Relación entre el índice de unidades motoras (MUNIX) y la función manual en pacientes con Esclerosis Lateral Amiotrófica (ELA) en un hospital de Bogotá
Introducción: El MUNIX es una herramienta electrofisiológica para hacer una estimación cuantitativa de las unidades motoras. Se ha utilizado en la caracterización y seguimiento de pacientes con enfermedades motoneuronales y no se ha descrito en la literatura la asociación entre el MUNIX de músculos...
- Autores:
-
Gómez Gil, Jully Carolina
Rojas Beltrán, Cristhian David
- Tipo de recurso:
- Fecha de publicación:
- 2022
- Institución:
- Universidad Nacional de Colombia
- Repositorio:
- Universidad Nacional de Colombia
- Idioma:
- spa
- OAI Identifier:
- oai:repositorio.unal.edu.co:unal/83116
- Palabra clave:
- 610 - Medicina y salud::616 - Enfermedades
610 - Medicina y salud::612 - Fisiología humana
Esclerosis lateral amiotrófica
Recopilación de datos
Amyotrophic lateral sclerosis
Data collecting
MUNIX
ALSFRS-R
ALS
manual dexterity
data correlation
ELA
destreza manual
correlación de datos
- Rights
- openAccess
- License
- Atribución-NoComercial-SinDerivadas 4.0 Internacional
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|
| dc.title.spa.fl_str_mv |
Relación entre el índice de unidades motoras (MUNIX) y la función manual en pacientes con Esclerosis Lateral Amiotrófica (ELA) en un hospital de Bogotá |
| dc.title.translated.eng.fl_str_mv |
Relationship between motor unit index (MUNIX) and manual function amyotrophic lateral sclerosis (ALS) patients at a hospital in Bogotá |
| title |
Relación entre el índice de unidades motoras (MUNIX) y la función manual en pacientes con Esclerosis Lateral Amiotrófica (ELA) en un hospital de Bogotá |
| spellingShingle |
Relación entre el índice de unidades motoras (MUNIX) y la función manual en pacientes con Esclerosis Lateral Amiotrófica (ELA) en un hospital de Bogotá 610 - Medicina y salud::616 - Enfermedades 610 - Medicina y salud::612 - Fisiología humana Esclerosis lateral amiotrófica Recopilación de datos Amyotrophic lateral sclerosis Data collecting MUNIX ALSFRS-R ALS manual dexterity data correlation ELA destreza manual correlación de datos |
| title_short |
Relación entre el índice de unidades motoras (MUNIX) y la función manual en pacientes con Esclerosis Lateral Amiotrófica (ELA) en un hospital de Bogotá |
| title_full |
Relación entre el índice de unidades motoras (MUNIX) y la función manual en pacientes con Esclerosis Lateral Amiotrófica (ELA) en un hospital de Bogotá |
| title_fullStr |
Relación entre el índice de unidades motoras (MUNIX) y la función manual en pacientes con Esclerosis Lateral Amiotrófica (ELA) en un hospital de Bogotá |
| title_full_unstemmed |
Relación entre el índice de unidades motoras (MUNIX) y la función manual en pacientes con Esclerosis Lateral Amiotrófica (ELA) en un hospital de Bogotá |
| title_sort |
Relación entre el índice de unidades motoras (MUNIX) y la función manual en pacientes con Esclerosis Lateral Amiotrófica (ELA) en un hospital de Bogotá |
| dc.creator.fl_str_mv |
Gómez Gil, Jully Carolina Rojas Beltrán, Cristhian David |
| dc.contributor.advisor.none.fl_str_mv |
Ortiz Corredor, Fernando |
| dc.contributor.author.none.fl_str_mv |
Gómez Gil, Jully Carolina Rojas Beltrán, Cristhian David |
| dc.contributor.researchgroup.spa.fl_str_mv |
Cifel Centro de Investigación en Fisiatría y Electrodiagnóstico |
| dc.contributor.subjectmatterexpert.none.fl_str_mv |
Mendoza Pulido, juan Camilo |
| dc.contributor.orcid.spa.fl_str_mv |
Gómez Gil, Jully Carolina [0000-0001-8742-2502] |
| dc.contributor.cvlac.spa.fl_str_mv |
Gómez Gil, Jully Carolina [0001781420] |
| dc.subject.ddc.spa.fl_str_mv |
610 - Medicina y salud::616 - Enfermedades 610 - Medicina y salud::612 - Fisiología humana |
| topic |
610 - Medicina y salud::616 - Enfermedades 610 - Medicina y salud::612 - Fisiología humana Esclerosis lateral amiotrófica Recopilación de datos Amyotrophic lateral sclerosis Data collecting MUNIX ALSFRS-R ALS manual dexterity data correlation ELA destreza manual correlación de datos |
| dc.subject.lemb.spa.fl_str_mv |
Esclerosis lateral amiotrófica Recopilación de datos |
| dc.subject.lemb.eng.fl_str_mv |
Amyotrophic lateral sclerosis Data collecting |
| dc.subject.proposal.eng.fl_str_mv |
MUNIX ALSFRS-R ALS manual dexterity data correlation |
| dc.subject.proposal.spa.fl_str_mv |
ELA destreza manual correlación de datos |
| description |
Introducción: El MUNIX es una herramienta electrofisiológica para hacer una estimación cuantitativa de las unidades motoras. Se ha utilizado en la caracterización y seguimiento de pacientes con enfermedades motoneuronales y no se ha descrito en la literatura la asociación entre el MUNIX de músculos de la mano y pruebas funcionales de destreza manual, escala ALSFRS-R y niveles de dependencia funcional en pacientes con ELA. Objetivo: Establecer la relación entre el número de unidades motoras calculadas con el MUNIX y la función manual de los pacientes con ELA. Metodología: Estudio descriptivo, corte transversal, con recolección prospectiva de datos. Se realizaron dos tomas por cada músculo (APB, ADM y FDI) no consecutivas por el mismo evaluador siguiendo el protocolo actualizado de registro de MUNIX. Se establece nivel funcional de los pacientes según escala ALSFRS-R, índice de progresión, clasificación ALS-MITOS y Ortiz et al. Se hicieron pruebas funcionales de destreza manual el mismo día de realización. Se estableció un coeficiente de correlación intraclase entre las tomas de cada músculo. Para el análisis se realizó un promedio de los datos según las categorías de nivel funcionales. La correlación de variables se realizó por coeficiente de correlación tau (τ) de Kendall de acuerdo con el tipo de distribución. Resultados: Se obtuvo 81 registros de pacientes diagnosticados con ELA según criterios Gold Coast, 64% fueron hombres, con un promedio de edad de 59 años, tiempo promedio de evolución de la enfermedad de 31.7 meses, promedio de MUNIX de APB de 59.2, ADM de 73.0 y FDI de 96.0. Los dos registros de MUNIX por cada músculo demostraron un ICC de >0.95. Se encontraron correlaciones estadísticamente significativas entre los valores MUNIX y las pruebas funcionales (τ>0.4, p<0.001), así como diferencias entre los grupos funcionales. Discusión: Se encontró diferencias estadísticamente significativas entre MUNIX de los tres músculos de la mano y el fenotipo de inicio cervical, pruebas de caja y cubos, prueba de giro de la moneda, prueba de nueve hoyos y clavijas, dinamometría manual, escala ALSFRS-R con puntaje total y específico de ítems de destreza manual. Conclusiones: El MUNIX en músculos de la mano se correlaciona con pruebas y clasificación funcional de pacientes con ELA, específicamente para los que tienen compromiso cervical. (Texto tomado de la fuente) |
| publishDate |
2022 |
| dc.date.issued.none.fl_str_mv |
2022-12-07 |
| dc.date.accessioned.none.fl_str_mv |
2023-01-25T16:26:52Z |
| dc.date.available.none.fl_str_mv |
2023-01-25T16:26:52Z |
| dc.type.spa.fl_str_mv |
Trabajo de grado - Especialidad Médica |
| dc.type.driver.spa.fl_str_mv |
info:eu-repo/semantics/masterThesis |
| dc.type.version.spa.fl_str_mv |
info:eu-repo/semantics/acceptedVersion |
| dc.type.content.spa.fl_str_mv |
Text |
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http://purl.org/redcol/resource_type/TM |
| status_str |
acceptedVersion |
| dc.identifier.uri.none.fl_str_mv |
https://repositorio.unal.edu.co/handle/unal/83116 |
| dc.identifier.instname.spa.fl_str_mv |
Universidad Nacional de Colombia |
| dc.identifier.reponame.spa.fl_str_mv |
Repositorio Institucional Universidad Nacional de Colombia |
| dc.identifier.repourl.spa.fl_str_mv |
https://repositorio.unal.edu.co/ |
| url |
https://repositorio.unal.edu.co/handle/unal/83116 https://repositorio.unal.edu.co/ |
| identifier_str_mv |
Universidad Nacional de Colombia Repositorio Institucional Universidad Nacional de Colombia |
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spa |
| language |
spa |
| dc.relation.references.spa.fl_str_mv |
Agosta, F., Al-Chalabi, A., Filippi, M., Hardiman, O., Kaji, R., Meininger, V., WFN Research Group on ALS/MND. (2015). The El Escorial criteria: strengths and weaknesses. Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration, 16(1-2), 1–7 Ahn, S. W., Kim, S. H., Kim, J. E., Kim, S. M., Kim, S. H., Park, K. S., Sung, J. J., Lee, K. W., & Hong, Y. H. (2010). Reproducibility of the motor unit number index (MUNIX) in normal controls and amyotrophic lateral sclerosis patients. Muscle & nerve, 42(5), 808–813 Alix, J. J. P., Neuwirth, C., Gelder, L., Burkhardt, C., Castro, J., de Carvalho, M., Weber, M. (2019). Assessment of the reliability of the motor unit size index (MUSIX) in single subject ‘round-robin’ and multi-centre settings. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 130(5), 666–674 Arasaki, K., Tamaki, M., Hosoya, Y., & Kudo, N. (1997). Validity of electromyograms and tension as a means of motor unit number estimation. Muscle & Nerve Boekestein, W. A., Schelhaas, H. J., van Putten, M. J. A. M., Stegeman, D. F., Zwarts, M. J., & van Dijk, J. P. (2012). Motor unit number index (MUNIX) versus motor unit number estimation (MUNE): a direct comparison in a longitudinal study of ALS patients. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 123(8), 1644–1649 Bostock, H. (2016). Estimating motor unit numbers from a CMAP scan. Muscle & Nerve, 53(6), 889–896 Bostock, H., Jacobsen, A. B., & Tankisi, H. (2019). Motor unit number index and compound muscle action potential amplitude. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 130(9), 1734–1740 Boulay, C., Delmont, E., Audic, F., Chabrol, B., & Attarian, S. (2021). Motor unit number index: A potential electrophysiological biomarker for pediatric spinal muscular atrophy. Muscle & Nerve, 64(4), 445–453 Bromberg, M. B. (2004). Motor unit number estimation: new techniques and new uses. Supplements to Clinical Neurophysiology, 57, 120–136 Bromberg, M. B. (2007). Updating motor unit number estimation (MUNE). Clinical Neurophysiology. Bromberg, M. B., & Brownell, A. A. (2008). Motor unit number estimation in the assessment of performance and function in motor neuron disease. Physical Medicine and Rehabilitation Clinics of North America, 19(3), 509–32, ix Brooks, B. R., Miller, R. G., Swash, M., Munsat, T. L., & World Federation of Neurology Research Group on Motor Neuron Diseases. (2000). El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders: Official Publication of the World Federation of Neurology, Research Group on Motor Neuron Diseases, 1(5), 293–299 Campos, T. S., Rodríguez-Santos, F., Esteban, J., Vázquez, P. C., Mora Pardina, J. S., & Carmona, A. C. (2010). Spanish adaptation of the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R). Amyotrophic Lateral Sclerosis: Official Publication of the World Federation of Neurology Research Group on Motor Neuron Diseases, 11(5), 475–477 Chan, Y., Alix, J. J. P., Neuwirth, C., Barkhaus, P. E., Castro, J., Jenkins, T. M., Weber, M. (2021). Reinnervation as measured by the motor unit size index is associated with preservation of muscle strength in amyotrophic lateral sclerosis, but not all muscles reinnervate. Muscle & Nerve Cao, B., Gu, X., Zhang, L., Hou, Y., Chen, Y., Wei, Q., Shang, H. (2020). Reference values for the motor unit number index and the motor unit size index in five muscles. Muscle & Nerve, 61(5), 657–661 Cheah, B. C., Vucic, S., Krishnan, A. V., Boland, R. A., & Kiernan, M. C. (2011). Neurophysiological index as a biomarker for ALS progression: validity of mixed effects models. Amyotrophic Lateral Sclerosis: Official Publication of the World Federation of Neurology Research Group on Motor Neuron Diseases, 12(1), 33–38 Chiò, A., Hammond, E. R., Mora, G., Bonito, V., & Filippini, G. (2015). Development and evaluation of a clinical staging system for amyotrophic lateral sclerosis. Journal of Neurology, Neurosurgery, and Psychiatry, 86(1), 38–44 CMAP scan discontinuities: Automated detection and relation to motor unit loss. (2014). Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 125(2), 388–395 Czell, D., Neuwirth, C., Weber, M., Sartoretti-Schefer, S., Gutzeit, A., & Reischauer, C. (2019). Nine Hole Peg Test and Transcranial Magnetic Stimulation: Useful to Evaluate Dexterity of the Hand and Disease Progression in Amyotrophic Lateral Sclerosis. Neurology research international, 2019, 7397491 de Carvalho, M., Barkhaus, P. E., Nandedkar, S. D., & Swash, M. (2018). Motor unit number estimation (MUNE): Where are we now? Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 129(8), 1507–1516 Diaz-Gomez, M. F., & Ortiz-Corredor, F. (2017). [Design and validation of a classification system for assessing the degree of disability of patients with amyotrophic lateral sclerosis]. Revista de neurologia, 64(3), 112–118 Dimitriadis, Z., Kapreli, E., Strimpakos, N., & Oldham, J. (2015). Reliability of the chin tuck neck flexion test for assessing endurance of short neck flexors in healthy individuals. Physiotherapy Theory and Practice, 31(4), 299–302 Escorcio-Bezerra, M. L., Abrahao, A., de Castro, I., Chieia, M. A. T., de Azevedo, L. A., Pinheiro, D. S, Manzano, G. M. (2016). MUNIX: Reproducibility and clinical correlations in Amyotrophic Lateral Sclerosis. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 127(9), 2979–2984 Escorcio-Bezerra, M. L., Abrahao, A., Nunes, K. F., De Oliveira Braga, N. I., Oliveira, A. S. B., Zinman, L., & Manzano, G. M. (2018). Motor unit number index and neurophysiological index as candidate biomarkers of presymptomatic motor neuron loss in amyotrophic lateral sclerosis. Muscle & Nerve, 58(2), 204–212 Escorcio-Bezerra, M. L., Abrahao, A., Santos-Neto, D., de Oliveira Braga, N. I., Oliveira, A. S. B., & Manzano, G. M. (2017). Why averaging multiple MUNIX measures in the longitudinal assessment of patients with ALS? Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 128(12), 2392–2396 Escorcio-Bezerra, M. L., Oliveira, A. S. B., De Oliveira Braga, N. I., & Manzano, G. M. (2017). Improving the reproducibility of motor unit number index. Muscle & Nerve, 55(5), 635–638 Fatehi, F., Grapperon, A.-M., Fathi, D., Delmont, E., & Attarian, S. (2018). The utility of motor unit number index: A systematic review. Neurophysiologie Clinique = Clinical Neurophysiology, 48(5), 251–259 Fathi, D., Mohammadi, B., Dengler, R., Böselt, S., Petri, S., & Kollewe, K. (2016). Lower motor neuron involvement in ALS assessed by motor unit number index (MUNIX): Long- term changes and reproducibility. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 127(4), 1984–1988 Gawel, M., & Kuzma-Kozakiewicz, M. (2016). Does the MUNIX Method Reflect Clinical Dysfunction in Amyotrophic Lateral Sclerosis: A Practical Experience. Medicine, 95(19), e3647 Geevasinga, N., Menon, P., Scherman, D. B., Simon, N., Yiannikas, C., Henderson, R. D. Vucic, S. (2016). Diagnostic criteria in amyotrophic lateral sclerosis: A multicenter prospective study. Neurology, 87(7), 684–690 Gooch, C. L., Doherty, T. J., Chan, K. M., Bromberg, M. B., Lewis, R. A., Stashuk, D. W. Daube, J. R. (2014). Motor unit number estimation: a technology and literature review. Muscle & Nerve, 50(6), 884–893 Henderson, R. D., & McCombe, P. A. (2017). Assessment of Motor Units in Neuromuscular Disease. Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics, 14(1), 69–77 Higashihara, M., Menon, P., van den Bos, M., Geevasinga, N., & Vucic, S. (2018). Reproducibility of motor unit number index and multiple point stimulation motor unit number estimation in controls. Muscle & Nerve, 58(5), 660–664 Howard, I. M., & Rad, N. (2018). Electrodiagnostic testing for the diagnosis and management of amyotrophic lateral sclerosis. Physical Medicine and Rehabilitation Clinics of North America, 29(4), 669–680 Huisman, M. H. B., de Jong, S. W., van Doormaal, P. T. C., Weinreich, S. S., Schelhaas, H. J., van der Kooi, A. J., van den Berg, L. H. (2011). Population based epidemiology of amyotrophic lateral sclerosis using capture-recapture methodology. Journal of Neurology, Neurosurgery, and Psychiatry, 82(10), 1165–1170 Jacobsen, A. B., Kristensen, R. S., Witt, A., Kristensen, A. G., Duez, L., Beniczky, S., … Tankisi, H. (2018). The utility of motor unit number estimation methods versus quantitative motor unit potential analysis in diagnosis of ALS. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 129(3), 646–653 Jarmusch, S., Baber, L., Bidlingmaier, M., Ferrari, U., Hofmeister, F., Hintze, S., Drey, M. (2021). Influence of IGF-I serum concentration on muscular regeneration capacity in patients with sarcopenia. BMC Musculoskeletal Disorders, 22(1), 807 Jenkins, T. M., Alix, J. J. P., Fingret, J., Esmail, T., Hoggard, N., Baster, K., McDermott, C. J., Wilkinson, I. D., & Shaw, P. J. (2020). Longitudinal multi-modal muscle-based biomarker assessment in motor neuron disease. Journal of neurology, 267(1), 244–256 Karpati, G. (2010). Disorders of Voluntary Muscle. Cambridge University Press Kaya, R. D., Nakazawa, M., Hoffman, R. L., & Clark, B. C. (2013). Interrelationship between muscle strength, motor units, and aging. Experimental Gerontology, 48(9), 920–925 Labra, J., Menon, P., Byth, K., Morrison, S., & Vucic, S. (2016). Rate of disease progression: a prognostic biomarker in ALS. Journal of Neurology, Neurosurgery & Psychiatry Li, X., He, W., Li, C., Wang, Y.-C., Slavens, B. A., & Zhou, P. (2015). Motor unit number index examination in dominant and non-dominant hand muscles. Laterality, 20(6), 699– 710 Logroscino, G., Traynor, B. J., Hardiman, O., Chiò, A., Mitchell, D., Swingler, R. J., EURALS. (2010). Incidence of amyotrophic lateral sclerosis in Europe. Journal of Neurology, Neurosurgery, and Psychiatry, 81(4), 385–390 Ludolph, A., Drory, V., Hardiman, O., Nakano, I., Ravits, J., Robberecht, W., WFN Research Group On ALS/MND. (2015). A revision of the El Escorial criteria - 2015. Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration, 16(5-6), 291–292 Mathiowetz, V., Volland, G., Kashman, N., & Weber, K. (1985). Adult norms for the Box and Block Test of manual dexterity. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 39(6), 386–391 Mendoza, J. E., Apostolos, G. T., Humphreys, J. D., Hanna-Pladdy, B., & O’Bryant, S. E. (2009). Coin rotation task (CRT): a new test of motor dexterity. Archives of Clinical Neuropsychology: The Official Journal of the National Academy of Neuropsychologists, 24(3), 287–292 Mokkink, L. B., Boers, M., van der Vleuten, C. P. M., Bouter, L. M., Alonso, J., Patrick, D. L., Terwee, C. B. (2020). COSMIN Risk of Bias tool to assess the quality of studies on reliability or measurement error of outcome measurement instruments: a Delphi study. BMC Medical Research Methodology, 20(1), 293 MSc, D. K. M., Robinson, L., & Buschbacher, R. (2015). Buschbacher’s Manual of Nerve Conduction Studies, Third Edition. Demos Medical. Nandedkar, S. D., Barkhaus, P. E., & Stålberg, E. V. (2010). Motor unit number index (MUNIX): principle, method, and findings in healthy subjects and in patients with motor neuron disease. Muscle & Nerve, 42(5), 798–807 Nandedkar, S. D., Barkhaus, P. E., & Stålberg, E. V. (2011). Reproducibility of MUNIX in patients with amyotrophic lateral sclerosis. Muscle & Nerve Nandedkar, S. D., Barkhaus, P. E., Stålberg, E. V., Neuwirth, C., & Weber, M. (2018). Motor unit number index: Guidelines for recording signals and their analysis. Muscle & Nerve, 58(3), 374–380 Neuwirth, C., Barkhaus, P. E., Burkhardt, C., Castro, J., Czell, D., de Carvalho, M., … Weber, M. (2015). Tracking motor neuron loss in a set of six muscles in amyotrophic lateral sclerosis using the Motor Unit Number Index (MUNIX): a 15-month longitudinal multicentre trial. Journal of Neurology, Neurosurgery, and Psychiatry, 86(11), 1172–1179 Neuwirth, C., Barkhaus, P. E., Burkhardt, C., Castro, J., Czell, D., de Carvalho, M., Weber, M. (2017). Motor Unit Number Index (MUNIX) detects motor neuron loss in pre- symptomatic muscles in Amyotrophic Lateral Sclerosis. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 128(3), 495–500 Neuwirth, C., Burkhardt, C., & Weber, M. (2016). Motor unit number index in the nasalis muscle in healthy subjects and patients with amyotrophic lateral sclerosis. Muscle & Nerve, 54(4), 733–737 O’Toole, O., Traynor, B. J., Brennan, P., Sheehan, C., Frost, E., Corr, B., & Hardiman, O. (2008). Epidemiology and clinical features of amyotrophic lateral sclerosis in Ireland between 1995 and 2004. Journal of Neurology, Neurosurgery, and Psychiatry, 79(1), 30–32 Oxford Grice, K., Vogel, K. A., Le, V., Mitchell, A., Muniz, S., & Vollmer, M. A. (2003). Adult norms for a commercially available Nine Hole Peg Test for finger dexterity. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 57(5), 570–573 Preston, D. C., & Shapiro, B. E. (2020). Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic-Ultrasound Correlations. Elsevier Querin, G., Lenglet, T., Debs, R., Stojkovic, T., Behin, A., Salachas, F., … Pradat, P.-F. (2021). Development of new outcome measures for adult SMA type III and IV: a multimodal longitudinal study. Journal of Neurology, 268(5), 1792–1802 Quinn, C., Mcmillan, C. T., Owegi, M. A., Almasy, K., Douthwright, C., Mckenna-Yasek, D., Brown, R. H. (2021). Single breath counting is an effective screening tool for forced vital capacity in ALS. Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration, 22(sup1), 5–8 Ravits, J. M., & La Spada, A. R. (2009). ALS motor phenotype heterogeneity, focality, and spread: deconstructing motor neuron degeneration. Neurology, 73(10), 805–811 Schreuders, T. A. R., Selles, R. W., Roebroeck, M. E., & Stam, H. J. (2006). Strength measurements of the intrinsic hand muscles: a review of the development and evaluation of the Rotterdam intrinsic hand myometer. Journal of Hand Therapy: Official Journal of the American Society of Hand Therapists, 19(4), 393–401 Shefner, J. M., Al-Chalabi, A., Baker, M. R., Cui, L.-Y., de Carvalho, M., Eisen, A., … Kiernan, M. C. (2020). A proposal for new diagnostic criteria for ALS. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 131(8), 1975–1978 Shefner, J. M., & Gooch, C. L. (2003). Motor unit number estimation. Physical Medicine and Rehabilitation Clinics of North America, 14(2), 243–260 Swaine, B. R., Desrosiers, J., Bourbonnais, D., & Larochelle, J.-L. (2005). Norms for 15- to 34-year-olds for different versions of the finger-to-nose test. Archives of Physical Medicine and Rehabilitation, 86(8), 1665–1669 van Es, M. A., Hardiman, O., Chio, A., Al-Chalabi, A., Pasterkamp, R. J., Veldink, J. H., & van den Berg, L. H. (2017). Amyotrophic lateral sclerosis. The Lancet, 390(10107), 2084– 2098 Verma, S., Forte, J., Ritchey, M., & Shah, D. (2020). Motor unit number index in children with later-onset spinal muscular atrophy. Muscle & Nerve, 62(5), 633–637 Vucic, S., Kiernan, M. C., Menon, P., Huynh, W., Rynders, A., Ho, K. S., Hotchkin, M. T. (2021). Study protocol of RESCUE-ALS: A Phase 2, randomized, double-blind, placebo- controlled study in early symptomatic amyotrophic lateral sclerosis patients to assess bioenergetic analysis with CNM-A8 as a mechanism to slow disease progression. BMJ Open, 11(1), e041479. Vucic, S., & Rutkove, S. B. (2018). Neurophysiological biomarkers in amyotrophic lateral sclerosis. Current Opinion in Neurology, 31(5), 640–647 Zhang, S., Yang, X., Xu, Y., Luo, Y., Fan, D., & Liu, X. (2021). Application Value of the Motor Unit Number Index in Patients With Kennedy Disease. Frontiers in Neurology, 12, 705816 |
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Bogotá - Colombia |
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Universidad Nacional de Colombia |
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Bogotá - Medicina - Especialidad en Medicina Física y Rehabilitación |
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Facultad de Medicina |
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Bogotá - Colombia |
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Universidad Nacional de Colombia - Sede Bogotá |
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Universidad Nacional de Colombia |
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https://repositorio.unal.edu.co/bitstream/unal/83116/1/license.txt https://repositorio.unal.edu.co/bitstream/unal/83116/3/U.FT.09.006.004%20Licencia%20para%20publicaci%c3%b3n%20de%20obras%20en%20el%20Repositorio%20Institucion.pdf https://repositorio.unal.edu.co/bitstream/unal/83116/2/1016022097.2022.pdf https://repositorio.unal.edu.co/bitstream/unal/83116/4/1016022097.2022.pdf.jpg |
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Repositorio Institucional Universidad Nacional de Colombia |
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Atribución-NoComercial-SinDerivadas 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Ortiz Corredor, Fernandodd9170f7d7c356c2ce1438bdff6a9d1dGómez Gil, Jully Carolina37c7987fefc3733e32bc52213e7f9ff7Rojas Beltrán, Cristhian Daviddb67d9ab94022d309367aaa075ed35d0Cifel Centro de Investigación en Fisiatría y ElectrodiagnósticoMendoza Pulido, juan CamiloGómez Gil, Jully Carolina [0000-0001-8742-2502]Gómez Gil, Jully Carolina [0001781420]2023-01-25T16:26:52Z2023-01-25T16:26:52Z2022-12-07https://repositorio.unal.edu.co/handle/unal/83116Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/Introducción: El MUNIX es una herramienta electrofisiológica para hacer una estimación cuantitativa de las unidades motoras. Se ha utilizado en la caracterización y seguimiento de pacientes con enfermedades motoneuronales y no se ha descrito en la literatura la asociación entre el MUNIX de músculos de la mano y pruebas funcionales de destreza manual, escala ALSFRS-R y niveles de dependencia funcional en pacientes con ELA. Objetivo: Establecer la relación entre el número de unidades motoras calculadas con el MUNIX y la función manual de los pacientes con ELA. Metodología: Estudio descriptivo, corte transversal, con recolección prospectiva de datos. Se realizaron dos tomas por cada músculo (APB, ADM y FDI) no consecutivas por el mismo evaluador siguiendo el protocolo actualizado de registro de MUNIX. Se establece nivel funcional de los pacientes según escala ALSFRS-R, índice de progresión, clasificación ALS-MITOS y Ortiz et al. Se hicieron pruebas funcionales de destreza manual el mismo día de realización. Se estableció un coeficiente de correlación intraclase entre las tomas de cada músculo. Para el análisis se realizó un promedio de los datos según las categorías de nivel funcionales. La correlación de variables se realizó por coeficiente de correlación tau (τ) de Kendall de acuerdo con el tipo de distribución. Resultados: Se obtuvo 81 registros de pacientes diagnosticados con ELA según criterios Gold Coast, 64% fueron hombres, con un promedio de edad de 59 años, tiempo promedio de evolución de la enfermedad de 31.7 meses, promedio de MUNIX de APB de 59.2, ADM de 73.0 y FDI de 96.0. Los dos registros de MUNIX por cada músculo demostraron un ICC de >0.95. Se encontraron correlaciones estadísticamente significativas entre los valores MUNIX y las pruebas funcionales (τ>0.4, p<0.001), así como diferencias entre los grupos funcionales. Discusión: Se encontró diferencias estadísticamente significativas entre MUNIX de los tres músculos de la mano y el fenotipo de inicio cervical, pruebas de caja y cubos, prueba de giro de la moneda, prueba de nueve hoyos y clavijas, dinamometría manual, escala ALSFRS-R con puntaje total y específico de ítems de destreza manual. Conclusiones: El MUNIX en músculos de la mano se correlaciona con pruebas y clasificación funcional de pacientes con ELA, específicamente para los que tienen compromiso cervical. (Texto tomado de la fuente)Introduction: MUNIX is part of quantitative techniques to estimate motor units. It has been used in the characterization and monitoring of patients with motor neuron diseases and there is no information about hand muscles MUNIX and manual dexterity test, ALSFRS-R scale and ALS functional levels. Objective: Establish the relationship between the number of motor units by MUNIX and the manual function of ALS patients. Methodology: Descriptive, cross-sectional study, with prospective data collection. Two non-consecutive measurements were taken for each muscle (APB, ADM and FDI) by the same evaluator following the updated MUNIX protocol. The functional level was recorded by ALSFRS-R scale, progression index, ALS-MITOS classification, and Ortiz et al. Functional manual dexterity tests were performed the same day. An intraclass correlation coefficient was established between the MUNIX of each muscle. An average data was made according to the functional level categories. Variable correlation was performed using Kendall's tau (τ) correlation coefficient according to the distribution. Results: 81 patients diagnosed with ALS according to Gold Coast criteria were obtained, 64% were men, with an average age of 59 years, average time of disease evolution was 31.7 months, MUNIX average APB of 59.2, ADM of 73.0 and FDI of 96.0. The two MUNIX recordings per muscle area demonstrated an ICC of >0.95. Statistically significant correlations were found between the MUNIX values and the functional tests (τ>0.4, p<0.001), as well as differences between the different functional groups. Discussion: Statistically significant differences were found between MUNIX of the three hand muscles and the cervical onset phenotype, box and cube tests, coin toss test, nine- hole peg test, manual dynamometry, ALSFRS-R scale total score and specific manual dexterity items. Conclusions: Hand muscles MUNIX correlates with tests and functional classification of patients with ALS, specifically for those with cervical involvement.NingunoEspecialidades MédicasEspecialista en Medicina Física y RehabilitaciónSe trata de un estudio descriptivo, tipo corte transversal, con recolección prospectiva de datos, que se llevará a cabo en el servicio de Electrofisiología del Instituto Roosevelt, teniendo como población objetivo mayores de 18 años con diagnóstico de ELA. Se realizó muestreo por conveniencia. Durante el desarrollo de este trabajo se tuvo en cuenta la herramienta COSMIN para evaluar la validez del MUNIX en pacientes con ELA (Mokkink et al., 2020).Enfermedades de la neurona motoraEnfermedades NeuromuscularesElectrodiagnóstico Adultos87 páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Especialidad en Medicina Física y RehabilitaciónFacultad de MedicinaBogotá - ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud::616 - Enfermedades610 - Medicina y salud::612 - Fisiología humanaEsclerosis lateral amiotróficaRecopilación de datosAmyotrophic lateral sclerosisData collectingMUNIXALSFRS-RALSmanual dexteritydata correlationELAdestreza manualcorrelación de datosRelación entre el índice de unidades motoras (MUNIX) y la función manual en pacientes con Esclerosis Lateral Amiotrófica (ELA) en un hospital de BogotáRelationship between motor unit index (MUNIX) and manual function amyotrophic lateral sclerosis (ALS) patients at a hospital in BogotáTrabajo de grado - Especialidad Médicainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TMBogotá - ColombiaAgosta, F., Al-Chalabi, A., Filippi, M., Hardiman, O., Kaji, R., Meininger, V., WFN Research Group on ALS/MND. (2015). The El Escorial criteria: strengths and weaknesses. Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration, 16(1-2), 1–7Ahn, S. W., Kim, S. H., Kim, J. E., Kim, S. M., Kim, S. H., Park, K. S., Sung, J. J., Lee, K. W., & Hong, Y. H. (2010). Reproducibility of the motor unit number index (MUNIX) in normal controls and amyotrophic lateral sclerosis patients. Muscle & nerve, 42(5), 808–813Alix, J. J. P., Neuwirth, C., Gelder, L., Burkhardt, C., Castro, J., de Carvalho, M., Weber, M. (2019). Assessment of the reliability of the motor unit size index (MUSIX) in single subject ‘round-robin’ and multi-centre settings. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 130(5), 666–674Arasaki, K., Tamaki, M., Hosoya, Y., & Kudo, N. (1997). Validity of electromyograms and tension as a means of motor unit number estimation. Muscle & NerveBoekestein, W. A., Schelhaas, H. J., van Putten, M. J. A. M., Stegeman, D. F., Zwarts, M. J., & van Dijk, J. P. (2012). Motor unit number index (MUNIX) versus motor unit number estimation (MUNE): a direct comparison in a longitudinal study of ALS patients. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 123(8), 1644–1649Bostock, H. (2016). Estimating motor unit numbers from a CMAP scan. Muscle & Nerve, 53(6), 889–896Bostock, H., Jacobsen, A. B., & Tankisi, H. (2019). Motor unit number index and compound muscle action potential amplitude. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 130(9), 1734–1740Boulay, C., Delmont, E., Audic, F., Chabrol, B., & Attarian, S. (2021). Motor unit number index: A potential electrophysiological biomarker for pediatric spinal muscular atrophy. Muscle & Nerve, 64(4), 445–453Bromberg, M. B. (2004). Motor unit number estimation: new techniques and new uses. Supplements to Clinical Neurophysiology, 57, 120–136Bromberg, M. B. (2007). Updating motor unit number estimation (MUNE). Clinical Neurophysiology. Bromberg, M. B., & Brownell, A. A. (2008). Motor unit number estimation in the assessment of performance and function in motor neuron disease. Physical Medicine and Rehabilitation Clinics of North America, 19(3), 509–32, ixBrooks, B. R., Miller, R. G., Swash, M., Munsat, T. L., & World Federation of Neurology Research Group on Motor Neuron Diseases. (2000). El Escorial revisited: revised criteria for the diagnosis of amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders: Official Publication of the World Federation of Neurology, Research Group on Motor Neuron Diseases, 1(5), 293–299Campos, T. S., Rodríguez-Santos, F., Esteban, J., Vázquez, P. C., Mora Pardina, J. S., & Carmona, A. C. (2010). Spanish adaptation of the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R). Amyotrophic Lateral Sclerosis: Official Publication of the World Federation of Neurology Research Group on Motor Neuron Diseases, 11(5), 475–477Chan, Y., Alix, J. J. P., Neuwirth, C., Barkhaus, P. E., Castro, J., Jenkins, T. M., Weber, M. (2021). Reinnervation as measured by the motor unit size index is associated with preservation of muscle strength in amyotrophic lateral sclerosis, but not all muscles reinnervate. Muscle & NerveCao, B., Gu, X., Zhang, L., Hou, Y., Chen, Y., Wei, Q., Shang, H. (2020). Reference values for the motor unit number index and the motor unit size index in five muscles. Muscle & Nerve, 61(5), 657–661Cheah, B. C., Vucic, S., Krishnan, A. V., Boland, R. A., & Kiernan, M. C. (2011). Neurophysiological index as a biomarker for ALS progression: validity of mixed effects models. Amyotrophic Lateral Sclerosis: Official Publication of the World Federation of Neurology Research Group on Motor Neuron Diseases, 12(1), 33–38Chiò, A., Hammond, E. R., Mora, G., Bonito, V., & Filippini, G. (2015). Development and evaluation of a clinical staging system for amyotrophic lateral sclerosis. Journal of Neurology, Neurosurgery, and Psychiatry, 86(1), 38–44CMAP scan discontinuities: Automated detection and relation to motor unit loss. (2014). Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 125(2), 388–395Czell, D., Neuwirth, C., Weber, M., Sartoretti-Schefer, S., Gutzeit, A., & Reischauer, C. (2019). Nine Hole Peg Test and Transcranial Magnetic Stimulation: Useful to Evaluate Dexterity of the Hand and Disease Progression in Amyotrophic Lateral Sclerosis. Neurology research international, 2019, 7397491de Carvalho, M., Barkhaus, P. E., Nandedkar, S. D., & Swash, M. (2018). Motor unit number estimation (MUNE): Where are we now? Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 129(8), 1507–1516Diaz-Gomez, M. F., & Ortiz-Corredor, F. (2017). [Design and validation of a classification system for assessing the degree of disability of patients with amyotrophic lateral sclerosis]. Revista de neurologia, 64(3), 112–118Dimitriadis, Z., Kapreli, E., Strimpakos, N., & Oldham, J. (2015). Reliability of the chin tuck neck flexion test for assessing endurance of short neck flexors in healthy individuals. Physiotherapy Theory and Practice, 31(4), 299–302Escorcio-Bezerra, M. L., Abrahao, A., de Castro, I., Chieia, M. A. T., de Azevedo, L. A., Pinheiro, D. S, Manzano, G. M. (2016). MUNIX: Reproducibility and clinical correlations in Amyotrophic Lateral Sclerosis. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 127(9), 2979–2984Escorcio-Bezerra, M. L., Abrahao, A., Nunes, K. F., De Oliveira Braga, N. I., Oliveira, A. S. B., Zinman, L., & Manzano, G. M. (2018). Motor unit number index and neurophysiological index as candidate biomarkers of presymptomatic motor neuron loss in amyotrophic lateral sclerosis. Muscle & Nerve, 58(2), 204–212Escorcio-Bezerra, M. L., Abrahao, A., Santos-Neto, D., de Oliveira Braga, N. I., Oliveira, A. S. B., & Manzano, G. M. (2017). Why averaging multiple MUNIX measures in the longitudinal assessment of patients with ALS? Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 128(12), 2392–2396Escorcio-Bezerra, M. L., Oliveira, A. S. B., De Oliveira Braga, N. I., & Manzano, G. M. (2017). Improving the reproducibility of motor unit number index. Muscle & Nerve, 55(5), 635–638Fatehi, F., Grapperon, A.-M., Fathi, D., Delmont, E., & Attarian, S. (2018). The utility of motor unit number index: A systematic review. Neurophysiologie Clinique = Clinical Neurophysiology, 48(5), 251–259Fathi, D., Mohammadi, B., Dengler, R., Böselt, S., Petri, S., & Kollewe, K. (2016). Lower motor neuron involvement in ALS assessed by motor unit number index (MUNIX): Long- term changes and reproducibility. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 127(4), 1984–1988Gawel, M., & Kuzma-Kozakiewicz, M. (2016). Does the MUNIX Method Reflect Clinical Dysfunction in Amyotrophic Lateral Sclerosis: A Practical Experience. Medicine, 95(19), e3647Geevasinga, N., Menon, P., Scherman, D. B., Simon, N., Yiannikas, C., Henderson, R. D. Vucic, S. (2016). Diagnostic criteria in amyotrophic lateral sclerosis: A multicenter prospective study. Neurology, 87(7), 684–690Gooch, C. L., Doherty, T. J., Chan, K. M., Bromberg, M. B., Lewis, R. A., Stashuk, D. W. Daube, J. R. (2014). Motor unit number estimation: a technology and literature review. Muscle & Nerve, 50(6), 884–893Henderson, R. D., & McCombe, P. A. (2017). Assessment of Motor Units in Neuromuscular Disease. Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics, 14(1), 69–77Higashihara, M., Menon, P., van den Bos, M., Geevasinga, N., & Vucic, S. (2018). Reproducibility of motor unit number index and multiple point stimulation motor unit number estimation in controls. Muscle & Nerve, 58(5), 660–664Howard, I. M., & Rad, N. (2018). Electrodiagnostic testing for the diagnosis and management of amyotrophic lateral sclerosis. Physical Medicine and Rehabilitation Clinics of North America, 29(4), 669–680Huisman, M. H. B., de Jong, S. W., van Doormaal, P. T. C., Weinreich, S. S., Schelhaas, H. J., van der Kooi, A. J., van den Berg, L. H. (2011). Population based epidemiology of amyotrophic lateral sclerosis using capture-recapture methodology. Journal of Neurology, Neurosurgery, and Psychiatry, 82(10), 1165–1170Jacobsen, A. B., Kristensen, R. S., Witt, A., Kristensen, A. G., Duez, L., Beniczky, S., … Tankisi, H. (2018). The utility of motor unit number estimation methods versus quantitative motor unit potential analysis in diagnosis of ALS. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 129(3), 646–653Jarmusch, S., Baber, L., Bidlingmaier, M., Ferrari, U., Hofmeister, F., Hintze, S., Drey, M. (2021). Influence of IGF-I serum concentration on muscular regeneration capacity in patients with sarcopenia. BMC Musculoskeletal Disorders, 22(1), 807Jenkins, T. M., Alix, J. J. P., Fingret, J., Esmail, T., Hoggard, N., Baster, K., McDermott, C. J., Wilkinson, I. D., & Shaw, P. J. (2020). Longitudinal multi-modal muscle-based biomarker assessment in motor neuron disease. Journal of neurology, 267(1), 244–256Karpati, G. (2010). Disorders of Voluntary Muscle. Cambridge University PressKaya, R. D., Nakazawa, M., Hoffman, R. L., & Clark, B. C. (2013). Interrelationship between muscle strength, motor units, and aging. Experimental Gerontology, 48(9), 920–925Labra, J., Menon, P., Byth, K., Morrison, S., & Vucic, S. (2016). Rate of disease progression: a prognostic biomarker in ALS. Journal of Neurology, Neurosurgery & PsychiatryLi, X., He, W., Li, C., Wang, Y.-C., Slavens, B. A., & Zhou, P. (2015). Motor unit number index examination in dominant and non-dominant hand muscles. Laterality, 20(6), 699– 710Logroscino, G., Traynor, B. J., Hardiman, O., Chiò, A., Mitchell, D., Swingler, R. J., EURALS. (2010). Incidence of amyotrophic lateral sclerosis in Europe. Journal of Neurology, Neurosurgery, and Psychiatry, 81(4), 385–390Ludolph, A., Drory, V., Hardiman, O., Nakano, I., Ravits, J., Robberecht, W., WFN Research Group On ALS/MND. (2015). A revision of the El Escorial criteria - 2015. Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration, 16(5-6), 291–292Mathiowetz, V., Volland, G., Kashman, N., & Weber, K. (1985). Adult norms for the Box and Block Test of manual dexterity. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 39(6), 386–391Mendoza, J. E., Apostolos, G. T., Humphreys, J. D., Hanna-Pladdy, B., & O’Bryant, S. E. (2009). Coin rotation task (CRT): a new test of motor dexterity. Archives of Clinical Neuropsychology: The Official Journal of the National Academy of Neuropsychologists, 24(3), 287–292Mokkink, L. B., Boers, M., van der Vleuten, C. P. M., Bouter, L. M., Alonso, J., Patrick, D. L., Terwee, C. B. (2020). COSMIN Risk of Bias tool to assess the quality of studies on reliability or measurement error of outcome measurement instruments: a Delphi study. BMC Medical Research Methodology, 20(1), 293MSc, D. K. M., Robinson, L., & Buschbacher, R. (2015). Buschbacher’s Manual of Nerve Conduction Studies, Third Edition. Demos Medical.Nandedkar, S. D., Barkhaus, P. E., & Stålberg, E. V. (2010). Motor unit number index (MUNIX): principle, method, and findings in healthy subjects and in patients with motor neuron disease. Muscle & Nerve, 42(5), 798–807Nandedkar, S. D., Barkhaus, P. E., & Stålberg, E. V. (2011). Reproducibility of MUNIX in patients with amyotrophic lateral sclerosis. Muscle & NerveNandedkar, S. D., Barkhaus, P. E., Stålberg, E. V., Neuwirth, C., & Weber, M. (2018). Motor unit number index: Guidelines for recording signals and their analysis. Muscle & Nerve, 58(3), 374–380Neuwirth, C., Barkhaus, P. E., Burkhardt, C., Castro, J., Czell, D., de Carvalho, M., … Weber, M. (2015). Tracking motor neuron loss in a set of six muscles in amyotrophic lateral sclerosis using the Motor Unit Number Index (MUNIX): a 15-month longitudinal multicentre trial. Journal of Neurology, Neurosurgery, and Psychiatry, 86(11), 1172–1179Neuwirth, C., Barkhaus, P. E., Burkhardt, C., Castro, J., Czell, D., de Carvalho, M., Weber, M. (2017). Motor Unit Number Index (MUNIX) detects motor neuron loss in pre- symptomatic muscles in Amyotrophic Lateral Sclerosis. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 128(3), 495–500Neuwirth, C., Burkhardt, C., & Weber, M. (2016). Motor unit number index in the nasalis muscle in healthy subjects and patients with amyotrophic lateral sclerosis. Muscle & Nerve, 54(4), 733–737O’Toole, O., Traynor, B. J., Brennan, P., Sheehan, C., Frost, E., Corr, B., & Hardiman, O. (2008). Epidemiology and clinical features of amyotrophic lateral sclerosis in Ireland between 1995 and 2004. Journal of Neurology, Neurosurgery, and Psychiatry, 79(1), 30–32Oxford Grice, K., Vogel, K. A., Le, V., Mitchell, A., Muniz, S., & Vollmer, M. A. (2003). Adult norms for a commercially available Nine Hole Peg Test for finger dexterity. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 57(5), 570–573Preston, D. C., & Shapiro, B. E. (2020). Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic-Ultrasound Correlations. ElsevierQuerin, G., Lenglet, T., Debs, R., Stojkovic, T., Behin, A., Salachas, F., … Pradat, P.-F. (2021). Development of new outcome measures for adult SMA type III and IV: a multimodal longitudinal study. Journal of Neurology, 268(5), 1792–1802Quinn, C., Mcmillan, C. T., Owegi, M. A., Almasy, K., Douthwright, C., Mckenna-Yasek, D., Brown, R. H. (2021). Single breath counting is an effective screening tool for forced vital capacity in ALS. Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration, 22(sup1), 5–8Ravits, J. M., & La Spada, A. R. (2009). ALS motor phenotype heterogeneity, focality, and spread: deconstructing motor neuron degeneration. Neurology, 73(10), 805–811Schreuders, T. A. R., Selles, R. W., Roebroeck, M. E., & Stam, H. J. (2006). Strength measurements of the intrinsic hand muscles: a review of the development and evaluation of the Rotterdam intrinsic hand myometer. Journal of Hand Therapy: Official Journal of the American Society of Hand Therapists, 19(4), 393–401Shefner, J. M., Al-Chalabi, A., Baker, M. R., Cui, L.-Y., de Carvalho, M., Eisen, A., … Kiernan, M. C. (2020). A proposal for new diagnostic criteria for ALS. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 131(8), 1975–1978Shefner, J. M., & Gooch, C. L. (2003). Motor unit number estimation. Physical Medicine and Rehabilitation Clinics of North America, 14(2), 243–260Swaine, B. R., Desrosiers, J., Bourbonnais, D., & Larochelle, J.-L. (2005). Norms for 15- to 34-year-olds for different versions of the finger-to-nose test. Archives of Physical Medicine and Rehabilitation, 86(8), 1665–1669van Es, M. A., Hardiman, O., Chio, A., Al-Chalabi, A., Pasterkamp, R. J., Veldink, J. H., & van den Berg, L. H. (2017). Amyotrophic lateral sclerosis. The Lancet, 390(10107), 2084– 2098Verma, S., Forte, J., Ritchey, M., & Shah, D. (2020). Motor unit number index in children with later-onset spinal muscular atrophy. Muscle & Nerve, 62(5), 633–637Vucic, S., Kiernan, M. C., Menon, P., Huynh, W., Rynders, A., Ho, K. S., Hotchkin, M. T. (2021). Study protocol of RESCUE-ALS: A Phase 2, randomized, double-blind, placebo- controlled study in early symptomatic amyotrophic lateral sclerosis patients to assess bioenergetic analysis with CNM-A8 as a mechanism to slow disease progression. BMJ Open, 11(1), e041479.Vucic, S., & Rutkove, S. B. (2018). Neurophysiological biomarkers in amyotrophic lateral sclerosis. Current Opinion in Neurology, 31(5), 640–647Zhang, S., Yang, X., Xu, Y., Luo, Y., Fan, D., & Liu, X. (2021). Application Value of the Motor Unit Number Index in Patients With Kennedy Disease. Frontiers in Neurology, 12, 705816Relación entre el índice de unidades motoras (MUNIX) y la función manual en pacientes con Esclerosis Lateral Amiotrófica (ELA) en un hospital de BogotáNingunoEstudiantesInvestigadoresMaestrosLICENSElicense.txtlicense.txttext/plain; charset=utf-85879https://repositorio.unal.edu.co/bitstream/unal/83116/1/license.txteb34b1cf90b7e1103fc9dfd26be24b4aMD51U.FT.09.006.004 Licencia para publicación de obras en el Repositorio Institucion.pdfU.FT.09.006.004 Licencia para publicación de obras en el Repositorio Institucion.pdfapplication/pdf340595https://repositorio.unal.edu.co/bitstream/unal/83116/3/U.FT.09.006.004%20Licencia%20para%20publicaci%c3%b3n%20de%20obras%20en%20el%20Repositorio%20Institucion.pdfb1c2918071c7edf869f9d67dc99e3642MD53ORIGINAL1016022097.2022.pdf1016022097.2022.pdfTrabajo de grado en Especialista en Medicina Física y 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