Primerjava meritev repetitivnega draženja živca in testa devetih zatičev pri bolnikih z amiotrofično lateralno sklerozo s sumom na sindrom razcepljene roke : magistrsko delo

Blatnik, Jure (author), Leonardis, Lea (mentor), Kovačič, Tine (reviewer)

Uvod: Amiotrofična laterana skleroza (ALS) je progresivna nevrodegenerativna bolezen, katera povzroča propad motoričnih nevronov, posledica katerih je atrofija, mišična oslabelost in pojav sindroma razceljene roke. Ob tem je izraziteje prizadeta mišica kratki abduktor palca (APB) in prva dorzalna interosalna mišica (FDI) v primerjavi z manj prizadeto mišico kratki abduktor mezinca (ADM). Sindrom razcepljene roke lahko dokažemo z indeksom valov M (IVM). Namen: Namen magistrskega dela je bil preučiti razlike med elektrofiziološkimi meritvami in vrednostmi testa devetih zatičev pri bolnikih z ALS in zdravo populacijo ter ugotoviti, ali obstaja povezanost med meritvami IVM in repetitivnega draženja živca (RNS) s testom devetih zatičev. Metode dela: V raziskavi je sodelovalo 42 bolnikov z ALS in 45 zdravih preiskovancev, ki so opravili meritve vala M in upada amplitude vala M pri RNS na motoričnem nitju medianih in ulnarnih živcev. Iz elektrofizioloških meritev smo nato izračunali IVM, izpeljan iz zmnožka amplitud vala M mišic APB in FDI, deljeno z amplitudo vala M mišice ADM in indeks RNS z zmnožkom upadov aplitud vala M mišic APB in FDI, deljenim z upadom amplitude vala M mišice ADM. Poleg tega so vsi preiskovanci opravili deset neprekinjenih ponovitev testa devetih zatičev. Rezultati: Med skupinama smo ugotovili statistično pomembne razlike: zdravi preiskovanci so imeli višje amplitude valov M, večje vrednosti IVM, indeksa RNS in krajše absolutne čase izvedbe testa devetih zatičev. Mejna vrednost indeksa RNS -1,7 z 62 % očutljivosto in 71 % specifičnostjo slabo razlikuje med bolniki z ALS in zdravimi osebami. Povezanost IVM z izvedbo ponovitvenega testa devetih zatičev je bila visoka, povezanost IVM z indeksom RNS je bila nizka, kakor tudi amplitudni upad pri RNS v primerjavi z izvedbo ponovitvenega testa devetih zatičev. Razprava in zaključek: Bolniki z ALS imajo višje vrednosti amplitudnega upada RNS in časovne vrednosti izvedbe ponovitvenega testa devetih zatičev in so zato dovzetnejši za pojav izvedbene utrudljivosti. IVM je še vedno natančnejša metoda pri prepoznavanju sindroma razcepljene roke v primerjavi z indeksom RNS, vendar lahko v kombinaciji pripomoreta k hitrejši diagnozi bolezni ALS.

• Language: Slovenian
• Keywords: magistrska dela, fizioterapija, amiotrofična lateralna skleroza, sindrom razcepljene roke, repetitivno draženje živca, indeks valov M, test devetih zatičev
• Work type: Master's thesis/paper
• Typology: 2.09 - Master's Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [J. Blatnik]
• Year: 2024
• Number of pages: 60 str., [3] str. pril.
• PID: 20.500.12556/RUL-162632
• UDC: 615.8
• COBISS.SI-ID: 208974083
• Publication date in RUL: 26.09.2024

Secondary language

• Language: English
• Title: Comparison of repetitive nerve stimulation and nine hole peg test in amyotrophic lateral sclerosis with split hand occurence : master thesis

Abstract

Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease, that causes motor neuron degeneration, resultin in atrophy, muscle weakness and the appearance of the split-hand syndrome. Abductor pollicis brevis (APB) and firs dorsal interosseous muscle (FDI) are more affected compared to abductor digiti minimi (ADM). Split-hand syndrome can be demonstrated by the split hand index (SHI). Purpose: The purpose of master's thesis was to examine the differences between electrophysiological measurements and nine hole peg test within ALS patients and healty controls, and determine whether there is correlation between SHI and repetitive nerve stimulation (RNS) with nine hole peg test. Methods: 42 ALS patients and 45 healthy controls were included in the study, who performed measurements of the CMAP and its amplitude decline in RNS on median and ulnar motor nerves. Using electrophysiological measurements, SHI was then calculated by the product of CMAP of APB and FDI muscle, divided by the CMAP of the ADM muscle. RNS index was calculated by the product of CMAP decrement of APB and FDI muscle, divided by the CMAP decrement of the ADM muscle. In addition, all subjects completed 10 repetitions of the nine hole peg test. Results: There was statistically significatn differences between ALS and control group in CMAP amplitude, SHI, RNS index and absolute times of nine hole peg test performance. A cutoff value -1,7 of RNS index poorly discriminates between ALS patients and healthy controls with 62 % sensitivity and 71 % specificty. Correlation of SHI with repeated nine hole peg test was high, correlation of SHI with RNS index and amplitude decline with repeated nine hole peg test was low. Discussion and conclusion: ALS patients have higher RNS decrement and repeated nine hole peg test time values and are therefore more susceptible to the phenomenon of performance fatigue. SHI is still a more accurate method in identifying split-hand syndrome compared to the RNS index, but in combination they can help to diagnose ALS more quickly.

• Keywords: master's theses, physiotherapy, amyotrophic lateral sclerosis, split-hand syndrome, repetitive nerve stimulation, split-hand index, nine hole peg test