Back Module: S-N-S3

Nerve Conduction Studies & Evoked Potentials 2

Module information

Module details

Title
Nerve Conduction Studies & Evoked Potentials 2
Type
Specialist
Module code
S-N-S3
Credits
10
Phase
3
Requirement
Compulsory

Aim of this module

This module aims to provide the trainees with a fundamental theoretical background in Neurophysiology. Trainees will have the opportunity to engage in and report on a range of conduction studies including lower limb nerve and peripheral nerve conduction studies and evoked potential studies within clinical context of the patient’s history and symptoms.

Work-based content

Training activities

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

Plan and prepare for lower limb nerve conduction studies to screen a patient for peripheral neuropathy

 Type ETA Action View
# 2 Learning outcome 2, 3, 4, 7, 12 Training activities

Obtain a history and perform a clinical examination of a patients attending for lower limb nerve conduction studies

 Type ETA Action View
# 3 Learning outcome 4, 12 Training activities

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

 Type ETA Action View
# 4 Learning outcome 5, 7, 12 Training activities

Perform sensory, motor and F-Wave lower limb nerve conduction studies for peripheral neuropathy including the following measurements:

  • Limb temperature
  • Amplitude and latency
  • Velocity
 Type ETA Action View
# 5 Learning outcome 8, 12 Training activities

Produce factual reports for a lower limb nerve conduction study for peripheral neuropathy screen

 Type ETA Action View
# 6 Learning outcome 6, 9, 12 Training activities

Interpret results of upper limb nerve conduction studies and make recommendations for further investigations/tests in line with clinical context:

  • Carpal tunnel syndrome
  • Ulnar neuropathy at the elbow
 Type ETA Action View
# 7 Learning outcome 6, 9, 12 Training activities

Interpret results of lower limb nerve conduction studies and make recommendations for further investigations/tests in line with clinical context of peripheral neuropathy

 Type ETA Action View
# 8 Learning outcome 6, 9, 12 Training activities

Interpret results of evoked potential studies and make recommendations for further investigations/tests in line with clinical context of patient’s history and symptoms

 Type ETA Action View
# 9 Learning outcome 7,10,12 Training activities

Attend consultant led EMG clinics and feedback to colleagues on how EMG can aid further diagnosis

 Type DTA Action View
# 10 Learning outcome 7, 11,12 Training activities

Review the evidence base for the use of IOM on patients and feedback to colleagues

 Type DTA Action View

Assessments

Complete 2 Case-Based Discussions

Complete 2 DOPS or OCEs

Direct Observation of Practical Skills Titles

  • Perform motor nerve study in one lower limb.
  • Perform sensory study in one lower limb.
  • Perform F-Wave study in one lower limb.

Observed Communication Event Titles

  • Obtain a history from a patient having an EMG investigation.
  • Explain further testing required to a patient.
  • Discuss the results from an EMG with a colleague.
  • Discuss with a colleague differential diagnoses on the basis of findings of peripheral neuropathy screen.

Learning outcomes

# Learning outcome
1

Plan and prepare lower limb nerve conduction studies.
2

Perform clinical examination of a patient attending for a peripheral neuropathy investigation.
3

Obtain a clinical history from a patient attending a peripheral neuropathy investigation.
4

Explain procedures to patients in order to obtain informed consent for peripheral nerve conduction studies.
5

Perform lower limb nerve conduction studies on a range of patients.
6

Identify further investigations in line with clinical context and the patients history and symptoms.
7

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

Prepare reports that reflect an understanding of patient pathways.
9

Interpret peripheral nerve conduction studies and evoked potential studies.
10

Discuss uses and typical EMG findings.
11

Appraise intraoperative monitoring (IOM) techniques and evidence base for practice.
12

Demonstrate effective and compassionate communication skills with all stakeholders, 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

  1. Attend a clinic where patients requiring lower limb nerve conduction studies may be seen e.g. neurology, community, orthopaedic, spinal, physiotherapy etc.
  2. Follow a patient along a pathway from initial consultation to treatment.
  3. Observe a peripheral nerve surgery.
  4. Attend multidisciplinary team meetings where the need for IOM is discussed.
  5. Observe IOM procedures.
  6. Attend a clinical scientist led centre.
  7. Observe paediatric EMG.
  8. Observe EMG in intensive care settings.
  9. Observe and reflect on advanced evoked potential techniques such as the use in prognosis in patients in intensive care settings.

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. Explain the pathophysiology and clinical presentation of common lower limb entrapments and the associated pathological changes observed in nerve conduction and electromyography assessment.
  2. Describe the pathophysiology and clinical presentation of different peripheral neuropathy and the associated pathological changes observed in the nerve conduction and electromyography assessment.
  3. Describe the pathophysiology and clinical presentation and pathological changes in the electroneuromyography studies of skeletal muscle diseases.
  4. Interpret multimodality evoked potentials (visual, auditory and somatosensory) and from electroneuromyography studies.
  5. Critically evaluate the ambulatory and intraoperative use of evoked potentials and electroneuromyography techniques.

Indicative content

  • Anatomy of peripheral nerves in the lower limbs:
    • Tibial
    • Sural and common peroneal nerve
  • Recording and stimulus parameters used in the motor/sensory nerve conduction studies of lower limbs
  • Electrode placement for nerve conduction studies (motor and sensory):
    • Tibial
    • Sural
    • Common peroneal nerve
  • Potentials related to EMG:
    • Motor units
    • Insertion activity
    • End-plate noise
    • Fibrillations
    • Fasciculations
    • Positive sharp waves
    • Spontaneous repetitive activity
    • Myotonic discharges
    • Complex repetitive discharges
    • Neuromyotonia
    • Reinnervation
  • The pathophysiology and clinical presentation of nerve conduction and electromyographic findings in the following conditions:
    • Peripheral neuropathy
    • Fibre-selective neuropathies
      • Large and small fibre neuropathies
    • Autoimmune and demyelinating diseases
    • Acute onset, hereditary, acquired and mononeuropathies
    • Entrapment neuropathies
      • Tarsal tunnel
    • Lowe limb radiculopathies
    • Myopathies
      • Inflammatory, endocrine and genetically determined myopathies
      • Plexus and root lesions
      • Neuromuscular junction disorders
      • Motor neuron disorders
  • Grading peripheral neuropathy severity
  • The neuropathy and myopathy in the critically ill patient
  • Motor evoked potential: theory and instrumentation
  • Pathophysiology of a range of conditions requiring motor evoked potential testing:
    • Spinal cord, brainstem, stroke and trauma lesions
    • Central demyelination and degenerative diseases
    • Prognostic value in motor recovery
  • Intraoperative monitoring – reasons for IOM, electrode types, electrode placement, types of stimulation and clinical applications
  • Uses of evoked potential and electroneuromyography for intraoperative monitoring
  • Other evoked-potential modalities: cognitive (event-related) evoked potentials
    • P300 and MMN: theory, paradigms and clinical uses

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 SPS2-3-25 Specialty title Neurophysiology: Intraoperative Neuromonitoring [2025] Action View
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