Primerjava dinamometričnega in elektrofiziološkega indeksa razcepljene roke pri bolnikih z amiotrofično lateralno sklerozo : diplomsko delo

Okorn, Doroteja (author), Leonardis, Lea (mentor), Rugelj, Darja (reviewer)

Uvod: Pri amiotrofični lateralni sklerozi (ALS) je pogosteje prizadeta lateralna stran dlani in s tem mišica kratki abduktor palca in prva dorzalna interosalna mišica, medtem ko je medialna stran dlani, in s tem mišica abduktor mezinca, redkeje prizadeta. Ta nenavadna porazdelitev mišične šibkosti in atrofije se imenuje sindrom razcepljene roke, ki ga dokažemo z indeksom valov M (IVM), izračunanega iz amplitud valov M. V naši raziskavi kot alternativo pri dokazovanju sindroma predstavimo nov indeks dinamometrije (ID), izračunanega iz sil mišic. Namen: Namen diplomskega dela je bil primerjati IVM in ID ter preveriti povezavo med indeksoma in njuno klinično uporabnost pri dokazovanju sindroma razcepljene roke. Metode dela: V raziskavi je sodelovalo 13 bolnikov z ALS in 14 zdravih preiskovancev, ujemajočih se po starosti in spolu. Amplitude valov M smo dobili z meritvami prevajanja po motoričnem nitju medianih in ulnarnih živcev. IVM smo izračunali z zmnožkom amplitud vala M mišice kratkega abduktorja palca in prve dorzalne interosalne mišice, deljenim z amplitudo vala M abduktorja mezinca. Mišične sile smo izmerili z ročnim dinamometrom in jih uporabili pri izračunu ID, ki smo ga dobili z zmnožkom sile mišice kratkega abduktorja palca in prve dorzalne interosalne mišice, deljenim s silo mišice abduktorja mezinca. Indeksa smo med seboj primerjali s t-testom za dva neodvisna vzorca in z neparametričnim Mann-Whitney testom. Povezave med indeksoma smo preverili s Pearsonovim in Spearmanovim testom korelacije. S krivulje karakteristike delovanja sprejemnika smo dobili ploščino pod krivuljo in razbrali mejni vrednosti posameznih indeksov. Rezultati: Bolniki z ALS so imeli znižane vrednosti obeh indeksov. Pri bolnikih z ALS je med IVM in ID prisotna močna povezava (rs = 0,8376, p < 0,0001). Mejna vrednost IVM 5,4 s 77 % občutljivostjo in 96 % specifičnostjo ter mejna vrednost ID 29,5 s 62 % občutljivostjo in 79 % specifičnostjo dobro razlikujeta med bolniki z ALS in zdravimi osebami. Razprava in zaključek: IVM je bolj občutljiv in specifičen pri prepoznavanju sindroma razcepljene roke pri bolnikih z ALS. Dinamometrija, ki je za bolnike prijetnejša, se je z ID izkazala za zmerno natančno diagnostično metodo.

• Language: Slovenian
• Keywords: diplomska dela, fizioterapija, amiotrofična lateralna skleroza, sindrom razcepljene roke, indeks valov M, indeks dinamometrije
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [D. Okorn]
• Year: 2021
• Number of pages: 37 str., [3] str. pril.
• PID: 20.500.12556/RUL-129581
• UDC: 615.8
• COBISS.SI-ID: 75460099
• Publication date in RUL: 05.09.2021

Secondary language

• Language: English
• Title: Comparison of dynamometric and electrophysiological split-hand index in patients with amyotrophic lateral sclerosis : diploma work

Abstract

Introduction: In amyotrophic lateral sclerosis (ALS), lateral hand muscles, the abductor pollicis brevis (APB) and the first dorsal interosseous (FDI), are usually more affected than the medial hand muscle, namely the abductor digiti minimi (ADM). This unusual pattern of muscle weakness and atrophy is called the split-hand syndrome, which can be demonstrated by the split-hand index (SHI), calculated from compound muscle action potential (CMAP) amplitudes. Our study developed a novel dynamometric index (DI), which is calculated from the muscle forces, as an alternative method to SHI. Purpose: The purpose of this diploma work was to compare the SHI to DI and to define the correlation between them as well as their diagnostic utility. Methods: 13 ALS patients and 14 healthy sex and age matched controls were included in the study. CMAP amplitudes were obtained by motor nerve conduction studies. The SHI was derived by multiplying the CMAP amplitudes recorded from the APB and FDI muscles and dividing this product by the CMAP amplitude recorded from the ADM muscle. Muscle forces were measured by hand-held dynamometer and used to calculate the DI by multiplying the APB and FDI muscle forces and dividing this product by the ADM muscle force. The indices were compared using the unpaired t-test and nonparametric Mann-Whitney test. Pearson's and Spearman's correlation coefficient were used to examine the relationship between the indices. Receiver-operator characteristic curve analysis of SHI and DI was performed to determine the area under the curve and cut-off values of the indices. Results: The SHI and DI were significantly lower in ALS patients. A strong correlation (rs = 0,8376, p < 0,0001) was observed between the indices in ALS patients. SHI cut-off value of 5,4 with 77 % sensitivity and 96 % specificity and DI cut-off value of 29,5 with 62 % sensitivity and 79 % specificity moderately differentiate ALS patients from healthy controls. Discussion and conclusion: The SHI is more sensitive and specific for determining split-hand patterns in ALS patients. Dynamometry is patient friendlier and DI showed moderate diagnostic accuracy.

• Keywords: diploma theses, physiotherapy, amyotrophic lateral sclerosis, split-hand syndrome, split-hand index, dynamometric index