Back Module: S-N-S1

Nerve Conduction Studies & Evoked Potentials 1

Module information

Module details

Title
Nerve Conduction Studies & Evoked Potentials 1
Type
Specialist
Module code
S-N-S1
Credits
10
Phase
2
Requirement
Compulsory

Aim of this module

This module will provide trainees with a fundamental theoretical background in Neurophysiology. Trainees will have an opportunity to practice upper limb nerve conduction studies and multi-modality evoked potentials.

Work-based content

Training activities

# Learning outcome Training activity Type Action
# 1 Learning outcome 1, 7 Training activities

Produce plans for upper limb nerve conduction studies on patients and prepare the room

 Type ETA Action View
# 2 Learning outcome 2, 3, 4, 7, 9 Training activities

Obtain a history and perform appropriate clinical examination for patients attending for upper limb nerve conduction studies

 Type ETA Action View
# 3 Learning outcome 4,9 Training activities

Obtain informed consent for upper limb nerve conduction studies and inform patient of results dissemination

 Type ETA Action View
# 4 Learning outcome 5, 7, 9 Training activities

Perform sensory and motor nerve conduction studies on the upper limbs for carpal tunnel and ulnar nerve neuropathy including the following measurements:

  • Limb temperature
  • Amplitude and latency
  • Velocity
 Type ETA Action View
# 5 Learning outcome 8, 9 Training activities

Produce a factual report for an upper limb nerve conduction study for:

  • Carpal tunnel syndrome
  • Ulnar nerve neuropathy
 Type ETA Action View
# 6 Learning outcome 1, 7 Training activities

Produce plans and prepare the room to conduct the following evoked potential studies for:

  • Visual
  • Auditory
  • Somato-sensory
 Type ETA Action View
# 7 Learning outcome 3,9 Training activities

Obtain and document a history from patients attending for the following evoked potentials studies:

  • Visual
  • Auditory
  • Somato-sensory
 Type ETA Action View
# 8 Learning outcome 4 Training activities

Explain and obtain consent for evoked potential tests, including:

  • Visual
  • Auditory
  • Somato-sensory
 Type ETA Action View
# 9 Learning outcome 5, 6, 7, 9 Training activities

Perform the following evoked potentials including latency and amplitude measurements for:

  • Visual, including visual acuity
  • Auditory, including auditory threshold
  • Somatosensory, including sensory threshold
 Type DTA Action View
# 10 Learning outcome 8, 9 Training activities

Produce factual reports for the following evoked potentials including:

  • Visual
  • Auditory
  • Somato-sensory
 Type DTA Action View

Assessments

Complete 2 Case-Based Discussions

Complete 2 DOPS or OCEs

Direct Observation of Practical Skills Titles

  • Perform and mark up a sensory and motor nerve conduction test on one limb.
  • Prepare and apply electrodes for an evoked potential recording.
  • Record a visual evoked potential for one check size.
  • Record an auditory evoked potential.
  • Record an upper limb somato-sensory evoked potential.
  • Record a lower limb somato-sensory evoked potential.

Observed Clinical Event Title

  • Obtain a patient history.
  • Explain procedure and obtain informed consent.
  • Explain how to conduct a clinical examination for upper limb nerve conduction studies to a colleague.

Learning outcomes

# Learning outcome
1

Plan and prepare to undertake upper limb nerve conduction studies and multi-modality evoked potential studies.
2

Perform clinical examinations of patients attending for upper limb nerve conduction studies.
3

Obtain a clinical history from patients attending an upper limb nerve conduction study and a multi-modality evoked potential studies.
4

Explain procedures to patients in order to obtain informed consent for upper limb nerve conduction studies and multi-modality evoked potential studies.
5

Perform diagnostic tests including upper limb nerve conduction studies and multi-modality evoked potential studies on a range of patients.
6

Perform pre-test measure, including: visual acuity, height of patient, hearing and sensory thresholds.
7

Apply legislation and guidelines and manage risk in the performance of upper limb nerve conduction studies and multi-modality evoked potential studies.
8

Prepare reports for upper limb nerve conduction studies and multi-modality evoked potential studies.
9

Demonstrate effective and compassionate communication skills with all stakeholder including patients and the multidisciplinary team.

Clinical experiences

Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.

Activities

To develop a broader understanding of their specialty practice and support the completion of assessments and competencies, it is recommended a trainee should:

  1. Attend a clinic where patients requiring upper limb nerve conduction studies may be seen e.g. neurology, community, orthopedic, spinal, physiotherapy etc.
  2. Follow a patient along a pathway from initial consultation to treatment.
  3. Observe a peripheral nerve surgery.
  4. Attend relevant multidisciplinary team meeting e.g. multiple sclerosis.
  5. Observe research procedures relating to nerve conduction studies/evoked potentials.
  6. Observe and reflect on advanced evoked potential techniques such as the use in prognosis in patients on intensive care settings.
  7. Observe reporting of nerve conduction studies and evoked potentials.

Academic content (MSc in Clinical Science)

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning outcomes

On successful completion of this module the trainee will be able to:

  1. Apply integrative understanding of the anatomy and physiology of the central and peripheral nervous system.
  2. Evaluate the fundamentals of electroneuromyography procedures, the types of potentials that can be obtained and the range of conditions that can be diagnosed using these techniques.
  3. Describe the pathophysiology and clinical presentation of upper limb entrapments and associated changes observed in nerve conduction and electroneuromyography assessment.
  4. Evaluate the fundamentals of evoked potentials including types of modalities and recording standards.
  5. Critically evaluate the clinical uses of evoked potentials.
  6. Critically analyse the sources of error encountered and the non-pathological effects in the recording of nerve conduction studies and evoked potentials as well as their elimination.

Indicative content

  • The generation of neural, membrane, propagation, resting potentials and refractory periods:
    • Saltatory conduction
      • F waves
      • H reflex
    • Compound nerve, muscle and sensory action potentials
  • Anatomy of the upper limb peripheral nerves:
    • Brachial plexus
    • Median
    • Ulnar
    • Radial
  • Recording and stimulus parameters used in the electromyogram and motor/sensory nerve conduction studies:
    • Different types of needle electrodes
      • Concentric
      • Monopolar and single fibre
    • Electrode placement for nerve conduction studies (motor and sensory)
      • Median
      • Ulnar
      • Radial
    • Instrumentation and calibration of EMG equipment including stimulators
  • Non-pathology effects of NCS and EMG:
    • Errors in measurements and reproducibility of results
    • Limitation of motor conduction velocity measurements
    • Effect of age, gender and limb temperature
  • Pathophysiological changes in nerve conduction studies:
    • Axonal degeneration, demyelination and re-innervation
    • Block and slowed conduction
  • The pathophysiology and clinical presentation and nerve conduction and electromyographic findings in the following conditions:
    • Types of neuropathy (axonal, demyelinating and mixed)
    • Entrapment neuropathies
      • Carpal tunnel syndrome
      • Ulnar nerve at the elbow
    • Upper limb radiculopathies
    • Traumatic nerve lesions
  • Clinical examination of patients attending for upper limb entrapments
  • Grading severity of nerve entrapments
  • Measure visual acuity: hearing threshold and sensory threshold
  • Different types of electrodes used for recording evoked potentials
    • Surface
    • Gold foil
    • DTL needles
  • Principles of derivation and electrode placement used for evoked potentials (visual, auditory and somatosensory)
  • Instrumentation and calibration of evoked potential equipment including the range of electrodes and stimulators and the importance of impedance
  • Nomenclature for measuring all modalities of normal and abnormal evoked potentials:
  • Electroretinography: flash, pattern and multifocal
  • Visual evoked: full, central, half field and multifocal
  • Auditory evoked: short, middle and long latency
  • Somatosensory evoked: upper/lower limb measurement and early and late components
  • Non-pathological effects on all types of evoked potential (e. contrast and luminance, stimulus rate and duration, age and gender):
    • Visual/auditory/somatosensory
    • Visual acuity, age and gender
    • Attention and fixation
    • Contrast and luminance
    • Check and field size
    • Temperature
    • Anaesthesia
    • Stimulus rate, intensity, rate, duration and polarity
    • Physical contributes, i.e. height and limb length
  • Pathophysiology of a range of conditions requiring evoked potential testing:
    • Visual
      • Non-organic visual loss: cortical blindness
      • Chiasmal and retrochiasmal lesions
      • Optic tract and optic radiation disease
      • Occipital lesions
      • Inflammatory autoimmune and demyelinating diseases
      • Prognostic value
    • Auditory brainstem
      • Sensorineural hearing loss
      • Lesions of the acoustic nerve and brainstem lesions
      • Demyelination, ataxias, tumoural, degenerative disorders
      • Prognostic value in coma
    • Somatosensory
      • Spinal cord, brainstem and trauma lesions
      • Tumours of the spinal cord
      • Giant SEPs
      • Central demyelination
      • Prognostic value in coma and disorders of consciousness
  • Effect of medications on electroneuromyography studies and evoked potentials

Module assigned to

Specialties

Specialty code Specialty title Action
Specialty code SPS2-3-22 Specialty title Neurophysiology [2022] Action View
Specialty code SPS2-3-23 Specialty title Neurophysiology [2023] Action View
Specialty code SPS2-3-24 Specialty title Neurophysiology [2024] Action View
Specialty code SPS2-3-preview Specialty title Private: Neurophysiology: Interoperative Neuromonitoring [Neurophysiology: Interoperative Neuromonitoring] Action View
Specialty code Specialty title [] Action View
Specialty code Specialty title [] Action View
Specialty code SPS2-3 Specialty title Neurophysiology: Interoperative Neuromonitoring [Neurophysiology: Interoperative Neuromonitoring] Action View
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