce increased, especially three times more in male patients than in females. A 16.6% of patients employed caregivers, and used them 6.2 days per week, 18 hours a day on average. Conclusion: This study reemphasized the worsening socioeconomic state of patients with brain disorders and their families. Increasing tendency of social isolation was also noted. (J Korean Acad Rehab Med 2010; 34: 120-127)

Objective
To investigate the characteristics and severity of swallowing difficulties among stroke patients with a tracheostomy tube, compared to those without. Method: A retrospective study was performed on two groups of 17 stroke patients with a tracheostomy tube (58.8 years) and without a tracheostomy tube (69.8 years) fed by Levine tube or a gastrostomy tube. There were no differences in the FIM (functional independence measure) score and brain lesions between the two groups. We evaluated the functional dysphagia scale (FDS) and aspiration; classified before, during, and after swallowing aspiration and silent aspiration. The swallowing task consisted of 2 ml of fluid and a videofluoroscopic swallowing study. Results: There were no significant differences between the oral preparatory, oral and pharyngeal phase for the two groups in FDS. However, frequency of silent aspiration (p=0.007) and the total frequency of aspiration (p=0.038) were significantly higher in patients with tracheostomy. Conclusion: Patients with stroke who underwent tracheostomy showed no meaningful difference in FDS. However, there were significant differences in terms of silent aspiration and the total frequency of aspiration; caused by laryngopharyngeal desensitization and the anterior tethering effect on the tracheostomy tube. We have to pay more attention to the treatment and care of patients with tracheostomy tubes. (J Korean Acad Rehab Med 2010; 34: 128-133)

Objective
To test the repeatability and the reproducibility of a newly developed device which measures tongue pressure and laryngeal movement, to identify the range of tongue pressure and to reveal the relationships between tongue pressure and age, gender and diet formula. Method: One hundred five healthy subjects (50 males, 55 females, range 20 to 74 years) were recruited for the study. They had examinations of tongue pressure and laryngeal movement. The pressure was measured with two air-filled bulbs connected to a transducer. Laryngeal movement was measured with a strain gauge. The test was repeated three times with a two minute rest interval and monitored twice by the same investigator and once by another investigator. All subjects performed 10 times of swallowing: 5 times each of 3 ml liquid and dry swallowing. Results: Intraclass correlation coefficient (ICC) for both the repeatability and the reproducibility revealed good to moderate reliability for tongue pressure measurement and the time of maximum tongue pressure (ICC, 0.60∼0.84). However, it was poor for measurement of laryngeal movement. There were no significant differences between gender and age groups in tongue pressure, the time to maximum tongue pressure and laryngeal movement. The tongue pressure was higher in dry swallowing than in wet swallowing. Also, the time to maximum tongue pressure and overall laryngeal movement were prolonged in dry swallowing. Conclusion: The newly developed tongue pressure measurement system is a reliable apparatus and there are no significant age and gender differences in tongue and laryngeal movement in healthy subjects. (J Korean Acad Rehab Med 2010; 34: 134-140)

Objective
To examine the reliability of upper extremity proprioceptive assessment test using virtual environment technique (VET) in patients with stroke with test-retest paradigm and define criterion for normal value by comparing with unimpaired control group. Method: Thirty stroke patients and 30 control groups were recruited. The VET apparatus is consisted of virtual reality upper extremity tester (VRUPT), encoder, and head-mounted display (HMD). VET-based test is composed of two tasks. Angle assessment task is required matching of imposed joint positions without visual feedback for checking angle error. Reaching assessment task is required matching of imposed cylinder with visual feedback for checking time, number of click, total interaction error. Results: In the test-retest analysis, correlation coefficients ranged from 0.73 to 0.99 (p＜0.01). Significant differences consistently found between affected upper extremity joint of stroke group and corresponding upper extremity joint of control group for the major variables (p＜0.05). The cut off value in shoulder, elbow, wrist joints were calculated as 8.24^o, 8.41^o, 10.31^o and the frequency of proprioceptive abnormalities based on these cut off value of angle error in shoulder, elbow, wrist joints showed 60%, 67%, 83% respectively, in our stroke group. Conclusion: This VET-based proprioceptive assessment test shows promise in assessing proprioception in patients with stroke more objectively and quantitatively. (J Korean Acad Rehab Med 2010; 34: 141-149)

Objective
To test the effectiveness of the METS (modified extension-type sling) in reducing subluxation in patients with hemiplegic shoulders, and to assess the functional support of METS as the angle of the elbow changes. Method: Sixteen flaccid hemiplegics were assessed by the anteroposterior shoulder radiographs. Three parameters, vertical distance (VD), horizontal distance (HD) and joint distance (JD), were measured on both affected and unaffected sides before and after the fitting of the METS and the Bobath sling. Three parameters were also measured in each elbow flexion angle (0^o, 30^o, 60^o, 90^o) after the fitting of the METS and extension-type sling with a forearm cuff to evaluate the effectiveness in the dynamic condition. Results: In the Bobath sling, the mean values of VD and JD reduced significantly (p＜0.05), but on the contrary, HD increased significantly (p＜0.05). In the METS, VD and JD reduced significantly (p＜0.05), and there were no changes in HD (p＞0.05). In the Bobath sling, VD, HD and JD were different from the unaffected side (p＜0.05), but in the METS, three parameters were not different from the unaffected side (p＞0.05). As the elbow flexion angle increased with the METS, three parameters were not different from the unaffected side (p＞0.05), but with the extension-type sling with a forearm cuff, VD and JD were different from the unaffected side (p＜0.05). Conclusion: The METS was more effective not only in the reduction of the hemiplegic shoulder subluxation, but also in the maintenance of reduction as the elbow flexion angle changes within various activities. (J Korean Acad Rehab Med 2010; 34: 150-157)

Objective
To find out how many causes constitute hemiplegic shoulder pain (HSP) and how they distribute in an individual patient. Method: Twenty-three consecutive patients with HSP which had newly developed within 3 months after stroke were enrolled from January 2008 till July, 2008. They all performed a passive range of motion test for adhesive capsulitis, modified Ashworth test for spasticity, simple x-ray for subluxation, ultrasonography for rotator cuff problems and three- phase bone scintigraphy for complex regional pain syndrome (CRPS). The causes of HSP were analyzed in number and distribution. Results: Average 2.26 causes constituted with HSP in an individual patient. Most common causes were adhesive capsulitis and CRPS (respectively 14 patients). Two patients had 4 and eight patients had 3 types of shoulder pathology. Conclusion: More than two types of shoulder pathology existed in a patient with HSP. These findings shoulde be carefully considered when treating the patients with HSP. (J Korean Acad Rehab Med 2010; 34: 158-162)

Objective
To investigate the effect of action related visual and auditory stimuli on the motor evoked potential (MEP) of hand. Method: Right handed fifteen healthy adults without neurological deficit were included. Visual lingual stimulation was given on the computer monitor with the sentence and auditory lingual stimulation was given 10 repetitions of the above sentence using computer speaker with eyes closed. MEPs from transcranial and transcervical magnetic stimulation were recorded on the abductor pollicis brevis of the right hand. Results: The latency of MEPs was shortened and the amplitude of MEPs with transcranial magnetic stimulation after lingual stimulation (p＜0.05). However, the latency and amplitude of with transcervical stimulation did not show significant changes. Conclusion: Cortical excitability was enhanced by action related visual or auditory stimuli. Exercise accompanied by visual or auditory lingual stimulation rather than simple exercise might be useful for facilitating cortical excitability. (J Korean Acad Rehab Med 2010; 34: 163-167)

Objective
To evaluate the effects of high frequency repetitive transcranial magnetic stimulation (rTMS) of the affected hemisphere on the motor recovery and spasticity in chronic post-stroke hemiplegic patients. Method: Thirteen chronic stroke hemiplegic patients were randomized to receive real and sham rTMS. rTMS was carried out 10 times at a frequency of 10 Hz with 10 s stimulation followed by 50 s rest, totalling 1,000 stimulations to the affected primary motor cortex using an intensity of 100% of resting motor threshold of unaffected hemisphere. Median nerve H-reflex, modified Ashworth scale (MAS) at elbow and wrist, and manual function test (MFT) were measured at baseline and after 2 weeks of treatment. Results: High frequency rTMS resulted in increased H- reflex latency and decreased H-reflex amplitude and H/M ratio. Also MAS decreased and MFT score increased after 2 weeks of treatment. Conclusion: High frequency rTMS in the affected motor cortex might facilitate motor recovery and reduce spasticity in chronic stroke patients. (J Korean Acad Rehab Med 2010; 34: 168-173)

Objective
To investigate the influence of depressive symptoms on cognitive and functional recovery in chronic stroke patients. Method: Seventy-four chronic stroke patients were included. They had inpatient rehabilitation program for 2 months. Depressive symptoms were evaluated with the Beck depression inventory (BDI), cognitive functions by the Korean mini-mental status examination (MMSE-K) and functional status by the modified Barthel index (MBI) before and after the rehabilitation. We investigated whether the improvement of depressive symptoms after rehabilitation had influenced the cognitive and functional recovery, by comparing the changes of MMSE-K and MBI in patients with depressive symptoms. Results: Before inpatient rehabilitation program, patients with depressive symptoms had low scores of MMSE-K and MBI compared to those without. While patients with depressive symptoms had significant improvement of MMSE- K after rehabilitation (p＜0.05), those without did not. Both groups with and without depressive symptoms had significant improvement of MBI after rehabilitation, but the changes of MBI were not different significantly. Among patients with depressive symptoms at admission, those who showed improved depression after rehabilitation had the significant improvement of MMSE-K after rehabilitation (p＜0.05), but those with sustained depressive symptoms did not. Conclusion: Post-stroke depressive symptoms may influence on cognitive function. However, post-stroke depressive symptoms did not have any effect on functional recovery. (J Korean Acad Rehab Med 2010; 34: 174-178)

Objective
To investigate the electrophysiological changes after botulinum toxin type A injection in children with cerebral palsy. Method: Sixteen children with spastic cerebral palsy enrolled in the study. Botulinum toxin type A (Dysport^Ⱂ) was injected into gastrocnemius muscles. Electrophysiological assessments included the compound motor action potential of the tibial nerve, the sensory nerve action potential of the sural nerve, the H-reflex and the T-reflex before injection, and at 2 weeks and 4 weeks after the injection. Modified Ashworth scale was used to evaluate spasticity before, 2 weeks and 4 weeks after the injection. Results: Modified Ashworth scale of the ankle decreased at 2 weeks and 4 weeks after injection. The amplitude of the H-reflex and H_max/M_max ratio decreased significantly at 4 weeks. The amplitude of the T-reflex decreased at 2 weeks and 4 weeks. The correlation between changes in modified Ashworth scale of the ankle and the changes in electrophysiological parameters at 4 weeks after injection were not significant. Conclusion: The change in T-reflex is faster than the change of H-reflex and H_max/M_max ratio after botulinum toxin A injection in children with cerebral palsy. Electrophysiological tests could quantify the change in spasticity after botulinum toxin injection. (J Korean Acad Rehab Med 2010; 34: 179-184)

Objective
To investigate the clinical usefulness of the transdermal scopolamine patch applied to control drooling of saliva in patients with cerebral palsy. Method: We enrolled twenty two patients with cerebral palsy residing in a rehabilitation center. The mean age of the patients was 24.0 years old. Transdermal scopolamine patch was applied to the patients for 2 weeks. We measured drooling quantity, severity of drooling, and visual analog scale of care givers' labor intensity at pre-application, post 1 week, and post 2 weeks. Results: Drooling quantity decreased significantly from 4.1 ±1.9 ml to 2.8±1.5 ml at post 1 week (p＜0.01), and 2.2±1.6 ml at post 2 weeks (p＜0.01). Severity of drooling decreased from 4.1±0.8 to 2.9±1.1 at post 2 weeks (p＜0.01). Visual analog scale of care givers' labor intensity decreased from 78.2±17.4 (mm) to 52.7±18.6 at post 1 week (p＜0.01), and 45.9±22.8 at post 2 weeks (p＜0.01). Conclusion: These findings suggested that the transdermal scopolamine patch is effective to reduce the drooling of saliva in patients with cerebral palsy within short term. (J Korean Acad Rehab Med 2010; 34: 185-188)

Objective
To evaluate characteristic gait patterns of transfemoral amputees who have been using polycentric knee for a long time. Method: Subjects were 22 transfemoral amputees using prosthesis for 29.0 years and 23 age-matched healthy adults. The three-dimensional gait analysis was performed. Temporospatial, kinematic and kinetic parameters were measured. Results: Cadence and walking velocity of amputees decreased (p＜0.05). Single support period decreased in amputee limb. There were no significant differences in hip flexion moment and power. In amputated limb, knee flexion in loading response was not observed and ankle plantar flexion was less than sound limb and control group. Excessive compensations of amputee side hip joint were not significant. Conclusion: Long term polycentric knee unit transfemoral prosthesis users show asymmetry of gait pattern which can increase the risk of musculoskeletal problems. Epidemiologic investigation would be necessary for prevention and proper management. (J Korean Acad Rehab Med 2010; 34: 189-196)

Objective
To investigate gender differences in pain patterns and psychological variables among patients with chronic musculoskeletal pain. Method: Thirty-five male and thirty-eight female patients who visited our outpatient clinic due to chronic musculoskeletal pain were evaluated using a questionnaire survey. Chronic musculoskeletal pain was defined as pain lasting longer than 6 months. Patients were evaluated with visual analogue scale (VAS), pain site, pain duration and frequency. Beck depression inventory, state-trait anxiety index, somatization scale of symptom checklist-revised, symptom interpretation questionnaire, and pain catastrophizing scale were checked for psychological variables. Correlations among each variable were evaluated statistically. Results: Female patients with chronic musculoskeletal pain recorded higher scores on number of pain site, pain catastrophizing scale, rumination, magnification and catastrophic attribution than male patients (p＜0.05). In female patients, VAS was correlated significantly with depression, static anxiety, somatization, catastrophizing thought. rumination, magnification, helpless, and catastrophic attribution. Pain frequency was correlated significantly with somatization, catastrophizing thought, rumination, and helpless. Number of pain site was correlated with somatization, catastrophizing thought, magnification, and helpless. The correlation between pain patterns and psychological variables was also observed in male patients, but statistically less significant than female patients. Conclusion: We found gender difference associated with pain patterns and psychological variables in chronic musculoskeletal pain patients. Consideration of psychological factors may be important for management in female patients with chronic musculoskeletal pain. (J Korean Acad Rehab Med 2010; 34: 197-203)

Objective
To determine the efficacy of transforaminal epidural steroid injections according to nerve root enhancement in lumbar disc herniations. Method: Twenty seven patients who had extruded or seques tered lumbar disc herniations on enhanced MR imaging were investigated: fifteen patients with corresponding nerve root enhancement (enhanced group), and twelve patients without enhancement (non-enhanced group). All patients received transforaminal epidural steroid injection. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry disability index (ODI) before treatment and one month after injection. Results: The averages of VAS for lower extremity and back pain in both groups one month after injection significantly reduced compared to that of pretreatment, respectively (p＜0.001). The amount of decrease in pain in enhanced group was larger than that of non-enhanced group (p＜0.05). The averages of ODI in both group one month after injection significantly reduced compared to that of pretreatment (p＜0.0001), however, there was no difference between the two groups. Conclusion: The nerve root enhancement on contrast-enhanced MR imaging indicates the presence of severe inflammatory reaction of nerve root, which means well-responsiveness to anti-inflammatory treatment such as transforaminal epidural steroid injection, even if patients' symptom is very severe. (J Korean Acad Rehab Med 2010; 34: 204-208)

Objective
To evaluate the accuracy and effect of ultrasonography guided subacromial subdeltoid (SASD) bursa injection on the shoulder pain and function compared to blind technique. Method: Twenty-eight patients diagnosed as SASD bursitis were administered with SASD injection of corticosteroids randomly by either blind or US guided technique and then assessed by ultrasonography to confirm the accuracy. Shoulder pain and function were evaluated by visual analog scale with Hawkin's impingement test, active range of motion (ROM) of the shoulder, University of California-Los Angeles (UCLA) shoulder rating scale before and 1 week after the injection. Results: The accuracy of SASD injection using blind technique was 42.8%, however, US-guided injection showed 100% accuracy, significantly higher than blind technique (p＜0.05). We could find significant improvement in pain with Hawkin's impingement test, active ROM of the shoulder, UCLA shoulder rating scale 1 week after injection in both groups. But there were no significant differences between the groups. In eight patients, failure was observed: four in the suprascapularis tendon, three in the deltoid muscle, and one in the subcutaneous tissue without side effects. Conclusion: Ultasonography guided injection into SASD bursa improved the accuracy of injection. However the injection method and the success of injection did not affect to the pain and shoulder function. (J Korean Acad Rehab Med 2010; 34: 209-213)

Objective
To determine the effects of mattresses and positioning on interface pressure (IP) and skin blood flow in young healthy persons. Method: Ten healthy subjects were included. Three types of mattresses including standard hospital mattress, alternating pressure pump and pad, and alternating pressure air mattress (APAM) and four positions including supine, 30 degree trunk elevation, 30 degree leg elevation, and right 90 degree lateral position were evaluated. IP over the buttock was measured with force sensing array (FSA) pressure mapping system for every subjects lying in four positions on each mattresses. Skin blood flow was measured with laser doppler flowmeter probes that placed over the sacrum and right greater trochanter. Results: IP was significantly lower on the APAM than on the other types of mattresses in all positions. In the right 90 degree lateral position, the IP was significantly higher on all mattresses than that in the other positions, and in the 30 degree leg elevation, the IP was significantly lower on standard hospital mattress and APAM than that in the supine position. There were significant differences in the skin blood flow over the greater trochanter between the APAM and the other types of mattresses, while there were no significant differences over the sacrum on all mattresses. Conclusion: APAM is likely to be the most effective as a preventive and treating measure for pressure ulcers. However, combined use of the APAMs with periodic position change might be necessary over the trochanter for effective pressure relief. (J Korean Acad Rehab Med 2010; 34: 214-219)

Objective
To compare effectiveness of corticosteroid injection, foot orthoses and oral anti-inflammatory medication for the management of the plantar fasciitis by sequential ultrasonographic follow-up. Method: Thirty-three patients with plantar fasciitis were assigned to one of 3 treatment groups. Twelve patients received steroid injection and ten were applied with custom- made foot orthoses and eleven received 4-week course of a non-steroidal anti-inflammatory medication. All patients of each group were instructed to perform self stretching exercise of the Achilles tendon and plantar fascia for the follow- up period. Ultrasonographic evaluation and clinical assessments were performed during 12 weeks; before treatment, every week during the first 8 weeks, and then every 2 weeks during the last 4 weeks. Results: On ultrasonographic examination, fascial thickness decreased significantly in all three groups (p＜0.05) but earlier and greater change was noticed in injection group (p＜0.05). Hypoechoic lesions were observed less commonly after treatment in injection and orthoses groups (p＜ 0.05). Pain was not significant different among three groups after two or three weeks of treatment. Conclusion: Corticosteroid injection showed earlier and greater effect on pain and ultrasonographic feature than other treatments. Although pain aspects of three groups were similar after 12 weeks of follow-up, improved ultrasonographic features were well preserved in injection and orthoses groups. Ultrasonographic feature that was mostly related to the symptom relief was the decrease in fascial thickness other than resolution of hypoechoic lesion. (J Korean Acad Rehab Med 2010; 34: 220-226)

Objective
To investigate the effect of extracorporeal shock wave therapy (ESWT) on pressure ulcers which is a major, functionally-limiting medical problem impairing quality of life for many people each year. Method: Seven patients who had stage 3 pressure ulcers were enrolled for the study. Each patient was treated with 6 sessions of low-energy (0.10∼0.15 mJ/mm², 1,000 impulses) ESWT. The length, width, depth and soft tissue biopsy of pressure ulcers were evaluated every 2 weeks for 6 weeks. Results: The length, width and depth decreased significantly after 2 weeks of ESWT application. Healthy granulation tissue was formed. Soft tissue biopsy revealed increased the number and size of capillaries and decreased inflammatory cells in treated case. Conclusion: ESWT promoted wound healing and revealed favorable histological changes in pressure ulcers. We suggest that ESWT can be used for the safety and effective management of pressure ulcer. (J Korean Acad Rehab Med 2010; 34: 227-232)

Objective
To find out the effect of depressive symptoms at acute stage on the course of disease progression in whiplash patients. Method: Thirty-eight patients with neck pain after acute whiplash injury were enrolled. The patients were prospectively surveyed within 7 days after whiplash injury and followed up after discharge by telephone interview. Depressive symptoms, self-perceived disability from neck pain, and pain intensity were measured by Center for Epidemiological Studies-Depression Scale (CES-D), neck disability index (NDI), and visual analog scale (VAS), respectively. Depressive group was defined as CES-D scores more than 21. The correlation between duration of total treatment and CES-D score and other variables was investigated by calculating independent t-test, Pearson's correlation coefficient and linear regression analysis. Results: The mean overall score of CES-D was 20.8±11.7 and 20 (52.6%) patients were classified as depressive group. Depressive group showed longer duration of total treatment (55.1±35.1 vs 38.9±16.4, p＞0.05) and higher pain intensity after total treatment (37.0±21.3 vs 29.4±20.1, p＞0.05) than non-depressive group, but statistical significance was not sufficient. Duration of total treatment was correlated with NDI score (Ճ=0.454, p＜0.01) and initial pain intensity (Ճ=0.349, p＜0.05), but not related with socio-demographic factors - age, gender, marital status - and CES-D score. Conclusion: Duration of total treatment was correlated with physical disability and initial pain intensity. Depressive symptoms at acute stage of whiplash injury was correlated with both of them. Depressive symptoms could affect the outcome of whiplash injury indirectly through pain intensity and physical disability. (J Korean Acad Rehab Med 2010; 34: 233-237)

Pure epidural cavernous hemangiomas of the spinal canal are extremely rare. We describe a case of lumbar epidural hemangioma suspected as a lumbar radiculopathy in a 78-year-old man who presented with a 1-month history of the low back pain and right lower extremity pain. An electrodiagnostic study demonstrated right L4 radiculopathy. Noncontrast magnetic resonance image (MRI) showed a nodular lesion suggestive of a sequestered disc with compression of right L4 root, most likely. Contrast MRI revealed an oval enhancing nodular lesion, 1.4×0.5 cm in size, indicative of a hemangioma in right anterior epidural space at L4 level. He underwent an excisional biopsy. The pathological diagnosis was cavernous hemangioma. His symptoms resolved after the operation. Spinal epidural cavernous hemangioma should be considered as a cause of a lumbar radiculopathy. (J Korean Acad Rehab Med 2010; 34: 238-241)

Pseudoaneurysm arises from disruption in arterial wall continuity resulting from inflammation, trauma or iatrogenic cause. Stroke patient with pseudoaneurysm during rehabilitation has not been reported yet. A 62-year-old man who participated in comprehensive rehabilitation program after stroke presented with right thigh swelling and pain. On physical examination, non-pulsatile tender and broad mass was palpated in the lateral region of right lower thigh. A 2.7 cm-sized pseudoaneurysm in right vastus muscle was identified by a duplex ultrasonography and enhanced CT- angiogram. The patient was successfully treated with ultrasonography-guided thrombin injection and embolization. At this time, laboratory test revealed prolongation of aPTT, undetectable factor VIII levels and the presence of the factor VIII antibody, which made the diagnosis of acquired hemophilia A. The patient was discharged 7 weeks later. We report a case of pseudoaneurysm during rehabilitation program in hemiplegic patient with acquired hemophilia A. (J Korean Acad Rehab Med 2010; 34: 242-246)

Occipitocervical posterior fusion itself is an uncommon cause of severe dysphagia. But occipitocervical malalignment after posterior fusion can be a cause of severe dysphagia. A 46-year-old man was referred to the department of rehabilitation medicine because of swallowing difficulty. He complained of severe dysphagia immediately after the occipitocervical posterior fusion. From the lateral view of video-fluoroscopic swallowing study (VFSS), we could conclude that the mechanical cricopharyngeal relaxation failure was a direct cause of his dysphagia and this was due to malalignment of the occipitocervical fixation. His occipitoaxial angle was fixed in hyperflexed position and this lead to the severe dysphagia and even dyspnea. After the revision operation, his dysphagia and dyspnea symptom was dramatically resolved. The occipitoaxial angle can be a useful index, which measure the anatomic relation of the occiput and the cervical vertebrae on sagittal plane, on evaluation of the swallowing function in the patient who had occipitocervical posterior fusion. (J Korean Acad Rehab Med 2010; 34: 247-251)