The Korean Society of Cardiac Rehabilitation (KSCR) have recommended standards for establishing cardiac rehabilitation programs in terms of facility, equipment and staff. This is the first time a statement concerning these types of standards has been issued in Korea, and presents the minimal requirements for establishing cardiac rehabilitation programs. Cardiac rehabilitation facilities should contain individual spaces for patient examination, exercise stress testing, monitoring exercise training, patient education, patient preparation, storing medical records, showers and lockers, toilets, and walking tracks. Essential equipment must include at least four sets of aerobic exercise equipment such as treadmills, bicycles, arm ergometers, step machines, and floor mats, and medical equipment such as exercise stress test for ECG with gas analysis, telemetry ECG monitoring systems, sphygmomanometers, stethoscopes, pulse oximeters, glucometers, portable oxygenators, and emergency carts with defibrillators. Hospital staff should include a medical director (a physician with a subspecialty in cardiac rehabilitation), exercise physiologist, nurse specializing in cardiac rehabilitation, exercise specialist, physical therapist, and clinical nutritionist. All should have an expertise in exercise science and be trained in basic life support or advanced cardiac life support. This statement is a recommendation by KSCR and cardiac rehabilitation council of regional cardiocerebrovascular center, and set forth the standards for facilities, equipment, and staff to set up or upgrade cardiac rehabilitation programs in Korea. These recommendations should be developed as a national standard for the establishment of cardiac rehabilitation programs, and adjusted for the current situation of the Korean medical industry through nationwide and long-term research. (J Korean Acad Rehab Med 2010; 34: 491-497)

Objective
To evaluate the correlation between duration of dysphagia and magnetic resonance image (MRI) findings in patients with stroke. Method: Ninety seven patients, who were evaluated by video fluoroscopic swallowing studies (VFSS), were recruited for 28 months. They were divided into two groups (transient group (n=52), prolonged group (n=45)) by removing time of NG tube from onset of stroke. Their MRI findings (lesion location and lesion size) were interpreted by one experienced radiologist retrospectively. Results: The duration of dysphagia had statistically significant correlation with lesion size but there was no statistically significant correlation between lesion location and duration of dysphagia in patients with stroke. Compared with transient group (51.5±53.8 cm³), a larger lesion was found in prolonged group (95.5±107.7 cm³). Conclusion: Lesion size, not lesion location, can be a more important factor to predict early removal of NG tube in patients with stroke. More careful interventions about dysphagia are needed in patients with larger stroke lesion. (J Korean Acad Rehab Med 2010; 34: 498-502)

Objective
To investigate the aspiration of saliva itself in bedridden patients with brain lesion using the response of radionuclide salivagram, and its association with patient characteristics and clinical factors. Method: Thirty two patients (21 men and 11 women) in bedridden state with brain lesion were performed the radionuclide salivagram. ^99mTc sulfur colloid (1.0 mCi in a drop of saline) was instilled into patients' tongue with supine position. The sequential images were obtained at first 5 minutes and 10 minutes interval for 1 hour, and evaluated the presence of saliva aspiration as the entrance of tracer into major airways or lung parenchyma. The characteristics of patients and the states of cooperation, drooling, tracheostomy, and method of feed were also assessed. Results: Seven out of 32 subjects exhibited positive response of saliva aspiration by radionuclide salivagram. Men, uncooperative, and anterior drooling was significantly associated with positive finding of salivagram (p＜0.05). Conclusion: In bedridden patients with brain lesion, it seems that radionuclide salivagram may be one of methods for detection of the aspiration of saliva itself. (J Korean Acad Rehab Med 2010; 34: 503-507)

Objective
To investigate the effect of mirror therapy on recovery of upper limb function and strength in subacute hemiplegia after stroke. Method: Fourty subacute hemiplegic stroke patients (onset ＜6 months) were enrolled and randomly assigned to either the mirror therapy (MT, n=19), or control group (n=21). MT group received mirror therapy for 30 minutes after each treatment, additionally with the traditional rehabilitation programs, 5 days per week for 4 weeks; 2 hours or more per day, 3 days or more per week. To measure the outcome, we performed the manual muscle test (MMT), manual function test (MFT) and Jarmar grip strength test. Results: MT group showed significant improvements in MMT, grasp and lateral pinch force of grip strength test (p＜0.05), compared to control group. Improvement in MFT was more evident in MT group (p＜0.05). Conclusion: Mirror therapy can be used as an adjuvant therapeutic technique for improving upper limb function and strength for subacute hemiplegia. (J Korean Acad Rehab Med 2010; 34: 508-512)

Objective
To evaluate the correlation between the K-BBS (Korean version of Berg balance scale), a tool for assessing balance, with the WISCI (walking index for spinal cord injury), and SCIM (spinal cord independence measure) in patients with post-acute spinal cord injuries. In addition, the difference in the K-BBS, WISCI, SCIM according to the degree of severity of the SEP (somatosensory evoked potential) findings of the posterior tibial nerve was analyzed in these patients. Method: Thirty patients with post-acute spinal cord injuries were assessed with the K-BBS, WISCI, and SCIM every other week until discharge. A posterior tibial SEP study was recorded at the beginning of rehabilitation. Delayed latency or small amplitude in the SEP on one or both sides was regarded as the mild group, and non-evoked SEP on both sides was regarded as the severe group. Improvement in walking was based on the change in the scores from admission to discharge. The statistical analysis included the non-parametric Spearman rank correlation and t-test; p＜ 0.05 Results: The assessment scales showed a high correlation between the K-BBS, WISCI, and SCIM (p＜0.05). The relationship between the K-BBS and WISCI was specifically strong (r=0.936). Moreover, there was a significant difference in the scores of the K-BBS, WISCI, and SCIM according to the severity of the SEP (p＜0.05). Conclusion: The findings of a statistical correlation of the K-BBS and the posterior tibial SEP with the WISCI and SCIM provides strong support for their use as outcome measures. (J Korean Acad Rehab Med 2010; 34: 513-517)

Objective
To verify the safety and clinical utility of noninvasive respiratory management as an alternative method of invasive respiratory management for the patients with cervical spinal cord injury (CSCI) who often present with ventilatory insufficiency (due to inspiratory muscle paralysis) or difficulty in removing airway secretions (because of expiratory muscle weakness). Method: Nineteen patients with CSCI (male: 15, female: 4, mean age: 45.6) were recruited. All of the patients were in need of mechanical ventilation due to ventilatory failure or indwelling tracheostomy tube for secretion management. In order to switch from invasive to noninvasive means of respiratory management, expiratory muscle aids such as manual assist or CoughAassist^Ⱂ and inspiratory muscle aids such as noninvasive ventilatory support were applied to all candidates. Results: Fifteen out of the 19 patients had indwelling tracheostomy tubes, and the remaining 4 patients were intubated via endotracheal tubes at admission. Through the noninvasive respiratory management, we were able to remove intubation or traheostomy tubes for all of the patients. Eleven patients were able to maintain normal ventilation status without ventilatory support, as time went on. The rest 8 patients were continuously in need of ventilatory support, but they could maintain normal ventilation status by noninvasive method. Conclusion: Noninvasive respiratory management is safe and equally effective in treating ventilatory insufficiency or removing airway secretions for patients with CSCI. In cases of long-term ventilator dependency or chronic tracheostomy state, it can be replaced as a creditable alternative to invasive respiratory management. (J Korean Acad Rehab Med 2010; 34: 518-523)

Objective
To translate the English Qualiveen questionnaire which was developed to measure the specific impact of urinary problems on the quality of life of patients with neurogenic bladder into Korean and validate it. Method: First, we made the Korean version Qualiveen questionnaire through translation and cross-cultural adaptation followed by the international guideline. This process consisted of 6 steps including translation, reconciliation, back translation into English and debriefing. And then to assess the reliability and construct validity of the questionnaire, 32 patients with neurogenic bladder conducted the Korean Qualiveen questionnaire twice at an interval between three and four weeks. Results: We translated and arbitrated a total of 151 questions. In step of the backward translation, we went through discussion and corrected 12 questions. We found out that 7 questions delivered inaccurate meanings or were unhandy items such as method of writing age or date in debriefing process. A reliability study revealed strong internal consistency (Cronbach's alpha coefficients above 0.7 for all domains) and test-retest reliability (Pearson's coefficient range from 0.524 to 0.837). The sub-domain strongly correlated with each other (Pearson's coefficient range from 0.625 to 0.936) in the construct validity study. Conclusion: The Korean version of the Qualiveen Questionnaire was successfully translated and validated. (J Korean Acad Rehab Med 2010; 34: 524-543)

Objective
To investigate the usefulness of Capute developmental test (Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale, CAT/CLAMS) as a screening test for detecting the language delay by evaluating the correlation with sequenced language scale for infants (SELSI). Method: Subjects were comprised of 101 children (18∼48 months) who were referred for evaluation of language delay. Administering CAT/CLAMS, the developmental quotients (DQs) of CAT and CLAMS, including receptive language quotient (RLQ) and expressive language quotient (ELQ), were calculated. The results of RLQ, ELQ and DQs of CAT/CLAMS were compared with the receptive, expressive and total speech quotient (SQ) of SELSI. Results: The correlation between CLAMS DQ and total SQ (r=0.75, p＜0.01), between CLAMS RLQ and receptive SQ (r=0.76, p＜0.01), and between CLAMS ELQ and expressive SQ (r=0.79, p＜0.01) was statistically significant. CLAMS (DQ＜70) revealed a sensitivity of 87% and a specificity of 78% for detecting language delay defined by total SQ＜70. Conclusion: Correlation coefficient comparing CLAMS with SELSI test was significantly high in children with language delay. CLAMS DQ 70 is a reasonable screening cutoff score for detecting total SQ＜70. (J Korean Acad Rehab Med 2010; 34: 544-549)

Objective
To compare the balance parameters, the diabetes mellitus (DM) composite score representing the severity of diabetic polyneuropathy, and the neuropathy impairment score-lower limb (NIS-LL). Method: Thirty patients with DM were studied. Subjects were evaluated with nerve conduction study in upper and lower extremities, DM composite score, and NIS-LL, various balance parameters such as plantar pressure difference of both sides and unipedal standing time. The subjects who could not stand without support by any reasons were excluded. Results: NIS-LL showed strong correlation with DM composite score (r_s=0.683) and unipedal standing time (r_s=0.663) (p＜0.01). NIS-LL also revealed moderate correlation with plantar pressure difference of both sides (r_s=0.512) (p＜0.05). DM composite score showed strong correlation with unipedal standing time (r_s=0.646) (p＜0.01), but revealed no significant correlation with plantar pressure difference of both sides (r_s=0.137) (p＞0.05). Conclusion: NIS-LL was considered to have clinical usefulness in the evaluation of balance problems related to DM. (J Korean Acad Rehab Med 2010; 34: 550-553)

Objective
To develop and validate the Korea version of falls efficacy scale-international (KFES-I) in Korean elderly which was developed to assess fear of falling in older people and have been already validated in some European countries. Method: Surveys of 385 older persons from the public health center in Korea based on KFES-I and fall questionnaire such as presence, frequency of fracture within last 6 months, and combined medical illness were taken. KFES-I was composed with 16 items of activities of daily living including social activities and graded from 1 to 4 in each item. Two-week KFES-I re-test data were collected. Reliability and validity estimates were computed as well as KFES-I sum scores according to age, sex, and falls history. Results: Cronbach's alpha was 0.971 and mean inter-item correlation was 0.665. Test-retest Pearson correlation coefficient was 0.960 (p＜0.01). As expected, KFES-I scores were associated with age, sex, and falls history (p＜0.05). In addition, the KFES-I discriminated between sub-groups somewhat better than the original ten-item KFES scale. Conclusion: KFES-I appears to be a reliable and valid method for measuring fear of falling in older adults. This study provides the preliminary evidence that KFES-I is a useful tool in evaluating Korean elderly who fear falling. (J Korean Acad Rehab Med 2010; 34: 554-559)

Objective
To investigate the optimal number of repetition trials and to evaluate the test-retest reliability of passive knee joint position sense test. Method: Thirty healthy subjects were tested with isokinetic machine. The knee joints were placed in starting angle of 0^o for flexion test and 90^o for extension test. To memorize the target angle, the knees were passively positioned to the target angle (30^o in flexion test and 60^o in extension test) and left hold for 10 seconds, and returned to starting position. After these processes, knee joints were passively moved toward target angles. The subjects were instructed to press button when the memorized angles were estimated to be reproduced. The tests were performed 6 times for each test angle. After 48 hours, the tests were repeated. Intra-class correlation coefficients (ICC) were calculated with the values of test and retest. Results: There were no significant differences in absolute angular errors (AAE) between dominant and non-dominant side. The ICC value of above five repetitions of test showed excellent reliability (0.807) whereas three and four repetitions showed moderate reliabilities (0.536∼0.709). Conclusion: From the results of this study, we suggest that five repetitions of test could be appropriate for the passive joint position sense test. (J Korean Acad Rehab Med 2010; 34: 560-564)

Objective
To investigate the sonographic appearance of plantar fibromatosis in Korean adults, thus enabling sonographic diagnosis of the benign, focally invasive fibrous neoplasm. Method: The medical records, pathologic reports, and sonographic reports and image of 42 patient with plantar fibromatosis were reviewed retrospectively. Results: US demonstrated plantar fibromatosis as a fusiform nodular thickening of the plantar fascia oriented according to its major axis. A total of 60 fibromatosis nodules in 42 patient were examined. Thirty-eight (63.33%) of the 60 were elongated. The remaing 22 were rounded or oval. Thirty- five (58.33%) were hypoechoic; fivty-one (85%) were 20 mm long or less. Eight of 9 lesions that had mixed echogenicity were longer than 20 mm. Conclusion: Our results suggest that the lesions of the plantar fibromatosis were characteristically located on the surface of the plantar fascia, longitudinally elongated, most often less than 20 mm long, fusiform and hypoechoic. Lesions longer than 10 mm often exhibited mixed echogenicity. Our sonographic finding was helpful in diagnosing planatar fibromatosis in the Korean. (J Korean Acad Rehab Med 2010; 34: 565-569)

Objective
To investigate the actual driving status and driving related safety issues of older drivers aged 65 years or older. Method: We conducted a survey on 56 elderly drivers about driving status, driving habits, safe driver self check list, and medical conditions that may affect safe driving. For comparison, 50 younger drivers aged between third and fifth decades were also surveyed. Results: The mean age of total 56 elderly drivers was 69.96 years old. Their mean driving time in life was 23.6 years and the purposes of driving were shopping (23.2%), religion activity (21.4%) and leisure (16.1%). Most vehicles were equipped with automatic transmission (83.9%) and power steering (91.1%) and the most common type of vehicle was a sedan (82.1%). The incidence of their motor vehicle accidents in recent 2 years was 21.4%, which was higher than that of control group (18.0%) without statistical significance. The driving habits questionnaire revealed elderly drivers tend to avoid rush-hour traffic, driving at night, and high-traffic roads in 75.0%, 69.6%, 51.8% of subjects respectively. The result of safe driver self check list showed that mean demerit score of elderly drivers was 4.3, which was higher than that of younger drivers (3.2). Elderly drivers had hypertension (33.9%), diabetes mellitus (17.9%), eye disorders (8.9%), heart disease (8.9%), arthritis (8.9%), stroke (7.1%), and respiratory disease (5.4%). Conclusion: Compared to younger drivers, elderly drivers tend to avoid unsafe driving situations and reported more safety problems in the safe driver self check list. Elderly drivers also had more medical conditions that may affect safe driving, such as eye disorders, cardiovascular, and metabolic diseases. (J Korean Acad Rehab Med 2010; 34: 570-576)

Objective
To provide normal reference values of the sonographic diameters and cross sectional area (CSA) of the posterior tibialis tendon (PTT) in Korean adults for early diagnosis and treatment of PTT dysfunction. Method: 240 feet from 120 healthy volunteers (63 males; 57 females, mean age: 36.40±11.37) were included in this study. Those with a previous history of surgery or trauma to the lower extremities and systemic disease, such as, hypertension, diabetes, or rheumatoid arthritis were excluded. PTT was examined through ultrasonograhy with the patient placed in the prone oblique position, with the knee extended, and ankle dorsiflexed to neutral angle. We evaluated the anterioposterior (AP) and transverse diameter and CSA of the PTT along the line that connected from the posteroinferior angle of the medial malleolus to the heel. Results: The AP diameter of PTT measured by sonography was 3.42±0.03 mm and the transverse diameter of the PTT was 9.20±0.08 mm. The CSA was 21.46±0.26 mm². Differences in diameters and CSA related to sidedness, sex did not show statistical significance (p＞0.05). There was weak linear relationship in AP and transverse diameter and CSA with weight, height, leg and foot length. Conclusion: The normal Korean reference values of the PTT diameter and CSA that we obtained from ultrasonography can be used as useful reference data in diagnosing early pathologic conditions of PTT dysfunction. (J Korean Acad Rehab Med 2010; 34: 577-582)

Dystonia is a movement disorder caused by involuntary, sustained muscle contractions, frequently resulting in twitching and repetitive movements or abnormal postures. Dopa- responsive dystonia (DRD) is characterized by early childhood onset, marked diurnal fluctuation of symptoms and dramatic response to levodopa. The aim of this report is to present the two cases of DRD misdiagnosed respectively as cerebral palsy and hereditary spastic paraplegia. Proper understanding of this disease entity and its treatment options are necessary for comprehensive rehabilitative management of DRD. (J Korean Acad Rehab Med 2010; 34: 583-586)

Patients with severe cerebral palsy (CP) are susceptible to bone fractures due to low bone mineral density, deformity from contracture and developmental disability. We experienced a 12-year-old spastic CP female who sustained recurrent fracture of the right femur. The first episode occurred when she had been moved passively by another child in residential care. She underwent operative treatment with plate fixation, but seventeen days after operation, spasticity of legs aggravated and refracture happened at the fixation site. She underwent re-operative fixation, but at three days after the second operation, she sustained another fracture at the top of the plate, for which she underwent the third operation. She was then referred to our department for scissoring patterns of the lower extremities. We performed bilateral obturator nerve block which relieved patient's spasticity. We think that her recurrent fracture may be related with ignored risk factor of refracture such as uncontrolled spasticity. (J Korean Acad Rehab Med 2010; 34: 587-590)

Congenital muscular torticollis (CMT) is called 'pseudotumor of infancy' because it is commonly discovered and diagnosed within 14∼28 days after birth as a sternomastoid tumor. We report two cases of CMT which presented as head tilt without any palpable neck mass immediately after birth but later developed into sternomastoid tumors. Serial ultrasonography confirmed increased echogenicities of the sternocleidomastoid muscles. We think that these findings are prodromal signs of sternomastoid tumors. Close physical examination by a neonatologist is crucial for an early diagnosis of CMT. Neonates with head tilt and increased ecogenicity of the sternocleidomastoid muscle on ultrasonography should be carefully followed up to see whether neck mass develops later. The authors suggest that CMT is not a static entity but rather one that progress to mass alteration after birth. (J Korean Acad Rehab Med 2010; 34: 591-594)

Subacute progressive ascending myelopathy is a rare condition complicating spinal cord injury, unrelated to mechanical compression, instability, hemorrhage or syrinx formation. Clinically, ascending neurological deficit may extend at least two segments above the level established at the initial insult within the first 3 weeks of the initial spinal cord insult. MR imaging characteristically demonstrates cord changes ascending at least four vertebral levels above the initial injury site. The development of progressive myelopathy is a dreaded complication of spinal cord injury and is not misunderstood for post-op complication. We describe a case of a 29-year-old male patient who suffered a falling down accident. He initially presented with a T12 vertebral fracture with associated cord compression and signal changes in the spinal cord. During the subsequent 3 weeks, he developed progressive sensory changes with cord signal abnormalities on magnetic resonance imaging extending above from the injury site. (J Korean Acad Rehab Med 2010; 34: 595-598)

Bisphosphonates are the most widely prescribed medications for the treatment of osteoporosis. However, bisphosphonate- related osteonecrosis of the jaw (BRONJ) is recently recognized as a serious complication among patients receiving bisphosphonate therapy. Most reports relate to BRONJ result from intravenous bisphosphonate or dental procedure. We report a case of mandible osteonecrosis related with oral bisphosphonate medication. A-63-year old woman suffered from toothache, cheek swelling and heating sense visited our dental clinic. She had taken oral alendronate and antihypertensive agents for 4 years because of osteoporosis and hypertension. Dental physical examination, radiologic study and pathologic study showed the severe inflammation and osteonecrosis of the mandible. Therefore we diagnosed the patient as having BRONJ and she stopped to take bisphosphonate and received surgical treatment with bone curettage. After surgical treatment and stopping bisphosphonate, her symptoms were improved. (J Korean Acad Rehab Med 2010; 34: 599-602)

Achalasia is rare disorder with an estimated prevalence of 0.5∼1 per 100,000 per year and secondary achalasia due to trauma is rarer. The following case report describes a patient who developed achalasia after chest trauma. This report presents a 22 year-old male with chest trauma who had hoarseness and postprandial reflux. We suggested the achalasia through video-fluoroscopic swallowing study (VFSS), and confirmed superior and recurrent laryngeal neuropathies through laryngeal electromyography (EMG). VFSS and laryngeal EMG are helpful to diagnose the achalasia due to vagus nerve injury after chest trauma. (J Korean Acad Rehab Med 2010; 34: 603-606)

The causes of leg length discrepancy in childhood include neurologic, musculoskeletal, tumor and vascular diseases. It may contribute secondary complications such as gait disturbance, scoliosis, hip joint arthritis or cosmetic problem etc. Acquired arteriovenous fistula is a rare cause of leg length discrepancy. Multiple vascular punctures in the neonates, especially in prematures, can result in iatrogenic arteriovenous fistula formation. We report two cases of arteriovenous fistula secondary to vascular punctures, diagnosed by color doppler ultrasonography and CT angiography. The lesions were explored and treated surgically. (J Korean Acad Rehab Med 2010; 34: 607-610)