Mental retardation is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and adaptive skills, which originates before the age of 18. The prevalence of mental retardation among elementary school children in Korea is estimated as 9∼12/1,000. In most cases of mental retardation, the interplay of genetic and environmental influences remains poorly understood. However, recent ad-vances in molecular genetic techniques have enabled us to understand more about the molecular basis of several genetic syndromes associated with mental retardation. This article presents a review of three common genetic conditions causing mental retardation-Down syndrome, fragile X syndrome, and Prader-Willi syndrome-with the summary of the effectiveness of early intervention for the children with mental retardation. (J Korean Acad Rehab Med 2006; 30: 103-110)

Objective
To evaluate the efficacy of donepezil on cognitive dysfunction in subacute post-stroke patients. Method: Sixty subacute stroke subjects were enrolled and randomly assigned into an experimental or control group. There was no significant difference between the two groups in age, sex and post-onset duration. Donepezil 5 mg was administered daily for 6 weeks to patients in the experimental group. Mini-Mental Status Examination (MMSE), Wechsler Memory Test (WMT) and Colored Progressive Matrices (CPM) were performed before and 6 weeks after administration of the study drug in both groups. Results: There was no difference between the two groupsin the MMSE, WMT, CPM scores at baseline. Six weeks later, the total score, memory input, recall and judgement as measured by the MMSE and the score on the WMT were significantly more improved in the experimental group when compared to the control group (p＜0.05). However, there was no significant difference between the two groups on the CPM score. Conclusion: These results suggested that donepezil may be helpful for improving cognitive function, especially memory in post-stroke patients. (J Korean Acad Rehab Med 2006; 30: 111-115)

Objective
To assess the clinical utility of the swallowing provocation test (SPT) and water swallowing test (WST) as a predictive factor of supraglottic penetration (SP) and subglottic aspiration (SA) in stroke patient with dysphagia. Method: Fourty-one patients suffered from ischemic stroke with dysphagia and 20 normal controls were recruited. We performed 2-step SPT (0.4 ml, 2.0 ml) via nasopharyngeal tube and 2-step WST (10 ml, 30 ml) per oral, combined with the videofluoroscopic swallowing study (VFSS) to determine the presence of SP and SA. Results: The cutoff values of the swallowing provocation latency in SPT for the detection of SP and SA were 2.45 sec, 2.75 sec (first step) and 2.25 sec, 2.34 sec (second step). For SPT, the sensitivity and specificity were 78.8%, 64.3% (first step) and 71.4%, 77.8% (second step) for the SP, and 77.8%, 76.7% (first step) and 75.0%, 66.7% (second step) for the SA. For WST, the sensitivity and specificity were 66.7%, 90.9% (first step) and 70.0%, 90.9% (second step) for the SP, and 61.1%, 56.5% (first step) and 72.2%, 60.9% (second step) for the SA. Conclusion: SPT was more useful for the detection of SA than WST in stroke patient with dysphagia. (J Korean Acad Rehab Med 2006; 30: 116-121)

Objective
To evaluate the benefit of digital infrared thermography imaging (DITI) and three-phase bone scintigraphy (TPBS) for detecting the post-hemiplegic complex regional pain syndrome (CRPS). Method: DITI and TPBS were done in 26 patients with post-hemiplegic CRPS clinically and 14 hemiplegic patients without CRPS as controls. Positive findings were interpreted when the affected hands were 1.0^oC higher than those of unaffected hands in DITI system and pathological uptake in the regions of interest (hands without fingers-carpal bones, metacarpal bones and metacarpopharyngeal joints) in de-layed phase of the TPBS. Results: The sensitivities of DITI and TPBS to detect CRPS were the same to each other as 46.2%, and specificities were 85.7% and 100% respectively. Nineteen of 26 patients (sensitivity=73.1%) were interpreted as abnormal when at least one test showed a positive finding. As a result, an increased diagnostic strength was achieved.Conclusion: These findings suggest that the combination of TPBS and DITI can improve the diagnostic strength of post- hemiplegic CRPS. (J Korean Acad Rehab Med 2006; 30: 122-127)

Objective
To develop an evaluation tool of cognitive perceptual function for safe driving of the brain injured patients and to check the suitability of the tool. Method: Cognitive Perceptual Assessment for Driving (CPAD) was constructed with 8 tasks of depth perception, sustained attention, divided attention, Stroop test, digit span test, field dependence, trail making test A, and trail making test B. The predriving assessment with CPAD and road test were applied to 101 brain injured patients. The reliability and the validity of CPAD, and the cut-off score to resume driving were determined. Results: The CPAD scores of pass group (n=46) and fail group (n=55) for on-road test were 51.67⁑5.53 and 44.30⁑8.44 respectively (p=0.0001). The internal consistency of the CPAD measured by Cronbach's α was 0.85. The cut-off score based on 95% confidence interval was 53 or above for pass group, 42 or below for fail group, 43∼52 for borderline group. The positive and negative predictive value was 90.7% and 50.3%, respectively. Conclusion: The CPAD could be useful for the evaluation of driving ability of persons with brain injury. (J Korean Acad Rehab Med 2006; 30: 128-134)

Objective
The purpose of this study was to find reliable behavioral measures for the evaluation of motor dysfunction in photothrombotic ischemia rat model. Method: Male Sprague-Dawley rats were trained for behavioral test including tray reaching task (TRT), single pellet reaching task (SPRT), and rotarod task (RRT) for more than 2 weeks. Photothrombotic ischemia was induced in a stereotactically held rats using Rose Bengal dye (20 mg/kg) and cold light. Rats were assigned to either control (n=10) or experimental ischemic group (n=10). Post-lesional behavioral tests were performed for 4 weeks after confirma-tion of lesion by magnetic resonance imaging (MRI), followed by histological examination. Results: RRT showed no difference between control and experimental group. SPRT and TRT showed significant difference between control and experimental group (p＜0.05). SPRT could well demonstrate the recovery of motor dysfunction after over time. Conclusion: SPRT could be the most reliable test to measure not only motor dysfunction but also motor recovery in unilateral motor cortex lesion of photothrombotic ischemia rat model. (J Korean Acad Rehab Med 2006; 30: 135-141)

Objective
To investigate the characteristics of the central neuropathic pain (CNP) after contusive spinal cord injury in rats. Method: Twenty Sprague-Dawley rats (300⁑50 g, male) undergone the free-drop contusion injury from the drop- height of 2.5 cm at T10 cord (n=20) and ten rats undergone sham operation (n=10) were subjected to the neurobehavioral analyses by the Basso Beattie Bresnahan (BBB) locomotor rating scales, Touch test^TM sensory evaluator (TTSE, North Coast Medical Inc., Canada) and Plantar test^Ⱂ (Ugo Basile, Italy) after contusion at the 1^st, 3^rd, 5^th, 7^th, 14^th, 21^st and 28^th day. Results: The scores of BBB scales were the lowest at the1^st day and then slowly increased to spontaneous recovery state, but they were significantly lower than those of control group (p＜0.05). The thresholds of mechanical allodynia were significantly increased just after cord contusion, but progressed to decline, and significantly decreased after the 21^st day (p＜0.05). The latencies of thermal hyperalgesia were delayed just after cord contusion, but significantly shorter than those of the control group after the 7^th day (p＜0.05). Conclusion: These results would be helpful for the study of the CNP after contusive spinal cord injury in rats. (J Korean Acad Rehab Med 2006; 30: 142-147)

Objective
To investigate the relationship between autonomic neuropathy and peripheral neuropathy through analysis of heart rate variability (HRV) in diabetic patients, and ultimately to investigate usefulness for HRV analysis for quantitative evaluation and prediction of diabetic autonomic neuropathy. Method: We performed nerve conduction study (NCS), H- reflex, and HRV test with 42 diabetic patients. We classified patients by presence of peripheral neuropathy and abnormality of H-reflex, respectively. By comparing standard deviation of RR interval (SDNN), high frequency (HF), low frequency (LF), very low frequency (VLF), and total power (whole level of frequency, TP) of HRV, we analyzed therelationship between these parameters and duration of diabetes, age, and results from NCS. Results: There were significant differences of SDNN, HF, TP according to the presence or the absence of peripheral neuropathy. There were significant differences of SDNN, HF according to the presence or the absence of H-reflex abnormality. SDNN and HF had reversed-relationship to the degree of H-reflex abnormality. Conclusion: We expect HRV might be used as an efficient quantitative method to detect diabetic autonomic neuropathy and suggest HRV to be used for early detection of diabetic peripheral neuropathy. (J Korean Acad Rehab Med 2006; 30: 148-152)

Objective
This study was designed to investigate the effect of lateral wedged insole on foot of osteoarthritis patients. Method: 11 osteoarthritis patients participated in this study. Plantar peak pressures in shoes were measured by pedar^Ⱂ during a comfortable gait in three conditions (no wedge, with 5 degree wedged insole and with 10 degree wedged insole). Plantar pressure was analyzed by pedar C-expert program at TO (whole foot), M1 (medial heel), M2 (lateral heel), M3 (medial midfoot), M4 (lateral midfoot), M5 (1st, 2nd metatarsal area), M6 (3rd, 4th, 5th metatarsal area), M7 (great toe), M8 (2nd, 3rd toe area), M9 (4th, 5th toe area) zones respectively. Results: There were significant differences in peak plantar pressures of whole foot, heel zone, and lateral midfoot zone according to wedge type. But there was no significant difference in peak plantar pressures at medial midfoot zone and forefoot zone according to wedge type. Conclusion: There were difference in peak plantar pressures of osteoarthritis patients according to wedge type. (J Korean Acad Rehab Med 2006; 30: 153-157).

Objective
To identify the effectiveness of a weight loading device as a method for assessment of unilateral knee pain. Method: Twenty-five patients with unilateral knee pain and 25 pain-free controls participated in this study. Patients with a score of 2 or more on modified Kellgren-Lawrence scale based on the radiologic findings were diagnosed as degenerative arthritis. We constructed a device of segmental foot plates with strain gauge weight sensors to measure the weight load of each leg during self-selected walking speed. Using this device, we obtained the ratio of symptomatic side to asymptomatic side of weight load (RATIO) for each patient. The degree of pain according to visual analogue scale (VAS), abnormalities in radiologic findings, and weight load ratio were compared with each other. Results: The RATIO was 1.00⁑0.03 in the control group, and 0.92⁑0.08 in the patient group (p＜0.05). In the patient group, there was a significant correlation between RATIO and the VAS score (r=⁣0.44, p=0.03). In the patient group with degenerative arthritis, the RATIO (p=0.75) and VAS (p=0.94) were not different from those in patient group without degenerative arthritis. Conclusion: The foot plate weight loading device may be an effective tool for convenient measurements of knee pain. (J Korean Acad Rehab Med 2006; 30: 158-162)

Objective
The purposes of this study were to evaluate the change of temperature before and after thoracic sympathectomy in patients with palmar hyperhidrosis and to find the usefulness of infrared thermography for the assessment of effects of thoracic sympathectomy. Method: The skin temperature was measured before, one day and 30 days after sympathectomy in 28 patients with palmar hyperhidrosis. Temperature was recorded on forehead, cheek, neck, axilla, umbilicus and 6 sites of each hand and foot by infrared thermography and thermometer. Patient's satisfaction with operation was assessed by 10 point scale. Results: All patient who had undergone sympathectomyshowed significantly decreased discomfort owing to hyperhidrosis by 10 point scale (p＜0.05). The temperature significantly elevated on postoperative 1 day and 30 days on both palms as compared with preoperative state, bilaterally (p＜0.05). There were no significant differences of sole temperatures among preoperative, postoperative 1 day and postoperative 30 days, bilaterally. Conclusion: We proved significant effect of thoracic sympathectomy to the patients with palmar hyperhidrosis objectively, and we also quantified the elevation of palm temperature after sympathectomy. (J Korean Acad Rehab Med 2006; 30: 163-168)

Objective
The aim of this study is to evaluate the surface anatomical landmark for the cervical epidural block by investigating the proportion of patient's prominence in the 7th cervical vertebra. And the most optimal insertion angle over the mid point between the 6th and the 7th cervical spinous process is also measured. Method: Patients who did a plane x-ray examination of cervical spine were selected. We performed plane x-ray after marking on cervical vertebra prominence that was assumed as the spinous process of the 7th cervical vertebra by inspection and palpation. We identified where the marker were located on the spinous process. Moreover, we mea-sured optimal insertion angle in the plane x-ray of cervical spine lateral. Results: A total 100 cases were identified. The vertebra prominence was on the 7th cervical vertebra in 62 cases and the 6th cervical vertebra in 29 cases. The 1st thoracic vertebra was in the 2 cases and the 6th and 7th cervical vertebra in the 7 cases. Conclusion: The vertebra prominence was identified as the spinous process of the 7th cervical vertebra in sixty two percent of the cases. And the most optimal insertion angle is a ⁣25.28 degree angle from the perpendicular line of the skin. (J Korean Acad Rehab Med 2006; 30: 169-172)

Objective
Although the clinical effects of prolotherapy on osteoarthritis has been reported, there have been few previous studies showing the effects as a proliferant on articular cartilage. Also the autologous blood has been reported to used as a growth factor stimulant recently, we were trying to use dextrose and autologous serum for tissue regeneration respectively and evaluated the proliferative effect of autologous serum comparing with that of dextrose. Method: Twenty four rabbits were used for this study. The rabbits were divided into three groups. Group A did not get any special treatment. Group B was treated with 10% dextrose and group C with autologous serum. Six weeks la-ter, gross appearance and histologic findings were evaluated. Results: After sacrifice, the gross inspection of the knee joints revealed that group B and C were filled with the translucent tissue in defective cartilage. Group A still had defective cartilage. Histologic evaluation revealed increase of cellularity in the defect of the injected specimens when compared with the control. There was no morphological difference between group B and C. Conclusion: The repair process of the articular cartilage defects using dextrose and autologous serum were shown to be more effective than that of control group. (J Korean Acad Rehab Med 2006; 30: 173-178)

Objective
The aim of this study was to investigate the types of impairments in burn patients. Method: The retrospective data of 143 patients with burn injury was collected who were admitted to the burn rehabilitation department in Hangang Sacred Heart Hospital from Jan 2000 to Jul 2004. We have collected the informations on impairment of burn injury. Results: Limitation of joint motion (78.6%) was the most common disability, followed by hypertrophic scar (53%), peripheral neuropathy (32.9%), and amputation (20.3%) in burn injured patients in rehabilitation management. The common sites of joint limitation were finger joint (38.1%), shoulder (35.7%), elbow (30.8%) and knee (28.0%) joint. Neuropathy by the order of frequency were median (29.7%), ulnar (22.6%) and peroneal (20.2%) nerve lesion. The most common site of amputation was transradial amputation (8.4%). Conclusion: Above analytic data will provide the useful information about disability of burn patients to know where we should focus on to reduce complication rate or to restore body functional level in burn patient rehabilitation. (J Korean Acad Rehab Med 2006; 30: 179-183)

Terson's syndrome is one of the cerebro-ocular syndrome which entails the findings due to intraocular hemorrhage in association with increased intracranial pressure following subarachnoid hemorrhage. We reported a patient suffering from total blindness after basal ganglia hemorrhage, who was diagnosed as Terson's syndrome and vitrectomy was done. Our patient recovered normal visual acuity after vitrectomy, which fascilitated rehabilitative process. We alsoperformed diffusion tensor tractography to investigate abnormalities of brain related to the visual dysfunction, which revealed decreased orientation and integrity of the right optic radiation. It is important to diagnose Terson's syndrome early because it is one of the cerebro­ocular syndrome which needs early intervention with consideration of the integrity of optic pathway. (J Korean Acad Rehab Med 2006; 30: 184-187)

The treatment and prophylactic therapy of meningeal leukemia with intrathecal methotrexate in acute lymphoblastic leukemia is the standard method. Intrathecal overdose of methotrexate may produce severe toxicities such as paraplegia. We experienced a case of paraplegia diagnosed by magnetic imaging examination of the spine in a 24-year-old woman received repeated intrathecal methotrexate for meningeal leukemia. (J Korean Acad Rehab Med 2006; 30: 188- 190)

We experienced a patient who presented recurrent episode of pain, swelling, and weakness of right lower leg. She was diagnosed as Behcet's disease 1 year ago. The symptom was developed after exercise and was relieved by rest. After several different examinations and differential diagnoses, we confirmed the diagnosis as chronic exertional compartment syndrome on the basis of measuring intramuscular compartmental pressure. The patient was recommended to take a rest and she got a shoe-modification, prescription of ankle- foot orthosis, and physical therapy. She experienced symptom relief after that. Chronic exertional compartment syndrome is uncommon disease caused by reversible ischemia secondary to increased pressure within a closed osseofascial compartment after exercise producing expansion of muscle volume. (J Korean Acad Rehab Med 2006; 30: 191-194)

We developed a new, affordable, and easy-to-use natural-fill cystometric device to overcome the limitation of conventional cystometry, long been criticized for being unphysiological. The device was composed of one transurethral catheter, one rectal catheter, two digital manometers, and a portable computer. The transurethral and rectal catheters were connected to manometers, which were then connected to the computer. Three persons with neurogenic bladder were recruited for testing the device. To shorten the test duration, we gave patients 500 ml water before the test. As urine filled inside the bladder, the transurethral and rectal catheters transmitted respectively the intravesical and abdominal pressures to the digital manometers. The pressures were stored within the portable computer and turned into graphs indicating pressure changes. The natural-fill cystometry is thought to be a physiological test that is affordable and convenient because of its simple structure and small size. (J Korean Acad Rehab Med 2006; 30: 195-198)