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At least 19 recordsLinked to original sources
PubMedDate not supplied

Customer needs, expectations, and satisfaction with clinical neurophysiology services in Ireland: a case for tele-neurophysiology development.

Although equitable access to services should be based on need, geographical location of patients and their clinicians can give rise to inequalities in healthcare delivery. Development of tele-medicine services can improve equity of access. The specialty of Clinical Neurophysiology (CN), currently under-developed in Ireland provides an example of such potential. This study aimed to determine the needs, expectations, and satisfaction of CN customers, namely patients and referring clinicians. The goal was to examine geographical impediments to access that might be addressed by the introduction of tele-neurophysiology. Two customer surveys were conducted: CN referring clinicians and CN patients. Thirty-one North Western Health Board (NWHB) consultant clinicians responded to a postal survey. Distance and delays caused by long waiting lists were felt to deter or make CN referral irrelevant. Ninety-seven percent believed the lack of a local service negatively impacts on patient management and 93% would welcome the introduction of a tele-neurophysiology service. The geographical location of patient's residence and/or the location of the referring clinician's practice influenced waiting lists for CN. Fifty-eight (105/182) percent of patients living in a region with a CN service compared to 39% (50/128) of those living in a region with no service received an appointment within one month. In addition to the current insufficient CN service capacity in Ireland, these surveys highlighted geographical inequities. Tele-neurophysiology has the potential to speed-up diagnosis, result in more patients being appropriately investigated and be fairer to patients.

Consumer Behavior↗
PubMedDate not supplied

Intraoperative neurophysiological monitoring. Part 2: Neurophysiological background.

Continuous intraoperative monitoring of neurophysiological signals provides a reliable way to determine the functional integrity of the nervous system during the course of neurological, orthopedic, or vascular surgery. To understand the use of electrophysiological recording in the operating room, the basic mechanisms that give rise to the recorded signals are briefly reviewed. Additionally, the equipment necessary for proper signal recording and presentation of the results is described. Finally, a short introduction to anesthesia management and some commonly induced neuroprotective conditions, such as hypothermia and hypotension, are provided, since these are the main factors affecting the signals, thus contributing to the difficulty of correct interpretation of the recordings during the course of an operation.

Anesthesia↗
PubMed1983

Data acquisition in neurophysiology. A flexible microcomputer system for recording neurophysiological data.

The advent of the microprocessor, and its incorporation in relatively low-cost microcomputer systems, offers a new range of possibilities for the recording of evoked and event-related potentials. A flexible system for recording evoked potentials, entitled DAN, has been developed using an Apple microcomputer. The main objective in developing DAN was to make it sufficiently flexible so that it could be used in both a research and a clinical environment for a wide range of responses, from the auditory brainstem to much slower cortical responses. A specific response can be selected from a standard range of evoked responses, or if a non-standard response is required, it is a simple matter to specify the response stimulus parameters, time duration and data sampling rate. This degree of versatility is achieved by designing a programmable audiometer, a special-purpose hardware interface for the Apple and software to generate the stimulus and control the data-acquisition interface. The main hardware components of the DAN system are listed (a) Apple microcomputer operating under U.C.S.D. PASCAL operating system; (b) dual 5 1/4 inch floppy disk drives and controller; (c) Video monitor; (d) DAN data-acquisition interface; (3) programmable audiometer; (f) Epson MX-80 printer/plotter. Disk drive 1 of the dual drive set is used to store the PASCAL operating system and the DAN programs. Drive 2 is used to store the data. The data-acquisition interface and audiometer interface plug into slots in the Apple. The software includes routines to generate the stimulus and store it in the audiometer prior to the data-acquisition phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Computers↗
PubMed2001

Neurophysiological classification of ulnar entrapment across the elbow.

Ulnar nerve entrapment across the elbow (UAE), a common entrapment, requires neurophysiological evaluation for a diagnosis, but a standardised neurophysiological classification is not available. The aim of our study was to evaluate the validity of a neurophysiological classification of UAE, developed by us. To this end, we examined whether sensorimotor deficits, as observed by the physician and as referred by the patients, increased with the neurophysiological severity according to the classification. We performed a multiperspective assessment of 63 consecutive arms from 52 patients with a clinical diagnosis of UAE. Neurophysiological, clinical and patient-oriented validated measurements were used. The neurophysiological classification is based on the presence or absence of evoked responses and on the normality or abnormality of conduction findings. A strict relationship was observed between the degree of neurophysiological severity and the clinical findings (sensorimotor deficits). Moreover, a significant positive correlation between hand functional deficit and neurophysiological classification was observed. Conversely, a clear correlation between neurophysiological pattern and symptoms was not found. The neurophysiological classification is easy to use and reliable, but further multicentric studies should be performed.

Adult↗
PubMed2004

Neurophysiological testing correlates with clinical examination according to fibre type involvement and severity in sensory neuropathy.

OBJECTIVE: To investigate a comprehensive battery of neurophysiological tests for objective evaluation of sensory neuropathies including fibre type involvement and severity, and to determine the relation between neurophysiological data and clinical examination. METHODS: 45 patients referred for sensory neuropathy were studied using a standardised clinical evaluation of large and small fibre symptoms and an original neurophysiological battery. Clinical evaluation included: assessment of tactile, vibratory, and pin sensation; tendon reflexes; toe position sense; ataxia score; pain level; and presence of trophic, vasomotor, or sudomotor abnormalities. The neurophysiological battery included: recording of large fibre and small fibre components of the sural sensory nerve action potential; somatosensory evoked cortical potentials and soleus H reflex following tibial nerve electrical stimulation; laser evoked potentials following Nd:YAG laser stimulation of the foot; and plantar sympathetic skin response to median nerve stimulation. Neuropathy was classified according to the predominantly affected fibre type, and a severity score was established based on clinical and neurophysiological abnormalities. RESULTS: On clinical examination there were 22 patients with large fibre sensory neuropathy (LFSN), 18 with mixed sensory neuropathy (MSN), and five with small fibre sensory neuropathy (SFSN). Neurophysiological classification identified 25 patients with LFSN, 13 with MSN, and seven with SFSN. Clinical and neurophysiological classifications and severity scores were correlated, whatever the type of neuropathy. CONCLUSIONS: The correlation between clinical examination and the results of an original neurophysiological test battery offers a comprehensive clinical and neurophysiological approach to the objective assessment of peripheral neuropathies according to fibre type involvement and overall severity.

Adult↗
PubMed1987

Clinical neurophysiology in the assessment of neurological symptoms in systemic lupus erythematosus.

Neurophysiological studies were performed on 22 randomly selected patients with systemic lupus erythematosus in order to determine whether this form of assessment might be of value in the diagnosis and management of neurological lupus. Sixteen patients described neurological lupus. In eight, neurological symptoms were present at the time of neurophysiological testing. All eight had neurophysiological abnormalities. In six the abnormality was of central origin manifesting as a disorder of either visual evoked response (VER) or brain-stem auditory evoked response (BAER). In the remaining two, an isolated disorder of peripheral nerve conduction (PNC) was present. In the eight patients with previous neurological symptoms five (63%) had neurophysiological abnormalities, but a central disorder was observed in only one and abnormal PNC was present in all. Of the six patients with no neurological symptoms, three (50%) had central neurophysiological disorders. No correlation between individual neurophysiological disorders and specific neurological symptoms was observed. However, all four patients with active vasculitis and all seven with lymphopenia had a neurophysiological disorder. If these observations are extended and confirmed, neurophysiological studies may provide a useful test to the clinician in the evaluation and management of neurological lupus.

Adult↗
PubMed1998

Patterns of neurophysiological abnormality in prolonged critical illness.

OBJECTIVE: To describe the various patterns of neurophysiological abnormalities which may complicate prolonged critical illness and identify possible aetiological factors. DESIGN: Prospective case series of neurophysiological studies, severity of illness scores, organ failures, drug therapy and hospital outcome. Some patients also had muscle biopsies. SETTING: General intensive care unit (ICU) in a University Hospital. PATIENTS: Forty-four patients requiring intensive care unit stay of more than 7 days. The median age was 60 (range 27-84 years), APACHE II score 19 (range 8-33), organ failures 3 (range 1-6), and mortality was 23%. RESULTS: Seven patients had normal neurophysiology (group I), 4 had a predominantly sensory axonal neuropathy (group II), 11 had motor syndromes characterised by markedly reduced compound muscle action potentials and sensory action potentials in the normal range (group III) and 19 had combinations of motor and sensory abnormalities (group IV). Three patients had abnormal studies but could not be classified into the above groups (group V). All patients had normal nerve conduction velocities. Electromyography revealed evidence of denervation in five patients in group III and five in group IV. There was no obvious relationship between the pattern of neurophysiological abnormality and the APACHE II score, organ failure score, the presence of sepsis or the administration of muscle relaxants and steroids. A wide range of histological abnormalities was seen in the 24 patients who had a muscle biopsy; there was no clear relationship between these changes and the neurophysiological abnormalities, although histologically normal muscle was only found in patients with normal neurophysiology. Only three of the eight patients from group III in whom muscle biopsy was performed had histological changes compatible with myopathy. CONCLUSIONS: Neurophysiological abnormalities complicating critical illness can be broadly divided into three types -- sensory abnormalities alone, a pure motor syndrome and a mixed motor and sensory disturbance. The motor syndrome could be explained by an abnormality in the most distal portion of the motor axon, at the neuromuscular junction or the motor end plate and, in some cases, by inexcitable muscle membranes or extreme loss of muscle bulk. The mixed motor and sensory disturbance which is characteristic of 'critical illness polyneuropathy' could be explained by a combination of the pure motor syndrome and the mild sensory neuropathy. More precise identification of the various neurophysiological abnormalities and aetiological factors may lead to further insights into the causes of neuromuscular weakness in the critically ill and ultimately to measures for their prevention and treatment.

Adult↗
PubMed2007

Intraoperative neurophysiological monitoring technology: recent advances and evolving uses.

Intraoperative neurophysiological monitoring has evolved over the last 25 years to become an important component of many types of orthopedic and neurosurgical procedures. From its foundations in VIII cranial nerve surgeries and scoliosis corrections surgeries, intraoperative neurophysiological monitoring has expanded to incorporate nearly all spine procedures and many involving the brain and brainstem. Fundamental to this growth in the use of intraoperative neurophysiological monitoring has been the development of the technology used to perform the neurophysiological tests. Advancements in electronics and computer technology have resulted in significant improvements in the capacity, ease of use, quality and reliability of the equipment as well as the quality of and control over the acquired data. These technological advancements have resulted in remarkable improvements in not only the quality and availability of intraoperative neurophysiological monitoring, but also, as a consequence, patient care, and have arguably propelled the expansion of the use that intraoperative neurophysiological monitoring has seen over the last 10 years.

Biomedical Technology↗
PubMed2001

Reproducibility of neurophysiological and myometric measurement in the ulnar nerve-abductor digiti minimi system.

Reliability in strength and neurophysiological measurements is important in evaluating progression of neuromuscular diseases. No data are available on the variability of neurophysiological parameters as compared with maximal voluntary isometric contraction (MVIC) in the same muscles, in healthy subjects. A control population of 26 healthy subjects was studied twice on different days. We evaluated the reliability of neurophysiological parameters obtained from bilateral ulnar nerve stimulation, recording the response over the abductor digiti minimi (ADM) muscle, including distal motor latency, compound muscle potential amplitude and area, F-wave frequency and mean F-wave latency, and the derived neurophysiological index that we have described previously. MVIC force was measured in each session in both ADM muscles. The variances between the grouped data obtained in the two recording sessions were identical, indicating a low intrinsic variability with this experimental methodology. Comparison of the mean values obtained in the two sessions revealed no statistically significant differences. The reliability of these neurophysiological and strength measurements in the same nerve/muscle system suggests they may be useful in comparing the dynamics of weakness and neurophysiological change in neuromuscular disease.

Adult↗