In this paper, we give an overview of the child psychiatry perspectives on developmental disorders and introduce the diagnostic categories of developmental disorders, based on the DSM-IV and ICD-10 classification systems. Pervasive developmental disorders, mental retardation and specific developmental disorders are the three main diagnostic categories of developmental disorders in this article. Pervasive developmental disorders include autistic disorder, Asperger's disorder, Rett disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified. Specific developmental disorders include communication disorder, learning disorder and motor skills disorder. This article discusses the developmental and clinical characteristics of the above mentioned disorders, focusing on the developmental disabilities of each disorder and the differential diagnosis with other disorders. Future directions for diagnosis are also highlighted. (J Korean Acad Rehab Med 2006; 30: 303-308)

Objective
This study was designed for evaluating the clinical usefulness of the Korean Denver Developmental Screening Test II (KDDST II) for screening of speech-language delays, for evaluating the co-morbidity of psychiatric disorders and examining the prevalence of hearing impairment in speech-language delays. Method: Fifty eight preschoolers whose chief complaints fell into 'late talker', 'dysarticulation' or 'stuttering' performed KDDST II, speech-language evaluation and hearing screening. Psychiatric consultation was performed if the child had any behavioral or emotional red flags. Results: More than 50% were classified as 'language delay only', 25.9% as 'language delay with speech disorder', 22.4%as 'phonological disorder only'. Eleven children (34.4%) with language delay were classified as 'global developmental delay'. Sensitivity of KDDST II as a screening tool of language delay was only 84.4%. Two cases of hearing impairment and 3 cases of complicated otitis media were detected by hearing screening. Seventeen children (29.3%) also had psychiatric disorders such as attention deficit hyperactive disorder, anxiety disorder, and autism spectrum disorder. Conclusion: Evaluation of whole spectrums of development and hearing screening were recommended in the children with speech-language delays. Psychiatric consultation should be also considered in a case of any behavioral or emotional concerns. (J Korean Acad Rehab Med 2006; 30: 309-314)

Objective
This study is to investigate the prognosis of functional ambulation in each type of cerebral palsy (CP). Method: Medical records of 385 patients were retrospectively reviewed that visited outpatients department and were diagnosed as CP. Various information was surveyed including CP type, gestational age at birth, birth weight and associated problems such as mental retardation and seizure and gross motor functional status such as ambulational status and Gross Motor Functional Classification System (GMFCS). All of them were compared between each type. The influences of seizure and mental retardation on gross motor function were also investigated. Results: Functional ambulation was achieved in 58.2% in overall. Inspecting in each type, 93.7% of spastic hemiplegia, 67.6% of spastic diplegia, 12.2% of spastic quadriplegia, 78.7% of dyskinetic type can ambulate functionally. Birth weight or gestational age had no independent influences on ambulation within each type. Seizure influenced negatively on ambulation of diplegic CPs with significance and mental retardation in diplegic CPs and quadriplegic CPs than any other type. Conclusion: Over the half of CP patients achieved functional ambulation. Hemiplegia and diplegia had good prognosis among all types. Seizure and mental retardation negatively affected ambulation function of CP patients, especially in diplegic CPs and quadriplegic CPs. (J Korean Acad Rehab Med 2006; 30: 315-321)

Objective
To investigate the findings of patients with autism or mental retardation shown in ¹H magnetic resonance spectroscopy (¹H MRS) and the correlation between findings in ¹H MRS and degree of language developmental delay. Method: ¹H MRS was performed in thirty five patients with autism or mental retardation. [N-Acetylaspartate (NAA)/ Creatine (Cr)], [Choline (Cho)/Cr], and [Myoinositol (mI)/ Cr] were measured and compared with those of control group. Also the correlation between ¹H MRS findings and the degree of language developmental delay was investigated. Results: Increased [Cho/Cr] was shown in parietal white matter and frontal gray matter in patients with autism and mental retardation. No significant differences were revealed in any metabolite ratio between mental retardation and autism. There were no significant correlations between the degree of language developmental delay and metabolite ratios. Conclusion: Myelin degeneration in parietal white matter and fronal gray matter could be related to autism and mental retardation. (J Korean Acad Rehab Med 2006; 30: 322- 327)

Objective
To determine the effects of integrative art therapy on social competence and hand function in children with cerebral palsy. Method: Nine children with cerebral palsy were given integrative art therapy and conventional occupational therapy for 50 minutes, once a week over 6 months. Ten children were selected as a control group and were given only conventional occupational therapy. To estimate the effectiveness of integrative art therapy, both groups were evaluated by Denver Developmental Screening Test (DDST-II), Box and Block test and Walker-McConnell scale before and after therapy. Results: Children of integrative art therapy showed significant improvement in 'personal and social' category of DDST-II and 'adaptive behavior' and 'adjustment to social relationships with peers' of Walker-McConnell scale. They also showed improvement of Box and Block test. Conclusion: This study revealed that integrative art therapy was effective on social competence as well as hand function in children with cerebral palsy. So, integrative art therapy is expected to be an adjuvant therapy for children with cerebral palsy. (J Korean Acad Rehab Med 2006; 30: 328-332)

Objective
To evaluate the neuroprotective effect of growth hormone (GH) following lateral fluid percussion brain injury. Method: Sprague-Dawley rats weighing 200∼250 g were subjected to moderate lateral fluid percussion brain injury and evaluated at 1, 7, 14 and 28 days post-injury. Rats were divided into control and GH pretreatment groups. GH (10 μg/10μl) or normal saline (10μg/10μl) was administered by intracerebro-ventricular injection 30 min before brain injury. We measured histopathological changes with TUNEL and toluidine blue Nissl stain and conducted motor function tests and an 8-arm radial maze test to identify neurobehavioral deficits and cognitive deficits, respectively, at oneday to 4 weeks post-injury. Results: In the pretreated GH group, a significant reduction in TUNEL-positive cells was found compared with the control group at 1 day and 1 week post-injury (p＜0.05). The pretreated GH group showed significantly greater improvement than controls motor function tests at 1 day post-injury (p＜0.05) and in an 8-arm radial maze test at 2 and 4 weeks post-injury (p＜0.05). Conclusion: These findings suggested that GH had a neuroprotective effect in neuronal cell death, motor function and cognitive deficits following experimental brain injury. (J Korean Acad Rehab Med 2006; 30: 333-339)

Objective
To classify complete spinal cord injury (SCI) patients based on the preservation of desire to void and to make clear the difference between each group Method: This study was performed retrospectively on 117 complete SCI patients with lesions above T11 who were referred to the urodynamic laboratory. Patients were classified according to the preservation of desire to void during conventional urodynamic study. The clinical and urodynamic characteristics of each group were analyzed. Results: There were 37 patients (31.6%) with the preserva-tion of desire to void. There were significantly lower compliance of bladder and longer duration from onset to examination in the sensory preservation group than the nonpreservation group (p＜0.05). There were no significant difference in clinical features such as voiding method, the presence of autonomic dysreflexia between each group. Conclusion: The presence of desire to void was noted in 31.6% of complete SCI patients observed. (J Korean Acad Rehab Med 2006; 30: 340-345)

Objective
The purpose of this study was to determine the natural history of symptomatic hands without electrodiagnostic evidence of carpal tunnel syndrome (CTS). Method: This study was comprised of 88 hands of 49 subjects with symptoms consistent with CTS without median mononeuropathy who were recruited during a community health examination and followed after two years. 88 hands of 44 people with age and sex-matched healthy controls were followed for comparison. Symptoms and electrodiagnostic findings were compared between the two groups. Results: 62 hands of the symptomatic group had persistent symptoms after 2 years while 16 hands of the control group had symptoms consistent with CTS. Median motor distal latencies were significantly delayed after two years in the symptomatic group (p＜0.05). Median sensory latencies were also delayed in the symptomatic group, but this was not statistically significant (p=0.064). The occurrence rate of median mononeuropathy at wrist was significantly higher in the symptomatic group than in the control group (13.6% vs. 2.3%)(p＜0.05). Conclusion: The results of this study suggested that a significant number of symptomatic hands without electrodiagnostic evidence of CTS may have persistent symptoms and may progress to electrodiagnostically evident CTS. (J Korean Acad Rehab Med 2006; 30: 346-352)

Objective
To exhibit the caveolin-3 immunoreactivities (IRs) in the peripheral nerve, which was previously known to be present only within the muscle and to be a causative agent of myopathy Method: The sciatic nerves of the rat were removed after the perfusion and frozen after cryoprotection by sucrose. The tissue specimens were cut on cryostat and immunostained with anti-caveolin-3 and growth associated protein-43 (GAP-43) antibodies. The sections were observed with a fluorescence microscope. Results: We detected caveolin-3 IRs in myelin sheath of the peripheral nerves, while GAP IRs were detected in the axon. Caveolin-3 IRs were active in the rat of postnatal 1 week, but they were reduced in the rat of postnatal 3 week and disappeared in that of 5 week. Conclusion: We detected caveolin-3 IRs in the myelin sheath of peripheral nerve. Caveolin-3 might play roles in the early myelination of peripheral nerve. (J Korean Acad Rehab Med 2006; 30: 353-356)

Objective
To clarify the relationship between the morphologic changes of and the clinical course of conservatively treated herniated cervical disc patients Method: Follow-up magnetic resonance imaging (MRI) and clinical assessment by the visual analogue scale were performed in 21 patients at a mean interval of 22.7 months. Results: An average reduction ratio of herniation on the sagittal and axial images were 11.65% and 19.5%, respectively. The clinical features improved significantly and the degree of clinical improvement was unrelated to the reduction ratio of herniation. Conclusion: 8 out of 21 (38.09%) showed reduction of herniated mass on follow up MRI after conservative treatment. The patients with extruded and sequestered disc herniation showed more morphologic changes on MRI. There was no correlation between the clinical state and the morphological change of herniated cervical disc. (J Korean Acad Rehab Med 2006; 30: 357-361)

Objective
To determine the diagnostic value of ultrasonography in detection of the partial and full-thickness rotator cuff tear compared with arthrography. Method: One hundred twenty one cases were diagnosed as the patients with rotator cuff tear. Patients with full-thickness tear were divided into subgroups based on the size of small (＜1 cm), large (1∼3 cm) and massive (＞3 cm) tear. With arthrography as the standard of comparison for diagnosis of rotator cuff tear, full-thickness tear was confirmed by leakage of contrast extending into the subacromial-subdeltoid bursa. Results: Ultrasonography detected full-thickness tear in 90 cases, partial-thickness tear in 24 cases and no tear in 7 cases. A comparison of the results from ultrasonography and arthrography demonstrated a sensitivity of 83.8%, a specificity of 43.9% and an accuracy of 70.2% for detection of full-thickness tear. The size of supraspinatus full-thickness tear in inconsistent group of ultrasonographic and arthrographic findings was significantly smaller than that of consistent group. Conclusion: Ultrasonography may be used as the primary screening test for patients who may have suspected rotator cuff tears. However, other diagnostic techniques are recommended to confirm in patients who show small full-thickness tear on ultrasonography. (J Korean Acad Rehab Med 2006; 30: 362-367)

Objective
To compare an isotonic lumbar extension exercise program utilizing lumbar extension exercise machines with modified combination program of isotonic lumbar extension exercises, including dynamic stabilization exercise, to improve and maintain trunk stability in the patient with microscopic lumbar discectomy. Method: We studied 41 male workers who underwent microscopic lumbar discectomy. Group 1 (n=24) was treated with the isotonic lumbar extension exercise program. Group 2 (n=17) was treated with the modified combination program of dynamic lumbar stabilization exercise and isotonic lumbar extension exercise. The categories that were evaluated and measured were trunk stability, isometric peak tor-que of lumbar extensor, weight distribution rate of both leg and trunk muscle balance, and Oswestry low back pain (LBP) disability index. Results: After 3 months, group 1 revealed higher isometric peak torque, weight distribution rate of both leg and trunk muscle balance compared with that of group 2. At the end of 6 months, group 2 revealed higher isometric peak torque compared with that of group 1. Conclusion: We suggested that combined exercise program, that included the dynamic lumbar stabilization exercise and the isotonic lumbar extension exercise, was a valuable treatment for postoperative lumbar rehabilitation. (J Korean Acad Rehab Med 2006; 30: 368-377)

Objective
To investigate the effects of nonsteroidal anti- inflammatory drugs (NSAIDs) and acetaminophen on histologic changes of the Achilles tendon in an experimental prolotherapy model. Method: The right Achilles tendon of 60 rats was injected with 20% dextrose on experimental day 1, 7, and day 14, whereas the left was not injected and used as control. Rats were divided into 3 subgroups: NSAIDs medication group (10 mg/kg/day), acetaminophen medication group (100 mg/ kg/day) and no medication group. Medications were given for 3 consecutive days after each injection. Rats were sacrificed at 3 and 6 weeks after first injection. The transverse diameter of gross specimen, the number of fibroblasts on light microscope, and the distribution of collagen fibril on electron microscope were assessed. Results: The transverse diameter and the count of fibroblasts of all groups increased significantly in the injected tendon compared to the non-injected tendon. However, there were no differences among all groups significantly (p＜0.05). On electron micrograph, fibril diameters of injected tendon consisted of mainly smaller sizes with the intermediate sizes. Conclusion: Prolotherapy enhances fibroblastic stimulation and elaboration of extracellular matrix. Short term use of NSAIDs may not have any adverse effects on tissue proliferation after prolotherapy. (J Korean Acad Rehab Med 2006; 30: 378-384)

Objective
The purpose of this study was to compare the kinematic and kinetic parameters in sit-to-stand (STS) movement between healthy elderly and young people. Method: We measured the maximal isometric hip and knee extension moment of the ten healthy young volunteers and ten elderly and analyzed the STS movement using a motion analyzer. The differences of temporal, kinematic, and kinetic variables between young and elderly were assessed. Results: The maximal knee isometric moment of elderly was lower than that of young. There were no differences in total duration and the range of motion of hip and knee during STS movement between young and elderly. Com-paring the kinetic variables normalized by maximal isometric extension moment, maximal knee extension moment and knee work were significantly higher in elderly. There were no differences in maximal knee power and kinetic variables of hip between young and elderly. Conclusion: It was the marked difference of STS movement between young and elderly that maximal knee extension moment normalized by maximal isometric extension moment was higher in elderly. It was reasonable that this difference was due to the difference of maximal knee isometric torque. (J Korean Acad Rehab Med 2006; 30: 385-391)

Objective
To investigate the effect of foot orthosis on spinal curvature, by correction of foot pronation and limb length discrepancy Method: 38 cases of foot-pronated children were investigated for changes in Cobb's angle before and after applying foot orthosis, and followed up after 6 months. Results: There were 25 males and 13 females, and the average age was 10.28⁑0.45 years. There were no significant correlation among Cobb's angle, limb length discrep-ancy, and difference of pronation. Cobb's angles were improved in 26 cases after applying foot orthosis, by mean 5.84⁑2.47 degree. 16 cases were followed up after 6 months, and Cobb's angle were maintained or improved in 11 cases. Mean correctability was 47.93⁑26.47%. Conclusion: This study showed that foot orthosis could be one of the effective method to improve spinal curvature. (J Korean Acad Rehab Med 2006; 30: 392-397)

Hypertonicity of the cricopharyngeal muscle often results in dysphagia. Current available treatments for this problem include the mechanical balloon dilation and cricopharyngeal myotomy. Recently, a botulinum toxin injection into the cricopharyngeal muscle has been proved to be a successful approach. The case well proved the effectiveness of botulinum toxin injections as a viable treatment for patients suffering from cricopharyngeal dysphagia. A 58 year-old man, who had right lateral medullary infarction, claimed severe difficulties in swallowing which was complicated by aspiration pneumonia. A videofluoroscopic barium swallow test indicated aspiration and cricopharyngeal hypertonicity. Botulinum toxin was injected into the cricopharyngeal muscle, through endoscopic identification. After treatment, videofluoroscopy showed a significant improvement in the cricopharyngeal muscle opening and no more silent aspiration was seen. This case implicated the effectiveness of endoscopic botulinum toxin injection treatment for cricopharyngeal dysphagia in situations where there was no response to traditional swallowing rehabilitation. (J Korean Acad Rehab Med 2006; 30: 398-401)

Collet-Sicard syndrome is one of the syndromes of the multiple lower cranial nerve palsies, characterized by unilateral paralysis of 9th through 12th cranial nerves. Meningioma has rarely been reported as a cause of Collet-Sicard syndrome. This case was a 34-year-old man who had dysphagia, loss of taste, and dysarthria. Brain MRI showed a mass in the left cerebellopontine angle. Videofluoroscopic swallowing study revealed severe dysphagia during pharyngeal phase and cricopharyngeal dysfunction. Laryngoscopy revealed left vocal cord palsy, and eletrodiagnostic study showed paralysis of the left IX, X, XI and XII cranial nerves. (J Korean Acad Rehab Med 2006; 30: 402-405)

Leigh syndrome is a subacute necrotizing encephalomyelopathy of infancy or early childhood. The clinical presentation can be highly variable. The classical presentations are central hypotonia, developmental regression or arrest, ataxia, ophthalmoplegia, and abnormal respiratory pattern. Diagnosis is usually confirmed by radiologic evidence of focal, bilateral and usually symmetric lesions of the both gray and white matter in the brain and the spinal cord. We experienced 2 cases of Leigh syndrome in a brother and sister.The first case, 4 year-old boy, was misdiagnosed as a cerebral palsy initially, but after acute infection, he revealed developmental regression and abnormal movement. His disease was confirmed by typical magnetic resonance imaging findings. The second case, 1 year-old girl with nystagmus, showed bilateral symmetric high signal intensity in globus pallidus on T₂W_I. We reported these cases with a brief review of the related literature. (J Korean Acad Rehab Med 2006; 30: 406-408)

The epiphyseal fracture-separation of the distal humerus is extremely rare injury in neonates. It is frequently misdiagnosed as a elbow dislocation owing to the invisible cartilagenous portion of the distal humerus in roentgenograms. We described a case, 9-day-old neonate with finally diagnosed the Salter-Harris type 1 injury of the distal humeral epiphysis. He was referred for further evaluation of 'refusal to use the left arm' from a local clinic. The injury had initially misdiagnosed as normal roentgenograms by a local orthopedic specialist, so we preferentially give an impression of the brachial plexus injury or the hemiplegic cerebral palsy. But electromyography and brain magnetic resonance imaging were negative findings. A neonate was referred to the pediatric orthopedic subspecialist and properly diagnosed. He was treated with the closed reduction and the percutaneous pinning. No complication has occurred. (J Korean Acad Rehab Med 2006; 30: 409-412)