Based on the principles of active participation and non- discriminatory treatment, the Five Year Plan II for the Welfare of the Disabled (the Plan-II) is a policy initiative upgraded from its predecessor, the Five Year Plan-I.

The goal of the Plan-II is social integration. People with disabilities should be able to join other members of society in a number of activities including, but not limited to, economic ones. Under this goal, the Plan-II sets forth the following five objectives. First, age-specific welfare services should be developed. Second, students with disabilities should have equal opportunities for education in the same setting as other students. Third, the disabled should enjoy job security through the balanced development of welfare and economy. Fourth, the disabled should have an equitable access to IT (information technology)-enabled services. And fifth, safe and convenient transportation system should be put in place for the disabled.

The Plan-II also contains the budget and the means of financing, previously excluded in the Plan-I. An estimated KRW 7 trillion and 472.6 billion is needed to finance the above-mentioned programs between 2003 and 2007. (J Korean Acad Rehab Med 2003; 27: 463-470)

Objective
The aims of this study were to evaluate quantitatively the effect of tizanidine on spasticity reduction and to evaluate the effective and tolerable dosage of it in stroke patients.

Method: A prospective, randomized controlled study was carried out. 24 stroke patients were included and randomly assigned to a control and experimental group. In experimental group, tizanidine was medicated from starting dose of 3 mg/day and titrated up by 3 mg/day increments every 3 days to a maximal dose of 15 mg/day. In both group assessment of spasticity was done by clinical and biomechanical-neurophysiological methods one day before medication (baseline), on 9th and 15th days after medication. Biomechenical-neurophysiological assessment was done through isokinetic dynamometer and BIOPAC system.

Results: In control group, no significant changes were found in the degree of spasticity between each assessment. In experimental group, most of the parameters that determine the degree of spasticity revealed the significant reduction of spasticity on the post-medication assessment compared with the baseline assessment (p＜0.01). The degree of spasticity reduction was increased with the increase of dosage. The incidence of adverse effect was also increased with the increase of dosage, but tolerable within the dosage of 15 mg/day.

Conclusion: Tizanidine was effective in reducing spasticity in stroke patients. Its efficacy and adverse effects were dosage-related. (J Korean Acad Rehab Med 2003; 27: 471-479)

Objective
To assess the influence of reflex sympathetic dystrophy (RSD) on functional status and recovery of the hemiplegic upper extremity in stroke patients.

Method: Retrospective chart review was performed in 561 patients. Among 561 stroke patients, 116 subjects were recruited and classified into two groups: patient group, 43 cases with RSD; control group, 73 cases without RSD. Upper extremity function was assessed based on feeding, dressing and personal hygiene scores of the modified Barthel index at the beginning of rehabilitation treatment and at the time of discharge. Causes of stroke and length of stay were recorded. Median nerve-somatosensory evoked

potential studies were performed and assessed.

Results: The incidence of RSD was 7.7% and the time to development of RSD was 62.3±34.1 days after the onset of stroke. There was no significant difference in functional status between two groups at initial and final evaluation. The upper extremity function had improved in both groups although the length of stay was longer in patient group. SSEP abnormalities were more frequent in the patient group.

Conclusion: The presence of well-managed RSD affected neither the functional status nor the functional recovery of upper extremity in stroke patients. (J Korean Acad Rehab Med 2003; 27: 480-484)

Objective
To help adjusting the proper timing of replacement of the percutaneous endoscopic gastrostomy (PEG) Foley catheter in brain injured patients.

Method: Twenty one brain injured patients with PEG Foley catheter were studied and divided into three groups by indwelling duration. The balloon of Foley catheter was inflated with 5 ml of normal saline. We calculated the deflating velocity of the balloon by estimating remained amount of normal saline and indwelling duration at the time of replacement.

Results: In 6 patients, the PEG Foley catheter was pulled out easily before aspiration of remained normal saline. In all of these cases, remained amount of normal saline was less than 2 ml. The deflating velocities of the balloons were 0.057⁑0.024 ml/day in cases with 3 to 4weeks of indwelling duration, 0.066⁑0.005 ml/day with 4 to 5 weeks, 0.067⁑0.012 ml/day with above 5weeks. The mean deflating velocity was 0.063⁑0.016 ml/day in human. The deflating velocity was slower than that of the previous study in vitro.

Conclusion: The mean days of deflation of the balloon of total PEG Foley catheter down to 2.5 ml were 42.1 days. We suggest that the PEG Foley catheter would be replaced within 42 days after exchange. (J Korean Acad Rehab Med 2003; 27: 485-488)

Objective
To assess the sensitivity and specificity of bedside swallowing evaluation for detecting tracheal aspiration.

Method: Thirty patients who complained of swallowing difficulty or had potential for dysphagia were evaluated using videofluoroscopy and bedside swallowing evaluation for dysphagia. The bedside swallowing evaluations included gag reflex, laryngeal elevation, water swallowing test and swallowing provocation test. We compared bedside swallowing evaluations with videofluoroscopy to determine the sensitivity and specificity in detecting tracheal aspiration.

Results: The comparison of the all combination of bedside swallowing evaluation and videofluoroscopic results suggested that the sensitivity and specificity in the detection of tracheal aspiration was 84.6%, 47.0% respectively.

Conclusion: Bedside swallowing evaluations are limited for screening test of tracheal aspiration, so videofluoroscopic swallowing studies would be necessary to evaluate swallowing difficulty. (J Korean Acad Rehab Med 2003; 27: 489-493)

Objective
To evaluate the frequency distribution and causes of death according to number of days after stroke.

Method: We reviewed in 158 cases of the stroke patients who had died in hospitalization from January 2000 to June 2002 by medical records retrospectively. We evaluated the correlations between the frequency of death and causes of death by frequency analysis.

Results: Mean age was 65.8⁑11.5 years old and average survival days after stroke were 16.2⁑24.1 days. The proportion of stroke subtypes were infarct (51.3%), intracranial hemorrhage (36.7%), and subarachnoid hemorrhage (12.0%). The frequency of death at 7 days and 30 days after stroke onset were 52.5% and 89.2%, respectively. The most frequent cause of death was respiratory arrest due to transtentorial herniation or brain stem lesion (48.1%), followed in frequency by pneumonia (22.2%), cardiac origin (10.8%), and vasospasm (6.3%). Within the first 30 days, the leading cause of death was respiratory arrest due to transtentorial herniation or brain stem lesion. After the first 30 days, the most frequent cause of death was pneumonia.

Conclusion: The results of this study are valuable as basic data of mortality and causes of death after stroke during an acute stroke management and early rehabilitation. (J Korean Acad Rehab Med 2003; 27: 494-499)

Objective
Stroke is a major cause of mortality throughout the world and several studies have reported survival experience following stroke in different populations. This study estimates the prevalence of behavioral risk factor after stroke and explores lifestyle changes.

Method: The subjects were 529 patients, who were admitted at the Kyung Hee Medical Center from January 2000 to February 2001. Data collection was done through chart reviews, telephone interviews, and mail. Main measures included smoking status, alcohol use, and obesity. Chisquare test and multiple logistic regression were used to determine sociodemographic differences in these measures.

Results: At 1 year after stroke, 11.2% of patients still smoked, 31.4% of patients were obese, and 13% drank excessively. Younger patients and patients with high blood pressure were more likely to smoke. Younger patients were more likely to drink excessively. Women, patients with diabetes, and those living in the metropolitan areas were more likely to be obese.

Conclusion: Different behavioral risk factors were associated with specific sociodemographic groups within the stroke population. After stroke, high-risk groups should continue to be targeted to prevent stroke recurrence. (J Korean Acad Rehab Med 2003; 27: 500-506)

OBJECTIVE
Study was designed preliminarily to observe the accordance of caregivers strain and depression with other factors such as sex of the patient, caregiver, lesion side, Mini Mental Status Examination (MMSE) score and Beck's Depression Index (BDI). METHOD: We composed a questionnaire with BDI, and the Sense of Competence Questionnaire (SCQ) in order to evaluate the amount of stress and depression of caregivers. Evaluation of the patient was done by interviewing them along with reviewing their medical records and obtaining scores such as the MMSE, Functional Inependence Index (FIM) and the Geriatric Depression Scale (GDS). RESULTS: BDI of the caregivers showed a negative correlation with the patients' age. Lesion side nor age, nor the prevalence of hemiplegia of patients did not show statistical relevance with the strain that the caregiver felt. The first subscale of SCQ showed a positive correlation with the caregiving time that the caregiver gave. In accordance to the sex of the caregiver, females showed to spend more time with the patient, showed to be more unsatisfied with the patient but showed a tendency of lesser SCQ score. CONCLUSION: Depression, strain and burden that the caregivers went through showed to have slight correlation with the patient and caregiver factors.

OBJECTIVE
In patients with cervical spinal cord injury (SCI), it is known that vital capacity of the supine position is larger than that of the sitting position, but after pulmonary rehabilitation treatment, the effect on assessment of vital capacity according to the posture is not yet clearly known. In this study, we evaluated the significance of posture on assessment of pulmonary function after pulmonary rehabilitation treatment in patients with cervical SCI. METHOD: Twenty-eight patients with cervical SCI were participated in this study. The pulmonary function was evaluated by measuring vital capacity (VC), tidal volume (TV), maximum insufflation capacity (MIC) and forced expiratory volume at the first second (FEV1) in both supine and sitting position, before and after the 4 weeks pulmonary rehabilitation treatment. The parameters of pulmonary function were analyzed and compared according to the posture. RESULTS: Before pulmonary rehabilitation treatment, VC, TV, MIC and FEV1 of the supine position were significantly larger than those of the sitting position (p<0.05). After pulmonary rehabilitation treatment, VC, TV, MIC and FEV1 of the supine position were also significantly larger than those of the sitting position (p<0.05). Vital capacity, TV, MIC and FEV1 were significantly improved after pulmonary rehabilitation treatment both supine and sitting position (p<0.05), but the improvement ratio of VC, TV, MIC and FEV1 between supine and sitting position were not significantly different (p>0.05). CONCLUSION: For the proper assessment of the pulmonary function after pulmonary rehabilitation treatment in patients with cervical SCI, the significance of posture should be considered.

OBJECTIVE
To evaluate the influences of age and height on pulmonary function in cervical spinal cord injury patients and to suggest the reference value of Pulmonary Function Test (PFT) with respect to each level of injury. METHOD: One hundred eighteen subjects with complete cervical spinal cord injury underwent PFT. Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 second (FEV1) were measured and percentages of normal predictive values were also calculated. RESULTS: Age, height and injury level were determinants of FVC and FEV1. But only injury level affected the percen-tages of FVC and FEV1 predictive values. The mean FVC of C4, C5, C6, C7, C8 tetraplegic subjects were 1.78 L, 2.00 L, 2.20 L, 2.74 L, 2.94 L respectively. The mean FEV1 of C4, C5, C6, C7, C8 tetraplegic subjects were 1.64 L, 1.83 L, 2.08 L, 2.59 L, 2.74 L respectively. CONCLUSION: Age and height should be considered when interpreting PFT of tetraplegic patients. The reference values suggested would help to evaluate the severity of pulmonary function loss in complete cervical spinal cord injury patients.

OBJECTIVE
To evaluate the effect of a transcranial magnetic stimulation on reciprocal inhibition of the human leg.
METHOD
Twenty healthy human subjects who showed significant inhibition of soleus H reflex after conditioning electrical stimulation of tibialis anterior at a conditioning-test interval of 2 ms were included in this study. Changes in the amount of reciprocal inhibition by conditioning electrical stimulus were compared after transcranial magnetic stimulation of tibialis anterior. RESULTS: Approximately 12% inhibition of H reflex was produced by motor threshold stimulation, and 14% inhibition by maximum stimulation of common peroneal nerve. When a submotor threshold cortical shock was given with test-conditioning interval 0 ms, this inhibition was not significantly changed. There was no significant change of H reflex amplitude ratio by conditioning electrical stimulation after delivering supramotor threshold cortical shock. Amplitude of H reflex was enhanced by transcranial magnetic stimulation at each same conditioning electrical stimulation. CONCLUSION: We conclude that TMS can produce excitatory effects on spinal motor neurons rather than Ia inhibitory interneuron and there is no evidence for convergence onto Ia inhibitory interneurons from the fiber systems excited by magnetic stimulation over the cortex.

OBJECTIVE
To evaluate the effect of agonistic and antagonistic isometric contraction on the motor evoked potentials (MEP). METHOD: The MEP responses of right flexor carpi radialis (FCR) and extensor carpi radialis (ECR) muscles were simultaneously recorded during constant isometric flexion and extension of wrist. The intensities of isometric flexion and extension were 30%, 50%, and 100% of maximal voluntary contraction, which were achieved by isokinetic dynamometer. Background electromyographic activities in surface and needle electrodes were used for selective contraction. RESULTS: In agonistic muscles, the amplitudes of MEP responses were significantly increased according to the intensity of isometric contraction. In antagonistic muscles, the amplitudes of MEP responses in ECR were significantly increased with increasing intensity of isometric flexion. The amplitudes of MEP responses in FCR were increased with increasing intensity of isometric extension in spite of suppression in H-reflex of FCR during isometric extension. CONCLUSION: In antagonistic muscles, facilitation of MEP response in ECR and FCR during isometric contraction was occurred as in the agonistic isometric contraction.

OBJECTIVE
To determine the normal values of medial calcaneal nerve (MCN) conduction study for the diagnostic reference value. METHOD: The subjects were healthy 54 adults (30 males, 24 females). Antidromic sensory nerve conduction study of medial calcaneal nerve was performed in 108 feet of the subjects. The active surface electrode (G1) was placed to the point of one third of the distance from the apex of the heel to a point midway between the navicular tuberosity and prominence of the medial malleolus. The reference surface electrode (G2) was placed to the apex of the heel. The stimulation was done at the site of 10 cm proximal to the proposed G1 site. RESULTS: Reference values (mean+/-2 SD) were determined for MCN onset latency (1.62+/-0.16 msec), peak latency (2.41+/-0.19 msec), baseline-to-peak amplitude (12.46+/-4.87 microV), onset conduction velocity (62.28 +/-6.30 m/sec), and peak conduction velocity (41.70+/-3.19 m/sec). The maximum intrasubject side-to-side differences of above values were 0.17 msec, 0.17 msec, 2.90 micro V, 6.63 m/sec, and 2.87 m/sec respectively. The MCN response was elicitable in 92.6% of the subjects.
CONCLUSION
The results of this study would be used for the electrophysiologic evaluation of the MCN.

OBJECTIVE
To evaluate the effect of vascular abnormality on diabetic neuropathy with the use of pedal vascular pulsation and electrodiagnostic study. METHOD: One hundred-eight non-insulin dependent diabetes mellitus patients were studied. All patients underwent nerve conduction studies. Evaluation of vascular status was done using pedal pulse palpation. Four groups were formed. Electrophysiologically normal group was subdivided into non-vascular abnormality group (A1) and vascular abnormality group (A2). Neuropathy group was subdivided into non-vascular abnormality group (B1) and vascular abnormality group (B2). The frequency of diabetic neuropathy among whole groups and the difference of amplitude, conduction velocity, and F-wave latency within A groups and B groups were investigated, respectively.
RESULTS
Diabetic neuropathy was significantly correlated with vascular abnormality (p<0.05). There was no definite difference of electrophysiologic parameters between A1 and A2 groups. B1 group showed significantly reduced amplitude of SNAPs in sural and median sensory nerves compared with B2 group (p<0.05). CONCLUSION: The results of the study support the influence of vascular abnormality on diabetic neuropathy and suggest that vascular abnormality in patients with diabetic neuropathy results in axonal injury rather than demyelination injury.

OBJECTIVE
To evaluate the effectiveness and electrophysiological changes after alcohol neurolysis of the tibial nerve motor branches to gastrocnemius muscles on the treatment of ankle spasticity in stroke patients. METHOD: Fourteen poststroke hemiplegic patients who had an abnormal gait pattern due to the ankle spasticity participated. They were evaluated by modified Ashworth scale (MAS) score, passive range of motion (PROM) of ankle, and ankle clonus, and were studied using electrophysiological measurements such as amplitude and latency of H-reflex and M response, and H/M ratio. 50% alcohol was injected into the tibial nerve motor branches to the both gastrocnemius muscles with electromyography guidance. Follow-up evaluations were performed immediately, and then, at the one-week, one-month, and three-months following the neurolysis. RESULTS: The MAS scores significantly decreased and the PROM of the ankle significantly increased. The M response and H-reflex amplitude of gastrocnemius muscles significantly decreased after the neurolysis and they had a tendency to increase at the 3-months follow-up. Also, H/M ratio significantly decreased. There were no serious postinjection complications. CONCLUSION: Alcohol neurolysis of the tibial nerve motor branches was an effective and safe method for the treatment of the ankle spasticity in poststroke hemiplegic patients.

OBJECTIVE
To know the correlation between the grading of facial neuropathy by facial nerve conduction study (FNCS) and dysphagia severity by videofluoroscopic swallowing study (VFSS) in patients with acute peripheral facial palsy (PFP).
METHOD
Twenty patients with acute PFP were recruited for this study. The causes of acute PFP were limited to idiopathic Bell's palsy and Ramsay-Hunt syndrome. The time interval from the onset of PFP to study of FNCS and VFSS was 10 to 14 days. The severity of PFP was graded according to House-Brackmann facial nerve grade (H-B FNG). Percent degeneration grade (PDG) was determined by FNCS. Baseline-to-peak amplitude of compound muscle action potentials in orbicularis oris muscle was used as an evaluation parameter. Oral transit time (OTT), pharyngeal transit time (PTT), pharyngeal delay time (PDT) and dysphagia limit were obtained by VFSS. RESULTS: There was a significant correlation between PDG and H-B FNG. The severity of oropharyngeal dysfunction was increased as the severity of the PDG increases. Delayed OTT, delayed PDT, and/or reduced dysphagia limit were revealed as a presentation of oropharyngeal dysfunction in acute PFP.
CONCLUSION
The severity of PFP and oropharyngeal dysfunction were significantly correlated. And so we think that precise evaluation and adequate management of oropharyngeal dysfunction will be needed in acute PFP patients.

OBJECTIVE
This study was designed to investigate the effect of steroid injection on the blood sugar level in shoulder pain patients with diabetes mellitus. METHOD: Fifteen patients with shoulder pain and diagnosed diabetes mellitus were included. The blood sugar, insulin, cortisol and HbA1c level were measured before and twice (at 24 hours and 1 week) following a intraarticular, intratendinous or intrabursal injection containing triamcinolone. Statistical significance was determined by the paired t-test. RESULTS: The blood sugar, insulin and HbA1c levels had no significant difference between before and after steoid injection (p>0.05). But, the cortisol level significantly fell at 24 hours after steroid injection compared with preinjection level and returned to preinjection level by 1 week after steroid injection (p<0.05). CONCLUSION: One time triamcinolone injection resulted in significant suppression of cortisol level, but it returned to preinjection level after a week. The blood level of sugar, insulin and HbA1c showed no significant change after one time steroid injection.

OBJECTIVE
To evaluate the pain patterns of patients with osteoarthritis (OA) of the knee. METHOD: Forty-four patients (mean age 56.1 years) with pain around the knee who met the Simons' criteria for myofascial pain syndrome (MPS). Patients drew in their pain areas on a pain drawing diagram. The pain areas were input into the Pain Chart System (PCS) software program for analysis. Physical examination, trigger point injection, and exercises for knee muscles were performed. Oral analgesics were not prescribed. RESULTS: MPS was clinically diagnosed in all 44 patients. Radiologic examination revealed degenerative changes in 49 knees. Pain patterns detected by the PCS revealed pain patterns compatible with myofascial trigger point in the vastus medialis in 37 cases, rectus femoris in 32 cases, adductor longus in 5 cases, sartorius in 2 cases, vastus lateralis in 1 case, and the popliteus in 1 case. Following treatment, 36 of the 44 patients experienced pain relief. CONCLUSION: Degenerative changes of the joint seem not to be cause of the knee joint pain. Instead, pain relief following MPS treatment indicates the cause of knee pain as MPS. We recommend that the first step in the treatment for knee pain include recognition and treatment of MPS before applying invasive treatment.

OBJECTIVE
To compare the patients of chronic low back pain with and without emotional depression in terms of psychosomatic aspect and clinical outcome by cross-sectional and prospective study. METHOD: We evaluated 100 patients who were admitted due to chronic low back pain. The patients were classified into three groups (moderately depressed, mild depressed, non-depressed) by the score of Beck Depression Inventory (BDI). And three groups were compared by Pain Disability Index (PDI), Visual Analogue Scale (VAS), Pain Rating Score (PRS) and special diagnostic studies such as MRI and EMG. All subjects took the same conservative treatments for 4 weeks and then, they were re-evaluated by PDI, VAS and PRS. RESULTS: BDI score was positively correlated with VAS and PRS significantly. All groups were not different with respect to functional limitation (measured by PDI) and organic lesion (measured by MRI and EMG study). But, subjective pain (measured by VAS, PRS) were severe in depressed group. All groups showed improvement in PDI, VAS and PRS after 4 weeks of treatment. But, the amount of improvement was greater in non-depressed group.
CONCLUSION
The clinician treating chronic low back pain should be familiar with depression and prepare for screening on that.

OBJECTIVE
The purpose of this study was to evaluate the effect of interferential current therapy (IFT) of swing pattern frequency alteration on the RIII nociceptive reflex.
METHOD
Ten healthy volunteers received IFT of both constant (100 Hz) and swing (20~100 Hz) pattern frequency. Before and after the IFT application RIII nociceptive reflex was evoked by stimulation of sural nerve and recording at biceps femoris muscle. Twenty nine patients with low back pain were treated with IFT of constant or swing pattern frequency and degrees of pain relief were evaluated by Visual Analogue Scale (VAS) and Present Pain Intensity (PPI). RESULTS: The threshold of RIII reflex was increased immediately after both constant and swing frequency, but the increased threshold was lasted for 15 minutes only after swing pattern frequency alteration. Pain relieving effect of IFT evaluated by PPI was also lasted for 15 minutes only after swing frequency alteration. CONCLUSION: These results suggest that IFT of swing pattern frequency alteration had longer lasting effect on the inhibition of RIII nociceptive reflex and the relief of pain than that of constant frequency.

OBJECTIVE
To identify the range of the precise locations of the motor points of triceps surae muscles in relation to bony landmarks. METHOD: Eight limbs of four male cadavers were dissected. The number and location of the motor points from the tibial nerve to each head of the triceps surae muscle were identified related to the bony landmarks. Bony landmarks were medial and lateral epicondyles of the femur, and medial and lateral malleolli of the tibia. The length of the lower leg was defined as the distance from the intercondylar line of the femur to the intermalleolar line of the tibia. The locations of the motor points were expressed as the vertical distance from the intercondylar line, which was normalized to the length of the lower leg.
RESULTS
The most proximal motor points of the medial gastrocnemius, lateral gastrocnemius, and soleus were located in 9.6+/-3.5%, 12.0+/-3.4% and 20.5+/-3.9% of the lower leg below the intercondylar line of the femur. The most distal points were in 37.5+/-5.5%, 37.9+/-2.3% and 46.7+/-3.6%. CONCLUSION: The identification of the locations of motor points related to the bony landmarks would increase the ease and accuracy of the motor point blocks to the triceps surae muscles.

OBJECTIVE
This study was designed to observe the general characteristic of patients with shoulder pain, interrelation between the ultrasonographic findings, physical examination and radiological findings, and the effect of treatment of shoulder pain classified by ultrasonographic findings.
METHOD
We examined 334 patients (165 male and 169 female) with shoulder pain who had been consulted to us. We examined degenerative changes such as subacromial spur, greater tuberosity sclerosis using radiological method. We classified patients into three categories -capsular, noncapsular and mixed - in accordance to physical examination and ultrasonographic findings. In order to estimate the effect of treatment, VAS change one week after injection, treatment duration, and frequency of injection were checked. RESULTS: The mean age of patients was 54.4 (range: 22~77) years. The average VAS change, duration of treatment, and frequency of injection were 4.68+/-2.93, 6.14 +/- 4.83 weeks, 3.59 +/- 2.70 times. There was meaningful correlation between diagnosis done with physical examination and ultrasonography in cases showing capsular and noncapsular patterns. Although there was meaningful difference of treatment effect classified by ultrasonographic findings, no meaningful difference in treatment effect was ween in patients classified by physical examination. CONCLUSION: Ultrasonography is an useful tool supporting diagnosis based on physical examination. The ultrasonography of shoulder could predict progress and prognosis of patients with shoulder pain.

OBJECTIVE
To compare the efficacy of epidural injection in accordance the distribution of dye in the epidural space for low back pain patient. METHOD: Twenty nine patients with herniated nucleus pulposus or spinal stenosis confirmed by the radiologic studies were treated with epidural injection of steroid. The patients were divided into two groups: 1) patients whose distribution of dye was in the posterior part of epidural space and 2) patients whose distribution of dye was in the anterior and posterior parts of epidural space.
RESULTS
The efficacy of epidural injection was assessed using the visual analog scale (VAS) and straight leg raising test (SLR) on pre-treatment and post-treatment. The VAS and SLR change of pre-treatment and post-treatment in the first group was from 7.81 +/- 1.54 and 50.00 +/- 18.97 degrees to 4.45 +/- 2.16 and 75.00 +/- 17.61 degrees (p<0.05), respectively. The VAS and SLR change of pre- and post-treatment in the second group was from 7.72 +/- 1.56 and 43.33 +/- 15.28 degrees to 3.72 +/- 1.64 and 60.00 +/- 10.00 degrees (p<0.05), respectively. The VAS and SLR change between groups has no statistically significant difference (p>0.05). CONCLUSION: The different distribution of dye in epidural space had no significant difference in treating patients with low back pain.

OBJECTIVE
To investigate and describe the peak plantar pressures and ground contact times of the foot during walking in diabetic patients and healthy adults. METHOD: 17 age-matched diabetic patients without any complications and 33 healthy adults participated in this study. The foot was divided into 10 different areas, and peak plantar pressures and ground contact times were measured during walking by EMED system . RESULTS: There were no significant differences in peak plantar pressures of both feet in both groups, but there were significant increases in peak plantar pressures of hindfoot and hindfoot contact times in the diabetic group. CONCLUSION: Despite having no definite diabetic neuropathy and vascular disease, diabetic patients have higher peak plantar pressures of hindfoot and prolonged hindfoot contact times because limb muscle dysfunction or impairment of proprioception may induce faster descent of the foot towards the ground or improper pattern of stance phases.

OBJECTIVE
To investigate the efficiency of custom-made diabetic shoes through the measurement of peak plantar pressure, compared between bare foot and in-shoe in diabetic patients METHOD: Seventeen diabetic patients participated in this study. It used diabetic shoes manufactured by Apex and P.W. minor & son. The foot was divided into 6 different areas, and peak plantar pressures of bare foot and in-shoe were measured during walking by EMED system and PEDAR , respectively. RESULTS: There were significant decreases in peak plantar pressures of all plantar areas in all types of diabetic shoes. Especially, peak plantar pressures of diabetic shoes manufactured by P.W. minor & son in medial metatarsal and big toe areas were more decreased than by Apex. CONCLUSION: The custom-made diabetic shoes can effectively reduce plantar pressures in all palntar areas of the foot, and also can prevent the development or recurrence of foot ulcers at specific areas according to the variable physical constitution of diabetic shoes.

OBJECTIVE
This study was designed to analyse quantitatively the change in rigidity of plastic ankle foot orthoses (AFOs) corresponding with regulated ankle width and to find the appropriate ankle width for spastic ankles. METHOD: Five different plastic AFOs were fabricated according to the regulated ankle width. The resistance to dorsiflexion and plantar flexion movements was measured by bending the plastic AFOs at intervals of 2 degrees with the measuring device. Plantar flexion moments of hemiplegic spastic ankles were also measured. RESULTS: The rigidity of plastic AFOs increased nearly in proportion to the increase of the ankle width. The plantar flexion moments of hemiplegic spastic ankles increased in proportion to the severity of the spasticity. If the plastic AFOs would be used only for the prevention of toe dragging in swing phase, the ankle width of plastic AFOs could be reduced up to 60% which was enough to support the ankle in swing phase. CONCLUSION: These findings suggested that the degree of rigidity of plastic AFOs could be adjusted by trimming about the ankle to meet the individual patient's requirement. And this study could be helpful to quantify empirical approach of the prescription of plastic AFOs.

OBJECTIVE
To compare the Madopar(R) (Levodopa Benserazide) test with Insulin Tolerance Test (ITT) as a provocation test for growth hormone (GH). METHOD: One hundred eighty-seven subjects who had not organic disease such as hypothalamic-pituitary disease were studied. Seventy-one subjects underwent an ITT by injection of 0.1 U/kg of regular insulin and blood samples for GH assay were taken at 0, 30, 60 and 120 minutes. One hundred sixteen subjects underwent a Madopar(R) test by administration of Madopar(R) and blood samples for GH assay were taken at 0, 60, 120 and 180 minutes. RESULTS: The GH mean peak response in ITT was significantly higher than that of the Madopar(R) test. Below 50 years, 18 of ITT and 24 of Madopar(R) test showd a GH peak response of less than 5 ng/ml. Above 50 years, 14 of ITT and 53 of Madopar(R) test showd a GH peak response of less than 5 ng/ml. CONCLUSION: The results suggested that the GH response to the Madopar(R) test was much less than that of the ITT. The Madopar(R) test was limited in diagnosis of the adult GH deficiency in normal adults.

Neurocysticercosis is the most common parasitic disease of the central nervous system. Generally, the spinal cord involvement of neurocysticercosis is very rare. We experienced a 52-year-old female patient presented with tetraplegia. She was diagnosed as mixed type neurocysticercosis involving brain parenchyma, ventricle and cervical spinal cord. She underwent an operation of intradural mass removal with cervical laminectomy. In spite of gradual improvement in activities of daily livings, muscle power and sensation, she revealed the fluctuation of mental status and tetraplegia, possibly associated with perilesional inflammation, twice during the period of admission. So, we administered prednisolone 20 mg and albendazole 800 mg a day for a week per event and then her mental status and aggravated tetraplegia were improved. After comprehensive rehabilitation for 4 months, her ASIA impairment scale changed from ASIA C to ASIA D with the improvement of modified Bathel index, Functional independence measure and Mini-mental status examination scores.

Gabapentin, a novel anti-convulsant, is recently used to manage symptomatic treatment of neuropathic pain. Gabapentin is known to have few side effect profiles such as drowsiness, dizziness, somnolence, and nausea. We experienced a case of neutropenia associated with gabapentin. A 74-year-old man was hospitalized because of left side weakness caused by acute thalamocortical infarction. He complained of tingling sen- sation, aching pain, and dysesthesia on his left side. We prescribed gabapentin to manage his symptoms. Fever developed at 22 days of gabapentin therapy and peripheral blood examination revealed neutropenia. At 2 days after stopping gabapentin, neutrophil counts started to revert.

The atlantoaxial joint has a little stability and is secured and supported chiefly by soft tissue such as ligaments and articular capsule, so it has free motions to all directions. Relaxation or rupture of these supportive structures due to inflammation or trauma may cause instability or subluxation, and it results in compression of the spinal cord and it reveals various neurologic symptoms. The atlantoaxial rotatory subluxation, the rare disease found in children mostly, is known to be one of the reasons of the temporal torticollis in children. An adult type is very rare, but it is possible to be combined with rheumatoid arthritis and/or trauma, but we experienced the 25-year-old female patient who had the atlantoaxial rotatory subluxation spontaneously without rheumatoid arthritis and/or trauma, so we report this case with review of literature.