Introduction to Neurophysiology

Module details

Title

Introduction to Neurophysiology

Type

Rotation

Module code

SPS202

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with the knowledge, understanding and awareness of the diversity of patients referred to a Neurophysiology Department. Trainees will undertake a range of investigations and assist with the assessment and management of a wide range of patients with conditions affecting the central or peripheral nervous system.

 

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Control infection risks in accordance with departmental protocols.	Action View
# 2	Learning outcome 1	Competency Minimise risks and hazards in compliance with Health and Safety policies.	Action View
# 3	Learning outcome 1	Competency Plan evoked potential recordings.	Action View
# 4	Learning outcome 1	Competency Prepare environment, equipment and subject for evoked potential recordings	Action View
# 5	Learning outcome 1	Competency Explain the procedure to the subject and address any questions they may have relating to the procedure, including the process after the procedure and how they will be informed of the results.	Action View
# 6	Learning outcome 1	Competency Gain informed consent for evoked potential recordings.	Action View
# 7	Learning outcome 1	Competency Obtain a full patient history from an adult patient.	Action View
# 8	Learning outcome 1	Competency Measure and apply the electrodes for the recording of a visual evoked potential on a normal subject and assist in performing evoked potential recordings.	Action View
# 9	Learning outcome 2	Competency Measure and document the latencies and amplitude of the major components of the evoked potentials	Action View
# 10	Learning outcome 1,2	Competency Identify causes of error/artefacts encountered and the non-pathological effect in the recording of evoked potentials and their elimination.	Action View
# 11	Learning outcome 1,2	Competency Complete and annotate evoked potential recordings.	Action View

Assessments

You must complete:

• 1 case-based discussion(s)
• 1 of the following DOPS/ OCEs:

Perform internal and external calibration on neurophysiological equipment	DOPS
Perform evoked potential of choice	DOPS
Obtain a full patient history from an adult patient relevant to the investigation and record the information accurately	OCE

Learning outcomes

1. Measure visual, auditory or somatosensory evoked potentials in a normal subject.
2. Measure and label, using the correct nomenclature, the major components of a patient evoked potential (visual, auditory or somatosensory).

Learning outcomes

1. Describe, compare and contrast a range of methods and equipment used for the routine neurophysiological assessment of patients.
2. Explain the internal and external calibration of neurophysiological equipment, describing the effects of the recording characteristic of the equipment components.
3. Evaluate the type of patient recording derivations and stimulus and recording parameters used in the recording of all modalities of evoked potentials (visual, auditory and somatosensory).
4. Recognise, measure and label using the correct nomenclature the major components of all modalities in patients when using evoked potentials (visual, auditory and somatosensory).
5. Critically evaluate the causes of error encountered and the non- pathological effects in the recording of evoked potentials and their elimination.
6. Describe patient special needs and circumstances as applied to neurophysiology services, such as people with learning difficulties, cognitive, sensory impairment, physical disabilities, older people, paediatrics and intensive care.
7. Describes the ways that non-NHS or external statutory, voluntary, charitable agency services in the community can assist with patient care in neurophysiology services, e.g. social services.

Indicative content

• Routine test procedures and equipment used in neurophysiology for assessment of neurological conditions
• Instrumentation and internal and external calibration of neurophysiological equipment
• Demonstrates knowledge of the components and their function of the equipment used in Clinical Neurophysiology for the recording of the signals
  • Amplifiers
  • Filter
  • Signal average
  • Delay lines
  • Triggers
  • Nomenclature for measuring all modalities of normal evoked potentials
  • Electroretinography: flash; pattern
  • Visual evoked: full; central; half field
  • Auditory evoked; brainstem
  • Somatosensory evoked; upper/lower limb measurement
• Types of recording derivation, stimulus and recording parameters used for the recording of all modalities of evoked potentials
• Types of stimulators and electrodes used in all modalities of evoked potentials
  • Pattern; onset/offset; flash pattern; Ganzfeld
  • Click; tone; pips
  • Constant current; voltage; magnetic
• Non-pathological effects on all types of evoked potential (i.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, limb length
•   The diversity of neurophysiology services; special needs; people with learning difficulties, cognitive and sensory impairment, physical disabilities, older people, paediatrics, intensive care
•   Statutory, voluntary, charitable agencies or services, e.g. social services

Activities

• Observe the calibration procedures undertaken on neurophysiological equipment and discuss with your training officer the effects of the recording characteristic of the equipment components.
• Observe the recording of electroencephalograms (EEGs) in a range of patients and reflect on the contribution this diagnostic test to the relevant patient pathway.
• Observe history taking and clinical examinations in patients with signs and symptoms of neurological conditions and discuss with your training officer how the history and clinical investigations inform the referral for neurophysiological investigation.
• Attend outpatient departments where patients with neurological conditions are referred and reflect on the multidisciplinary approach to the care and treatment of patients with neurological conditions.
• Attend a multidisciplinary team meeting and case presentation session and evaluate the methods of communication between team members and the patient and their family.