Global Perceptions and Utilization of Clinical Neurophysiology in Movement Disorders

BACKGROUND

Clinical neurophysiology (CNP) involves the use of neurophysiological techniques to make an accurate clinical diagnosis, to quantify the severity, and to measure the treatment response. Despite several studies showing CNP to be a useful diagnostic tool in Movement Disorders (MD), its more widespread utilization in clinical practice has been limited.

OBJECTIVES

To better understand the current availability, global perceptions, and challenges for implementation of diagnostic CNP in the clinical practice of MD.

METHODS

The International Parkinson and Movement Disorders Society (IPMDS) formed a Task Force on CNP. The Task Force distributed an online survey via email to all the members of the IPMDS between August 5 and 30, 2021. Descriptive statistics were used for analysis of the survey results. Some results are presented by IPMDS geographical sections namely PanAmerican (PAS), European (ES), African (AFR), Asian and Oceanian (AOS).

RESULTS

Four hundred and ninety-one IPMDS members (52% males), from 196 countries, responded. The majority of responders from the AFR (65%) and PAS (63%) sections had no formal training in diagnostic CNP (40% for AOS and 37% for ES). The most commonly used techniques are electroencephalography (EEG) (72%) followed by surface EMG (71%). The majority of responders think that CNP is somewhat valuable or very valuable in the assessment of MD. All the sections identified "lack of training" as one of the biggest challenges for diagnostic CNP studies in MD.

CONCLUSIONS

CNP is perceived to be a useful diagnostic tool in MD. Several challenges were identified that prevent widespread utilization of CNP in MD.

Undergraduate students' neurophysiological reasoning: what we learn from the attractive distractors students select

The basis for mastering neurophysiology is understanding ion movement across cell membranes. The Electrochemical Gradients Assessment Device (EGAD) is a 17-item test assessing students' understanding of fundamental concepts of neurophysiology, e.g., electrochemical gradients and resistance, synaptic transmission, and stimulus strength. We collected responses to the EGAD from 534 students from seven institutions nationwide, before and after instruction. We determined the relative difficulty of neurophysiology topics and noted that students did better on "what" questions compared to "how" questions, particularly those integrating concentration gradient and electric forces to predict ion movement. We also found that, even after instruction, students selected one incorrect answer, at a rate greater than random chance for nine questions. We termed these incorrect answers attractive distractors. Most attractive distractors contained terms associated with concentration gradients, equilibrium, or anthropomorphic and teleological reasoning, and incorrect answers containing multiple terms were more attractive. We used χ² analysis and alluvial diagrams to investigate how individual students moved or did not move between answer choices on the pre- and posttest. Interestingly, students selecting the attractive distractor on the pretest were just as likely as other incorrect students to move to the correct answer on the posttest. In contrast, of students incorrect on both the pre- and posttest, students who selected the attractive distractor on the pretest were more likely to stick with this answer on the posttest than students choosing other incorrect answers. Combining the EGAD results with alluvial diagrams can inform neurophysiology instruction to address points of student confusion.NEW & NOTEWORTHY Investigating students' alternative reasoning in neurophysiology, this research is the first to investigate how analyzing the most common incorrect answer can shed light on the concepts students struggle with when reasoning about neurophysiological problems, especially those dealing with both chemical and electrical driving forces to predict ion movement across cell membranes.

Guidelines for Qualifications of Neurodiagnostic Personnel: A Joint Position Statement of the American Clinical Neurophysiology Society, the American Association of Neuromuscular & Electrodiagnostic Medicine, the American Society of Neurophysiological Monitoring, and ASET-The Neurodiagnostic Society

SUMMARY

The Guidelines for Qualifications of Neurodiagnostic Personnel (QNP) document has been created through the collaboration of the American Clinical Neurophysiology Society (ACNS), the American Society of Neurophysiological Monitoring (ASNM), the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), and ASET-The Neurodiagnostic Society (ASET). The quality of patient care is optimized when neurophysiological procedures are performed and interpreted by appropriately trained and qualified practitioners at every level. These societies recognize that neurodiagnostics is a large field with practitioners who have entered the field through a variety of training paths. This document suggests job titles, associated job responsibilities, and the recommended levels of education, certification, experience, and ongoing education appropriate for each job. This is important because of the growth and development of standardized training programs, board certifications, and continuing education in recent years. This document matches training, education, and credentials to the various tasks required for performing and interpreting neurodiagnostic procedures. This document does not intend to restrict the practice of those already working in neurodiagnostics. It represents recommendations of these societies with the understanding that federal, state, and local regulations, as well as individual hospital bylaws, supersede these recommendations. Because neurodiagnostics is a growing and dynamic field, the authors fully intend this document to change over time.

Effects of digitalized university curriculum-associated teaching on the equilibrium of autonomic neurophysiology and disposition of learners in medical school (EDUCATE-AND-LEARN): protocol for a randomized crossover study

BACKGROUND

Homoeostasis of the autonomic nervous system (ANS) contributes to cognitive functional integrity in learners and can be greatly influenced by emotions and stress. While moderate stress can enhance learning and memory processes, long-term stress compromises learning performance in a face-to-face classroom environment. Integrative online learning and communication tools were shown to be beneficial for visualization and comprehension but their effects on the ANS are poorly understood. We aim to assess the effects of video conference-supported live lectures compared to on-site classroom teaching on autonomic functions and their association with learning performance.

METHODS AND DESIGN

Fifty mentally and physically healthy medical students will be enrolled in a randomized two-period crossover study. Subjects will attend a seminar, which is held in face-to-face and simultaneously transmitted via videoconference. Subjects will be allocated in two arms in a randomized sequence determining the order in which both seminar settings will be attended. At baseline and throughout the interactive seminar subjects will undergo detailed autonomic testing comprising neurocardiac (heart rate variability), sudomotor (sympathetic skin response), neurovascular (laser Doppler flowmetry) and pupillomotor (pupillography) function. Furthermore, learning progress will be evaluated using pre- and post-tests on the seminar subject and emotions will be assessed using profile of mood state (POMS) questionnaire.

STATISTICAL ANALYSIS

Carryover effects will be handled using a two-way repeated measures (mixed model). Between-group differences (baseline vs face-to-face vs videoconference) will be determined using one-way analysis of variance ANOVA followed by Student-Newman-Keul test.

LIMITATIONS AND STRENGTHS

This study may elucidate complex interactions between autonomic and emotional dynamics during conventional on-site and video conference-based teaching, thus providing a basis for customized learning and teaching methods. Understanding and utilizing advanced distance learning strategies is particularly important during the current pandemic, which has been limiting on-site teaching dramatically in nearly all countries of the world.

A new assessment to monitor student performance in introductory neurophysiology: Electrochemical Gradients Assessment Device

The basis for understanding neurophysiology is understanding ion movement across cell membranes. Students in introductory courses recognize ion concentration gradients as a driving force for ion movement but struggle to simultaneously account for electrical charge gradients. We developed a 17-multiple-choice item assessment of students' understanding of electrochemical gradients and resistance in neurophysiology, the Electrochemical Gradients Assessment Device (EGAD). We investigated the internal evidence validity of the assessment by analyzing item characteristic curves of score probability and student ability for each question, and a Wright map of student scores and ability. We used linear mixed-effect regression to test student performance and ability. Our assessment discriminated students with average ability (weighted likelihood estimate: -2 to 1.5 Θ); however, it was not as effective at discriminating students at the highest ability (weighted likelihood estimate: >2 Θ). We determined the assessment could capture changes in both assessment scores (model r² = 0.51, P < 0.001, n = 444) and ability estimates (model r² = 0.47, P < 0.001, n = 444) after a simulation-based laboratory and course instruction for 222 students. Differential item function analysis determined that each item on the assessment performed equitably for all students, regardless of gender, race/ethnicity, or economic status. Overall, we found that men scored higher (r² = 0.51, P = 0.014, n = 444) and had higher ability scores (P = 0.003) on the EGAD assessment. Caucasian students of both genders were positively correlated with score (r² = 0.51, P < 0.001, n = 444) and ability (r² = 0.47, P < 0.001, n = 444). Based on the evidence gathered through our analyses, the scores obtained from the EGAD can distinguish between levels of content knowledge on neurophysiology principles for students in introductory physiology courses.

A framework for the ethical assessment of chimeric animal research involving human neural tissue

BACKGROUND

Animal models of human diseases are often used in biomedical research in place of human subjects. However, results obtained by animal models may fail to hold true for humans. One way of addressing this problem is to make animal models more similar to humans by placing human tissue into animal models, rendering them chimeric. Since technical and ethical limitations make neurological disorders difficult to study in humans, chimeric models with human neural tissue could help advance our understanding of neuropathophysiology.

MAIN BODY

In this article, we examine whether the introduction of human neural tissue and any consequent cognitive change is relevant to the way we ought to treat chimeras. We argue that changes in cognitive abilities are morally relevant to the extent that they increase the capacities that affect the moral status of any entity, including awareness, autonomy, and sociability. We posit that no being, regardless of species, should be treated in a way that is incommensurate with its moral status. Finally, we propose a framework that can be used to guide ethical assessment of research involving chimeras with advanced cognitive capacities.

CONCLUSION

We advance this framework as a useful tool for bringing relevant considerations to the forefront for those considering the ethical merit of proposed chimeric research. In doing so, we examine concepts relevant to the question of how any entity may be treated, including moral status, dignity, and capacities.

Evaluation of a virtual neurophysiology laboratory as a new pedagogical tool for medical undergraduate students in China

This study compared the effect of a virtual laboratory, a living tissue laboratory, and a blended laboratory on student learning about the generation and conduction of neural action potentials and perceptions about life science. Sixty-three second-year medical students were randomly assigned to one of three groups (living tissue laboratory, virtual laboratory, and blended group). The students conducted the practical activity, and then they were given a postlaboratory quiz and an attitude survey. The blended group euthanized fewer animals and spent less time to finish the animal experiment than the living tissue group did. In the postlaboratory quiz, students who performed the virtual laboratory alone got significantly lower scores than students in the other two groups, and the blended group did not get better scores than the living tissue group. The attitude surveys showed that the virtual laboratory group had a lower perceived value of the science research and activity in which they participated than the other two groups did. Here, 77.8% of all students chose the blended style as the ideal teaching method for experiments. Our findings led us to believe that isolated use of the virtual laboratory in China is not the best practice: the virtual laboratory serves as an effective preparation tool, and the blended laboratories may become the best laboratory teaching practice, provided that the software design for the virtual laboratory is further improved.

[Intraoperative neurophysiological monitoring in Spain: its beginnings, current situation and future prospects]

Intraoperative neurophysiological monitoring (IONM) is nowadays another tool within the operating room that seeks to avoid neurological sequels derived from the surgical act. The Spanish Neurophysiological Intra-Surgical Monitoring Association (AMINE) in collaboration with the Spanish Society of Clinical Neurophysiology (SENFC), and the IONM Working Group of the SENFC has been collecting data in order to know the current situation of the IONM in Spain by hospitals, autonomous communities including the autonomous cities of Ceuta and Melilla, the opinions of the specialists in clinical neurophysiology involved in this topic and further forecasts regarding IONM. The data was gathered from November 2015 to May 2016 through telephone contact and/or email with specialists in clinical neurophysiology of the public National Health System, and through a computerized survey that also includes private healthcare centers. With the data obtained, from the perspective of AMINE and the SENFC we consider that nowadays the field of medicine covered by IONM is considerably large and it is foreseen that it will continue to grow. Therefore, a greater number of specialists in Clinical Neurophysiology will be required, as well as the need for specific training within the specialty that involves increasing the training period of MIRs based on competencies due to the increase in techniques/procedures, as well as its complexity.

An evaluation of a pain education programme for physiotherapists in clinical practice

OBJECTIVE

The present study evaluated the implementation and acceptability of a pain education programme delivered to physiotherapists in clinical practice.

METHODS

A pre-test/post-test design with 10 physiotherapists was employed. Descriptive and inferential statistics were used for outcome measure data. Focus groups were carried out with seven physiotherapists within 1 month post-intervention. These data were analysed using the framework approach.

RESULTS

Ten musculoskeletal physiotherapists were recruited. It was possible to develop and deliver the intervention and this was found to be acceptable to physiotherapists within clinical practice. The study explored trends within outcome measures, and one was considered appropriate. The focus groups yielded three interlinked themes, which related to the impact of the programme: "providing a context for pain education", "influence on aspects of the patient-therapist encounter" and "logistics of the education programme in clinical practice".

CONCLUSIONS

A pain education programme delivered to physiotherapists in clinical practice was both possible to deliver and acceptable to participants. A key strength of the programme was the applicability to real-life practice, which was valued by physiotherapists. While physiotherapists felt that pain neurophysiology education was important, they reported lacking confidence in implementing their pain neurophysiology knowledge with patients. Thus, more time is needed to focus on pain neurophysiology education, with the aim of increasing confidence with the application of this approach in clinical practice.

Interactive laboratory classes enhance neurophysiological knowledge in Thai medical students

Interactive laboratory class (ILC) is a two-way communication teaching method that encourages students to correlate laboratory findings with materials from lectures. In Thai medical education, active learning methods are uncommon. This paper aims to establish 1) if ILCs would effectively promote physiology learning; 2) if effectiveness would be found in both previously academically high-performing and low-performing students; and 3) the acceptability of ILCs to Thai medical students as a novel learning method. Two hundred seventy-eight second-year medical students were recruited to this study. We conducted three ILC sessions, which followed corresponding lectures. We carried out multiple-choice pre- and post-ILC assessments of knowledge and compared by repeated-measures ANOVA and unpaired t-test. Subgroup analysis was performed to compare high-performance (HighP) and low-performance (LowP) students. After the ILCs, participants self-rated their knowledge and satisfaction. Post-ILC test scores increased significantly compared with pre-ILC test scores in all three sessions. Mean scores of each post-ILC test increased significantly from pre-ILC test in both LowP and HighP groups. More students self-reported a "very high" and "high" level of knowledge after ILCs. Most students agreed that ILCs provided more discussion opportunity, motivated their learning, and made lessons more enjoyable. As an adjunct to lectures, ILCs can enhance knowledge in medical students, regardless of previous academic performance. Students perceived ILC as useful and acceptable. This study supports the active learning methods in physiology education, regardless of cultural context.

Redesigning a course to help students achieve higher-order cognitive thinking skills: from goals and mechanics to student outcomes

Here we describe a 4-yr course reform and its outcomes. The upper-division neurophysiology course gradually transformed from a traditional lecture in 2004 to a more student-centered course in 2008, through the addition of evidence-based active learning practices, such as deliberate problem-solving practice on homework and peer learning structures, both inside and outside of class. Due to the incremental nature of the reforms and absence of pre-reform learning assessments, we needed a way to retrospectively assess the effectiveness of our efforts. To do this, we first looked at performance on 12 conserved exam questions. Students performed significantly higher post-reform on questions requiring lower-level cognitive skills and those requiring higher-level cognitive skills. Furthermore, student performance on conserved questions was higher post-reform in both the top and bottom quartiles of students, although lower-quartile student performance did not improve until after the first exam. To examine student learning more broadly, we also used Bloom's taxonomy to quantify a significant increase in the Bloom's level of exams, with students performing equally well post-reform on exams that had over twice as many questions at higher cognitive skill levels. Finally, we believe that four factors provided critical contributions to the success of the course reform, including: transformation efforts across multiple course components, alignment between formative and evaluative course materials, student buy-in to course instruction, and instructional support. This reform demonstrates both the effectiveness of incorporating student-centered, active learning into our course, and the utility of using Bloom's level as a metric to assess course reform.

Drawing on student knowledge of neuroanatomy and neurophysiology

Drawings are an underutilized assessment format in Human Anatomy and Physiology (HA&P), despite their potential to reveal student content understanding and alternative conceptions. This study used student-generated drawings to explore student knowledge in a HA&P course. The drawing tasks in this study focused on chemical synapses between neurons, an abstract concept in HA&P. Using two preinstruction drawing tasks, students were asked to depict synaptic transmission and summation. In response to the first drawing task, 20% of students (n = 352) created accurate representations of neuron anatomy. The remaining students created drawings suggesting an inaccurate or incomplete understanding of synaptic transmission. Of the 208 inaccurate student-generated drawings, 21% depicted the neurons as touching. When asked to illustrate summation, only 10 students (roughly 4%) were able to produce an accurate drawing. Overall, students were more successful at drawing anatomy (synapse) than physiology (summation) before formal instruction. The common errors observed in student-generated drawings indicate students do not enter the classroom as blank slates. The error of "touching" neurons in a chemical synapse suggests that students may be using intuitive or experiential knowledge when reasoning about physiological concepts. These results 1) support the utility of drawing tasks as a tool to reveal student content knowledge about neuroanatomy and neurophysiology; and 2) suggest students enter the classroom with better knowledge of anatomy than physiology. Collectively, the findings from this study inform both practitioners and researchers about the prevalence and nature of student difficulties in HA&P, while also demonstrating the utility of drawing in revealing student knowledge.

Proposal for research and education: joint lectures and practicals on central nervous system anatomy and physiology

We coordinated anatomy and physiology lectures and practicals to facilitate an integrated understanding of morphology and function in a basic medical science program for dental students and to reduce the time spent on basic science education. This method is a means to provide the essential information and skills in less time. The overall impression was that the practice of joint central nervous system lectures and practicals was an efficient method for students, which suggests that joint lectures might also be useful for clinical subjects. About two-thirds of students felt that the joint anatomy and physiology lecture on the central nervous system was useful and necessary in understanding the relationship between morphology and function, at least for this subject. One-third of students were neutral on the effectiveness of this method. However, the survey results suggest that improvements are needed in the method and timing of joint lectures and practicals. The present teaching approach can be further improved by conducting combined lectures in which the form and function of anatomic structures are presented by the relevant departments during the same lecture. Finally, joint lecturers and practicals offer an opportunity to increase student understanding of the importance of new research findings by the present authors and other researchers.

Positive outcomes increase over time with the implementation of a semiflipped teaching model

The flipped teaching model can engage students in the learning process and improve learning outcomes. The purpose of the present study was to assess the outcomes of a semiflipped teaching model over time. Neurophysiology students spent the majority of class time listening to traditional didactic lectures, but they also listened to 5 online lectures and spent 8-10 class periods completing an active learning assignment. At the end of the term, students completed a survey to assess the outcomes of the active learning assignments. The positive outcomes were greater the second time the course was taught in a semiflipped manner. While completely flipping a course takes a tremendous amount of time, instructors can still obtain positive outcomes by implementing a semiflipped teaching model.

The neurophysiology of failed visual perceptions: some implications for medical teaching

Failed perceptions of clinical abnormalities may have a neurophysiological explanation including three major covert eye problems and seven major brain-processing problems. Seven suggestions are made in an attempt to minimise their effect. We see in detail much less than we think and there is no substitute for seeing real-life clinical abnormalities.

Using a classic paper by Bell as a platform for discussing the role of corollary discharge-like signals in sensory perception and movement control

Decades of behavioral observations have shown that invertebrate and vertebrate species have the ability to distinguish between self-generated afferent inputs versus those that are generated externally. In the present article, I describe activities focused around the discussion of a classic American Physiological Society paper by Curtis C. Bell that lays the foundation for students to investigate the neural substrate underlying this ability. Students will leave this activity being able to 1) describe the technical aspects and limitations of an electric fish preparation commonly used to acquire single unit (extracellular) neurophysiological data, 2) provide physiological evidence showing that the activity of principal cells in the posterior lateral line lobe of the electric fish brain reflects that of a reafference comparator that could be used in dissociating self-generated versus externally generated sensory signals, and 3) knowledgeably discuss hypotheses concerning the role of corollary discharge and cerebellar-like structures in vertebrate and invertebrate species. The skills and background knowledge gained in this activity lay the platform for advanced study of scientific investigations into sensory, motor, and cognitive processes in undergraduate, graduate, or medical school curricula.

[Problems and perspectives of teaching neurology to today's medical students]

Currently, the following statements in teaching neurology should be considered: 1) the successful study of nervous diseases is impossible without knowledge of basic science (neuroanatomy, neurophysiology); 2) the feedback between the teacher and the student is important for effectiveness of teaching process; 3) theoretical knowledge should be combined with practical skills (communication between the young specialist and the patient, individual approach to the patient); 4) special attention should be drawn to the formation of personal qualities of the physician and ethical principles of future work.

Proprioception and tension receptors in crab limbs: student laboratory exercises

The primary purpose of these procedures is to demonstrate for teaching and research purposes how to record the activity of living primary sensory neurons responsible for proprioception as they are detecting joint position and movement, and muscle tension. Electrical activity from crustacean proprioceptors and tension receptors is recorded by basic neurophysiological instrumentation, and a transducer is used to simultaneously measure force that is generated by stimulating a motor nerve. In addition, we demonstrate how to stain the neurons for a quick assessment of their anatomical arrangement or for permanent fixation. Staining reveals anatomical organization that is representative of chordotonal organs in most crustaceans. Comparing the tension nerve responses to the proprioceptive responses is an effective teaching tool in determining how these sensory neurons are defined functionally and how the anatomy is correlated to the function. Three staining techniques are presented allowing researchers and instructors to choose a method that is ideal for their laboratory.

The zebrafish brain in research and teaching: a simple in vivo and in vitro model for the study of spontaneous neural activity

Recently, the zebrafish (Danio rerio) has been established as a key animal model in neuroscience. Behavioral, genetic, and immunohistochemical techniques have been used to describe the connectivity of diverse neural circuits. However, few studies have used zebrafish to understand the function of cerebral structures or to study neural circuits. Information about the techniques used to obtain a workable preparation is not readily available. Here, we describe a complete protocol for obtaining in vitro and in vivo zebrafish brain preparations. In addition, we performed extracellular recordings in the whole brain, brain slices, and immobilized nonanesthetized larval zebrafish to evaluate the viability of the tissue. Each type of preparation can be used to detect spontaneous activity, to determine patterns of activity in specific brain areas with unknown functions, or to assess the functional roles of different neuronal groups during brain development in zebrafish. The technique described offers a guide that will provide innovative and broad opportunities to beginner students and researchers who are interested in the functional analysis of neuronal activity, plasticity, and neural development in the zebrafish brain.

Development of a computer-assisted cranial nerve simulation from the visible human dataset

Advancements in technology and personal computing have allowed for the development of novel teaching modalities such as online web-based modules. These modules are currently being incorporated into medical curricula and, in some paradigms, have been shown to be superior to classroom instruction. We believe that these modules have the potential of significantly enriching anatomy education by helping students better appreciate spatial relationships, especially in areas of the body with greater anatomical complexity. Our objective was to develop an online module designed to teach the anatomy and function of the cranial nerves. A three-dimensional model of the skull, brainstem, and thalamus were reconstructed using data from the Visible Human Project and Amira®. The paths of the cranial nerves were overlaid onto this 3D reconstruction. Videos depicting these paths were then rendered using a "roller coaster-styled" camera approach. Interactive elements adding textual information and user control were inserted into the video using Adobe Creative Suite® 4, and finally, the module was exported as an Adobe Flash movie to be viewable on Internet browsers. Fourteen Flash-based modules were created in total. The primary user interface comprises a website encoded in HTML/CSS and contains links to each of the 14 Flash modules as well as a user tutorial.

A housefly sensory-motor integration laboratory

Insects have many interesting behaviors that can be observed in an introductory biology laboratory setting. In the present article, we describe several reflexes using the housefly Musca domestica that can be used to introduce students to sensory and motor responses and encourage them to think about the underlying neural circuits and integration of sensory information that mediate the behaviors.

What is transmitted in "synaptic transmission"?

Even students that obtain a high grade in neurophysiology often carry away a serious misconception concerning the final result of the complex set of events that follows the arrival of an action potential at the presynaptic terminal. The misconception consists in considering that "at a synapse, information is passed on from one neuron to the next" is equivalent to (and often expressed explicitly as) "the action potential passes from one neuron to the next." More than half of four groups of students who were asked to comment on an excerpt from a recent physiology textbook that openly stated the misconception had no clear objection to the text presented. We propose that the first culprit in generating this misconception is the term "synaptic transmission," which promotes the notion of transferring something or passing something along (implicitly unchanged). To avoid establishing this misconception, the first simple suggestion is to use words like "synaptic integration" rather than "synaptic transmission" right from the start. More generally, it would be important to focus on the function of synaptic events rather than on rote listing of all the numerous steps that are known to occur, which are so complex as to saturate the mind of the student.

Teaching dental pain with and without underlying oral physiology: learning implications

This study investigated whether teaching undergraduate dental students the diagnosis and management of acute dental pain alongside the underpinning oral physiology helped them to understand the topic better than teaching them acute dental pain as a separate entity. Each of three clinical years of dental students at the same dental school was taught in two groups. Each group was taught the signs/symptoms of five acute dental pain conditions by the same member of the staff. However, the teaching for one group of students in each year reminded the students about the physiology that underpinned the clinical symptoms. One week later, the students completed an open-ended questionnaire that required them to list signs/symptoms of the five dental pain conditions. For each year of dental students that was examined, the mean student marks were significantly higher (p<0.05) for those who were taught dental pain and the underlying physiology compared with students who were only taught dental pain as a stand-alone subject. This suggests that integrating biomedical science and clinical teaching is beneficial.

Teaching neurophysiology, neuropharmacology, and experimental design using animal models of psychiatric and neurological disorders

Animal models have been widely used for studying the physiology and pharmacology of psychiatric and neurological diseases. The concepts of face, construct, and predictive validity are used as indicators to estimate the extent to which the animal model mimics the disease. Currently, we used these three concepts to design a theoretical assignment to integrate the teaching of neurophysiology, neuropharmacology, and experimental design. For this purpose, seven case studies were developed in which animal models for several psychiatric and neurological diseases were described and in which neuroactive drugs used to treat or study these diseases were introduced. Groups of undergraduate students were assigned to one of these case studies and asked to give a classroom presentation in which 1) the disease and underlying pathophysiology are described, 2) face and construct validity of the animal model are discussed, and 3) a pharmacological experiment with the associated neuroactive drug to assess predictive validity is presented. After evaluation of the presentations, we found that the students had gained considerable insight into disease phenomenology, its underlying neurophysiology, and the mechanism of action of the neuroactive drug. Moreover, the assignment was very useful in the teaching of experimental design, allowing an in-depth discussion of experimental control groups and the prediction of outcomes in these groups if the animal model were to display predictive validity. Finally, the highly positive responses in the student evaluation forms indicated that the assignment was of great interest to the students. Hence, the currently developed case studies constitute a very useful tool for teaching neurophysiology, neuropharmacology, and experimental design.

Real-time development of data acquisition and analysis software for hands-on physiology education in neuroscience: G-PRIME

We report on the real-time creation of an application for hands-on neurophysiology in an advanced undergraduate teaching laboratory. Enabled by the rapid software development tools included in the Matlab technical computing environment (The Mathworks, Natick, MA), a team, consisting of a neurophysiology educator and a biophysicist trained as an electrical engineer, interfaced to a course of approximately 15 students from engineering and biology backgrounds. The result is the powerful freeware data acquisition and analysis environment, "g-PRIME." The software was developed from week to week in response to curriculum demands, and student feedback. The program evolved from a simple software oscilloscope, enabling RC circuit analysis, to a suite of tools supporting analysis of neuronal excitability and synaptic transmission analysis in invertebrate model systems. The program has subsequently expanded in application to university courses, research, and high school projects in the US and abroad as free courseware.

Brain, mind, and body: interactions with art in renaissance Italy

The Renaissance saw the first systematic anatomical and physiological studies of the brain and human body because scientists, for the first time in centuries, were allowed to dissect human bodies for study. Renaissance artists were frequently found at dissections and their attention to detail can be observed in their products. Scientists themselves were increasingly artistic, and they created astonishing anatomical models and illustrations that can still be studied. The cross-fertilization of art and science in the Renaissance resulted in more scientific analyses of neuroanatomy as well as more creative ways in which such analyses could be depicted. Both art and science benefited from the reciprocal ways in which the two influenced each other even as they provided new ways of explaining the mysteries of the human body and mind.

Neurobiological formulations: integrating clinical and biological psychiatry

OBJECTIVE

The authors describe a pilot program allowing psychiatric residents to participate in neurobiological evaluations of patients with Axis I disorders. The program aimed to familiarize residents with available tools for assessing cognitive and neuroanatomical abnormalities in psychiatric patients and to foster greater interest among residents in correlating psychiatric symptoms with abnormalities in neural structures and pathways.

METHODS

Residents meet weekly with a faculty mentor to plan and construct a neurobiological formulation. Residents review the salient literature on the Axis I condition present in a patient of their choosing. The patient undergoes neuroanatomical, physiological, and cognitive testing relevant to his disorder. The resident then integrates the findings from this testing with the patient's clinical presentation. Using a questionnaire, the authors obtain feedback from residents based on residents' experiences with this didactic program.

RESULTS

Residents felt they obtained a greater appreciation and understanding of the relevance of neuroanatomical and neurophysiological abnormalities and testing in clinical psychiatry. The project was well received and residents rated it highly for its educational value.

CONCLUSION

Neurobiological formulations offer a new educational method to foster knowledge and interest among psychiatric residents about the importance of neuroscience in clinical practice.

EEG departments in Great Britain: A survey of practice

OBJECTIVE

Guidelines have been published recently on when an electroencephalogram (EEG) should be undertaken and the expected waiting time for a routine EEG, but have not included recommendations on how an EEG should be undertaken or who should undertake and report EEGs. The purpose of this survey was to obtain background information on the composition and practice of EEG departments throughout Great Britain that might form the basis for additional recommendations and guidelines.

METHODS

A postal questionnaire was sent to all EEG departments in Great Britain in 2001/2002; non-responders were sent a further copy of the questionnaire.

RESULTS

Fifty-two departments responded, representing a response rate of 48%. The reasons for this relatively poor response rate are not known. Findings indicated that a single doctor reported EEGs in 44% of all departments. The speciality of doctor reporting EEGs included neurophysiologists (59%), neurologists (22%), paediatric neurologists (PNs) (13%), psychiatrists (5%) and one general practitioner (GP). EEG recordists from 28 departments (54%) and medical staff in 21 departments (40%) stated that they had not received any formal training in, respectively, undertaking and reporting EEGs in children. In 29 departments (55%), medical staff report EEGs independently from the recordists. Fourteen departments (27%) undertake less than 500 EEGs per year. Ten of the 42 departments providing a paediatric service perform less than 100 paediatric EEGs per year. Eighteen (35%) and eight (15%) units have a waiting time of 2-4 and over 12 weeks, respectively, for a routine EEG.

CONCLUSIONS

This survey has identified a range of practice and operational procedures in 52 EEG departments throughout Great Britain. These findings may have implications on the investigation and management of people with non-epileptic seizures and epilepsy.

Teaching resources. The Sherlock Holmes lab: investigations in neurophysiology

This Teaching Resource describes a research project that can be used in an advanced undergraduate course in neurobiology that covers basic electrophysiology and synaptic transmission. A thought experiment is provided that can be used to assess student understanding of (i) the scientific method, (ii) the process whereby nerve stimulation leads to muscle contraction, and (iii) the use of pharmacological agents to analyze a physiological system.

The academic lineage of Sir John Carew Eccles (1903-1997)

This report reviews the academic lineage of Sir John Eccles; who trained him, whom he then trained and with whom he collaborated, and the subsequent impact of his trainees and collaborators on neuroscience and other areas. In a post-training career at five institutions in four countries (Great Britain, Australia, New Zealand, back to Australia, USA) and during retirement in Switzerland, Eccles trained and collaborated with over 180 people (mostly neuroscientists) from 21 countries. Most of them have had stellar research and training records that span the cellular-behavioral-philosophical spectrum of neuroscience, with a focus from peripheral neuromuscular issues to the forebrain. Some have been equally distinguished in other areas of biomedical science. Eccles' academic contributions and lineage are a valuable colloquium topic in a neuroscience training program. His experimental work spanned much of the 20th C before the recent emphasis on the application of the techniques of molecular biology. He continually sought to integrate information from the cellular to the systems and behavioral levels of analysis and synthesis. He also devoted a substantial amount of his intellectual effort to the mind-brain and other philosophical issues. Eccles' prodigious working hours and enthusiasm for his projects were a role model for such trainees. Hard-working trainees often ask how can they retain their all-round interests, and indeed their humanity and citizenry, as they focus more and more on their necessarily narrowly focused neuroscience research. Again, Eccles' writings and overall behavior show that it can indeed be done, but only by the application of extraordinary effort and dedication.

Factors Affecting Reliability of Interpretations of Intra-Operative Evoked Potentials

Objective. There are two objectives of this study. The first is to understand how practitioners of differing backgrounds approach the process of interpreting intra-operative neurophysiologic monitoring. The second is to understand whether the experience and educational background of practitioners influences the degree of agreement in their interpretations. Methods. A survey was distributed at the 2004 American Society of Neurophysiological Monitoring meeting. A total of 92 responses were obtained. The effect that various characteristics of the respondents including their experience, degree, certification and role in monitoring had on a number of outcome measures was assessed. These outcome measures included the probability that the surgeon responded to a warning, the chance that the patient would wake without a deficit after a warning was delivered, and the degree to which respondents agreed on interpretations of SSEP traces. Results. It was found that surgeons were more likely to respond to warnings issued by a monitrist with a higher degree of experience. Respondents with higher levels of experience, certification level, and degree level were more likely to agree on interpretations of evoked potential tracings. Overall, however, the degree of agreement between respondents was at most moderate. Respondents with higher levels of experience and training were more likely to provide correct answers to a subset of traces that were designed to reflect a classic pattern of change. Conclusions. This study indicates the need for additional studies on the criteria for providing warnings during IOM and the characteristics of monitrists that influence their interpretations.

[Towards the establishment of a postgraduate training program of neurology--in the case of Tokyo Medical and Dental University]

The training as neurologist in Department of Neurology and Neurological Science, Tokyo Medical and Dental University has mainly been performed through 3rd to 5th year after the graduation. It includes training for neurophysiology, neuroradiology and neuropathology as well as clinical neurology. Neurophysiology training has the separate 3 months course where trainee residents study exclusively neurophysiology but neuroradiology and neuropathology were learned during training for clinical neurology in general. The major problem of our training program is that the quota is so small to prepare enough trainee's positions. This appears also true in many institutes in Japan according to a questionnaire survey by this workshop. The number of neurology staff should be increased to accomplish better training for Neurology in each institute. The Japanese Society of Neurology should support this effort in each institute.

A randomized controlled trial of intensive neurophysiology education in chronic low back pain

OBJECTIVES

Cognitive-behavioral pain management programs typically achieve improvements in pain cognitions, disability, and physical performance. However, it is not known whether the neurophysiology education component of such programs contributes to these outcomes. In chronic low back pain patients, we investigated the effect of neurophysiology education on cognitions, disability, and physical performance.

METHODS

This study was a blinded randomized controlled trial. Individual education sessions on neurophysiology of pain (experimental group) and back anatomy and physiology (control group) were conducted by trained physical therapist educators. Cognitions were evaluated using the Survey of Pain Attitudes (revised) (SOPA(R)), and the Pain Catastrophizing Scale (PCS). Behavioral measures included the Roland Morris Disability Questionnaire (RMDQ), and 3 physical performance tasks; (1) straight leg raise (SLR), (2) forward bending range, and (3) an abdominal "drawing-in" task, which provides a measure of voluntary activation of the deep abdominal muscles. Methodological checks evaluated non-specific effects of intervention.

RESULTS

There was a significant treatment effect on the SOPA(R), PCS, SLR, and forward bending. There was a statistically significant effect on RMDQ; however, the size of this effect was small and probably not clinically meaningful.

DISCUSSION

Education about pain neurophysiology changes pain cognitions and physical performance but is insufficient by itself to obtain a change in perceived disability. The results suggest that pain neurophysiology education, but not back school type education, should be included in a wider pain management approach.