The Application of Three-Dimensional Printed Finger Splints for Post Hand Burn Patients: A Case Series Investigation

The application of three-dimensional (3D) printing is growing explosively in the medical field, and is especially widespread in the clinical use of fabricating upper limb orthosis and prosthesis. Advantages of 3D-printed orthosis compared to conventional ones include its lower cost, easier modification, and faster fabrication. Hands are the most common body parts involved with burn victims and one of the main complications of hand burns are finger joint contractures. Applying orthotic devices such as finger splints are a well-established essential element of burn care. In spite of the rapid evolution of the clinical use of 3D printing, to our knowledge, its application to hand burn patients has not yet been reported. In this study, the authors present a series of patients with hand burn injuries whose orthotic needs were fulfilled with the application of 3D-printed finger splints.

Diagnosis of Ilioinguinal Nerve Injury Based on Electromyography and Ultrasonography: A Case Report

Being located in the hypogastric area, the ilioinguinal nerve, together with iliohypogastric nerve, can be damaged during lower abdominal surgeries. Conventionally, the diagnosis of ilioinguinal neuropathy relies on clinical assessments, and standardized diagnostic methods have not been established as of yet. We hereby report the case of young man who presented ilioinguinal neuralgia with symptoms of burning pain in the right groin and scrotum shortly after receiving inguinal herniorrhaphy. To raise the diagnostic certainty, we used a real-time ultrasonography (US) to guide a monopolar electromyography needle to the ilioinguinal nerve, and then performed a motor conduction study. A subsequent US-guided ilioinguinal nerve block resulted in complete resolution of the patient's neuralgic symptoms.

Diagnostic Value of the Second Lumbrical-Interosseous Distal Motor Latency Comparison Test in Severe Carpal Tunnel Syndrome

OBJECTIVE: To examine the usefulness of the second lumbrical-interosseous (2L-INT) distal motor latency (DML) comparison test in localizing median neuropathy to the wrist in patients with absent median sensory and motor response in routine nerve conduction studies. METHODS: Electrodiagnostic results from 1,705 hands of patients with carpal tunnel syndrome (CTS) symptoms were reviewed retrospectively. All subjects were evaluated using routine nerve conduction studies: median sensory conduction recorded from digits 1 to 4, motor conduction from the abductor pollicis brevis muscle, and the 2L-INT DML comparison test. RESULTS: Four hundred and one hands from a total of 1,705 were classified as having severe CTS. Among the severe CTS group, 56 hands (14.0%) showed absent median sensory and motor response in a routine nerve conduction study, and, of those hands, 42 (75.0%) showed an abnormal 2L-INT response. CONCLUSION: The 2L-INT DML comparison test proved to be a valuable electrodiagnostic technique in localizing median mononeuropathy at the wrist, even in the most severe CTS patients.

Myotonic Dystrophy Type 1 Complicated With Peripheral Arterial Occlusive Disease: A Case Report

Myotonic dystrophy (MD) is the most common adult muscular dystrophy characterized by multi-systemic clinical manifestations involving the brain, smooth muscle, cardiovascular and endocrine systems. However, peripheral arterial occlusive disease (PAOD) is an uncommon presentation of MD type 1 (DM1), which has not been reported in recent literature. A 53-year-old female, previously confirmed as DM1, presented with vague claudication of both lower limbs. The diagnosis of PAOD based on results of ankle-brachial index, ultrasonography, and abdominal computed tomography angiography studies was followed by aortobifemoral artery bypass surgery. Although the arterial patency was restored after the operation, she did not recover from post-operative respiratory complications. Screening of PAOD is necessary for DM1 with general risk factors of occlusive arteriopathy. However, surgery should be reserved for the most severe cases.

Delayed Improvement after Endoscopic Carpal Tunnel Release

OBJECTIVE: In most patients with carpal tunnel syndrome (CTS), pain and/or paresthesia disappeared or decreased in a month after endoscopic carpal tunnel release (ECTR). However, subpopulation of patients showed delayed improvement following ECTR. We analyzed the delayed improvement hands to investigate the characteristics of those patients and to determine the predictable factors of delayed improvement. METHODS: Single-portal ECTRs were performed in 1194 hands of 793 CTS patients from 2002 to 2011. Five-hundred seventy hands with minimal 1-year postoperative follow-up were included. We divided the 545 satisfied hands into early (group A) and delayed (group B) groups according to improvement period of 1 month. Demographic data, clinical severity and electrodiagnostic abnormality were compared between groups. RESULTS: Group A included 510 hands and group B included 35 hands. In group B, 11 hands improved in 2 months, 15 hands in 3 months and 9 hands in 6 months, respectively. In group A/B, according to clinical severity, 60/1 hands were graded to I, 345/24 hands to II, 105/10 hands to III. In group A/B, based on electrodiagnostic abnormality, 57/3 hands were classified to mild, 221/11 hands to moderate and 222/21 hands to severe group. Statistical analysis between groups did not reach significance but electrodiagnostic or clinical severity had a tendency to affect the delayed response. CONCLUSION: It is difficult to predict the factors contributing to postoperatively-delayed response in subpopulation of CTS patients. However, we recommend that postoperative observation for at least 6 months is necessary in patients without symptomatic improvement.

Garlic powder intake and cardiovascular risk factors: a meta-analysis of randomized controlled clinical trials

BACKGROUND/OBJECTIVES: Although preclinical studies suggest that garlic has potential preventive effects on cardiovascular disease (CVD) risk factors, clinical trials and reports from systematic reviews or meta-analyses present inconsistent results. The contradiction might be attributed to variations in the manufacturing process that can markedly influence the composition of garlic products. To investigate this issue further, we performed a meta-analysis of the effects of garlic powder on CVD risk factors. MATERIALS/METHODS: We searched PubMed, Cochrane, Science Direct and EMBASE through May 2014. A random-effects meta-analysis was performed on 22 trials reporting total cholesterol (TC), 17 trials reporting LDL cholesterol (LDL-C), 18 trials reporting HDL cholesterol (HDL-C), 4 trials reporting fasting blood glucose (FBG), 9 trials reporting systolic blood pressure (SBP) and 10 trials reporting diastolic blood pressure (DBP). RESULTS: The overall garlic powder intake significantly reduced blood TC and LDL-C by -0.41 mmol/L (95% confidence interval [CI], -0.69, -0.12) (-15.83 mg/dL [95% CI, -26.64, -4.63]) and -0.21 mmol/L (95% CI, -0.40, -0.03) (-8.11 mg/dL [95% CI, -15.44, -1.16]), respectively. The mean difference in the reduction of FBG levels was -0.96 mmol/L (95% CI, -1.91, -0.01) (-17.30 mg/dL [95% CI, -34.41, -0.18]). Evidence for SBP and DBP reduction in the garlic supplementation group was also demonstrated by decreases of -4.34 mmHg (95% CI, -8.38, -0.29) and -2.36 mmHg (95% CI, -4.56, -0.15), respectively. CONCLUSIONS: This meta-analysis provides consistent evidence that garlic powder intake reduces the CVD risk factors of TC, LDL-C, FBG and BP.

Neuroprotective Effect of Steamed and Fermented Codonopsis lanceolata

Codonopsis lanceolata has been used as an herbal medicine for several lung infl ammatory diseases, such as asthma, tonsillitis, and pharyngitis. Previously, we showed the neuroprotective effect of steamed and fermented C. lanceolata (SFC) in vitro and in vivo. In the current study, the treatment of HT22 cells with SFC decreased glutamate-induced cell death, suggesting that SFC protected HT22 cells from glutamate-induced cytotoxicity. Based on these, we sought to elucidate the mechanisms of the neuroprotective effect of SFC by measuring the oxidative stress parameters and the expression of Bax and caspase-3 in HT22 cells. SFC reduced contents of ROS, Ca2+ and NO. Moreover, SFC restored contents of glutathione and glutathione reductase as well as inhibited Bax and caspase-3 activity in HT22 cells. These results indicate that steamed and fermented C. lanceolata (SFC) extract protected HT22 cells by anti-oxidative effect and inhibition of the expression of Bax and caspase-3.

Value of Ultrasonography in the Diagnosis of Carpal Tunnel Syndrome: Correlation with Electrophysiological Abnormalities and Clinical Severity

OBJECTIVE: To investigate a diagnostic value of ultrasonography in carpal tunnel syndrome (CTS) patients and to evaluate a correlation of sonographic measurements with the degree of electrodiagnostic abnormalities and clinical severity. METHODS: Two-hundred-forty-six symptomatic hands in 135 patients and 30 asymptomatic hands in 19 healthy individuals as control group were included. In ultrasonographic study, we measured the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve at the pisiform as well as palmar bowing (PB) of the flexor retinaculum. Sensitivity and specificity of ultrasonographic measurements were evaluated and ultrasonographic data from the symptomatic and control hands were compared to the grade of electrodiagnostic and clinical severity. RESULTS: The mean CSA was 13.7+/-4.2 mm2 in symptomatic hands and 7.9+/-1.3 mm2 in asymptomatic hands. The mean FR was 4.2+/-1.0 in symptomatic hands and 3.4+/-0.4 in asymptomatic hands. The mean PB was 3.5+/-0.5 mm in symptomatic hands and 2.6+/-0.3 mm in asymptomatic hands. Statistical analysis showed differences of the mean CSA, FR and PB between groups were significant. A cut-off value of 10 mm2 for the mean CSA was found to be the upper limit for normal value. Both the mean CSA and PB are correlated with the grade of electrophysiological abnormalities and clinical severity, respectively. CONCLUSION: Ultrasographic measurement of the CSA and PB is helpful to diagnose CTS as a non-invasive and an alternative modality for the evaluation of CTS. In addition, ultrasonography also provides a reliable correlation with the grade of electrodiagnostic abnormalities and clinical severity.

Effect of Codonopsis lanceolata with Steamed and Fermented Process on Scopolamine-Induced Memory Impairment in Mice

Codonopsis lanceolata (Campanulaceae) traditionally have been used as a tonic and to treat patients with lung abscesses. Recently, it was proposed that the extract and some compounds isolated from C. lanceolata reversed scopolamine-induced memory and learning deficits. The purpose of this study was to evaluate the improvement of cognitive enhancing effect of C. lanceolata by steam and fermentation process in scopolamine-induced memory impairment mice models by passive avoidance test and Morris water maze test. The extract of C. lanceolata or the extract of steamed and fermented C. lanceolata (SFCE) was orally administered to male mice at the doses of 100 and 300 mg/kg body weight. As a result, mice treated with steamed and fermented C. lanceolata extract (SFCE) (300 mg/kg body weight, p.o.) showed shorter escape latencies than those with C. lanceolata extract or the scopolamine-administered group in Morris water maze test. Also, it exerted longer step-through latency time than scopolamine treated group in passive avoidance test. Furthermore, neuroprotective effect of SFCE on glutamate-induced cytotoxicity was assessed in HT22 cells. Only SFCE-treated cells showed significant protection at 500 microg/ml. Interestingly, steamed C. lanceolata with fermentation contained more phenolic acid including gallic acid and vanillic acid than original C. lanceolata. Collectively, these results suggest that steam and fermentation process of C. lanceolata increased cognitive enhancing activity related to the memory processes and neuroprotective effect than original C. lanceolata.

The Relationship Between Muscle Fatigue and Balance in the Elderly

OBJECTIVE: To investigate the effect of gastrocnemius muscle fatigue on postural control ability in elderly people. METHODS: Twenty-four healthy elderly people participated in this study. The postural control ability of single leg standing was evaluated with Health Improvement & Management System (HIMS) posturography before and after fatiguing exercises. After evaluating initial postural control ability, the maximal voluntary contraction (MVC) of ankle plantarflexion was assessed using a surface electromyogram from the medial belly of the gastrocnemius muscle. After a 5-minute resting period, subjects began submaximal isometric ankle plantarflexion (40% MVC) until 40% of MVC was dropped below 95% for 5 seconds, or subject couldn't continue working out due to muscle fatigue. And postural control ability was assessed after fatiguing exercise. The mean deviation of center of pressure (COP), length of COP movement, occupied area of COP were measured, and analyzed by paired t-test. RESULTS: Mediolateral deviation, length of COP movement, and area of COP occupied were increased after fatiguing exercise of the gastrocnemius muscle. Anteroposterior deviation and length of COP movement were also increased, but had low statistical significance. CONCLUSION: These findings suggest that the gastrocnemius muscle fatigue affects mediolateral stability and accuracy during single leg standing in elderly people. Therefore muscle endurance training is necessary to prevent falls in elderly people.

The Impacts of ACE Activity according to ACE I/D Polymorphisms on Muscular Functions of People Aged 65

OBJECTIVE: To investigate associations between angiotensin-converting enzyme (ACE) polymorphisms and muscle fatigability in 65-year-old Koreans. METHOD: The study participants were 49 Koreans aged 65 years. ACE insertion/deletion (I/D) polymorphisms were determined by polymerase chain reaction and serum ACE activity, by spectrophotometry. Body mass index (BMI), body fat mass (BFM), and lean body mass (LBM) were determined. To evaluate muscle fatigability, dynamic Electromyography was used to measure maximum voluntary isometric contractions (MVICs) of ankle plantar flexor muscles. Patients were seated with their hips flexed at 90degrees, knees fully extended, and ankles at 0degrees. Continuous submaximal VICs (40% MVIC) were then performed, and contraction duration and EMG frequency changes during the initial 2 min were measured. A self-reported physical activity questionnaire was used to evaluate effects of ACE activity levels on muscle fatigability. RESULTS: Among the 49 volunteers, 15 showed II genotype; 22, ID genotype; and 12, DD genotype. Serum ACE activity levels were significantly higher in DD genotype subjects than in II genotype subjects (p<0.05). Furthermore, the duration of submaximal isometric contractions was longer in II and ID genotype subjects than in DD genotype subjects (p<0.05). Dynamic EMG showed significantly lower mean frequency changes in II genotype subjects than in DD genotype subjects (p<0.05). However, LBM, BFM, and BMI were independent of ACE genotypes. CONCLUSION: ACE II genotype subjects showed significantly higher resistant to muscle fatigue than that by DD genotype subjects. However, body composition and BMI showed no correlations with ACE I/D polymorphisms.

A Comparison of Diagnostic Usefulness of Sonography and Electrophysiologic Study in Patients with Carpal Tunnel Syndrome

OBJECTIVE: To compare the diagnostic accuracy of ultrasonography(US) and electrophysiologic study in patients with carpal tunnel syndrome (CTS). METHOD: Two hundred twenty-seven hands in patients and 40 hand in healthy control group were used. Patients were diagnosed clinically with CTS. All groups had nerve conduction study (NCS) and sonographic measurement of the cross-sectional area (CSA) of the median nerve. Using the receiver operating characteristic curve, the optimal cutoff value was obtained and the sensitivity and specificity was evaluated. The correlation between the Hi-Ob score and the electrophysiologic severity, Hi-Ob score and CSA of the median nerve, and between the electrophysiologic severity and CSA were assessed. RESULTS: The cutoff value of the difference of median sensory latency (DMSL) was 1.55 ms with a sensitivity and specificity of 94.7% and 92.3% respectively. The cutoff value of CSA was 9.5 mm2, had a sensitivity of 85.5% and a specificity of 92.3%. In mild CTS, NCS showed a sensitivity of 92.1% and CSA showed a sensitivity of 81.2%. The electrophysiologic severity and Hi-Ob score appeared to show a significant positive correlation (r=0.34, p<0.01), and as the Hi-Ob score increased, the CSA was increased (r=0.54, p<0.01). The increase in electrophysiologic severity and the CSA also showed a significant correlation (r=0.33, p<0.01) There was bifurcation of the nerve in 9 hands, persistent median artery in 4 hands and cyst in 1 hands. And tenosynovitis was observed in 1 hands. CONCLUSION: In clinical CTS, electrophysiologic study showed higher sensitivity than US. But US can give us anatomical informations.

Effects of Panicum miliaceum L. extract on adipogenic transcription factors and fatty acid accumulation in 3T3-L1 adipocytes

The dietary intake of whole grains is known to reduce the incidence of chronic diseases such as obesity, diabetes, cardiovascular disease, and cancer. To investigate whether there are anti-adipogenic activities in various Korean cereals, we assessed water extracts of nine cereals. The results showed that treatment of 3T3-L1 adipocytes with Sorghum bicolor L. Moench, Setaria italica Beauvois, or Panicum miliaceum L. extract significantly inhibited adipocyte differentiation, as determined by measuring oil red-O staining, triglyceride accumulation, and glycerol 3-phosphate dehydrogenase activity. Among the nine cereals, P. miliaceum L. showed the highest anti-adipogenic activity. The effects of P. miliaceum L. on mRNA expression of peroxisome proliferator-activated receptor-gamma, sterol regulatory element-binding protein 1, and the CCAAT/enhancer binding protein-alpha were evaluated, revealing that the extract significantly decreased the expression of these genes in a dose-dependent manner. Moreover, P. miliaceum L. extract changed the ratio of monounsaturated fatty acids to saturated fatty acids in adipocytes, which is related to biological activity and cell characteristics. These results suggest that some cereals efficiently suppress adipogenesis in 3T3-L1 adipocytes. In particular, the effect of P. miliaceum L. on adipocyte differentiation is associated with the downregulation of adipogenic genes and fatty acid accumulation in adipocytes.

Hog millet (Panicum miliaceum L.)-supplemented diet ameliorates hyperlipidemia and hepatic lipid accumulation in C57BL/6J-ob/ob mice

Dietary intake of whole grains reduces the incidence of chronic diseases such as obesity, diabetes, cardiovascular disease, and cancer. In an earlier study, we showed that Panicum miliaceum L. extract (PME) exhibited the highest anti-lipogenic activity in 3T3-L1 cells among extracts of nine different cereal grains tested. In this study, we hypothesized that PME in the diet would lead to weight loss and augmentation of hyperlipidemia by regulating fatty acid metabolism. PME was fed to ob/ob mice at 0%, 0.5%, or 1% (w/w) for 4 weeks. After the experimental period, body weight changes, blood serum and lipid profiles, hepatic fatty acid metabolism-related gene expression, and white adipose tissue (WAT) fatty acid composition were determined. We found that the 1% PME diet, but not the 0.5%, effectively decreased body weight, liver weight, and blood triglyceride and total cholesterol levels (P < 0.05) compared to obese ob/ob mice on a normal diet. Hepatic lipogenic-related gene (PPARalpha, L-FABP, FAS, and SCD1) expression decreased, whereas lipolysis-related gene (CPT1) expression increased in animals fed the 1% PME diet (P < 0.05). Long chain fatty acid content and the ratio of C18:1/C18:0 fatty acids decreased significantly in adipose tissue of animals fed the 1% PME diet (P < 0.05). Serum inflammatory mediators also decreased significantly in animals fed the 1% PME diet compared to those of the ob/ob control group (P < 0.05). These results suggest that PME is useful in the chemoprevention or treatment of obesity and obesity-related disorders.

The Activities of Trapezius and Deltoid in Rotator Cuff Tear Patients Injected Local Anesthetics in Subacromial Space

OBJECTIVE: To investigate the activities of upper trapezius and deltoid muscles in shoulder abduction in full can and empty can position in rotator cuff tear patients. METHOD: Twelve subjects with right rotator cuff tear patients participated in this study. Each subject performed scapular plane abduction with humeral external rotation (full can position) and with humeral internal rotation (empty can position). Electromyography (EMG) was recorded with surface electrodes at the both upper trapezius, anterior, lateral, and posterior deltoid muscles during shoulder abduction. The EMG activity of each muscle was normalized according to the highest EMG activity during a maximum manual muscle test for the corresponding muscle. RESULTS: Muscle activities of the lesion side's upper trapezius and lateral deltoid were significantly greater than those of the normal side in full can position. In empty can position, the activities of upper trapezius, anterior, and lateral deltoid increased in lesion side. In comparison between full can and empty can exercises, over 30degrees abduction arcs, empty can exercise showed increased muscle activities of upper trapezius and all deltoid muscle in lesion side. In contrast, anterior and lateral deltoid only showed increased in the muscle activities under empty can exercise in sound side. CONCLUSION: Rotator cuff tear is involved in changed the activities of upper trapezius and deltoid muscles. And these results suggested that in rotator cuff tear patients, the changed pattern of muscle contraction should be considered in shoulder exercise.

The Effects of Intradialytic Exercise on Dialysis Efficacy and Autonomic Function in Hemodialysis Patients: Preliminary Study / 대한스포츠의학회지

The study investigated the effects of an intradialytic exercise program on autonomic function and dialysis efficacy in maintenance hemodialysis in 18 patients. The patients undertook a 6-month intradialysis exercise program. Each session consisted of a 5-minute warm-up, 40-minute main exercise program, and 5-minute cool-down period. Autonomic symptom questionnaire and autonomic function test by heart rate variability on supine and standing position, and dialysis efficacy were assessed at the beginning and end of the study by comparison using the Wilcoxson signed rank test. Heart rate variability in the supine position was not improved. In the standing position the ratio between the low frequency and high frequency (LF/HF) increased significantly after 6 months of exercise (p<0.05), with the LF component being normally dominant. Statistical differences were evident at 6 months in autonomic symptoms questionnaire and autonomic function (p<0.05), but not in dialysis efficacy. The results suggest that intradialytic exercise is an effective therapy to improve autonomic symptoms and a heart rate variability parameter.

Autonomic Function in Chronic Alcoholic Patients

OBJECTIVE: To investigate the relationship among the alcohol drinking history, autonomic symptom scores (ASS), and the autonomic functions measured with sympathetic skin response (SSR) and heart rate variability (HRV) of alcoholic patients, and to assess the difference between the values from the autonomic function tests of patients and normal controls. METHOD: SSR and HRV were measured in 44 patients and 26 controls. ASS and Toronto clinical neuropathy scoring system (TCNSS) scores were also assessed. For the HRV, the mean heart rate, standard deviation of the NN intervals (SDNN), total power (TP), very low frequency (VLF), low frequency (LF), and high frequency (HF) in both the supine and standing positions were evaluated. For the SSR, the onset latency and amplitude of both the palm and sole were measured. RESULTS: There were no significant relationships among the alcohol history, the TCNSS, and the results of the autonomic function tests. There were, however, significant relationships among their ASS and some values from autonomic function tests [i.e., the sole amplitudes, the SDNNs (supine), and the TPs (standing)]. There were significant differences between the sole amplitudes of the patients and controls. In HRV, there were significant differences between the patients and controls with respect to their SDNNs and TPs at a standing position. CONCLUSION: Autonomic function tests such as SSR and HRV are related to ASS, but not to alcohol history and TCNSS. Moreover, the values from the autonomic function tests of the alcoholic patients decreased, unlike the normal controls.

Usefulness of Infrared Thermography in Diagnosis of Unilateral Carpal Tunnel Syndrome

OBJECTIVE: To evaluate the usefulness of infrared thermography in the diagnosis of unilateral carpal tunnel syndrome (CTS). METHOD: Thirty six patients confirmed electrodiagnostically as CTS and fifteen adults with normal electrodiagnostic study were included in this study. For the thermographic diagnosis, we measured the skin temperature of the palmar area of all 5 fingers, thenar area, hypothenar area and volar area of forearm bilaterally. We compared the interside peak temperature difference between median nerve innervated area and noninnervated area in three different groups (normal control, mild CTS and moderate to severe CTS groups). RESULTS: Thermography of the CTS patients showed significant temperature differences in more than one area of the median vasomotor nerve territory, and no significant temperature difference in all the areas that were not innervated by the median vasomotor nerve. When we considered interside temperature differences of more than 0.3 degrees C as abnormal findings, the sensitivity of thermography was 2.7% and the specificity was 86.6%. With more than 0.6 degrees C as abnormal, the sensitivity was 25% and the specificity was 66.6%. With more than 1.0 degrees C, the sensitivity was 8.3% and the specificity was 73.3%. There was no significant interside peak temperature difference in all groups. CONCLUSION: This study suggests that infrared thermography has low sensitivity and specificity, which implies that it is not useful for the diagnosis of CTS.

A Review of the AMA Guides to the Evaluation of Permanent Impairment

The American Medical Association's Guides to the Evaluation of Permanent Impairment (Guides) has provided an useful guideline in interpreting information on permanent impairment based on the in-depth knowledge and experience in impairment ratings accumulated for a long period of time. Since its first publication by American Medical Association (1958), as A Guide to the Evaluation of Permanent Impairment of the Extremities and Back', 12 additional guides' has been published by the JAMA over the next 12 years. All the guides were consolidated to become the first official edition of the Guides' in 1971. The 'Guides' has been updated periodically to reflect current scientific clinical knowledge and judgment methods. It has become the best system available to evaluate permanent impairments across many disciplines. The latest sixth edition created a "paradigm shift" in the area of the impairment assessment by introducing a contemporary model of disablement. The standardized methods elaborated in the sixth edition clearly enhances the relevancy of impairment ratings, improves internal consistency of the methods and renders the application of the rating process easier. It adopts the terminology and conceptual framework from the International Classification of Functioning, Disability and Health in order to generate five impairment classes. A diagnosis-based grid has been developed for each organ system. Functional history, physical findings and objective clinical test results are integrated to determine the grade within the impairment class. The Guides' is the most widely used source for assessing and rating permanent impairments in the United States and can be considered as the best available method for the assessment of permanent impairment.

Development of the Korean Academy of Medical Sciences Guideline for Rating the Impairment in the Brain Injured and Brain Diseased Persons with Motor Dysfunction

To develop an objective and scientific method to evaluate the brain injured and brain diseased persons with motor dysfunction, American Medical Association's Guides to the Evaluation of Permanent Impairment was used as an exemplar. After the motor dysfunction due to brain injury or brain disease was confirmed, active range of motion and muscle strength of affected extremities were measured. Also, the total function of extremities was evaluated through the assessment of activities of daily living, fine coordination of hand, balance and gait. Then, the total score of manual muscle test and functional assessment of impaired upper and lower extremity were added, respectively. Spasticity of upper and lower extremity was used as minus factors. Patients with movement disorder such as Parkinson's disease were assessed based on the degree of dysfunction in response to medication. We develop a new rating system based on the concept of total score.