Objective
To identify the effective injection route for adult human bone marrow stromal cells into traumatic brain injured rats. Method The TBI rats were created by the lateral percussion model (HD1700, Dragonfly, Silver Spring, USA). Eight rats without stem cell transplantation were assigned to a control group. We performed adult human bone marrow stromal cell transplantation into the contralateral hemisphere (n=7), the ipsilateral brain lesion (n=8) and via a tail vein (n=11), respectively, at 24 hours after brain injury. For all of the groups, MRS (magnetic resonance spectroscopy) study, behavior tests, rotarod tests and Barnes maze tests were conducted on day 1, day 7, day 42 and day 84. Sixteen rats were randomly assigned and were sacrificed for immunohistochemical staining. Results At day 42 (p=0.048) and day 84 (p=0.031) after TBI, the ratio of N-acetylaspartate to creatine (NAA/Cr) of the ipsilateral hemisphere was decreased in the control group, as assessed by MRS, whereas the ratio was increased in the other groups. On the post hoc analysis, significant differences were obtained among the intravenous group and the control group for the NAA/Cr ratio of the ipsilateral hemisphere at day 84 after TBI (p=0.050). However, there was no significant improvement on the behavior test, the rotarod test and the Barnes maze test. The cells were positively stained with antibodies to MAB-1281 and to GFAP. Conclusion We confirmed that adult human bone marrow stromal cell transplantation induced an increase of the NAA/Cr ratio of the ipsilateral hemisphere at day 84 in the intravenous group. Therefore, we suggest the intravenous route is more effective for mesenchymal stem cell transplantation.

Objective
To assess the effect of visuomotor coordination training on the visual perception of geriatric stroke patients. Method Thirty (n=30) cooperative geriatric stroke patients were randomly assigned into 2 groups. The control group received conventional rehabilitation therapy, and intervention group received additional visuomotor coordination training with Dynavision for 30 minutes a day, 3 times a week for 4 weeks. We assessed visual perception and functional status before and after intervention by measuring K-MMSE, K-MBI, K-DRS scores, and by conducting Computerized Neuropsychological Test (CNT) (Maxmedia, Seoul, Korea) 1) visual memory; visual span backward & forward, 2) visual attention; visual continuous performance test (correct response, reaction time), 3) visuomotor coordination; trail making A test. Results The intervention group showed significant improvement in visual attention (p＜0.05). There was no significant difference in visual memory, visuomotor coordination and K-DRS (p＞0.05). Both groups showed significant increase in K-MMSE and K-MBI scores (p＜0.05), but there was no significant difference between the two groups (p＞0.05). Conclusion Dynavision training improved the primary visual skill - visual attention, but did not improve higher order visual skills, such as visual memory, visuomotor coordination, cognition or functional performance in the elder stroke patients. Dynavision could be a useful tool for cognitive rehabilitation in patients with cognitive impairment and attention deficit by improving visual attention.

Objective
To investigate the effects of high frequency (10 Hz) repetitive transcranial magnetic stimulation (rTMS) on visuospatial motor learning, stimulated on the premotor cortex in basal ganglia hemorrhage patients. Method Nine patients were randomized to receive real and sham rTMS. We subdivided into two groups according to the integrity of the corticospinal tract measured by diffusion tensor tractography. The implicit visuospatial learning paradigm composed of numbers 1 to 4, in which 12 sequential numbers (2-3-1-4-3-2-4-1-3-4-2-1) were incorporated randomly. We obtained the mean fraction anisotrophy (FA) and apparent diffusion coefficient (ADC) values from the corticospinal tract and subdividing into two groups by calculating the relative value (laterality %). Results rTMS on the premotor cortex was effective only in simple motor learning but not in visuospatial learning in group analysis. The primary motor cortex excitability after the premotor cortex stimulation has been changed significantly. Subdividing into two groups according to the integrity of the corticospinal tract using the ADC value, the low ADC value group showed significant reduction of the visuospatial response time. Conclusion High frequency rTMS on the premotor cortex was effective in simple motor learning and also in the group who maintained more integrity of the corticospinal tract in basal ganglia hemorrhage.

Objective
To determine the effects of dynamic ankle foot orthosis (AFO) on balance control by comparing it with conventional plastic AFO and barefoot conditions in hemiparetic patients. Method Fifteen hemiparetic patients with brain lesions were recruited for this study. All subjects were capable of standing up independently and had a modified Ashworth score of less than two. The postural control capabilities of the subjects were assessed using the timed up and go (TUG) test, and Tetrax^Ⱂ tetra-ataxiametric posturography. The stability index, weight distribution index, and synchronization index were measured at six different head positions with dynamic AFO, conventional AFO and under barefoot conditions. Results There were nine males and six females, whose average age was 45.1 years. There was a significantly even weight distribution for the dynamic AFO and conventional AFO conditions relative to the barefoot condition in neutral, right-sided head, and left-sided head with eyes closed (p<0.05). And there was significantly increased stability in left sided-head, neck flexed positions with eyes closed for dynamic AFO and conventional AFO (p<0.05). However, there was no significant difference in weight distribution or stability between dynamic and conventional AFO conditions, except the stability in right-sided head position with eyes closed. Conclusion In this study, the balance control of hemiparetic patients with dynamic AFO was better than in the barefoot condition, and was similar to conventional AFO. Therefore, we suggest that dynamic AFO may be a useful orthosis for hemiparetic patients with mild to moderate spasticity with poor balance control and foot drop.

Objective
To evaluate the effects of neuromuscular electrical stimulation on the swallowing function in healthy older adults without clinical dysphagia. Method The subjects were 18 healthy older adults aged >70 years and 10 young adults aged <30 years without symptoms or a history of dysphagia. Both groups were evaluated by the functional dysphagia scale (FDS) and pharyngeal transit time (PTT), using a videofluoroscopic swallowing study with semisolid material. Only the healthy older adults group received neuromuscular electrical stimulation (NMES) on suprahyoid and infrahyoid muscles, 60 min/day, 5 days/wk, for 2 weeks. The healthy older adults group was then re-evaluated by FDS and PTT. Results The average PTT in young adults was lower than in healthy older adults. FDS of the oral phase was larger in the older adults than in the young adults. After NMES for 2 weeks in older adults, there was a significant improvement in the averages for PTT and FDS. Conclusion The results of this study showed that healthy older adults without clinical dysphagia had decreased swallowing function when they were compared with young adults. After NMES, the swallowing function, evaluated by FDS and PTT, was improved in healthy older adults.

Objective
To investigate the short term effects of prefrontal transcranial direct current stimulation (tDCS) in healthy older adults aged more than 65 years by means of verbal and visuospatial working memory tasks. Method Twenty four healthy older adults (14 males and 10 females, age range: 65-78 years old) were enrolled in this study. A double-blind study was conducted. The subjects underwent sham or anodal tDCS over the left prefrontal cortex (F3 in the international 10-20 EEG system). DC was delivered for 30 minutes at 2 mA with 25 cm² saline- soaked sponge electrodes. A cathode electrode was applied to the left arm. Before and after tDCS, the subjects performed 2-back verbal working memory and visuospatial memory tasks. The rates of improvement of the accuracy and the reaction time were analyzed. Results On the 2-back verbal working memory tasks, the verbal working memory accuracy was improved in the real group compared with that of the sham group. On visuospatial working memory task, the working memory accuracy and reaction time were not improved in either the real group or the sham group. Conclusion The results showed beneficial effects of noninvasive anodal tDCS on the cognitive function in healthy older adults. We suggest that tDCS induces functional changes on the left prefrontal cortex, and it improves the age-related cognitive impairment in the healthy elderly population.

Objective
To investigate the effects of complex decongestive physiotherapy (CDPT) with sodium selenite compared to the effects of CDPT without sodium selenite for the treatment of breast cancer-related lymphedema (BCRL). Method Patients (n=40) who were diagnosed with BCRL were randomly assigned to the two groups: sodium selenite group or the non-sodium selenite group. In the sodium selenite group, sodium selenite was administered for 100 days concurrently with CDPT. In the non-sodium selenite group, only CDPT was administered. The main outcome measurements included limb circumference (proximal, distal and total) to indicate volume changes, the visual analogue scale (VAS) and the short form-36 version 2 questionnaire (SF-36) scores to evaluate the quality of life (QoL) pre- treatment, 100 days post-treatment and 130 days post-treatment for each patient. Results The sodium selenite group experienced volume reduction of 8.22% and 9.21%, at 100 and 130 days post- treatment, respectively. The non-sodium selenite group experienced 5.57% and 6.11% reduction in swelling at the same periods. Between the two groups, more significant volume reduction was observed in the affected distal limbs of patients assigned to the sodium selenite group compared to patients in the non-sodium group. However, the VAS and the SF-36 scores were not significantly different between the two groups. Conclusion Sodium selenite therapy in combination with CDPT is effective in reducing the volume of upper limb in BCRL, and significantly reduce the volume of the affected distal upper limb compared to CDPT alone.

Objective
To evaluate the effect of stellate ganglion block (SGB) on the lymphoscintigraphic findings in patients with secondary lymphedema after breast cancer treatment. Method Fourteen patients were included in this retrospective study. Consecutive SGBs were performed three times, once every two weeks. The parameters for the lymphoscintigraphic findings included the extent of dermal backflow (small extent/large extent group), the presence of a washout pattern (washout/non-washout group) and visualization of lymph nodes on the 3-hour image (visualized/non-visualized group). The upper arm and forearm circumferences were used as the outcome parameters. We investigated the relationship between the lymphoscintigraphic findings and the arm circumferences. Results Regardless of the extent of dermal backflow, significant decreases of the upper arm and forearm circumferences were observed between the initial and final follow-up data. The small extent group showed a significant decrease of the forearm circumference at the first follow-up. The large extent group showed a pattern of significant decrease of the forearm circumference since the second follow-up. The washout group showed a decrease in both the upper arm and forearm circumferences, while the non-washout group showed a decrease only in the forearm circumference at the last follow-up. No difference was observed between the visualized and the non-visualized group. Conclusion The extent of dermal backflow and the presence of a washout pattern on lymphoscintigraphy showed correlation with the change of arm circumference. Lymphoscitigraphy prior to performance of SGB for lymphedema patients might be helpful to predict the outcome of SGB.

Objective
To investigate the reference value for cross sectional area (CSA) of the fibular nerve in Koreans. Method One musculoskeletal radiologist and one physiatrist performed fibular nerve ultrasonography (US) on 60 lower extremities of 30 asymptomatic Korean volunteers (16 males, 14 females). The mean age was 46.6 years (range: 21-75 years). We measured CSA of the fibular nerve at three sites: proximal portion (PP) at the bifurcation, mid-portion (MP), and an area just above the fibular head (FH). In addition, the fibular nerves of 7 lower extremities from 4 cadavers were cut from the fibular head to the proximal portion and divided into three sections (PP, MP, FH). They were subsequently fixed with 10% neutral buffered formalin and perpendicularly excised to 2 mm thickness. They were photographed by an operating microscope and CSA was measured. Using the Kruskal-Wallis test, measurements obtained from US images were compared between asymptomatic volunteers with a significance level of 0.05. Results In asymptomatic volunteers, the CSA of the three portions were PP: 13.8±1.2 mm², MP: 11.1±1.0 mm², FH: 10.9±0.6 mm². The fibular nerves were well visualized with clear borders by US. In cadavers, the CSA of three portions were PP: 20.3±10.3 mm², MP: 16.7±8.6 mm², FH: 14.4±8.9 mm². There was no significant difference between the three portions in asymptomatic volunteers and cadavers (p＞0.05). Conclusion In normal Korean adults, the area of fibular nerve at the fibular head is 10.9±0.6 mm². Ultrasonographic evaluation of the fibular nerve can be helpful in diagnosing fibular nerve lesions.

Objective
Compared to elderly men, elderly women have substantially reduced performance of postural balance and greater risk of falls. To investigate the effect of age and sex on electromyographic (EMG) reaction time of tibialis anterior muscle contraction. Method Fifty-nine elderly subjects and 29 young subjects participated in this study. Subjects were instructed to dorsiflex the ankle of the dominant leg as forcefully and quickly as possible in response to audible beeps. EMG activity was recorded over the tibialis anterior muscle and delays in initiation and termination of EMG signal were measured by two examiners. Mean and intrasubject variability of each delay were used as outcome measures. Results Both the intra-examiner and inter-examiner reliability of delay variables were above 0.97. Delays in initiation and termination of muscle contraction, as well as their intrasubject variability, were significantly greater in the elderly (p＜0.01). However, there were no sex differences or interaction in all outcome measures. Conclusion These results demonstrate that the EMG reaction time and their variability increase in the elderly population with no sex difference.

Objective
To establish reference data for dermatomal somatosensory evoked potentials (DSEP) using a stimulation intensity lower than what is conventionally utilized. Method Fifty subjects (25 older adults＞48 years old; 25 younger adults＜32 years old) without history of neck pain or cervical spine surgery were enrolled. The DSEP study was performed with stimulation intensities of 1.0, 1.5, and 2.5 times sensory threshold (ST) on right arms for C5, C6, C7, and C8 dermatomes. Results The mean latencies of DSEP stimulating C5, C6, C7, and C8 dermatomes with 1.5 times ST intensity were 17.6±1.7 ms, 22.2±2.1 ms, 22.8±1.4 ms, and 22.6±1.8 ms, respectively. The mean amplitude (N1P1) of DSEP stimulating C5, C6, C7, and C8 dermatomes with 1.5 times ST intensity were 0.9±0.4 ՌV, 0.9±0.5 ՌV, 1.0±0.6 ՌV, and 1.1±0.8 ՌV, respectively. The C5, C6, C7, and C8 DSEP were evoked in 84%, 98%, 100%, and 96% of cases with 2.5 times ST compared to 64%, 56%, 60%, and 62% with 1.5 times ST, respectively. When one DSEP was not evoked, the DSEP of the opposite side was evoked only in 2 subjects. Conclusion This study provides the reference data of DSEP with lower stimulation intensities than are conventionally utilized. Additionally, two cases of clinical significance were reported.

Objective
To delineate the clinical manifestation of myofascial pain syndrome (MPS) around the face, neck and shoulders in patients with cervical vertigo (CV) and to determine whether treatment of MPS can improve CV. Method We evaluated 72 patients who were diagnosed with CV and 72 patients as controls who had MPS in the neck and shoulder without vertigo symptoms. Clinical evaluations for MPS were performed on all subjects, and vestibular function tests were also performed in patients with vertigo symptoms. Most patients and controls received treatments including trigger point injection, physical therapy or medication, and were then followed up. Results Seventy CV patients (97%) had MPS in the face, neck and shoulders. The distribution of trigger points in CV patients differed from that in controls, especially in the lateral neck muscles (odds ratio=0.361, p=0.019). The gender, age, symptom duration and number of trigger points were not different between CV patients and controls. 57 CV patients and 56 controls that had received treatments were followed up. Vertigo symptoms improved in 40 CV patients (70%) after treatment of MPS and pain symptoms improved in 77% of CV patients and 75% of controls after treatment. Conclusion Most CV patients had myofascial pain syndrome and the distribution of trigger points differed from that in controls. Treatment for myofascial pain syndrome could improve vertigo symptoms in CV patients, but further study is required to delineate the relationship between MPS and CV.

Objective
To access the clinical features of peripheral arterial disease (PAD) combined with lumbar spinal stenosis (LSS) in patients, and the effects of peripheral arterial disease rehabilitation after peripheral vascular intervention. Method We studied 21 patients who were diagnosed with PAD combined with LSS. We investigated the past histories symptoms, diagnoses and treatment of the 21 patients to determine if there were atypical features that could be attributed to PAD. Thirteen patients who were diagnosed with PAD combined with LSS received peripheral arterial disease rehabilitation after peripheral vascular intervention. A control group (n=11) was instructed to practice self- exercise training in the community exercise program after peripheral vascular intervention. Initial claudication distance (ICD), absolute claudication distance (ACD), peak oxygen uptake, and ankle-brachial index (ABI) were measured at baseline, 3 months, and 6 months after peripheral arterial disease rehabilitation. Results Thirteen of 16 patients were satisfied with the cardiac rehabilitation program and experienced symptom relief, however, there was a recurrence of symptoms and peripheral arterial restenosis in 2 patients. After peripheral arterial disease rehabilitation, PAD and LSS groups showed significant changes in ABI, ICD, ACD, and peak oxygen uptake. The control group also showed significant improvements of ABI, ICD, ACD, and peak oxygen uptake. There were significant differences between the two groups in ICD, ACD, and peak oxygen uptake after 6 months. Conclusion Attention should be paid to patients complaining of back pain, lower limb radiating pain, and claudication, because they were diagnosed with neurogenic intermittent claudication by simple spinal stenosis and it would overlook the PAD. We recommend also considering the possibility of PAD. Compared with angioplasty alone, angioplasty in combination with subsequent training is a superior treatment modality for patients with intermittent claudication.

Objective
To investigate the effect of the body shape molded inner system on attenuation of spinal curvature and pelvic obliquity in cerebral palsy (CP) with scoliosis. Method Fifteen patients with CP who had fixed or non-fixed scoliosis were recruited. By radiographic studies, Cobb's angle and pelvic obliquity were measured with or without sitting in the body shape molded inner system. Results Spinal curvature assessed by Cobb's angle was significantly reduced when CP patients were seated in the body shape molded inner system rather than in conventional seats. Although pelvic obliquity was not improved in patients with fixed scoliosis, it was significantly ameliorated in patients with non-fixed scoliosis when seated in the body shape molded inner system. Conclusion The body shape molded inner system attenuated spinal curvature and pelvic obliquity in CP patients with non-fixed scoliosis which had a flexible spinal curve.

Objective
To evaluate the prevalence of dysphagia in neonates who showed abnormal findings on videofluoroscopic swallowing studies (VFSSs), and to compare the accuracy of the clinical evaluation with the VFSS results. Method A clinical investigation of 142 neonates admitted to a neonatal intensive care unit was carried out to evaluate the presence of low O₂ saturation (＜80%), symptoms of cyanosis, coughing and/or vomiting, nasal regurgitation, drooling saliva, voice change and crying during feeding. VFSSs were performed on the neonates who had at least one of these clinical abnormalities. Results Of the 142 patients, 37 (26.1%) had at least one of the clinical symptoms of dysphagia. Twenty two of 37 (59.5%) showed abnormal findings on the VFSS. The patients exhibiting cyanosis and coughing during feeding had a higher incidence of aspiration (11 of 11, 100%) on the VFSSs than did the patients with other symptoms: cyanosis (3 of 13, 30.8%), cyanosis with vomiting (0 of 2, 0.0%), coughing without cyanosis (2 of 5, 40.0%), voice change (2 of 2, 100%) and nasal regurgitation (1 of 3, 33.3%). Conclusion The prevalence of laryngeal penetration or subglottic aspiration among those neonates who were clinically suspected of dysphagia was 59.5%. Coughing with cyanosis during feeding was the best predictor of both these abnormalities.

Objective
To present the clinical characteristics of abnormal posture of the head and neck (APHN) caused by unilateral superior oblique palsy (USOP) for differential diagnosis of childhood APHN. Method The medical charts of children who came to Department of Physical Medicine and Rehabilitation, Ajou University Medical Center from 2003 to 2008 for APHN were reviewed with special reference to ocular causes of APHN. Children who showed a positive Bielschowsky's head tilt test were strongly suspected to have USOP. In-depth ophthalmic evaluations were done after 6 months of age to identify USOP for those children. The clinical characteristics of children with USOP were compared with those of children with congenital muscular torticollis. Results Sixteen children were diagnosed with APHN related to ocular causes. Seven children out of 16 (43.8%) had APHN secondary to USOP, which was the most common ocular cause of APHN. The initial clinical presentation of 7 children with USOP was contralateral laterocollis toward the shoulder on the non-USOP side at a mean age of 15.57±12.55 months; USOP was diagnosed at a mean age of 19.07±11.29 months. APHN was aggravated by staring at objects, and craniofacial asymmetry was not evident at this age compared to children with congenital muscular torticollis. Conclusion The clinical characteristics of USOP were presented, which showed laterocollis toward the shoulder of non-USOP. Differential diagnosis of APHN is critical for proper management for APHN and high index of suspicion for USOP by non-ophthalmologic physicians could make earlier diagnosis of USOP possible.

Objective
To determine the factors which influence the level of sexual adjustment. Method A total of 96 subjects were enrolled in this study. The measuring instruments consisted of the dependent variables related to the perception of sexual adjustment and the independent variables that have an influence on sexual adjustment. The dependent variables were comprised of three sub-elements: satisfaction with sexual life, negative attitudes and prejudices, and sexual attractiveness. The independent variables were comprised of physical factors including sexual functioning; psychological factors including self-esteem, depression, the acceptance of disability, and ego-resilience; and domestic factors including feelings of intimacy with the partner, and support from family. Results The level of the sexual adjustment in men with spinal cord injury (SCI) was relatively high. When considering the correlation between the factors and sexual adjustment, the level of intimacy with the partner showed the highest correlation, followed by depression, ego-resilience, self-esteem, acceptance of disability, support from family, and sexual functioning, respectively. Finally, sexual adjustments were mainly influenced by psychological and domestic factors such as the intimacy with the partner and depression. Conclusion Despite the disability of sexual function, men with SCI, recorded overall high levels of the sexual adjustment. The level of intimacy with the partner and depression were the variables that had effects on sexual adjustment.

Objective
To describe the current status of medical care for victims of industrial disaster in Korea, and especially for representative diseases requiring rehabilitation, such as ischemic, hemorrhagic stroke, intervertebral disc disease, and spinal fracture. Method Data were extracted from the electronic data interchange database of the Korea Workers' Compensation and Welfare Service. Patients who had been approved as industrial disaster victims between January 1 and December 31, 2006 were included. This study covered 4 representative diagnoses: ischemic stroke, hemorrhagic stroke, intervertebral disc disease, and spinal fracture. We conducted an analysis of the length of in-patient and out-patient treatment, total length of treatment, medical cost according to types of disease, first admitted medical institute, age, sex, and the number of admissions from the approved time up to June 30, 2008. Results A total of 4,581 patients were included. There were 49, 373, 1,223, and 2,936 patients with ischemic stroke, hemorrhagic stroke, intervertebral disc disease, and spinal fracture, respectively. The total length of care tended to be longer in cases of neurologic disease. Positive correlations were observed between the total length of treatment and the type of first admitted medical institute in cases of ischemic stroke and spinal fracture. Medical cost showed an increasing trend in association with length of in-patient care. Conclusion Differences were observed in the total length of care and medical cost, depending on the type of disease. The number of admissions showed a correlation with the length of inpatient treatment. The length of inpatient treatment was the most important factor determining medical cost.

Saphenous mononeuropathy is an uncommon neuropathy in clinical condition, which may incur from various surgical procedures, direct trauma, or entrapment, and most frequently involves at the adductor canal, or Hunter's canal. A 17-year old female, who was majoring in ballet, visited our rehabilitation clinic for numbness in the medial aspect of the left lower leg for the previous 9 months, without weakness. The electrodiagnostic study revealed only a delayed small potential in the left saphenous nerve. MRI examination showed soft tissue swelling in the medial side of the left knee. Accordingly, we diagnosed the patient with saphenous mononeuropathy around the knee, without lumbar plexopathy or femoral neuropathy. We report a case of saphenous mononeuropathy which developed after repetitive compression on the medial side of the knee without any other iatrogenic injury, and include a review of the relevant literature.

Gluteal compartment syndrome is a rare disorder which often occurs in conjunction with prolonged immobility after an overdose of sedative. Signs of sciatic nerve compression frequently occur, and rhabdomyolysis may be associated with the syndrome. We recently encountered a patient with lumbosacral plexopathy, complicated by gluteal compartment syndrome. A 42-year-old man presented with weakness and swelling in the right lower extremity and gluteal area after an overdose of antipsychotic drug, accompanied by prolonged immobilization. Serum creatine phosphokinase and urinary myoglobin were markedly elevated, and a T2-weighted pelvis MRI showed hyperintensities and swelling in the gluteal muscles. An electrodiagnosis study showed incomplete lumbosacral plexopathy. The patient received medical treatment and rehabilitation. Six months later, his right lower limb weakness had improved and he could walk independently. Lumbosacral plexus injury with rhabdomyolysis is a rare but debilitating disorder. Therefore, early diagnosis and treatment are crucial for prevention of neurologic deterioration.