Method: Thirty-five registered disabled persons after stroke were evaluated by two physiatrists to assess the grades of disability according to CDGG and PDGG, which were in use. The evaluations of disabled persons for the grading were done by the physiatrists through house-visit and at the hospital according to CDGG (hereinafter called CDGG-visit and CDGG-OPD) and PDGG (hereinafter called PDGG-grade). These re-evaluated disability grades were compared with the initial disability grades recorded in their disability registries.

Results: There was a low level of agreement between the registered grade and the re-evaluated grades; however, there has shown a high level of agreement amongst the re-evaluated grades. The degree in the registered grade was evaluated upward compared to the degree in other reevaluated grades.

Conclusion: The difference degree between CDGG and PDGG of established was insignificant; however, a new candidate who wants to be evaluated using CDGG has possibilities of facing unfairness when compared to the disabled people with relatively higher registered degrees. (J Korean Acad Rehab Med 2003; 27: 329-334)

ated disability grades were compared with the initial disability grades recorded in their disability registries.

Results: There was a low level of agreement between the registered grade and the re-evaluated grades; however, there has shown a high level of agreement amongst the re-evaluated grades. The degree in the registered grade was evaluated upward compared to the degree in other reevaluated grades.

Conclusion: The difference degree between CDGG and PDGG of established was insignificant; however, a new candidate who wants to be evaluated using CDGG has possibilities of facing unfairness when compared to the disabled people with relatively higher registered degrees. (J Korean Acad Rehab Med 2003; 27: 329-334)

Method: Medical records of the 108 patients with stroke, spinal cord injury and traumatic brain injury were reviewed after the discharge from acute rehabilitation care. The demographic factors, socioeconomic status, disease characteristics and functional status of the patients were evaluated to investigate the affecting factors to the discharge destinations.

Results: Discharge destinations were subdivided into homes 67 (62%), transfer to other hospitals 31 (29%) and transfer to oriental medicine hospitals 10 (9%). The Functional independence measure (FIM) score, length of rehabilitation care, type of payment, operation and diagnosis significantly influenced discharge destinations (p＜0.05). The patients who were transferred to other hospital showed significantly lower FIM score and longer length of rehabilitation care compared with patients who were discharged to home or transferred to oriental medicine hospital (p＜0.05).

Conclusion: The FIM score, length of rehabilitation care, type of payment, operation, and diagnosis significantly influenced the discharge destinations of patients after rehabilitation. It is necessary to increase the subacute or chronic rehabilitation facilities for the case of patients with severe physical disabilities. (J Korean Acad Rehab Med 2003; 27: 269-274)

Objective: To evaluate the influence of aphasia on the cognitive screening test in stroke patients with unilateral cerebral hemispheric lesions.

Method: We evaluated 51 hemiplegic patients with unilateral cerebral hemispheric lesions using CT or MRI. We divided the subjects into three groups according to the presence of aphasia and motor weakness: right hemiplegic patients with aphasia, right hemiplegic patients without aphasia, and left hemiplegic patients. Functional Independence Measure (FIM), Mini-Mental Status Examination (MMSE) and Neurobehavioral Cognitive Screening (NCSE) Tests were applied in all patients.

Results: No differences were observed in motor FIM scores between three groups. Total FIM and cognitive FIM scores

of the right hemiplegic patients with aphasia were lower than those of the other two groups. MMSE and several sub-items of NCSE (orientation, attention, comprehension, repetition, naming and calculation) showed the same results. But the mean scores of memory, similarity, and judgement items in NCSE were higher in the left hemiplegic patients than the right hemiplegic patients. No differences were observed in the construction score.

Conclusion: All three cognitive screening tests used in this study were remarkably influenced by the ability of the language function of the patients. Lack of adequate items to detect right cerebral hemispheric lesions were also noticed. (J Korean Acad Rehab Med 2002; 26: 9-13)

Objective: Traumatic brain injury is related to the acute stress response, and this can be accompanied by an elevated serum glucose level. So we estimated the influence of hyperglycemia on neurologic, functional status and outcome.

Method: We studied the 139 traumatic brain injured patients who had been admitted to the department of neurosurgery from 1996 to 2000, retrospectively. We reviewed initial serum glucose level, postoperative glucose level, and Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS). We compared these values with functional independence measure (FIM) scores. Patients were divided into two groups according to the initial serum glucose level, then we analyzed the correlation between glucose level and GCS, GOS, FIM.

Results: The correlations of early hyperglycemia with GCS, GOS, initial FIM scores were significant (p＜0.01). But serum glucose levels were not correlated with plateau FIM scores (p＞0.05). Patients with unfavorable neurologic outcome after 10 days from head injury had significantly high serum initial and postoperative glucose levels than those with favorable neurologic outcome (p＜0.01).

Conclusion: In patients who had received rehabilitation therapy with moderate or severe head injury, early hyperglycemia were significantly correlated with initial FIM scores, GCS, GOS, but not with the plateau FIM scores.

Objective: To investigate complications of stroke patients with regard to incidence, predisposing risk factors and their effect on the patients's prognosis during rehabilitation management.

Method: Two hundred fifty nine patients with stroke admitted to Department of Rehabilitation Medicine were included in this study. We analyzed types of stroke, incidence of complications, outcome of rehabilitation treatment and the length of the hospital stay.

Results: Of the 259 patients who had received rehabilitation, shoulder pain occurred in 59 patients (22.8%), depressions in 24 (9.3%), falls in 24 (9.3%) and pneumonia in 21 (8.1%); 112 patients (42.9%) had a total of 174 complications. The incidence of complication was higher in patients who had lower initial FIM score or previous cardiac disease. The patients with complication had longer rehabilitation hospital stay and lower FIM gain and efficacy.

Conclusion: Early detection and treatment of the complications of acute stroke patients during rehabilitation will shorten the length of the hospital stay and improve the overall prognosis of the patients.

Objective: The purpose of this study was to determine whether ¹H magnetic resonance spectroscopy (MRS) is a potential tool for the detection of microscopic diffuse axonal injury (DAI) and for the evaluation of functional status of patients with traumatic brain injury (TBI).

Method: Seven patients with severe TBI and fourteen normal control volunteers were examined. Image guided spectra of localized in vivo ¹H MRS were obtained from parietal white matter (PWM) and occipital gray matter (OGM) in which definite abnormality was not detected in MR imaging. The severity of TBI was evaluated by the initial Glasgow Coma Scale (GCS), and the functional status was evaluated by Functional Independence Measure (FIM) at the time of the MRS examination, approximately 2 months after onset.

Results: In PWM, the [N-acetylaspartate(NAA)/Creatine(Cr)] ratio was significantly lower, and the [Choline(Cho)/Cr] and [myo-Inositol(mI)/Cr] ratios were significantly higher in the patients with TBI than those of normal volunteers. There was no significant correlation between the ratios of metabolites and GCS scores. However, interestingly, a significant correlation between the [NAA/Cr] ratio in PWM and the FIM scores was observed.

Conclusion: We could conclude that decreased [NAA/Cr], increased [Cho/Cr], and increased [mI/Cr] ratios in PWM can be considered as markers for DAI. Localized ¹H MRS has a potential to be used for the detection of DAI in vivo and evaluation of functional status of the patients with TBI.

Objective: To collect the informations of the traumatic spinal cord injury persons in Suwon city.

Method: Seventy-five traumatic spinal cord injury persons were evaluated by the neurological level, American Spinal Injury Association scale, Functional Independence Measure (FIM), Craig Handicap Assessment and Reporting Technique (CHART), Beck Depression Inventory (BDI), and questionnaire on their voiding methods, complications, etc.

Results: The leading cause of 75 persons with traumatic spinal cord injury was a traffic accident. Among them, paraplegics were 46 persons. The most common complication was a pressure sore which was also the leading cause of their rehospitalization. Twenty-six persons voided by reflex. Among five dimensions of CHART, the physical independence score was the highest and the economic self sufficiency score was the lowest. The total CHART scores were significantly correlated with BDI scores, FIM scores, and level of injury.

Conclusion: This study revealed that physical impairment, disability and depression affect the handicaps of spinal cord injury persons. These data could be used to develop a social rehabilitation program for the spinal cord injury persons in the community.

Objective: To identify the neurobehavioral impairment in the traumatic brain injured (TBI) patients and to determine the relationship between the neurobehavioral impairment and functional recovery.

Method: We analyzed and compared Functional Independence Measure (FIM) scores and neurobehavioral psychometry results in 16 patients with severe TBI. The neurobehavioral psychometry tests included Minimental Status Examination (MMSE), Galvestone Orientation and Amnesia Test (GOAT) as screening tools, Korean Wechsler Intelligence Scale (KWIS) for intelligence, Wechsler Memory Scale-Revised (WMS-R) test for memory function, Color Trail test (CTT) 1 and 2 for attention and concentration, Grooved Pegboard Test (GPT) and Finger Tapping Test (FTT) for motor function, Wisconsin Card Sorting Test (WCST) for executive function, and Symptom Checklist-90-Revision (SCL-90-R) for personality.

Results: At discharge, neurobehavioral psychometry of the TBI patients showed impairment of the attention and concentration as demonstrated by severe and moderate impairment in CTT 1 and CTT 2, repectively. Memory disturbance was also noted by the result of mental retardation in WMS-R. But GOAT and MMSE showed normal, KWIS was below average. Motor dysfunction was seen in GPT and FTT and mild executive dysfunction in WCST. Functional recuperation was influenced by attention and concentration, as the FIM score has significant correlation with CTT 1 and FTT.

Conclusion: The TBI patients have the pervasive neurobehavioral impairment, especially severe dysfunction in the memory, attention and concentration. And functional recovery was significantly correlated with attention. The neurobehavioral psychometry will be useful in neurobehavioral evaluation in TBI patients. A further prospective study using Neurobehavioral psychometry would bring a more precise and valuable information.

Objective: Anemia had been reported to be one of the common complications in the spinal cord injured patients. The purposes of this study were to investigate the incidence of anemia, its relating factors and efficacy of rehabilitation therapy in the acute spinal cord injured patients.

Method: A retrospective study was performed in the 103 acute spinal cord injured patients. We monitored serum hemoglobin, serum hematocrit, serum albumin and protein and change of the weight in the acute spinal cord injured patients at our rehabilitation department.

Results: The incidence of anemia was 62.1% (64/103). According to the level of injury, the incidence of anemia was 65.2% in cervical cord injury, 62.5% in thoracic cord injury and 46.2% in lumbar cord injury. The incidence of anemia was not different significantly by the severity of injury. The relating factors of anemia were urinary tract infection, pressure sore, acute bleeding, pneumonia, hypoalbuminemia, hypoproteinemia. Among these, hypoproteinemia was statistically related to anemia. The efficacy of functional independence measure (FIM) was significantly lower in the anemic group.

Conclusion: Therefore we should concern about the prevention and treatment of anemia in the spinal cord injured patients.

Objective: To determine the relationship of the Mini-Mental State Examination (MMSE) scores to the functional improvement of the brain-injured patients with a traumatic brain injury or cerebrovascular accident.

Method: Thirty patients who were admitted to a rehabilitation hospital for their initial brain injury were retrospectively studied. Subjects were administerd a MMSE as cognitive assessment and a Functional Independence Measure (FIM) and Modified Barthel Index (MBI) as functional assessment upon referral for the rehabilitation and at discharge.

Results: MMSE scores, FIM scores and MBI scores at discharge increased significantly compared to the scores at the start of rehabilitation. The changes of MMSE scores significantly correlated with the changes of FIM scores and MBI scores in 30 brain injured patients (p＜0.001). Among the subitems of FIM, the social cognition, communication, self care, and sphincter control were strongly correlated with the MMSE scores.

Conclusion: We conclude that the MMSE can be a relevant predicting factor for the changes of functional status of brain-injured patients from a inpatient stroke rehabilitation and post brain- injury rehabilitation.

Objective: The purposes of this study were to estimate the incidence and complications of the tracheostomy and after decannulation, and to compare the functional outcomes between tracheostomy and non-tracheostomy groups in the severe traumatic brain injury (TBI) patients.

Method: One hundred and fifteen severe TBI patients were included in this study and the functional outcomes were measured by the Functional Independence Measure (FIM) scores retrospectively.

Results: The incidence of tracheostomy was 45.2% and the average duration of tracheostmy was 69.7 days. Twenty seven complications associated with the tracheostomy (51.9%) were reported and a pneumonia was the most common complication. Fourteen complications (26.9%) were reported after the decannulation and a tracheal granuloma was the most common complication. Complications mostly occurred during the first two weeks of tracheostomy. The duration of rehabilitation treatment for the patients with tracheostomy was longer than the patients without tracheostomy. TBI patients with tracheostomy had significantly lower initial and discharge FIM scores, FIM gain, and FIM efficiency than the patients without tracheostomy.

Conclusion: The complications of tracheostomy were mostly occurred early in the acute stage. Functional outcomes were lower in severe TBI patients with tracheostomy, thus early comprehensive and aggressive rehabilitation treatments would be necessary.

Objective: The main purposes of this study were to understand the correlations among Modified Barthel Index (MBI), Functional Independence Measure (FIM), and ESCROW (Environment, Social support, Cluster of family members, Resources, Outlook, Work or School status) Profile, and to establish the more appropriate assessment standards to check patient's conditions in the hospital and in their homes and society.

Method: Thirty-four patients, who received the rehabilitation treatment and home visiting at the Presbyterian Medical Center, were evaluated for their functions by MBI, FIM, and ESCROW Profile.

Results: The mean scores of assessment measures by home visiting were all higher than in the hospital showing an improvement of the patients' functions after discharge from the hospital. The results of MBI and FIM in the hospital and home visiting showed a significant correlation, while the results of MBI and Cognitive FIM measure indicated a relatively low correlation coefficient. Although each result of MBI, FIM, and ESCROW provided a low correlation when the patients were in the hospital, the result for home visiting revealed very significant correlations. Especially, the items of environment, social support, outlook, and work status of ESCROW showed very significant correlations with MBI and FIM.

Conclusion: The results showed that MBI and FIM measurements were very useful in observing and following up the functional conditions of the patients, while ESCROW profile was more appropriate to evaluate the familial and social rehabilitation status.

The central somatosensory conduction time(CCT) was measured by recording the cerebral and spinal evoked potentials following median nerve stimulation in 24 traumatic brain injury patients. The findings of evoked potential study correlated to the functional independence measure(FIM), mini mental status examination(MMSE) and Glasgow outcome scale(GOS).

The CCT of head injured patients was prolonged compared to that of the controls. The CCT with stimulation of the affected side was significantly prolonged compared to that with non- affected side. Abnormal CCT was related to the poor functional status measured by FIM and GOS. There`s no significant difference between groups of absent evoked potential and prolonged CCT by FIM score.

These results suggest that the CCT correlates with the functional status of head injured patients. Follow up studies are required to evaluate whether the CCT could be a valuable prognostic indicator or not.

The correction of risk fators is very important in the prevention of stroke. This study was designed to investigate the risk factors of stroke patients and to correlate these risk factors with Functional Independence Measure(FIM) scores to be used for possible prognostic values in rehabilitation program.

The subjects were 75 patients from 36 to 84 years of age. Data collection was done through chart reviews on risk factors of stroke including hypertension, transient ischemic attacks or previous stroke history, diabetes mellitus, heart disease, cigarette smoking, alcohol intake and hypercholesterolemia. Risk factors in stroke by the order of frequency were hypertension(68.0%), previous stroke history(38.7%), heart diseases(22.7%), hypercholesterolemia(24.0%), and diabetes mellitus(16.0%). The frequency of hypercholesterolemia, diabetes mellitus, heart disease, smoking in cerebral infarction group was higher than in intracerebral hemorrhagic group. There was no stastically significant correlation between risk factors and FIM scores.

The results suggest that hypertension was the most important risk factor in stroke and the rate of risk factors was higher in cerebral infarction than in cerebral hemorrhage.

Cerebral ischemia in experimental animals was worsened by hyperthermia, whereas was improved by hypothermia. Whether these observations apply to human beings with stroke is unknown. The objective of this study is to determine the relation between body temperature of stroke patient on admission and infarct size and functional recovery. In a retrospective study, 101 charts of stroke patients who had been admitted to the hospital were reviewed. Initial body temperature on admission, infarct size, and functional recovery were checked and analyzed. Based on body temperature differences, cases were divided into three groups, hypothermia, normothermia, and hyperthermia group. Infarct size was measured by computed tomography. Functional recovery was evaluated with functional independence measure(FIM) on admission and discharge. Multiple regression of ANOVA and Student's T-test were used for statistical analysis. Results disclosed that body temperature had no correlation with functional recovery but cases with initial high body temperature trended to increase in infarct size.