Concepts of Normality and Abnormality in Clinical Neurophysiology Effects of Age and Systemic Disease

Details

Title

Concepts of Normality and Abnormality in Clinical Neurophysiology Effects of Age and Systemic Disease

Type

Stage One

Module code

HPS216

Requirement

Compulsory

Module objective

By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, critically evaluate and apply knowledge of the effects of age, biological variation and systemic disease to underpin specialist Consultant Clinical Scientist practice and be competent in the application of this knowledge. They should also consistently demonstrate the attitudes and behaviours necessary for undertaking the role of a Consultant Clinical Scientist.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will analyse, synthesise, critically evaluate and apply their knowledge with respect to the:

Statistical concepts of normality and abnormality:

• adequate sample sizes of normal data for neurophysiological investigations;
• parametric and non-parametric methods of analysis;
• sensitivity, specificity, positive predictive value and receiver operator functions.

Effects of age on the brain and nervous system:

• pathophysiology of the effects of prematurity;
• key stages of neuro‐development, including the newborn period, the first year of life, nursery age, school entry and late primary education;
• the impact of developmental disorders on the life of child and family at different developmental stages;
• normal brain ageing, including the effect of brain size, vasculature and cognition;
• factors that impact positively and negatively on the ageing brain;
• the effect of age on symptom reporting;
• the effect of age on normality and abnormality in clinical neurophysiology;
• pathophysiology, clinical presentation and management of developmental disorders and impaired cognition.

Neuroanatomy:

• embryological basis of brain nomenclature and the development of the brain and nervous system;
• anatomy of peripheral nerves;
• the major subdivisions of the central and peripheral nervous systems;
• fibre tracts and nuclei;
• cortical subdivision and function;
• visual, sensory, auditory and motor pathways;
• basal ganglia;
• cerebellum;
• autonomic nervous system;
• vascular supply to the brain;
• maturation of the nervous system.

Neurophysiology:

• nerve conduction from ion channel function to the massed responses of nerve trunks, fibre tracts and nuclei;
• synaptic function (inhibitory and excitatory) and the neuromuscular junction;
• different motor unit types; motor control and the cerebellum;
• visual, auditory and somatosensory physiology from receptor to cortex;
• biophysics of nerve stimulation (electrical and magnetic) and recording.

Neuropharmacology:

• central nervous system neurotransmitters and drugs that modulate them;
• mode of action of drugs affecting the central and peripheral nervous systems.

Neuropathology:

• reactions of peripheral and central nervous systems to disease, including tumours, infections, inflammation, infarction and immune-mediated mechanisms;
• demyelination and degeneration in the central nervous system;
• pathophysiology of epilepsy; mechanisms of excessive or hypersynchronous neural activity and of the generalised corticoreticular epilepsies;
• demyelination, degeneration and regeneration in the peripheral nervous system;
• effect of pathology on nerve conduction, particularly axonal degeneration and demyelination; how these two basic types of neuropathic abnormalities may be differentiated, and how they may overlap and inter-relate;
• changes in nerve conduction and needle electromyography (EMG) in neuropathic and myopathic conditions;
• temporal evolution of EMG and nerve conduction findings after complete and partial nerve injury;
• different patterns of neuropathies and the ways in which peripheral neuropathies may present: diffuse sensorimotor, predominantly sensory, predominantly motor (with conduction block), multifocal;
• patterns and distribution of myopathic disorders;
• pre- and post-synaptic defects of neuromuscular transmission.

Normality and abnormality in clinical neurophysiology:

• the importance of age in all normative studies;
• how to record age in infants;
• how to record age in paediatric populations and the use of months or years;
• the impact of gender in normative studies;
• the impact of the clinical condition, physical findings, patient behaviour, drug treatment, changes to standard protocols and body temperature;
• technical data;
• reporting normal results;
• reporting abnormal results;pre- and post-synaptic defects of neuromuscular transmission.
• interpretation of clinical neurophysiology investigations.

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply knowledge in practice to a range of clinical and communication skills to appropriately interpret the variance in clinical measures resulting from typical and atypical neurodevelopment during the production of supervised clinical reports.