A simple explanation of neurophysiologists? role is provided here:
?? engaged in the application and development of electrodiagnostic
procedures in neurology. They record the electrical activity of the
brain and nervous system, in order to diagnose diseases such as
epilepsy, strokes, dementia muscular dystrophy and multiple
How long a neurophysiologist is involved with a patient depends on
various factors, including the age, condition and improvement of the
patient and the results of the neurophysiological and neurological
testing. The neurophysiologist is part of the neurological team caring
for brain injury patients; s/he performs and oversees neurological
testing of the brain, diagnosis and treatment of neurological
disorders. Patients can continue to be tested and followed by a
neurophysiologist on an outpatient basis as long as necessary; testing
and the need for testing is determined by the neurological team. Once
testing shows a repeatedly consistent level, the frequency may
?Neurophysiologists specialise in recording the electrical activity
of the nervous system, such as the brain, spinal cord, or the
peripheral nerves in the limbs. They may concentrate on the
visual or auditory systems. They work closely with colleagues in
neurology, ophthalmology or neurosurgery, to assist in the
diagnosis of muscle and nerve disorders, and conditions such as
epilepsy, stroke, dementia, visual loss and multiple sclerosis.?
?Clinical neurophysiologists undertake a variety of recordings and
measurements of the electrical activity of the central and peripheral
nervous systems. This information can be used to aid the diagnosis and
management of a wide range of neurological conditions in all age
groups. Activity is usually divided into four areas:
Nerve conduction studies (NCS) and electromyography (EMG)
Evoked potential (EP) studies
Intraoperative monitoring (IOM)
?Clinical neurophysiology is largely a consultant-provided service.
The majority of neurophysiological investigations are undertaken by
consultant clinical neurophysiologists supported by trained
neurophysiology technicians. In general, NCS/EMG and intraoperative
procedures are undertaken by medical staff. EEG and EP examinations
are performed by technical staff and the results reviewed and reported
on by consultant clinical staff.?
?A neurophysiological opinion usually forms only part of the
management of a patient as the majority of referrals come from
consultants in the frontline specialties. Where referrals are accepted
directly from primary care the patient needs to receive understandable
information from the neurophysiology service to aid appropriate
consent and any subsequent discussion of the management of their
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?General description of the work Neurophysiologists undertake
Neurophysiologists are involved in the measurement of nerve activity
and neuromusclular damage. They undertake nerve conduction tests to
estimate nerve damage.
They may be involved in medical negligence cases in assessing the type
and extent of damage to a nerve following an injury or surgical
Neurophysiologists are unlikely to be the subject of a medical
negligence claim themselves.?
?Neurology centres Neurologists work together in neurology centres
to provide a general and special interest neurological service with
clinical neurophysiology, neuroradiology and neurorehabilitation
services, but without inpatient neurosurgery facilities. It is
anticipated that the number of these centres will increase.
A clinical neurophysiology service is required by the local
neurological service for electroencephalogram (EEG) and electromyogram
(EMG) investigations. The service should offer urgent appointments in
local hospitals for emergency admissions, and routine appointments
within four weeks for an EEG and eight weeks for an EMG. An adequate
neuropsychology service is necessary and should be based locally.?
? ?Provides a highly complex, Specialist Clinical Neurophysiology
service to patients of all ages from a range of specialties suffering
from a wide variety of medical disorders including those, which may be
neurological and/or psychiatric in nature. These to include advanced
procedures e.g. electroretingography, electro-oculography and
ambulatory EEG and videometry, thermal thresholds.?
One neurophysiologists view of his job:
?Neurophysiologists appear to have acquired the reputation of quirky
boffins who emerge blinking into the sunlight only occasionally for a
grilling by real clinicians at the weekly neurosciences academic
?The research activity of the Neurophysiology Research Group has
been particularly active with the development of biomedical sensors
and electronic circuits, as well as high precision mechanical
processing in support of these developments. Major developments
include a 300 channel automatic EEG electrode placement system, a new
skin screw EEG electrode which requires no skin preparation, and a
volume conduction based implantable data communication device that
transmits signals between the inside and outside of the human body.
Recent work in the area of energy metabolism and neurophysiology
technology is attempting to harvest energy from the human body by
converting glucose from within the body fluid into electricity in
order to power implantable devices such as those implanted within the
brain for the treatment of Parkinson disease and epilepsy.
In this way, battery life or device failures could be minimized.
Another area of new interest has been in the area of traumatic brain
injury in children. Traumatic brain injury remains the leading cause
of death and disability in children affecting over 150,000 children
each year. Many of these children, even those with mild concussions
frequently suffer long-term or permanent disabilities.?
?NEUROANATOMY AND NEUROPHYSIOLOGY
This section considers those regions of the brain relating to the
musculoskeletal system, which are important to the orthotist during
the initial evaluation. These regions include the cerebral cortex,
basal ganglia, and cerebellum. By understanding the functions of each
part of the brain, clinical implications of the injury are better
understood. The brain functions as a whole by interrelating its
components. For instance, a lesion may only disrupt a particular step
of an activity that occurs in a specific location. "The interruption
of that activity at any particular step, or out of sequence, can
reveal the problems associated with the injury.
"The cerebral cortex functions as the executive of the central nervous
system. It enables us to perceive, communicate, remember, comprehend,
and initiate voluntary movements. Its composition primarily includes
blood vessels and nerve cell bodies.
The cortex is separated into right and left hemispheres by a
longitudinal or interhemispheric fissure. Each cerebral hemisphere
controls the opposite side of the body. Although each hemisphere is
almost symmetrical in size and shape, they are not entirely equal in
function. Its convoluted surface has certain consistent positions in
all humans, which are used as landmarks to divide the cortex into four
lobes. These lobes are named after their overlying cranial bones:
frontal, parietal, temporal, and occipital.?
One neurophysiologist, Professor Marianne Thoresen, Department of
Clinical Science at South Bristol St Michaels Hospital, Bristol has
done research on:
? ?Developed experimental models that mimic disorders leading to
permanent handicap in children
? Used these models to understand the mechanism of disease
? Developed effective treatment in the laboratory models
? Carried out pilot and randomised controlled trials in patients
Our unique survival model demonstrates similar neurological signs, EEG
changes, multi-organ dysfunction and pathological changes as seen in
human infants. We were the first to demonstrate post-hypoxic
hypothermia's protective effect in the newborn brain and exploring
mechanisms of hypothermic neuroprotection such as lower cerebral
excitatory amino acid concentrations and reduced seizures activity. We
have also developed the first neonatal models of hydrocephalus
following intraventricular haemorrhage and we are currently exploring
the cell biology and testing out whether interventions and drugs
inhibit the processes that cause hydrocephalus.?
?The goal of the research carried out by the Developmental
Cognitive Neuroscience Unit (DCNU) is to understand the consequences
of brain disease or injury sustained during childhood, examine
brain/behaviour relationships, and provide diagnostic and prognostic
markers of cognitive and behavioural outcome.?
Fields covered by a neurophysiologist include:
Brain response to injury
Disorders of long term memory and visual-social cognition
Speech and language
Auditory processing and memory
Diagnostic tests overseen by neurophysiologists:
? Electroencephalogram (EEG)
? Sleep deprived electroencephalogram (EEG)
? Multiple sleep latency tests (MSLT)
? Electromyography (EMG)
? Nerve conduction studies (NCS)
? Evoked potentials :
o Visual evoked potential (VEP)
o Brainstem auditory evoked potential (BSAEP)
o Somatosensory evoked potential (SEP)
?Surgical Neurophysiologists perform intraoperative
neuromonitoring during surgeries in which there is a high risk of
damage to the nervous system. Such neurophysiologists should have
basic training in neuroscience, electrophysiology, and anatomy.
However, there is no required certification for performing surgical
neurophysiology. There are certifications available, though, including
the CNIM and ABNM.?
What is clinical neurophysiology?
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