NEUROPHYSIOLOGY Section

Learning Outcomes

1. Elucidate the different machine and procedure in the said section

2. Know the specific staff in the said section

Questions

1. Give 10 automated machines that are present in the said section. Indicate the following:
a. Specific use
b. quality control test
c. preventive maintenance
d. Principle used

Machine Specific use QC test Preventive Principle used

mainenancce

NeuroLog System intracellular Quality control Check the multi-channel

recording, test depends on machine daily. isolated
extracellular the Perform a full amplification
recording, spike manufacturer’s system backup system
detection, protocol regularly
electrical
stimulation, pulse
& train
generation,
multi-channel
isolated EMG or
EEG recording,
pressure or other
transducer
recordings

Cadwell Cascade capable of Quality control Check the crosspoint

IONM System performing EP test depends on machine daily. technology
(including SEP, the Perform a full
TceMP, BAEP, manufacturer’s system backup
VEP), free-run protocol regularly
EMG, stimulated
EMG, EEG, and
train of four tests
simultaneously

Grass General purpose Quality control Check the synchronization

Technologies S48 stimulator test depends on machine daily.
Square Pulse intended for the Perform a full
Stimulator nerve and muscle manufacturer’s system backup
stimulation protocol regularly
procedures with
applications
extending from
single cell to
entire muscle
stimulation. It can
be set to deliver
single, repetitive,
twin pulses, trains
of pulses and
trains of twin
pulses from its
single output.

Ds7a Constant provides constant stimulus polarity If the stimulator constant current
Current High current high control requires cleaning, high voltage
Voltage voltage pulses of it should be pulses
Stimulator brief duration for unplugged from
percutaneous the mains power
stimulation during supply and wiped
investigation of with a
the electrical damp cloth.
activity of nerve This equipment
and muscle tissue does not require
any regular
maintenance but
Digitimer
recommends that
the DS7A is
returned to the
factory for
inspection and
re-testing every 2
years.

MagPro R30 intended as an Quality control Check the Motor Evoked

electro-physiologi test depends on machine daily. Potentials
cal aid to assess the Perform a full
diagnosis and to manufacturer’s system backup
monitor diseases protocol regularly
of the central and
peripheral
nervous system.
 Biometrics’ designed Quality control No periodic Biometrics
goniometers and for the test depends on maintenance is instrumentation
torsiometers measurement of the required to
limb angular manufacturer’s ensure the correct
movement protocol functioning of the
sensors

Lumex Patient Lift intended to aid in Quality control Inspecting the Lumex six-point,
the transfer of an test depends on unit before each four-point slings
individual who is the use, periodic or 2-point slings
unable to manufacturer’s maintenance
independently protocol checks should
transfer between be done.
bed, chair,
wheelchair,
and/or commode.

Brainsight TMS For image-guided Quality control Clean the strap Integrated
TMS test depends on and foam pad 2-channel EMG
the with a cloth
manufacturer’s dampened with
protocol water and mild
soap. Do not use
any detergents
that can cause
skin irritations
when wearing the
strap.
Dust can be
removed from a
reflective sphere
using compressed
air, or by lightly
brushing it with a
photographic lens
brush.

2. Give 10 test performed in the said section. Indicate the following:

a. Procedure
b. Quality control
c. Specimen criteria
d. Estimated Time
 Test Procedure Quality Control Specimen criteria Estimated Time

Electromyography During an EMG, If an EMG test No specimen an hour or longer

(EMG) very fine needles detects electrical criteria
or wires are activity in a
inserted into a relaxed muscle, it
muscle to assess may be due to:
changes in neuropathy,
electrical signals carpal tunnel,
at rest and during syndrome
movement. The inflammation of
needles are the muscle tissue
attached through (myositis)
wires to an EMG
machine. If an EMG test
shows sporadic,
random activity
during a muscle
contraction, it
may indicate:
amyotrophic,
lateral sclerosis,
spinal muscular
atrophy, carpal
tunnel syndrome

Cerebral The person, Contrast dye No specimen up to 3 hours

Angiogram wearing a hospital flowing out of the criteria followed by a 6-
or imaging gown, blood vessel may to 8-hour resting
lies on a table be a sign of period
that is wheeled internal bleeding.
into the imaging Narrowed arteries
area. A physician may suggest
anesthetizes a cholesterol
small area of the deposits, a spasm,
leg near the groin or inherited
and then inserts a disorders.
catheter into a Out of place
major artery blood vessels may
located there. The be due to brain
catheter is tumors, bleeding
threaded through within the skull,
the body and into aneurysm
an artery in the (bulging of the
neck. Dye is artery walls), or
injected and arteriovenous
travels through malformation.
 the bloodstream
into the head and
neck. A series of
x-rays is taken.
The person may
feel a warm to hot
sensation or slight
discomfort as the
dye is released.

Electroencephalo A person being 1. Alpha waves No specimen an hour or 3

graphy (EEG) tested usually are related to criteria hours for certain
reclines in a chair relaxation and disorders
or on a bed during attention. They
the test. A series are present when
of cup-like you are awake
electrodes are with your eyes
attached to the closed. They
scalp with a usually disappear
special when you open
conducting paste. your eyes and pay
The electrodes attention to
are attached to something.
wires (also called 2. Beta waves are
leads) that carry normal in people
the electrical who are awake. It
signals of the doesn’t matter
brain to a whether your
machine. During eyes are open or
an EEG recording closed. Certain
session, a variety drugs, such as
of external sedatives, can
stimuli, including influence these
bright or flashing waves.
lights, noise or 3. Theta waves
certain drugs may are related to
be given. sleep. These slow
Individuals may waves are normal
be asked to open for all ages during
and close their sleep. They
eyes, or to change generally aren’t
their breathing obvious when
patterns. Changes adults are awake.
in brain wave 4. Delta waves are
patterns are also related to
transmitted to an sleep. These
EEG machine or waves are normal
 computer. in adults who are
in deep sleep and
in young
children.-

Electronystagmog Small electrodes Test results are No specimen

raphy (ENG) are taped on the normal if there criteria
skin around the are no abnormal
eyes to record eye involuntary eye
movements. If movements
infrared during the test.
photography is Some nystagmus
used in place of occurs normally
electrodes, the when you turn
person being your head. Results
tested wears of the caloric test
special goggles are normal if
that help record involuntary eye
the information. movements have
Both versions of normal direction
the test are and intensity.
painless and
risk-free.

Auditory evoked The person being Normal results No specimen 45 minutes

potentials (also tested sits in a vary, and depend criteria
called brain stem soundproof room on the patient
auditory evoked and wears and the
response) headphones. instruments used
Clicking sounds to perform the
are delivered one test.
at a time to one
ear while a
masking sound is
sent to the other
ear. Each ear is
usually tested
twice.

Visual evoked The person sits Normal results No specimen 30-45 minutes
potentials close to a screen vary, and depend criteria
and is asked to on the patient
focus on the and the
center of a instruments used
shifting to perform the
checkerboard test.
pattern. One eye
 is tested at a
time. Each eye is
usually tested
twice.

Myelography Following an normal No specimen 1 hour

injection of myelogram shows criteria
anesthesia to a nerves that
site between two appear normal,
vertebrae in the and a spinal canal
lower back, a of normal width,
small amount of with no areas of
the cerebrospinal constriction or
fluid is removed obstruction-
by spinal tap (see
cerebrospinal
fluid analysis,
above). Contrast
dye is injected
into the spinal
canal and a CT
scan or a series of
x-rays is taken.
People may
experience some
pain during the
spinal tap as well
as headache
following the
spinal tap. There
is a slight risk of
fluid leakage or
allergic reaction
to the dye.

Ultrasound During an - No specimen 15-30 minutes

imaging ultrasound criteria
(ultrasonography) examination, the
person lies on a
table or reclines
in an examination
chair. A jelly-like
lubricant is
applied to the
bare skin and a
transducer, which
both sends and
 receives
high-frequency
sound waves, is
passed over the
body. The sound
wave echoes are
recorded and
displayed as a
computer-generat
ed real-time visual
image of the
structure or tissue
being examined

Cerebrospinal During the lumbar Pressure: 70 to 1 mL CSF per vial, 45 minutes

fluid analysis puncture the 180 mm H2O refrigerated (but
(lumbar puncture person will either Appearance: not for
or spinal tap) lie on one side, clear, colorless Microbiology)
with knees close CSF total protein:
to the chest, or 15 to 60 mg/100
lean forward mL
while sitting on a Gamma globulin:
table, bed, or 3% to 12% of the
massage chair. total protein
The perosn’s back CSF glucose: 50 to
will be cleaned 80 mg/100 mL (or
and injected with greater than two
a local anesthetic. thirds of blood
The injection may sugar level)
cause a slight CSF cell count: 0
stinging to 5 white blood
sensation. Once cells (all
the anesthetic has mononuclear),
taken effect, a and no red blood
special needle is cells
inserted between Chloride: 110 to
the vertebrae into 125 mEq/L
the spinal sac and
a small amount of
fluid (usually
about three
teaspoons) is
withdrawn for
testing. Most
people will only
feel a sensation of
pressure as the
 needle is inserted.
Generally, people
are asked to lie
flat for an hour or
two to reduce the
after-effect of
headache.

Wada Test Medical - No specimen 30-60 minutes

professionals criteria
conduct the test
with the patient
awake.
Essentially, they
introduce a
barbiturate
(usually sodium
amobarbital) into
one of the
internal carotid
arteries via a
cannula or
intra-arterial
catheter from the
femoral artery.
They inject the
drug into one
hemisphere at a
time into the right
or left internal
carotid artery. If
the right carotid is
injected, the right
side of the brain is
inhibited and
cannot
communicate
with the left side.
The effect shuts
down any
language and or
memory function
in that
hemisphere in
order to evaluate
the other
hemisphere ("half
 of the brain"). An
EEG recording at
the same time
confirms that the
injected side of
the brain is
inactive as a
neurologist
performs a
neurological
examination. The
neurologist
engages the
patient in a series
of language and
memory related
tests. They
evaluate the
memory by
showing a series
of items or
pictures to the
patient
and—within a few
minutes, as soon
as the effect of
the medication
dissipates—testin
g the patient's
ability to recall.

3. Identify the Section head and give 3 Staff under the said section

Head: Ma’am Dawn

Staffs: Ma’am Cristel, Ma’am Daisy, & Ma’am Angge

References:

● MagVenture. (n.d.). ​MagPro R30.​ Retrieved July 16, 2020 from

https://pdf.medicalexpo.com/pdf/magventure/magpro-r30/84839-223260.html
● MFI Medical. (n.d.). ​Cadwell Cascade IONM System.​ Retrieved July 16, 2020 from
https://mfimedical.com/products/cadwell-cascade-ionm-system
● Digitimer. (n.d.). ​Neurolog System.​ Retrieved July 16, 2020 from
https://www.digitimer.com/product-category/neurolog-system/
● Artisan Technology Group. (n.d.). ​Astro-Med / Grass Technologies S48H Square Pulse Stimulator​.
Retrieved July 16, 2020 from
https://www.artisantg.com/Scientific/91349-1/Astro-Med-Grass-Technologies-S48H-Square-Pul
se-Stimulator
● Digitimer. ​Constant Current Stimulator Ds7a (Including DS7AH) Operator’s Manual​. Retrieved
July 16, 2020 from
https://www.staff.universiteitleiden.nl/binaries/content/assets/sociale-wetenschappen/facultei
tsbureau/solo/research-support-website/equipment/manual-digitimer-ds7a_23122019.pdf
● Biometrics Ltd. (n.d.). ​Goniometer And Torsiometer Operating Manual.​ Retrieved July 16, 2020
from ​https://www.motion-labs.com/pdf/biometrics_goniometer_ug.pdf
● Lumex. (n.d.).​ Lf1031 Hydraulic Patient Lift User Manual.​ Retrieved July 16, 2020 from
https://www.rehabmart.com/pdfs/lumex_easy_lift_patient_lifting_system_op_man.pdf
● Brainbox Ltd. (n.d.). ​Brainsight TMS Navigation Brochure.​ Retrieved July 16, 2020 from
https://brainbox-neuro.com/cms-data/products/Brainsight%20TMS%20Navigation%20Brochure
.pdf
● Human Neurophysiology Laboratory. (n.d.). ​About the Human Neurophysiology Laboratory.
Retrieved July 16, 2020 from ​https://sites.ualberta.ca/~dcollins/about_lab.html
● National Institute of Neurological Disorders and Stroke. (2020, March 16). ​Neurological
Diagnostic Tests and Procedures Fact Sheet.​ Retrieved from
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurological-Di
agnostic-Tests-and-Procedures-Fact
● Cleveland Clinic. (n.d.). ​Wada Test​. Retrieved July 16, 2020 from
https://my.clevelandclinic.org/health/diagnostics/17628-wada-test
● Shelat, A. M. (2019, April 21). ​Cerebral spinal fluid (CSF) collection​. Retrieved from
https://medlineplus.gov/ency/article/003428.htm
● Medical News Today. (2020, Feb 19). ​What to know about electromyography (EMG) tests​.
Retrieved from ​https://www.medicalnewstoday.com/articles/emg-test#results
● UCSF. (2010, Nov 22). ​Cerebral Angiography.​ Retrieved from
https://www.ucsfbenioffchildrens.org/tests/003799.html
● Lewis, S. (2018, June 24). ​Understanding Your EEG Results.​ Retrieved from
https://www.healthgrades.com/right-care/electroencephalogram-eeg/understanding-your-eeg-
results
● Healthwise. (2019, March 28). ​Electronystagmogram (ENG)​. Retrieved from
https://wa.kaiserpermanente.org/kbase/topic.jhtml?docId=aa76377
● Encyclopedia.com. (n.d.). ​Myelography.​ Retrieved July 16, 2020 from
https://www.encyclopedia.com/medicine/divisions-diagnostics-and-procedures/medicine/myel
ography