Reading the news, there is always somewhere to contribute money, offer assistance and reach out beyond your own home to aid those who need it. This quarter, we are going to highlight opportunities we already contribute to or would like to do some day. I personally would love to do overseas medical mission work at some point, maybe after the kids are grown.
I already do a little volunteering here and there and I love it. If it paid the bills, I would be volunteering full time. Starting as a kid, I found a love for helping others with no expectation of payment or reward of any kind. It is just something I have a passion for. This quarter, we asked the Special Interest Section Leaders what drives them to volunteer those extra minutes of their day? What keeps them volunteering for ASET and other organizations?
As always, if you need anything, just write/call or message me. I’m around.
Petra, BS, R. EEG/EP T., FASET
ACUTE & CRITICAL CARE
By Sabrina Faust, BS, R. EEG/EP T., CNIM, CLTM
Volunteer work within the field of Neurodiagnostics is vital to sharing best practices in the field and can be so rewarding! When I first entered the field 15 years ago, I was truly inspired by all of the great mentors that I had the pleasure of working with and was encouraged to get more involved in the field by volunteering my time and talents. My first endeavor was to join my local state society ISET, and I began networking with those leaders to offer assistance where it could be of most use. I was soon nominated to join the ISET board as Secretary which I was most honored to accept. And after having served two years in the Secretary roll, I was once again nominated and voted in to serve as President for the organization. I learned a lot in that time about the importance of giving back and that we all have something of value that we can learn from each other. I found that volunteering within my field of study allowed me to expand my own professional knowledge and it provided me the opportunity to meet other colleagues in the field.
During my time serving my local state society, I was afforded another opportunity to serve as a board examiner for ABRET. I had the pleasure to assist with multiple oral exams for both EEG and EP boards. This soon expanded to additional opportunities with the board to participate in written exam reviews as a subject matter expert. After many years of volunteering and serving ABRET, I was nominated and voted in to serve on the Board of Directors. At present time, I have served two terms on the board, currently serve as the President for the next two years and will have served seven years in all by the time my term ends as Past President.
Volunteering in the field is also a wonderful method for improving self-confidence. Look for opportunities to share your knowledge and experiences with others. The first time I spoke at a meeting I can remember how nervous I was, and I found that everyone was so supportive and encouraging. If you haven’t had an opportunity to attend an educational conference I encourage you to put it on your to-do-list immediately! In addition to ASET, many states have local society meetings that hold conferences annually and there are several regional societies that serve multiple states. I have had the opportunity to attend many of these and I am always amazed by the great knowledge that is shared by all the fantastic speakers!
If you are interested in volunteering and leadership opportunities, I encourage you to begin by signing up for the ASET/ABRET Leadership Academy. These online modules were developed by both organizations to prepare volunteers with the leadership skills necessary for serving both organizations and the field of Neurodiagnostics. Enrollment is open throughout the year and graduates are recognized and honored each year at the ASET annual conference. Join today – I think you will find the skills learned will also prove to be of value when applied to your current day-to-day professional work!
By Jennifer Carlile, R. EEG T.
Interesting 3-day Ambulatory EEG case study:
Thirteen-year-old, left handed female, presenting with daily staring spells and a single generalized seizure. Per patients’ mother, patient has daily staring spells that lasts seconds at a time and have been occurring since birth. Patient’s mother stated about 1 month ago, patient had an episode of +loss of consciousness followed by generalized tonic/clonic activity lasting 10-25 minutes. No aura, no incontinence noted. Afterwards patient was very tired and amnestic of event. PMH: CP, Seizures, Autism, Insomnia and maternal grandmother has seizures. Current medication list: Ethosuximide, Banzel, Clonazepam, Olanzapine, Trazodone. Patient has had multiple uneventful routine EEGs. During this recording session, the patient was staying with her maternal grandparents while mother was working. Detailed instructions for ambulatory monitoring were given to the patient’s mother, both verbal and written. After 3 days of recording, there were 7 push button events and 192 seizure files. Unfortunately, neither the mother nor grandparents communicated with each other as when or why to press the event marker for the patient’s staring episodes. Fortunately, the monitoring session captured abnormalities even though the patient’s mother stated as far as she is aware, “…there were no intentional push button events, if there were any, they were accidents”. After downloading the data, the technologist questioned the mother and then the mother questioned the grandparents. Luckily, the grandparents stated, “Oh yes, we pressed the black button when we thought she was staring.” Communication is everything…right?
Click the photos below to enlarge.
The board-certified epileptologist read this as abnormal; bifrontal L>R epilepsy, no clear seizures were recorded. The spike wave discharges were seen in bursts and noted that there was sustained tachycardia of greater than 110 beats per minute.
By Marcia Hawthorne, R. EEG T., CAP
It’s hard to find a charitable cause or volunteer opportunity for Autonomic Testing because it is such a new field. The most interesting thing to me about the autonomic testing world is that there is still so much to learn. When searching for “autonomic testing” on the internet very little information is found on the testing itself. How cool is it to be part of something so groundbreaking?!
The Neurodiagnostics field in general is changing every day. The human body is so complex, especially the brain. People ask me what I do and I always go into way too much detail because I love what I do. I always know it’s time to go onto a new subject because the person I’m talking to ends up with that glazed look in their eyes, and I know you know what I’m talking about.
The Neurodiagnostics field is one to be proud of. I will continue to help in any way that I can. For now I will continue to support our field and our patients by participating in our local Walk for Epilepsy and the Walk to Defeat ALS. Our department also does several bake sales & sub sales each year to support these causes and others, such as Autism and Multiple Sclerosis.
By Pat Lordeon, R. EEG T., FASET
I have to admit, I am one of those folks who greatly admire people who volunteer their time, talents and skills to different projects, but who personally finds it hard to fit such altruistic pursuits into my schedule. I would like to be that person, truly I would, but I’m not certain I’m cut out for it. I can’t pound a nail straight so any houses I build will fall down in 24 hours; I can only cook certain things so bake sales are not for me; I’m not creative so that leaves out anything that requires arts and craft skills. I hate to travel so forget going to a remote village on the other side of the world. Long ago I realized there are certain folks whose job it is to cheer on the volunteers… and that’s me!
Now, that’s not to say that I don’t volunteer. I do, just not in such a big time manner. Like most of you, I started as a child, staying after school to help the teacher. My family was active in our church, and that was another way to volunteer. Church choir, church organist, parish festival…. I helped with all of these and more. Back then, it didn’t seem like volunteering… it was just fun. As I got older and life became busier, my volunteering took a different route. Now I volunteer my time to techs who are preparing to take their board exams. We work together, one on one, as many times as we can make our schedules overlap. There is nothing in the world that compares to the thrill of hearing that the tech you have mentored has passed their ABRET boards. Their success becomes your success.
I also offer my time to ASET, and have done so for many years now. They have accepted my offers and asked for more. This has resulted in a wonderful (at least for me) partnership in which I have learned many things, challenged myself, stepped out of my comfort zone and had a great time doing it! I have lectured at ASET conferences, written an article for The Neurodiagnostic Journal, act as Assistant Editor for the journal, write for the quarterly ASET newsletter and am a member of several committees. Of course, I didn’t start out doing all of this… it just gradually happened. And that’s true for most of the folks who volunteer for ASET…. one thing leads to another. For those of you who have not extended your time to ASET yet, I can only say: What are you waiting for???? You will never regret it. It is fun, educational, and self-fulfilling.
Although I sometimes regret not doing “traditional” volunteer work, I feel that the donation of time I give to ASET is a fair substitute. Time is more precious than money, and any gift of time is a gift from the heart. The folks at ASET work tirelessly to help Neurodiagnostic Techs like you and me. If you’re looking for an opportunity to “pay it forward”, all you have to do is complete and return the volunteer form. There is a place on the form that asks you what you are interested in doing. ASET will pair you up with the committee you are most suited for, based on the options you select on the volunteer form. The committees are composed of volunteers like you and they are always looking for more help. You don’t have to be a registered tech to volunteer with ASET. You don’t have to be the smartest person in the room. You DO have to be willing to put yourself out there and become a part of something that is bigger than you. ASET will guide you on the way. But the first step is up to you. Take it.
By Kathy Johnson, R. EEG/EP T., RPSGT, FASET
Our topic for this edition of the newsletter is volunteering. I have to admit my volunteerism has been much less dramatic than many of our colleagues who travel the world to help set up EEG labs or provide clean drinking water or save the whales—bless them for all they do. The bulk of my volunteering has been for our professional societies, like ASET and my state and regional societies. I won’t bore our readers with a recitation of my small contributions but rather I would like to use this platform (soapbox maybe?) to point out the benefits you might experience from volunteering for ASET. In the interest of transparency, I will divulge that I have a large conflict of interest, namely the fact that I am involved with the Volunteer and Leadership Development Committee, so I may have ulterior motives.
So, why would anyone spend time volunteering for ASET? There are many reasons and I will name a few for you.
Payback is great… If you are in this profession of Neurodiagnostics you are one lucky duck. While our specialty is small compared to some others, we make up for it in dedication, enthusiasm and caring. In my 44 year career, I have not met any other group of medical professionals who are more passionate about their job than NDT technologists. Once you enter into this exclusive club, you are likely hooked for life and as the saying goes, if you are doing something you love, you will never work a day in your life. So volunteering is a way to pay back.
Learn something new by volunteering… I have learned so much by working with the ASET team, both officers, committee chairs, members and the office staff. From how to organize a conference and to how to run a board meeting to the inner workings of bylaws and standards of practice.
Establish professional relationships… the opportunity to network with people who are experts in the field can be invaluable in helping you along your career path. There is always someone who has experienced the same issues you face in the workplace and ASET members are unfailingly generous in providing you with opinions, suggestions, policies and just overall support for you, besides it is very impressive when you are able to tell your boss that you can contact someone at a renowned institution to help you out (think “my friend at the Mayo Clinic” or “my colleague at Duke University” or “the director of the program at Cleveland Clinic”). Believe me, your administration will be impressed that you have these contacts.
Get the inside scoop on NDT education… the educational materials published by ASET are second-to-none in the field of neurodiagnostics. From the fabulous online courses, to the widely recognized journal, to the boot camps and, of course, the annual conference, there is something for everyone and as a volunteer, you can be part of the action. Do you have a particular specialty? Do you like to teach or write or research a topic? It is all available for ASET volunteers.
Make lifelong friends… volunteering for ASET is a way to make friends that will last a lifetime. When I think of all the people who I have met through my involvement with ASET, from across the country and beyond, I know that I have BFFs that I will never forget, even after I retire… I hope we never lose touch.
So, these are a few of the reasons why volunteering has been special to me. Volunteering doesn’t always take a lot of time and the time you spend will be repaid over and over again.
By Stephanie Jordan, R. EEG/EP T., CNIM, CLTM
What Drives Me to Volunteer those Extra Minutes of My Day?
Gratitude. Gratitude to the technologists that gave of themselves to help me with my EEG training from the very beginning of my career. Gratitude to the mentors; educators, coworkers, and physicians, who encouraged me to challenge myself to learn and apply new ideas. Gratitude for a career where I can show compassion and comfort to others. Gratitude for a career that has allowed personal growth. Gratitude for a career that has supported my family and those less fortunate. It is gratitude that allows me to find the time to volunteer and give back to the community that gave to me.
By Magdalena Warzecha, R. EEG/EP T., CLTM
As NDT professionals working in medical field, we are privileged to do meaningful and rewarding work every day. We provide medical care, perform neurodiagnostic tests, monitor surgeries and consequently, help in the diagnosis and treatment of patients. The goal of all our efforts is to improve lives and help alleviate human suffering. What motivates some of us to volunteer in addition to our work? I have found volunteer work not only very rewarding, but also perspective-enhancing.
In 2017 I had an opportunity to go on a medical mission trip organized by a neurologist from Alabama. With a group of physicians, dentists, nurses and other medical professionals we went to Haiti. From our base in Jacmel, we traveled to remote villages high in the mountains and offered medical attention to people who have never before been seen by a physician or treated with medications. We often worked in sanitary conditions far from acceptable by our U.S. infection control standards, setting up outdoor clinics on benches and furniture in peoples’ homes. We recorded several EEGs on children and adult patients who were thought by their community to be possessed because of their seizures. One of the patients, a 12 year-old-boy, was expelled from school because of seizures, his legs were covered in burn scars from falling into fire pit while seizing. No one helped him, thinking he is taken by spirits and could be contagious. His abnormal EEG was read by neurologist, he was given medications and his seizures are now less frequent. Medications for Haiti were donated by pharmaceutical companies and EEG equipment was donated to a small local clinic in Jacmel by a U.S. equipment vendor. We taught a local doctor how to measure and mark the head using the international 10-20 system, and how to apply electrodes and perform EEGs. We continue to work with this doctor remotely to review his EEGs and explain EEG patterns and correlations.
It may be cliché, but this trip truly was eye-opening for me and helped me gain valuable perspective in life. I learned that we need to be thankful for what we have. I noticed while in Haiti how happy and appreciative the people are despite living in very difficult conditions, without electricity or running water. They are able to find joy in the little things in life and see past socioeconomic status, while in the United States, we are often annoyed at minor inconveniences.
More importantly, it gave me an idea how great the need really is for medical help in developing countries. It will require the organized work of many passionate people to elevate medical care in developing countries, bring sustainable education and resources and it will take time, but it can and will be done.
I came to the realization that while we won’t be able to solve world’s problems in one trip, if we can make a positive difference in one person’s life, it is worth all the time and effort; we just need to focus on it.
Regardless of what motivates us to volunteer and how much we can do, it is always enriching, gratifying and, most importantly, needed. This new perspective was what I found to be most enlightening in my volunteering experience.
If you are interested in medical trips, or want to help NDT educational efforts in Africa, I will be happy to provide contact info for people and organizations you can work with.
INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING
By Justin W. Silverstein, DHSc, CNIM
About 6 years ago I was introduced by a good friend and colleague to the world of medical volunteerism. Being a volunteer in any capacity is such a fulfilling experience. My first foray into volunteering was when a group of orthopedic spine surgeons I work with brought a girl from Ethiopia to the United States to perform a scoliosis correction on her. My company assisted with travel expenses for the young girl and I personally monitored the procedure. The case went phenomenally and the girl had a great outcome. Next, I got involved in a number of fund raisers to help generate awareness and increase financial contributions to charities that were providing medical missions in underserved countries. I had the opportunity to go on a medical mission to Costa Rica with Spine Hope. Medical missions are not just one and done situations, the idea is to go into an underserved area and help create infrastructure or train the staff that is currently there, whilst at the same time doing what you can to help the population. It is hard but extremely rewarding work. Below is a chronicle of the trip to Costa Rica:
The clinic was packed! Children traveled from all over the country to come see the team. Costa Rica has one of the best health care systems in Central America; however, only those living in San Jose (the Capital) or within proximity to a major city have access to care. Those in rural areas are not so fortunate. There is also a lack of medical specialization in the country. Part of the role of this trip was not only to perform surgery on the children, but for the team to train their respective counterparts so that one day, they would be self-sufficient without the need for outside help.
For this trip, there were 4 orthopedic spine surgeons, two neurophysiologists, 1 anesthesiologist, & 1 physician assistant. The other neurophysiologist and I split duties between 2 operating rooms. Above, I am with Dr. Mermelstein evaluating a 14-year-old girl for whether or not she would be a candidate for surgery.
One of the persons who worked for the charity and also acted as a translator for us, worked in neuromonitoring at one point in her career. She had created these neurophysiological screening forms that we used to make preoperative assessments and plans.
The hospital was about a 10-15-minute walk from our hotel. The walk was all downhill from hotel to hospital and the operating room was on the 5th floor. There was no elevator, so we had to carry our equipment and supplies each time. We did surgeries 4 out of 6 days and each surgical day averaged around 12 hours. Day 1 was clinic and Day 6 was conference.
Here I am with one of the local neuromonitoring clinicians. He came to my OR each day we had surgery. He was very interested in learning from us and documented how I did my set-ups, which muscles I targeted and what modalities I chose to monitor for the cases we did. My Spanish is not great, so we communicated via Google Translate the entire time. It worked really well and I learned a lot about the neuromonitoring climate in Costa Rica, which is privately owned but government funded.
Here we are with one of the 11 patients that we treated during our time in Costa Rica. This was 2 days post op.
The top picture is our team plus the OR team and different people that helped bring this trip to fruition (we had a big dinner the night before the last day of surgery). On the last day of the trip, we had a spine conference, where we were able to watch all the surgeons lecture on various topics. Dr. Mermelstein and I gave a lecture on neuromonitoring during spinal deformity surgery.
If you ever have an opportunity to provide services during a medical mission, I highly recommend doing it. It is a great way to give back to people less served as well as meet new colleagues and friends.
NERVE CONDUCTION STUDIES
By Dorothy J. Gaiter, MHA, R. EEG T., CNCT, R.NCS.T., FASET
“One of the greatest gifts you can give is your time” ~ #Volunteer
What does volunteerism or volunteer actually mean… hmmm? The dictionary defines volunteerism as: the policy or practice of volunteering one’s time or talents for charitable, educational, or other worthwhile activities, especially in one’s community. Whereas volunteer is defined as a person who voluntarily offers himself or herself for a service or undertaking. A person who performs a service willingly and without pay.
Volunteering is a noble thing … it is a selfless act to sacrifice one’s time to helping others to have a better life and a hopeful future. Volunteering has great rewards, the joy in knowing you have made a positive difference in someone’s life. The individuals receiving the assistance in whatever capacity it is given, know that they are not forgotten. The act of doing for others gives one the opportunity to focus on someone else rather than one’s self.
That being said, I have and continue to be a volunteer of ASET and it has given me a broader perspective of our professional organization. It afforded me the opportunity to learn and work with some great people over the years who are dedicated and committed to ASET’s mission: “To provide leadership, advocacy and resources that promote professional excellence, and patient safety and quality care in Neurodiagnostics.”
Additionally, it is important to volunteer in one’s community as well. Elizabeth Andrew said, “Volunteers do not neccesarily have the time, they have the heart.” I volunteer at my church’s Care Center for those who are on the streets and in transition, needing a place to shower, have their clothes laundered and serving them water, coffee and food, as well as providing prayer and counseling. Working at the Care Center is most rewarding when you see a person’s life transform and he or she is no longer on the street because of what was done to help them make that transformation. It is about love and compassion to help others to make that change.
One of the most rewarding aspects of volunteering is working with teenage girls at church and having a small part in their development and growth, inspiring and encouraging them to just be themselves and knowing that I have made a positive influence on their lives!
“Everybody can be great. Because anybody can serve. You don’t have to have a college degree to serve. You don’t have to make your subject and your verb agree to serve. You don’t have to know the second theory of thermodynamics in physics to serve. You only need a heart full of grace.” ~ Martin Luther King, Jr
By Anna-Marie Beck, MOL, R. EEG T.
A volunteer is a person who gives of their time freely to complete a task. While I do not have a great deal of free time (especially during the school year), I still find ways to freely give my time. I often can be found volunteering my time for students outside of school hours (including weekends and evenings). I have been known to donate my time to help those in my community prepare for their exams. I also freely provide resources for those less fortunate than myself. It is my responsibility to set an example for my children. In doing so, we volunteer at shelters and collect food for drives and give what we can. In the last couple years, I found a wonderful organization that my children are a part of called KindCraft in the Kansas City area, which is a non-profit designed for children. This organization finds service projects to get kids involved in volunteering and helping those less fortunate. There are many ways to give freely of our time, you should find something that makes you feel fulfilled.
By Mark Ryland, AuD, R. EP T., R.NCS.T., CNCT, RPSGT
About 20 years ago, I saw a segment on 60 Minutes where they followed a group of Physicians & Allied Health Career people involved in an organization called Remote Area Medical. They basically enter an impoverished community in the United States for one week, set up tents, and treat various medical conditions. For direct patient care, you need to be either a physician, nurse, or have training in Ophthalmology or Dental. Although I have no training in any of these allied medical professions, I have remained intrigued in this type of concept. I am certain, however, there are similar organizations where my background and training would be useful.
My career and family life have not allowed me to participate in anything like this, but my retirement is approaching fast, and I really want to investigate opportunities like this. I am sure I will get bored in retirement, so I am going to need something to keep me busy and out of trouble. I consider myself to be one of the most fortunate people in the known universe. I really want to give something back. Perhaps there is an organization I can find, or some of my ASET colleagues would be willing to recruit a dumb old Audiologist/Neuro Tech for something to do!
NEW TECHNOLOGIES & RESEARCH
By Andrew Ehrenberg, BS, R. EEG T., CNIM
Volunteering is a greatly rewarding enterprise, as is being wonderfully described in this quarter’s newsletter. I would echo the many stories here, of the intrinsic and emotional value it brings. Sharing the knowledge and skills we have acquired (many of us also share neurophysiology as a passion) is always rewarding, even more so when it truly helps others. When it comes to research, volunteering can also be a key first step.
Often times, technologists will be interested in research, but have no idea where to start. The three keys to getting into research are a good mentor, opportunity, and experience. Volunteering can open the door to all three of these. Here, I will discuss the main type of research to look for as a volunteer opportunity and why, as well as the types of people you should look for to ask about it.
Two main types of research are funded and unfunded. Funded research is paid for by grants, where there is funding to support the needed resources. Unfunded research is usually conducted by a physician with an interesting idea or as a pilot for future grant requests. Unfunded research, however, often suffers from a lack of resources. The primary researcher, and possibly some additional researchers, are conducting the study and writing the publication on their own time. There aren’t the funds (usually) to hire a lot of extra resources.
Believe it or not, if you ask around within your physician groups, there will either be a current unfunded study, or one of them might have had an idea in their mind for one, and they would be happy to have your involvement and skills. That truly is all there is to it. The primary researcher will likely be more than happy to mentor you and teach you the ropes of research, as they are getting highly skilled technical assistance in return.
No, you won’t likely be paid, hence the volunteering part, but this can open the door to future opportunities to participate in larger rolls, possibly even to co-author, or as part of funded studies. Simply asking the question to the right people can yield you the mentor you need to get there, the opportunity to get involved, and the experience. Do keep in mind, this involves work, lots of it. There is benefit that comes from the introduction to the research world, but it will definitely be earned.
Two things I would ask, however. First, if you decide to give this a shot, and end up being able to get involved in research, send me an email. I truly believe in, and love hearing about this type of professional growth. Secondly, once you have the experience, give back by finding techs who are interested in research and mentor them in how to get involved.
PEDIATRICS AND NEONATALOGY
By Melanie Sewkarran, R. EEG T., CLTM
I haven’t found many volunteer opportunities that leverage my skills as an EEG technologist, but I’ll be ready when the situation arises. Most of my volunteer opportunities come through my church. Whether it’s mission trips, a work day at our building, helping elderly members with yard work, or providing childcare for certain events, it is always a very rewarding experience. As my young kids grow, I am eager to get involved in activities that allow us to serve as a family. I want to impress upon them the importance of giving without expecting anything in return, and then show them that there really is plenty of “return,” it just isn’t money.
I also serve on the Board of a foster care/adoption/counseling agency in town and while I’m not the most financially or business-minded individual, I enjoy getting to help where I can. Finding something you believe in and using what resources you have to support its vision is very fulfilling.
What I love about volunteering is that it takes many forms, anyone can do it, and while the results for the helped and the helper may be different, both lives are enriched by the experience.
By Janna Cheek, R. EEG T., CNIM
It’s so odd that volunteering and “giving back” is the theme for this newsletter since my daughter-in-law who is an RN, specializing in cataract, cornea and retina surgical procedures just returned from a mission trip in Honduras. We have communicated non-stop on how many lives this mission changed. Not only the poor and needy individuals receiving their eye sight but my daughter-in-law, several of her fellow nursing friends and the surgeon who organized this mission trip for them. All of their hearts are so full of LOVE and sincere delight from being able to help and they cannot wait to go back.
Now, after listening to her talk about her passion from the mission work, it way surpasses the nominal donation checks that I write out to help the police and their families, the firefighters and veterans. Each of these local organizations give everything to protect our communities with their lives because they want to. My son is a police officer and I see what it involves. Not only the concerns of mom, but with his wife and two little girls that never let him leave without a hug, a kiss and an “I LOVE YOU” because in this day and age, we never know if we will see him again.
But on a happier and job-related note, the NeuroLinks family (staff) pitched in with each buying items like cheese crackers, small tooth paste, tooth brush, comb, small deodorant, wet wipes and pieces of hard candy. We wrote a loving note with a scripture verse to place into a zip-lock baggie. Staff took 6 – 8 filled baggies and, as they travel to and from work or stop at a red light, we give one to a homeless person or someone in need. This type of “giving” is so easy and inexpensive. This is a great way to start or end each day and words cannot express the feeling you get by helping someone in need.
Welcome from the Interest Section Chair
By Petra Davidson, R. EEG/EP T., FASET, BS
Greetings Fellow ASET member,
Happy Spring! Hopefully, you are enjoying spring wherever you reside. We are not yet there in Minnesota. Currently, nearly 18 inches of snow coat my yard. Tiny bunny tracks dotted across the glittery, diamond like snow suggest that spring is in fact on its way.
Recently, I changed employment. After 20 years as a clinical technologist, I am now a remote technologist. Everything I do resides behind a computer screen and headset. As I reconfigure my elevator speech to fit my new role, I called on our Special Interest Section Leaders to do the same. There are a few surprises in the articles that follow. I hope that you enjoy them as much as I did.
It is always intriguing to me to hear how others in the field describe what we do. I ask that you read these carefully and let us know what you find interesting or how you might change things to fit your unique role. That is the beauty of our field, each of us has a unique position! Happy reading!
Acute/Critical Care Neurodiagnostics
By A. Todd Ham, R. EEG T., CLTM, BS
For this section, I’ve prepared an “All Things EEG, 2nd Edition” crossword puzzle for you to exercise your brain muscles. To view the crossword puzzle, click here.
By Jennifer Carlile, R. EEG T.
Because I wear a few hats in my position, here is how I describe my job is: First, I always start with how much I love what I do. I’ve been in the Neurodiagnostic field for almost 30 years and I help Neurologists make a diagnosis for their patients who might have epilepsy. The other way I describe my job is: I offer a service to physicians, helping them determine whether their patients have epilepsy, seizures, or brain injury. I have been able to say for the past 29+ years that I love what I do and still love this field. How many people can honestly say that? I have been so blessed. In the beginning of my career journey, I started working in a major hospital system that saw the worst-case scenarios of brain-related issues, followed by selling equipment that helps detect brain-related issues, and now, full circle, I have the best of both worlds, offering an amazing service to these physicians and taking care of their patients. Love, love, love, love in honor of Valentine’s Day. Sounds sappy, but it is the truth! #blessed#lucky!
By Emily Scanlan, R. EEG T., BS
When asked about what I do, I try and relate it in terms that are appropriate to my audience. If I am talking to another healthcare professional, I will tell them that I monitor brainwaves of patients and look for any seizure-like activity or any abnormalities. Now, if I am talking to a non-healthcare person, I try and make my description fit their intellectual capabilities. My dad was a professor at the University of Minnesota and likes to know the little details of my job, so I will go into more details including why I may see certain things and how it may impact a patient’s prognosis. On the other hand, if I am talking to my sons (mind you, they have helped me as subjects for marking with my students), I go really high-level and say that I am monitoring their brain to see if anything is wrong. There is no need to go into detail as they won’t get it, which will, more than likely, just confuse them.
By Vicki Sexton, R. EEG/EP T., R.NCS.T., CNCT, CLTM, BS
My 5-second elevator speech to my patients who do not speak English and who have no one to translate, or a patient who is developmentally delayed is to say what I am going to do and act out what I am saying at the same time. As I explain what I am going to do, I do part of it on myself, then I show them either on their head (with marker and tape measure), or I show them on their hand. I will mark their hand, then rub with the prep, then apply an electrode so they know how it feels before I apply it their head. As I perform the test, I act out what I want the patient to do while speaking English. They usually start to understand as I repeat common commands, such as open eyes and close eyes. With the hyperventilation, I usually do it along with the patient, so they understand.
Taking the little extra time to explain, while acting out the steps usually gives a thorough study and calms the patient at the same time.
By Stephanie Jordan, R. EEG/EP T., CNIM, CLTM
One thing I certainly enjoy teaching the NDT students at our lab is how to communicate with our patients and put them at ease for their procedure no matter the challenge. We are fortunate here to have a diverse patient population with different ages, cultures, and ability to comprehend. For many, it is their first EEG and the patient arrives to the lab apprehensive and uncertainty.
First things first is to make the patient comfortable in their physical surroundings then explain what the EEG is. I avoid calling it a test because so many are apprehensive about “taking tests”. I tell the patient that the EEG is a recording of their brain cell activity in waveform, recorded by electrodes pasted onto the scalp. At this point I show them the electrodes and how they lay flat on the scalp by pasting an electrode on my hand. Speaking slowly and allowing time for the patient to ask questions as they occur helps to relax them. It is helpful to let the patient know that the test is non-invasive by telling them “I am not putting anything into or out of your brain, just recording the activity that naturally occurs there.” For young children, a simpler way is to say, “I am going to put these golden buttons on your head and take pictures of your brainwaves.” Children know they need to stay still for pictures and most enjoy it, so this is a good strategy. For all patients showing the entire bunch of electrodes and letting them know you will measure and mark with a crayon for each one gives them an idea of how the set up will go. Show the measuring tape and marker to the patient and let them know when you are going to touch their head. After the marking, let them know you are going to clean each spot and paste the electrode on there (show the cotton swab and cleanser). Letting the patient know that everything washes off with water when done can also put them at ease. For older patients who are familiar with EKGs, letting them know that the EEG is for recording brain activity like the EKG is for recording heart activity gives them a familiar comfort. For my 5-second elevator speech – my job is to get the best brain cell recordings for each patient I serve.
By Patricia Lordeon, R. EEG T., FASET
We frequently hear about and discuss how important communication is within our work space, but even then most of us don’t really communicate well. For example, we lament when a new policy is implemented, and we feel that insufficient information has been communicated to us about the change. We assume that our coworkers know what we mean without us having to actually utter the words. We think that everyone knew about that “something” being changed and are surprised to realize that some individuals were unaware (you mean the grapevine let us down??). And work issues are only the tip of the iceberg of communications. Don’t even get me started on communication in politics!
When you are trying to communicate with someone and there is a language barrier, the stakes are increased exponentially. At our hospital, we are fortunate to have the “blue phone”. It is a device that has two hand sets and plugs into a jack on the side of our existing hospital phone. Via the magic of technology, we can choose from a large variety of languages and dialects, and have a real-time, three-way conversation between tech, patient and translator. The company maintains a staff of translators available to speak with and translate for healthcare professionals. This luxury is obviously not available for every hospital and clinic setting, and we are blessed to have this advantage when working with non-English speaking patients. If you have to make do without this marvel of modern technology, you can prepare for these situations in advance by making a picture book of the application process. YouTube is another great resource, and of course, Google Translator makes everyone an instant linguist.
When I was a young tech, none of this technology existed (gives you a hint of how old I am). So, we had nothing to use or help us when working with patients who did not speak our language. Pantomime and picture drawing were our only resources when faced with this situation. It was far from optimal, and we have come a long way from those days. Obviously, communicating with non-English speaking patients and families is not an issue for us in our current work environment.
Back in those days, we were sometimes fortunate enough to test patients who had some small understanding of English, or even better, we had some small understanding of their native language. One day, long ago, I had the pleasure of working with a four-year-old patient and her mother who were at our facility for long-term video EEG monitoring. The patient and her mother spoke French exclusively. I was thrilled to be able to use my four years of high school French to help comfort them and assist in achieving good quality testing. I quickly realized that my school-taught French was no match for a native French speaking parent. I was able to communicate much better with the four-year-old patient (which told me that four years of high school French puts you on par with the conversational level of a four-year-old, French speaking child).
Despite our language barrier, we soldiered on with the testing. We made due with a smattering of French (on my part), lots of head nodding and pantomime, and some diagram drawing. This patient continued to travel to our hospital for the next twelve years, and we forged a strong bond during that time. The fact that the patient took an English class at home in her grade and high schools helped tremendously in our being able to communicate over the years. Her English was excellent, while I am sad to confess my French never really progressed beyond the four-year-old level I started with.
For me, determination and good humor were the two most influential factors in establishing a communication process with this patient. While there are certainly easier methods available now, nothing can replace the shared trial-and-error that made us laugh and smile and learn together. This family never forgot how, during the patient’s first-ever video EEG, I asked, in all seriousness, to “Ferme tes oeufs” (Close your eggs) instead of the intended “Ferme tes yeux” (Close your eyes). And I will tell you that I never, ever had the opportunity to use the only French phrase I recall from those four years of French class. “Ou est la piscine?” (Where is the pool?) is not something I have ever needed to ask when obtaining a medical history.
By Susan Hollar, R. EEG T., BA
There are many approaches to describing what an EEG technologist does each day. Of course, you should tailor your description based on your audience. Children tend to be very literal in their interpretation of what adults say. I have encountered more than one child, including my own grandson, who thought we sucked out the brains of children with our electrodes! There have been many who believed we could tell what they were thinking. I, personally, am glad that is not the case! My explanation has evolved as I have witnessed what seemed to work and what fell totally flat.
My typical, quick explanation for what an EEG tech does is: We make a recording of how your brain is working. We do that by placing recording wires called electrodes on your head (scalp). My main job is to make sure the recording is free from artifact or noise. We will have you do some activities to help the Neurologist see how your brain works. Those activities will include some special breathing, opening and closing of your eyes, and a special flashing light. All of this helps us see how your brain works.
I also really like the explanation (when appropriate) that it is like looking for a bolt of lightning or listening for thunder to see if there is likely to be a storm coming in the future.
It is also important to ask what the patient knows about EEG and then build on their knowledge.
Intraoperative Neurophysiological Monitoring
By Jeffrey R. Balzer, Ph.D., FASNM, D.ABNM
“So, What Is It You Do for a Living?”
In 26 years of performing IONM, if I had a quarter for every time someone asked me “what do you do at work?” I could have retired 10 years ago. Unlike other professions where people say, “I’m a pharmacist” or “I’m a mechanic” we typically answer, “I am a neurophysiology technologist” or a “surgical neurophysiologist” and that’s where people stop and look at us like we are speaking a different language. It is at this point that we often default to saying “oh, I work in the operating room” in an attempt not to go into detail of what we do. What we fail to realize is that we are missing the perfect opportunity to create and deliver a succinct layman’s explanation of what IONM is and what role we play in the care of our patients. Our answer should be almost reflexive and polished so that we can clearly convey what we do and how we generally perform IONM.
Typically answers begin with “I monitor the spine and brain during surgery in the operating room.” Family members then say, “so you are a surgeon”? Our answers concerning what we do should attempt to be more detailed while maintaining a level of basic verbiage. I begin by explaining that most, if not all surgical procedures, pose some level of risk. I then, for example, talk about the ideal situation for detecting complications during surgery. I tell people that if every spine or brain surgery could be done awake to allow for a continuous assessment of neurological function, we would do it that way. The confounding factor is that our patients are under general anesthesia, so a traditional neurological examination is impossible to perform. As such, we use specific tools that reflect an awake neurological examination and reliably provide information to the surgical team so that interventions might occur, thereby potentially preventing or lessening complications.
The next thing to describe are the tools we use and how we perform IONM. Depending on where and what the surgery is, I say we use tools to stimulate the nervous system and record activity that is generated. I often attempt to use analogies that most people understand to describe what we do. A basic description involving electricity and wiring is often very useful in these instances. I tell folks that what we do is analogous to us generating an electrical signal that travels along a wire. We continuously watch the signal moving along the wire measured at different points. If the wire (the spinal cord being the wire, for example) is interrupted, then we know when and where the problem occurred along the length of the wire. Once we detect an interruption, we immediately inform the surgical team who, in turn, investigates the potential cause. This typically gets the message across particularly for cases involving spine monitoring. As IONM become more complex our explanations need to be a bit more complex as well, and using these types of analogies is often very useful.
We should be using the opportunity with friends and family to polish our explanation of IONM testing so that we can utilize the explanation with patients and patient’s families when we are explaining the details of IONM to them or more importantly, acquiring an informed consent. The explanation needs more detail but still be succinct and accurate as patients and their families are often under far more stress than a family member who is casually asking what we do in the operating room.
One of the major components of informed consent is that information is given about a treatment or test so that the patient can decide if they wish to undergo a treatment or test. This process of understanding the risks and benefits of treatment is known as informed consent. The key component is that the patient must understand the relevant information. Decision-making capacity is also referred to as competency. Competency may be the most important components of informed consent. There are several different components of decision-making capacity:
- Ability to understand options
- Ability to understand consequences of choosing the options
- Ability to evaluate costs and benefits of consequences and relate them to personal values and priorities
The key to decision-making capacity or competency is predicated on the patient understanding the IONM, the risks and the options. We therefore need to ensure that our patients understand exactly why we are there and what we are going to do.
The explanation during informed consent should be more formalized, but nonetheless, basic enough for the patient to understand. If need be, similar analogies to those described above are perfectly fine to use conversationally. As for the written IONM consent, the following is an excerpt from a typical IONM consent form:
“Intraoperative neurophysiological monitoring is performed during a variety of surgical procedures to measure the function of the brain, brainstem, cranial nerves, spinal cord, spinal nerve roots and peripheral nerves depending on the type(s) of testing performed and the surgery. Electrophysiological measurements provide information to the surgeon in the operating room that may assist in identifying neural structures, aid in performing the surgical procedure itself and in detecting and preventing injury to the nervous system.
Central and peripheral nervous system function is measured using electroencephalography (EEG, an electrical map of the brain), electromyography (EMG, measurement of electrical energy to the muscles) and/or evoked potentials (EP, stimulated electrical activity) recordings. The surgical procedure and the parts of the nervous system at risk will determine which of these tests will be monitored. In some cases, these will be recorded simultaneously.
After the induction of general anesthesia but before the start of surgery, small, sterile subdermal (under the skin) needle electrodes will be placed and used as stimulating and recording devices. Baseline recordings will be made so that differences during the surgical procedure can be detected. Once the surgery has begun, recordings will be monitored continuously or near-continuously throughout the procedure and any significant changes will be reported to the surgical team. The information will be interpreted by a board-certified Neurophysiologist and recommendations will be made. Prior to you awakening from anesthesia, all the electrodes will be removed.”
Once an explanation, such as the one above has been given, the patient should be given a detailed description of what the potential morbidities are as they relate to performing IONM. In addition to the potential morbidities, quoting incidence as a percent is important. This can be based on the literature or on personal institutional experience. Some examples of these include the following:
- Infection. Infection may occur at the site of electrode application in the skin (estimated risk <0.1%).
- Burns. Burns at electrode site caused using electrical equipment such as cautery or by a malfunction of the neurophysiological monitoring equipment (estimated risk <0.1%).
- Hematoma. Because a needle is placed beneath the skin, blood may collect to form a hematoma (bruise or blood clot) (estimated risk <0.1%).
It is important that this list be complete and describe all possible instances in a succinct and understandable manner. This is all part of a complete description of IONM that needs to be provided to the patient and their families prior to the procedure.
Regardless of who we are explaining IONM to, whether family, friends or patients, we need to take great care to provide accurate and succinct information. Perhaps most important, particularly with patients and their families, we must make sure they understand the information and details because without this fundamental understanding, a legitimate decision cannot be made about the IONM.
Nerve Conduction Studies
By Jerry Morris, MS, R.NCS.T., CNCT, FASET
Hey, everyone! I hope everyone had a wonderful holiday season. I know I did. January and February are usually the dreariest months around Louisiana. Usually by March things start to brighten up and spring is around the corner. It’s still a good time to be inside, and my northern and eastern friends have so many colder and drearier days and nights ahead.
Having said that, I am writing this article during my fourth week of rehabbing from right knee replacement surgery. I finally bit the bullet and had it surgically repaired the second week of January. The surgery went great; only two nights in the hospital in a room right down the hall from my EMG lab. Great nurses, therapists, the works… They had me up and walking on a walker less than 24-hours post-op and with very little pain. NOTE: I got rid of the walker and the cane 6-days post-op. Debby, my wife, said I was showing off. The only drawback was that they ran bags of D5W continuously for two days. I have never gone to the bathroom that much in my entire life! Fluids were going in my arm and seemingly going right through me. I think I slept in 30-minute shifts during those two days. Discontinuing the IV was a significant highlight of my stay, but it did feel humbling to see the patient care and staff interaction from the other side of the fence. Once I got home, I began going to physical therapy (PT) two days later. For what it’s worth, the surgery was a piece of cake compared to the PT. For an hour, two to three days a week, I got pushed and shoved and flexed and extended until I was ringing wet with sweat. One of the patients who was there at the same time called them “physical terrorists”. They said it, not me! Then I got to do the same thing at home on my off days. By the time you read this I should be back at work, either on light duty or full time. Four to six weeks off is pretty normal for this type of surgery. Debby is being a jewel at taking care of me since it was my right knee I cannot drive until I get clearance, she has become my chauffeur. Being stuck at the house has given me time to work on projects for ASET and AANEM, as well as the “Honey Do” lists Debby writes out for me each morning! I miss my patients, doing clinical work, and the day-to-day routine, but keeping busy at home has eased my boredom. If I get tired of my computer work, I just turn on the sports talk shows for a while. I could really get used to this, but I still want to get back to my work routine. Can’t change 43 years of working habits in only three to four weeks…
For this article, I have been asked to give a quick explanation of what I do when I do nerve conduction studies and how I go about that explanation. I can probably safely say that NCS/EMG can be, and probably are, the most painful modalities of neurodiagnostic technologies, with the possible exception of SSEPs. EEGs and LTM, BAERs, VEPs, sleep studies are relatively painless unless you scrub and prep the skin too hard. IOM studies are started and finished under sedation, and therefore not painful, unless your anesthesia person likes to wake the patient up a tad too early. EMG/NCS procedures are a bit more painful, depending on the patient’s sex, age, pain tolerance, attitude, and overall general health. Although an explanation of the procedures is supposed to be done by the referring physician, more often than not, an explanation is never given. So, as I am getting the patient ready for the NCS procedure, I explain to them, and their family if present, what I am going to be doing in the next 30 minutes or so. This involves answering any questions they have and trying to calm any anxiety they have about having the test. If I don’t know the answer to one of their questions, I tell them I will find out the answer as soon as I can and get back with them once the test is over. Once I start the test, I try to talk them through the process of cleaning their skin, putting on the electrodes, performing the actual stimulation, measuring distances, and marking for conduction velocities, etc. After doing this once or twice, most patients learn what the routine is, and any further detailed explanation is usually unnecessary, although there are always patients who need to have further details given to them. At all times, be POSITIVE! Every patient is different and needs to be treated with care, no matter how challenging they are personally. Technical challenges are often less difficult to deal with than personal ones. We, as techs, don’t really know what our patients go through day to day, so trying to be tuned-in to their feelings really helps a lot, no matter how difficult the situation. Once the NCS is completed, I start a simple and preliminary explanation of the EMG study if it is being performed. I try not to go into a lot of detail because the physician performing the EMG will do that. During the study, the doctor will adjust his explanation to his specific study criteria for that patient. Once the study is completed, any unanswered questions will try to be resolved. If the patient asks specific diagnostic questions, it is the doctor who will answer them. If no EMG is performed, I tell the patient and their family that the study will be given to the interpreting physician and that a final report will then go to the patient’s referring physician, even though at times this answer is frustrating to the patient. Remember that you are doing a painful and difficult test to a hurting and anxious patient. A good bedside manner, a sympathetic ear, and a willingness to listen often is the difference between a good and a mediocre study, no matter how technically sound you are.
Please have a wonderful spring and summer. Stay tuned in to ASET for the latest and greatest things in neurodiagnostics.
By Anna-Marie Beck, MOL, R. EEG T.
As I look back at all the times I have attempted to explain what I do to people I have to giggle. I have said things such as:
“Have you seen an ECG? What I do is similar, but I work with the brain, not the heart.” I overheard a physician explain it to a patient this way, and they understood it, so I used it.
“I put ‘buttons’ on a person’s head and watch their brain waves.” I have used this especially with children.
“I teach students how to perform tests on the nervous system, primarily the brain.”
“I work with neurologists.”
If I am speaking to someone who knows a little more about allied health, or health care in general, I give a few more details. However, it is usually simplified for them as many do not know or understand the scope of what we do and who we work with. While this is frustrating to me, especially as an educator and a parent of a child with epilepsy, I must remember not every person in health care is exposed to everything in health care.
Recently some of my students and I were speaking with local high school students about a career in neurodiagnostics. I loved hearing my students tell the high school students that this field is full of possibilities as we don’t know all there is to know about the brain and nervous system and if you want to be a part of something bigger than yourself, neurodiagnostics is a great way to do that. My 5-second blurb regarding our field: “If you have a passion for working with people, learning something new daily, being a detective for physicians, providing answers to the puzzle a physician is trying to figure out; then maybe neurodiagnostics is something you might be interested in. We work closely with physicians and direct patient care staff, but we all work together to ‘solve the puzzle’ for the patient. No two days are the same. I have always enjoyed what I do. The field of neurodiagnostics is ever changing and in that I take comfort. As I near 20 years in the field, I can honestly say that I have not regretted one day of my choice for neurodiagnostics.”
By Mark Ryland, AuD, R. EP T., RPSGT, R.NCS.T., CNCT, FASET
I consider myself to be one of the most fortunate people in the known universe as I have the honor and privilege to be part of an awesome team of dedicated individuals who are responsible for educating and training the next generations of Neurodiagnostic Technologists in our area of Ohio. Our field provides an enormous contribution to patient care, which is so very important. Because the field is changing, growing, and expanding so much, formal education of future technologists is an absolute necessity.
By Bill Coslett, Ph.D., CNIM, BCIA, EEG-C
“……Sleep that knits up the raveled sleeve of care. The death of each day’s life, sore labor’s bath. Balm of hurt minds, great nature’s second course. Chief nourisher in life’s feast…..”
William Shakespeare, one the world’s most prolific dramatist, was a very keen observer of human behavior. Many of his protagonists were afflicted with the pains of life including problems with sleep and vivid dreams. There are those today who say that Shakespeare’s lavish descriptions of character afflictions sets the foundation for many of our present sleep disorders such as night terrors, sleep paralysis, and insomnia. According to Shakespeare, sleep was a “blessing” given to many, but also serves as a curse to those with “restless minds.” Shakespeare understood how sleep effected the immune system as well as our overall general health and wellness. He understood how anxiety/stress and our ability to calm the mind prevents sleep onset and uninterrupted sleep.
Shakespeare’s observation in early 1600 rings true today. It is estimated that insomnia and daytime drowsiness affect 35–40% of the adult population annually and are a significant cause of morbidity and mortality (Ncbi.nlm.nih.gov). The untold impact of insomnia is staggering in terms of loss of productivity, increased risk of chronic health conditions, as well as increased negative impact of our mental health.
Today’s sleep industry is enormous, with billions of dollars in revenues being spent each year to combat the effects of our inability to get and stay sleep. Sleeping medications, such as Lunesta and Ambien, are one of the most widely prescribed prescriptions for general practitioners. Although these medications are safer now than were the benzodiazepines of years ago, there still are concerns about side effects, as well as issues of dependence.
There are so many over-the-counter sleep aids that a comprehensive listing would be impossible for this article. Although many times these medications may help bring about restorative sleep patterns, there remains issues of undesirable and possibly dangerous side effects.
An area that has received a lot of attention in sleep medicine is Neurofeedback. NF is a powerful tool that can help people with difficulties in getting and staying asleep. Studies are beginning to emerge demonstrating that neuro training impacts the sleep regulatory mechanisms in the brain. Many clinicians have documented that the first noticeable change with NF training is an improvement of sleep quality. This seems to hold true whether training is done for ADHD, chronic pain, and/or substance abuse.
The sensory motor rhythm (SMR) is an oscillatory brain wave noted over the sensory motor strip. It is considered by many to an idle rhythm of the brain. For most individuals, this frequency oscillates in the range of 12-15 Hz and is produced with a quieting of the motor cortex. Motion or the thought of movement diminishes the sensory motor rhythm. Another name for this oscillation is the Mu rhythm or what is commonly referred to as a Wicket Rhythm.
In 1963, Barry Sternman, a pioneer in the field of neuroscience, was doing some research involving a Pavlov-like experiment training the brains of cats. Sternman was the first to show that instrumental condition of the SMR was possible. Two very interesting observations were made by Sternman in his research of cats:1) SMR training selectively enhanced spindle activity in subsequent sleep and 2) SMR training produced longer periods of undisturbed sleep.
It is hypothesized that SMR training impacts sleep by increasing sleep spindle density, which results in a normalization of sleep onset. Others suggest that the rationale for SMR training is that increased relaxation combined with inhibition of motor activity should counteract the hyperarousal associated the problems of sleep onset.
Generally, training is placed with one electrode placed on the sensory/motor strip (C3 or C4) and the other electrode placed as a reference over the ear (A1/A2). As a general rule, training from the right side at C4-A2 produces a calming and relaxed affect while left hemisphere (C3-A1) training produces a more energizing and focused affect. The goal of the training is to increase the amplitude of the SMR with auditory and or visual feedback given as a reward when amplitudes exceed a specific threshold. Some NF therapists incorporate a reward for inhibition of Beta along the sensory motor strip. As a general rule, changes in sleep patterns can emerge in as quickly as 6–10 sessions.
Any comprehensive treatment of sleep insomnia should include incorporating positive sleep hygiene practices, general physical exercises, as well as cognitive behavior strategies. It is now being recognized that neurofeedback can be added to help those individuals who have trouble in getting and staying sleep.
By Janna Cheek, R. EEG T., CNIM
Ideas and maneuvers to translate our job and its description to patients by being able to relate to generational phrases or activities to help with communication:
NeuroLinks provides multiple NDT procedures to both in- and outpatients; to the young and old, which at times becomes challenging to explain exactly what we are doing to their head. We commonly answer questions, such as, “Do earlobes have brainwaves in them?” or “Can you read my mind or see what I’m thinking?”
I have explained to the elderly females that it is like the perms their moms use to give them, but this one won’t damage their hair. Another comical explanation I have given elderly men is that I am just needing to confirm that your brain is “clicking on all cylinders” and if not, we have an extra supply of them (cylinders) at a discount price in our backroom.
But I think the most memorable and precious explanation came from a little 6-year-old girl many years ago who told me to please send pretty music to her brain to listen to when she went to sleep. I explained to her that I would do my best, but that this test doesn’t send things into her brain, only records what comes out of her brain. If she likes pretty music, then this test can write down the pretty music she likes to hear on a piece of paper (analog back then) in a language that that the doctor can read.
At the end of her test, I tore off the first couple of pages of recording (BioCal), folded it up, drew a heart on the outside of it with my red china marker, wrote her name on it, and handed it to her on her way out of the exam room letting her know that this was the music her brain wrote down for her doctor to see. That easy little gesture made this little girl so happy and proud. You would have thought I’d given her the moon. She showed it to everyone in the waiting room and her mom called the next week to let me know that she was still sleeping with her “mind’s music waves”.
It takes a lot of creativity and thinking outside the box many times to be able to get your patient to relate, relax, and understand what an EEG is all about and why they need these wires placed on their head.