Historically WHO has concentrated on infection control and mortality reduction. However, diagnosis alone does not explain what patients can do, what their prognosis will be. To answer these questions, significant challenges are presented in model the International Classification of Impairment, Disability and Handicap (ICIDH) announced in 1980. Following several revisions of ICIDH, WHO (2001) finally approved the International Classification of Functioning, Disability and Health (ICF), which is universal and clear terminology with qualifiable assessment measures. The ICF is a new form which (1) is not based on disability, rather on human function, (2) is interactive rather than linearly progressive, and (3) is not medical or social model, rather integration model. Also, the new language ICF is an landmark event for rehabilitation. Key to successful rehabilitation management is the understanding and proper assessment of the relationship between disease (ICD-10) and impaired body functions and structures and psychosocial and environmental factors(ICF). (J Korean Acad Rehab Med 2004; 28: 401-411)

Objective
The aim of this study was to elucidate how the location of cerebral infarct influences cortical recovery pattern in hemiparetic stroke patients.Method: Forty-three chronic stroke patients and 21 control subjects were recruited for the study. The patients were classified into 4 groups according to infarct locations: cortex (CO), corona radiata (CR), posterior limb of the internal capsule (PL), and brainstem (BS). Functional MRI was performed using the blood oxygen level-dependent technique at 1.5 T with the motor task of hand grasp-release movements.Results: The activation pattern of the primary sensori-motor cortex (SM1) was found to be significantly influenced by the lesion locations, but that of the secondary motor area was not (Pearson's chi-square test, p＜0.05). The 'contralateral' SM1 activation was the major response in the control group (85.7%) and in the BS group (75.0%). On the other hand, the major activation pattern was 'peri-lesional' in the CO group (peri-lesional 57.1%, peri-lesional and ipsilateral 42.9%), 'bilateral activation' in the CR (85.7%) and the PL group (100.0%).Conclusion: Our results suggested that motor recovery mechanisms could be different according to location of cerebral infarct. (J Korean Acad Rehab Med 2004; 28: 412-417)

Objective
This study was designed to make a comparison of motor function according to the age group after the rehabilitation management in poststroke hemiplegic patients.Method: We examined 23 cases of young age stroke with hemiplegia aged ≤50 years and 24 cases of old age stroke aged ≥70 years. Motor power of affected side was measured by Motricity Index (MI) and Trunk Control Test (TCT). Level of ambulation was determined by Massachusetts General Hospital Functional Ambulation Classification (MGHFAC). Scores of each scale at admission and reassessment were obtained after rehabilitation management to compare the level of motor function in each age group and according to the age group. Results: Scores of MI, TCT and MGHFAC scale were significantly increased after rehabilitation management in each group. Although both groups differed regarding to those of MGHFAC, there was no difference for the increment of MI and TCT according to the age group after rehabilitation. Conclusion: Both age group showed significant improvement of the motor function and ambulation level after rehabilitation management. Ambulation level improvement of younger patient was greater than that of older patients. However, there was no difference in the extent of motor function improvement of affected side according to the age groups. (J Korean Acad Rehab Med 2004; 28: 418-421)

Objective
To assess the inter-tester and test-retest reliability and validity after developing of Korean version of National Institutes of Health Stroke Scale (NIHSS).Method: This research was conducted on 27 patents with stroke with less than 12 months since the onset of disease. Five physiatrists translated NIHSS into Korean. Video taping were used for objective scorings. Four physiatrists conducted scorings in order to seek for inter-tester reliability and one conducted scorings three weeks interval for test-retest reliability. Six physiatrists conducted scorings in order to seek for concurrent validity with the original NIHSS and four conducted scorings for validity with other impairment scale. Each score was analyzed based on Spear-man correlation coefficient. Results: According to inter-tester reliability for Korean version of NIHSS, rho value reached over 0.70, with over 0.72 concerning test-retest reliability. The test on concurrent validity with the original NIHSS reached over 0.70 at rho value, with over 0.653 for MMSE, Motricity index, Brunnstrom stage.Conclusion: Newly developed Korean version of NIHSS showed high inter-tester and test-retest reliabilities, together with high concurrent validity with the original and other impairment scales, to be regarded to be used as primary impairment scale for patients with stroke. (J Korean Acad Rehab Med 2004; 28: 422-435)

Purpose
To investigate the brain areas related with the deficit in visuospatial attention in patients with traumatic brain injury (TBI) using functional MRI (fMRI). Method: Twenty TBI and fifteen normal subjects were enrolled. The endogenous visuospatial attention task was used as an activation paradigm during fMRI. FMRI was performed on a 3T ISOL Forte scanner. Thirty slices were acquired using a single-shot EPI sequences (TR/TE=3000/ 30 ms, Flip angle 70^o, FOV=220 mm, 64⁓64 matrix, slice thickness 4 mm). The accuracy and reaction time to the attention task were measured during fMRI. Imaging data were analyzed using SPM-99 software. Results: The ratio of accurate responses was lower (p＜0.01)and the average reaction time was slower (p＜0.01) in the TBI group than the normal group. The fMRI analysis showed more activation in the bilateral prefrontal cortices (the middle and inferior frontal gyri) and less activation in the cingulate gyrus, medial frontal lobe, bilateral temporo- occipital areas, and cerebellum in the TBI group compared with the normal group.Conclusion: In TBI patients, impaired visuospatial attention might be resulted from the decreased activity of the cingulate, medial frontal, and temporo-occipital regions accompanied with compensatory hyperactivation of the prefrontal cortex. (J Korean Acad Rehab Med 2004; 28: 436-443)

Objective
To determine the effectiveness of body weight- supported treadmill training on gait pattern in children with cerebral palsyMethod: Seventeen children with cerebral palsy were given with body weight-supported treadmill training. The gait training was offered on treadmill and they were trained five times a week, 20 minutes a session for three weeks. To evaluate the ambulatory function, we estimated the walking distance for one minute and gait analysis before and after the treatment. Gait analysis was done for 11 children with Vicon 370 computerized gait analyzer and linear parameters, kinematic and kinetic data were obtained.Results: Walking distance for one minute increased from 6.74⁑6.16 m to 11.06⁑7.98 m. In linear parameters by gait analysis, gait speed (0.15⁑0.18 m/sec to 0.23⁑0.24 m/sec, p＜0.05), cadence (53.0⁑26.3 steps/min to 65.9⁑35.7 steps/min, p＜0.05), and stride length (0.30⁑0.17 meters to 0.35⁑0.18 meters, p＜0.05) increased following body weight-supported treadmill training. Also, there was a significant difference in knee flexion during loading response. Conclusion: In rehabilitation of cerebral palsy, body weight- supported treadmill training improved gait pattern. So, we recommend this gait training method for children with cerebral palsy. (J Korean Acad Rehab Med 2004; 28: 444-448)

Objective
To investigate neurophysiologic changes of peripheral nerves, which were injured by radiofrequency thermocoagulation and evaluate an effective distance between the lesioning electrode and target nerve tissue.Method: Thirty Sprague-Dawley rats were used and divided into three groups by the distance between the lesioning electrode and the sciatic nerve: 2 mm, 4 mm, 6 mm for each group (10 rats for each group). Radiofrequency lesioning was performed with 1.5 Volt, 1 MHz-frequency and 1 ms duration current for 90 sec. On the first and the fifth day after radiofrequency lesioning, latencies and amplitudes of compound muscle action potential were compared with the baseline values.Results: No statistically significant latency change was observed on the first and the fifth day after lesioning. The amplitude was significantly reduced in group I and II on the first and the fifth day after lesioning, in contrast that, there was no significant change in the group III.Conclusion: There was significant decrement in the amplitude after effective radiofrequency lesioning to the sciatic nerve with the distance of 4 mm or less. However, changes of the latencies was not significant. It was suggested that effective distance between raidiofrequency lesioning electrode and target peripheral nerve was 4 mm or less. (J Korean Acad Rehab Med 2004; 28: 449-453)

Objective
To evaluate the difference in vital capacity (VC) between sitting and supine position in patients with amyotrophic lateral sclerosis (ALS) and Duchenne muscular dystrophy (DMD). Method: VC was measured in the sitting and supine position for 30 patients with DMD and for 30 patients with ALS. The highest value in three or more attempts in each position was chosen.Results: VCs measured in ALS patients in the sitting and supine position were 1591.7⁑634.6 ml and 1290.0⁑580.3 ml respectively. The VC in the sitting position showed significantly higher value than the VC in the supine position (p＜0.05). VCs measured in DMD patients were 903.7⁑518.1 ml and 795.3⁑505.6 ml respectively. There was no statistically significant difference between the measurements in both positions.Conclusion: Difference in postural change of VC was observed in patients with different types of neuromuscular disorders. Such difference in VC suggest that postural change of VC should be considered in management of neuromuscular disease with respiratory muscle weakness. (J Korean Acad Rehab Med 2004; 28: 454-457)

Objective
To identify the relation between height and limb length using anthropometric data in healthy people.Method: One hundred and fifty healthy subjects between the age of 7 months and 67 years were subdivided into five groups: group I (age under 5), group II (5∼10), group III (11∼20), group IV (21∼60), and group V (61 or more). Each group included 15 males and 15 females. Upper arm was measured between acromion and olecranon, and forearm was measured between olecranon and thumb tip. Thigh was measured between ASIS and medial plateau of tibia, and lower leg was measured between medial plateau of tibia and the floor vertically. Results: Ratios of upper arm to height were 0.18⁑0.01 in group I, 0.19⁑0.02 in group II, 0.19⁑0.01 in group III, 0.19⁑0.01 in group IV, and 0.18⁑0.01 in group V. Ratios of forearm to height were 0.23⁑0.03, 0.23⁑0.03, 0.23⁑0.02, 0.22⁑0.01, and 0.22⁑0.01, respectively. Ratios of thigh to height were 0.27⁑0.03, 0.29⁑0.02, 0.31⁑0.02, 0.31⁑0.01, and 0.31⁑0.01 in each age group. Ratios of lower leg to height were 0.22⁑0.02, 0.25⁑0.02, 0.25⁑0.01, 0.26⁑0.01, and 0.25⁑0.01, respectively.Conclusion: Ratio of each body segment to height was useful in producing prosthesis for the people lost their both upper or lower extremities calculating the ultimate length of extremities through it. (J Korean Acad Rehab Med 2004; 28: 458-461)

Objective
To evaluate the influence of weight-bearing on foot shape measured by 3-D foot scanner. Method: Forty-two feet of twenty-one normal subjects were studied. The foot length, width, girth and arch parameters under non weight-bearing and weight-bearing conditions were measured by 3-D foot scanner (Nexcan^Ⱂ, K & I, Korea), analysis software (EnFOOT^Ⱂ, K & I, Korea) and 3-D foot arch measurement program. Results: The foot length, ball width, ball girth, waist girth, instep girth, short heel girth, long heel girth and length from heel point to proximal arch point significantly increased under weight-bearing condition (p＜0.01). However, vamp height, waist height, instep height, length of arch, height of arch, width of arch, length from heel point to distal arch point, maximal arch height and volume of arch were significantly decreased under 50% weight-bearing condition (p＜0.01). Conclusion: Foot parameters associated with length, width and girth increased but volume, width, length, and height of medial longitudinal arch decreased under weight bearing condition. We suggest that these findings under weight- bearing condition result from the pronation of subtalar joint and the decrement of heights of transverse and longitudinal arch heights. (J Korean Acad Rehab Med 2004; 28: 462-468)

Objective
To evaluate and quantify the medial longitudinal arch of foot using a 3-D foot scanner and 3-D arch measurement program. Method: 997 subjects (363 men and 634 women) were selected. The foot length, width, girth and medial longitudinal arch parameters were measured with a 3-D foot scanner (Nexcan^Ⱂ, K&I, Korea), analysis software (EnFOOT^Ⱂ, K&I, Korea) and 3-D measurement program of the medial longitudinal arch. Results: The mean arch lengths were 100.3 mm for men, 90.4 mm for women. The mean arch height and arch volume in both genders were 14.7 mm, 12.1 mm and 10.3 cm³, 6.0 cm³, respectively. We compared the arch parameters of both genders by univariate analysis of variance and in most cases the parameters of men were larger than those of women. Moderate positive relationships were found between foot length and arch width of talonavicular joint in cases of men, foot length and length from heel point to distal arch point in both genders (Pearson correlation coefficient＞0.3, p＜0.01). Conclusion: We evaluated the medial longitudinal arch of Korean feet three dimensionally. These data sould be a useful reference for making shoes, insoles, and orthoses. (J Korean Acad Rehab Med 2004; 28: 469-476)

Objective
This study was designed to investigate the mechanism of the primary afferent input to spread of contralateral hyperalgesia in the persistent muscle pain model in the rat.Method: Muscle pain was induced by twice repeated intramuscular injections of pH 6.0 buffered saline into the unilateral gastrocnemius muscle of the rats. Change of mechanical withdrawal threshold to von-Frey filament was measured after ipsilateral laser irradiation, anesthetic blockade with lidocaine and dorsal rhizotomy (L2∼L6) to reduce primary afferent input from the tissue injury. Results: Bilateral persistent mechanical hyperalgesia in the hind paw was evoked after second injection. Ipsilateral laser irradiation, lidocaine injection and dorsal rhizotomy had no effect on the contralateral spread of mechanical hyperalgesia.Conclusion: These results suggest that contralateral hyperalgesia was produced by, but didn't need to be maintained by inputs from an injury. Therefore, central nervous systems are responsible for the contralateral spread of hyperalgesia. (J Korean Acad Rehab Med 2004; 28: 477-482)

Objective
To evaluate quantitative changes in arterial blood flow in the legs and systemic changes in blood flow after hot pack therapy on a leg.Method: It was conducted on 60 legs of 30 adults without the symptom of peripheral vascular disease. The blood flow of both popliteal arteries were recorded before and after hot pack therapy on a leg. Also, the blood pressure and pulse rate were recorded every two minutes using a pulsimeter. T-test was done to examine differences between blood flow of the popliteal artery on both legs before and after hot pack therapy. Paired t-test was used to examine differences in each leg before and after hot pack therapy and systemic effect after hot pack therapy.Results: After hot pack therapy, there were statistically meaningful changes in all the variables except the popliteal arterial diameter in a leg with hot pack therapy, whereas there were no significantly meaningful changes in a leg without therapy. Pulse rate was changed significantly, but blood pressures were not.Conclusion: There were an increase in regional arterial blood velocity and blood flow, skin temperature, and a reduction in peripheral resistance in a leg with hot pack therapy, but no meaningful changes without thrapy. There is no evidence of reflex vasodilatation. There is no meaningful changes in blood pressure, but an increase in pulse rate. (J Korean Acad Rehab Med 2004; 28: 483-487)

Objective
The aim of this study is to evaluate the acceleration of the center of mass (COM) of the body in stroke patients.Method: Seventeen stroke patients and 9 normal subjects were participated. Three dimensional gait analysis was used to classify gait phases for the reference. The accelerometer held over the COM were used to record vertical and medio- lateral accelerations of the COM of the body. Modified Ashworth scale and Brunnstrom stage were used to evaluate the clinical status of stroke patients.Results: In normal subjects, the acceleration showed symmetric pattern. The maximum peak of vertical acceleration occurred in loading response. In stroke patients, theacceleration wave was characterized by asymmetry and polyphasicity. Maximum peak in affected side was higher than that in unaffected side (p＜0.05). There were significant correlations between several elements of hemiplegic gait and the correspondent acceleration values; interval of successive peak I in vertical acceleration vs. step time, walking velocity and swing symmetry ratio vs. mean peak I, swing symmetry ratio vs. affected side peak I, step length symmetry ratio vs. peak I symmetry ratio.Conclusion: The accelerometer can be an easy and useful way to evaluate gait characteristics in stroke patients. (J Korean Acad Rehab Med 2004; 28: 488-493)

Objective
To introduce a Modified triangular Bobath sling (MTBS) and a MTBS with distal support (MTBSDS) as a new slings and to compare with previous slings in the therapeutic effects of shoulder subluxation in stroke patient.Method: Using a simple X-ray with and without slings, the vertical and horizontal distances were measured for 17 stroke patients. MTBS and MTBSDS were compared with 3 conventional slings, which were hemisling, Bobath sling and Extension-type sling, in the effects of correction. The questionaire was used to evaluate preference of patients.Results: In two developed slings, inferior subluxation showed significant correction and lateral displace was lessincreased than a Bobath sling although it was not statistically significant (p＜0.05). MTBS had the preference during non-walking because of comfort and easiness for donning and doffing, whereas MTBSDS had the preference during walking because of reciprocal arm swing and protecting the hemiplegic upper extremity from trauma.Conclusion: The results indicated MTBS and MTBSDS were more effective on shoulder subluxation in stroke patients. Further study on the development of slings for decrement of lateral displacement is recommended. (J Korean Acad Rehab Med 2004; 28: 494-500)

The patients who have high cervical cord injury with paralysis of diaphragm are not able to live without mechanical ventilatory support. In conventional concept, tracheostomy is necessary for long-term use of mechanical ventilation. We reported a 33-year-old man diagnosed with complete tetraplegia due to C1 spinal cord injury. He had used intermittent mechanical ventilation via tracheostomy tube. He had no movement of diaphragm and showed hypercapnia and hypoxemia without ventilatory support for several hours. He showed 400 ml of vital capacity and un-obtainable peak cough flow level but it could be obtained 300 L/min of assisted peak cough flow. Noninvasive intermittent positive pressure ventilation (NIPPV) was applied from invasive method and decannulation and tracheostomy closure was performed successfully. He had no pulmonary complications for six months. This case could be a good model for the indication of NIPPV application and decannulation. (J Korean Acad Rehab Med 2004; 28: 501-504)

Patients with spinal cord injury (SCI) have an increased prevalence of cholecystitis. Neurologically intact patients with cholecystitis usually complain biliary colic of the right upper quadrant (RUQ). Because of the inability to localize visceral pain in patients with SCI, the pattern of symptoms are quite different. We reported a case of 48-year-old man with C5 incomplete tetraplegia (ASIA C) who presented an increased spasticity and vague pain of RUQ and later diagnosed as an acute acalculous cholecystitis. Antibioticstreatment and Percutaneous Transhepatic Gall Bladder Drainage (PTGBD) were performed. An open cholecystectomy was performed after the laparoscopic cholecystectomy which failed due to severe adhesion. Postoperatively, patient recovered well without complications. We suggested that even a vague abdominal pain shouldn't be underestimated in SCI patients. (J Korean Acad Rehab Med 2004; 28: 505-507)

We presented a 64-year-old man who complained sudden onset of ulnar sided wrist pain, paresthesia in ulnar aspect of left hand after swinging a golf club. The intermittent pain was not relieved by physical therapy, local injection and medication on local clinics. Physical examination revealed tenderness on the area of the hook of hamate and weakness on flexion of 5th finger in the left side. Plane X-ray and electrodiagnostic study did not show abnormal findings.Bone scan revealed increased uptake localized on left ulnar site of wrist joint. For proper diagnosis, MRI and carpal tunnel view of left wrist were performed and fracture of the hook of hamate was found. We reported a case of non-union of golf related fracture of the hook of hamate by delayed diagnosis with the review of literatures. (J Korean Acad Rehab Med 2004;28:508-510)