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SYLLABUS COURSE ENDT 2662 Electroencephalography Clinical II McLennan Community College Revised for 2008-09 1 Electroencephalography Clinical II ENDT 2662 SYLLABUS Instructor: Office Location: Telephone: Office Hours: Email Mary Feltman CSC C113 299-8525 Home 420-3543 (Hewitt) Posted mfeltman@mclennan.edu Course Description: Performance of clinical EEG's, NCV s and EP s in a clinical setting along with instruction in the recognition and understanding the test results displayed. (40 clinical hours) General Course Objective: Students will be able to apply theory, concepts, and skills of electroencephalography in a clinical setting. . Topic Outline: Resource: ASET, reviewed July 2005, for performing electroencephalogram. 1. The student provides a safe recording environment by: a. b. c. d. e. f. g. h. i. j. k. 2. Verifying identify of patient Cleaning electrodes after each procedure Following universal precautions for infection control Attending to patient needs appropriately Recognizing/responding to life threatening situations Being certified to perform CPR Following laboratory protocols for sedation Complying with lab protocols for emergency and disaster situations Complying with hazardous material handling procedures Maintaining instrument/equipment in good working order Taking appropriate precautions to ensure electrical safety The student establishes rapport with the patient and the patient s family by: a. Using personal communication skills to achieve patient relaxation/cooperation b. Explaining all test procedures including activation procedures c. Explaining the electrode application method (paste, collodion, etc.) d. Interacting on a level appropriate to patient s age and mental capacity e. Maintaining respect and patient confidentiality an 2 3. a. b. c. d. e. f. g. h. The student evaluates the patient to: Determine the patient s mental age, mental state and comprehensive level Note the patient s overall physical condition Decide appropriate method of electrode application Ascertain the patient s capacity to cooperate with activation procedures Determine if hyperventilation is contraindicated Accommodate for disabilities or special needs Determine the need for additional physiological monitors Document unusual or inappropriate behavior suggestive of seizure or pseudo seizure i. Determine the possible need for restraints or emergency intervention The student prepares a basic data sheet ( tech sheet ) that includes: a. b. c. d. e. f. g. h. i. Patient information (name, age, ID number, doctor, etc.) Recording time, date and technologist s name or initials Noting pertinent patient history and familial medical history Listing current medications/sedation and time of last dosage Noting time of last meal Noting time, date, aura and circumstances of last seizure or symptoms Specifying the patient s mental, behavioral and consciousness states Diagramming skull defects or anomalies (if any) Diagramming any modifications in electrode placement The student s electrode application follows a method that includes: a. Measuring and marking the head following the 10/20 measurement system b. Adjusting electrode placement for anatomical defects or anomalies c. Prepping patient s scalp prior to electrode application d. Applying electrodes with paste or with collodion and electrolyte e. Verifying electrode impedances are balanced and below 5,000 Ohms 4. 5. 6. The student documents the working condition of an analog EEG instrument and EP instrument by: a. Calibrating with a square wave to 0.) Verify standard filter and sensitivity settings 1.) Verify or adjust mechanical baseline 2.) Verify or adjust electrical baseline 3.) Verify or adjust time axis 4.) Verify or adjust pen deflection b. Imputing a biological signal (bio-cal) into all channels c. Calibrating, at the end, on all filter and sensitivity settings utilized during the EEG d. Recognizing/correcting any malfunctions seen with calibration 3 7. The student documents the working condition of a digital EEG instrument and EP instrument by: a. b. c. d. e. 8. a. b. c. d. e. f. g. h. i. 9. a. b. c. d. e. f. g. h. 10. a. b. c. d. e. 11. a. b. c. d. e. f. Calibrating system amplifiers Verify standard filter settings Verify sensitivity settings Imputing a biological (bio-cal) signal to all channels Corrects or reports deviations as appropriate The student obtains a standard EEG that includes: At least 20 minutes of technically acceptable recording (120 pages) Eye opening and closing to check effects of stimuli on EEG Hyperventilation for a minimum of 3 minutes Photic stimulation at frequencies appropriate for history and reactivity Mental stimulation/assessment procedures Periodic checks of electrode impedance Natural drowsiness and sleep, if possible Notations of montage, filters, paper speed & sensitivity setting changes Notes on observed behavior, clinical seizure manifestations, etc. The student customizes the recording procedure by: Evaluating reason for referral, history and observed waveforms Utilizing techniques to bring out or enhance clinical symptoms Selecting montages appropriate for abnormalities seen and/or expected Selecting appropriate instrument settings Encouraging drowsiness and sleep Applying additional electrodes to localize abnormal activity Monitoring respiration if appropriate Monitoring ECG rhythms for abnormality The student understands and follows technical criteria for: Recording electrocerebral inactivity (brain death) Recording neonatal studies Recording pediatric studies Recording in intensive care or cardiac care units Recording in the operating room The student differentiates artifacts from cerebral waveforms by: Recognizing possible artifactual waveforms Documenting (on the recording) patient movements Applying/recording leads for eye potentials Applying/recording leads for ECG Replacing electrodes exhibiting questionable activity or contact Troubleshooting for possible electrical interference 4 12. a. b. c. d. When the EEG recording is finished the student: Removes electrode past/glue from the patient s scalp and hair Describes clinically significant behavior Document sedation used, dosage and effects (if applicable) Reviews EEG for appropriate documentation of amplifier settings & montage changes e. Reviews EPs for appropriate documentation of settings and montage changes 13. The EEG student applies the principles of electronics and mathematics to recording by: a. b. c. d. e. f. g. h. i. Knowing how differential amplifiers work Computing voltage and frequency of waveforms Calculating the duration of waveforms Understanding the polarity of the waveforms Understanding impedance Understanding analog to digital conversion Signal averaging and noise reduction Effects of stimulus and recording parameters on EP waveforms Electrical safety The student knows how waveform displays are affected by: a. b. c. d. e. f. g. h. i. 60 Hertz filter Filter settings Sensitivity settings Paper speed Referential and bipolar montages Digital filters Electrode types and electrode material composition Malfunctioning equipment Grounding The student recognizes: a. b. c. d. e. Normal and normal variant awake and asleep patterns for each age range Abnormal awake and asleep patterns for each age range EEG patterns for levels of consciousness Clinical seizure patterns Waveforms obtained from stimulating appropriate nerves. 14. 15. 16. The student performs a standard evoked potential that includes: A. Brainstem Auditory Evoked Potential 1. Threshold testing. 2. Masking determination. 3. Application of necessary electrodes with acceptable impedance. 5 4. Appropriate nomenclature to waveforms. 5 Measure and calculate appropriate absolute latency, amplitudes and interpeak latency measurements. 6. Use of appropriate click polarity, rate and intensity to obtain various waveforms. 7. Use of montage variations to enhance resolution of various waveforms. 8. Performs latency intensity series with infants and other patients as needed. B. Visual Evoked Potential 1. Performs visual acuity testing. 2. Application of necessary electrodes with acceptable impedance. 3. Performs study with use of same parameters and conditions I.e. ambient light, pattern luminance and contrast, for all patients. 4. Measure and calculate appropriate absolute latency, amplitudes and interpeak latency measurements. 5. Appropriate nomenclature to waveforms. 6. Use of flash stimuli in patients as needed. 7. Use of hemi-field stimulation as needed. C. Somatosensory Evoked Potential 1. Applying appropriate stimulating electrodes: active cathode over the nerve and anode placed distally. 2. Applies appropriate ground to reduce stimulus artifact. 3. Selects appropriate timebase, sensitivity and settings. 4. Selects current of sufficient intensity and duration to elicit a motor twitch from the appropriate area of stimulation. 5. Measure and calculate appropriate absolute latency, amplitudes and interpeak latency measurements. 6. Appropriate nomenclature to waveforms. 7. Uses additional techniques to clarify the abnormalities seen. D. Nerve Conduction Velocities 1. Cleansing the skin where the electrodes will be placed 2. Creating the environment which is optimal for patient relaxation and ability to record waveforms 3. Placing the stimulus probe directed appropriately for test being performed 4. Recognizing, identifying and resolving artifact and determining whether it is physiologic or non-physiologic 5. Applying stimulus at low intensity and slowing increasing the intensity to achieve appropriate muscle twitch as needed 6. Measure and calculate appropriate absolute latency, amplitudes and calculates conduction velocities 7. Appropriate nomenclature to waveforms 6 8. Documents and obtains limb temperature 9. Appropriate use of sensitivity, intensity, filters, timebase, averaging and duration to ensure integrity of the response. 10. Determines which tests are necessary to provide clarification of disease process and/or clinical symptoms to aid the physician in determining the diagnosis. In addition, 1. the student understands (has a working knowledge of): Functional neuroanatomy and neurophysiology Medication effects on the EEG background and waveforms Medical terminology and accepted abbreviations Signs, symptoms and EEG correlates for adult neurological disorders Signs, symptoms and EEG correlates for pediatric neurological disorders Seizure manifestations, classifications and EEG correlates Psychiatric and psychological disorders and EEG correlates Technical and electrical aspects of procedures Pathologic and non-pathologic factors affecting EPs Pathologic and non-pathologic factors affecting NCVs 2. The student maintains and improves knowledge and skills by: Reviewing tracings/tests with an appropriate physician on a regular basis Reading journal articles Studying textbooks related to the field Attending continuing education courses in Electroneurodiagnostics The student will demonstrate the following affective qualities: 1. Self-direction. 2. Responsibility for actions. 3. Compassion for the patient. 4. Maintains the patient s confidentiality. 5. Enthusiasm and interest for learning. 6. Establishes and maintains good rapport with the clinical staff, faculty and other students. 7. Recognizes the value of teamwork and functions well as a student member of the team. 8. Ethical and professional in all interaction with others. 9. Always receptive to constructive suggestions and corrections. 10. Responds calmly and effectively under pressure. 11. Readily accepts direction form clinical staff and faculty. 12. Adjusts well to new tasks and situations, in various clinical assignments. 13. Understands the importance of professional development and life long learning. 7 14. 15. Demonstrates problem solving skills. Uses good judgment, knows when to ask for help. SCANS: The Secretary s Commission for Achieving Necessary Skills is incorporated into the learning outcomes and activities. SCANS Competencies: Resources: Allocates time (C1) Information: Acquires and evaluates information (C5) Interprets and communicates information (C7) Uses computers to process information (C8) Interpersonal: Participates as a member of a team (C9) Works with cultural diversity (C14) Technology: Selects technology (C18) Applies technology to task (C19) Maintains and troubleshoots technology (C20) SCANS Foundation Skills: Basic skills: Reading Writing (F1) (F2) Arithmetic(F3) Listening (F5) Speaking (F6) Problem solving (F9) Seeing thi8nmgs in the mind s eye (F10) Reasoning (F12) Personal qualities: Responsibility (F13) Self esteem (F14) Social (F15) Self management (F16) Integrity/ Honesty (F17) TEXTBOOK: 1. Current Practice of Clinical Electroencephalography, Ebersole and Pedley, Lippincott, 3rd ed., 2003. 2. Fisch and Spehlmann s EEG Primer, Bruce J. Fisch, 3rd Ed. 3. Primer of EEG with a Mini Atlas, A. James Rowan and EugeneTolunsky, 2003. 4. The Little Black Book of Neurology, Zaidat and Lerner, 5th Ed. 2008 8 5. 6. 7. 8. Nerve Conduction Studies from A to Z, Barbara O. Crout and Charles W. Flicek, 1977 Spehlmann s Evoked Potential Primer, Karl E. Misulis and Toufic Fakhoury, 2001 Atlas of EEG Patterns, John Stern, 2005, Lippincott Blackboard. Grading System: The grading will be based on a percentage system. Each assignment will be worth a total of 100%. The grade the student receives on any assignment will be the percent correct on that assignment. The grade scale will be as follows: 90 -100% = A 80 - 89% = B 75 79% = C At the end of the semester the average percentage grade that the student obtained in the semester will be the student s grade in the course. The student must obtain a C or better in all courses within the Electroneurodiagnostics and Polysomnography program (all courses with the rubrics ENDT and PSGT) to successfully complete the course requirements for the program. NO grades will be given over the phone. Evaluation: The student will meet with the instructor during the course to evaluate the student s progress in the course. The evaluation will be based on the number of competencies (knowledge and skills) the student has completed and the student s affect (Dependability, Communication Skills, Interpersonal Skills, Clinical Competence, and Professional Development). The student s affective evaluation will be documented as satisfactory, needs improvement or unsatisfactory. Areas that need improvement or are unsatisfactory will require documentation to indicate that the student agrees to the plan for improvement. If a student does not show improvement and the problem persists, points will be deducted from the course grade. For further description of the behaviors expected of the students refer to the MCC Student Handbook and the ENDT PSGT Student Handbook. Progress toward achieving a degree of mastery of the clinical competencies will be evaluated to assure that the student develops the knowledge and skills expected of an entry level electroencephalography technologist. Documentation will be provided on: 1. Daily clinical summery cards. 2. A rotation summary form that documents satisfactory progress toward achieving a degree of mastery of the competencies identified in the topic outline. The student will be responsible to assure that all the paperwork (daily summary cards and rotation summary) is completed at the time of the clinical evaluation. 9 Penalties will be applied to the course grade if the student does not provide the appropriate documentation during the evaluation. A penalty will be applied to the course grade if the student is absent from the evaluation. In order to successively complete this course the student must achieve a 70% to receive credit in the course. Two or more unsatisfactory evaluations in the course or any unacceptable behaviors may be sufficient grounds for an unsatisfactory course grade. Class Attendance Policy: The student is expected to prepare in advance for clinical assignments and arrive ready to start the clinical assignment at the designated time. Regular and punctual attendance is expected of all students and the instructor will maintain a complete record of attendance. Students will be counted absent from missed assignments, beginning with the first official day of classes. Students, whether present or absent, are responsible for all material presented or assigned for a course and will be held accountable for such materials in the determination of course grades. The goal of the clinical portion of this program is to introduce the student to skills necessary to become competent, efficient, and successful ElectroNeuroDiagnostic Technologist. Due to the importance of achieving these clinically related criteria, the student must attend and actively participate in the clinical activities during the clinical portion of this program. The program s clinical practice attendance policies sets forth the minimum guidelines required the student to follow, in order to obtain the aforementioned practitioner skills and credit. Clinical hours are 8am to 430p, which includes 30 minutes for lunch, unless specifically changed by the instructor and/or the specific clinical affiliate. Absence of scheduled clinical assignments will be taken as evidence that a student does not intend to complete the course. Unless the instructor has reason to believe the student will complete the course, the student will be withdrawn from the course with a grade of W. The instructor may reinstate the student if the instructor is satisfied that the student will resume regular attendance and will complete the course. The instructor has the prerogative of determining whether a student may make up work missed due to absences for other reasons. It is the student s responsibility to inform the instructor of the reason for the absence and to do so in a timely fashion. All students are required to complete 36 clinical days this semester, eight hours per day, regardless of personal circumstances. The completion of these 36 clinical days must be accomplished before the Friday in Dead Week. Absences from all clinical assignments, shall automatically receive a W if this goal has not been accomplished before the Monday, beginning finals week. It is the student s responsibility alone to assure that they have satisfactorily completed all clinical requirements. 10 Punctuality A tardy occurs when the student arrives at the clinical assignment after the assigned time. The first tardy indicates a potential problem that needs improvement. Two or more tardies are unsatisfactory and may result in a penalty applied to the clinical course grade. Four tardies may result in withdrawal from the course. One hour late will constitute an absence. Notified and Non-Notified Absences "Non-Notified" Absence, defined - failure of the student to notify the clinical affiliate and course instructor s voice mail of that clinical absence. "Notified" Absence, defined - student notifies the clinical affiliate and course instructor s voice mail prior to the start of the clinical assignment. A major portion of the electroneurodiagnostics and polysomnography program is clinical education and training. No "non-notified" absences will be allowed for any clinical assignment. The faculty does realize, however, that there are times when a student must be absent; therefore, the student must notify both the clinical site [where the student is scheduled] and the course instructor via voice-mail prior to the scheduled time of the clinical assignment. The student may inform the affiliate site of an anticipated absence by leaving a message at the earliest possible opportunity. When leaving such a message, note the name of the person to whom the student spoke. The student may be allowed to make up a "notified" absence. Make-ups will be scheduled only after a written request is submitted by the student a minimum of 2 days prior to the requested scheduled activity and will be subject to approval by the course instructor. After the make-up time has been completed, written documentation (Daily Written Summary Card) must be provided. Time for which the student is paid by the clinical facility cannot be used as make-up time. Make-up's do not remove clinical absences or extend the allowable limit of clinical absences. Any "non-notified" absence from a scheduled make-up is subject to appropriate disciplinary action and penalties that will affect the grade in the clinical course. This will not only affect the student's satisfactory completion of that clinical course; it will jeopardize the student's enrollment in the program. To be excused after arriving at the clinical site: 11 Students must obtain prior approval from the clinical instructor and/or MCC faculty and recorded on the student's daily clinical card. An authorized leave, regardless of the circumstances, constitutes an absence. Any unauthorized clinical absence or leave without the consent of the clinical instructor and/or MCC faculty from the clinical site constitutes a "non-notified" absence and is strictly prohibited, subjecting the student to appropriate consequences, (e.g., withdrawal from the program or penalties applied to the course grade). Dismissal from the clinical site: The student will receive an absence if a student is dismissed from the clinical area for any reason (e.g., no name tag, inappropriate dress, hygiene, disrespectful attitude, etc.) If the student corrects the deficiency and returns to the clinical site within the first hour of the scheduled time, the student will receive a tardy. If the student cannot correct the deficiency within an hour, the student must accept a clinical absence, and correct the deficiency before the next clinical assignment. CONFIDENTIALITY: All information regarding patients is to be treated with the utmost confidentiality and in compliance with the HIPAA rules and regulations. Clinical affiliates will allow use of patient information only for the purpose of education and training. This is especially pertinent in regards to the student projects. GENERAL EXPECTATIONS: The student will dress in the assigned scrub uniforms with lab coat. Tennis shoes are allowed. Open toed shoes are not acceptable. The student will NOT smoke from pre-arrival in the car till final departure from the clinical site. If a complaint is made from the clinical site, patients and or physicians that the student smells of smoke or is caught smoking at the clinical site, the student will be dismissed from clinicals. This will count as an unexcused absence. BEEPERS, CELLULAR PHONES AND PERSONAL PHONE CALLS All beepers and cellular phones must be turned off at the beginning of class. Pagers and cell phones must be turned off at the clinical sites. The student will be notified of an emergency telephone call by the health careers secretary. No personal phone calls (non-emergency) will be accepted. Strict adherence to patient confidentiality (HIPPA) is required at all times. Students are not allowed to discuss a patient, history or the events of testing with family, other by-standers, or other medical personnel. Violation of this policy will result in immediate dismissal from the program. 12 STUDENTS WITH DISABILITIES "In accordance with the requirements of the Americans with Disabilities Act (ADA), and the regulations published by the United States Department of Justice 28 C.F.R. 35.107(a), MCC s designated ADA co-coordinators, Dr. Johnette McKown, Executive Vice President and Dr. Lynn Abernathy, Vice President, Student Services shall be responsible for coordinating the College s efforts to comply with and carry out its responsibilities under ADA. Students with disabilities requiring physical, classroom, or testing accommodations should contact Mr. Marcus Sweatt, Disabilities Specialist, at 299-8122 or msweatt@mclennan.edu. . PROJECT: Policy and procedure manual. Specifically included: Table of Contents, Signature page, hospital or clinical appropriate statements, Code of Ethics, Patient Rights and Responsibilities, Release forms, Confidentiality, PSG, CPAP or BiPap, MSLT, MWT, Interpretation, Reports. Evals, Job Descriptions, Code of Ethics, etc. A policy format should be included. This project is due at the end of the semester at the time of the Capstone Exam. Any time the clinical affiliate schedules late patients or allows the student to leave since the work has been completed or the patients have been dismissed, this time will be considered project work time to complete clinical competency hours. At no time is the student allowed to request to leave early. All assignments and assigned projects to be turned in must be in the following format: Double Spaced Times Roman Style Size 12 Font APA. Any papers submitted not complying with the above requirements will be considered incomplete and graded as a 0 . Project is due at the time of the Capstone Final exam. 13

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