Learning Objectives

Differential diagnosis, interpretation of electrophysiologic findings and proper interpretation of the findings is the overlying theme of this course. The participants and the faculty will explore and discuss the etiology, pathology, clinical course, patient presentation, clinical examination, and expected findings from the electrophysiological examination of numerous pathological conditions.

1. Describe and discuss how the nerve conduction study and electromyographic exam can be used delineate between a pre-ganglionic and post-ganglionic lesion and further localize the site of injury in cervical radiculopathy.
2. Describe and discuss what history, patient presentation, clinical exam, clinical course, nerve conduction study, and electromyographic exam data in combination suggest the presence of central nervous system disease and differentiate between cervical spondylitic myelopathy, ALS, spinal muscular atrophy, syringomyelia and post-polio syndrome.
3. Compare Seddon’s & Sunderland’s nerve injury classifications; be able to describe in detail each level of injury, the causes, expected nerve study and electromyogram findings and pathologies that exhibit these changes.
4. Describe and discuss the etiologies, pathophysiology, patient presentation, clinical examination, laboratory and other diagnostic findings, and EMG/NCS findings for presynaptic and postsynaptic neuromuscular junction disorders, such as, myasthenia gravis, Lambert Eaton syndrome and botulism.
5. Describe and discuss the etiologies, clinical course, patient presentation, clinical examination, and expected findings from the electrophysiological examination in polyneuropathy. Recognizing that polyneuropathy is not pathognomic for specific disease, students will further be able to recognize, characterize and classify polyneuropathies by electrodiagnostic findings. The polyneuropathies to be addressed include multifocal motor neuropathy, alcoholic/toxic neuropathy, amyloid neuropathy, diabetic neuropathy, diabetic amyotrophy, Guillain-Barre syndrome, CIDP/CSDN and Charcot Marie Tooth Disease/HSMN.
6. Describe and discuss the clinical presentation of patients with common upper/lower extremity/cranial neuropathies as well as the clinical electrodiagnostic characteristics expected conditions including, but not limited to carpal tunnel syndrome, ulnar neuropathy at the elbow, peroneal neuropathy at the knee, axillary neuropathy, suprascapular neuropathy, anterior interosseous syndrome/pronator teres syndrome, Bell’s Palsy and brachial plexopathy.
7. Describe and discuss what history, patient presentation, clinical exam, clinical course, nerve conduction study, and electromyographic exam data in combination suggest the presence of a myopathy and differentiate between polymyositis, inclusion body myositis, dermatomyositis and muscular dystrophy.
8. Describe and discuss the components and functions of the EMG/NCS testing system including how to manipulate common settings and the function of filters.
9. Describe and discuss normal and abnormal EMG and NCS waveform morphology and how to troubleshoot technical anomalies to differentiate these from pathologic waveforms.
10. Describe and discuss the findings in both neural and muscle fiber injury and findings seen during neural healing.
11. Review and demonstrate an extensive knowledge of neuromuscular anatomy and physiology to include:
    • Describe microanatomy of the axon-membrane and supporting structures.
    • Compare the structure of myelinated and unmyelinated nerves.
    • Identify the microanatomy of muscle.
    • Describe nerve and muscle membrane physiology such as potential and permeability.
    • Compare impulse propagation in myelinated and unmyelinated nerves.
    • Describe muscle contraction at the cellular level to include actin-myosin binding, ratcheting effect, sarcomere shortening.
12. Describe Practice Parameters for common conditions encountered in electrodiagnostic practice.
13. Describe and discuss normal and abnormal SSEP waveforms and Interpretation of SSEP results.
14. Review and demonstrate knowledge of basic statistics and research design as it pertains to physical therapy and electrodiagnostic practice.
15. Understand and demonstrate knowledge of proper billing for electrodiagnostic testing.
16. Describe ethical considerations pertinent to the electrodiagnostic practice.