Module - Electromyography and Nerve Conduction Studies and Evoked Potentials


Work-based learning outcomes


  1. Plan, prepare and perform nerve conduction studies obtaining recordings from the upper and lower limbs in adult and/or paediatric patients referred for investigation of disorders of the peripheral nervous system, eg carpal tunnel syndrome, peripheral neuropathy, etc
  2. Assist in electromyography (EMG) studies and identify the electropotentials associated with electromyography
  3. Plan, prepare and perform evoked potential studies (visual, auditory and somatosensory) and measure visual acuity and hearing and sensory threshold
  4. Interpret the data and produce high-quality reports with respect to nerve conduction studies and evoked potentials, and differentiate between artefact and physiological occurrences

Work-based Competencies


Learning outcome Title Knowledge
1 1,2,3

Control infection risks in accordance with departmental protocols

  • Protocols and requirements for hygiene and infection control related to the relevant range of investigations, including preparation, conduct and completion of investigation
  • Protocol for hand washing and how effective hand washing contributes to control of infection
2 1,2,3

Minimise risks and hazards in compliance with health and safety policies

  • The relevant health and safety regulations specific to neurophysiology investigations, the potential hazards and risks, and the actions to be taken to minimise these
3 1,2

Prepare for nerve conduction studies including the environment, equipment and patient

  • Local standard operating procedure (SOP) for peripheral nerve conduction studies
  • Clinical indications and contraindications for nerve conduction studies in the range of conditions of patients referred for nerve conduction studies
  • The referral system for EMG and nerve conduction studies
  • The range and types of information required and its importance
  • How to check for validity of information
  • Appropriate action to be taken in the event of missing or invalid information
  • Types of nerve conduction study, their purpose and the appropriateness for conditions presented
  • How to assess whether investigations requested are appropriate to clinical question and the reason for referral
  • Potential special needs of the patients
  • Possible patient needs and environmental needs
  • Factors that may influence the duration and quality of investigations
  • Safe and correct operation of the equipment to be used, including all peripheral devices
  • The importance of confirming the patient’s identity from the referral document and correct entry on the recording system
  • How to establish and maintain effective communication with the patient, including explaining the test in a manner that will ensure cooperation
  • The importance of checking there is adequate storage volume for the investigation to be performed
  • The effects of sensitivity, time base, filters, signal to noise (S:N) ratio
  • The range of electrodes and stimulators used in nerve conduction recordings
  • Factors of key importance to patient history
  • How to record information and check for validity
4 1,2,3

Explain the procedure for each type of investigation to the patient and address any questions they may have relating to the procedure, including the process after the procedure and how the patient will be informed of the results

  • The appropriate choice of investigation considering the findings from the history and clinical examination
  • Common questions and concerns of patients about procedures
  • Risks and benefits of undertaking the investigation
  • The information needs of patients following the investigation
  • The authority level for provision of information to patients
5 1,3

Gain informed consent for each investigation

  • The importance of explaining the procedure for each investigation to the patient and gaining informed consent
  • The relevant procedures and requirements for patient conformance
  • Principles, guidance and law with respect to informed consent
6 1

Identify and place recording and stimulating electrodes at the correct sites of the major peripheral nerves and obtain recordings of nerve conduction studies (upper and lower limbs)

  • The importance of ensuring the patient is in a comfortable position and the effect on the quality of the recording
  • Importance of limb temperature maintenance
  • The recording and stimulus parameters for motor and sensory recording
  • The principles and importance of correct electrode placement for motor, sensory and F wave studies
  • Principles and importance of correct positioning of the stimulator
  • The use of supra-maximal stimulus
  • Measurement of sensory and motor latencies and amplitudes
  • The importance of correct measurement and documentation of distances between recording and stimulating electrodes
  • Conduction velocity calculation
  • Protocols and requirements for hygiene and infection control related to the relevant range of investigations
7 2

Observe/assist in EMG recording

  • Clinical rationale for undertaking EMG
  • Indications/contraindications for EMG
  • Electropotentials  associated  with electromyography
8 1,2,3

Identify the cause(s) of errors and recognise the non-pathological effects on the recording on nerve conduction studies and evoked potentials and their elimination

  • Identification, elimination and minimisation of physiological and non- physiological artefacts
9 1

Interpret the results and formulate accurate reports for peripheral nerve conduction studies, recognising the pathophysiological changes

  • Importance of continued information and reassurance for the patient
  • Correct annotation and documentation of results
  • The importance of evaluation and reviewing the findings
  • Identification of the need for further investigations
  • When to seek assistance and advice beyond the level of expertise
  • Interpretation of the results in the clinical context Hospital and community-based services for patients
10 3

Plan and prepare for evoked potentials (visual, auditory and somatosensory)

  • The range of conditions of patients referred for clinical neurophysiology testing
  • The referral system for multimodality evoked potentials
  • The range and types of information required and its importance
  • Checking for validity of information
  • Appropriate action to be taken in the event of missing or invalid information
  • Types of evoked potentials, their purpose and the appropriateness for conditions presented
  • Assessment of appropriateness of investigation requested with respect to the clinical question and referral
  • Potential special needs of the patients
  • Possible patient needs and environmental needs
  • Factors that may influence the duration and quality of investigations
  • Contraindications to investigations
  • Safe and correct operation of the equipment to be used, including all peripheral devices
  • The importance of confirming the patient’s identity from the referral document and correct entry on the recording system
  • Establish and maintain effective communication with the patient, including explaining the test in a manner that will ensure co- operation
  • The importance of checking there is adequate storage volume for the investigation to be performed
  • The effects of sensitivity, timebase, filters, Common Mode Rejection Ratio, S:N averaging
  • The range of electrodes and stimulators used in evoked potential recordings
  • Factors of key importance to patient history
  • Recording information and checking for validity
  • Visual acuity, auditory and somatosensory thresholds
11 3

Perform evoked potentials (visual, auditory and somatosensory) using a range of stimulators

  • Local SOP for evoked potential investigations
  • Principles of derivation and electrode placement used for evoked potentials (visual, auditory and somatosensory)
  • The importance of electrode impedance and its effects
  • Correct machine, recording and stimulus parameters
  • The importance of patient positioning and compliance
  • The principle and effects of limb temperature
  • Positioning and use of correct stimulators (visual, auditory and somatosensory)
  • Requirements and principles of recording and monitoring evoked potentials, including the monitoring of technical quality of raw data and identifying and eliminating biological and non-biological artefacts
  • The importance of the independent testing of right and left (eye, ear and limb)
  • The importance of acquiring sufficient samples and checking for reproducibility
  • Appropriate waveform marking to published nomenclature
  • Importance of continued information and reassurance for the patient
12 4

Interpret the results and formulate accurate factual reports for peripheral nerve conduction studies

  • Correct annotation and documentation of results
  • The importance of evaluation and reviewing the findings
  • Identification of the need for further investigations
  • When to seek assistance and advice beyond the level of expertise
  • Interpretation of the results in the clinical context
  • Hospital and community-based services for patients
13 4

Interpret the results and formulate accurate factual reports for evoked potentials (visual, auditory and somatosensory), recognise, label and critically evaluate the major components of all modalities of evoked potentials

 

  • Correct annotation and documentation of results
  • The importance of evaluation and reviewing the findingsIdentification of the need for further investigations
  • When to seek assistance and advice beyond the level of expertise
  • Interpretation of the results in the clinical context
  • Hospital and community-based services for patients

Work-based assessment


Complete 3 Case-Based Discussion(s)
Complete 2 of the following DOPS and/or OCEs
Type Title
DOPS Perform carpal tunnel syndrome screening procedure
DOPS Perform visual evoked potential
DOPS Perform brainstem auditory evoked potential
DOPS Perform upper limb somatosensory evoked potentials
DOPS Perform lower limb somatosensory evoked potentials
DOPS Perform a peripheral neuropathy screen
OCE Take a patient history
OCE Apply electrodes/transducers
OCE Assess sensory threshold
OCE Explain procedure and obtain informed consent
OCE Assess visual acuity
OCE Assess hearing threshold
OCE Apply electrodes/transducers for peripheral neuropathy screenq
OCE Apply electrodes/transducers for carpal tunnel syndrome screening procedure
OCE Apply electrodes/transducers for lower limb somatosensory evoked potentials