MCCCD Program Description

Applied Evoked Potentials and Nerve Conduction Studies

Course: EEG205

First Term: 2012 Spring

Lecture 1 Credit(s) 1 Period(s) 1 Load
Subject Type: Occupational
Load Formula: S

Description: Theoretical and practical aspects of Evoked Potentials (EP), mainly Visual Evoked Response (VER), Brain Auditory Evoked Response (BAER), and Somatosensory Evoked Potential (SSEP) tests. EP instrumentation, recording techniques and data analysis of electrical activity of the nervous system elicited by using selected physical stimuli (evoked potentials) and concepts of signal averaging, (in accordance with the most recent American Clinical Neurophysiology Society (ACNS) guidelines on Evoked Potentials.)

MCCCD Official Course Competencies
1. Describe the origin of Evoked Potentials (EP). (I) 2. Establish clinical applications of EP. (I) 3. Describe recording parameters for intraoperative monitoring of Evoked Potentials, including upper and lower SSEP`s and BAER`s. (I, II, III, V, VI) 4. Identify the EP System (equipment). (II) 5. Diagram the concept of signal averaging and Signal to Noise ratio. (II) 6. Identify and describe the EP Amplifier, including analog to digital (A/D) Conversion, Common Mode Rejection (CMMR), Instrument Calibration, and electrode Impedance. (II) 7. Define EP concepts such as Sampling Rate, Analysis Time, Dwell Time. (II) 8. Describe Instrument maintenance / Patient Safety. (II) 9. Demonstrate accurate head measurement specific to each EP modality (i.e., Queen Square Placement for VER Accurate placement of electrodes over recording/ stimulation sites). (II) 10. Describe the anatomy and location of the EP waveforms generators in the central and peripheral nervous system (sensory pathway). (II) 11. Describe the various stimuli used in these EP tests: BAER, VER, and SSEP. (II) 12. Demonstrate adequate communication skills when preparing patient for test and acquiring relevant medical history according to the EP modality performed. (II, IV) 13. Describe Recording Parameters for each EP modality and variations. (III) 14. Plot Montage for each EP modality in accordance to EP Polarity convention. (III) 15. Obtain reproducible waveforms for each EP modality. (III) 16. Identify commonly encountered sources of artifacts and possible means of their rejection from data used for analysis (troubleshooting unclear responses). (III) 17. Demonstrate simultaneous recording of multiple SSEP sites for intraoperative monitoring of Evoked Potentials. (III, IV, V, VI) 18. Demonstrate ability to interpret testing data, trouble shoot and communicate findings to surgical staff during data acquisition. (III, IV, V, VI) 19. Demonstrate clean up of patient and equipment after test. (IV) 20. Identify and label obligate peaks for each EP modality by amplitude and latency-inter-side differences. (IV) 21. Demonstrate recording of all pertinent data including EP findings on technical worksheet, comparing with normative data. (IV) 22. Describe common surgical procedures that would warrant EP monitoring. (V) 23. Describe appropriate handling of surgery patient, and effective communication skills with surgery team. (V) 24. Identify anesthetic agents and effect on EP waveforms. (V) 25. Describe the origin of Nerve Conduction Velocity (NCV) Studies. (VII) 26. Establish clinical applications of NCV Studies (VII) 27. Describe Recording Parameters for each NCV modality performed. (VII, VIII) 28. Demonstrate adequate communication skills when preparing patient for testing and acquiring relevant medical history according to the NCV modality performed. (VII, VIII, IX) 29. Demonstrate accurate placement of electrodes and stimulators for NCV Studies of the arms and legs. (VIII, IX)
MCCCD Official Course Competencies must be coordinated with the content outline so that each major point in the outline serves one or more competencies. MCCCD faculty retains authority in determining the pedagogical approach, methodology, content sequencing, and assessment metrics for student work. Please see individual course syllabi for additional information, including specific course requirements.

MCCCD Official Course Outline
I. EP Origin, History, and Relationship of Specific EP Tests to Diseases A. BAER 1. Hearing function in infants 2. Childhood autism 3. Multiple sclerosis 4. Acoustic neurinoma 5. Trigeminal neuralgia B. SSEP 1. Multiple sclerosis 2. Peripheral neuropathies 3. Charcot-Marie Tooth C. VER 1. Retinal degeneration 2. Retrobulbar neuritis 3. Multiple sclerosis 4. Malingering 5. Hysterical blindness 6. Cortical blindness II. Fundamentals of EP Instrumentation and Essential concepts of EP data collection A. Signal averaging 1. Single response size 2. Control of trigger timing 3. Selection of signal of interest 4. Repetition of trigger (stimulus) B. Signal to noise (S/N) ratio 1. S/N ratio 2. Selected sources of noise a. Preamplifiers b. Atmospheric c. Muscle d. EEG C. Common mode rejection 1. Recognition of wave frequencies 2. Selection with instrumentation D. Artifact Reject 1. On/Off 2. Percent of rejection E. Accurate identification of EP recording sites 1. Near Field Potentials 2. Far Field Potentials 3. Stationary response 4. Propagated response F. Stimulus Site for EP testing 1. Modality and intensity 2. Characteristics of stimulus onset 3. Stimulus influence on size and morphology of EP a. Intensity b. Location c. Quality G. Specific stimulus type 1. BAER testing a. Earphones b. Clicks 2. VER testing a. Light source b. Screens and goggles 3. SSEP testing a. Vibration b. Light electrical shock III. Recording Parameters for EP testing A. Analysis Time 1. Msec per division 2. Msec Full Screen B. Sensitivity C. Frequency Bandwidth 1. High Frequency Filter 2. Low Frequency Filter D. Montage selection for each EP modality according to Polarity Convention 1. Calibration 2. Bipolar 3. Referential 4. Common EP artifacts identification/ troubleshooting a. Stimulus artifact b. 60 Hz noise c. Muscle potentials d. Skin potentials e. Non cerebral potentials f. EEG IV. BAER, VER, and SSEP testing demonstrations A. Preparation of equipment B. Explanation of procedure to patient C. Patient History taking relevant to EP 1. Previous EP test findings 2. Previous NCV findings 3. Audiology test results 4. Visual symptoms D. Preparation of patient 1. Head measurement / Queen Square Placement 2. Electrode Application E. Conduct supervised testing F. Waveform identification 1. Morphology 2. Latency G. Label obligate peaks / measurements H. Clean up patient, area and equipment after testing I. Preparation and presentation of data on technical worksheet 1. Use of normative data J. Clean up patient, area, and equipment after testing V. Surgical Applications A. Hostile Environment B. Communication C. Sterile Field D. Common Anesthetic Agents E. Surgical Procedures F. Appropriate Monitoring G. Documentation VI. Intraoperative Hands on Demonstration of Intraoperative Monitoring Procedures A. Electrode application for both upper and lower SSEP`s for simultaneous monitoring in the operating room (OR) environment B. Electrode application for BAER in the OR environment C. Communication and troubleshooting of findings of testing to surgical team VII. Fundamentals of Nerve Conduction Velocity Studies Instrumentation and Essential Concepts of NCV Data Collection A. Signal averaging 1. Single response size 2. Control of trigger timing 3. Selection of signal of interest 4. Repetition of trigger (stimulus) B. Signal to noise (S/N) ratio 1. S/N ratio 2. Selected sources of noise a. Preamplifiers b. Atmospheric c. Muscle VIII. Stimulus Site for NCV Testing A. Modality and intensity B. Characteristics of stimulus onset C. Stimulus influence on size and morphology of NCV 1. Intensity 2. Location 3. Quality D. Performance of supervised testing E. Waveform identification 1. Morphology 2. Latency F. Label obligate peaks / measurements G. Clean up of patient, area and equipment after testing H. Preparation and presentation of data on technical worksheet 1. Use of normative data IX. NCV Testing Demonstrations A. Preparation of equipment B. Explanation of procedure to patient C. Patient History taking relevant to NCV

MCCCD Governing Board Approval Date: 10/25/2011

All information published is subject to change without notice. Every effort has been made to ensure the accuracy of information presented, but based on the dynamic nature of the curricular process, course and program information is subject to change in order to reflect the most current information available.