Objective
To explore whether the growth hormone is effective in the treatment of degenerative cartilage of knee in rabbits.Method: Thirty New Zealand white rabbits were administered intra-articular injection with monosodium iodoacetate (Sigma, St. Louis, USA) 2.5 mg and divided into 3 groups. Each group was administered with hyaluronic acid (Hyruan plus^Ⱂ, LG life science, Seoul, Korea)(group A) 0.6 ml, growth hormone (Declage^Ⱂ, LG life science, Seoul, Korea) (group B) or saline (group C) 0.6 ml intra-articulary once a week for 4 weeks, beginning 4 weeks after the degeneration induction. All rabbits were killed 9 weeks after degeneration induction. The histologic morphology was observed by optical microscope with knee cartilage.Results: Mankin score was 2.4±1.3 in group A, 3.9±1.7 in group B, 7.4±0.8 in group C. Yoshimi score was 1.5±0.7 in group A, 2.2±0.9 in group B, 4.4±0.6 in group C. Gross and microscopic morphologic findings showed that group C represented the more severe than group A & B (p＜0.01), also group A was better than group B (p＜0.05).Conclusion: Growth hormone is effective on degenerative knee cartilage in rabbit model, but less than the hyaluronic acid. (J Korean Acad Rehab Med 2008; 32: 247-252)

Objective
To investigate and quantify functional deficit in ischemic stroke rat. Method: Male Sprague-Dawley rats were divided into sham group and stroke group. Permanent cerebral ischemia was inflicted on the stroke group by occluding the middle cerebral artery (MCAO). The proportion of hind limb weight bearing pressure was also measured. The withdrawal threshold values in the hindpaws were measured by using von-Frey hair for seven days from the day before ischemia.Results: The proportion of paretic hind limb pressure to whole hind limb pressure in stroke group was significantly reduced than sham group (p＜0.05). The withdrawal threshold values of the paretic hindpaw in stroke group were not different from those in the sham group during whole experimental session (p＞0.05). Garcia motor score of stroke group was reduced significantly than sham group in whole experimental session after MCAO (p＜0.05). The proportions of right hind limb pressure showed no correlation with Garcia motor score after MCAO (p＞0.05).Conclusion: Ischemic stroke in rats can lead to the reduction of pressure at paretic hind limb. The motor test for pressure weight borne on the paretic leg may provide functional information in the future studies with ischemic stroke rat. (J Korean Acad Rehab Med 2008; 32: 253-257)

Objective
To investigate the effects of robot-assisted gait therapy on locomotor recovery in hemiparetic patients after stroke.Method: Twenty five stroke patients were randomly divided into 2 groups. Robotic training group received 30 minutes of robot-assisted gait therapy, 3 times a week for 4 weeks, while control group received conventional gait training with same duration and frequency as robotic group. Outcome was measured using Motricity index, Fugl-Meyer assessment (FMA), function ambulation category, modified motor assessment scale, 10-meter gait speed, isometric torque, Ashworth scale, gait analysis, body tissue composition, and Beck's depression inventory (BDI).Results: Robotic training group showed significant improvement in motor functions measured by Motricity Index, FMA, 10-meter gait speed, isometric torque of hip compared with the baseline and with those of control group. Ashworth scale of hip, BDI, and muscle mass showed significantly greater improvement in robotic training group than control group. In gait analysis, stride length of unaffected leg demonstrated significant improvement in robotic training group (p＜0.05).Conclusion: The robot-assisted gait therapy with body weight-support is considered to facilitate locomotor recovery of the hemiparetic stroke patient. (J Korean Acad Rehab Med 2008; 32: 258-266)

Objective
To assess the effect of oral desmopressin administration for nocturia and sleeping in brain injured patients and to confirm its safety.Method: 20 brain injured patients waking up more than twice a night for urination during sleeping have been subjected to take 0.1 mg of desmopressin at 9 p.m. everyday for 30 days. To analyze the effect of the drug before and after its administration, the frequency of patient's awakening for urination, duration of time to first urination after sleeping, total urination volume during sleeping and Pittsburgh sleep quality index (PSQI) were evaluated. All newly found symptoms one month after taking the medication were recorded to confirm the safety of the drug.Results: After taking the medication, the mean urination frequency of 20 patients was reduced from 2.4 to 1.4, the mean duration of time to the first urination after sleeping was increased from 3.4 hours to 4.9 hours (p＜0.01). The mean PSQI score of 20 patients was decreased from 9.7 to 4.8 (p＜0.01). 2 patients had side effects (hyponatremia, headache).Conclusion: The oral administration of desmopressin was relatively safe and effective on brain injured patients with nocturia. (J Korean Acad Rehab Med 2008; 32: 267-272)

Objective
To evaluate the utility of Cognitive Perceptual Assessment for Driving (CPAD) through the on-road test in predicting the actual road driving skills in brain injured patients.Method: 25 brain injured patients with actual driving experience before the occurrence of diseases participated in the handicapped driving adaptation training program of our hospital as the subjects of the study, and one round of CPAD and on-road test were performed. CPAD evaluations and on-road tests for all patients were evaluated by the same therapist. Results: 11 patients passed the CPAD and all of them passed the on-road test. 3 patients failed from CPAD and they turned out to be failed at the on-road test. The mean CPAD score of the on-road test passed group was 53.6 which was significantly different from the mean 43.6 CPAD score acquired by the on-road test failed group by showing a significant difference between two groups (p＜0.05). Among the 11 patients who received the borderline CPAD score, 9 patients passed the on-road test. Conclusion: CPAD is considered to be useful in predicting the actual road driving skills of brain injured patients who previously had driving experiences before the occurrence of the diseases. (J Korean Acad Rehab Med 2008; 32: 273-279)

Objective
To identify the effects of isokinetic strengthening of trunk muscles on balance in hemiplegic patients after stroke. Method: All participants were ambulatory hemiplegic patients, injured at least 6 months prior to study. The patients (n=16) were randomly divided into two groups. The control group received neurodevelopmental treatments and gait training 3 times a week. In addition to the same treatments provided for the control group, the experimental group received trunk isokinetic strengthening exercises using isokinetic dynamometer 3 times a week. Trunk muscle peak torque and balance in the experimental group were compared with those in control group at baseline and 4 weeks after treatments. Results: There were no significant differences in age, lesion of hemiplegia, time after stroke onset, trunk muscle strength and Berg balance score before treatments between two groups. In the experimental group, peak torques of trunk extensor increased significantly at 60°/sec and 90°/sec at 4 weeks (p＜0.05), but there were no significant improvements in peak torques of trunk flexor at all degree and extensor peak torques at 120°/sec. Both the extensor and flexors showed no significant changes in the control groups. In the experimental group, a mean percent change in peak torque involving the trunk extensor was significantly increased at 60°/sec. In the experimental group, Berg balance scores, 10 m gait velocity, sit to stand and gait 3 m and return, and 10 seconds stair up and down were improved (p＜0.05). No significant improvements were noted in the control group. Conclusion: Isokinetic strengthening of trunk muscles can improve balance in hemiplegic patients. (J Korean Acad Rehab Med 2008; 32: 280-284)

Objective
To localize lesions which correlate with depression after stroke. Method: This study was performed in 98 stroke patients who admitted at two hospitals in Daegu in 2006. Lesions on magnetic resonance imaging were reviewed by same neuroradiologist and depression was diagnosed by same phychiatrist using DSM-III-R and ICD-10 criteria. We tried to find the correlation between the lesion location and depression.Results: Depression was not related to age, sex, dominant hemisphere, underlying disease (HTN, DM, heart disease), and many lesions of interest of brain. Lesions in prefrontal area, limbic lobe, cingulate gyrus, post white matter and frontal lobe correlated significantly with depression.Conclusion: We found that there was a strong correlation between post stroke depression and the pathologic lesion which is frontal-subcortical circuit except basal ganglion and thalamus. (J Korean Acad Rehab Med 2008; 32: 285-288)

Objective
To determine the time period and factors inhibiting recovery of orthostatic hypotension during head up tilt with ischemic stroke patients.Method: Fourty two ischemic stroke patients with orthostatic hypotension were included. Blood pressure and heart rate were taken after resting in the supine position for 10 minutes and again after standing for one minute every week. Age, gender, body mass index, laboratory findings, diabetes mellitus, anti-hypertensive use, side of involved hemisphere and K-MBI were obtained.Results: The numbers of orthostatic hypotension patients were significantly decreased at 3rd week. Non recovering group until 3rd week were older in age and had higher plasma creatinine level. On the other hand, body mass index and K-MBI were lower than the group without orthostatic hypotention. Multivariate analysis revealed that age, body mass index, anti-hypertensive medication were independently associated factors for resistant orthostatic hypotension during head up tilt.Conclusion: For 7 weeks, especially at 3rd week, the numbers of orthostatic hypotension patients significantly decreased. Age, BMI, and antihypertensive medication were inhibitiing factors for recovery of orthostatic hypotension. (J Korean Acad Rehab Med 2008; 32: 289-293)

Objective
To evaluate the effects of the dilution volume of botulinum toxin A on spasticity of children with cerebral palsy. Method: Total 18 legs of 9 children with cerebral palsy were enrolled. 100 units of botulinum toxin were diluted with 4 cc or 2 cc of normal saline and injected to the medial and lateral heads of Gastrocnemius. Modified Ashworth scale, modified Tardieu test and range of motion (ROM) of ankle and knee were measured. Measurements were obtained before and at 1, 7, 14, 30, 60, 90, and 180 days after injection, respectively. Results: Spasticity tested by modified Ashworth scale and modified Tardieu test decreased and ROM of ankle and knee increased after 14 days since injection in both groups (p＜0.05). In low dilution group, maximal ROM of ankle and knee was obtained at 30^th day after injection. In high dilution group, maximal ROM of ankle and knee was achieved at 14^th day after injection and maximal ROM of knee at 30^th day after injection. However, there was no significant differences between high dilution group and low dilution group in different times. Conclusion: Management of spasticity with botulinum toxin in cerebral palsy was not related to dilution volume. (J Korean Acad Rehab Med 2008; 32: 294-299)

Objective
To find a new method and usefulness of study on sensory nerve conduction of lateral sural cutaneous nerve (LSCN). Method: The 60 extremities of 30 adults without peripheral neuropathy were placed in a prone position. Next, each subject was administered with an antidromic stimulation at a point 3 cm lateral from the center of the popliteal fossa. With the aid of active electrodes, the sensory nerve action potentials (SNAPs) were recorded at points 10 cm inferior and 1 cm lateral to the stimulation site. The method of sensory nerve conduction study suggested by Campagnolo et al. was performed simultaneously, to compare of the frequency of SNAPs and the amplitudes. Results: For the sensory nerve conduction study of the LSCN suggested in this report, SNAPs were obtained in 49 extremities, with a revelation rate of 81.7%. The mean amplitude was 11.91±3.68ՌV. In the results of the tests suggested by Campagnolo et al., the SNAPs were obtained in 29 extremities, with a revelation rate of 48.3%. The mean amplitude was 8.37±5.21ՌV. Significance testing of the electrodiagnostic method recommended in this study revealed that many SNAPs were observed for the LSCN, with statistically significant action potential amplitudes. Conclusion: This study presents the new method and reference values of sensory nerve conduction for LSCN, which is thought to be useful in electrodiagnostic studies to diagnose entrapment neuropathy. (J Korean Acad Rehab Med 2008; 32: 300-304)

Objective
To evaluate the frequency of forearm anastomosis in healthy Korean subjects. Method: Healthy Korean adult subjects (70 males, 30 females) were included. Median and ulnar nerves were stimulated at wrist and elbow and recorded with the surface electrodes over abductor pollicis brevis (APB), first dorsal interossei (FDI) and abductor digiti quinti (ADQ). Results: Martin-Gruber anastomosis (MGA) was found in 18 males and 8 females (26/100, 26%). MGA was found in 37 arms (18.5%). But, Marinacci anastomosis was not observed. For each type of MGA, type II was found in 36 arms (97.3%) whereas type I was found in 11 arms (29.7%), and type III was found in 1 arm (2.7%). Anastomosis was comprised 67.6% of type II, 2.7% of type III, and 29.7% of coexistence of type II and type I. Average innervation ratio of crossing fibers was the highest in FDI (16.2%). Conclusion: Compound muscle action potential (CMAP) comparison method using modified incremental technique is a simple and sufficient method for evaluating forearm anastomosis without stimulus spread to adjacent nerve. In evaluating MGA, the FDI is a very important muscle because of high frequency and innervation ratio. (J Korean Acad Rehab Med 2008; 32: 305-312)

Objective
To determine abnormal vascular response to cuff ischemia in patients with spinal cord injury (SCI). Method: Ankle blood pressure (ABP) and ankle-brachial index (ABI) in 20 SCI patients (14 men, 6 women, mean age 39.8 years) and control group (14 men, 6 women, mean age 40.2 years) were measured using impedance plethysmography at rest and after distal thigh cuff compression for 5 and 10 minutes. The patients were divided into tetraplegia (10), paraplegia (10), complete injury (8) and incomplete injury (12). Results: There was no significant difference in ABP and ABI at rest and 5 minutes of ischemic compression between the patients and control groups. However, ABP and ABI decreased more at 10 minutes of ischemic compression in SCI compared to control groups (p＜0.001). Changes of ABP and ABI between tetraplegia and paraplegia were not different. Complete injury of SCI decreased more than incomplete injury at 10 minutes of ischemia in the APB and ABI (p＜0.001). Conclusion: Vascular control was significantly impaired in patients with spinal cord injury. Impedance plethysmography can be a useful and objective tool in evaluation of vascular response for the patients with spinal cord injury. (J Korean Acad Rehab Med 2008; 32: 313-318)

Objective
To compare the effects of intermittent mechanical traction with spinal decompression therapy (SDT), using the newly introduced device DRX 3000^Ⱂ, in patients suffering from low back pain associated with lumbosacral disc herniation documented on MRI. Method: Thirty-five patients with low back pain with or without lower extremity radiating pain were prospectively enrolled in this study. They were all diagnosed with lumbosacral disc herniation according to physical examinations and MRI. Patients over age 60 years or those with previous spinal surgery, spondylolisthesis, severe osteoporosis, rheumatic diseases, hypertension, and other serious medical problems were excluded. Patients were randomly assigned to intermittent mechanical traction group (15 patients) or SDT group (20 patients) and compared visual analog pain scale (VAS) pre- and post-treatment. Results: There was a significant improvement in VAS in SDT group compared to intermittent mechanical traction group. The mean reduction in VAS for intermittent mechanical traction group equaled 1.93±0.83 (from 6.4±1.28 to 4.5±1.22) while the mean reduction in VAS in SDT group equaled 4.35±2.21 (from 6.9±1.86 to 2.6±1.43) (p=0.0006). Conclusion: Spinal decompression therapy can be used as an effective treatment for discogenic low back pain without serious complications. (J Korean Acad Rehab Med 2008; 32: 319-323)

Objective
To evaluate the effect of tear after passive ROM exercise during distension arthrography in patients with frozen shoulder. Method: Fifteen patients (male: 7, female: 8, mean 57.5 years old) who had complained of shoulder pain with decreased ROM at least 3 months prior were enrolled. Distension arthrogrphy of 35 ml of fluid which contained 10 ml of 1% lidocaine, 1 ml of depomedrol (40 mg), 19 ml of normal saline, and 5 ml of radiocontrast material was injected by a single physician. Then if there was no capsular tear, passive ROM exercise was performed for two minutes. Results: In seven of the thirteen patients, the occurrence of capsular tear was observed after only distension arthrography. In five of the six patients without capsular rupture, the occurrence of capsular tear was observed by passive ROM exercise after distension arthrography. Two patients were interrupted because of severe pain. Clinical outcomes of occurrence of capsular tear by conventional distension arthrography and by passive ROM exercise after distension arthrography were similar. Conclusion: Passive ROM exercise after distension arthrography could serve as an effective method of capsular tear in patients with frozen shoulder. (J Korean Acad Rehab Med 2008; 32: 324-326)

Objective
To determine the effects of subtalar joint ankle brace used with shoes on static postural sway and limb load asymmetry (LLA) in elderly. Method: 620 healthy adults volunteered. These subjects were administered with the balance test on three different conditions, with bare foot, with shoes only and with aircast and shoes. All subjects were divided into two groups; younger (＜65 years) and older (≥65 years) group and tested for LLA and postural sway with a balance tester. Results: In both younger and older group, wearing shoes only and wearing ankle brace with shoes reduced the LLA and postural sway significantly compared to bare foot condition (p＜0.05). In older group, there was also significant LLA and postural sway reduction in wearing ankle brace with shoes compared to wearing shoes only (p＜0.05). The differences of LLA between bare foot and ankle brace with shoes in older group was more prominent than in younger group (p＜0.05). Conclusion: Wearing a subtalar joint ankle brace with shoes improved right-left static postural balance as compared with wearing shoes alone in elderly. (J Korean Acad Rehab Med 2008; 32: 327-332)

Objective
To determine the effect of respiratory muscle training in patients with chronic obstructive pulmonary disease (COPD) by pulmonary function test and fluoroscopy- guided diaphragm movement. Method: The respiratory muscle training program included breathing retraining, self-exercise and electromyography- assisted biofeedback therapy. 22 COPD patients underwent training program for 177±47.8 (84∼259) days and were followed up regularly. To evaluate the effect of respiratory muscle training, we tested pulmonary function test before and after training. We also evaluated difference of area at full inspiratory and full expiratory time by fluoroscopy- guided diaphragm motion. Results: Parameters in pulmonary function test showed no significant differences before and after respiratory muscle training. In fluoroscopic examination, the difference in the diaphragm movement area at full inspiration and expiration time showed significant improvement after respiratory muscle training (p＜0.05). Conclusion: Diaphragm movement increased in patients with COPD after respiratory muscle training, although pulmonary function test did not. (J Korean Acad Rehab Med 2008; 32: 333-339)

Cerebral palsy is the most common motor disorder in childhood. In cerebral palsy, spasticity can be a very disabling feature：limited locomotor abilities, contracture and gait difficulty. We present two cases of cerebral palsy patients who had treated with oral medication and chemodenervation with the Botulinum toxin A or alcohol but could not walk independently. We performed percutaneous selective radiofrequency thermocoagulation in the tibial motor nerve branch under the general anesthesia. The degree of spasticity, which was measured with modified Ashworth scale and modified Tardieu scale, was reduced and recurrence of the spasticity wasn't seen untill 6 months. Percutaneous selective radiofrequency thermocoagulation could be a treatment option for spasticity of cerebral palsy with little adverse effect. (J Korean Acad Rehab Med 2008; 32: 340-344)

Striatal hand is characterized by flexion in metacarpopharyngeal (MCP) joints and hyperextension in proximal interphalangial (PIP) joints and flexion in distal interphalangeal (DIP) joint. In clinical practice, this problem is often overlooked or misdiagnosed as rheumatoid arthritis and the opportunity for an early diagnosis and a correct management of the patient's is missed. In this report, a case with striatal hand following traumatic brain injury (TBI) without cardinal Parkinsonian signs is presented, and the differential diagnosis of the disease is discussed. A-62-year-old man presented with hemiplegia subsequent to traumatic brain injury. During the last two years, "swan neck" deformity of the hands occurred. We could diagnose this case as striatial hand with exclusion of similar rheumatologic causes by careful study and its characteristic deformity pattern. Clinician should consider the possibility of striatal hand when the patient with TBI presents swan neck deformity for an early diagnosis and a correct management. (J Korean Acad Rehab Med 2008; 32: 345-348)

Thirty-year old female developed limited range of motion (ROM) of both ankles after radiofrequency muscle reduction procedure for one month prior to her visit. Dorsiflexion of both ankles was severely limited to zero degree. Plantar flexion of both ankles was limited to 20 degree on the right and 15 degree on the left. The electrodiagnostic study and MRI showed normal nerve conduction study and inflammatory change of both gastrocnemius and soleus muscles. She received ROM and stretching exercise for 1 hour per day and twice per week for 4 weeks as an outpatient with continuous home programming. After 2 weeks of treatment, ROM improved to 20 degree plantar flexion and to 20 degree dorsiflexion on the right ankle and to 20 degree plantar flexion to 10 degree dorsiflexion on the left ankle. This is a case of severe muscles contracture after radiofrequency procedure reversible after intensive strengthening exercise. (J Korean Acad Rehab Med 2008; 32: 349-351)

Peripheral polyneuropathy is caused by various disorders such as diabetes mellitus. Cryoglobulinemia, as a cause of peripheral polyneuropathy, has been well documented in many reports. Recently we experienced a case of essential cyroglobulinemic polyneuropathy and therapeutic effect of plasmapheresis was shown even in chronic periods. In a patient with peripheral polyneuropathy with no known etiology, one should always consider cryoglobulinemia as a cause since early diagnosis and proper treatment will lead to better outcome. (J Korean Acad Rehab Med 2008; 32: 352-356)

Epidural abscess and vertebral osteomyelitis induced by epidural injection is rare but one of the most serious complications. A 58-year old woman complained of aggrevating radicular pain to bilteral lower legs, tenderness on coccygeal area and claudication, after epidural injection for management of intractable sciatica. MRI and ultrasound revealed epidural abscess compressing dural sac at the level of L5-S1 vertebral body, sacrococcygeal abscess, and later S5- 1^stcoccyx osteomyelitis. We report epidural abscess and vertebral osteomyelitis induced by caudal epidural injection. (J Korean Acad Rehab Med 2008; 32: 357-360)

Atlantoaxial subluxation in undifferentiated spondyloarthropathy is extremely rare and has not been reported. We describe a case of 27-year-old man who was diagnosed as undifferentiated spondyloarthropathy with atlantoaxial subluxation with an initial complaint of painful swelling of right 1st metatarsophalangeal joint and posterior neck pain. Roentgenograms showed sclerotic change and increased hazziness in right 1st metatarsophalangeal joint. Magnetic resonance images and roentgenograms of the cervical spine showed inflammation of odontoid process and atlantoaxial subluxation. Bone scan showed hot uptakes in left sacroiliac joint, right 1st & 4th metacarpophalangeal joints and 1st metatarsophalangeal joint. HLA-B27 gene was positive. Spontaneous atlantoaxial subluxation and undifferentiated spondyloarthropathy was diagnosed and conservatively treated with oral medication. Currently, there is no definite neurological sign. Early recognition and awareness of potential clinical complications is important in preventing compressive damage on central nervous system. (J Korean Acad Rehab Med 2008; 32: 361-365)

Allodynia is pain following a non-noxious stimuli which does not provoke pain normally and develops after incomplete spinal cord injury more commonly in cervical rather than thoracic level, and central cord syndrome. This article presents an unusual patient who presented with the single symptom of an intense allodynia after cervical intervertebral disc herniation. This 36-year-old male patient developed acute lancinating and burning pain aggravated by skimming light touch on both thenar area. Cervical magnetic resonance imaging (MRI) revealed central disc herniation and spinal cord compression. The allodynia secondary to acute herniated cervical disk has been successfully disappeared through pharmacotherapy with pulsed-use of steroid, gabapentin and comprehensive rehabilitation. (J Korean Acad Rehab Med 2008; 32: 366-369)