Method: Total 139 children who visited the department of rehabilitation medicine for the evaluation of suspected speech-language delay. All children were evaluated for receptive and expressive language quotients, articulation accuracy, verbal, performance and full-scale intelligent quotients and social maturation assessment. Results: Approximately 70% of the children who had chief complaints of speech or language disorder were diagnosed as 'receptive and expressive language developmental delay'. Intelligent and social quotients of the children with receptive and expressive language developmental delay were significantly lower than those of the other groups (p＜0.05). Both receptive and expressive language quotients, but not dysarticulation, were significantly correlated with intelligent and social quotients (p＜0.05). Multiple regression analysis demonstrated that the language quotients could predict intelligent and social quotients as simple equations (p＜0.01). Conclusion: Primary result of receptive and expressive language quotients from screening test of language evaluation might be able to predict cognitive function and social maturity, which also showed high-degree positive correlation with intelligent and social quotients. This result could provide a useful guideline for further developmental studies in children with speech and language disorder who received primary speech evaluation. (J Korean Acad Rehab Med 2008; 32: 129-134)
Method: 79 teenagers with cerebral palsy attending special schools were examined for deformities of the spine and the lower extremities with physical examinations and radiographic studies. Results: The number of cases with scoliosis was 47 (59.5%) and the mean of Cobb's angle was 21.7 degrees. There were 42 joints (26.6%) of hip subluxation and 10 joints (6.3%) of hip dislocation out of 158 hip joints. The mean of migration percentage was 53.6%. 30 participants (38.0%) had pelvic obliquity. The coxa valga appeared in 147 hip joints (93.0%), with the mean of femur neck-shaft angle was 156.0 degrees. It had a casual link with migration percentage (p＜0.001). 131 knee joints (82.9%) had the increased popliteal angle and 113 knees (71.5%) had patella alta. 72 cases (91.1%) had equinus feet, and 49 cases (62.0%) had planovalgus feet deformities on radiographic studies. As the score of Gross motor function measure (GMFM) was decreased, the migration percentage (p＜0.01), the Cobb's angle (p＜0.01), the popliteal angle increased (p＜0.001) and femur neck- shaft angle (p＜0.05). Conclusion: Teenagers with cerebral palsy are highly risk to develop musculoskeletal deformities in their spine and the lower extremities. Therefore, a close medical inspection should be paid on this group. (J Korean Acad Rehab Med 2008; 32: 135-142)
Method: We examined 29 children with CP treated in our rehabilitation center (CP group) and 27 normal children from one of the local kindergartens (control group). We checked DMF (decayed, missing and filled teeth) and DMF ratio (DMFR) and asked them if they underwent regular dental examinations or not. Results: The mean age (±standard deviation) of the CP and control groups was 4.75 (±1.99) and 4.96 (±0.71), respectively. The prevalence of dental caries in the CP and control groups was 69% and 44%, respectively; moreover the percentage of patients in the CP group who underwent regular dental examinations was lower, as compared to the control group. Moreover, a significant statistical relationship between dental caries and regular dental examinations was observed only in the CP group. Conclusion: As compared to the control group, the prevalence of dental caries in children with CP was higher, and they also underwent regular dental examinations less frequently. (J Korean Acad Rehab Med 2008; 32: 143-146)
Method: Eighteen siblings of children with cerebral palsy aged 5 to 12 years and their mothers were included and the interview and psychological assessment were administered by developmental psychologist. All children were asked to complete the Children's Depression Inventory (CDI), State- Trait Anxiety Inventory (STAI), Piers-Harris Children's Self- Concept Scale, Korea Child Behavior Checklist and Korean Educational Developmental Institute-Wechsler Intelligence Scale for Children (KEDI-WISC). All participating mother were asked to complete Minnesota Multiphasic Personality Inventory (MMPI), Beck's Depression Inventory (BDI). For control group, eighteen children with healthy sibling and their mothers were enrolled. Results: Siblings of children with cerebral palsy showed higher mean score of CDI and STAI. And there were no differences in the CDI and STAI according to frequency of treatment, duration of treatment of children with cerebral palsy. There were no significant difference in Piers-Harris children's Self-Concept Scale and Korea Child Behavior Checklist between study group and control group. More than half of mothers of children with cerebral palsy showed depression in BDI and higher score of psychopathic Deviate and psychasthenia in MMPI. Children of mothers with depression in BDI showed higher mean score of CDI and STAI. Conclusion: It is necessary to consider extended service to promote psychosocial well-being of children with cerebral palsy and siblings in community-based service organizations. (J Korean Acad Rehab Med 2008; 32: 147-153)
Method: Between January 2004 and March 2006, 274 patients were engaged who had been diagnosed as flatfoot in 586 patients aged between 0 and 18. All patients were examined physically by one physiatrist to find other biomechanic abnormalities of lower extremities and to measure resting calcaneal stance position (RCSP) angle, bimalleolar angle (BMA). To detect the existence of scoliosis and the difference in leg length, radiographs were taken of the spine and the lower extremities. Flat foot was defined as when either of the feet had lower than −4° degrees of RCSP angle. Results: When comparing the value of RCSP angle between right side and left side, the left side was more pronated than the right side. The value of RCSP angle increased in proportion to age but there are other factors that caused the persistence of foot pronation and ligament laxity. The value of BMA tends to increase in proportion to age. The foot was more pronated, the tibia of the same side was more rotated internally and tibia of the other side was more rotated externally. The most common combined biomechanic abnormality of lower extremities was toe-in gait. Conclusion: Because the biomechanic effect of a foot could influence the leg, pelvis of the same side and the other side lower extremity, the flat foot should be regarded as an element of malalignment syndrome, anatomical abnormality, and also functional impairment. (J Korean Acad Rehab Med 2008; 32: 154-159)
Method: Our disability prevention program was a 60 minutes program composed of watching an education video for disability prevention and having a conversation with disabled speakers in wheelchairs. A questionnaire to measure the effect of the education was administered among 5,315 students in the 4th to 6th grades. The questionnaire was administered at 7 days before and after education. The questionnaire was to measure the changes in self-efficacy and in confidence to follow safety regulation. Also the questions on satisfaction about program were asked. Results: The result showed that only 9.7% of bicycle owners, 18.9% of inline skate owners wore helmets, 9.3% of quick board (or skateboard) owners wore helmets, and only 47.6% of students fastened seat-belts in a car. After the program was conducted, there were significant improvements in self-efficacy and practice-confidence to wear protective device and to fasten seat belt in a car (p＜0.01). The most impressive part of the program for students was 'conversation with disabled speaker' and the next was 'watching the video'. After program was conducted, 51.5% of students answered "I will keep safety regulations in mind and practice it" and 10.1% of students answered "I could learn a better understanding of the disabled and I also want to help them". Conclusion: The 'disability prevention program with disabled speakers in wheelchair' was effective in improving the self-efficacy and practice-confidence for safety regulation. (J Korean Acad Rehab Med 2008; 32: 160-168)
Method: 98 patients with SCI in post-acute rehabilitation hospitals were included. In order to identify rehabilitation desire, interviews were conducted among patients or their family members in a direct line. Discharge plans of patients after post-acute rehabilitation hospitals were surveyed. All participants completed demographic measures, Korean Modified Barthel Index (K-MBI) and International Classification of Functioning, Disability and Health (ICF) core-set for patients with neurological problems in post-acute rehabilitation facilities to determine the influences on rehabilitation desire. Results: Most (80.6%) of patients desired more intensive rehabilitation services and 47 patients (48.0%) purposed to get physical therapy focused on motor recovery. Only 15 patients (15.3%) planned to discharge to home. Patients who planned to discharge to home had higher K-MBI score and lower numbers of decreased body functioning, activities and participation in ICF core-set than patients who would admit to another rehabilitation hospitals after discharge. Conclusion: Appropriate and intensive educations after spinal cord injury on the recovery process and goal of rehabilitation are required to supply adequate rehabilitation services and to avoid unnecessary admission to rehabilitation hospitals. And the rehabilitation program focusing on functional recovery should be emphasized in patients with SCI. (J Korean Acad Rehab Med 2008; 32: 169-174)
Method: 62 physiatrists and 42 hand surgeons were surveyed with self administered questionnaire. The questionnaire was made up of 5 categories: (1) whether physicians had experienced these procedures in the past three years, (2) if they have had no experience, what the reasons were, (3) whether physicians desired to be involved in these procedures, (4) what the solution to promote these procedures should be, (5) the attitudes and beliefs of physicians about these procedures. The last category was analyzed by odds ratio between physicians who desired to be involved in the procedure and who didn't. Results: Only two physiatrists and six surgeons had experienced these procedures in the past three years. However many physicians desired to be involved in these procedures. The main reason of not performing these procedures was a lack of referral between physiatrists and surgeons. The physicians who desire to practice upper extremity reconstruction surgery or related rehabilitation had higher confidence on the benefits of the procedures and thought that they had knowledge and skills for the procedure. Conclusion: In spite of positive attitude to the upper extremity reconstruction for tetraplegic patients, few physicians have experienced in these procedures. This phenomenon was due to a lack of referral between physiatrists and surgeons. Advancing cross-specialty relationships and educating related physicians could be solutions to promote these procedures. (J Korean Acad Rehab Med 2008; 32: 175-181)
Method: Thirty-six post-stroke hemiplegic patients with a lesion in the internal capsule were included in this study. Diffusion tensor imaging (DTI) was performed with a 3.0 tesla MR at about 1 month after stroke. FA ratio was measured in posterior limb of the internal capsule of the patients. Motor evoked potential (MEP) was obtained by magnetic stimulation of the motor cortex and recorded from the abductor pollicis muscle. Somatosensory evoked potential (SSEP) was obtained by electrical stimulation of the median nerve at the wrist and recorded from the somatosensory cortex. Hand movement scale was obtained at about 1 month and 3 months after stroke. Results: Hand movement scale at about 1 month and 3 months after stroke and FA ratio were reduced significantly in patients who showed no response on MEP. However, no significant differences were observed between the patients who showed SSEP response and those who did not. FA ratio and hand movement scale were highly correlated to each other. Conclusion: MEP and FA ratio can be helpful in assessing the hand function at about 1 month and 3 months in post-stroke hemiplegic patients. (J Korean Acad Rehab Med 2008; 32: 182-188)
Method: Thirteen patients (24 hands) with CTS diagnosed clinically and electrophysiologically were included. All subjects were examined by ultrasonography with high-resolution linear array transducer and injected with 40 mg of triamcinolone acetonide. The ultrasonography was evaluated with regard to cross-sectional area and the flattening ratio of the median nerve and cross-sectional area of the flexor pollicis longus tenon at pisiform and hamate bone. After 4 weeks, the patients were re-evaluated with electrophysiologic study and ultrasonography. Results: Most patients (11/13) showed improvement of clinical symptoms and electrophysiologic parameters after the local steroid injection. The cross-sectional area of median nerve at pisiform using ultrasonography significantly decreased after the local steroid injection. However, flexor pollicis longus tendon did not show significant change after the injection. Conclusion: Local steroid injection in the patients with CTS caused improvement in ultrasonographic findings of median nerve. (J Korean Acad Rehab Med 2008; 32: 189-193)
Method: MRI images were reviewed from thirty two patients who were diagnosed electrodiagnostically as unilateral S1 radiculopathy. Areas of herniated disc and spinal canal were measured and the ratio of disc herniation was calculated from the axial images stored and analyzed by PACS. The radiologic measurements were compared with the results of electrodiagnostic studies. Results: The presence of abnormal spontaneous activities in needle EMG and no response in H reflex were associated with larger disc herniation (p＜0.05). There was no other single electrodiagnostic study that showed correlation with any of radiologic measurements. With increasing number of abnormal electrodiagnostic tests, area of disc herniation grew larger (p＜0.05). Area of spinal canal and the ratio of disc herniation did not show difference between normal and abnormal groups in most of electrodiagnostic studies. Conclusion: There were limited correlations between electrodiagnostic results and severity of disc herniation. The size of disc herniation, regardless of the size of spinal canal, was associated with abnormal results of electrodiagnostic tests. (J Korean Acad Rehab Med 2008; 32: 194-199)
Method: The experimental subjects were divided into 3 groups (Group 1: 100 persons; control, Group 2: 100 persons; RA without hand deformity, Group 3: 100 persons; RA with hand deformity). They were assessed with using the Modified Barthel Index (MBI), evaluating the activity of daily living (ADL). A JAMAR Hand DynamometerⰒ, JAMAR Hydraulic Pinch GaugeⰒ (Sammons Preston Rolyan, Ilinois, USA) were used to measure grip and pinch strength. Further assessments included joint deformity counts, and visual analogue scales. Results: The grip and pinch strength significantly decreased in all groups. The total MBI with other groups significantly decreased in RA patients with hand deformity (group 3). The MBI correlated well with visual analogue scales in group 2 and with joint deformity counts in group 3. Conclusion: Hand grip and pinch strength tests would be a useful tool for the evaluation of hand function in rheumatoid arthritis patients. (J Korean Acad Rehab Med 2008; 32: 200-205)
Method: From April 2006 to August 2007, we operated a mobile clinic equipped with a physical therapy unit during the professional golf competition. For professional golfers who had visited the clinic during this period of time, we investigated distribution of pain and its characteristics through interviews and medical records. Results: A total of 118 professional golfers visited the mobile clinic during the service period. The analysis of pain distribution showed that spine (56.3%) including low back, cervical, thoracic spine was the most common area of pain complaints, followed by upper extremity (33.1%), lower extremity (9.1%) in order. Based on the detailed anatomical distribution, low back was the most common pain site (22.5%). In case of the upper extremity pain group, left side pain was more prevalent than that of right side. Compared with spine pain group, upper extremity pain group was significantly older and also had more professional career (p＜0.05). This implies that upper extremity injury may relatively caused from repetitive stress of golf swing. Conclusion: The results imply that golf imposes a relatively high burden on spine and upper extremity in professional golfers. (J Korean Acad Rehab Med 2008; 32: 206-210)
Method: Thirty-two patients whose BAEP test showed normal latency were included after patients whose somatosensory ratio and visual ratio from posturography showed abnormality were excluded. Ten healthy participants were set up as control group. We made comparison between P13 latency in VEMP and vestibular ratio posturography among these participants. Results: Among the participants 47% showed normal P13 latency, and 53% showed abnormal P13 latency. In normal P13 latency group, 86.7% of patients showed normal vestibular ratio, and in abnormal P13 latency group, 70.6% of patients showed abnormal vestibular ratio. Conclusioin: VEMP showed high correlation between vestibular ratio of posturography. VEMP can be used in screening test and clinically complementary diagnostic method of vestibular function test for patients with vertigo. (J Korean Acad Rehab Med 2008; 32: 211-215)
Method: Eighteen wheelchair ambulators with spinal cord injury who had neurological level below T2 were studied. Patients with peripheral or central neuropathies were excluded. Patients were assigned to either the electrodiagnostic CTS (group CTS, 7) or electrodiagnostically negative (group non- CTS, 11), and healthy volunteers (15) were classified as control group. The cross sectional area of the median nerve (MN-CSA) at carpal pisiform level was ultrasonographically measured. The degree of painful restriction to execute ADL by hands (TR-ADL), the pain grade (visual analog scale, VAS) of upper extremities and revised version of Korean spinal cord independence measure (KSCIM-R) for functional level were measured and analyzed. Results: Nine hands (14.3%) of 7 patients out of 34 hands had CTS in electrodiagnostic study. There were significant difference among groups in TR-ADL hours (CTS group; 5.0 vs non-CTS group; 10.2, p＜0.05), VAS (4.1 vs 2.0, respectively, p＜0.05), and no statistical difference in KSCIM-R (68.4 vs 52.1, p＞0.05), MN-CSA (12.3 mm2 vs 7.9 mm2 vs control group; 8.0 mm2, p＜0.05). Using the ROC curve, the cut-off value of MN-CSA produced 8.5 mm2 providing a diagnostic sensitivity of 77.8% and specificity of 59.6%. Conclusion: The ultrasonographic measurement of the median nerve may be a useful non-invasive screening test for the diagnosis of CTS in paraplegic patients with wrist pain. (J Korean Acad Rehab Med 2008; 32: 216-221)
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