Technical User s Manual NTS Trolley EMG/EP System. Operation Manual. NCC Medical Co.

Transcription

1 Technical User s Manual NTS Trolley EMG/EP System Operation Manual NCC Medical Co., Ltd

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3 Table of Contents Notice to Users... 1 Rights and Responsibilities... 5 Copyright Reservation... 5 Chapter 1 System Overview EMG Main unit EMG Acoustic & Visual Stimulator Shortcut Keys... 9 Chapter 2 Software Description Main Project New Case Module Patient Information Button Introduction: Case List Patient Information Query Display the Patient Information List Display the module information of the marking patient who are examined Print General Report Set the head content of report: System Setting Hospital information Nerve/Muscle edit Add common nerve/muscle Edit stimulation point and record point: Add nerve/muscle Input setting of interface Report set Backup set Exit Motor Conduction Velocity (MCV) Sensory Conduction Velocity (SCV) Electromyography (EMG) F-wave H-reflex Repetitive Nerve Stimulation (RNS) Blink Reflex (BR) Sympathetic Skin Response (SSR) Segmental Conduction (SSCT) Upper/Lower Limb Somatosensory Evoked potential (USEP / LSEP) Auditory Evoked Potential (AEP)... 96

4 2.13 Visual Evoked Potential (VEP) Event-Related Potential (P300) Chapter 3 Maintenance and Servicing Chapter 4 Important Safety Information Appendix A: Manufacturer Information Appendix B: Power Supply & Battery Operation Appendix C: Electromagnetic Compatibility

5 Notice to Users Users are advised to read this manual carefully before using this equipment. The Users should follow the operation steps that is consisted in this manual, otherwise it would lead to abnormal operation results and cause damage to the equipment or even cause injuries and physical dangers to the user. The company does not hold any responsibility for any property damages, injuries or physical dangers caused by the misuse of this equipment. Precautions on using this device: Equipment installation environment and location requirements: 2 Ensure the power switch is off when installing the device. The device should only be switched on during examinations; 3 The location should have good ventilation to remove gases in the air which will either affect the readings or cause danger to the users and patients; 4 There are temperature and humidity control device to ensure that the appropriate test subjects skin temperature, the room temperature maintained at 20 C ~ 24 C, humidity 20% to 80% is appropriate; 5 The location should have controlled lighting, preferably incandescent; 6 There should be a shading device in the location to help achieving better results during VEP examination; 7 The location should be soundproof to prevent external noise interference during AEP examination; 8 The device should be placed away from electrical instruments, high-frequency radiant point, etc. to avoid interference during examination; 9 The location should have a special hand-washing station installed for the convenience of use. After all, all operating personnel and the patient should wash their hands first to release static electricity before the examination; 10 The device should be kept away from moisture or water, extreme air pressure, excessive humidity and temperature, poor ventilation and acid gas or alkaline dust during the examination; 11 Use of this device is not advisable in the presence of any flammable anesthetics to prevent voltaic arc which may cause explosion; 12 This device is not suitable for use in places with chemical storage or gas 1

6 chambers such as a medical hyperbaric oxygen chamber, as it may trigger an explosion or fire. Ground wire connection requirements of equipment: 13 This equipment complies with Class I in GB9706.1; 14 The ground wire must be used with the supplied 3-pin power plug. Otherwise, it may cause electric shock to the patient and the operator; 15 An effective connection with the potential equalization terminal should be secured for safe grounding; 16 When several medical devices are used together, all devices should be grounded at the same place to prevent any potential differences between the devices, which may cause electric shock to the patient and operating personnel. Precautionary Steps 1. Before Operation: Check to ensure that the equipment is cleaned and are in good operating conditions; Place the equipment in appropriate position; Make sure all the wire connections and lead connections are correct; When the device is used with other instruments, extra measures should be taken to avoid diagnostic errors or other problems, such as making sure they share the same grounding; All lead cables which be connected with patient should be checked carefully. 2. During Operation: 1. Both the patient and the instruments should be given sustained, careful attention; 2. To ensure patient s safety, switch off the power before removing the electrodes and/or sensors, even just to switch the electrode positions; 3. Patient should avoid touching the devices directly for safety reasons. 3. After Operation: Return all the devices back to initial position before switching them off; Remove the electrode cable gently; Clean the equipment and accessories for future use. 2

7 Other Notes: Do not use this device for other uses than medical examinations; If the device is connected with multiple instruments on the same patient simultaneously, superimposed leakage current of each instrument will cause security risk. Any such combination should be checked by relevant security personnel before it is being put into use; Removable multi-jack provided with the EEG system package is strictly for use with instruments within the original system only; When the system power is powered by the removable multi-jack socket with isolation transformer, user should not connect non-medical electrical equipment to the wall outlet directly; The equipment parts that are in physical contact with human body after equipment should be confirmed to be working in stable condition; This amplifier of this instrument is powered by rechargeable battery, which should be charged before operation; The Acoustic & Visual stimulation for the stimulator is designed specifically to meet the general safety requirements; For instrument power supply, voltage and frequency of power supply used for this instrument must correspond to the specifications in the manual; The EMG amplifier, receiver, electrodes and stimulator are medical electrical devices designed for use in a clinical environment; Maximum allowable load for removable multi-jack socket is 2500VA; Do not connect device electrodes to other conductive parts of the device or to the ground; The equipment and its attachments should be examined regularly; This device does not have anti-defibrillation function, so it cannot be used together with the defibrillator or any high-frequency surgical equipment; When the device is used together with other equipment (such as a pacemaker or electrical stimulation), safety of the combination should be confirmed by clinical engineers, so it will not affect the equipment's diagnostic results or cause harm to the patient. Warning! Removable multi-jack socket should not be placed on the ground. Requirements for Accessories: All accessories that are used together with the device should be approved by 3

8 the Company. Unapproved device and accessories will affect the effectiveness of the instrument and safety to the users and patient. Staff Requirements: 1. Operator must be trained, have some skills before they can operate the equipment; 2. Operators must be familiar with electrical safety knowledge. Warning: Computer, monitor and printer which are used with this equipment should meet national safety standards, and the power supply for the medical equipment should be insulated using an isolation transformer unit. Clinical usage: This device is designed for EMG monitoring and examination. Prognosis, evaluation and monitoring of the electrophysiological aids for diseases of central nervous system and peripheral nervous system, diagnosis, but also for rehabilitation medicine (physical medicine), occupational medicine and sports medicine and other areas of neuromuscular function studies. Contraindications: Patients with cardiac pacemakers or cardiac catheterization; Patients with skin diseases; Patients with bleeding tendencies; Patients who are susceptible to recurrent and/or systemic infections. Applicability statement: This manual is only applicable for NTS-2000 Trolley EMG/EP system stated as below: NTS-2000-A 1/2/4 channels Trolley EMG/EP system 4

9 Rights and Responsibilities Information in this manual is subject to change, and the details of the changes will be embodied in the updated version. NCC Medical does not assume responsibility for any use or reliability for the software and device which is not provided by NCC Medical or NCC's distributor. Copyright Reservation NCC Medical Co., Ltd. reserves all rights to the copyright of this publication. This manual is only for personal use of buyers, and any parts of this manual cannot be copied or transmitted, including photocopying and recording in any form or by any means (electronic or mechanical) without the written permission of NCC Medical Co., Ltd. 5

10 Chapter 1 System Overview System Components Fig 1.1 Systems components 1,2, or 4-channel optional system System consists of the various components: EMG/EP Main unit; EMG acoustic & visual stimulator; USB-DB9 cable; DB15 extension cable; 6

11 Computer; Speaker; In addition, it also includes electrodes, electrode cables and NTS-2000 Software and other accessories in standard configuration. 1.1 EMG Main unit Fig 1.2 Front view Fig 1.3 Back view EMG Amplifier is divided into 1 channel, 2 channels and 4 channels. It mainly achieves amplification of physiological signals and transmission functions, the amplifier use AC power supply. As shown in the pictures above, take '4 Ch' as example, the channel in front view should connect to six-pin type electrodes cable, after connected to electrodes, it will be activated after connected to electrode cable, then the indicator at the top of that channel will turn on, The interface in the middle place of amplifier is used for connecting to the body ground cable), the indicator above the interface is power indicator, It shows the different status 7

12 which motioned in the table below. The green button in back view picture is power switch; it is used for turning on/off amplifier power. And then the connecting interface for power supply, extra stimulator, USB cable, sound box and extra backup interface. 1.2 EMG Acoustic & Visual Stimulator Fig 1.6 The front of EMG Acoustic & Visual Stimulator The rectangular LED indicator is light when stimulation device is power on. When one channel is activated, the indicator on the top side of the output port will be light. The detailed description for the front ports are as below: 1 To access headphone. 2 Special end and does not be used now. 3 To access goggles. 4 To access LCD monitor for pattern reversal. Fig 1.7 The back of EMG Acoustic & Visual Stimulator The detailed description for the back ports are as below: 1 Don't need to connect it here. 2 Special port and does not be used now. 3 To access DB15 extension cable and connect it with the output end of main unit. 8

13 1.3 Shortcut Keys Button icon Function Help Knob 1 Knob 2 Adjust the volume Adjust the current intensity Change side Overlap / Record Acquisition / Stop Adjust the volume of the sound box Change the current intensity Change left/right side To send out the continuous stimulation by the frequency setting. Note: It is overlap function for EP module; It is recording function for F wave, H reflex, RNS. The overlap or recording will stop until it reaches the default value of overlap or recording. To send out single stimulation when pressing it, this button will be gray during stimulation. It can be used again after single stimulation finished. 9

14 Chapter 2 Software Description System specific requirements: Desktop: a) CPU:2.0G Hz and above. b) Memory: 512M or above. c) USB: USB 2.0. d) Operating System: Windows XP SP3 or Win7 Ultimate 32-bit version. e) Hard disk:500g or above f) Monitor: 17'' or 19'' standard LCD display; Resolution: 1280*800; 1280*1024; 1366*768. NTS-2000 software Software modules include the main interface, USEP / LSEP (somatosensory evoked potentials), AEP (auditory evoked potential), VEP (visual evoked potential), P300 (event-related potentials), EMG (electromyography), MSC (motor conduction velocity), SCV (sensory conduction velocity), BR (instantaneous reflex), SSCT (multi-segmental conduction), RepStim (repetitive nerve stimulation), SSR (sympathetic skin response), F-wave (F response) and H-reflex. 10

15 2.1 Main Project The main control module consists of New Case Module,Case List Module,Set Module, Exit Module. Fig Main Interface 11

16 2.1.1 New Case Module Patient Information Click 'New Case' button on the main control module to pop up the following interface: Fig Case Information 4. Exam Date: Generating this date is according to the current date of system. 5. EMG Record Number: Create an unique medical record number for each patient and this number need to be manually entered by yourself. 6. Inpatient No.: Input the inpatient N. of patient or vacant. 7. Name: To enter the name of patient. 8. Sex: To Select the gender of the subject. 9. Date of birth: Method 1: Input the data of birth of the patient, and click 'Exam' button to choose the modules. Method 2: Input the age of patient directly and click Exam button to choose the modules. Note: Each method is OK, the age of patient is necessary. Height: To enter the height of subject; Weight: To enter the weight of subject; 12

17 Department: Able to record the department; Ward Section: Able to record the ward number; Handedness: To select the patient of left or right hand; Bed No.: Input the bed No. of patent or vacant. Clinic Diagnosis: choose clinic information (the information can be chose through setup---input interface setting--clinic diagnosis setting), also we can input the clinic diagnosis information directly; Electrophysiological Diagnosis: choose the information of Electrophysiology (the information can be chose through setup--- input interface setting---electrophysiological Diagnosis Setting), also we can input the Electrophysiological information directly; Note: Able to enter other any information Button Introduction: Exam : After clicking this button, you can enter into the interface of module option; Return : Go back to the main control module; Examination Module Option: a. As shown in following screen shot for the Module Option. b. Selecting a desired module examination on the left side of the interface; For example: If user need to examine the 'MCV' recently, just only select the module examination 'MCV' as shown below: Fig Examination Module 13

18 Separate displaying the name of Nerve /Muscle of each part of body is according to different parts of patient. c. After selecting one nerve/muscle, click the 'Display' button on the top right corner of the interface to pop up a picture window. It shows some names of never roots which belong to themselves never or show some never roots controlled by Muscle. The Median nerve and the lower right corner of picture indicate the name of median nerve root as shown below: Fig Display d. After selecting the examination module and nerve/muscle, click the 'Next' button to acquire signal for selected model. 14

19 2.1.2 Case List Click the 'Case List' button on main control module to pop up following interface: Fig Case List This interface mainly consists of Patient Information Query, Patient Information List, Module Examination List, Note Information box. Generate of comprehensive report Patient Information Query The patient Information Query is divided to two parts. One is 'Accurate Inquiry' and the other is 'Fuzzy Inquiry': [Accurate Inquiry] User can select 1 or (2-3) key words to search patient information from the [Exact Search] box. These key words include the Exam date, EMG Record, Name, Age, Height, Weight, Date of birth, Sex, Inpatient No., Department, Ward Section, handedness and Clinical. [Fuzzy Inquiry] User can able to enter a content in the [Fuzzy Inquiry] box to search patient information. This content is that user has entered the patient information into Note information box Display the Patient Information List Introduction of function: Displaying the Patient Information List includes Exam date, EMG Record, Name, Age, Height, Weight, Date of birth, Sex, Inpatient No., Department, 15

20 Ward Section, handedness and Clinical. Select the case and right click it to refresh, edit or delete Display the module information of the marking patient who are examined Introduction of function: In the list you can select your desired file. Double click this file to open the saved waveform and data file; Left click the file which you do not need from the list and right click it to select delete; After saving the file in every function menu,go back main interface. When you right click to select refresh, the saved file will be displayed; Note information Display the information inputted in the note box when recording the patient information Print General Report After clicking the 'Generate Report' button, one interface will pop-up as shown below: Fig Generate Report Select the print content: Select all: Select all: the system select all data examined as default, also users can continue to select waveform. Display data waveform one by one: The report shows all data firstly, and 16

21 then shows all waveforms. Display data waveform separated: The report display the data and waveform for one modular only, then display the next modular. Generate report: Display the preview with the word file type according to the selected content; Reset: Clear the current content and select it again; Cancel: Cancel the report. Examination Function Click 'exam' to enter the interface of modular selection to select modular, side, nerve for examination Set the head content of report: Double click to open the WORD file named as 'Title' which be placed in 'E:\EMG-EP\DataModule'. To import hospital name, and adjust the position or format, then save and exit. The hospital information will be displayed in the report, and it is effective during using software period. (No modified) Note: You should set the hospital name according to above methods when generating comprehensive report Add/Modify item in comprehensive report template. Steps: Step 1: Open and Run EMG-EP software, add new case and click button 'Exam' to enter into examination interface; Step 2: Enter into the Module which needs to be modified for acquiring waveforms; (If you should save it for getting data, then save it firstly.) Step 3: Record the data which needs to modify or add items; ( If the data is not existed, you should analyze the waveforms acquired for getting useful data depended on the module.) Step 4: Open file folder 'C:\EMG-EP\Data\' (The folder which named as EMG No.), and find its configure file. For example: the file which named as INI is one configure file of 'C:\EMG-EP\Data\'; Step 5: Open the configure file, hold shortcut key 'Ctrl+F' for popup research dialog box, input the record data to find out and copy corresponding characters; Step 6: Then open Module file which need to modify in file folder 'C:\EMG-EP\Data Module', find the item which need to be replaced under the corresponding Module. Modify item name first, paste the code you copied to corresponding code column, save it and exit. (Add/Modify item success) 17

22 For Example: Requirement: Item of general report which generated by MCV Module---Speed is replaced by distance; Step 1: Open and Run EMG-EP software, add new case (EMG No.00003), click button 'Exam' enter into examination interface; Step 2: Enter into MCV Module, acquire two waveforms, (This data will be saved automatically); Step 3: Input '22mm' into distance column of the second waveform and record it; Step 4: Open file folder 'C:\EMG-EP\Data\00003' for finding its configure file; Fig File folder Step 5: Open the configure file, hold shortcut key 'Ctrl+F' for popup research dialog box, input the recorded distance data (22mm) to find out and copy corresponding characters(mwmr_dat3$2e); 18

23 Fig research dialog box Step 6: Then open MCV file in file folder 'C:\EMG-EP\Data Module', find out the item name 'distance' and 'Speed', and replace them to the data you copied. Save it and exit. Fig Replace See the picture for Finish Modification as shown below: 19

24 Fig Finish Modification Add/Modify item name or format of other Module, both can operation according to methods above System Setting This function includes Hospital information, Nerve/Muscle edit, Input interface set, Report set, and Backup set Hospital information User can input the hospital s Name, Address, Telephone No., and Website in this module. Fig Hospital information 20

25 Nerve/Muscle edit Add common nerve/muscle Select the modular you want to edit firstly, and then select the nerve or muscle you want to examine by double clicking ' ' When it becomes ' ', it means this nerve or muscle is add into the module successfully. Note: MCV\SCV\F-wave\H-reflex\BR\SSR\SSCT linked to nerve module and EMG\RNS link to muscle module. Fig Add nerve/muscle Edit stimulation point and record point: Select Module, then select the nerve/muscle which you have added, Right-click to select edit, and open the dialog box of nerve and muscle separately, see the pictures as shown below: 21

26 Fig Edit stimulation point and record point Above picture is dialog box of editing nerve, user can input stimulation position and record position (maximum inputted 18 characters per item, 26 items edited) Add nerve/muscle Method 1: Select from drop-down box, it includes the nerve/muscle which often be used, user can select the nerve/muscle to Module directly; Method 2: If there is no nerve/muscle information you needed, you should input it manually, then click button Add, it will popup the following dialog box: Fig Add nerve/muscle Click button 'OK', the dialog box will be closed. And the content you have added will be displayed at the bottom of drop-down box. 22

27 Input setting of interface Fig Input setting of interface User can set the input interface of patient according to the personal habits information. Left Side Set: Display item on the left side of new case; Right Side Set: Display item on the right side of new case; Display: The item which be select will display, otherwise, it will not display; Difference between Area Marking and new Area Marking: New Area Marking will overlay Area Marking, it means replacement function; Clinical Diagnosis Setting: Input clinical diagnosis result in empty text box below, click button 'Add', it will be displayed in the text box above. Select diagnosis result you have added, click button 'Add', the content will be deleted. Set 'Clinical Diagnosis' of new case here; Electrophysiological Diagnosis Setting: Input Electrophysiological Diagnosis result to empty text box below, click button 'Add', it will be displayed in the text box above. Select diagnosis result you have added, click button 'Add', the content will be deleted. Set 'Electrophysiological Diagnosis' of new case here; Button 'Left', 'Right': Move case information you select to left/right direction; Button 'Upper', 'Down': Move case information you select to left/right direction; 23

28 Report set Fig Report set Text setting: Set the font, style, size of the display content in General Report set. Graph Element Set: Set the Waveform Color and Background Color in the General Report set. Color for Normal Value Area: Set the color of Data display. It is divided to three levels: Normal, Slight Normal, Serious Normal. Other: set paper of Single-page print report: A4 or B5. Able to set the format of General Report: Original or Self-define. 24

29 Backup set Fig Backup set User can create a saving file's path and backup file's path Exit Fig Exit Click this button to exit the software. 25

30 2.2 Motor Conduction Velocity (MCV) Select the MCV module and after selecting the nerve which you want to exam click 'next step' to enter into 'Motor nerve conduction velocity' module. Fig MCV The parameter on the page is the parameter which is being used. The interface is divided into four parts: 2.1 Display of Nerve/Muscle, stimulation &record place 2.2 Waveform and current intensity; 2.3 Data list; 2.4 Function Buttons. 26

31 2.2.1 Display of Nerve/Muscle, stimulation & record Place The picture is as shown below: Fig Display of Nerve/Muscle, stimulation &record place The picture represents: area of Lateral, nerve exam, stimulation point, record point. User can set stimulation &record point in the setting item of main interface. The content which be set is effective during using period of software. User can modify the stimulation &record point temporarily, or effective in the current interface. Step as follows: 1. Move cursor to line number, Right-click to popup following dialog box. 2) Self define to input the stimulation and record place, click 'OK', the dialog box will be closed,setting successfully. 27

32 About the waveform and current intensity control, controlling area of MCV waveform and current stimulus intensity, see the picture as shown below: Fig Controlling area See detail introduction of button scanning speed, Sensitivity, current stimulus intensity as below: Scanning speed: Method 1: Click button 'Left' 'Right' in the interface, adjust the current intensity to increase or decrease, button 'Left' means decrease, 'Right' means increase. Method 2: Hold shortcut key ' ' to decrease scanning speed ' ' to increase scanning speed. Method 3: Hold shortcut key 'U' to decrease scanning speed, 'I' to increase scanning speed. Current intensity controlling: Method 1: Click button 'Upper' 'Down' in the interface for controlling current output, button 'Upper' means increasing, 'Down' means decreasing; Method 2: Hold shortcut key: Twist the knob clockwise can increase current intensity, twist it in an anti-clockwise direction, can decrease current intensity. Method 3: Use keyboard, 'Z' means decreasing current intensity; 'M' means increasing it. 28

33 Sensitivity controlling: Method 1: Click button 'Upper' 'Down' in the interface for controlling sensitivity, button 'Upper' means decrease 'Down' means increase; Method 2: Hold shortcut key ' ' to decrease sensitivity, ' ' to increase sensitivity. Method 3: Use keyboard, 'T' means decreasing sensitivity, 'Y' means increasing it. Method 4: Use wheel button to adjust it, move cursor to waveform displaying area, Upper direction means decreasing sensitivity, down direction means increasing it. Signal controlling: Start/stop signal acquisition Method 1: Click button Single stimulate, continuous stimulate for acquiring signal, Click button continuous stimulation again to stop continuous stimulation. Method 2: Hold shortcut key: Click button 'single stimulate' for one time stimulation, Click button 'continuous stimulate' for stimulation continuously, Click this button to stop it. Method 3: Use keyboard: Press key 'space' for one time stimulation, Press key 'F' for continuous stimulation, Click key 'F' again to stop it. Cache function: User can storage one or more waveforms in each line number temporarily, but just can save one of waveforms when quit from this Module. (Exit, Switch nerve, Switch lateral) Method: Select 'Cache' function in item 'parameter setting', click button Use as default for adding this function to display in the interface; Usage: After acquired one waveform in the current acquisition position, Click button 'Cache' for saving current waveform temporarily and acquiring waveforms again. Add a value in the drop-down box of 'Cache' when acquire again, value 1 means one waveform be cached, no limitation for maximum cache times. Click the value in the drop-down box for opening waveform which be cached. See pictures as below: 29

34 Fig Cache Switched by page/ item: It means to turn items or pages one by one. MCV can acquire six waveforms each time, maximum 26 waveforms totally. It will popup button 'Switched by page/item' automatically when the sixth line number is active, see pictures as below: FiFig Switched by page/item Method 1:Click 'Switched by item' for displaying it one by one, Click 'Switched by page' for displaying it page by page; Method 2: Use button of Shortcut key Waveforms operation and analysis Waveforms operation: Select waveform line and left-click it for dragging it in the displaying area of waveform arbitrarily. Delete current: Right-click waveforms in the displaying area, Click 'Delete current' to delete the waveform which you chose. Delete all: Right-click waveforms in the displaying area, Click 'Delete all' to delete all waveforms in the displaying area which you had acquired. Overlap Display: Right-click waveforms in the displaying area, user can overlap all the waveforms which acquired for displaying it. Click it again to stop it. Waveform Reverse Phase: Right-click waveforms in the displaying area, user can display the waveform in reverse phase, click it again to recover it. 30

35 Waveform analysis: Scale: The first vertical line in color red means starting position of latent period, the second vertical line in color yellow means ending position of latent period. Auto-mark: System will mark the waveform automatically while stop acquisition. Manual-Mark: Move mark-line manually. Method: Press and hold the left mouse button around the mark-line for dragging its position, Click around the curve line while mark-line closed to curve line which you needed, then the mark-line will be marked on the position of curve line you clicked directly. Remark 1: The data will change while the position of mark-line moved Remark 2: User can drag the mark-line directly during the period of moving, no need to select line number. Calculate: Input the distance value to item of distance result, the system will calculate value of speed automatically. The formula: Speed=distance/latency Data List Please see the picture for MCV data list as shown below: Fig Data List Date items: Line difference, distance, speed, latent period, amplitude, amplitude ratio, area. (Refer to the detailed introduction below) 31

36 11. This is just a code of current waveform and the waveform which is calculated. The first curve line is default as *, which means its own curve line. The second curve line would be calculated with the first one by analogy. If the third one needs to be calculated with the first one, the user could just select the first one for calculation. 12. Distance: Enter the values which need to be calculated manually between two points, the unit of which is mm. Then the cursor will correspond with line number which is active, and the cursor will be displayed in the distance box when some line numbers is active. 3) Speed: the system automatically calculates the speed value after the user enters a distance value. Unit: m /s. 4) Latency: The onset latency values of the measured waveform. unit: ms. 5) Amplitude: The system defaults to the amplitude of the measured waveform. Unit: mv. 6) Amplitude Radio: the percentage that an amplitude compared with the last amplitude. 7) Area: the area of the measured waveform. Unit: ms * mv. Refer to the following pictures for how to operate the buttons of MCV. Fig Button Functions 32

37 2.2.4 Function Buttons Left O : Click this button to switch the side position. After clicking this button it would display the right side if the left side is being testing. Clicking this button can switch to the right side of the same nerve directly, save the content of the left side detected automatically and open a new interface. Nerve N : Click this button to popup the nerve choice box and then choose nerves in it. To select the button Display in the upper-right corner, it would show the clinical test program of the nerve as shown below: Single stimulation Space Fig Choose nerves : One time current stimulation. Continuous stimulation F : To send out the continuous stimulation in accordance with the frequency set, and click the button [stop] again to stop command and the current stimulation. 33

38 Waveform comparison K : To click this button to popup the dialog box of waveform comparison. After selecting the measured contents of the detected waveforms and this waveform can be showed in the display area by dotted line. It can show the difference of two results directly. Click the button Cancel to cancel the comparison. Impedance test F6 : To popup the dialog box impedance test to display electrode reference side and impedance value recorded. To set the impedance value through the Set button, and it will show red color when it exceeds the threshold set, it will show green when it s in the threshold range as shown below: Skip Fig Impedance : To skip into EMG, SCV, SSCT, and F-wave module quickly for the signal acquisition. Notes: When it skips into the F-wave module, the current intensity would be put into the value of F-wave module automatically; Exammed Item : To click the button to popup dialog box of the Exammed Item. To select any inspection items, click OK button to open the content of the Exammed Item. 34

39 Parameter setting : To Click the button to popup dialog box of Parameter setting, and then setup Amplification Multiples, scanning speed, sensitivity, Low-Pass Frequency, High-Pass Frequency, Stimulation Intensity, Stimulation Frequency, Stimulation Pulse Width, Auxiliary Intensity, Stimulation Direction, Cache, sound, Acquisition Color, Activating Color, waveform color, Background Color, grid and contrast color and so on. Help F11 : link with Help file which includes the introduction and installation of this device, software operation, normal value range of current nerve based on different ages and different parts in the clinical application. Report P : Click this button and then popup dialog box of report selected, it can automatically generate a single-page report or comprehensive report. Generate single-page report: the system prints the data or waveform of selected module as default, which is as shown below: Fig Report 35

40 Generate comprehensive report: it can output a comprehensive report that the content has been detected currently through selecting data and waveform only in the Select, or user-defined to select data and waveform from module outputted as shown below: Fig Report Exit Esc selection. : Exit the current module, and return to the interface of module 36

41 2.3 Sensory Conduction Velocity (SCV) Select the SCV module and after selecting the nerve which you want to exam click next step to enter into Sense nerve conduction velocity module. Fig SCV The parameter on the page is the parameter which is being used. The interface is divided into four parts: 3.1. Display of Nerve/Muscle, stimulation &record place; 3.2. Waveform and current intensity; 3.3. Data list; 3.4. Function Buttons. 37

42 2.3.1 Display of Nerve/Muscle, stimulation & record Place Fig Display The picture represents area of Lateral, nerve exam, stimulation point, and record point. User can set stimulation &record point in the setting item of main interface. The content set is effective during using period of software; User can modify the stimulation & record point temporarily, or effective in the current interface Waveform and Current Intensity The functions of SCV are the same as MCV, such as the display area and usage methods of scanning speed, current intensity and sensitivity, cache function, turn articles/ pages function, waveform operation, and analyzing capabilities. Signal controlling: start / stop signal acquisition Method 1: Click [single stimulation], [average stimulation] button to start signal acquisition, and click again to stop average stimulation. It could also stop automatically after reaching average times; Method 2: Use the Shortcut keyboard: Press the single stimulation button to send once stimulation command, press the continuous stimulation button to send out continuous stimulation commands, and press again to stop; Method 3: Use the keyboard of computer; Press the space bar to send out once stimulation command; Press F key to send out continuous stimulation commands, and press again to stop; 38

43 Note: The functions are the same as MCV, such as cache function, turn articles/pages function, waveform operation, and analyzing capabilities Data List Please see the picture for SCV data list as shown below: Fig SCV data list Data items: Line Difference, distance, speed, latency, Amplitude, Amplitude Radio and area. The detailed descriptions are as below: 1) Line Difference: it is the code of the current waveform and the waveform calculated. The system defaults each curve as *. It means this curve also could be selected in the drop down list. 2) Distance: Input the value which needs to be calculated manually between two points, the unit of which is mm. The cursor is in correspondence with line number which is active, and the cursor will be displayed in the distance box while some line number is active. 3) Speed: the system automatically calculates the speed value after inputting a distance value Unit: m / s; 4) Latency: The onset latency values of the measured waveform, unit: ms; 5) Amplitude: The system defaults to the amplitude of the measured waveform, unit: mv; 6) Amplitude Radio: the percentage that an amplitude compared with the last amplitude; 7) Area: the measured space of the amplitude radio, unit ms*μv 39

44 3.4 Function Buttons The buttons for SCV function, referring to the following pictures: Fig Buttons Function The detailed descriptions for the function buttons are as below: Buttons Functions Left O : Click this button to switch the side position. Clicking this button will display the right side if the left side is being testing currently. Clicking this button can switch to the right side of the same nerve directly, save the content of the left side detected automatically and open a new interface. Nerve N : Click the button to popup the nerve choice box and then choose nerves in it. To select the button Display in the upper-right corner, it can show clinical test program of the nerve. 40

45 Single stimulation Spac : One time current stimulation. Continuous stimulation F : To send out the continuous stimulation in accordance with the frequency set, and click the button [stop] again to stop command and stop the current stimulation. Waveform comparison K : To click this button to popup the dialog box of waveform comparison. After selecting the measured contents of the detected waveforms and this waveform would be showed in the display area by dotted line. It can show the difference of two results directly. Click the button Cancel to cancel the comparison. Impedance test F6 : To popup the dialog box impedance test to display electrode reference side and impedance value recorded. To set the impedance value through the Set button, and it will show red color when it exceeds the threshold set, it will show green when it s in the threshold range. Skip quickly for signal acquisition. : To skip into EMG MCV RNS and F-wave module Notes: When it skips into the F-wave module, the current intensity can be put into the value of F-wave module automatically. 41

46 Exammed Item : Click the button to popup dialog box of Exammed Item. To select any inspection items, click OK button to open the content of Exammed Item. Parameter setting : To Click the button to popup dialog box of Parameter setting, and then setup Amplification Multiples, scanning speed, sensitivity, Low-Pass Frequency, High-Pass Frequency, Stimulation Intensity, Stimulation Frequency, Stimulation Pulse Width, Auxiliary Intensity, Stimulation Direction, Cache, sound, Acquisition Color, Activating Color, waveform color, Background Color, grid and contrast color and so on. Help F11 : Linked with Help file, it includes the introduction and installation of this device, software operation, normal value range of current nerve based on different ages and different parts in the clinical application. Report P : Click this button and then popup dialog box of report selection, which could generate a single-page report or comprehensive report automatically. Generate single-page report: the system prints the data or waveform of selected module as default, as shown below: 42

47 Fig Single-page Report Generate comprehensive report: it can output a comprehensive report that the content has been detected currently through selecting data and waveform only in the Select, or user-defined to select data and waveform from module outputted as shown below: Fig Comprehensive Report Exit Esc Exit the current module, and return to the interface of module selection. 43

48 2.4 Electromyography (EMG) The EMG function consists of the following features: EMG Scan, MUP Analysis and IP Analysis. These 3 features could be selected by using the interface shown below: Fig EMG Once EMG waveform has been collected, select MUP and it will start Analyzing. The software will automatically use the EMG waveform to process data for analysis. For more information on how to run the analysis, please refer to MUP Analysis and IP Analysis QEMG From the main menu, select EMG to bring up the interface as shown below: Fig QEMG Waveform Analysis: In the waveform interface, there are 2 red horizontal lines that can be used to 44

49 measure the peak-peak value. Click and drag the 2 lines to plot the boundaries on the graph. Function introduction: Fig Rows 1: The waveform will be displayed in a single row on the screen; the waveform display will be overwritten once it reaches the end; 3: Waveform will be split into 3 rows and simultaneously displayed on screen; 5: Waveform will be split into 5 rows and simultaneously displayed on screen; 10: Waveform will be split into 10 rows and simultaneously displayed on screen. Muscle Voice : Control the volume of the EMG sound from speaker during waveform acquisition. This could be controlled by shortcut keyboard. Or use keyboard: "Z" represents decreasing volume; "M" represents increasing volume. The left button means reviewing the collected waveform above, while the right means reviewing the collected waveform below. Scanning Speed : Click the Left arrow to reduce scan speed; Right arrow to increase scan speed. Sensitivity : Click the Up arrow to increase sensitivity; Down arrow to decrease sensitivity. Project Switch : Allow user to switch to other features. Choice : Lower limb and upper limb muscle selection can be modified from the Main Project > System Setup. 45

50 Fig Select muscle Start/Stop : Control the Amplifier from starting/stopping the data collection. Parameter : Allow users to modify the settings for the amplifier and display settings. Once modification is done, user can save the configuration as default settings. It ensures that the user would not have to reconfigure the parameters again. 46

51 Fig Parameter Setting Note: The parameters of EMG, MUP and IP item can be set separately. Waveform Analysis : In the waveform interface, there are 2 red horizontal lines that could be used to measure the peak-peak value. Click and drag the 2 lines to plot the boundaries on the graph. Fig Waveform Analysis 47

52 2.4.2 MUP Analysis After inputting a new case in main interface, click EMG to enter EMG modular, and then click MUP to enter into MUP interface. Fig MUP Analysis Parameter setting Click parameter setting to set up parameters. Please refer to the pictures as shown below: Fig Parameter setting 48

53 Sensitivity: Select the sensitivity, choose Set as default and the current parameter will be saved as default. Scanning speed: Select the scanning speed, choose Set as default and the parameter would be saved as default. High pass frequency: Only record the signal lower than the frequency that has been selected. Low pass frequency: Only record the signal lower than the frequency that has been selected. Channel selection: select the channel to collect data. Amplitude: set the waveform amplitude that users want to pick-up. Rising time: set the waveform rising time that users want to pick-up. Ratio of amplitude: the ratio of amplitude between two waveforms. Ratio of slope: the ratio of slope between two waveforms. During the data acquiring, users can click -> and <- to adjust the scanning speed and click and to adjust sensitivity. Acquire controlling: In initial state, click it to start scanning, this button will change to stop when scanning. You can click it to stop scanning, and the data will not be saved during scanning. Record controlling: In initial state, click acquire to record the selected waveform. The button will become stop recording during data recording. Click it to stop record. Cursor measurement: There are 2 Vertical red cursors and 2 horizontal red cursors in the waveform display area. Users can move these cursors by mouse after stopping acquiring. The software will show the time value between 2 vertical cursors and the amplitude difference value between 2 horizontal cursors. switch the side: Click the button Left to switch to right side. 49

54 Select Muscle: Click the button Select Muscle and pop up the following dialog box: Fig Select Muscle Please select the muscle in this dialog box, click the button Next to build a testing interface of selected muscle. Impedance Test: To click the button Impedance Test to pop up the following interface: Fig Impedance Test It shows the body impendence value of each channel in the dialog box. 50

55 Save: During Acquire, click Save, save the waveform data. Stop Acquire, click Save to pop up the patient diagnosis dialog box. Fig Save Print: Click Print to pop up the MUP report. Examined Item: To click Examined Item to pop up the following interface: Fig Examined Item Skip: Click IP\QEMG to skip to IP or QEMG interface. Help: Click Help to pop up the following interface: 51

56 Fig Help << >> Page down/up: To click << to review the last saved waveform, and click >> to review the next saved waveform. Analyze Fig Analyze 52

57 Users could analyze the waveform in waveform part. Drag the white box to the waveform you want analyze and double click, the analyze result will show on the right list. Analyze setup: Click Analyze setup to pop-up the analyze setup interface Delete: Fig Analyze setup You can select the analyze No. and delete it IP Analysis Enter the IP interface, and click and select the IP from the EMG interface: Fig IP 53

58 Waveform Analysis: In the waveform interface, there are 2 red horizontal lines that can be used to measure the peak-peak value. IP Operation Procedures: Please Select the Operation Index: Select desired waveform from the menu on the bottom left. Analysis Result: The menu displays analysis results such as turning, accumulated amplitude, average amplitude, turning/average amplitude. Button Features: IP Analysis : Select the interference pattern analysis to obtain results such as turning, accumulated amplitude, average amplitude, and turning/average amplitude; Delete : Delete the selected analysis data; Playback : Display the selected waveform; Save :Save the selected analysis results; Print : Allows user to select the format of report before printing it out; Return : Exits IP analysis and returns to EMG menu. 2.5 F-wave Select the F-wave module. After selecting the nerve which you want to exam, click next step to enter into F-wave module. The parameter on the page is the parameter which is being used. The interface is divided into four parts: 5.1. Display of Nerve/Muscle, stimulation &record place; 5.2. Waveform and current intensity; 5.3. Data list; 5.4. Function Buttons. 54

59 2.5.1 Display of Nerve/Muscle, stimulation & record Place Display of Nerve/Muscle, stimulation &record place as shown below: Fig Display The picture represents: area of Lateral, nerve exam, stimulation point, record point. User can set stimulation & record point in the setting item of main interface. The content set is effective during using period of software; User can modify the stimulation & record point temporarily, or in the current interface Waveform and Current Intensity Controlling area of F-wave waveform and current intensity, referring to the picture as shown below: 55

60 Fig The waveform and current intensity Waveform and current intensity control is divided into the M-wave and F-wave dividing line, scanning speed, current intensity, M-wave sensitivity, F-wave sensitivity, waveform overlapping display area and measuring line The operation guide of Scanning speed and current intensity are the same with MCV. Sensitivity Controlling: Method 1: Click the direction button of M-wave in the interface to adjust the sensitivity of M-wave. And click the direction button of F-wave in the interface to adjust the sensitivity of F-wave. The upper direction is reducing the sensitivity, and the down direction is increasing the sensitivity. Method 2: Use the shortcut keyboard to reduce sensitivity of M-wave, and click to increase the sensitivity of M-wave. Method 3: Use the keyboard of computer: T is to reduce the sensitivity of M-wave, and Y to increase the sensitivity of M-wave. Method 4: Use the mouse wheel to adjust, and to move the cursor to the display area of left side of M-wave. The upper direction is reducing the sensitivity of M-wave, and the down direction is increasing the sensitivity. To move the cursor to the display area of right side of the F-wave, the upper direction is reducing the sensitivity of F-wave, and the down direction is increasing the sensitivity. 56

61 M-wave and F-wave dividing line: 1) The line separates the waveform display area. The left side of display area displays the M-wave, the right side displays F-wave, and both sides can be used to set different sensitivities. 2) The location of the dividing line is movable; Methods: Put the cursor on the dividing line, and hold down left Key dragging to move on. Both sides are different sensitivities. Waveform overlapping display area: To display all waveforms in the region. Measuring line: 1) The left side of the measuring line is on behalf of the M-wave measuring line, and the value displayed is the latency values of M average waveform measured. Unit: ms; 2) The right side of the measuring line is on behalf of the F-wave measuring line, and the value displayed is the latency values of F average waveform measured. Unit: ms; 3) The two lines can be moved. Methods: Put the cursor on the measuring line, and hold down left key dragging to move on. Signal controlling: Start/stop signal acquisition Method 1: Click button Single stimulate, continuous stimulate for acquiring signal, and click button continuous stimulation again to stop continuous stimulation. Method 2: Hold shortcut key: Click button single stimulate for one time Stimulation, click button continuous stimulate for stimulation continuously, and click this button to stop it. Method 3: Use keyboard: Press key space for one time stimulation, Press key F for continuous stimulation, and click key F again to stop it. Waveform operation and analysis: 1) Waveforms operation: Waveform dragging: Pitch on waveform line, hold down the left key to move on arbitrarily in the waveform displaying area; 57

62 Delete the current: Open the waveform display area by the right key, click Delete the current to delete the waveform on the line; Delete all: To open the waveform display area by right key, click Delete all to delete all of the acquired waveform in the waveform display area;; Waveform Reverse Phase: To open the waveform display area by right key, invert waveform on the line, and restore it by clicking it again; 2) Waveform analysis: Cursor: The first vertical red line represents the onset latency position of the M-wave. The second vertical red line represents the onset latency position of the F-wave. The first group of horizontal lines represents the amplitude measurements of M-wave, and the second group of horizontal lines represents the amplitude measurements of F-wave. Auto-tagging: after the waveform acquisition stopped, software can mark it automatically; Manual- tagging: Move the tag line manually; Method: Hold down the left key of mouse and drag to move the position of tag line near the tag line, and click the curve labeled near the tag line to mark the curve labeled directly; Note 1: Move the location of the tag line and the value of data results will be changed synchronously; Note 2: When you move the tag line, you do not have to select the line, but just drag it directly; Note 3: Move the F-wave marked point to the last one of the waveform displaying area for the F-wave disappeared. And if this value does not show out, it indicates that the curve did not have F-wave, and will not participate in the probability statistics of F-wave. Calculation: Input the value in the distance results, and the system can calculate the speed value automatically. Formula: conduction velocity value= distance * 2 (mm) / {(FM) latency -1} (ms). 58

63 2.5.3 Data List See the picture for F-wave data list as shown below: Fig Data List Data items: M latency, F latency, F-M latency, M P-P Value, F P-P Value, F / M amplitude, F probability %, distance and conduction velocity. The detailed descriptions are as below: 1) M latency: the onset latency value of M-wave, Unit: ms. The table columns respectively include the minimum, maximum, average value of M wave latency, and M-wave latency values activated currently; 2) F latency: the onset latency value of F-wave, Unit: ms, The table columns respectively includes the minimum, maximum, average value of F wave latency, and F-wave latency values activated currently; Note: Move the F-wave marked point to the last one of the waveform display area for the F-wave disappeared. And if this value does not show out, it indicates that the curve did not have F-wave, and will not participate in the probability statistics of F-wave. 3) F-M latency: To calculate latency difference of F-wave and M-wave; Formula: F-M latency = onset latency value of F-wave - onset latency value of M-wave, Unit: ms; The table columns respectively include the minimum, maximum, average 59

64 value of F-M latency, and F-M latency values activated currently. 4) M P-P Value: The amplitude value of M-wave from the highest to the lowest value, Unit: mv; The table columns respectively includes the minimum, maximum, average value of M P-P Value, and M P-P Value activated currently; 5) F P-P Value: The amplitude value of F-wave from the highest to the lowest value, Unit: mv; The table columns respectively includes the minimum, maximum, average value of F P-P Value, and F P-P Value activated currently; 6) F / M amplitude ratio: the ratio of F P-P Value and M P-P Value; 7) F probability %: the software can calculate the amplitude of each F-wave and M-wave based on that the users set the measurement location of the cursor; Formula: Amplitude = the voltage of cursor 1 - the voltage of cursor 2 It can calculate the probability of F-wave according to the amplitude of each F-wave calculated. Formula: F probability % = the times of F-wave amplitude that is not 0 / the times of total acquisitions * 100%. 8) Distance: Input the distance value of stimulation point and record point by manually. Unit: mm; the cursor point is on the line activated as default; 9) Conduction velocity: the system will calculate the conduction velocity automatically after inputting the distance; unit is m/s; Function Buttons See the pictures for F-wave function buttons as shown below: Fig Function Buttons 60

65 The detailed descriptions for the function buttons are as below: Left O : Click this button to switch the side position. After the user Clicking this button it will display the right side if the left side is being testing currently. Clicking this button can switch to the right side of the same nerve directly, save the content of the left side detected automatically and open a new interface Nerve N : Click the button to popup the nerve choice box and then choose nerves in it. To select the button Display in the upper-right corner, it can show clinical test program of the nerve as shown below: Fig Select Nerve Single stimulation Spac : One time current stimulation; Continuous stimulation F : Send out the continuous stimulation in accordance with the frequency set, and click the button [stop] again to stop command and stop the 61

66 current stimulation; Waveform comparison K : Click this button to popup the dialog box of waveform comparison. After selecting the measured contents of the detected waveforms and this waveform can be showed in the display area by dotted line. It can show the difference of two results directly. Click the button Cancel to cancel the comparison; Impedance test F6 : Popup the dialog box impedance test to display electrode reference side and impedance value recorded. Set the impedance value through the Set button, and it will show red color when it exceeds the threshold set, or green when it is in the threshold range; Skip quickly for the signal acquisition; : Skip into EMG, SCV, RNS, and MCV module Exammed Item : Click the button to popup dialog box of Exammed Item. Select any inspection items, click OK button to open the content of Exammed Item; Parameter setting : Click the button to popup dialog box of Parameter setting, and then setup Amplification Multiples, scanning speed, sensitivity, Low-Pass Frequency, High-Pass Frequency, Stimulation Intensity, Stimulation Frequency, Stimulation Pulse Width, Auxiliary Intensity, Stimulation Direction, Cache, sound, Acquisition Color, Activating Color, waveform color, Background Color, grid and contrast color and so on; 62

67 Help F11 : linked with Help file, it includes the introduction and installation of this device, software operation, normal value range of current nerve based on different ages and different parts in the clinical application; Report P : Click this button and then popup dialog box of report selection, it can automatically generate a single-page report or comprehensive report; Generate single-page report: the system prints the data or waveform of selected module as default, as shown below: Fig Reports Generate comprehensive report: it can output a comprehensive report that the content has been detected currently through selecting data and waveform only in the Select, or user-defined to select data and waveform from module outputted. Exit Esc Exit the current module, and return to the interface of module selection. 63

68 2.6 H-reflex Select the H-reflex module. After selecting the nerve which you want to exam, click Next to enter into H-reflex module. Fig H-reflex The parameter on the page is the parameter which is being used. The interface is divided into four parts: 6.1. Display of Nerve/Muscle, stimulation &record place; 6.2. Waveform and current intensity; 6.3. Data list; 6.4. Function Buttons Display of Nerve/Muscle, stimulation & record Place Display of Nerve/Muscle, stimulation &record place are as shown below: 64

69 Fig Display Waveform and Current Intensity Controlling area of H-reflex waveform and current intensity are as shown below: Fig The waveform and current intensity control Among all these above, Scanning speed, Electricity intensity, Sensitivity will be used same as MCV. 65

70 Signal controlling: Start/stop signal acquisition Method 1: Click button Single stimulate, continuous stimulate for acquiring signal, and Click button continuous stimulation again to stop continuous stimulation. Method 2: Hold shortcut key: Click button single stimulate for one time stimulation, Click button continuous stimulate for stimulation continuously, and Click this button to stop it. Method 3: Use keyboard: Press key space for one time stimulation, Press key F for continuous stimulation, Click key F again to stop it. latency measuring line: Purpose: this line can measure the latency of waveform real time; the data will show under the vertical line. Unit: ms. Methods: Put the cursor on the dividing line, and to hold down left key dragging to move on Data List See the picture for H-reflex data list as shown below: Fig Data Area Data items: M latency, H latency, M max amplitude, H max amplitude, latency difference, Max amplitude ratio, M amplitude, H amplitude, stimulate intensity, M latency, H latency. The detailed descriptions are shown as below: 66

71 1) M amplitude: the latency of maximum amplitude of M wave. Unit: ms; 2) H amplitude: the latency of maximum amplitude of H wave. Unit: ms; 3) M maximum amplitude: the maximum amplitude data in the list. Unit: mv; 4) H maximum amplitude: the maximum amplitude data in the list. Unit: mv; 5) Latency difference: the difference of M latency and H latency; 6) Ratio of amplitude: the radio of M max amplitude and H max amplitude; 7) Line number: the number of waveform, which is the same with the number in collecting interface; 8) M amplitude: the amplitude of M waveform. Unit: mv; 9) H amplitude: the amplitude of H waveform. Unit: mv; 10) Stimulate intensity: the current intensity used when collecting. Unit: ma; 11) M latency: the latency of M waveform. Unit: ms; 12) H latency: the latency of H waveform. Unit: ms; Function Buttons The functions will be used with the same as MCV module. Note: the parameter setting is different from MCV module. the parameters include Amplify Multiple, scanning speed, sensitivity of M waveform, low pass, high pass, stimulate intensity, stimulate frequency, stimulate pulse width, increment of current, use the increment current, voice, numbers of waveform, collecting color, activation color, waveform color, background color, square color, contrast color, and measure color as shown below: Fig parameter setting 67

72 Amplifier: a) Amplify Multiple: the amplification of waveform. b) Scanning speed: the data quantity of each div, the range is 1ms, 2ms, 3ms, 5ms, 10ms, 20ms, 50ms, 100ms; c) Sensitivity: the range is 0.001mV 0.002mV 0.005mV 0.01mV 0.02mV 0.05mV 0.1mV 0.2mV 0.5mV 1mV 2mV 5mV 10mV 20mV; d) Low pass: only record the data lower than the frequency users selected. e) High pass: only record the data higher than the frequency users selected. Current stimulator: a) Stimulate intensity: the intensity of current stimulator. b) Stimulate frequency: the frequency of current stimulator. c) Plus width: the plus width of current. d) Increment of current: the range is , unit: ma. Other settings: a) Increment of current: when users select current increment, setting the number, it shows the increment of current stimulator when collecting. For example: the original intensity is 5 ma, the increment is 0.5mA, then the current intensity will be 5.5mA, 6.0mA,6.5mA It's the maximum output if the total current intensity is equal to 100mA, and it cannot increase anymore; b) Sound: selects the "sound" in parameter setting interface to open loudspeaker. Users can monitor sound when data acquiring to find the best stimulation position. Button introduction: Set it as default value : Save present setup as a default setup, it will be effective after turn off the PC; OK : To save present setup and it's effective this time; Cancel : To close present parameter setup dialogue. 68

73 2.7 Repetitive Nerve Stimulation (RNS) Select the RNS module. After selecting the nerve which you want to exam, click "next" to enter into "RNS" module. Fig RNS The parameter on the page is the parameter which is being used. The interface is divided into four parts: 7.1. Display of Nerve/Muscle, stimulation & record place; 7.2. Waveform and Current intensity; 7.3. Data list; 7.4. Function Buttons Display of Nerve/Muscle, stimulation & record Place Display of Nerve/Muscle, stimulation &record place as shown below: 69

74 Fig RNS Display Waveform and Current intensity See the picture for selecting RNS is as shown below: Fig Waveform and current intensity Among of them, scanning speed, current intensity and sensitivity will be used as the same with MCV module. 70

75 Stimulation times: It's available to select between 10~100 times randomly, and the default value is 10. Compressed waveform display area: To display 50ms waveform. Raw waveform display area: 1). To display raw waveform, and to modulate sensitivity. 2). To modify waveform marker: Its 4 marker on each waveform, the two vertical lines are for left marker and right marker of latency separately, the two horizontal lines are for upper marker and below marker of amplitude. The amplitude value will be refreshed when modulating the position of marks, and the data results will be refreshed too. To display amplitude data: Display the amplitude value of first 10 waveforms during raw waveform acquiring every time. Stimulation frequency switch area: Click frequency levels displayed on switch interface and it's convenient to use Data List See the picture for RNS data list is as shown below: Fig Data List Data item: There are six items including Record Number, Stimulation Frequency, Maximum value, 4/1 Attenuation Rate, Stimulation Intensity, see following for the details: 71

76 1) Record Number: The number to record signal; 2) Stimulation Frequency: The stimulation frequency value to be used for this record waveform while acquiring. Unit: Hz; 3) The Maximum Value: The maximum amplitude value of this record. Unit: mv; 4) The Minimum Value: The minimum amplitude value of this record. Unit: mv; 5) Attenuation Rate: Amplitude rate between target waveform and raw waveform; The calculation formula set forth here: The forth waveform amplitude-the first waveform amplitude)/the first waveform amplitude*100%. Calculation Range: The software can calculate attenuation rate of 2/1~10/1 automatically, Click left-mouse to decrease attenuation range, click right-mouse to increase attenuation range. For example, left key can be modulated to 2/1,right key can be modulated to 10/1, the default one is 4/1; 6) Stimulation intensity: The current intensity value to be used for this signal acquiring. Unit: ma; Analysis interface: Chart 1: A chart to display and record amplitude of 10 waveforms, the horizontal line represents line number for waveform, the vertical line represents volume of amplitude, which will changed synchronized with the changes of sensitivity. It will display 10 results when record 10 time, it only display the previous 10 results if record waveforms is more than 10; Chart 2: Display 10 waveforms and amplitude chart in different time. The horizontal line represents time of signal result, the vertical line represents volume of amplitude, which will changed synchronized with the changes of sensitivity. It can record 20 time at most and it generate automatically every time. 72

77 2.7.4 Function Buttons Please see the RNS function Buttons as shown below: Fig Button Functions The detailed descriptions for the function buttons are as below: Button Functions Left O : Click this button to switch the side position. Click this button will display the right side if the left side is testing currently. Clicking this button can switch to the right side of the same nerve directly, save the content of the left side detected automatically and open a new interface. Muscle N : To Click the button to popup the nerve choice box and then choose nerves in it. To select the button Display in the upper-right corner, it can show clinical test program of the nerve. 73

78 Single stimulation Space : Once current stimulation. Continuous stimulation F : To send out the continuous stimulation in accordance with the frequency set, and click the button [stop] again to stop command and stop the current stimulation. Impedance test F6 : To popup the dialog box impedance test to display electrode reference side and impedance value recorded. To set the impedance value through the "Set" button, and it will show red color when it exceeds the threshold set, it will show green when it in the threshold range. Skip : To skip into EMG, SCV, SSCT, and F-wave module quickly for the signal acquisition. Notes: When it skips into the F-wave module, the current intensity can be raised the value of F-wave module automatically. Exammed Item : To click the button to popup dialog box of Exammed Item. To select any inspection items, click "OK" button to open the content of Exammed Item. Parameter setting : To Click the button to popup dialog box of Parameter setting, and then setup Amplification Multiples, scanning speed, sensitivity, Low-Pass Frequency, High-Pass Frequency, Stimulation Intensity, Stimulation Frequency, Stimulation Pulse Width, Auxiliary Intensity, Stimulation Direction, Cache, sound, Acquisition Color, Activating Color, waveform color, Background Color, grid and contrast color and so on. 74

79 Help F11 : To link with Help file. It includes the introduction and installation of this device, software operation, normal value range of current nerve based on different ages and different parts in the clinical application. Report P : Click this button and then popup dialog box of report selection, it can automatically generate a single-page report or comprehensive report. Generate comprehensive report: it can output a comprehensive report that the content has been detected currently through selecting data and waveform only in the "Select", or user-defined to select data and waveform from module outputted. Exit Esc Exit the current module, and return to the interface of module selection. 2.8 Blink Reflex (BR) Select the BR module. After selecting the nerve which you want to exam, click "Next to enter into "BR" module. Fig BR The parameter on the page is the parameter which is being used. 75

80 The interface is divided into four parts: 8.1. Display of Nerve/Muscle, stimulation & record place; 8.2. Waveform and current intensity; 8.3. Data list; 8.4. Function Buttons Display of Nerve/Muscle, stimulation & record Place Display of Nerve/Muscle, stimulation &record place as shown below: Fig BR Display Waveform and Current intensity Among of them, Scanning speed, Electricity intensity, Sensitivity will be used same as MCV Data List See the picture for BR data list as shown below: 76

81 Fig BR Data area Data item: Latent period 1, Latent period 2, Latent difference, P-P value 1, P-P value 2, and please see the detailed description as below: 1) Latent period 1: It's latent period value of R wave, the unit is ms. It will appear latent value 1 at left side when you stimulate left side now, and it's not latent value 1 for the right side; 2) Latent period 2: It's latent value of R' wave, and the unit is ms; 3) Latent period difference: It's the difference value of latent period 1 and latent period 2, the unit is ms; 4) P-P value 1: It's P-P value of R wave, the unit is μv; 5) P-P value 2: It's the P-P value of the highest wave in R2 group wave, the unit is μv Function Buttons The function buttons of SSCT module is same with MCV. 2.9 Sympathetic Skin Response (SSR) On module selection interface, click the button "SSR" to enter into waveform acquiring interface. The parameter on the page is the parameter which is being used. The interface is divided into four parts: 9.1. Display of Nerve/Muscle, stimulation & record place; 77

82 9.2. Waveform and current intensity; 9.3. Data list; 9.4. Function Buttons Display of Nerve/Muscle, stimulation & record Place Display of Nerve/Muscle, stimulation &record place as shown below: Fig SSR Among of them, Scanning speed, Electricity intensity, Sensitivity will be used same as MCV module Waveform and Current Intensity Among of them, Scanning speed, Electricity intensity, Sensitivity will be used with same as MCV Data List See the picture for SSR data list as shown below: 78

83 Fig SSR Data List Date items: latency1, latency2,p-p value, area. Please see the detailed description as below: 1) Latency 1: The onset latency values of the measured waveform. unit: S 2) Latency 2:The completed latency values of the measured waveform. unit: S 3) P-P value: Amplitude of measured waveform set as default in software. unit: S 4) Area: the area value of waveform. unit: ms*mv Function Buttons See the pictures about SSR function buttons as shown below: 79

84 Fig SSR Button Functions The detailed description for the function buttons are as shown below: Nerve N : To Click the button to popup the nerve choice box and then choose nerve in it. To select the button Display in the upper-right corner, it can show clinical test program of the nerve. Single stimulation Spac : Once current stimulation. Waveform comparison K : To click this button to popup the dialog box of waveform comparison. After selecting the measured contents of the detected waveforms, and this waveform can be showed in the display area by dotted line. It can show the difference of two results directly. Click the button Cancel to cancel the comparison. Impedance test F6 80

85 : To popup the dialog box impedance test to display electrode reference side and impedance value recorded. To set the impedance value through the "Set" button, and it will show red color when it exceeds the threshold set, it will show green when it in the threshold range. Skip : To skip into EMG, SCV, RNS, and MCV module quickly for the signal acquisition. Exammed Item : To click the button to popup dialog box of Exammed Item. To select any inspection items, click "OK" button to open the content of Exammed Item. Parameter setting : To Click the button to popup dialog box of Parameter setting, and then setup Amplification Multiple, scanning speed, sensitivity, Low-Pass Frequency, High-Pass Frequency, Stimulation Intensity, Stimulation Frequency, Stimulation Pulse Width, Auxiliary Intensity, Stimulation Direction, Cache, sound, Acquisition Color, Activating Color, waveform color, Background Color, grid and contrast color and so on. Fig Parameter Setting 81

86 Help F11 To link with Help file. It includes the introduction and installation of this device, software operation, normal value range of current nerve based on different ages and different parts in the clinical application. Report P Click this button and then popup dialog box of report selection, it can automatically generate a single-page report or comprehensive report. Generate single-page report: the system prints the data or waveform of selected module as default. Generate comprehensive report: it can output a comprehensive report that the content has been detected currently through selecting data and waveform only in the "Select", or user-defined to select data and waveform from module outputted. Exit Esc Fig Report Exit the current module, and return to the interface of module selection Segmental Conduction (SSCT) On module selection interface, click the button "SSCT" to enter into waveform acquiring interface. 82

87 Fig SSCT The parameter on the page is the parameter which is being used. The interface is divided into four parts: Display of Nerve/Muscle, stimulation & record place; Waveform and current intensity; Data list; Function Buttons Display of Nerve/Muscle, stimulation & Record place Display of Nerve/Muscle, stimulation & record place as shown below: 83

88 Fig SSCT Display The way to edit stimulation/recording position is the same with MCV module Waveform and Current intensity From the main interface, click SSCT to pop up the interface as shown below: Fig The waveform and current intensity control Among of them, Scanning speed, Electricity intensity, Sensitivity will be used same with MCV. Latent abnormal limit: Alternative item for latent period abnormal standard 84

89 limit, click pull-down button, which display optional range is "0.1~2.0ms" in item "Latent period abnormal limit", it will appear abnormity when latent period difference is more than that value. Abnormal ways: 1) The waveform color change to red ( Latent period marker adjustment is correct); 2) This piece of content is red in data result ( Latent period marker adjustment is correct); Waveform average display area: To average and display all the waveforms collected, it can observe abnormal waveform intuitively Data List See the picture for SSCT data list as shown below: Fig Data List Data items: There are eight items including Latent period, Latent period difference, Amplitude, Amplitude difference ratio, Area, Lineal difference, Distance and Speed. The detailed description is as shown below: 1) Latent period: It's the onset latent value of measured waveform, the unit is ms; 2) Latent period difference: It's the difference value of present waveform's 85

90 onset latent and last waveform's onset latent, the unit is ms; 3) Amplitude: It's a software defaulted amplitude value of measured waveform, the unit is mv; 4) Amplitude difference ratio: Percentage that compared with last amplitude; 5) Area: Area value of measured waveform, the unit is ms*mv; 6) Linear difference: It's the code name of present waveform and the waveform will be calculated, the first curve is defaulted as * by system, the second curve (B) will process calculation with the first curve (A). In the same way, to calculate with the first curve if it's on the position of third curve, it s OK to choose A in the linear number; 7) Distance: Input distance value of two points which will be calculated and input number manually, the unit is mm; It is one-to-one relationship both of Cursor and enabled linear number. The cursor will stop in the distance frame of enabled linear number when activating one linear number. 8) Speed: Input speed and the system will calculate speed value automatically, the unit is m/s Function Buttons The function buttons of SSCT module is same with MCV. Notes: The parameter setup is different from MCV module. The specific parameters include Amplification times, Scanning speed, Sensitivity, Low-pass frequency, High-pass frequency, Stimulation intensity, Stimulation pulse width, Auxiliary intensity, Buffer memory, Sound, Waveform pieces, Acquiring color, Activated color, Waveform color, Background color, Gridding, Contrastive color, Abnormal color. 86

91 Fig Parameter Setting 2.11 Upper/Lower Limb Somatosensory Evoked potential (USEP / LSEP) On the Main interface, click [USEP] or [LSEP] to pop up the interface as shown below: Fig USEP / LSEP 87

92 Item : Save the current file, generate a new check number, and create a new interface. Project Selection : Enter into the module; you can directly capture the waveform, but the capture waveform is not used to check nerves and information of parts name at this time, mark the waveform after the acquiring is finished, and the waveform is saved. Right-click the waveform pre-marked area at this time, you can open the dialog box in the picture below to supplement the location of choose position and waveform record position. Fig Project Selection Users can also directly open the "project options" before acquiring, select the position and the position of checking nerve and waveform recording for patients, then start to acquire, the waveform can display the information of checked parts which has settled before. It can select right side and left side. Also it can select upper and lower limbs, trigeminal, spinal cord. Upper extremity (USEP): Select the upper limb, then the "nerve choices" and "Record location" of the upper extremity is an optional condition, it can conduct operations, and the test results are automatically linked to the USEP data tables; Lower limbs (LSEP): Select the lower limbs, then the "nerve choices" and "record position of the lower limbs is an optional condition, it can conduct operations and the test results automatically linked to the LSEP data tables; Trigeminal (TSEP trigeminal somatosensory evoked potential): "Record position (Trident)" is an optional condition after selection, and the test results are automatically linked to the TSEP data list; The spinal cord (SCEP spinal somatosensory evoked): "Record position (spinal cord)" is an optional condition after selection and the test results are 88

93 automatically linked to the TSEP data tables; Note: the adding contents in the neural selection (upper) and neural selection (lower limb) which refer to the "Add neurological settings" in the "System Settings". Space / Stop : control amplifier for signal acquisition start and stop. It will display stop when it spacing, and it will display Space when it stopping. Waveform spacing is divided into four steps: The first step: user must select the name and record nerve location before acquiring the waveform, see "Select Location". The second step: when electrode is connected to the human body, ask patient to relax, click the "Space" button, the waveform display area appears waveform curve, as shown below: It can modify the parameters associated with the waveform display at this time; it can adjust the waveform sensitivity scanning speed and circuit strength by up and down cursor button. Fig Waveform Curve Sensitivity Total Control: Method 1: Click the up arrow to increase the sensitivity, click the down arrow to reduce the sensitivity; Method 2: Use keyboard shortcut "T", "Y" can also be adjusted. A single scan line Sensitivity Control: Method: Direct-click with the mouse sensitivity adjustment button by the right side of each scan-line, then you can control it. Scan speed adjustment: Method 1: Click the left arrow to reduce the scanning speed, click the right arrow to increase the scanning speed; Method 2: Use the keyboard shortcut "U", "I" can also be adjusted. Circuit strength adjustment: Method: Click the up arrow to increase the current intensity, click the down arrow to reduce the current intensity; Note: The stimulation pulse width and stimulation frequency have to modify in 89

94 the "parameter setting". The third step: click the "Splice" button after the patient in a resting state and the waveform stability. Waveform display area appears two scan lines; one for the original waveform of each collection, the other one is the average waveform after splice; the figure below shows the green curve is original waveform, the blue curve is the average waveform after splice. Fig Average Waveform The forth step: click J" button to mark symbols appear on the waveform, and the waveform is temporary after the waveform overlay has been completed, (the original waveforms automatically disappear, leave superimposed waveform). The method for mobile wave location: select the scan-line number to be dragging, hold down the left mouse button, moving the mouse position, then move the scan line position. In accordance with the above method can space multiple waveforms. Splice : Splice for each collected signal and make the average value. Continue splice : Base on the existing waveform to continue splice, then make the average value. Mark : Auto-mark the peak latency and amplitude of the waveform and automatically put the measurement results populate into the data list of test results, the operator can manually adjust them. Method: Click a marker point on the waveform (red line above); hold down the left mouse button and move it to the specified location, data in test results data table will refresh at the same time. Click the button after waveform sampling is finished, it can automatically mark the incubation period and the peak wave on the waveform, and memory the curve, measurement results are displayed in the table. Test results have four record sheets, named USEP, LSEP, TSEP, SCEP. The selected nerve location of the classification results which base on the Select Location", it filled with the recorded waveform data to the appropriate table, table area is the testing area for latency, amplitude and area. Line Number: Select a waveform which has been marked. 90

95 Parameters: Select the value of peak period and peak-peak. Starting point: Select starting position of calculation. End: Select the end position of the calculation. Calculated: it can calculate the selected data and displayed them in the following corresponding column. If there is not necessary for some calculation results, click "delete" to delete it. Note: All the marked points of the data list will mark on the waveform when it marking the waveform, if the user don t need a part of mark points, they can manually drag the mark points of the waveform to the end area of waveform, the data in the table data will be automatically removed. Delete : Delete the selected waveform. Odd/even : After finishing the acquiring, but non-marked the waveform, click on this button, it can show 2 averaged waveforms, one display the Odd averaged waveform, the another display the even averaged waveform. click that button again, the waveform will back to their original situation. Overlap / Separation : It overlaps the waveform which display on the interface, that is easily to observed reproducibility, and separate display function will make a separation display of the overlap waveform. That function can make a comparison display for two and more than two waveforms. parameter setting : Click the "parameter setting" button to open the dialog box of parameter setting as shown below: Fig USEP / LSEP parameter setting channel selection Four-channel is corresponding to the four channels of EMG amplifier. During 91

96 operation please pay attention to: the selected channel number should be have the same with the channel which connect with the signal input wire. There are two methods for channel selection, Method 1: directly to select channel number on the user interface; Method 2: Select channel number in the "parameter setting". Note: The using channel number must be keeping same with the connection cable during the operation. Scanning Speed Unit is ms/ D, the range is 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 20, 30, 40, 50, 60,70,80,90,100. Sensitivity Unit is μv/ D, the range is 0.05, 0.1, 0.2, 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 20,30,40,50,60,70,80, 90,100. High cut frequency High cut frequency (also called low-pass) is the upper limit setting for a pass-band, the range is 10, 20, 30, 50, 100, 200, 300, 500, 1000, 2000,3000,5000,10000, Low-cut frequency Low-cut frequency (also called high-pass) is a lower limit setting for pass-band, the range is 0.1, 0.2, 0.3, 0.5, 1, 2, 3, 5, 10, 20, 30, 50,100,200,300,500. Current intensity (ma) Current intensity refers to output value for intensity, and the range is 0 ~ 100mA, and the interval is 0.5 ma. Stimulus frequency (Hz) Stimulus frequency refers to the output frequency of the current stimulation, the range is 0.1 Hz ~ 100Hz, error ± 10%. Stimulus pulse width (ms) Stimulus pulse width refers to the duration of a output pulse from current stimulate box, the range is 50, 100, 200, 300, 400, 500, 600, 700, 800, 900, Overlay number set the overlay number of collection, the range is 10, 20, 50, 100, 200, 500, 1000, 2000 and

97 Reject Range Waveform overlay, if the acquisition of the signal amplitude exceeds the default value, the signal does not overlay, and it can effectively control the accuracy of the waveform acquisition. Whether display the original waveform or not If selected this item, it means that it will show not only the original waveform, but also show the averaged waveforms during overlapping; If not selected, then means only shows the average waveforms. Color setting It can set the color of the curve during overlapping the waveform, the color of average curve, the background color of screen in space waveform area and the regional grid line color of space waveform area. Print Select direct printing mode to print current screen mode. Direct printing mode means to print all waveforms and data in medical case. Selected printing mode, click "Print", it will popup dialog box, hold down the Ctrl key to select the optional waveform and data. Printing current screen mode means to print the current waveform and data displayed on the screen. Set Default All of the above parameter values can be set, click on the button to set the parameter to the original value as shown below: Fig Set Default 93

98 Item : Open the exammed items of patient, click it to enter the menu of exammed item, and view the saved waveforms as shown below: Fig Exammed Item Save : Save marked waveform. (Note: not save the waveform which is not marked) Fig Save Medical History, Case No., Exam No., Department, Inpatient No. and Exam Date, and all the information which have been established; the nerve can be selected before the examination, it can also be selected here. If user did not click "Save" to save the waveform when exiting, the software will also automatically save the patient s information. Print :The list in the above figure is a list of saved waveforms, the user can select some waveforms for printing, it can output print report, hold down the Ctrl key while using the mouse to select the waveform, and then print the report. help : Open help file. Exit : Click "Exit" to exit the menu directly and directly returned to the main interface, it will be prompted if the file was not saved, then the file can be saved. 94

99 Waveform adjusting : It can open the drop-down list as shown below: Fig Processing Back : close the drop-down list. Wave add: two waveforms are added together, taking the result of the adding waveform. Methods: choose the two wave-line number which will add, such as the A1 and B1; click "Add" button, the top of the waveform area will get the added waveform; If you want the waveform displayed in the interface, click the "Add" button. Waveform average It can splice for two waveforms, whichever is the average waveform, methods with the "wave sum. take the average waveform, same way with the "wave add." Waveform subtraction Subtract the two waveforms, take the minuses waveform, same way with the "wave add." Waveform inversion It will invert the selected waveform, with the same way with the "wave add.". Waveform Smoothing smoothing one selected waveform, same way with the "wave add". (Note: for multiple smooth, but it will change the original waveform) collect condition : Display the parameters of each waveform when they collection. Mark setting 95

100 Editing steps: First to select the items which want to edit, optional USEP, LSEP, TSEP, SCEP; Enter the name at the sign marking the name; Select the nature of the mark in the sign type, optional latency, amplitude; Click the "Add" button, make the sign; To delete a generated symbol, select and press "Delete" button; Modify the edited signs, select and press "Edit" button; Click "OK" button to save and exit after finished editing; If can also click "Exit" button, directly to exit the dialog box; Normal reference values : Open the module's normal number of help document; Impedance Test : Measurement the electrode resistance which connect to human; Click the "Start" button in the Impedance Measurement; open the Impedance Test dialog box: Setting : Set up the scan process, impedance threshold of testing (when the measured value below the threshold shows a green, when it above the threshold value shows red) Start : Start impedance test feature that measures the impedance value, the corresponding channel shows resistance values; Exit : Exit Impedance Test dialog box Auditory Evoked Potential (AEP) Click AEP button on the main interface and open the AEP module as shown below: 96

101 Fig AEP The functions of the buttons are the same as those of USEP/LSEP. Choose Position Select item for examination. Fig Select item for examination Select parts of patient for examination: 1. LEar: left ear of the earphone for stimulation noise and left ear for white noise. 2. REar: left ear of the earphone for white noise and right ear for stimulation noise. 97

102 3. DEar: both ears output stimulation noise without any white noise. Select items for examination: BAEP: brain audio evoked potential. Voice Mode in Parameter Setting is Short Pure Sound, Stim Fashion is adjustable. Save it and auto-generate BAEP format MAEP: Middle Latency Auditory Evoked Potentials(parameter setting refer to BAEP) LAEP: Long Latency Auditory Evoked Potentials(Parameter setting refer to BAEP) EoochG: Electrocochleography, voice mode in Parameter Setting is short pure sound, refer to BAEP for the method. 40Hz EP electronic. Sound mode is a short pure-tone in Parameter setting, the sound frequency is adjustable. Parameter Setting : Click "Parameter setting" button to open the dialog box as shown below: Fig Parameter setting The amplifier and other settings are the same with SEP module. Audio stimulator Stimulus frequency: selectable frequency of output sound; Signal Strength: the voice of strength is given by stimulus; 98

103 Noise Intensity: refers to the sound intensity of white noise; Sound Mode: optional pure-tone, short pure-tone and short sound; It can set the audio frequency when you select a pure tone, short pure tone,; It can set the stimulation when you select a short sound; Collect The steps are the same with SEP module. Stimulus voice strength adjust Signal Strength: Click the up arrow to increase the sound intensity, click the down arrow to reduce the sound intensity; sound intensity range: 0 ~ 120dB; Noise intensity: same way for adjust; noise intensity range: 0 ~ 120dB; Adjust other parameters; see the introduction for SEP module. Operation steps of Mark is the same with SEP, measured result will be showed in the following table: Note: The table respectively records the peak of each wave latency, amplitude, and peak interval and amplitude ratio Visual Evoked Potential (VEP) Click VEP button on the main interface and open the VEP module as shown below: 99

104 Fig VEP Basically the function buttons are the same with USEP/LSEP. SelPart : Select the item name firstly. Fig Select item Choose Item: Right eye, left eye. Function Select: PRVEP: Chessboard VEP (pattern reversal evoke) FVEP: Flash evoke ERG: Electroretinogram EOG: Electro-Oculogram Click "Next" and enter into parameter adjusting interface. PRVEP Stimulation Mode: images displayed on visual stimulator Optional: Gridiron Pattern, CrossBand, and Vertical. Image size: refers to the scale of the output image. Eyeshot Pattern: refers to the eyeshot of the output image. FVEP Stimulation Fashion: 13. L-eye stim: stimulation from left side of the flash stimulator. 14. R-eye stim: stimulation from right side of the flash stimulator. 15. Stim on L&R: stimulation from left and right side of the flash stimulator. 16. Stim alternate: alternate stimulation from left and right side of the flash stimulator. EOG StimPattern: flash 100

105 StimFashion: L-eye stim, R-eye stim, Stim on L&R, Stim Alternate. ERG StimFashion: Please refer to the above descriptions for Lside, Rside, Dside, and other parameters. Mark : Mark the waveform after adding the PL, IPL, IPL Ratio, AMP, AMP Ratio auto-evaluated, the data showed on the Imp test result as following: PL: corresponding to the first mark N75, second mark P100 and the third mark N145. IPL: IPL 1 is the difference between N75 and P100, IPL2 is the difference between P100 and N145, and IPL3 is the sum of N75 and N145. IPL Ratio: Ratio1 is the ratio of the ratio1 to ratio 2, Ratio2 is the ratio of the ratio2 to ratio 3, and Ratio3 is the ratio of the ratio1 to ratio 3. AMP: peak value between N75 and P100. AMP Ratio: refers to the ratio of L-eye peak value to R-eye peak value as long as both L&R eye have peak value Event-Related Potential (P300) Click P300 button on the main interface and open the P300 module as shown below: Fig P300 This module includes target stim and No-target stim which are two different stimulation signals. 101

106 Splice: splicing status, sum up the target signals. No-target splicing status: splicing status, summing up the no target signals. While sampling, there are two spliced waveforms in display area, one is for target signals, and another is for no target signals. StimMode: Sound, light, electricity. Fig Stimulate Mode Sound Stimulation Setting Fig Sound Stimulation Setting Sound Intensity: range from 1~120dB, the interval is1db. Sound Mode: pure tone; short pure tone Target Stim Signal: the range is 0.25KHz 0.5KHz 0.8KHz 1KHz 2KHz 5KHz 7KHz. Nontarget Stim Signal: the range is 0.25KHz 0.5KHz 0.8KHz 1KHz 2KHz 5KHz 7KHz. Note: Do not select the same frequency for Target Stim Signal and Nontarget Stim Signal. Light Stimulation Setting Fig Light Stimulation Setting Nontarget Stim Graphic: To select grid or vertical. Target Stim Signal Gaphic: To select grid or vertical. Note: Tg and NoTg image should be of different pattern, For example, if Gridiron Pattern select TgStim, the NoTg Stim must select vertical. 102

107 Electricity Stimulation Setting Fig Electricity Stimulation Setting Current Intensity : The range is from 0~100mA, the interval is 0.5mA. Target Stim Current Pulse Width : The range is us. Nontarget Stim Current Pulse Width : The range is us. Note: Do not select the same current Width for Tg Stim and NoTg Stim. Other Setting Fig Other Setting StimFreq(Hz): 0.1Hz 0.3Hz 0.5Hz 0.7Hz 1Hz 2Hz. TgStimRatio: TgCount: The range is from 10~50, the interval is