Objective: To evaluate the effects of continuous epidural electrical stimulation (ES) on the behavioral recovery, and the molecular proliferation of synapse and neural cell in rats with photothrombotic stroke. Method: The male Sprague-Dawley rats were pre-trained on a single pellet reaching task (SPRT), and then received the photothrombotic infarction on dominant sensorimotor cortex (SMC) and implantation of electrode over the peri-lesion SMC surface. All rats were randomly assigned to one of two groups: anodal ES on infarcted SMC (ES group) and no ES on infarcted SMC (control group). Rats received daily SPRT and neurological examinations for 14 days. After the rats had been sacrificed, brain sections were immunostained for quantification of infarct volumes and evaluation of the structural remodeling markers (MAP2, synaptophysin and GFAP). Results: The functional improvement of SPRT was significantly increased in the ES group compared to control group. There were no significant group differences in the infarct volumes, neurological examinations, structural remodeling markers. But, in the ES group, MAP2 and synaptophysin in affected peri-infarct area tended to increase compared with unaffected hemisphere. In affected hemisphere of ES group, many structural remodeling markers tended to increase compared with unaffected hemisphere. Especially, the staining of synaptophysin and GFAP in peri-infarct area showed more increased uptake than unaffected hemisphere in ES group and control group, respectively (p＜0.05). Conclusion: The ES improved greatly the behavioral motor function after SMC infarction and induced the significant synaptogenesis with the widespread neuronal proliferation in peri-infarct area. Postischemic astrogliosis was not remarkable in ES group. (J Korean Acad Rehab Med 2008; 32: 375-387)

Objective: To better delineate the changes in cortical excitability that accompany perceptual to motor transformations when people are asked to observe and/or image two kinds of action. Method: Twenty right handed young adult without neurological deficit were included. Motor evoked potentials (MEPs) from transcranial magnetic stimulation were recorded in the abductor pollicis brevis of the dominant hand in six different conditions: (1) passive observation (PO) of the slow (1 Hz) action (abduction of right thumb); (2) imagery of the slow action; (3) active observation (AO) of the slow action; (4) PO of the fast (4 Hz) action; (5) imagery of the fast action; and (6) active observation of the fast action. MEPs were also recorded at resting state. Results: The mean amplitude of MEPs at rest condition was 0.85±0.84 mV; PO of the slow action, 1.27±1.13 mV; imagery of the slow action, 1.76±1.49 mV; AO of the slow action, 2.46±2.02 mV; PO of the fast action, 1.90±1.31 mV; imagery of the fast action, 2.35±1.32 mV; and AO of the fast action, 3.44±1.85 mV. And at a constant speed of action, AO produced the largest amplitude of MEPs. A comparison between the slow and fast action revealed the latter produced larger amplitude of MEPs than the former during each task. Conclusion: The observed and/or imagined action can alter cortical excitability without actual execution of movement. And active observation of the fast action might be more useful for facilitating cortical excitability. (J Korean Acad Rehab Med 2008; 32: 388-393)

Objective: To investigate the effects of balance control of affected lower extremity on berg balance scale and gait in hemiparetic patients, using the newly developed balance control trainer of lower extremity. Method: Thirty five hemiparetic patients who could stand and ambulate more than 10 meters without assist on even surface were included in this study. The balance control trainer of lower extremity was designed to measure weight shift and knee flexion angle of hemiparetic side and to play a game named "Board cleaner" which use these data, so considering the vertical movement of the center of gravity. We measured above three parameters, and also evaluated with clinical tests including berg balance scale (BBS). We evaluated correlations between parameters on the balance control trainer of lower extremity and clinical parameters. Results: Weight shifting to affected side statistically significantly correlated only with BBS. Affected knee flexion had statistically significant correlations with all clinical tests examined, especially 10 meters walking time (10mWT), timed up and go test (TUG), and BBS. Scores earned from board cleaner game also had statistically significant correlations with all clinical tests examined, especially 10mWT, TUG, and BBS. Conclusion: Correlation exists between the ability to control the affected knee measured by balance control trainer of lower extremity and clinical parameters including 10mWT, TUG, and BBS, so we think the balance control trainer can be a useful tool for the evaluation in hemiparetic patients. (J Korean Acad Rehab Med 2008; 32: 394-399)

Objective: To investigate the effect of environmental factors on the ability of mobility in subjects with chronic stroke who can perform nearly independent activities of daily living (ADL). Method: Sixty one patients were divided into three groups (superior, middle, and inferior) by the degree of independent walking. Modified self-administered questionnaire was completed to report how well the patients encountered the environmental elements faced in community mobility. In addition, all patients were assessed to find out the difference of ADL performance, Berg balance scale (BBS), 10 m walking time (10 mWT) and patterns of 'going out' among the three groups. Results: The group 1 (superior group) had shown better performance than group 2 (middle group) and group 3 (inferior group) in performance of ADL, BBS, 10 mWT. Secondly, the group 1 visited more places or destinations per day than the group 2 and 3, and they used more various transportation systems than other groups. Finally, there were significant differences in the distance dimension, the temporal dimension, terrain dimension (except for a 'getting on a elevator' component), and density dimension among the groups. Conclusion: Environmental factors as well as functional abilities could affect the mobility of subjects with chronic stroke. This result suggests that any kinds of compensation and the supports of social institutions are needed even in subjects of nearly independent ADL for their improvement of mobility and convenience. (J Korean Acad Rehab Med 2008; 32: 400-405)

Objective: To investigate the effect of extracorporeal shock wave therapy (ESWT) on muscle spasticity of elbow and wrist affected by stroke. Methods: We studied 21 patients affected by stroke with spasticity in upper limbs. The neurological status of the stroke patients were evaluated by K-NIHSS and the evaluation of efficacy on the upper limb spasticity were based on modified Ashworth scale (MAS), modified Tardieu scale (MTS), and active elevation of upper limb. Treatment was performed 1 session/week, total 3 sessions in each patient. Patients were evaluated at baseline and 4 weeks after treatment using MAS of elbow flexor and active elevation of upper limb. Patients were monitored at baseline, after sham stimulation, and at 1, 4 weeks after ESWT using MTS of elbow flexor and wrist pronator. Results: After ESWT, patients showed significant improvement in muscle tone of elbow flexor and wrist pronator after the 1st and 4th weeks compared with baseline and sham stimulation (p＜0.001). The active elevation of hemiplegic upper limb was significantly increased (p＜0.05). Conclusion: We suggest the ESWT could be a useful treatment method on upper limb spasticity in the patients of stroke. Further studies with a larger group of patients are warranted. (J Korean Acad Rehab Med 2008; 32: 406-410)

Objective: To evaluate the presence of swallowing difficulties in patients with post-poliomyelitis syndrome (PPS) by characterizing their swallowing patterns with videofluoroscopic swallowing study. Method: Eleven patients diagnosed with PPS were enrolled. All subjects answered the self assessment questionnaire for swallowing difficulty and gastric symptoms. We assessed the ability of tongue control, the oral transit time, cricopharyngeal opening time, and pharyngeal transit time. We also assessed the presence of aspiration or penetration and the amount of residue in the vallecular and pyriform sinus by four grade scales. A gastroenterologist examined esophagus, stomach and duodenum through an esophagogastroduodenoscopy. Results: Six patients complained swallowing difficulty and nine patients showed symptoms of esophageal regurgitation. Although finding of penetration or aspiration was not seen, all patients showed swallowing dysfunction in the videofluoroscopic swallowing study. In the esophagogastroduodenoscopy, chronic superficial gastritis was observed in all enrolled patients (n=11) and reflux esophagitis was found in 4 patients (36%). Conclusion: About half patients with PPS complained of dysphagia. Routine evaluation of dysphagia with videofluoroscopic swallowing study and esophagogastroduodenoscopy is needed in all patients with PPS due to the low reliability in their subjective symptom. (J Korean Acad Rehab Med 2008; 32: 411-416)

Objective: To know if electro-magnetic stimulation can induce the contraction of gluteus medius and minimus muscles, and to compare pain induced by electro-magnetic stimulation of the gluteal muscles with that induced by transcutaneous neuromuscular electrical stimulation (NMES). Method: Two different intensity of transcutaneous NMES (40 mA, 60 mA) and electro-magnetic stimulation (60%, 100%) were applied to the left buttock of 15 healthy male volunteers in random order. The ultrasound images of gluteal muscles and visual analog scale (VAS) of pain were obtained three times at each type of stimulation. The grade of muscle contraction and the VAS score of each type of stimulation were compared. Results: At maximal stimulation intensity of our equipments, the mean VAS score was lower (p=0.012) in electro-magnetic stimulation than in transcutaneous NMES, and the grade of gluteus minimus contraction was higher (p=0.035) in electro-magnetic stimulation than in transcutaneous NMES. When the mean VAS scores at the same grade of contraction were compared, the VAS scores of electro-magnetic were lower than transcutaneous NMES in both gluteus medius (3.92±1.79 vs. 5.35±2.98, p=0.033) and minimus (4.12±1.85 vs. 5.69±3.00, p=0.046). Conclusion: Electro-magnetic stimulation induced the contraction of gluteus medius and minimus muscles with less pain than electrical stimulation for the same amount of muscle contraction. These results suggest that electro-magnetic stimulation can replace transcutaneous NMES in deep, large muscles such as gluteal muscles. (J Korean Acad Rehab Med 2008; 32: 417-423)

Objective: To investigate the relations among pain, emotional factors and cognitive-behavioral factors in chronic musculoskeletal pain patients. Method: This study was designed as a questionnaire survey. 73 patients who visited our outpatient clinics due to chronic musculoskeletal pain were evaluated. They checked visual analogue scale (VAS), pain site and frequency. Beck depression inventory (BDI) and state-trait anxiety index (STAI) were checked for evaluation of emotional factors. Somatization scale of symptom checklist-revised (SCL-R- 90) and pain catastrophizing scale (PCS) were checked for cognitive-behavioral factors. Correlations among each variable were evaluated by statistical analysis. Results: VAS was correlated with pain frequency (r=0.538, p＜0.01), somatization and catastrophizing thought. Rumination thought was correlated with VAS (r=0.443, p＜0.01), pain frequency (r=0.446, p＜0.01) and static anxiety (r= 0.449, p＜0.01). Magnification thought was correlated with depression (r=0.403, p＜0.01) and static anxiety (r=0.447, p＜0.01). Helpless thought was correlated with VAS (r= 0.442, p＜0.01), pain frequency (r=0.429, p＜0.01), depression (r=0.510, p＜0.01), static anxiety (r=0.640, p＜0.01) and somatization (r=0.504, p＜0.01). Duration was not correlated with VAS, depression, anxiety, somatization and catastrophizing thought in chronic musculoskeletal pain patients (p＞0.05). Conclusion: Cognitive-behavioral factors such as catastrophizing thought are strongly correlated with both pain aspects and emotional factors. Consideration of cognitive- behavioral factors as well as emotional factors may be important for management of chronic musculoskeletal pain. (J Korean Acad Rehab Med 2008; 32: 424-429)

Objective: To evaluate the preference of transtibial amputees for the total surface bearing (TSB) socket versus the patellar tendon bearing (PTB) socket, to examine the reasons for their preferences and to determine the clinical indications of each socket. Method: We investigated fifty five subjects who could walk with the TSB silicon liner socket and had already used the PTB socket with supracondylar suspension. The subjects responded to a questionnaire of the 19 items. Results: 67.3% (37/55) of the subjects preferred the TSB silicon liner socket over the PTB socket. More than 60% of the respondents regarded the wearing, appearance, donning & doffing, weight and noise positively. However, knee flexion, walking on an uneven surface, amount of perspiration, heating and odor were regarded negatively by more than 50% of respondents. When we compared the satisfaction scores of 37 respondents who preferred TSB socket and 18 respondents who did not, the two groups showed significant differences in the level of satisfaction for wearing appearance, walking, pistoning, donning & doffing, adaptation, perspiration, heating, odor, skin disorder, stump pain, tightening feeling, and noise (p＜0.05). Conclusion: The TSB silicon liner socket was preferred by many transtibial amputee patients. TSB silicon liner socket showed positive effects on comfort, donning & doffing and cosmesis. Also it improved prosthetic suspension as a decrease in pistoning compared to the PTB socket with supracondylar suspension. However the TSB silicon liner socket has some problems such as causing excessive perspiration, heating and odor etc. (J Korean Acad Rehab Med 2008; 32: 430-436)

Objective: To compare the exercise capacity after cardiac rehabilitation (CR) in patients with percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery. Method: 27 patients who underwent PCI and 18 patients who underwent CABG surgery were included. All the subjects performed supervised exercise training for 6∼8 weeks at hospital and self-exercise at community for additional 16~18 weeks. Exercise capacity was measured by symptom limited graded exercise tests at study entry and 6 months later. Results: After 6 months of CR, maximal oxygen consumption (VO_2max) was significantly increased, resting heart rate (HR) and submaximal rate pressure product (RPP) were significantly decreased in both groups (p＜0.05). There were no significant change of maximal HR in both groups (p＜0.05). Maximal RPP in CABG increased significantly (p＜0.05) but did not change significantly in PCI group. Resting HR was significantly higher, VO_2max was significantly lower in CABG group than PCI group at study entry (p＜0.05). Resting HR was not significantly different in both groups but, VO_2max was still lower in CABG group than PCI group even after 6 months of CR (p＜0.05). Conclusion: The cardiac rehabilitation program was effective in both PCI and CABG group. Although VO_2max in PCI group was higher than CABG group after 6 month CR, the range of improvement was greater in CABG group than PCI group. (J Korean Acad Rehab Med 2008; 32: 437-442)

Objective: To compare severity of disability and quality of life between the handicapped residing in a welfare facility and the handicapped living at home. Method: This research conducted a survey for the handicapped persons in Goyang city. The survey consisted of the following items: disability diagnosis, modified Barthel index (MBI), Korean-activities of daily living (K-ADL), 8-item short form health survey instrument (SF-8) and life domain satisfaction measure (LDSM). A total number of 144 handicapped persons participated, and 66 among them lived at home. Results: In regard to the range of activities of daily living MBI, K-ADL and quality of life; SF-8, those who resided in a welfare facility showed higher scores. In terms of satisfaction of life, the two groups did not show significant difference in housing, education and family relationship. However, as for leisure and health, those who resided in a welfare facility showed higher satisfaction. Conclusion: The handicapped persons residing in a welfare facility could function more independently in carrying out daily activities, and they showed higher quality and more satisfaction of life compared to those who lived at home. These results support that more attention would be needed for disabled persons at home to make welfare and rehabilitation policies. (J Korean Acad Rehab Med 2008; 32: 443-448)

Objective: To investigate the level of quality of life, life satisfaction, depression and demands of parents with children in special school. Method: Data were collected through a questionnaire answered by 152 parents whose children were enrolled in four special schools in Goyang City. The quality of life (QOL), life domain satisfaction measure (LDSM), Beck depression inventory (BDI) and the demand for rehabilitation and welfare service were obtained. Results: The average score of QOL was less than 50 and the mental health component in particular was the lowest of all. The average score of LDSM was 3.9±0.9, and most notably the score regarding economic status resulted to be the lowest. The average score of BDI was 13.4. The general health screening and medical service related needs of the parents with disabled children were most significant, including the need for the expansion of welfare facilities for disabled people. Conclusion: In order to provide better rehabilitation service to disabled children, a policy which could decrease the physical and mental burden of parents with disabled children should be considered. (J Korean Acad Rehab Med 2008; 32: 449-455)

We report a case of severe trismus following traumatic brain injury (TBI), which was treated successfully with botulinum toxin A. Its effect evidenced long-term resolution, for over one year. A 36 year-old man with a multifocal intracranial hemorrhage was admitted for quadriplegia with dysphagia and trismus. During ten months, a nasogastric tube was placed for feeding after TBI, and at that time his upper- to-lower interincisal distance was only 1.2 cm upon voluntary mouth opening. Botulinum toxin A 450 U (Dysport^Ⱂ) was injected into both masseter, medial pterygoid and left temporalis muscles under electromyographic guidance. The interincisal distance began to improve one week after injection. He successfully underwent percutaneous endoscopic gastrostomy, dysphagia rehabilitation therapy, and dental prosthesis. More than one month after injection, oral feeding proved possible. After 1 year his interincisal distance was maintained at 2.9 cm. (J Korean Acad Rehab Med 2008; 32: 456-459)

Wernicke's encephalopathy is a relatively underestimated disorder caused by a deficiency of thiamine and manifests with a classical triad of ocular abnormalities, ataxia, and mental-status changes. Specific laboratory tests are unavailable and the disease remains a clinical diagnosis. Among paraclinical studies, magnetic resonance imaging is currently considered the most valuable method to confirm a diagnosis of Wernicke's encephalopathy. Treatment is based on supplementation of thiamine that is administered parentally. We report a case of Wernicke's encephalopathy that was treated with thiamine and showed the characteristic clinical findings, as well as an extremely rare symptom of severe dysphagia that improved concurrently with neurological recovery. Only a few cases of dysphagia in Wernicke's encephalopathy have been reported worldwide. (J Korean Acad Rehab Med 2008; 32: 460-464)

Pyogenic sacroiliitis is a rare infection that may accompany psoas muscle abscess with vague clinical presentation, which present a diagnostic challenge requiring a high index of suspicion. We report a 48-year-old male, diagnosed pyogenic sacroiliitis with psoas abscess caused by Streptococcus intermedius and Sphingomonas paucimobilis. Magnetic resonance imaging showed multiloculated rim-enhancing lesion in right psoas muscle and joint effusion with osteomyelitis around sacroiliac joint. Intravenous antibiotics were administered after ultrasonographically guided abscess aspiration. Surgical drainage was done and his fever and symptom gradually subsided. (J Korean Acad Rehab Med 2008; 32: 465-468)

The use of teicoplanin is increasing with increase in the incidence of wound infections caused by methicillin-resistant Staphylococcus aureus. Teicoplanin has longer half-life than vancomycin, so it can be administerd once daily, whereas vancomycin has to be administered 3∼4 times daily. Teicoplanin is known to have lesser side effect profiles than vancomycin, such as skin eruptions, ototoxicity and nephrotoxicity. A 27-year old women in vegetative state had a grade 3 pressure sore at coccyx area. We prescribe teicoplanin to manage wound infected by methicillin-resistant Staphylococcus aureus. Plasma creatine phosphokinase (CPK) was elevated abruptly at 9th day of teicoplanin therapy. Five days after discontinuation of teicoplanin, CPK was normalized. We experienced a case of elevation of plasma creatine phosphokinase associated with teicoplanin. (J Korean Acad Rehab Med 2008; 32: 469-471)

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating conditions, which is usually monophasic. Recurrent ADEM and multiphasic disseminated encephalomyelitis (MDEM) is much less characterized entity, and its differentiation from multiple sclerosis (MS) poses a diagnostic challenge. We report a case of multiphasic disseminated encephalomyelitis (MDEM). The patient had two episodes of paraparesis and other neurologic symptoms, which were separated by 2 months. The patient presented with fever, headache, mental change, lower extremity weakness, voiding difficulty as well as focal neurologic deficits, which showed good response on steroid and acyclovir. Brain MRI revealed variable sized, multifocal, subcortical white matter lesions with gray matter involvement, and spine MRI revealed high signal intensity from C3 to T9 spinal cord. The CSF study showed elevated protein count and negative oligoclonal band. (J Korean Acad Rehab Med 2008; 32: 472-475)

Sacral agenesis is an uncommon condition characterized by absence of different segments of lumbar spine along with total or partial absence of sacrum. It does not have an established etiology but may be associated with insulin dependent diabetes mellitus in the mother. Motor deficits are present and correspond to the level of vertebral agenesis. Sensation is better preserved than motor function. Orthopedic deformities such as hip dislocation, flexion contractures, genu recurvatum, posterior compartment atrophy, scoliosis and so on are observed. Urinary and bladder dysfunction are constant and it can lead to fatal kidney damage, finally. We report one case of type IV sacral agenesis with review of literature. (J Korean Acad Rehab Med 2008; 32: 476-480)

The association between Arnold-Chiari type 1 malformation and hemihypertrophy has not been appreciated but a few case reports have suggested their association and proposed a common pathogenesis of dysembryoplasia of mesoderm. We report a case of 17 year-old girl presenting with left side hemihypertrophy and scoliosis. Magnetic resonance imaging (MRI) study of brain and spine revealed underlying Arnold- Chiari type 1 malformation and syringomyelia. The purpose of this paper is to emphasize the need for central nervous system evaluation in patients with hemihypertrophy. (J Korean Acad Rehab Med 2008; 32: 481-484)