Objective
To investigate the change of motor evoked potential (MEP) in the cerebral infarction, and observe the effect of stimulation intensity and location of cerebral infarction, using rat model of cerebral ischemia induced by endothelin-1 (ET-1). Method: Middle cerebral artery (MCA) infarct, cortical infarct, and internal capsular infarct were induced in Spraugue- Dawley rats, by injecting ET-1 stereotaxically. MEP was recorded in forelimb by transcranial magnetic stimulation at 100%, 120%, and 150% of motor threshold by a small figure-8 coil. The location of cerebral infarction was confirmed histologically by 2,3,5-triphenyltetrazolium chloride (TTC) staining. Results: In MCA infarct, MEP was not recorded at all intensity. In internal capsular infarct, no MEP was recorded at 100% of motor threshold, and amplitude was decreased at 120%. In cortical infarct, MEP was not recorded at 100%, but amplitude was maintained at 120% and 150%. Latency did not change significantly at all intensity. Conclusion: Amplitude of MEP decreased after cerebral infarction, but latency did not change. Decrease in amplitude was larger with deeper location of cerebral infarction. Cerebral cortex was stimulated at 100% of motor threshold, subcortical structure was stimulated at 120%, and deeper structure was stimulated at 150%, respectively. (J Korean Acad Rehab Med 2010; 34: 381-386)

Objective
To investigate the effect of spinal cord injury (SCI) on contractions of whole colonic preparation isolated from rats under the inhibition of nitrergic inhibitory neural system using tetrodotoxin (TTX). Method: Twenty Sprague-Dawley rats were used. A complete spinal cord transection was performed surgically at the T10 cord level in spinal cord injured group. After 1 week of operation, sensory and motor functions were assessed and colon was removed under anesthesia for in vitro motility study. Whole colon was divided into four segments: proximal, two mid colon and distal colon. Each segment of colon was mounted with longitudinal direction in a 10 ml organ bath. After 1 hour of equilibration, frequency, area under the curve of spontaneous contraction and the response to acetylcholine (Ach), KCl and TTX were measured in each segment. Also the responses to Ach and KCl response under TTX pretreatment were measured. Results: Enhanced contractile response to KCl solution (40 mM), TTX (1 ՌM) and Ach (10⁻⁶ M) was observed in both group. There was no statistical difference in spontaneous, Ach and KCl induced contraction between control and SCI rats, but TTX induced contraction was decreased in SCI group than control group (p＜0.05). In addtion, the Ach and KCl responses under the TTX pretreatment were significantly decreased in SCI group than control group (p＜0.05). Conclusion: These results suggest that the change of colonic contractility after the SCI is caused by at least partly from the change of TTX related inhibitory neural system. (J Korean Acad Rehab Med 2010; 34: 387-393)

Objective
To acquire normal anatomy of superficial radial nerve and cephalic vein and identify the optimal site for venipuncture of cephalic vein at wrist to decrease the damage of superficial radial nerve. Method: We examined anatomic relationships of the superficial radial nerve, cephalic vein, and styloid process of radius in 14 hands from 10 cadavers. The distances were measured from the styloid process of radius to the point at which the superficial radial nerve pierced fascia, and to the crossing point of superficial radial nerve with cephalic vein. Results: The mean distance from the styloid process of radius to the point at which the superficial radial nerve pierced fascia was 79.9±9.84 (60∼93) mm and from the styloid process of radius to the crossing point of superficial radial nerve with cephalic vein was 29.5±15.24 (13∼55) mm. Conclusion: The most optimal injection site for venipuncture of cephalic vein at wrist was located 55 mm more proximal area from styloid process. (J Korean Acad Rehab Med 2010; 34: 394-396)

Objective
To compare the effect of repetitive transcranial magnetic stimulation (rTMS) applied over the right or left parietal cortex with high- or low-frequency on visuospatial neglect in stroke patients. Method: Nineteen stroke subjects (10 males, 9 females) were enrolled. All subjects received 1,200 real rTMS over left parietal cortex at an intensity of 90% of motor thresholds with 1 Hz, sham rTMS over right parietal cortex with 20 Hz and real rTMS over right parietal cortex at same intensity with 20 Hz under randomized cross over design. To compare the effects of different rTMS protocols, letter cancellation test, line bisection test (near, far) and Ota's task were administered before and after rTMS. Results: Low frequency rTMS over left parietal cortex, compared with sham stimulation, significantly improve visuospatial neglect in Ota's task (p＜0.05). Conclusion: As low frequency rTMS over left parietal cortex showed beneficial effects on visuospatial neglect, low frequency rTMS can be used as a treatment modality for patients suffering from visuospatial neglect after stroke. (J Korean Acad Rehab Med 2010; 34: 397-402)

Objective
To investigate the risk factors for poststroke delirium and evaluate its influence on functional recovery after ischemic stroke. Method: Risk factors for delirium were investigated retrospectively in three hundred twenty nine acute ischemic stroke patients over 60 years of age. Among the 329 patients, sixty seven developed delirium. Data were analyzed between delirium group (n=22) and control group (n=22) according to age, sex, lesion location and clinical features. Korean modified Barthel index (K-MBI), Korean National Institutes of Health stroke scale (K-NIHSS) and Korean mini-mental state examination (KMMSE) were measured at second and sixth weeks after onset and compared for both groups. Results: Parameters showing statistically significant difference between two groups were age over 80, hyponatremia, sleep deprivation, cognitive impairment and cardiogenic embolism. There was no significant difference in K-MBI, K-NIHSS and K-MMSE scores at second week between the two groups. The delirium group showed significantly less improvement in K-MBI and K-NIHSS scores compared to control group (9.5±10.2 vs 18.5±11.6, p=0.011; −0.7±1.2 vs −1.8±1.3, p=0.014). There was no significant improvement in K-MMSE score. Conclusion: The possible risk factors for delirium in acute ischemic stroke are age over 80, hyponatremia, sleep deprivation, cognitive impairment and cardiogenic embolism. Stroke patients with comorbid delirium showed poorer functional outcome. Delirium seems to have detrimental effect in functional recovery after stroke. (J Korean Acad Rehab Med 2010; 34: 403-408)

Objective
To evaluate the incidence, associated neuropsychological symptoms, imaging feature and prognosis of pusher syndrome (PS). Method: One hundred-ninety-seven patients with unilateral acute stroke were enrolled. Patients were evaluated for the presence and severity of PS using a standardized scale for contraversive pushing, neurological examination, assessment of neuropsychological symptoms (neglect, anosognosia, aphasia, apraxia), activities of daily living (ADL) and neuroimaging studies (CT or MRI). ADL was measured with Korean version of modified Barthel index (K-MBI). Results: PS was found in 10.7% (n=21) of the included patients. No significant differences were found between patients with and without PS in age, sex, handedness, initial K-MBI score, neuropsychologic symptoms, lesion size and cortical involvement. Thalamic lesion was strongly correlated with PS (p＜0.05). PS had no independent influence on gain in ADL, but spent 4.8±1.7 weeks (p＜0.05) more to reach the same final outcome level than did patients without PS. Average symptom duration of PS was 14.6±3.6 weeks. Initial severity of PS did not influence on gain in ADL and recovery period. Conclusion: PS did not affect final functional outcome, but slowed the process of recovery considerably. And thalamus seems to be fundamentally involved in control of upright body posture. Presence of PS is more important than severity of initial PS for prognosis. (J Korean Acad Rehab Med 2010; 34: 409-416)

Objective
To investigate the effects of full-time integrated self upper-extremity training program (FISUTP) on functional recovery and length of stay in stroke patients. Method: Fifty-nine patients were enrolled and divided into FISUTP and control groups. The FISUTP group (n=29) underwent conventional physical and occupational therapy and FISUTP daily during their hospital stay, whereas control group (n=30) received only daily conventional therapy (physical and occupational therapy). The outcome was measured by Korean version of modified Barthel index (K-MBI), Fugl-Meyer motor assessment (FMA), and length of stay (LOS). Results: FISUTP group showed significantly shorter LOS and higher improvement in functional status changes (K-MBI changes and FMA changes) during hospital day than control group (p＜0.05). Conclusion: The results showed FISUTP is an effective treatment for the improvement of functional outcome and reduction of hospital stay in stroke patients. (J Korean Acad Rehab Med 2010; 34: 417-423)

Objective
To investigate the patterns of alcohol use among community-dwelling persons with spinal cord injury (SCI) and compare the results with those from general populations. Method: The persons with SCI living in community were recruited. They answered the self-administered questionnaire which was made based on the questionnaire of the third Korea National Health and Nutrition Examination Survey for data comparisons. The questionnaire consisted of the questions about personal information, drinking duration, drinking frequency, drinking amount, and impaired control over drinking. Results: Questionnaires of 340 persons with SCI from twenties to fifties were analysed. The annual and monthly drinking rates of SCI subjects were lower than those of general populations. In male, drinking frequency of SCI subjects was lower than that of general populations. In both male and female, risky drinking rates were lower than those of general populations. The degree of impaired control over drinking of SCI subjects was higher than that of general populations. Conclusion: Fewer persons with SCI used alcohol than general populations. But, the degree of alcohol dependence of SCI persons was higher than that of general populations. (J Korean Acad Rehab Med 2010; 34: 424-431)

Objective
To see the factors affecting wound recovery of the patients who decannulated tracheostomy tube and to provide an index to guide proper time for stomaplasty. Method: The subjects were 41 patients having received tracheostomy tube decannulation. The medical records of the subject patients were investigated retrospectively. Among the group with natural sealing off, the factors affecting spontaneous closure were compared in terms of the duration of tracheostomy tube cannulation, age, hemoglobin, protein, albumin, peak flow meter, mini-mental status examination (MMSE), and oral feeding. Results: The group with natural sealing off had 142 days as the average period of tracheostomy tube cannulation while the group without showed 652.33 days. The duration of tracheostomy was statistically significant in linear regression analysis. In addition, the groups with oral feeding and without oral feeding were significantly different from each other (p＜0.05). Conclusion: Significant factors affecting wound recovery after tracheostomy tube decannulation were the duration from tracheostomy operation to tracheostomy tube decannulation and oral feeding. (J Korean Acad Rehab Med 2010; 34: 432-435)

Objective
To assess motor development of preterm and term infants using the test of infant motor performance (TIMP) and to compare the reliability of the TIMP measuring by different raters. Method: 55 preterm and term infants were tested with the TIMP at ages ranging from 35 weeks postconceptional age to 14 weeks corrected age. A linear correlation analysis was used to assess the contributions of age, risk, and radiologic findings to the variance in TIMP scores. In the reliability study, the TIMP was administered to the infants by an occupational therapist, and infant performances were videotaped. The performance was then rescored by another tester to examine the interrater reliability. Results: No significant correlations between infant variables and TIMP score changes were revealed. In the reliability study, statistically significant correlation between two raters was found (Cohen's kappa: 0.959, p＜0.001). Conclusion: TIMP has a good interrater test reliability for use in clinical practice to assess infant motor performance. But the TIMP could not discriminate among infants with differing risks for motor developmental delay. Further evaluation and follow up survey is necessary to find correlation between the development process and medical risk factor among the participated subjects in this study. (J Korean Acad Rehab Med 2010; 34: 436-441)

Objective
To describe the quality of life (QOL) and care burden of caregivers of ventilator-dependent amyotrophic lateral sclerosis (ALS) patients and to compare the QOL of ALS caregivers with that of dementia caregivers. Method: Ninety-one pairs of ALS patients and their caregivers were interviewed. Patients were asked to provide their age, sex, time since diagnosis, and length of ventilator use, as well as complete the ALS functional rating scale- revised (ALSFRS-R). Caregivers were asked to provide baseline demographic data including age, sex, education level, marital status, link with the patient, occupation, care time, substitute caregiver, and personal caregiver. The short form- 36 (SF-36) and burden interview (BI) were also administered to evaluate caregivers' QOL and care burden. T-tests, ANOVA, and Pearson correlation coefficients were used for data analysis. Results: Ninety-one pairs of patients (men 69.2%, women 30.8%) and caregivers (men 24.2%, women 73.6%) completed the study. The mean SF-36 physical component summary (PCS), mental component summary (MCS), and total scores of caregivers were 131.5±13.2, 114.3±17.6, 245.8±28.2, respectively, which showed that the QOL of ventilator-dependent ALS patients was decreased. The BI score was 52.8±17.8, which meant that caregivers were heavily burdened. The SF-36 total and MCS were correlated with the BI. Care time was an important factor that influenced QOL and care burden. QOL was significantly lower for ventilator-dependent ALS caregivers than for dementia caregivers. Conclusion: This survey revealed the poor QOL and heavy burden of ventilator-dependent ALS caregivers, which necessitates social interventions including strategies about care time. (J Korean Acad Rehab Med 2010; 34: 442-450)

Objective
To evaluate the short-term and long-term effects of integrated fall prevention program comprised of exercise program to improve physical function, education of fall prevention strategy and environmental improvement in elderly Korean. Method: Elderly who were at high risk for fall participated in 8-week integrated fall prevention program. Outcome measures including fall efficacy scale (FES), activity-specific balance confidence (ABC), flexibility test, balance function test, short physical performance battery (SPPB) and isokinetic knee strength were evaluated and compared before and after the program. One year after the program, fall experience and frequency, FES and ABC were followed up by mail questionnaire. Results: Among 63 participants enrolled at the baseline, 43 completed the program. Flexibility, balance function and SPPB improved significantly whereas FES, ABC, anthropometric measure data and knee strength were not changed. One year after the program, the number of fallers decreased significantly. Conclusion: Integrated fall prevention program may improve flexibility and balance function, and can reduce the risk of fall in the elderly population. (J Korean Acad Rehab Med 2010; 34: 451-457)

Objective
To assess the driving ability of older drivers, their visual function, cognitive-perceptual function, motor function and driving performance were evaluated. Method: Subjects were 55 drivers aged 65 years or older. Visual function test included visual acuity, visual field, color vision and contrast sensitivity. Cognitive perceptual function was evaluated with the cognitive perceptual assessment for driving (CPAD) and clock drawing test. For motor function, muscle strength and range of motion were evaluated. Driving performance was evaluated by virtual reality based driving simulator. For comparision, 48 younger drivers aged between late twenties and early forties underwent the same evaluation. Results: Among older drivers, 21 (38.2%) had visual acuity less than 20/40, 3 (5.5%) had visual field narrower than 140^o bilaterally. Contrast sensitivity was significantly decreased in both day and night with glare light conditions. In cognitive- perceptual function assessment, 20 subjects (36.4%) passed CPAD test, 3 subjects (5.5%) failed, and 32 subjects (58.1%) fell into borderline group. Mean CPAD score was 50.65± 5.62, which was significantly lower than that of younger drivers. 18 subjects (32.7%) were incorrect in clock drawing test. In motor function assessment, 4 subjects (7.3%) in older drivers showed hemiparesis secondary to stroke. In driving simulator, 21 subjects (38.2%) failed whereas only 4 subjects (8.3%) did in younger drivers. Average demerit score was 24.09±15.53 and was significantly higher than that of younger drivers. Conclusion: Older drivers showed significantly higher incidence of visual and cognitive-perceptual dysfunction, and poorer driving performance compared to younger drivers group. (J Korean Acad Rehab Med 2010; 34: 458-464)

Objective
To analyze activities of left lower extremity muscles throughout phases of the golf swing, using surface electromyography. Method: We evaluated muscle activities during the golf swing of 5 amateur and 5 professional golfers using surface electromyography. Surface electrodes were placed in the left gluteus medius, gluteus maximus, biceps femoris, gastrocnemius, rectus femoris, peroneus longus, and tibialis anterior. Results: Muscle activities of professional golfers in the left gluteus medius, gluteus maximus, biceps femoris, tibialis anterior, rectus femoris abruptly increased from top-swing phase to impact phase but muscle activities of amateur golfers in these muscles increased to top-swing phase and decreased at follow swing phase. Muscle activities of professional golfers in left peroneus longus, gastrocnemius abruptly increase from forward swing to impact but muscle activity of amateur golfers in these muscles continuously increase to impact and abruptly increase at follow swing. Conclusion: Our findings demonstrate the importance of the muscles in the golfer's swing. (J Korean Acad Rehab Med 2010; 34: 465-470)

Congenital muscular dystrophies (CMDs) are autosomal recessive, heterogenous disorders characterized clinically by neonatal hypotonia, delayed motor milestones, joint contrac- tures, and dystrophic changes in the muscles. The classic forms of CMDs are subclassified into merosin positive and deficient (negative) types. Merosin (laminin Ձ chain)-negative CMD is caused by the mutation in the basal lamina of the Ձ2 chain gene (LAMA2 gene at 6q22-23). Merosin deficiency could disrupt the attachment of muscle cell to the extracellular matrix and lead to muscle cell necrosis. We report a case of merosin-negative CMD, confirmed by immunohistochemical staining of muscle samples, which is uncommon form in Korea. (J Korean Acad Rehab Med 2010; 34: 471-474)

Carpal tunnel syndrome (CTS) is the most frequent entrapment mono-neuropathy, a pressure-induced neuropathy of the median nerve at the wrist. Two patients with dyskinetic cerebral palsy presented tingling sense of bilateral hands and marked flattening of both thenar eminences. In two patients, the involuntary dystonic muscle contractions kept the wrist position in hyperextension or more frequently, in hyperflexion with ulnar deviation and finger in flexion strongly. We performed careful history taking and physical examination, and then diagnosed bilateral carpal tunnel syndrome in two patients through medical workup including electromyography and ultrasonography. In this report, we present these cases and discuss their physiopathology. (J Korean Acad Rehab Med 2010; 34: 475-479)

Gait disturbance in infants and toddlers results from various diseases, such as musculoskeletal, neuropathic, metabolic, and inherited disorders. These disorders lead to myopathies with muscle weakness. Nutritional deficiency can cause myopathy but it is very rare, because of early diagnosis and effective treatment. Vitamin D deficiency also can induce myopathy. Rickets, the clinical term of chronic vitamin D deficiency, results in secondary hyperparathyroidism that can show the characteristics of myopathy, such as muscle weakness, especially on the proximal muscles of lower extremities and the following waddling gait. We report a rare case of iatrogenic rickety myopathy. (J Korean Acad Rehab Med 2010; 34: 480-482)

Iliopsoas abscess is relatively uncommon condition that can present with vague clinical features. Its insidious onset and occult characteristics can cause delayed diagnosis, resulting in high mortality and morbidity. We report a 49-year-old male with T7 complete paraplegia (ASIA A) as a result of motor vehicle accident in 1994, presented with fever above 40^oC and myalgia for 15 days and later diagnosed as iliopsoas abscess. Magnetic resonance imaging showed infectious spondylitis, L3, with abscess formation in psoas muscle, bilateral. Intravenous broad spectrum antibiotics treatment, CT-guided percutaneous drainage and surgical management were performed. Febrile episodes are frequent in SCI (spinal cord injured) patients. However, it is sometimes difficult to ascertain the origin of fever in SCI patients, because of altered sensation and lack of localizing physical findings. We suggest that this infectious pathology must keep in mind in SCI patients with fever of unknown origin. (J Korean Acad Rehab Med 2010; 34: 483-485

We experienced musculoskeletal pain by somatization symptom and steroid myopathy in Cushing syndrome (adrenal adenoma) and hereby report this case. A 53-year old woman visited to clinic with chief complain of severe sole pain and tingling sensation (VAS 8.0) and multiple arthralgia (VAS 6.0) since 3 years ago. On examination, she showed severe depressive mood disorder, weakness of proximal limbs and other features of Cushing syndrome. The electromyelographic findings showed atypical type of myopathy without peripheral polyneuropathy. On laboratory examination, overnight and low dose dexamethasone suppression test was positive. The adrenal CT showed finding of left adrenal adenoma. After diagnosed of Cushing syndrome, laparoscopic adrenalectomy was done. The patient's severe pain and tingling sensation were immediately improved (VAS 3.0) concurrently with improvement of depressive mood following surgery. We concluded that the pain was originated from somatization symptom. (J Korean Acad Rehab Med 2010; 34: 486-489)