Objective
To investigate the effect of the recombinant human epidermal growth factor (rhEGF) on pressure ulcer treatment. Method: Eighteen patients who had stage 3 or 4 pressure ulcer were divided into two groups. For experimental group, we cleaned the wound with normal saline, applied 0.5 ml of EasyEF liquid^Ⱂ (rhEGF 0.5 mg/10 ml) and covered the wound with the humidified gauze 2 times a day. For control group, we cleaned with normal saline and covered with the medifoam for 2 times a day. We estimated the change of the size and the stage of the ulcer weekly for 4 weeks. The longest region of the wound was measured by the width, and the longest line perpendicular to the width was measured by the length. Results: The width and length of the stage 3 ulcer of experimental group significantly decreased, while control group showed a slightly decreased. The experimental group showed significant improvement compared to the control group (p＜0.05) in stage 3 ulcer. In stage 4 ulcer treatment, there were no significant differences between the two groups. In experimental group, 5 regions of the six stage 3 ulcer improved into the stage 2 ulcer during the study, even though only 1 region improved into the stage 2 ulcer in control group. Conclusion: We confirmed that rhEGF was effective in the stage 3 ulcer. rhEGF treatment may be useful for healing of the stage 3 ulcers. (J Korean Acad Rehab Med 2010; 34: 253-258)

Objective
To investigate the effects of continuous repetitive transcranial magnetic stimulation (rTMS) on pain response in spinal cord injured rat. Method: Forty Sprague-Dawley rats (200∼250 grams, female) were used. Thoracic spinal cord (T9) was contused using New York University (NYU) spinal cord impactor. Ten gram weight rod was dropped from a height of 25 mm to produce spinal cord contusion model with moderate injury. The animals were randomly assigned to two groups: one exposed to real magnetic stimulation (real-rTMS group) and the other not exposed to magnetic stimulation (sham- rTMS group). rTMS was applied for 8 weeks. To assess the effect of continuous rTMS on below-level pain responses after spinal cord injury (SCI), the hindpaw withdrawal response for thermal stimuli, cold stimuli and mechanical stimuli were compared between two groups. Results: Behavioral response for pain showed that hindpaw withdrawal response for cold stimuli was reduced significantly from 4 weeks after SCI in real-rTMS group compared with sham group (p＜0.05). Conclusion: These results suggest that continuous rTMS may have beneficial effects on attenuation of cold allodynia after SCI, and it might be an additional non-invasive therapeutic method in patients with chronic neuropathic pain after SCI. (J Korean Acad Rehab Med 2010; 34: 259-264)

Objective
To investigate school children's backpack loads, its association with backpack loads and backpain, schoolchildren's perception of their backpack loads, school conditions, and personal factors that determine backpack loads in Korea. Method: We weighed the backpacks of 642 school children in three elementary schools in Suwon city. A validated questionnaire evaluating backpain, features of backpack carrying and subjective perceptions of backpack loads was administered to 450 schoolchildren. The data were divided into two groups, those who had experienced backpain and those who had not. Each group was analyzed according to backpack load, perception of backpack load, school condition and personal factors. Results: The mean weight of the backpack was 2.65 kg, which was 7.85% of mean body weight. The number of children whose backpack loads exceeded 15% of their body weight was 3.3%. 34.5% of children experienced backpain and backpack weight and backpack weight/body weight ratio were significantly higher in the group who experienced backpain. Time spent carrying of backpacks was longer and more students reported heaviness and fatigue when carrying backpacks in the same group. There was a difference in manners of carrying of backpacks and locker usage between the two groups. An improper method of backpack carrying, which is more than 10 cm below the waistline was noted in 85% of the school children. Conclusion: Carrying a heavier backpack is related to backpain in schoolchildren and a wide investigation should be performed concerning backpack loads of school children in Korea. Adequate backpack load guidelines should be determined. (J Korean Acad Rehab Med 2010; 34: 265- 269)

Objective
To assess the impact of active training ("hands- on training") caregivers on their attitudes for handling the patients and to examine the effectiveness of hands-on training in improving psychosocial outcomes for stroke patients and their caregivers. Method: The subjects were 59 stroke patients and their family caregivers. They were randomly divided into two groups: a control group and a training group. The training group received active hands-on training about personal care with handling techniques. We collected the data through interviewing the patients and their caregivers on admission and at discharge. The stroke patients and caregivers were evaluated with the functional status, caregiver appraisal scale, psychological state, quality of life. Results: Caregivers in the training group experienced a significant reduction in caregiving burden and anxiety (p＜0.05). There were no differences in depression or physical health between the two groups, although caregivers in the intervention group were found to have significantly better mental health. Patients in the caregiver training group also experienced less anxiety and better mental health (p＜0.05), and had a modest benefit in functional status (independence in activities of daily living) (p＜0.05). Conclusion: A hands-on training for caregivers of post- stroke inpatients resulted in reducing burden of care and anxiety while improving psychosocial outcomes for caregivers, proving that the hands-on training might be helpful in caregivers of stroke inpatients. (J Korean Acad Rehab Med 2010; 34: 270-277)

Objective
To evaluate the change of balance of the trunk using the Trunk Impairment Scale (TIS) in acute stroke patients and to compare it with the improvement in activities in their daily living (ADL) and gait. Method: The mean days from the onset of stroke were 11.3 (6∼17) days, and functional improvement of 24 hemiplegic patients was evaluated using the trunk impairment scale, Berg balance scale, timed up and go test, 6 minutes walk test, and the modified Barthel index every week for 4 weeks' conventional rehabilitation programs. Correlations between the trunk impairment scale and the other parameters were evaluated. Results: The trunk impairment scale and the modified Barthel index, both which showed significant improvement after 4 weeks, had statistically significant correlation (p＜ 0.05). The Berg balance scale had not improved significantly in 4 weeks. The timed up and go test and the 6 minutes' walk test could not be evaluated in most of these patients within 4 weeks. Conclusion: The trunk impairment scale could be a useful parameter for evaluating activities in their daily living (ADL) improvement in acute stroke patients who are unable to ambulate independently. And good trunk balance in acute stroke period is positive correlation with ambulation potential. (J Korean Acad Rehab Med 2010; 34: 278-284)

Objective
To evaluate pre-stroke bone mineral density (BMD) of the patients with first stroke events. We previously reported that pre-stroke BMD of first stroke patients with severe immobility were relatively lower than those of normal population. In current study, we evaluated pre-stroke BMD of patients in first stroke patients regardless of severity or type of stroke. Method: The 121 patients with first stroke events were included. To reflect pre-stroke BMD, patients who had bone densitometry scans within the first thirty days from onset were chosen. The BMDs of the lumbar spine and both femurs (total hip and femoral neck) were examined. Results: Among the 121 stroke patients, 56.2% were osteoporotic and 28.1% were osteopenic. In the female patients, 78.1% were osteoporotic and 20.5% were osteopenic. In the male patients, 22.9% were osteoporotic and 39.6% were osteopenic. Conclusion: Patients with first stroke events showed a high prevalence of pre-stroke low BMD. In the acute stages of stroke, bone loss progression is rapid. Therefore, such a high prevalence of pre-stroke low BMD can bring on a greater risk of fractures and additional functional loss. Early screening and active intervention of osteoporosis including patient education from the acute stages of stroke is crucial. (J Korean Acad Rehab Med 2010; 34: 285-289)

Objective
To compare and discuss functional outcome and neurologic deficits of patients with either brain tumor or ischemic stroke after inpatient rehabilitation. Method: Sixty-two, brain tumor patients (32 benign and 30 malignant) admitted for inpatient rehabilitation during a five-year period and 70 acute ischemic stroke patients were enrolled. We retrospectively investigated their functional status at admission and discharge, the functional gain as measured by the Korean version of modified Bathel index (K-MBI) instrument, and their common neurologic deficits. Results: The K-MBI score at discharge was significantly improved in both groups (70.2 vs. 61.5). However, the K-MBI score at admission was found to be higher in the brain tumor group (45.3 vs. 35.5), whereas no significant differences were found in the K-MBI score at discharge or in the gain or efficiency of the K-MBI score. In the tumor group, the K-MBI score at discharge and the gain of the K-MBI score were significantly higher in the benign brain tumor patients. The most common neurologic deficit was motor weakness, followed by impaired cognition and cranial nerve palsy. The frequency of these deficits was more common in the ischemic stroke patients, although there were no differences between benign and malignant brain tumor groups. Brain tumor patients not receiving radiation therapy and having higher K-MBI scores at admission showed greater functional improvement (p＜0.01). Conclusion: Brain tumor patients can achieve comparable functional outcomes to ischemic stroke patients, and our study supports the benefits of comprehensive rehabilitation irregardless of a patient's tumor type. (J Korean Acad Rehab Med 2010; 34: 290-296)

Objective
To investigate the utilization of medical rehabilitation services and the degree of satisfaction about rehabilitation services in patients with brain disorders. Method: A total of 1903 patients agreed to participate in this study and were interviewed from September 2005 to May 2006. The subjects completed the questionnaires about the utilization of medical rehabilitation services and the degree of satisfaction with those treatments. Pearson's chi- square test, Student t-test and frequency analysis were used for statistical analysis. Results: A 78.0 percent of patients received inpatient rehabilitation treatment. A 66.9 percent of all patients were served of only physical therapy and 31.6 percent received both physical and occupational therapy. The main reason why patients could not have a chance to experience rehabilitation treatment was associated with environmental problems, such as the ignorance of the need about rehabilitation treatment, or the insufficient communication between doctors and patients. Most patients (54.6%) were satisfied with the rehabilitation treatment. However, as the number of admission was increased, patients tended to be less satisfied with the rehabilitation treatment. Conclusion: The inpatient rehabilitation treatment was limitedly served to patients with brain disorders mostly when the patients required rehabilitation services. It is necessary to provide more effective and various rehabilitation services to patients under the comprehensive guideline of the process of rehabilitation services. (J Korean Acad Rehab Med 2010; 34: 297-303)

Objective
To investigate the effects of elasticity difference in strapping therapy for 4 weeks in the patients with hemiplegic shoulder. Method: Total sixty-two patients with hemiplegic shoulder were randomly enrolled to three groups. In group I, two parts of a Y shaped first tape, were attached from humeral insertion of deltoid muscle to clavicle midline, following anterior and mid deltoid line, respectively, with 125% elasticity. And two parts of a Y shaped second tape were attached horizontally from head of greater tubercle to medial end of scapular spinous process, following supraspinatus and infraspinatus muscles, respectively, with 125% elasticity. Group II patients were applied by the tape with 100% elasticity. Group III was control. The effects of strapping therapy were evaluated by using visual analogue scale (VAS), range of motion (ROM), vertical distance (VD), horizontal distance and joint distance on radiologic findings of plain anteroposterior view and lateral distance on shoulder ultrasonography which was examined between lateral border of acromion and greater tuberosity of humeral head, at entry, 14 and 28 days later. Results: Repeated measured ANOVA indicated that the all groups of the VD showed corrective effect (p＜0.05). And for early 14 days, reductions of VAS between the study group I and the other groups were meaningful at this study (p＜0.05). Conclusion: The strapping therapy is a useful therapeutic tool to decrease the degree of shoulder subluxation and to reduce pain in early rehabilitation therapy of patients with post-stroke hemiplegic subluxation (J Korean Acad Rehab Med 2010; 34: 304-309)

Objective
To investigate the effects of sono-guided intraarticular steroid injection followed by sodium hyaluronate injection weekly for 2 weeks on adhesive capsulitis of the shoulder Method: In this prospective randomized controlled trial, 16 patients (group A) were treated with intraarticular injection with a mixture of 0.5% lidocaine 9 ml and triamcinolone 40 mg once a week for 3 weeks, and 13 patients (group B) were treated with intraarticular injection with a mixture of 0.5% lidocaine 9 ml and triamcinolone 40 mg for the first week, and subsequently a mixture of 0.5% lidocaine 8 ml and sodium hyaluronate 2 ml once a week for the next 3 weeks. A self exercise program was instructed for all subjects. The effects were assessed using visual numeric scale (VNS), shoulder pain and disability index (SPADI), and range of shoulder motion (flexion, abduction, internal rotation. external rotation, and extension) at study entry, every week until 2 weeks have passed after the last injection. Results: The VNS, SPADI, and range of shoulder motion improved 1 week after 1st injection and continued to improve until 2 weeks after last injection in both two groups. There were no difference in changes of VNS and SPADI between these two groups, but range of shoulder motion especially in passive and active internal rotation of patients in group A improved more than those in group B. Conclusion: Steroid injection combined with hyaluronic acid injection has comparable effects with triamcinolone for treatment of adhesive capsulitis of the shoulder. Sono-guided intraarticular injection of steroid combined with hyaluronic acid can substitute for intraarticular injection of triamcinolone and be useful especially for patients susceptible to adverse effects of steroid injection. (J Korean Acad Rehab Med 2010; 34: 310-315)

Objective
To investigate the activities of upper trapezius and deltoid muscles in shoulder abduction in full can and empty can position in rotator cuff tear patients. Method: Twelve subjects with right rotator cuff tear patients participated in this study. Each subject performed scapular plane abduction with humeral external rotation (full can position) and with humeral internal rotation (empty can position). Electromyography (EMG) was recorded with surface electrodes at the both upper trapezius, anterior, lateral, and posterior deltoid muscles during shoulder abduction. The EMG activity of each muscle was normalized according to the highest EMG activity during a maximum manual muscle test for the corresponding muscle. Results: Muscle activities of the lesion side's upper trapezius and lateral deltoid were significantly greater than those of the normal side in full can position. In empty can position, the activities of upper trapezius, anterior, and lateral deltoid increased in lesion side. In comparison between full can and empty can exercises, over 30^o abduction arcs, empty can exercise showed increased muscle activities of upper trapezius and all deltoid muscle in lesion side. In contrast, anterior and lateral deltoid only showed increased in the muscle activities under empty can exercise in sound side. Conclusion: Rotator cuff tear is involved in changed the activities of upper trapezius and deltoid muscles. And these results suggested that in rotator cuff tear patients, the changed pattern of muscle contraction should be considered in shoulder exercise. (J Korean Acad Rehab Med 2010; 34: 316-324)

Objective
To investigate the relationship between health- related quality of life (HRQOL) and upper extremity pain in workers using computer. Method: Ten thousand four hundred office workers using computer over 4 hours per day were enrolled, and two self-reported questionnaires were given to each candidate. First questionnaire included questions on location, duration, frequency and severity of pain, gender, age and history of alcohol, smoking and exercise. Second questionnaire used Korean job stress measurement scale (KJSMS) and medical outcome study 36 item short form health survey (SF-36) for assessing HRQOL. A total of 6,669 workers took part in interview. Results: Mean age of group with pain was lower than that of painless group. Male gender, working period of 11∼20 years, and smoking were associated with musculoskeletal pain, and similar result was found in group with no alcohol consumption, no exercise, and house chores for more than 2 hours per day. The short working period was associated with higher KJSMS Short Form score. For shoulder pain, only duty self-control showed significant difference according to pain scale in KJSMS. When adjusted with age, gender, working period, house chores and history of alcohol and smoking, there was no significant difference between musculoskeletal symptom and KJSMS, SF-36, respectively. Conclusion: Only shoulder pain and duty self-control score were related factors, comparing subjective symptoms of musculoskeletal pain and job stress. Additional investigation using strict definition and diagnostic criteria should be performed. (J Korean Acad Rehab Med 2010; 34: 325-335)

Objective
To investigate the safety of early symptom limited exercise stress test (GXT) performed within 10 days after coronary intervention in acute coronary syndrome patients. Method: Forty-six patients with acute coronary syndrome including unstable angina (UA) and acute myocardial infarction (AMI) were recruited. All of them performed GXT within 10 days after coronary intervention and received cardiac rehabilitation for 6 weeks. Results: Mean age of the patients was 57.6±9.8 years (unstable angina 26 patients, acute myocardial infarction 23 patients). The number of the patients complained of cardiac events during GXT was 8 (16%); chest pain (3), ischemic changes on electrocardiogram (2) and hemodynamic instability (3). However, none of them showed any major adverse cardiac events such as acute myocardial infarction (AMI). Major cause of termination of GXT was patient's request such as dyspnea, fatigue, and musculoskeletal pain. After early GXT, there was no significant difference between two groups in all variables (p＞0.05). Conclusion: Early GXT was safe in acute coronary syndrome patients and did not show any significant difference between UA patients and AMI patients. (J Korean Acad Rehab Med 2010; 34: 336-341)

Objective
To see whether there is a relationship between Korean Falls Efficacy Scale-International (KFES-I) developed for measuring fear of falling and frequency of fall. Method: KFES-I was composed with 16 items of activities of daily living including social activities and graded from 1 to 4 in each item. Surveys of 250 patients over 65 years of age from the public health center of Kang-dong and Seong-buk based on KFES-I and fall questionnaire such as presence, frequency and severity of fracture within last 6 months, and combined medical illness were taken. The data of KFES-I, fall questionnaire, and the inter-relationship of KFES-I items had been analyzed by Spearman and Kendall test. Results: There was strong positive correlation between KFES-I total score and the frequency of falls. Four items (item 4, 7, 11, 15) of KFES-I showed strong correlation with the frequency of falls. There was significant difference in KFES-I total score between control and fracture groups (p＜0.05). Conclusion: Our results showed that there was strong positive correlation between frequency of falls and KFES-I. It is suggested that frequency of falls can be predicted by KFES-I. (J Korean Acad Rehab Med 2010; 34: 342-346)

Objective
To investigate the real condition of pulmonary rehabilitation for patients with advanced neuromuscular diseases (NMDs) on mechanical ventilation in Korea. Method: In order to estimate current state of pulmonary rehabilitative management, chart review and pulmonary function evaluation were conducted in a total of 267 NMD patients who had applied mechanical home ventilator in our center from March 2001 to December 2008. Results: Total 267 patients were included: 95 with Duchenne muscular dystrophy, 69 with other types of myopathy, 83 with amyotrophic lateral sclerosis (ALS), 20 with spinal muscular atrophy. Among them, 18 who were previously intubated and 17 patients who had undergone tracheostomy were switched into volume-limited non-invasive ventilation (NIV). At the time of hospital discharge, 234 patients were applied NIV successfully. Twenty other patients who once used continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) ventilators inappropriately were switched into volume-limited NIV. However, 20 patients who had successfully applied NIV first underwent tracheostomy due to exacerbation of underlying disease. Conclusion: Adequate pulmonary management is the only promising method to prevent lethal complications, and to prolong life span of advanced NMD patients. We assume that more NMD patients can improve their quality of life and prolong their life through proper pulmonary rehabilitation including regular pulmonary function check-ups and ventilatory state monitoring as well as early NIV application. (J Korean Acad Rehab Med 2010; 34: 347-354)

Objective
To analyze the hospitals related rehabilitation, which were designated for industrial accident compensation insurance, focusing faculties and facilities by administrative district. Method: Total 1,031 hospitals having more than 30 beds were included. We investigated the numbers of hospital beds, medical departments, medical doctors, nurses, physical therapists, and occupational therapists of each hospital with official document of industrial accident compensation insurance. And we classified and analyzed all data by administrative district. Results: The average of each objects were estimated as following orders: total number of hospital beds (131.5); medical departments (5.8); medical doctors (11.2); nurses (33.8); physical therapists (4.2); occupational therapists (0.9). The percentage of hospitals with department of rehabilitation medicine was 28.4% in total, 26.7% in hospital and 35.3% in general hospital. Mean numbers of hospital beds, medical departments, medical doctors, nurses and physical therapists did not showed disparity among the administrative districts. However, the percentages of hospitals with department of rehabilitation medicine and of hospitals with occupational therapists showed disparity among the administrative districts. The regional distribution of hospitals with department of rehabilitation medicine showed similar distribution, as that of occupational therapists. Conclusion: These results demonstrate faculties and facilities of hospitals under the industrial accident compensation insurance which are related with rehabilitation treatment. We believe that these results would be helpful for constructing certification system of rehabilitation hospital and for further research about rehabilitation treatment associated with industrial accident compensation insurance. (J Korean Acad Rehab Med 2010; 34: 355-361)

Objective
To compare to type and size of rotator cuff tear (RCT) in the transverse view before and after arthro-3D sonography. Method: Total 24 cases with rotator cuff tear were diagnosed according to ultrasonographic finding. All of patients were performed by a posterior-lateral approach for sono-guided intra-articular injection and underwent by both before and after arthro 3D sonogrpahy. We measured size (transverse, longitudinal, area) of RCT on the transverse scan in search of the largest lesion and the difference to type and size of RCT after arthrography. Results: 3D ultrasonography detected full-thickness tear in 18 cases, partial-thickness tear in 6 cases before arthro-3D sonograhy. Change in the diagnosis of rotator cuff tear after arthro -3D sonogrphy; 3 partial-thickness tear were diagnosed as full-thickness tear. The size (transverse, longitudinal, area) of RCT was increased significantly after arthro -3D sonography compared with that before arthro 3D sonography. Conclusion: Arthro-3D sonography is useful for evaluation the configuration of RCT. Using this method, we can provide the objective and steric image of RCT. (J Korean Acad Rehab Med 2010; 34: 362-367)

Some reports provide conclusive evidence of close interactive regulation between the taste receptor and sympathetic nervous system. We report a middle-aged male patient with gustatory change after cervical sympathetic ganglion block (CSGB) who had been suffering from hypersensitivity to sour taste since developing complex regional pain syndrome (CRPS) type 1, diagnosed according to the revised CRPS criteria. Despite receiving two high doses of prednisolone therapy, he experienced the recurrence of CRPS symptoms. We attempted other therapy treatments, including pamidronate intravenous infusion, non-steroidal anti-inflammatory drugs, opioids, tricyclic antidepressants, and CSGB. Following each CSGB administration, the patient reported decreased hypersensitivity to sour-tasting foods, such as kimchi and oranges, with decreased pain and reduction of dysautonomic symptoms. This case demonstrates that overactivation of the sympathetic nervous system may influence sensitivity and regulation of gustatory receptors; therefore, a patient demonstrating CRPS symptoms, including taste alterations, may respond positively to CSGB therapy. (J Korean Acad Rehab Med 2010; 34: 368-371)

Sarcoidosis is an idiopathic multisystem disorder that usually develops in the respiratory system, but rarely in spinal cord. A 54-year-old female patient was presented with progressive right side weakness and paresthesia below C4 level dermatome which began 3 months ago. Cervical MRI findings showed T2 weighted high signal nodular lesion with surrounding edema at the C4 and C5 vertebra level, suggestive of intramedullary spinal cord tumor. She went through the resection of the part of the mass. The result of biopsy revelaed chronic granulomatous inflammation without caseous necrosis. Despite of tuberculosis medication and proper rehabilitation program for 2 weeks, there was no improvement of symptoms with exacerbated findings on cervical MRI and increased serum angiotensin converting enzyme level. We concerned about the cervical intramedullary sarcoidosis at this point, we treated her with steroid. After 3 months, her MRI findings were improved without improvement in her symptoms. (J Korean Acad Rehab Med 2010; 34: 372-375)

Secondary Parkinsonism caused by hypoparathyroidism in young patients has been rarely reported and the effectiveness of comprehensive rehabilitation management is widely varied. We experienced a case of 16 year old patient with secondary Parkinsonism caused by hypoparathyroidism, who has a chief complaint of progressive resting tremor and gait disturbance. At admission, the tremor subscore was 4 on the unified Parkinson's disease rating scale (UPDRS), the initial score of Korean-modified Barthel index (K-MBI) was 33 points and functional independence measure (FIM) was 52 points. Comprehensive rehabilitation consisted of oral antiparkinsonism drugs, range of motion exercise, motor control and coordination training, gait training with biofeedback, and activity daily living training were performed twice a day, 5 days a week. At one month after admission, she had more improved functional state. The tremor subscore was 2 on UPDRS, K- MBI was 72 points, and FIM was 89 points. (J Korean Acad Rehab Med 2010; 34: 376-379)