Content Outline and Competencies:

I. The History of Neurodiagnostic Technology

A. Explain the history of the NDT field.

B. Describe the electroencephalogram (EEG) and its role in NDT.

II. The Role of the Neurodiagnostic Technologist

A. Provide an overview of disease processes that can affect the EEG.

B. Define the role of the Neurodiagnostic Technologist.

C. Explore concepts of patient safety for all ages.

D. Explain patient centered care and rapport with patients and their families.

E. Demonstrate preparing a patient for a neurodiagnostic study.

F. Demonstrate performing a neurodiagnostic study.

G. Discuss other NDT modalities.

H. Outline Health Insurance Portability and Accountability Act (HIPAA) as it relates to NDT field.

I. Explore neurodiagnostic services as it relates to scope of practice, professionalism, ethical and legal practices, the operation of the organization, and other health care departments.

J. Explore effective methods of communication with patients, families, and other healthcare professionals.

III. ACNS Guidelines and Their Roles

A. Explain the Standards of Practice for NDT.

B. Discuss ACNS Guidelines necessary for performance of high quality studies.

C. Describe the role of the ACNS Guidelines and their relation to the NDT field.

IV. Neurodiagnostic Technology Specific Terms

A. Define the following terms referring to waveform characteristics: frequency, duration, amplitude, morphology, and location

B. Define the following terms referring to EEG instrumentation: sensitivity, filters, and paper speed

V. Basic Electronics 

A. Differentiate atoms and ions.

B. Define terms, as they relate to NDT: electromotive force, voltage, current, resistance

C. Explain Ohm's Law as it relates to NDT field.

D. Compare and contrast series and parallel circuits.

E. Connect the concepts of impedance as it relates to NDT field.

F. Describe the differential amplifier and its role in the NDT field.

G. Describe common mode rejection and its role in the NDT field.

H. Discuss the Nyquist Theorem and its role in the NDT field.

VI. Electroencephalographic Instrument Settings

A. Explain polarity and how it relates to the EEG.

1. Illustrate the polarity convention.

2. Demonstrate localizing activity based on the polarity convention.

B. Explain montages required to record a high quality EEG: Referential montage, longitudinal bipolar montage, transverse bipolar montage, double-distance montages.

C. Explain the following filter settings on the EEG: high frequency filter settings, low frequency filter settings, time constant settings, frequency response curves.

D. Explain sensitivity settings above and below Guidelines on the EEG.

VII. Lab Protocols for Emergency and Disaster Situations

A. Define the role of health professional in private settings.

B. Define the role of health professional in large (hospital) settings.

C. Describe a disaster plan.

D. Demonstrate universal standard precautions for infection control.

VIII. Head Measurement Using the International 10-20 System

A. Locate anatomical landmarks on a head.

B. Identify measurement steps necessary to complete the International 10-20 System.

C. Define common sources of error in measurements.

IX. Electrodes Application Using the International 10-20 System

A. Apply knowledge of skin preparation to obtain impedances under 5K ohms.

B . Apply electrodes to proper locations on a head.

C. Identify common sources of application errors.

D. Demonstrate application of electrodes using Collodion.

E. Demonstrate application of electrodes using paste.

X. Equipment and Instrumentation

A. Manipulate equipment settings in the lab to adjust EEG accordingly per patient.

B. Differentiate between types of electrodes (gold/silver/ silver-silver chloride, etc.).

C. Assess need to modify and/or document equipment settings as progress through study.

D. Summarize steps required to ensure electrical safety for patient and self.

XI. Patient History

A. Summarize a list of general questions necessary to ask patient.

B. Identify what neurological questions are necessary to ask a patient with regards to study performed.

C. Demonstrate soft-skills and their role in healthcare.

Content Outline and Competencies:

I. Medical Terminology of the Neurological, Respiratory and Cardiovascular Systems

A. Explore medical terminology.

1. Identify word parts, including word roots, suffixes and prefixes

2. Apply steps in defining medical terms

B. Explain the cardiovascular system using appropriate medical terminology. 

1. Provide an overview of the structure and function of the Cardiovascular System

2. Apply appropriate vocabulary pertaining to the Cardiovascular System, including medical terminology and abbreviations related to pathology, pertinent diagnostic studies, treatments and procedures

C. Explain the respiratory system using appropriate medical terminology. 

1. Provide an overview of the structure and function of the Respiratory System

2. Apply appropriate vocabulary pertaining to the Respiratory System, including medical terminology and abbreviations related to pathology, pertinent diagnostic studies, treatments and procedures

D. Explain the nervous system using appropriate medical terminology. 

1. Provide an overview of the structure and function of the Nervous System including the Central Nervous System, the Peripheral Nervous System and the Autonomic Nervous System

2. Apply appropriate vocabulary pertaining to the Nervous System, including medical terminology, and abbreviations related to pathology, pertinent diagnostic studies, treatments and procedures

E. Discuss the effects of pharmacology on the electroencephalogram.

1. Discuss preparing the data sheet for a patient who has neurological or psychological disorders

2. Explore methods to customize the recording procedures for patients who are taking medications for various disorders

3. Predict how the electroencephalogram would be altered for a given disorder

II. Anatomy and Physiology of the Nervous System

A. Correlate the function of the central nervous system to neurodiagnostic procedures.

1. Explain the central nervous system components and functions

2. Determine the cranial nerves including their locations and functions

3. Determine the roles and function of neurons and glial cells

4. Explain the causes and significance of electrical activity in neurons, muscle cells and sensory organs

5. Explain the production, storage and flow of cerebrospinal fluid

6. Understand cerebral blood flow

7. Explore collateral circulation

8. Explore sensory organs and their role in neurodiagnostics

B. Correlate the function of the peripheral nervous system to neurodiagnostic procedures.

1. Discuss the components of the peripheral nervous system

2. Compare and contrast the sympathetic and parasympathetic nervous systems

C. Explore the physiology of sleep medicine.

1. Discuss the elements involved in the generation of sleep, including circadian sleep/wake rhythms and the electrical brain wave/eye movement activity during sleep

2. Describe the neurological control of respiration and heart rate

3. Identify the stages and characteristics of normal sleep

4. Summarize the benefits of sleep and consequences of sleep deprivation

5. Give examples of age-specific sleep patterns

6. Identify normal and abnormal EEG patterns

III. Neuronal Activity and Human Behavior

A. Discuss the relationship between the brain and human behavior.

1. Identify neurotransmitters that play a role in mental health and neurological disorders

2. Explain the how communication occurs at the synapse

3. Discuss how neurotransmitters may be inhibitory, excitatory or a modulator

4. Discuss diseases related to the imbalance in neurotransmitters

B. Explore disease processes that alter human behavior and neuronal activity.

1. Discuss the role of neurotransmitters in the following mental health disorders: anxiety, thought, mood, memory, attention-deficit/hyperactivity and drug addiction

2. Discuss the role of neurotransmitters in neurological disorders such as seizures, brain tumors, stroke, head trauma and narcolepsy

IV. Anatomy and Physiology of the Respiratory System

A. Correlate the function of the respiratory system to neurodiagnostic procedures.

1. Review the respiratory anatomy and physiology of breathing

2. Describe physiological humidification of inspired gas

3. Define capacity as it relates to lung volumes and identify the lung volumes included in each lung capacity

4. Explain the significance of functional residual capacity (FRC) and describe the impact of an increased or decreased FRC

5. Describe the mechanics of normal inspiration and expiration which results in gas flow into and out of the thorax

6. Describe the changes in lung volumes and capacities and expiratory flows with restrictive or obstructive lung disease

7. Explain the physiology of the hypoxic and hypercapnic mechanisms of ventilatory drive

8. Explain the mechanics of breathing and mechanisms of upper airway collapse

9. Describe normal breathing patterns

B. Explore gas transport and acid-base regulation.

1. Describe internal and external gas exchange

2. Describe oxygen and carbon dioxide transport

3. Describe the four types of hypoxia and explain potential causes of each

4. Differentiate between PaO2 and CaO2 and discuss their respective roles in oxygen delivery

5. Relate oxygen saturation with oxygen partial pressure using the oxyhemoglobin dissociation curve (OHDC)

6. List factors causing the OHDC to shift left or right and identify the changes in O2 and hemoglobin (Hb) affinity that occur with associated shift

7. Analyze clinical situations including arterial blood gases (ABG) and recommend appropriate management

8. Define acidosis and alkalosis, acid and base, and buffers.

9. Describe how hydrogen ions (H+) and bicarbonate (HCO3) are regulated by the kidney in acid-base states

10. Identify the four types of acid-base disturbance and state representative causes for each type

11. Describe how the respiratory system and renal systems each compensate for an imbalance in pH

12. Interpret arterial blood gas studies for acid-base balance and oxygenation status

13. Associate possible causes for acid-base imbalance based on ABG interpretation and patient history

14. Determine the appropriate therapeutic action(s) given a clinical situation

IV. Anatomy and Physiology of the Cardiovascular System

A. Correlate the function of the cardiovascular system to neurodiagnostic procedures

1. Review the structures and function of the cardiovascular system

2. Describe pulmonary and systemic responses to hypoxia, hypocapnia and hypercapnia

3.Compare the function of the erythrocytes, leukocytes and thrombocytes of the plasma

4. Describe how blood volume affects blood pressure, stroke volume, heart rate and cardiac output

5. Describe the components of the pulmonary and systemic vascular systems

6. Trace the blood flow beginning at the superior and inferior vena cava through the valves and chambers of the heart

7. Explain the relationship of systole and diastole to the cardiac cycle

8. Determine sympathetic and parasympathetic effects as they relate to the heart

9. Briefly describe the electrical forces involved in membrane potential of the heart

B. Explore electrocardiography for the recognition and management of dysrhythmias.

1. Explain the electrical conduction within the heart and relate this conduction to the resultant EKG impulses

2. Describe the placement of electrodes for 12-lead ECG and for monitoring leads

3. Determine the cardiac rate and recognize normal sinus rhythms and arrhythmias including: atrial, junctional or nodal, heart blocks, ventricular, pulseless electrical activity, asystole, pacemaker and specific changes associated with certain conditions

4. Differentiate between life-threatening and non-life-threatening cardiac rhythms

5. Determine the appropriate therapeutic action(s), BCLS, electrical and pharmacological, given a clinical situation and rhythm

V. Treatment of Neurological and Psychological Disorders

A. Discuss pharmacology for the treatment of neurological and psychological disorders.

1. Explore the use of pharmacology in the treatment of mental health and neurological disorders

2. Identify the classification of specific drugs used to treat mental health and neurological disorders

3. Describe the relationship of the mechanism of action of a drug and the altered state of the neurotransmitters

4. Describe the how the route of administration affects the onset, peak and duration of a medication

B. Discuss effects of pharmacology on the electroencephalogram.

1. Discuss preparing the data sheet for a patient who has neurological or psychological disorders

2. Explore methods to customize the recording procedures for patients taking medications for various disorders

3. Predict how the electroencephalogram would be altered for a given disorder

Content Outline and Competencies:

I. Conceptual Age and Gestational Age

A. Determine conceptual age (CA) of a pediatric patient.

B. Determine gestational age (GA) of a pediatric patient.

C. Determine the corrected age as it relates to the role of a neurodiagnostic technologist.

D. Classify varying levels of development in the pediatric patient.

E. Explain the wake/sleep patterns and continuity of activity on the EEG pattern of a premature newborn (≤ 36 weeks CA).

F. Explain the wake/sleep patterns and continuity of activity on the EEG pattern of a full-term newborn (≥36 weeks CA).

G. Explain the wake/sleep patterns and continuity of activity on the EEG pattern of an infant (2-12 months CA).

H. Differentiate between wake, drowsy, and sleep patterns on the EEG pattern of an early toddler (12-36 months old).

I. Identify normal EEG variants for age for a toddler (12 - 36 months old).

J. Differentiate between wake, drowsy, and sleep patterns on the EEG pattern of a preschool child (3-5 years old).

K. Identify normal EEG variants for a preschool child (3-5 years old).

L. Relate effects of activation procedures on EEG on a preschool child (3-5 years old).

M. Differentiate between wake, drowsy, and sleep patterns on the EEG pattern of an older child (6-12 years old).

N. Identify normal EEG variants for an older child (6-12 years old).

O. Relate effects of activation procedures on EEG on an older child (6-12 years old).

P. Differentiate between wake, drowsy, and sleep patterns on the EEG pattern of an adolescent (13-18 years old).

Q. Identify normal EEG variants for an adolescent (13-18 years old).

R. Relate effects of activation procedures on EEG on an adolescent (13-18 years old).

II. ACNS Guidelines Related to Pediatric Patients

A. Examine technical requirements for performing a clinical EEG

B. Examine technical standards for performing a pediatric EEG.

C. Examine technical standards for EEG recordings in a suspected cerebral death.

D. Explore standards of practice in performing clinical EEGs.

E. Discuss standard electrode position nomenclature.

F. Discuss montages used in performing clinical EEGs.

G. Examine the guidelines for writing EEG reports.

H. Explore recording EEGs on digital media.

III. International League Against Epilepsy (ILAE) Seizure Classification

A. Identify EEG characteristics of focal seizures without impairment of consciousness.

B. Identify EEG characteristics of focal seizures with impairment of consciousness.

C. Identify EEG characteristics of evolving to bilateral, convulsive seizures.

D. Identify EEG characteristics generalized seizures.

IV. Pediatric Specific Seizure EEG Patterns

A. Identify EEG patterns of neonatal seizures.

B. Identify EEG patterns of infantile seizures.

C. Identify EEG patterns of childhood seizures.

D. Identify EEG patterns of adolescent seizures.

E. Correlate EEG patterns and patient behaviors of non-epileptic events (NEE).

V. Ictal and Status Epilepticus EEG Patterns

A. Define ictal events as they relate to the EEG.

B. Define convulsive status epilepticus as it relates to the EEG.

C. Define non-convulsive status epilepticus as it relates to the EEG.

D. Define electrical status epilepticus during slow wave sleep (ESES).

VI. Treatments for Various Seizure Types in Pediatric Patients

A. Explain anti-epileptic medications used for seizure classifications.

B. Explain the use of adrenocorticotrophic hormone (ACTH) and steroids.

C. Summarize the ketogenic diet for the treatment of seizures.

D. Summarize the use of the Vagus Nerve Stimulator (VNS).

E. Describe the role of epilepsy surgery in the pediatric patient.

VII. Sudden Unexpected Death in Epilepsy Patients (SUDEP)

A. Define SUDEP.

B. Differentiate between refractory and controlled epilepsies.

C. Differentiate SUDEP occurrences between children and young adults.

Content Outline and Competencies:

I. Maturation in an Older Pediatric Patient

A. Review pediatric levels of maturation from birth to adolescent.

B. Identify young adult changes on the EEG.

C. Identify older adult changes on the EEG.

D.Compare and contrast varying patterns throughout the lifespan.

II. Wake and Sleep Patterns on the EEG

A. Give examples and expectations of waking EEG.

B. Give examples and expectations of sleeping EEG.

C. Recognize the difference between wake and sleep on the EEG.

III. Drug Induced Changes Seen on the EEG

A. Recognize toxic effects of medications or illicit drugs on the EEG.

B. Determine reasons for patients to need medically induced coma and EEG.

C. Discuss hypothermia protocol and EEG changes.

IV. Headache Classifications

A. Identify migraines and the EEG characteristics.

B. Cite examples of questions for headache patients.

C. Classify headache types and symptoms.

V. ACNS Guidelines

A. Examine technical requirements for performing a clinical EEG

B. Examine technical standards for performing a pediatric EEG.

C. Examine technical standards for EEG recordings in a suspected cerebral death.

D. Explore standards of practice in performing clinical EEGs.

E. Determine standard electrode position nomenclature.

F. Discuss montages used in performing clinical EEGs.

G. Articulate the guidelines for writing EEG reports.

H. Describe recording EEGs on digital media.

VI. International League Against Epilepsy (ILAE) Seizure Classification

A. Identify physical manifestations and EEG characteristics of focal seizures without impairment of consciousness.

B. Identify physical manifestations and EEG characteristics of focal seizures with impairment of consciousness.

C. Identify physical manifestations and EEG characteristics of focal seizures evolving to a bilateral convulsive seizures.

D. Identify physical manifestations and EEG characteristics of generalized seizures.

VII. Patient History

A. Correlate patient history with abnormalities on the EEG recording.

B. Discuss abnormalities as they relate to the patient history.

C. Identify non-epileptic events (NEE) including patient behaviors and patterns on the EEG.

VIII. Ictal and Status Epilepticus EEG Patterns

A. Compare ictal events, convulsive status epilepticus, and non-convulsive status epilepticus EEG patterns.

B. Define electrical status epilepticus during slow wave sleep (ESES).

IX. Treatments for Various Seizure Types

A. Summarize the use of the Vagus Nerve Stimulator (VNS).

B. Discuss the use of surgery in adult patients with epilepsy.

C. Describe the deep brain stimulator (DBS) and its role in epilepsy patients.

X. Sudden Unexpected Death in Epilepsy Patients (SUDEP)

A. Summarize SUDEP in the adult patient.

B. Discuss the neurodiagnostic technologist's role in Epilepsy Monitoring Units (EMUs).

C. Recognize high risk patients for SUDEP.

Content Outline and Competencies:

I. ICU and Continuous Bedside EEG Monitoring

A. Differentiate EEG monitoring of children during routine clinical studies and ICU monitoring.

B. Discuss indications for EEG monitoring in critically ill children.

C. Modify headset application based on lab protocols.

D. Apply knowledge of normal and abnormal EEG activity to pediatric patients and conditions.

II. Encephalitis: Clinical Features and EEG Changes

A. Identify clinical features of encephalitis.

B. Explain focal discharges on the EEG related to encephalitis.

C. Explain widespread discharges on the EEG related to encephalitis.

D. Compare and contrast EEG recordings of a patient with encephalitis to that of a 'normal' pattern (same age.)

III. Toxic and Metabolic Disorders: Clinical Features and EEG Changes

A. Identify varying types of metabolic and toxic disorders.

B. Explain focal discharges on the EEG related to toxic and metabolic disorders.

C. Explain widespread discharges on the EEG related to toxic and metabolic disorders.

D. Compare and contrast EEG recordings of a patient with toxic and metabolic disorders to that of a 'normal' patterns (same age.)

E. Demonstrate appropriate infection control procedures during patient interactions.

IV. Developmental Birth Defects: Clinical Features and EEG Changes

A. Discuss the clinical features and EEG changes seen in patients with varying types of developmental birth defects.

B. Correlate the types of defects to other malformations.

C. Discuss the type of defects as it relates to life expectancy of patient.

D. Compare and contrast EEG recordings of a patient with developmental birth defects with 'normal' patterns (same age.)

V. Infectious Processes: Clinical Features and EEG Changes

A. Demonstrate appropriate infection control procedures during patient interactions.

B. Discuss the EEG changes related to Herpes Simplex. Meningitis, Brain, Abscess, fungal infections and parasitic infestation.

C. Explain the role of the EEG in the care of patients with an infection process.

VI. Degenerative Processes, Clinical Features and EEG Changes

A. Compare and contrast the EEG characteristics in patients with Niemann-Picks, Batten's, and Sturge-Weber disease.

B. Explain the role of the EEG in the care of pediatric patients with degenerative diseases.

VII. Intracranial Lesions: Clinical Features and EEG Changes

A. Explain focal discharges on the EEG related to intracranial lesions.

B. Explain widespread discharges on the EEG related to intracranial lesions.

C. Discuss EEG changes with varying types of head trauma.

D. Identify tumors more commonly seen in pediatric populations.

E. Discuss treatments of varying types of intracranial lesions.

VIII. Genetic Disorders: Clinical Features and EEG Changes

A. Discuss infantile spasms and genetic disorders.

B. Discuss myoclonic epilepsies and genetic disorders.

C. Discuss absence seizures and genetic disorders.

IX. Clinical Features of Psychiatric Disorders

A. Compare EEG changes and behaviors in patients with conversion disorders

B. Use critical judgment when collecting a history from a patient with conversion disorder.

C. Identify when to use provocative methods to trigger seizures.

X. Clinical Features of Cerebral Vascular Accidents

A. Define types of cerebral vascular accidents.

B. Discuss pediatric central nervous system (CNS) plasticity.

C. Compare outcomes after cerebral vascular accidents of adult and pediatric populations.

D. Discuss outcomes of cerebral vascular accidents dependent on area of brain involved.

E. Explain changes on the EEG commonly seen in cerebral vascular accidents.

XI. Differential Diagnosis and the Role of the EEG

A. Correlate cardiogenic syncopes and changes in the EEG recording.

B. Correlate breath-holding spells and changes in the EEG recording.

C. Correlate movement disorders and changes in the EEG recording.

Content Outline and Competencies:

I. Normal EEG Patterns Across the Lifespan

A. Compare Alpha, Beta, Theta, and Delta waves related to frequency, morphology and location,

B. Differentiate Alpha, Beta, Theta, and Delta waves in various ages and health states.

II. Abnormal EEG Patterns

A. Explain spikes on the EEG in regards to frequency, morphology, and duration.

B. Explain sharps on the EEG in regards to frequency, morphology, and duration.

C. Explain slow waves on the EEG in regards to frequency, morphology, and duration.

III. Artifacts on the EEG

A. Differentiate muscle artifact from fast EEG activity

B. Differentiate eye movement artifact from normal/abnormal EEG activity.

C. Contrast electrocardiogram (ECG) artifact and normal/abnormal EEG activity.

IV. Activation Procedures of Performing an EEG

A. Summarize the use of hyperventilation, photic stimulation, and sleep deprivation for and EEG recording.

B. Discuss care and safety of the patient while using hyperventilation, photic stimulation, and sleep deprivation strategies.

V. EEG Activity for Immediate Interpretation

A. Discern normal and abnormal activity during neurodiagnostic studies.

B. Determine if activity is epileptiform in nature.

C. Determine if activity is rhythmic and advancing towards an ictal event that requires attention.

Content Outline and Competencies:

I. Patient

A. Verify NDT study order and protocol needed.

B. Determine special precautions related to infection control and other patient-specific factors.

C. Clarify unclear or contradictory orders.

D. Interview patient to gain information for patient data sheet.

II. NDT Procedures

A. Anticipate special testing considerations or medical interventions that may be needed based on patient interview.

B. Explain testing procedure to patient in appropriate terms for patient age, mental or cognitive status.

C. Discuss activation procedures (photic stimulation, hyperventilation, sleep deprivation) to be completed during study with patient.

D. Discuss any post-test procedures with patient in appropriate terms for patient age, mental or cognitive status.

E. Assemble necessary materials to perform technically acceptable study.

F. Utilize appropriate communication skills when working with patients of all ages.

G. Review all NDT modalities.

III. NDT Equipment

A. Evaluate proper function of NDT equipment (calibrate the instrument) and assure there is an appropriate signal (according to guidelines) to the equipment.

B. Interpret American Clinical Neurophysiology Society (ACNS) Guidelines appropriate for each individual study performed.

C. Demonstrate troubleshooting techniques necessary to ensure patient safety.

D. Demonstrate knowledge of instrument settings (i.e. sensitivity, filters, paper speed, montages, etc.) necessary to perform technically acceptable study.

E. Summarize analog to digital conversion.

F. Illustrate polarity convention.

G. Demonstrate calculations to determine voltage, duration, and frequency.

H. Summarize the role of the differential amplifier as it relates to the NDT field.

IV. International 10-20 System of Head Measurement

A. Measure and mark a patient's head in 20 minutes or less using the International 10-20 System.

B. Apply recording electrodes to a patient's head 35 minutes or less using the International 10-20 System.

C. Demonstrate electrode impedances are balanced and less than 5K ohms, according to ACNS Guidelines (within the 35 minutes of application).

D. Demonstrates knowledge of electrode placement in the event of anatomical defects or anomalies.

V. Electroencephalographic Activity

A. Differentiate between normal and abnormal activity on the study (age appropriate).

1. Seizure classifications

2. Seizure signs

3. Benign EEG variants

B. Differentiate between wake and sleep activity on the study (age appropriate).

D. Document all activity performed by the patient during the study.

VI. Physician Intervention

A. Assess need to contact physician based on activity levels on study.

B. Determine appropriate ACNS Guideline to follow based on patient data.

C. Explain patient safety guidelines (lab protocols) for patient in need of intervention.

D. Determine if an activation procedure is contraindicated based on patient interview.

VII. Medical Terminology

A. Demonstrate understanding of prefixes and suffixes and word roots.

B. Demonstrate understanding of abbreviations commonly used.

C. Recognize other procedure names and their purpose in diagnosis.

VIII. Neuroanatomy and Neurophysiology

A. Demonstrate knowledge of various disease processes when performing NDT procedures.

B. Compare EEG activity with knowledge of intracranial structures to determine if activity is in normal or abnormal range.

C. Apply knowledge of ECG waveforms for interpretation of heart beats.

IX. NDT Studies

A. Breakdown physician interpretation of studies performed.

B. Compare and contrast physician interpretation of studies with student/technologist interpretation of studies.

C. Evaluate differences between physician and student/technologist interpretation.

X. NDT Professional Standards and Patient Safety and Emergency Procedures

       A. Comply with the American Clinical Neurophysiology Society Guidelines for Neurodiagnostic Technology.

       B. Follow laboratory and procedural protocols, guideline, and standards regarding safety and infection control issues. 

        C. Demonstrate effective written, non-verbal and verbal communication skills.

        D. Maintain a professional demeanor and interactions at all times with staff, supervisor, patients, and other health care professionals. 

E. Maintain professional responsibilities as they relate to attendance, punctuality, appearance, conduct, and continuing education activities.

        F. Recognize personal limitations and demonstrate ability to follow directions.

        G. Recognize and respond to patient safety and emergency situations. 

      H Integrate logistical approaches to improve timing, efficiency, and decision making without compromise to patient care in completing assigned activities. 

Content Outline and Competencies:

I. History and Overview of Sleep Medicine

A. Summarize the scope of practice of sleep medicine and technology.

B. Explain the purpose of the professional, accreditation and licensing agencies associated with the sleep profession, including the American Academy of Sleep Medicine (AASM), Association of Polysomnographic Technologists (APT), Commission on Accreditation of Allied Health Programs (CAAHEP), and Board of Registered Polysomnographic Technologist (BRPT).

II. Neuroanatomy and Physiology and Normal Sleep Mechanisms

A. Explain brain structure and function as it relates to the generation of sleep, including circadian sleep/wake rhythms and the electrical brain wave/eye movement activity seen during sleep.

B. Describe the neurological control of breathing and the heart.

C. Discuss the stages of normal sleep.

D. Describe the characteristics of normal sleep architecture.

E. Summarize the benefits of sleep and consequences of sleep deprivation.

F. Discuss age-specific sleep patterns.

III. Respiratory Anatomy and Physiology

A. Review respiratory anatomy and physiology.

B. Describe physiologic humidification of inspired gas.

C. Define capacity as it relates to lung volumes.

D. Identify the lung volumes included in each lung capacity.

E. Describe the mechanics of normal inspiration and expiration which result in gas flow into and out of the thorax.

F. Describe the changes in lung volumes, lung capacities and expiratory flows with restrictive or obstructive lung disease.

G. Explain the physiology of the hypoxic and hypercapnic mechanisms of ventilatory drive.

H. Explain the mechanics of breathing and upper airway collapse.

I. Describe normal and abnormal breathing patterns.

IV. Cardiovascular Anatomy and Physiology

A. Review the structures and function of the cardiovascular system.

B. Discuss pulmonary and systemic responses to hypoxia, hypocapnea and hypercapnea.

C. Compare the function of the erythrocytes, leukocytes and thrombocytes of the plasma.

D. Illustrate how blood volume affects blood pressure, stroke volume, heart rate, and cardiac output.

E. Examine the components of the pulmonary and systemic vascular systems.

F. Trace blood flow beginning at the superior and inferior vena cava through the valves and chambers of the heart.

G. Explain the relationship of systole and diastole to the cardiac cycle.

H. Discuss sympathetic and parasympathetic effects as they relate to the heart.

I. Describe the electrical forces involved in membrane potentials of the heart.

V. Gas Transport and Acid-base Regulation

A. Explain internal and external gas exchange.

B. Describe oxygen and carbon dioxide transport.

C. Describe the four types of hypoxia including potential causes of each.

D. Differentiate between partial pressure of oxygen in arterial blood (PaO2) and arterial oxygen content (CaO2).

E. Discuss the roles of PaO2 and CaO2 in oxygen delivery.

F. Relate oxygen saturation with oxygen partial pressure using the oxyhemoglobin dissociation curve (OHDC).

G. List factors causing the OHDC to shift left or right.

H. Identify the changes in oxygen and hemoglobin affinity that occur with a left and right shift.

I. Define acidosis and alkalosis; acid and base; and buffers.

J. Describe how hydrogen ions (H+) and bicarbonate (HCO3) are regulated by the kidney in acid-base states.

K. Identify the four types of acid-base disturbance including causes for each type.

L. Describe how the respiratory and renal systems each compensate for an acid-base (pH) imbalance.

M. Interpret arterial blood gas studies for acid-base balance and oxygenation status.

N. Associate possible causes for identified arterial blood gases (ABGs) based on ABG interpretation and patient history.

O. Determine the appropriate therapeutic action(s) for a patient with an abnormal ABG.

VI. Electrocardiography Recognition and Management

A. Describe the electrical conduction within the heart and relate this conduction to the resultant EKG impulses.

B. Compare the placement of electrodes for 12 lead ECG and monitoring leads.

C. Determine the cardiac rate and recognize normal sinus rhythms and arrhythmias, including: 

1. Atrial

2. Junctional or nodal

3. Heart blocks

4. Ventricular

5. Pulseless electrical activity

6. Asystole

7. Pacemaker

8. Specific changes associated with certain conditions

D. Differentiate between life threatening and non-life threatening cardiac rhythms.

E. Determine the appropriate therapeutic action (s), (basic cardiac life support, electrical and pharmacological), given a clinical situation and rhythm.

VII. Overview of the Pathophysiology and Nosology of Sleep Disorders

A. Identify the major categories of sleep disorders according to the International Classification of Sleep Disorders.

B. Describe the signs and symptoms associated with major categories of sleep and arousal disorders.

C. Summarize the major categories of sleep and arousal disorders based on age-specific criteria.

VIII. Sleep Disorders and Associated Conditions

A. Describe the etiology, clinical presentation, diagnosis and therapeutic interventions associated with insomnias, to include:

1. Psychophysiologic insomnia

2. Idiopathic insomnia

3. Insomnia due to medical disorder/condition

4. Inadequate sleep hygiene

5. Behavioral insomnia of childhood

B. Describe the etiology, clinical presentation, diagnosis and therapeutic interventions associated with sleep related breathing disorders, to include:

1. Central sleep apnea syndromes

2. Obstructive sleep apnea syndromes

3. Sleep-related hypoventilation/hypoxemic syndromes

C. Describe the etiology, clinical presentation, diagnosis and therapeutic interventions associated with hypersomnias of central origin, to include:

1. Narcolepsy

2. Recurrent hypersomnia

3. Idiopathic hypersomnias

4. Behaviorally induced insufficient sleep syndrome

5. Hypersomnia due to medical condition, drug or substances

D. Describe the etiology, clinical presentation, diagnosis and therapeutic interventions associated with circadian rhythm sleep disorders, to include:

1. Advanced/delayed sleep phase types

2. Irregular sleep-wake type

3. Shift work type

4. Associated with medical condition

E. Describe the etiology, clinical presentation, diagnosis and therapeutic interventions associated with parasomnias, to include:

1. Disorders of arousal

2. Parasomnias usually associated with rapid eye movement (REM) sleep

3. Other parasomnias

F. Describe the etiology, clinical presentation, diagnosis and therapeutic interventions associated with sleep related movement disorders, to include:

1. Restless legs syndrome

2. Periodic limb movement (PLM) Disorder

3. Sleep related leg cramps

4. Sleep related bruxism

5. Sleep related rhythmic movement disorder

6. Associated with medical condition, drugs or substances

G. Describe the etiology, clinical presentation, diagnosis and therapeutic interventions associated with other variant conditions associated with sleep disorders, to include:

1. Long/short sleeper

2. Snoring

3. Sleep Ssarts

4. Sleep talking—phonation

5. Hypnagogic foot tremor and alternating leg muscle activation

6. Excessive fragmentary myoclonus

7. Sleep related epilepsy

8. Sleep related gastroesophageal reflux disease

9. Fibromyalgia

10. Mood, anxiety, and psychotic disorders

H. Correlate etiology, clinical presentation, diagnosis, and therapeutic interventions with observed sleep study activities.

IX. Therapeutic Interventions Related to Sleep Medicine

A. Describe the types of surgical, non-surgical and behavioral treatment modalities commonly used to treat disorders.

B. Describe the purpose, indications, contraindications and complications associated with oxygen and positive airway pressure (PAP) therapy.

C. Recommend intervention and titration of O2 and/or PAP therapy based on written protocols when given a clinical scenario.

D. Demonstrate the ability to set-up, administer, and titrate O2 and PAP levels based on clinical protocols.

E. Describe the artifacts commonly seen during the therapeutic phase of the study.

F. Determine and take appropriate corrective action to assure proper signal display during the therapeutic phase of the study.

G. Identify the commonly used pharmacological interventions used to treat sleep disorders, including narcolepsy, restless leg syndrome, and periodic leg movements.

H. Describe the prominent patient care issues relating to PAP devices, such as patient adherence and fit of masks.

I. Describe and demonstrate the procedure for properly cleaning and maintaining therapeutic equipment.

J. Chart the general indications, contraindications, potential side effects and mechanism of action for each of the drug classifications related to sleep disorders.

K. Discuss the ways in which medications can affect the sleep/wake cycle or alter the recorded sleep/wake data.

L. Differentiate between the drugs used to treat sleep/wake disorders and drugs that commonly alter the recorded sleep/wake data.

X. PSG Instrumentation

A. Explain the frequency and voltage characteristics of electro-oculogram (EOG), electromyogram (EMG), and electrocardiogram (ECG).

B. Describe the cleaning, disinfecting and sterilizing methods used for equipment including evaluation of effectiveness of these methods.

C. Describe issues regarding safe use of equipment, to include equipment selection, preventive maintenance, quality improvement and practitioner competency.

D. Prepare sample montages indicating the channel derivation and how they differ for referential and bipolar recordings.

E. Explain PSG signal calibration.

F. Discuss the origins of artifact and artifact elimination.

G. Summarize the effect of different time bases on the PSG signal display.

H. Explain the principles of operation for amplifiers, transducers, airflow sensors, respiratory and abdominal effort sensors, snore sensors, position sensors, capnometers, and oximeters as they related to sleep diagnostics.

I. Give examples of interfacing devices with the acquisition system.

J. Give examples of methods of data storage and retrieval.

K. Describe issues regarding safe use of equipment including equipment selection, preventive maintenance, quality improvement and practitioner competency.

XI. Ancillary Equipment

A. Distinguish the variety of ancillary equipment devices used in polysomnography and their principles of operation including capnometers, esophageal pressure monitors, audio visual equipment, esophageal Ph meters, actigraphy, audiovisual equipment, and extended electroencephalogram (EEG).

B. Choose ancillary equipment with respect to various contexts (referring diagnoses, patient characteristics, and PSG protocols.)

C. Connect ancillary equipment to the acquisition system according to hardware and software specifications, and to the patient in a manner appropriate to the patient (re: age, gender, medical & psychological conditions.)

D. Differentiate normal vs. abnormal, or erroneous vs. true data recorded by ancillary equipment.

E. Recommend amplifier parameters for ancillary equipment, appropriate to various contexts (patient's medical history/condition, PSG events and artifacts.)

F. Describe issues regarding safe use of equipment, to include equipment selection, preventive maintenance, quality improvement and practitioner competency.

XII. Patient and Equipment Preparation Procedures

A. Determine which components of the medical and physical history are necessary to recognize a sleep-related complaint in patients of all age ranges.

B. Give examples of categories of medications and substances that have an effect on sleep architecture and sleep-disordered breathing.

C. Verify the medical order and protocol and evaluate the appropriateness of ordered procedures and treatments.

D. Demonstrate the ability to gather the appropriate medical and physical history necessary in preparing for a sleep related study.

E. Conclude which types of patients may require special precautions.

F. Give examples of routine patient safety precautions.

G. Explain the routine PSG protocols including multiple sleep latency test (MSLT), maintenance of wakefulness test (MWT), PAP PSG, as applied across all age ranges.

H. Describe pre-testing, testing, and post-testing procedures to the patient in terms appropriate for the patient's age, physical, mental, emotional or cognitive status.

I. Give examples of signs and behaviors that determine the patient's level of toleration and cooperation.

J. Describe the assessment of the patient necessary to correlate the clinical presentation with the medical record and history.

K. Determine electrode location for EEG, EOG, ECG, EMG across patient age ranges and conditions.

L. Summarize the principles of site preparation and attachment of electrodes across patient age ranges and conditions.

XIII. Monitoring and Documentation

A. Differentiate between an overnight PSG, a split night study and a portable.

B. Set-up a sleep montage consistent with the type of test requested.

C. Describe and demonstrate the location and attachment of sensors and routine ancillary equipment to the patient.

D. Summarize the indications, contraindications and limitations associated with the use of particular types of sleep recording/monitoring devices.

E. Select the appropriate equipment monitors required for practitioner-ordered testing.

F. Prepare, calibrate and adjust equipment required for testing to assure proper function.

G. Describe the purpose and procedure for performing a bio calibration.

H. Verify appropriate function for each electrode and make appropriate corrective action, as indicated.

I. Interface electrodes, sensors, and ancillary equipment to the data acquisition and recording system.

J. Label recordings with appropriate demographic and study information.

K. Follow "lights out" procedures to establish and document baseline values, such as body position, oxyhemoglobin saturation, respiratory and heart rates.

L. Identify and describe PSG events and their associated characteristics.

M. Describe the procedure for documenting and reporting routine observations, clinical events, changes in procedure/protocol, and other significant events.

N. Describe the purpose and procedure of making adjustments to the time base on the PSG signal display during the monitoring phase.

O. Describe and demonstrate appropriate removal of electrodes and other equipment.

P. Describe and demonstrate proper procedure for cleaning and maintaining sleep monitoring equipment.

Q. Communicate and conduct post-study assessments with the patient.

XIV. Protocols for Monitoring and Scoring

A. Differentiate between hypopnea and apnea.

B. Describe the general characteristics of upper airway resistance syndrome (UARS), primary snoring, Cheyne-Stokes, and periodic breathing.

C. Categorize abnormal respiratory events according to the definitions and sub classifications of apnea, hypopnea, hypoventilation, periodic breathing, Cheyne-Stokes respiration and UARS.

D. Describe the methods and techniques for scoring cardiac-related and respiratory related events.

E. Distinguish between central, mixed, and obstructive apnea.

F. Differentiate between normal and abnormal oxyhemoglobin saturation using oximetry data.

G. Differentiate artifact from arousals and abnormal results on cardiac-related and respiratory-related tracings and in identifying epileptiform or seizure activity.

H. Discuss common errors in evaluating respiratory and cardiac events on a PSG study.

I. Devise a plan to troubleshoot causes of artifact and common equipment problems.

J. Describe and differentiate characteristics of the various complexes, spindles, waves, and activity associated with sleep study activity.

K. Explain various types of adult and pediatric procedures for advanced PSG monitoring including bi-level PAP, nasal intermittent positive pressure ventilation (NIPPV), Pes, pH, parasomnia and seizure investigation.

L. Apply professionally accepted guidelines to differentiate between sleep stages, wake and sleep sub-classifications, arousals and in the use of scoring criteria.

M. Integrate new information such as age-specific EEG characteristics, EEG arousals, and alpha-intrusion to customize the sleep scoring rules to each clinical scenario.

N. Integrate sleep staging data, events-related data, and arousal data to calculate indices for report generation.

O. Calculate sleep onset, percent sleep stages, total recording time, total movement time, REM onset, and arousals using sleep/wake data.

P. Identify common errors in performing calculations on sleep/wake data.

Q. Verify the accuracy of a computer generated report by manually calculating latencies, percentages, and indices.

R. Explain the components of a PSG report.

S. Demonstrate the ability to prepare a sleep report for interpretation by the physician.

T. Differentiate between the pathophysiologic disorders based on their associated clinical and polygraphic signs and symptoms.

XV. Arousals and Periodic Limb Movement

A. Differentiate between artifact, movement-related, respiratory effort related arousals (RERAs), respiratory and spontaneous arousals

B. Describe the methods and techniques for monitoring and scoring PLM and non-PLM related events.

C. Apply professionally accepted criteria to classify limb movements associated with arousals.

D. Apply professionally accepted scoring criteria for arousals and sleep/wake data.

XVI. Pediatric/Infant Sleep Studies

A. Discuss normal developmental aspects of infant and children sleep.

B. Discuss methods used to interpret pediatric/infant sleep studies.

C. Describe the criteria used to score pediatric/infant sleep studies.

D. Identify the types of sleep studies that can be performed on a pediatric/infant.

E. Discuss the major challenges and limitations associated with performing a sleep study on a pediatric/infant.

G. Describe the most commonly encountered sleep disorders in infants and children.

G. Discuss the most common types of therapies and interventions used to treat infants and children with sleep disorders.

XVII. Multiple Sleep Latency Testing (MSLT)/Maintenance of Wakefulness Testing(MWT)

A. Describe the indications for performing a MSLT/MWT.

B. Describe the procedure for preparing a patient for a MSLT or MWT.

C. Describe the similarities and differences between the MSLT and MWT.

D. Describe the procedure for performing MSLT or MWT.

E. Describe the criteria for terminating, evaluating, and scoring MSLT/MWT.

F. Identify common errors in evaluating sleep/wake MSLT/MWT data.

G. Compare MSLT/MWT results to established norms and determine clinical significance of analysis results.

H. Apply professionally accepted scoring guidelines to MSLT/MWT.

Content Outline and Competencies:

I. Neurological Conditions and EEG Abnormalities

A. Compare and contrast rhythmic delta activity (IRDA)variations, periodic epileptiform discharge (PED) variations, and triphasic waves seen on the EEG.

B. Compare neurological clinical conditions with the EEG abnormalities.

II. Neuro-Imaging

A. Compare Wada testing, magnetic resonance imaging (MRI), and computerized tomography (CT).

B. Discuss the use of Wada testing , MRI, and CT in the NDT field.

III. Intensive Care Unit (ICU) and Continuous Bedside EEG Monitoring.

A. Differentiate EEG monitoring of adults in the ICU.

B. Identify indications for EEG monitoring in critically ill adults.

C. Modify headset application based on lab protocols.

D. Apply knowledge of normal and abnormal EEG activity to individual patients and conditions.

IV. Intracranial Lesions

A. Compare and contrast varying types of tumors and how they affect the brain.

B. Compare treatment for varying tumor types and how they affect the EEG.

C. Explain cerebral vascular accidents (CVAs) and how they affect the EEG.

D. Explain arteriovenous malformation (AVMs) and how they affect the EEG.

E. Explain head trauma and how it may affect the EEG.

V. Encephalitis and Attributing Metabolic or Toxic Processes

A. Identify clinical features of encephalitis.

B. Explain widespread discharges on the EEG of a patient with encephalitis.

C. Reconstruct the use of hypothermia protocols in anoxic encephalitis.

D. Explain the relationship of  organ failure (i.e. kidney, liver, dialysis, etc) to encephalopathies.

E. Correlate encephalopathies to other disease processes.

VI. Degenerative Diseases

A. Compare Parkinson's, Alzheimer's, Amyotrophic Lateral Sclerosis, and Multiple Sclerosis.

B. Correlate changes seen on the EEG with diseases such as Parkinson's, Alzheimer's, Amyotrophic Lateral Sclerosis, and Multiple Sclerosis.

VII. Infectious Diseases

A. Compare and contrast bacterial, fungal, and viral meningitis.

B. Explain how slow-virus encephalitis such as Subacute Sclerosing Panencephalitis (SSPE), Creutzfeldt - Jakob disease (CJD), and Progressive Multifocal Leukoencephalitis (PML.)

C. Explain changes on the EEG related to Acquired Immune Deficiency Syndrome (AIDS.)

D. Investigate Herpes Simplex Encephalitis (HSE.)

VIII. ACNS Guideline 3 (Minimum Technical Standards for EEG Recording in Suspected Cerebral Death)

A. Discuss the minimum requirements for recording in suspected cerebral death cases.

B. Outline steps necessary for eligibility to record exam.

C. Recognize differences between routine EEG and electrocerebral inactivity (ECI) recording.

IX. Psychiatric Disorders

A. Discuss the role of the neurodiagnostic technologist in performing an EEG on a patient with conversion disorders.

B. Document non-epileptic events (NEE.)

C. Demonstrate therapeutic interaction with depressed epileptic patients.

X. Differential Diagnosis

A. Inventory movement disorders.

B. Relate differential diagnosis in a patient with cardiac involvement.

C. Discriminate how the EEG is used in non-responsive patients in ICU settings.

XI. American Board of Electroencephalographic Technologists (ABRET) Exam

A. Validate the role instrument settings play in EEG recordings.

B. Summarize American Clinical Neurophysiology Society (ACNS) Guidelines relevant for performing technically adequate EEGs for interpretation.

C. Differentiate between normal and abnormal electrical activity (including variants).

D. Explain seizure classifications according to the International League Against Epilepsy (ILAE).

E. Compare disease processes for pediatric and adult populations.

F. Explain structural anatomy of brain and spinal cord.

G. Outline anti-epileptic medications use and implications for the neurodiagnostic technologist during an EEG recording.

Content Outline and Competencies:

I. Patient

A. Verify NDT study order and protocol needed.

B. Adapt to special precautions related to infection control and other patient-specific factors.

C. Question unclear or contradictory orders.

D. Interview patient to gain information for patient data sheet.

II. NDT Procedures

A. Recognize and anticipate any special testing considerations or medical interventions that may be needed based on patient interview.

B. Explain testing procedure to patient in appropriate terms for patient age, mental or cognitive status.

C. Discuss activation procedures (photic stimulation, hyperventilation, sleep deprivation) to be completed during study with patient.

D. Discuss any post-test procedures with patient in appropriate terms for patient age, mental or cognitive status.

E. Assemble necessary materials to perform technically acceptable study.

F. Utilize soft skills necessary when working with patients of all ages.

G. Review all NDT modalities.

III. NDT Equipment

A. Evaluate proper function of NDT equipment (calibrate the instrument) including an appropriate signal (according to guidelines) to the equipment.

B. Interpret American Clinical Neurophysiology Society (ACNS) Guidelines appropriate for each individual study performed.

C. Demonstrate troubleshooting techniques necessary to ensure patient safety.

D. Demonstrate knowledge of instrument settings (i.e. sensitivity, filters, paper speed, montages, etc.) necessary to perform technically acceptable study.

E. Summarize analog to digital conversion.

F. Illustrate polarity convention as it applies to NDT.

G. Define calculations to determine voltage, duration, and frequency.

H. Summarize the role of the differential amplifier as it relates to the NDT field.

IV. International 10-20 System of Head Measurement

A. Measure and mark a patient's head in 10 minutes or less using the International 10-20 System.

B. Apply recording electrodes to a patient's head 20 minutes or less using the International 10-20 System.

C. Demonstrate electrode impedances are balanced and less than 5K ohms, according to ACNS Guidelines (within the 20 minutes of application.)

D. Demonstrates knowledge of electrode placement in the event of anatomical defects or anomalies.

V. Electroencephalographic Activity

A. Differentiate between normal and abnormal activity on the study (age appropriate.)

1. Seizure classifications

2. Seizure signs

3. Benign EEG variants

B. Differentiate between wake and sleep activity on the study (age appropriate.)

C. Document all activity performed by the patient during the study.

VI. Physician Intervention

A. Assess need to contact physician based on activity levels on study.

B. Determine appropriate ACNS Guidelines to follow based on patient data.

C. Explain patient safety guidelines (lab protocols) for patient in need of intervention.

D. Determine if an activation procedure is contraindicated based on patient interview.

VII. Medical Terminology

A. Demonstrate understanding of prefixes and suffixes and word roots.

B. Demonstrate understanding of abbreviations commonly used.

C. Recognize other procedure names and their purpose in diagnosis.

VIII. Neuroanatomy and Neurophysiology

A. Consider effects of varying disease processes on the EEG.

B. Compare EEG activity with knowledge of intracranial structures to determine if activity is in normal or abnormal range.

C. Apply knowledge of ECG waveforms for interpretation of heart beats.

IX. NDT Studies

A. Paraphrase physician interpretation of studies performed.

B. Compare and contrast physician interpretation of studies with student/technologist interpretation of studies.

C. Evaluate differences between physician and student/technologist interpretation.

X. NDT Professional Standards and Patient Safety and Emergency Procedures

       A. Comply with the American Clinical Neurophysiology Society Guidelines for Neurodiagnostic Technology.

       B. Follow laboratory and procedural protocols, guideline, and standards regarding safety and infection control issues. 

        C. Demonstrate effective written, non-verbal and verbal communication skills.

        D. Maintain a professional demeanor and interactions at all times with staff, supervisor, patients, and other health care professionals. 

           E. Maintain professional responsibilities as they relate to attendance, punctuality, appearance, conduct, and continuing education activities.

        F. Recognize personal limitations and demonstrate ability to follow directions.

        G. Recognize and respond to patient safety and emergency situations. 

          H Integrate logistical approaches to improve timing, efficiency, and decision making without compromise to patient care in completing assigned activities. 

Content Outline and Competencies:

I. Evoked Potentials

A. Visual evoked potentials

1. Discuss instrument settings used for routine visual evoked potentials.

2. Explain visual evoked potential electrode application.

3. Differentiate values in routine visual evoked potentials.

B. Brainstem Auditory Evoked Responses

1. Discuss instrument settings used for routine brainstem auditory evoked responses.

2. Explain brainstem auditory evoked response electrode application.

3. Differentiate values in routine brainstem auditory evoked responses.

C. Somatosensory Evoked Potentials

1. Discuss instrument settings used for routine upper extremity somatosensory evoked potential studies.

2. Discuss instrument settings used for routine lower extremity somatosensory evoked potential studies.

3. Explain upper extremity somatosensory evoked potential electrode application.

4. Explain lower extremity somatosensory evoked potential electrode application.

5. Differentiate normal and abnormal values caused by improper somatosensory evoked potential electrode application.

II. Nerve Conduction Studies

A. Overview of nerve conductionstudies

1. Explain the pathophysiology of nerve conduction.

2. Explain the principles of motor nerve conduction studies.

3. Explain the principles of sensory nerve conduction studies.

4. Categorize normal and abnormal values of motor nerve conduction studies.

5. Categorize normal and abnormal values of sensory nerve conduction.

B. Technique

1.Show accurate placement of electrodes and stimulators for nerve conduction studies.

2. Explain the physiologic parameters involved in nerve conduction studies.

3. Discuss neuromuscular disorders and the rationale for nerve conduction study for each.

III. Continuous EEG (cEEG) Monitoring at the Bedside

A. Distinguish interictal from ictal activity.

B. Discuss the use of cEEG for patients with psychogenic nonepileptic seizures (PNES).

C. Distinguish ictal activity from status epilepticus.

IV. Electrocorticography (Ecog) Studies Utilizing Indwelling Electrodes

A. Explain the role of EcogS in NDT.

B. Explain the placement of indwelling and cortical (grid) electrodes.

C. Construct infection control procedures.

D. Demonstrate providing a safe environment for a patient with an indwelling electrode.

E. Describe special instrumentation settings required for EcgoS.

V. Long Term Monitoring (LTM) in the Epilepsy Monitoring Unit (EMU)

A. Discuss role of LTM in diagnosis of patient.

1. Demonstrate accurate documentation of patient’s behaviors.

2. Explain the role of video recording during LTM stay in EMU for evaluation of patient’s events.                  

B. Discuss patient’s safety during EMU stay.

1. Explain medication withdrawal for provocation of seizures.

2. Recognize medication withdrawal in patients.

3. Summarize potential hazards for patients in the EMU.

4. Relate Joint Commission (JC), American Epilepsy Society and National Association of Epilepsy Centers safety guidelines for inpatient stays.

VI. ICU EEG monitoring

A. Discuss role of EEG in therapeutic hypothermia.

B. Discuss EEG monitoring in the ICU.

C. Explain EEG pattern determinants that would require contain the physician for immediate interpretation.

VII. Amplitude Integrated EEG (aEEG)

A. Discuss role of aEEG in neonatal patients.

B. Differentiate between aEEG and cEEG.

C. Identify the role of the EEG technologist in aEEG.

VIII. Evoked Potentials During Intraoperative Neurophysiologic Monitoring

A. Compare a routine evoked potentials with an evoked potentials in the operating room (OR).

B. Discuss circumstances that would require a free running electromyography (EMG) in the OR.

C. Discuss the role and use of evoked potentials in the OR.

IX. Discuss Ecog During Intraoperative Neurophysiologic Monitoring

A. Differentiate Ecog during intraoperative monitoring and an EcogS post electrode implantation.

B. Discuss the role of Ecog in epilepsy surgery.

X. Discuss Autonomic Testing

A.  Discuss disorders of the autonomic system in pediatrics.

B. Discuss autonomic testing as it related to the neurology field.

C. Discuss the use of a transcranial Doppler.

Content Outline and Competencies:

I. Knowledge, Technical Proficiency, and Behaviors of NDT

A. Show knowledge of analyzing pre-testing information.

B. Demonstrate knowledge necessary to identify normal and abnormal electroencephalographic (EEG) activity.

C. Execute NDT studies with technical proficiency.

D. Exhibit professional behaviors.

E. Provide appropriate patient support and education.

II. NDT Clinical Applications

A. Connect diagnostic studies performed with patient case presentation.

B. Review patient history in anticipation of recorded activity.

C. Relate diagnosis to activity seen on NDT recordings.

D. Correlate activity seen during NDT recordings with diagnosis.

III. NDT Waveform Presentations of Patients in Across the Lifespan

A. Summarize waveforms seen during random exams.

B. Contrast normal vs. abnormal waveform activity.

IV. NDT Lab Functionality

A. Contrast roles within the NDT lab.

B. Analyze lab protocol.

C. Examine processes of calibration and verification of instruments.

V. Simulate ABRET and BRPT Board Exams

A. Validate electroencephalographic (EEG) knowledge.

B. Validate polysomnographic (PSG) knowledge.

C. Validate evoked potential (EP) knowledge.

Content Outline and Competencies:

I. Pre-Testing Phase

A. Verify the medical order and protocol.

B. Assess the history, physical information, medications, procedure request, and study protocol to  determine completeness and appropriateness.

C. Determine special precautions related to infection control and other patient-specific factors.

D. Recognize and clarify unclear, inappropriate, or contradictory orders.

E. Obtain and review the sleep history and pre-sleep questionnaires.

F. Confirm patient's medications and identify caffeine or alcohol intake.

G. Assess and respond to the patient's special needs (age, cognitive level, physical or emotional discomfort, ability to cooperate, etc.)

H. Recognize and respond to any special testing considerations or medical interventions that may be needed based on patient assessment.

I. Explain pre-testing, testing and post-testing procedures to a patient in terms appropriate for the patient's age and mental or cognitive status.

J. Orient the patient to their preparation/testing schedule and the sleep center, including their sleep room and bathroom/changing area and where to access food, water, and medication storage.

II. Equipment and Monitors

A. Determine, gather, and prepare the necessary equipment and supplies needed to conduct the specified study or protocol.

B. Correctly measure, apply and connect electrodes, sensors and monitors based on patient specific order/procedure and internationally-accepted standards.

C. Check for proper function and appropriate signal according to accepted standards.

D. Interface electrodes and ancillary equipment to data acquisition and recording system.

E. Label recording with patient demographic information, study information, sleep location and technologist identification.

F. Set up a correct montage based on patient orders/procedure and verify that proper filter and sensitivity settings are selected.

G. Calibrate all necessary equipment for the procedure as ordered.

H. Implement equipment and physiologic (bio)calibrations.

I. Verify proper electrode impedance values and signal quality of all channels

J. Adjust equipment to achieve proper function and report deviations from the ordered procedure.

III. Monitoring, Documentation, and Therapeutic Interventions

A. Adhere to procedural protocols, to include multiple sleep latency test (MSLT), maintenance of wakefulness test (MWT), parasomnia studies, positive airway pressure (PAP) therapy and supplemental oxygen titration.

B. Demonstrate the procedure for documenting and reporting routine observations, therapeutic levels, clinical events, changes in procedure, and other significant events to facilitate scoring and interpretation of PSG results.

C. Determine and take appropriate corrective action to assure proper signal display during the monitoring and therapeutic phases of the study.

D. Report any adverse clinical conditions through the use of appropriate monitoring and assessment skills.

E. Perform routine PAP mask sizing, mask fitting, and headgear adjustments.

F. Titrate therapeutic interventions to achieve optimal and safe clinical outcomes.

G. Follow lights-on procedures to verify integrity of collected data and complete the data collection process.

H. Demonstrate appropriate removal, maintenance, and cleaning of sleep monitoring and therapeutic equipment.

I. Administer a post-study questionnaire and finalize documentation of required paperwork.   

IV. PSG Record Scoring and Report Generation

A. Review study-related documentation that may impact record scoring procedures, including technologist worksheets and comments, patient history and questionnaires, and calibration data.

B. Evaluate sleep architecture and microarchitecture by comparing sleep/wake data obtained from the study to typical findings.

C. Identify sleep onset, percent sleep stages (Wake, I, II, III, IV, and rapid eye movement [REM]), total recording time, total movement time, REM onset, and arousals using sleep/wake data obtained from the study.

D. Score a PSG, PAP titration study, and MSLT/MWT according to professionally accepted guidelines.

E. Apply arousal scoring criteria to sleep/wake data according to professionally accepted guidelines.

F. Apply movement-related event scoring criteria to sleep/wake data according to professionally accepted guidelines.

G. Apply cardiac-related event scoring criteria to sleep/wake data according to professionally accepted guidelines.

H. Apply respiratory-related event scoring criteria to sleep/wake data according to professionally accepted guidelines.

I. Identify other sleep-related activities, such as seizure activity, alpha-delta sleep, drug spindles, and other significant electroencephalographic (EEG) abnormalities.

J. Utilize data from PSGs, PAP titrations, MSLTs, MWTs and other diagnostic and therapeutic procedures to determine the following parameters:

1. Lights-out/lights-on times

2. Total recording and total sleep time

3. Sleep efficiency

4. Amount and percentage of stages of sleep, REM sleep, NREM sleep, movement, and wake time.

5. Initial sleep latency and latency to each sleep stage.

6. REM sleep episode assessment (number of episodes and REM density).

7. Arousal (Respiratory Effort Related Arousals (RERAs), respiratory, spontaneous, limb movement) analysis (in both REM and NREM).

8. Range and averages for heart and respiratory rate.

9. Percent of apneic sleep time.

10. Apnea index, hypopnea index, and combined apnea/hypopnea index (AHI) in both REM and NREM).

11. Respiratory disturbance index (RDI).

12. Respiratory events per body position for total sleep (in both REM and NREM).

13. Range and averages for oxygen saturation level (in both REM and NREM).

14. Range and averages for respiratory event duration per total sleep (in both REM and NREM).

15. Number of periodic limb movements per total sleep (in both REM and NREM).

16. PLM index with and without arousal.

K. Retrieve, save, and archive patient information, sleep/wake data, and test results into the computer.

L. Recognize and correct invalid patient information, sleep/wake data, and test results.

M. Generate and verify accurate computerized reports by tabulating sleep/wake and clinical event data.

V. Technologist Professional Standards and Patient Safety and Emergency Procedures

A. Comply with the Board of Registered Polysomnographic Technologists (BRPT) Standards of Conduct.

B. Follow laboratory and procedural protocols, guidelines, and standards regarding safety and infection control issues.

C. Demonstrate effective written, non-verbal and verbal communication skills.

D. Maintain a professional demeanor and interactions at all times with staff, supervisor, patients, and other health care professional.

E. Maintain professional responsibilities as they relate to attendance, punctuality, appearance, conduct, and continuing education activities.

F. Recognize personal limitations and demonstrate ability to follow directions.

G. Recognize and respond to patient safety and emergency situations.

H. Demonstrate proper techniques for infection control.

I. Integrate logistical approaches to improve timing, efficiency, and decision making without compromise to patient care in completing assigned activities.