Objective
We evaluated a role of prefrontal and parietal cortex in verbal working memory and visuospatial attention using repetitive transcranial magnetic stimulation (rTMS). Method: In six healthy volunteers, bilateral prefrontal and parietal cortex was stimulated with rTMS (90% of motor threshold, 10 trains of 1 Hz rTMS) during performed cognitive tasks (two-back verbal working memory task and endogenous visuospatial attention task). rTMS was applied to 4 different sites over left prefrontal, right prefrontal, left parietal and right parietal areas at F3, F4, P3 and P4 location on the scalp, according to the 10/20 EEG system. The sham stimulation was applied with the coil placed perpendicular to the scalp. Results: Reaction time (RT) was significantly prolonged by left prefrontal TMS in verbal working memory. In addition, performance deterioration was also observed during rTMS over the right prefrontal and left parietal areas. In visuospatial attention task, RT was significantly prolonged by right parietal TMS.Conclusion: These results show that left prefrontal cortex play a major role in the network of working memory, and right parietal cortex is important area in the visuospatial attention. We suggest that an rTMS could be a useful method for evaluation of neural network in human brain. (J Korean Acad Rehab Med 2004; 28: 301-305)

Objective
In this study, we evaluate the efficacy of captopril comparing with nifedipine for management of hypertensive urgencies in autonomic dysreflexia in patients with spinal cord injury (SCI).Method: Twenty-four patients with SCI above T6 were documented and treated with drug therapy in this study whose systolic blood pressure (SBP) was at or above 150 mmHg despite the use of nondrug management during an autonomic dysreflexia episode. They were divided into two groups; captopril group (n=12) and nifedipine group (n= 12). Captopril group was administered captopril 25 mg sublingually and nifedipine group was administered nifedipine 10 mg sublingually. Diastolic blood pressure(DBP), systolic blood pressure (SBP), heart rate and side effects were monitored after administration. Results: Mean DBP and SBP at baseline and 15, 30, 60 minutes after captopril were significantly decreased (p＜0.05). There were no significant side effects such as reactive hypotension. The administration of nifedipine also successfully reduced mean SBP and DBP after 15, 30, 60 minutes (p＜0.05), but some side effects were reported such as reactive hypotension, tarchycardia and headache. Conclusion: For the management of hypertension in autonomic dysreflexia, captopril appears to be one of the safe and effective methods in patients with SCI. (J Korean Acad Rehab Med 2004; 28:306-310)

Objective
To develop an experimental model that is useful to evaluate the effect of antispastic medication administered intrathecally and to titrate the intrathecal baclofen effect quantitatively by using muscle stretch reflex.Method: Ten rabbits were laminectomized posteriorly and intrathecal catheter was inserted. Then the spinal cords were contused by 12.5 g⁓20 cm weight drop around 12th thoracic vertebra. After 8∼12 days, muscle stretch reflex was measured before intrathecal baclofen injection (ITBI) and after ITBI 30 minutes, 60 minutes, and 120 minutes. Rabbits' triceps surae were dissected and stretched 5 mm at the rate of 2 mm/sec using a step motor. The change of muscle tension was graphed into the time (length)-tensioncurve. The slope in the time (length)-tension curve was defined as stiffness index (SI).Results: The measurement of muscle stretch reflex was available in 5 of 10 spinal cord injured rabbits. The proportion of SI reduced significantly at 60 minutes and 120 minutes compared to baseline (p=0.005, p＜0.001).Conclusion: Our data proved the antispastic effect of ITBI quantitatively by using muscle stretch reflex. We concluded that the quantitative measurement method of the antispastic effect of ITBI will be useful in evaluating antispastic effect by intrathecal administration of the other antispastic medications. (J Korean Acad Rehab Med 2004; 28: 311-318)

Objective
To elucidate interhemispheric asymmetry of the neural generators of somatosensory evoked potential (SEP).Method: Median nerve SEP was recorded over 5 sites of each hemisphere in 20 healthy subjects and 23 stroke patients. One electrode was placed over C3'/C4' (position B) and two electrodes were located 2 cm medial (position A) and lateral (position C) to position B, respectively. Additional two electrodes were positioned at 3 cm anterior (position F) and posterior (position P) to position B. The common reference electrode was placed at Fz.Results: In healthy subjects, P22 was more frequently evoked than P27 in position F of the nondominant hemisphere and P27 in position P of the dominant hemisphere.In stroke subjects, fourteen patients demonstrated SEP waveforms over the affected hemisphere. In them, SEP amplitude significantly correlated with proprioception. However, distribution of the recording position showing significant correlation between SEP amplitude and proprioception was different according to dominancy of the affected hemisphere.Conclusion: P22 was more dominant in the nondominant hemisphere and P27 in the dominant hemisphere of normal group. Furthermore, clinical correlation of SEP amplitude was affected by the injured hemisphere dominancy in stroke group. These results demonstrate that asymmetry of neural generator distribution can be presumed. (J Korean Acad Rehab Med 2004; 28: 319-323)

Objective
To evaluate the correlation between the variables of sensory nerve conduction study of diabetic polyneuropathy patients and the factors that explain variations of multivariate data of sensory nerve conduction study.Method: Forty four early diabetic polyneuropathy patients and forty normal control people were included in our study. Early polyneuropathy patients were diagnosed by nerve conduction study. Their sensory nerve conduction meaurement variables were compared with normal control people in terms of correlation between amplitude and latency, and factors that were independent. Results: Age controlled partial correlations between amplitude and latency suggested that early diabetic polyneuro-pathy patients had more association between amplitude and latency than normal control people. Cannonical correlation also reinforced the above suggestion. Factor analysis revealed degenerative factor, demyelination factor, axonopathy factors that were independent in normal control people and degenerative factors, upper extremity demyelination factor, lower extremity functional factors in the dibetic polyneuropathy patients.Conclusion: The latency of sensory nerve conduction study was an important variable in assessing diabetic polyneuropathy patients. (J Korean Acad Rehab Med 2004; 28: 324-330)

Objective
To determine the prevalence and phases of dysphagia in inflammatory myositis.Method: We surveyed 106 patients diagnosed with inflammatory myositis by rheumatologist. After applying exclusion criteria, 64 patients were studied. We performed chart review and questionnaire survey for current feeding status, underlying diseases, the prevalence and phases of dysphagia. Questionnaire was composed of 11 different questions, 7 for the evaluation of oral phase and 4 for pharyngeal phase.Results: There were 25 males and 39 females, and the average age was 45.1⁑15.9 years. The average age when diagnosed was 41.4⁑14.8 years. The proportion of dysphagia at onset was 50%; 34.4% in oral phase and 43.8%in pharyngeal phase. There was no significant difference between dermatomyositis and polymyositis regarding the proportion. The most common cause of dysphagia in oral phase was dry mouth (28.1%), and the second common causes were opening of mouth (12.5%), chewing (12.5%), and residual material in mouth (12.5%). The most common cause in pharyngeal phase was pharyngeal muscle weakness (35.9%), and the second common cause was choking sign indicating aspiration (29.7%). Conclusion: With the high proportion of dysphagia in inflammatory myositis, we should pay more attention to dysphagia, because we need to do swallowing training in these patients. (J Korean Acad Rehab Med 2004; 28: 331-336)

Objective
To assess the changes of ultrasonographic findings of median nerve according to wrist position change in normal and carpal tunnel syndrome hands. Method: We studied 31 carpal tunnel syndrome and 34 normal hands that were diagnosed by nerve conduction study and evaluated crossectional area, flattening ratio and distance to ulnar artery with diagnostic ultrasound. The parameters were tested according to the change of wrist position with neutral, extension and flexion in normal control and carpal tunnel syndrome. Results: Crossectional area of carpal tunnel syndrome was larger than that of control. Flattening ratio of carpal tunnel syndrome was larger than that of control at extended position. Flattening ratio was greater in neutral and extended position than flexed position in carpal tunnel syndrome. Distance to ulnar artery were greater in flexed position than other positions in carpal tunnel syndrome. Frequency of least flattening ratio at flexion position in carpal tunnel syndrome was 64.52% and frequency of longest distance to ulnar artery at flexion position was 58.05%.Conclusion: Ultrasonography of median nerve showed no consistent findings according to change of wrist position between control and patients. Ultrasonographic diagnosis of carpal tunnel syndrome need further study for anatomical variations. (J Korean Acad Rehab Med 2004; 28: 337-342)

Objective
This study was designed to divide the patients with adhesive capsulitis into two groups by ultrasonographic findings, such as simple capsulitis and mixed capsulitis patients and to compare the improvement of range of motion and shoulder pain in one month.Method: We examined 50 patients with adhesive capsulitis diagnosed by physical examination. In accordance to ultrasonographic findings, we divided the patients into two groups such as capsulitis and mixed capsulitis in patients with adhesive capsulitis. We treated shoulder pain by intraarticular injection and medication. We examined the range of motion of shoulder and visual analogue scale at each visiting time in a month. Results: The mean age of patients was 55.3 (range: 39∼77) years. There were 26 patients with simple capsulitis and 24 patients with mixed capsulitis. The average duration of pain was 16.1⁑23.9 months. There was meaningful difference of shoulder range of motion and visual analogue scale between pretreatment and posttreatment in patients with simple capsulitis and mixed capsulitis. But, there was no meaningful difference of shoulder range of motion and visual analogue scale between two groups.Conclusion: No specific difference was noted between the simple and the complex groups of adhesive capsulitis in the effect of treatment. (J Korean Acad Rehab Med 2004; 28: 343-346)

Objective
The purpose of this study was to estimate the effects of a jazz dance program on musculoskeletal pains of female telephone operators.Method: Ten female telephone operators with neck and upper extremity discomfort were studied. The jazz dance program was carried out three times a week for 12 weeks. The effect of the jazz dance program was assessed with visual analogue scale (VAS) and the pressure thresholds of muscles of right neck and shoulder (the upper trapezius, rhomboideus, infraspinatus, and levator scapulae) withpressure algometer before and after exercise in every week.Results: There was significant increase of the pressure thresholds on four muscles of right neck and shoulder (p＜0.05). There was significant decrease of the averages of VAS of neck and upper extremity (p＜0.05). Conclusion: Jazz dance program is an effetive tool for the prevention and treatment of musculoskeletal pains in Visual Display Terminal (VDT) workers. (J Korean Acad Rehab Med 2004; 28: 347-351)

Objective
To investigate the effect of swimming exercise on the recovery after ischemia/reperfusion injury.Method: Forty male Sprague-Dawley rats were tested. Two groups of 20 rats were formed: 1- and 3-hours ischemia groups. Finally the groups were further divided into 2 groups that went through swimming (swimming groups) and those not (control groups). Baseline recordings of electromyographic and sciatic function index (SFI) were performed, then the femoral vessels of the rat were ligated for the complete ischemia. The reperfusion process was done according to the preset time. The methods to evaluate the functional status of nerve were the nerve conduction study (NCS), SFI and histologic study.Results: On the fourth week of experiment, amplitude of compound muscle action potentials was large in swimming groups compared to the control groups (p＜0.05). On the third week, amplitude was large in 1 hour swimming group compared to the control group. The muscle fiber was large in diameter in 1-hour-ischemic group at 4 week compared to the control, and the sciatic function index showed same results at the 3 hours group.Conclusion: The groups which swimming exercise done early after ischemia/reperfusion got better results compared with the nonswimming group (p＜0.05). The exercise had beneficial effect on motor function recovery after ischemia/ reperfusion injury. (J Korean Acad Rehab Med 2004; 28: 352-357)

Objective
The purposes of this study were to investigate the effect of suspension, the electrical stimulation and full weight bearing treadmill training on the muscle atrophy and transformation of muscle fibers. Method: Forty Spraque-Dawley rats were divided into control and 3 intervention groups: suspension control (n= 10), suspension with weight bearing treadmill (n=10), and suspension with electrical stimulation (n=10). After 4 weeks intervention, both gastrocnemius and soleus were dissected and the muscle weight and transformation of muscle fibers were analyzed. Results: In suspension control and suspension electrical stimulation groups, muscle to body weight ratio of gastro-cnemius was decreased compared to control group (p＜0.05). In all intervention groups, muscle to body weight ratio of soleus was decreased compared to control group (p＜0.05). In suspension electrical stimulation group, type I muscle fiber ratio of gastrocnemius was increased compared to control and suspension control groups (p＜0.05). In suspension electrical stimulation group, type IIa muscle fiber ratio of gastrocnemius was increased compared to suspension control group (p＜0.05). Conclusion: It is suggested that muscle atrophy induced by disuse and transformation of muscle fiber can be prevented by electrical stimulation intervention. (J Korean Acad Rehab Med 2004; 28: 358-365)

Objective
To examine the effects of changing the distance of spraying cold-jet stream (CS) on pain threshold and skin temperature. Method: Twenty one volunteers were examined. ⁣30^oC cold-air was applied from 5 cm and 10 cm away to the skin of the right wrist. The following parameters were taken to measure the efficiency of the application: the cooling time for the subject to express pain (1st period), the rewarming time for skin temperature to rise to 20^oC at room temperature (2nd period), the re-cooling time again (3rd period), 4th, 5th and 6th time again.Results: Skin temperature that subjects expressed pain was significantly at 10 cm distance than 5 cm. The rewarming speed of skin temperature was slower and slower according to repeat cold-air therapy in two groups. But there is no difference of rewarming time between 10 cm distance and 5 cm. Conclusion: There was no difference in rewarming time between 10 cm and 5 cm, hence, applying CS from 5 cm distance for a short period of time would be the more efficient method in terms of time-saving. (J Korean Acad Rehab Med 2004; 28: 366-370)

Objective
To analyze the relationship of clinical factors and gait parameters of patients with failed back surgery syndrome. Method: We investigated 25 male patients with back and /or lower limb pain who underwent lumbar spine operation. The following data were evaluated: clinical symptoms, physical examination, duration from operation to the gait analysis, number and level of operation, Visual Analogue Scales (VAS), modified Dallas pain questionnaire, psychological evaluations (Beck Depression Inventory, BDI) and gait parameters through 3 dimensional gait analysis.Results: Walking velocity was inversely correlated withscores of modified Dallas pain questionnaire and BDI.　Stride length was inversely correlated with scores of return to work, neurogenic claudication, VAS, modified Dallas pain questionnaire and BDI. Range of pelvic obliquity was inversely correlated with scores of modified Dallas pain questionnaire and BDI.　There was no significant differences between findings of physical exam and gait parameters.Conclusion: Results of the gait analysis of patients with failed back surgery syndrome showed significant relationship with clinical factors reflecting psychosocial background of patients. (J Korean Acad Rehab Med 2004; 28: 371-378)

We reported a girl diagnosed Schinzel-Giedion syndrome with severe psychomotor retardation and malformation that was characterized by mid face retraction, scoliosis, skull anomaly, wide cranial fontanels, brain cortical atropy, atrial septal defect, and hydronephrosis. Urinary tract infection, respiratorytract infection, and seizure were common. The neurodevelopment therapy was not effective and developmental stage was not improved. Spasticity was the only findings which was improved. (J Korean Acad Rehab Med 2004; 28: 379-382)

Klippel-Trenaunnay syndrome is characterized by three typical clinical manifestations; 1) Capillary malformations (port-wine stains), 2) bony and soft tissue hypertrophy, 3) varicosities or venous malforamation, but many other clinical manifestations can be presented. Although many associated clinical manifestations were reported in Klippel- Trenaunay syndrome, peripheral polyneuropathy or any other results of electrodiagonostic study were not reported previously. We experienced a 22 year old male who was transfered in rehabiliation program after surgical manage-ment of intra cerebral hemorrhage. During rehabilitation program we diagnosed him as Klippel-Trenaunay syndrome by three typical clinical manifestations associated with dilated cardiomyopathy. He also presented sensory impairment in distal part of all extremites. Electrodiagonostic study revealed peripheral polyneuropathy. We concluded that the possibility of peripheral polyneuropathy should be considered in Klippel-Trenaunnay syndrome. (J Korean Acad Rehab Med 2004; 28: 383-386)

Hirayama disease is characterized by focal amyotrophy of the upper limb associated with unilateral or asymmetric bilateral muscle weakness. It occurs in young men in their late teens or early twenties. Repeated or sustained neck flexion is thought to be a cause of the disease. It is important to prevent the progression of the disease through early recognition and management. We reported a patient with Hirayama disease in order to review the typical clinical, electrodiagnostic and radiological findings of Hirayama disease. (J Korean Acad Rehab Med 2004; 28: 387-391)

Thyrotoxic periodic paralysis (TPP) is rare in white Caucasian but a few in Asian. A 36-year-old man presented with suddenly developed paraparesis was brought by ambulance. He got some medications and injection for the upper respiratory infection in the morning of admission day. On admission he revealed bilateral proximal muscle weakness without pain. He didn't have any specific medical history of himself and his family. The laboratory results on admission revealed severe hypokalemia (2.1 mM/l). Potassiumreplacement was immediately started and his symptom was gone. We found TSH was extremely decreased (＜0.005μIU/ ml) but T3 and T4 were within normal level. We guess TPP was induced by some drugs to the patient with sub-clinical hyperthyroidism. Hyperthyroidism is not always clinically apparent and then may be easily missed. However just a single medication or injection that is usually prescribed can induce critical progressive hypokalemia. (J Korean Acad Rehab Med 2004; 28: 392-395)