Neurowerk Emg Manual en 20100104 en

NEUROWERK EMG A
Introduction Page 1
User Manual
NEUROWERK EMG
EMG/NCV/EP System
NEUROWERK EMG is a product of

SIGMA Medizin-Technik GmbH Germany
MANUFACTURER
SIGMA Medizin-Technik GmbH

Gewerbepark Am Gruendel 2
D-09423 Gelenau
Germany
Telephone: +49 - 37 297 / 82 5 - 0
Telefax: +49 - 37 297 / 82 5 - 23
E-mail: info@neurowerk.de
Internet: www.neurowerk.de
A NEUROWERK EMG
Page 2 Introduction
Copyright © 2007-2010 SIGMA Medizin-Technik GmbH

Status as per: 04/01/2010
Subject to change without prior notice. The information contained herein does not
found any obligation on the part of the dealer or manufacturer.
NEUROWERK EMG 0
CONTENTS Page 3
Table of Contents
A Introduction ....................................................................................................................................7
A.1 Field of application, indications/contraindications................................................................................7
A.2 Warnings and notes ...........................................................................................................................................8
A.3 Electrical safety ....................................................................................................................................................8
A.4 Safety notes on the EMC regulations...........................................................................................................9
A.5 Safety notes on the electrical stimulator....................................................................................................9
A.6 Further safety notes ........................................................................................................................................ 10
A.7 CE marking ......................................................................................................................................................... 10
A.8 Equipotential bonding................................................................................................................................... 10
A.8.1 Place of installation........................................................................................................................ 10
A.8.2 Combination with other equipment....................................................................................... 11
A.8.3 Using a defibrillator ....................................................................................................................... 11
A.8.4 Using high-frequency surgical devices .................................................................................. 11
A.9 Conditions for proper use............................................................................................................................. 11
A.9.1 Before getting started................................................................................................................... 11
A.9.2 When working with the equipment ........................................................................................ 12
A.9.3 After finishing work ....................................................................................................................... 12
A.9.4 Inspection and maintenance ..................................................................................................... 12
A.9.5 Hygiene and care of the equipment ....................................................................................... 12
A.9.6 Cleaning and sterilisation of electrodes................................................................................. 12
A.9.7 General notes................................................................................................................................... 14
A.9.8 Environmental protection........................................................................................................... 14
A.9.9 Symbols used and their meaning............................................................................................. 15
B Design and Installation ...............................................................................................................17
B.1 Hardware............................................................................................................................................................. 17
B.1.1 Technical description.................................................................................................................... 17
B.1.2 System components:..................................................................................................................... 20
B.1.3 Connections on the electrode input box............................................................................... 22
B.1.4 Connector panel on the central unit....................................................................................... 23
B.1.5 Connections on the PC................................................................................................................. 27
B.1.6 Remote control ............................................................................................................................... 28
B.2 Installation.......................................................................................................................................................... 29
B.2.1 Place of installation........................................................................................................................ 29
B.2.2 Mains power connection and equipotential bonding...................................................... 29
B.2.3 Connecting electrodes and peripherals................................................................................. 30
B.2.4 Switching on the equipment ..................................................................................................... 30
0 NEUROWERK EMG
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B.2.5 Switching off the equipment ..................................................................................................... 30

C Software Installation ...................................................................................................................31
C.1 Installation of the NEUROWERK EMG software..................................................................................... 31
D Electrodes and Accessories ........................................................................................................32
D.1 (EMG) needle electrodes ............................................................................................................................... 32
D.2 (NCV/EP) surface electrodes......................................................................................................................... 32
D.3 Earth electrode.................................................................................................................................................. 33
D.4 Stimulation electrodes................................................................................................................................... 33
D.5 Headphones....................................................................................................................................................... 33
D.6 VGA monitor for VEP stimulation............................................................................................................... 34
E General Handling of the System................................................................................................35
E.1 Screen structure ............................................................................................................................................... 35
E.1.1 General screen................................................................................................................................. 35
E.1.2 Screen for EMG................................................................................................................................ 36
E.1.3 Individual elements of the main screen................................................................................. 38
E.2 Method selection ............................................................................................................................................. 44
E.3 Preparation......................................................................................................................................................... 45
E.4 Monitor ................................................................................................................................................................ 46
E.5 Trigger.................................................................................................................................................................. 46
E.6 Analysis................................................................................................................................................................ 46
E.7 Inserting/removing sequences................................................................................................................... 46
E.8 Printing measurement results..................................................................................................................... 47
E.8.1 Summary Report............................................................................................................................. 48
E.9 Current stimulator ........................................................................................................................................... 51
E.10 Temperature sensor........................................................................................................................................ 51
F Examination programs................................................................................................................53
F.1 NCV – Nerve Conduction Velocity ............................................................................................................. 53
F.1.1 Motor NCV......................................................................................................................................... 53
F.1.2 Sensory NCV..................................................................................................................................... 58
F.1.3 Myasthenia test............................................................................................................................... 64
F.1.4 F response......................................................................................................................................... 69
F.2 Magnetic stimulation...................................................................................................................................... 76
F.3 SEP – Somatosensorially evoked potentials........................................................................................... 79
F.3.1 SEP ....................................................................................................................................................... 79
F.4 AEP – Acoustically evoked potentials....................................................................................................... 79
F.4.1 FAEP .................................................................................................................................................... 79
F.4.2 P300..................................................................................................................................................... 79
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CONTENTS Page 5
F.5 VEP – Visually evoked potentials................................................................................................................ 79

F.5.1 VEP....................................................................................................................................................... 79
F.6 EMG – Electromyography ............................................................................................................................. 79
F.6.1 Needle EMG trigger ....................................................................................................................... 79
F.6.2 EMG tremor analysis...................................................................................................................... 79
F.7 Reflex examinations........................................................................................................................................ 79
F.7.1 OOR ..................................................................................................................................................... 79
G Technical Data ..............................................................................................................................79
G.1 EMG/NCV/EP hardware – Technical data for standard configuration .......................................... 79
H Annex .............................................................................................................................................79
H.1 EMC guidelines ................................................................................................................................................. 79
H.2 Cables/lines/electrodes ................................................................................................................................. 79
NEUROWERK EMG A
Introduction Page 7
A Introduction
When compiling this User Manual, particular importance was attached to a clear and
readily understandable description of the individual applications.
The User Manual is intended to enable effective use of the NEUROWERK EMG system
and of the application possibilities it offers.
The User Manual is an integral part of the measuring system. It should always be
kept in the immediate vicinity of the system. Careful adherence to the User Man-
ual is imperative, as a condition for proper use and correct handling of the meas-
uring system.
The manufacturer reserves the right to implement modifications for technical im-
provement of the system without prior notice.
Please read this User Manual carefully before you install and start up the system. The
system must only be used by persons whose training, knowledge and practical experi-
ence constitute a guarantee for proper handling; these persons must have been in-
structed accordingly on proper handling of the system in accordance with the con-
tents of this User Manual. Such instruction must only be given by persons who, by way
of their knowledge and practical experience, are suitably qualified to provide instruc-
tion on the handling of the system.
Exact examination results and safe, trouble-free operation are only guaranteed if the
system is operated in accordance with the Instruction Manual.
A.1 Field of application, indications/contraindications

NEUROWERK EMG serves for the functional diagnosis of neurological malfunctions in
the field of the peripheral neuromuscular and central nervous system of the human
body and can be used to perform the following procedures:
1. Electromyography (EMG) as a technical examination method by which the natural
electrical activity of a muscle is measured by way of a needle electrode inserted into
the musculature to be examined. It gives indication as to whether the muscle itself is
affected or whether the nerve supplying this muscle with information is not function-
ing correctly. The result of the examination is available as an electromyogram after the
evaluation.
Contraindication is to be noted in the case of a blood-thinning therapy (e.g. with
MARCOUMAR, SINTRON; etc.). In this case, merely a surface EMG with reduced mean-
ingfulness can be performed.
2. Electroneurography (ENG) is an examination of the nerve conduction. It is used on
peripheral nerves, i.e. not in the area of the brain and spinal cord. In this way, the ve-
locity at which a nerve forwards electrical signals (nerve conduction velocity - NCV) can
be determined. Furthermore, it measures how effectively an electrical nerve stimulus is
transferred to the corresponding muscle (neuromuscular conduction).
3. Evoked potentials represent a neurological examination method which can be used
to test the conductivity and thus the function of nerve tracts. The principle of this
method is based on a stimulation of a sensory organ or a peripheral nerve and the
monitoring of the triggered electrical potential in the processing regions of the central
nervous system.
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4. The MEP examination (which requires an optional magnetic stimulator not included
in the NEUROWERK EMG) uses the transcranial or spinal magnetic stimulation to assess
proximal sections of the neuromuscular system.
Contraindication is to be noted for persons with cardiac pacemakers or intracranial fer-
romagnetic materials, and for patients suffering from epilepsy.
A.2 Warnings and notes

Always ensure that electrode cables or other accessories are never able to come into
contact with parts carrying mains power!
Never use both the shockproof DIN input socket connectors and the large DIN circular
connectors of a channel simultaneously to carry out measurements. This could lead to
incorrect measurements due to external faults, or to an endangering of the patient
through accidental contact of the unused electrodes with live parts. Remove also the
electrodes of an input channel which is not being used.
Stimulation currents greater than 2 mA r.m.s. per cm2 demand special attention on the
part of the user.
Never carry out an electrode impedance test when you are using needle electrodes to
trace signals!
Never use the needle electrodes for electrical stimulation!
Electrical stimulation on patients with an implanted electronic device, e.g. a cardiac
pacemaker, is only permitted after prior consultation with a specialist!
In individual cases, the use of visual stimuli (flash, pattern reversal) may bring on epi-
leptic seizures!
All accidental contact between the patient and system parts not immediately intended
for the measurement on the patient must be carefully avoided. The same applies to
the possible contact of such system parts with other conductive parts, including the PE
conductor.
Before commissioning the system and starting work, be sure to have read the User
Manual carefully, and here in particular the sections on safety precautions.
A.3 Electrical safety

The industrial association Verband Deutscher Elektrotechniker e.V. (VDE) has published
special standards serving to ensure the safety of the patient and operating staff in
connection with electromedical devices and rooms used for medical purposes. These
standards are summarised briefly here. For detailed information, please refer to the
original VDE standards.
All equipment is assigned to a so-called "protection class".
The NEUROWERK EMG system is assigned to Protection Class I in accordance with IEC
601-1. Protection Class I covers all devices and equipment whose exposed metallic
housing parts, which could be subject to a dangerous voltage in case of a fault, are
connected to the PE conductor of the mains supply system via an earthing contact. In
case of an insulation fault, the upstream fuse element is tripped.
The NEUROWERK EMG system must thus only be used when plugged into an earthed
socket with the supplied mains power cable. Connect the mains power cable correctly
and check that the frequency and voltage comply with the technical specifications.
NEUROWERK EMG A
Introduction Page 9
Due to the increased safety requirements applicable, the NEUROWERK EMG system
must not be connected via an extension cable or multi-socket distribution unit.
The device earthing is provided by the PE conductor of the mains cable.
A.4 Safety notes on the EMC regulations

NEUROWERK EMG systems place particular demands on the rooms in which they are
installed with regard to interference sources. Electromagnetic environments exceed-
ing the limit values can interfere with the operation of the system in such a serious
way, that partial or total function failure may result. Frequently occurring interference
sources are:
› Nearby radio or mobile communication stations
› Mobile telephones
› High-frequency interference from other equipment
› Effects of direct or indirect electrostatic discharge
Locate the cause of the interference and eliminate it, if possible.
If you cannot eliminate the interference cause, install the equipment at a different
place. You should always ensure that interference sources, such as mobile telephones,
are not brought into the vicinity of the device. If you cannot rectify the problem, please
consult your service company.
For further information and notes on the EMC guidelines with notes, please refer to
Annex H.
A.5 Safety notes on the electrical stimulator

Use of the equipment for purposes other than the intended purpose invalidates all
warranty claims against the manufacturer. It is the responsibility of the user to set the
applied currents such that no damage or injury is caused.
Patients with implanted electrical devices (e.g. cardiac pacemaker) should not be sub-
jected to electrical stimulation before having obtained the medical advice of a corre-
sponding specialist. Stimulation through the thorax is always to be avoided. If a pa-
tient is at the same time connected to a high-frequency surgical device, this may result
in burns under the stimulation electrodes. Use in the vicinity (e.g. within 1 metre) of a
short-wave or microwave therapy device may lead to fluctuation of the current output
values.
Use only original accessories listed in the accessories catalogue of SIGMA Medizin-
Technik.
The equipment must not be used for stimulation on the open heart. It is furthermore
not suitable for use in ophthalmology, dentistry and on individual exposed nerves, as
the stimulation current may exceed 10 mA.
The power supply of the electrical stimulator is switched on via the mains switch on
the isolating transformer. Never turn on the mains switch if the patient is connected to
the stimulator.
Effective current densities greater than 2 mA/cm² demand that particular attention be
paid to all electrode surfaces. Keep contact resistances to a minimum to avoid the pos-
sibility of local burns, e.g. in case of dry skin.
A NEUROWERK EMG
Page 10 Introduction
A.6 Further safety notes

Never use the needle electrodes for electrical stimulation!
In individual cases, the use of visual stimuli (flash, pattern reversal) may bring on epi-
leptic seizures!
Never carry out an electrode impedance test when you are using needle electrodes to
trace signals!
A.7 CE marking
SIGMA Medizin-Technik maintains a certified quality management system compliant
with the European standards EN ISO 9001 and EN ISO 13485 to monitor the whole life
cycle of the equipment it develops and manufactures. With our quality control proce-
dures, we are able to guarantee application of the fundamental standards defined in
the European directives, a maximum level of safety for the patients and users of the
equipment, and the optimum serviceability of our equipment.
The equipment meets the specifications of Hazard Class IIa (directive 93/42/EEC, Annex
IX).
A.8 Equipotential bonding

The NEUROWERK EMG system is provided with a connection fixture which enables the
isolating transformer to be connected to the equipotential bonding busbar of the
room by way of the supplied equipotential bonding cable.
Due to the increased safety requirements applicable, medical equipment must not be
connected via an extension cable or multi-socket distribution unit. The connection
must always be made directly to a wall socket.
A.8.1 Place of installation

Do not install or store the equipment in rooms where it may be subjected to humidity,
extreme atmospheric pressure or extreme temperatures, or where chemicals are
stored.
The measuring system is not designed for use in potentially explosive areas or com-
bustion-accelerating atmospheres.
The equipment must not be installed in the vicinity of transformers with a high con-
nected load, motors or x-ray equipment. The arising electrical and magnetic fields will
falsify the measurement results and may even make measurement impossible. The vi-
cinity of power cables should thus also be avoided.
When moved from a cold location to room temperature, the measuring system may
become damp due to condensation. In this case, it is imperative to wait until the de-
vice is fully dry again.
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Introduction Page 11
Operating temperature: 15°C to 40°C

Storage temperature: -20°C to 60°C
Relative humidity: 20% to 80%, non-condensing
The equipment should be placed on an even surface. Vibration should be avoided dur-
ing transport and operation.
A.8.2 Combination with other equipment

Make sure that the electrical isolation of the patient is not bridged in any way. Under
no circumstances must the electrode input box be connected to any other electrical
devices.
Devices or equipment which are not part of the NEUROWERK EMG system may only be
installed after prior consultation with your SIGMA Medizin-Technik dealer. If you in-
tend to modify the NEUROWERK EMG system configuration or add further devices or
equipment, then it is imperative to observe the relevant requirements set forth in the
Medical Devices Directives (MDD) 93/42 EEC, the German Medical Products Act (MPG)
of 2nd August 1994, and the European standard EN 60601-1-1. If the external devices
or equipment are also to be connected to the power supply unit of the NEUROWERK
EMG system, then it is especially important to observe also the maximum permissible
power consumption.
A.8.3 Using a defibrillator

The equipment is not protected against the discharge of a defibrillator. Remove all
electrodes from the patient before using a defibrillator.
A.8.4 Using high-frequency surgical devices

Before using a high-frequency medical device, an electrosurgical knife or a defibrilla-
tor, the electrodes should be disconnected from the electrode input box in order not
to endanger the patient and to avoid damage to the device.
A.9 Conditions for proper use
A.9.1 Before getting started

Before connecting the equipment to the mains power supply, check that the local
mains voltage and mains frequency comply with the permissible values specified on
the rating plate.
Do not connect the equipment if there is any deviation.
Make sure that the equipment is in a proper and safe condition.
Perform a full visual check of the mains connecting cables before use.
Check all cables, and in particular the connections to the patient.
Damaged cables or connectors must be replaced immediately by the service depart-
ment of SIGMA Medizin-Technik, an authorised technician or another properly quali-
fied person.
A NEUROWERK EMG
A.9.2 When working with the equipment

Switch off the equipment or remove the electrodes whenever this is deemed neces-
sary in the interest of the patient's safety.
Do not touch the electrodes when tracing. Make sure that neither the electrodes, nor
the patient come into contact with conductive parts.
Monitor the patient and the equipment during the entire tracing process.
A.9.3 After finishing work

Return all adjustments to their standard settings. Switch off the equipment. Clean all
accessories so that they are available immediately when you want to start work again.
A.9.4 Inspection and maintenance

Maintenance and repair work on the equipment must be entrusted to properly quali-
fied persons.
In case of any defect, a clearly visible note must be attached to ensure that the equip-
ment is not used inadvertently.
The equipment must not be changed or modified in any way.
The electrical safety of the equipment and its parts must be checked regularly every 12
months, as set forth in the German regulations on the installation, operation and use
of medical devices (Ordinance on the Operation of Medical Devices - MPBetreibV)
dated 29th July 1998.
If the device has been stored without use for a longer time, it should be checked care-
fully before starting work again.
A.9.5 Hygiene and care of the equipment

Mains-operated equipment must always be disconnected at the supply socket before
cleaning or disinfecting.
The components of the NEUROWERK EMG system are classified with degree of protec-
tion [IPx0] with regard to the penetration of moisture and water. This means that they
must be cleaned with a lightly dampened, non-linting cloth (never wet or dripping).
Use only mild, alcohol-based liquids for disinfection.
When cleaning, it is imperative to ensure that no moisture is allowed to penetrate into
the insides of the equipment.
To avoid all risk of mix-ups, chemicals used with or for care of the equipment must
only be kept and prepared in their intended containers.
For further information on hygienic handling of the electrodes, and in particular those
of the electrical stimulator, please refer to the information sheets enclosed with the
electrodes.
A.9.6 Cleaning and sterilisation of electrodes

Do not clean the electrode cables with alcohol as the cable surface will otherwise be-
come hard. If sterilisation is necessary to prevent infections, use a gas steriliser.
Clean the electrodes with neutral soap and rinse the soap off thoroughly with water.
After cleaning, dry the electrodes carefully to prevent oxidation of the metal parts.
Store the cleaned electrodes in a dry clean place.
NEUROWERK EMG A
Damaged electrode cables cannot be repaired. Use a multimeter to check any cable
thought to be defective. If the measurement shows that the cable is indeed damaged,
provide for proper disposal of the electrode and replace it with a new one.
Reusable EMG needle electrodes

Remove the electrode from the connecting cable after use and clean with alcohol. In-
sert the needle carefully into the protective cap. Make sure that the tip of the needle
does not touch the protective cap. The needle tip will then stay sharp for much longer.
Sterilise the electrode in an autoclave.
Clean the connecting cable and sterilise it in a gas steriliser.
Sterilisation in autoclaves (for concentric needle electrodes)
o Temperature: 121°C
o Pressure: 1 bar
o Duration: 20 minutes
Sterilisation in gas steriliser (for EMG needle electrodes/connecting cables)
o Gas: Ethylene oxide gas
o Duration: 30 minutes with 100% ethylene oxide gas
or 60 minutes with 50% ethylene oxide gas
or 120 minutes with 25% ethylene oxide gas
L
CAUTION:
EMG needle electrodes must always be sterilised before use (also before
their first use), in order to eliminate the risk of infections with hepatitis or
HIV. Cold sterilisation with chemical means is not sufficient.
NCV/EP surface electrodes

After use, clean the electrode carefully under running water. Use a small brush
(toothbrush) for cleaning. Make sure that no paste is left behind on the electrodes.
Dried paste is very difficult to remove later. Subsequently dry the electrode carefully.
Do not use alcohol for cleaning as the cable surface will otherwise become brittle over
time. If necessary, surface electrodes can be sterilised in a gas steriliser in the same way
as the EMG connecting cables.
CAUTION:
L Pulling or bending may damage the cable. If a cable break is suspected,

check the continuity of the electrode by joining the electrode to be checked
and a second, intact electrode at their conductive surfaces with electrode
paste and then connecting the electrode cables to the "+" or "-" socket of a
selected channel of the electrode input box. Select a sensitive examination
program (e.g. AEP) and then checking the graph displayed when the "Moni-
tor" button is selected. If a flat zero line is displayed, then the electrode is in
order; if strong artefacts are to be seen over the whole height of the screen,
however, the cable is damaged.
Alternatively, the continuity of individual electrodes can also be checked us-
ing a multimeter.
Defective electrodes and damaged cables cannot be repaired and must thus
be replaced with new ones.
A NEUROWERK EMG
Earth electrode
Clean the earth electrode with water after use and allow it to dry to avoid oxidation of
the metal parts.
Stimulation electrodes
Remove the felts from the stimulation electrodes and leave them to dry. Clean the
mounting holes for the stimulation electrodes with a cotton bud.
Finger electrode
Rinse the loops under running water. Subsequently dry the electrode carefully with a
cloth.
A.9.7 General notes

This User Manual has been compiled in accordance with the valid laws and regulations
of the Federal Republic of Germany. In other countries, the valid laws and regulations
of the country concerned must be observed.
The software is protected by copyright and may only be used as set forth in the terms
and conditions of the License Agreement.
SIGMA Medizin-Technik and our authorised dealers and service agents will only as-
sume responsibility for the measuring system if:
› all installation, expansion, calibration, modification or repair work has been carried out
by SIGMA Medizin-Technik or appropriately authorised dealers
› the measuring system has only been used by instructed persons and in accordance
with the User Manual
› the place of installation complies with the specified ambient conditions for the
equipment.
All liability, guarantee and warranty claims for the whole system become null and void
in case of independent modifications to the system settings of the processor, connec-
tion of any peripherals from other manufacturers or the installation of any external
software. SIGMA Medizin-Technik vouches only for original NEUROWERK EMG installa-
tions on the supplied operating system.
A virus scan was carried out on the measuring system within the framework of final
testing.
A.9.8 Environmental protection

There may be regulations under public law which contain special provisions concern-
ing the disposal of this product. Contact your SIGMA Medizin-Technik dealer if you in-
tend to take the equipment out of service permanently.
The user must observe all applicable local regulations concerning disposal of the
NEUROWERK EMG system. The same applies to the disposal of any accessories and
consumables.
NEUROWERK EMG A
A.9.9 Symbols used and their meaning
Symbol Description
NOTE: Observe the accompanying documents
Type BF applied part
CAUTION: Hazardous voltage!
Connection for LED goggles
Connection for headphones
Connection for PC network
Connection for VEP monitor
Connection for foot switch
Connection for amplifier
Central unit status display
Stimulator 1 status display
Stimulator 2 status display
Connection for active electrode
Connection for reference electrode
Connection for earth electrode
Connection for bus cable, channel 1

A NEUROWERK EMG
Connection for trigger input
Connection for trigger output

NEUROWERK EMG B
General handling Page 17
B Design and Installation
B.1 Hardware
The NEUROWERK EMG system comprises essentially the following components:
o Personal computer or laptop (option)
- CPU: Intel processor
- ≥512 MB RAM
- Hard disk > 80 GB
- DVD-RW drive
- 2 PCI slots
- Graphics adapter: max. 1,280 x 1,024 pixels
- Software: Windows XP Professional SP2
- TFT monitor, mouse, keyboard
- Safety isolating transformer
- Power supply: 230 V / 50 - 60 Hz, connected load max. 400 W
o Central unit with stimulators
o 2-channel, optionally 4-channel, AC amplifier
o Instrument trolley with support arm for amplifier (optional)
o EMG monitor speakers
o AEP headphones (EMG/NCV/EP system only)
o VEP monitor (EMG/NCV/EP system only)
o Remote control unit (optional)
o Inkjet printer (optional)
o NEUROWERK EMG software
o Electrode starter kit: EMG, NCV and EP electrodes as per SIGMA Medizin-
Technik accessories catalogue
o GDT interface, linking to surgery EDP (optional)
The conductive link-up to the NEUROWERK EMG system is to be entrusted exclusively
to the SIGMA Medizin-Technik service department or a person authorised by the ser-
vice department, observing the requirements of IEC 601-1-1.
B.1.1 Technical description

NEUROWERK EMG is intended for the PC-based measurement of evoked potentials
and nerve conduction velocity (NCV), and for electromyography. The measurement
covers somatosensorically evoked potentials (SEP), acoustically evoked potentials
(AEP) or visually evoked potentials (VEP). All stimuli are generated by way of corre-
sponding modules in the central unit. The stimuli are triggered via a trigger signal. This
can be controlled either from the PC, an external trigger generator, or the trigger gen-
B NEUROWERK EMG
Page 18 General handling
erator in the central unit. The traced EP signals are amplified accordingly in the elec-
trode input box, filtered, digitised, and issued to the PC software via the central unit.
The system is operated via the PC software.
B.1.1.1 Description of the central unit
The central unit comprises the pattern, goggle and headphone stimulators, and the
electrical stimulator.
The central unit communicates with the PC via a data line (network). This line transfers
bidirectional data for the settings of the stimulator (central unit) and the amplifier
(electrode input box), checkback messages to the PC, and the actual measured data
(evoked potentials measured using the electrode input box).
The central unit transmits control signals to the electrode input box via a serial inter-
face.
LEDs in the central unit indicate the following states:
LEDs in the Central Unit
Green LED Stimulator 1 Stimulator 2

(yellow) (yellow)
Is lit Is lit Is lit Power with reset
Flashing Flashing Flashing Reboot
Is lit OFF OFF Booted, but not con-

nected
Is lit OFF OFF Connected to the PC

(program)
A foot-switch connection is provided for remote-controlling the PC software. To this

end, a message is sent to the PC.
Electrical stimulator
This module generates the stimulation current for the electrical stimulator. The mod-
ule can be activated or deactivated. Furthermore, it is possible to activate or deactivate
the 400 V generation separately. The polarity can be inverted. The current can be set
between 0mA and 100mA in 25µA steps. If this current is not reached at the stimula-
tion electrode, the module issues a checkback message. This is the case if 100mA is set
for electrode impedances of >4kΩ. If the current is only halved, the critical electrode
impedance is doubled.
Goggle module
This module generates the stimuli for the visual stimulator (flash goggles). The module
can be activated or deactivated.
Visual stimulator
NEUROWERK EMG B
The monitor displaying the chequered pattern is connected to this module. It is possi-
ble to display a chequered pattern, horizontal and vertical lines. Furthermore, user-
defined fixation points (images) can be displayed, and it is possible to move the posi-
tion of the fixation point. The chequered pattern may consist of 4, 8, 16, 32, 64 or 128
fields. In addition to 0% (black screen), three contrast values (33%, 67% and 100%) can
be set.
Acoustic stimulator
The acoustic stimulator can output stimulus volumes of 0..125dBSPL or up to 100dBHL.
The masking of the contralateral ear is achieved by way of a white noise at a volume
below the stimulus volume. The volume is set in the trigger matrix in 0.375dB. The
stimulus types are "click" (positive stimulus, condensation), "clack" (negative stimulus,
rarefaction), alternating, random, tones (which are defined by the user) or white noise
(for masking of the contralateral ear).
B NEUROWERK EMG
B.1.2 System components:
10
3
9
11
2
1
5
12
NEUROWERK EMG B
Design
Legend Designation Description

1 Trolley (optional accessory) For the equipment components
2 Keyboard For inputs to control the equipment
3 Mouse To control important equipment functions
4 PC Central control system
5 Power supply Electrically isolated power supply
6 Foot switch To control important equipment functions
7 Printer (optional accessory) To print the recorded measurement results
8 Electrode input box To connect the electrodes to the equip-

ment
9 Stimulator box The electrical and acoustic stimulators
10 EMG monitor speaker Audio output for measurement signals

(EMG)
11 Basket To store the headphones
12 Foot switch holder To hold the foot switch during transport
- VEP monitor 19" monitor to display the stimulation pat-

terns for VEP.
B NEUROWERK EMG
B.1.3 Connections on the electrode input box

4-channel system:
1 2
3 4 5 6
7
NEUROWERK EMG B
Connectors

1 Channel number The assigned channel
2 DIN socket To connect electrodes with DIN circular

connector (EMG needle holder, finger elec-
trode for tracing)
3 Electrode input for the ac- "-" connection for electrodes with DIN con-
tive electrode nectors
If this input is used, then the electrode
cable must be removed from socket 2.
4 Electrode input for the ref- "+" connection for electrodes with DIN
erence electrode connectors
If this input is used, then the electrode
cable must be removed from socket 2.
5 Status LED Status indicator for the input socket
6 Electrode socket for the Connection for earth electrode

earth electrode
Note: The 3 inputs are connected internally
7 Cable connector Connection between amplifier and central

unit
B.1.4 Connector panel on the central unit
1 2 3
Connectors

1 Ready LED flashes when the central unit is
switched on
B NEUROWERK EMG
LED lights steady once the system has been

initialised via the software
2 STIM1 LED lights up on stimulation with

Stimulator 1
LED lights steady when the set current
cannot be passed to the skin via the stimu-
lation electrode (e.g. stimulation electrode
defective)
3 STIM2 LED lights up on stimulation with

Stimulator 2
LED lights steady when the set current
cannot be passed to the skin via the stimu-
lation electrode (e.g. stimulation electrode
defective)
ON
Connectors

1 On/Off On/Off switch of the central unit
NEUROWERK EMG B
1 2 3 4
Connectors

1 Electrical Stimulator 1 For connection of the electrical stimulator
2 Electrical Stimulator 2 For connection of the electrical stimulator
3 LED goggles For connection of the LED goggles (op-

tional)
4 Headphones For connection of the acoustic stimulator

(headphones)*
B NEUROWERK EMG
1 2 3 4 5 6 8 10
7 9
Connectors

1 VEP monitor To connect the visual stimulator
2 Amplifier To connect the central unit to the electrode

input box
3 Foot switch To connect a foot switch, e.g. to trigger a

stimulation
4 PC connection To connect the central unit to the network

connector of the PC
5 Trig. 2 OUT Trigger output 2
6 Trig. 1 OUT Trigger output 1
7 Trig. 2 IN Trigger input 2
8 Trig. 1 IN Trigger input 1
9 Equipotential bonding To connect the equipotential bonding

cable
10 Power cable connector Mains power supply

NEUROWERK EMG B
B.1.5 Connections on the PC
1 2 3 4 5 6 7 9
Connectors

1 Power cable connector Power supply
2 Keyboard To connect the keyboard
3 VGA To connect the monitor
4 USB printer To connect the printer
5 USB mouse To connect the mouse
6 USB remote control To connect the remote control unit
7 USB sound To connect the speakers
8 Network connector Connection to the PC network
9 2nd network connector Connection to the central unit

B NEUROWERK EMG
B.1.6 Remote control
"Analysis"
mode
Stop
Trigger
Next parameter / Next parameter /

CursorLeft CursorRight
Outer wheel: Next sequence

Direction of rotation CW Next sequence
Inner wheel: Change parameter/cursor position

Direction of rotation CW Increase value
Direction of rotation CCW Reduce value
NEUROWERK EMG B
B.2 Installation
B.2.1 Place of installation

When recording small potentials (0.5 to 10 µV, e.g. with evoked potentials), a shielded
room is recommended in order to ensure constant external measurement conditions.
If this is not possible, install the equipment in a place meeting the following condi-
tions:
o There should be no X-ray systems or other high-energy devices in the vicinity
of the equipment.
o The room should be protected against vibration and against excessive noise.
To reduce magnetic or AC interference as far as possible, position the examination bed
or chair such that the patient is as far away as possible from mains cables and other
devices or equipment. The equipment itself and any other devices or equipment in the
room should be installed such that the interference radiation emitted from the moni-
tors of the other devices or equipment is kept to a minimum.
CAUTION:
L Electrically adjustable beds and heated blankets, if used by the patient,

should be disconnected from the mains power supply during the measure-
ment (remove the plug from the supply socket!)
Before using a high-frequency medical device, an electrosurgical knife or a
defibrillator, the electrodes must be disconnected from the electrode input
box in order not to endanger the patient and to avoid damage to the device.
B.2.2 Mains power connection and equipotential bonding

Connect the mains cable of the power supply unit to a properly installed earthed
socket outlet. The individual system components, such as PC, associated monitors,
EMG monitor speakers and printer are connected via the power cables brought out
from the interior of the power supply unit. The power supply unit contains an isolating
transformer providing for electrical isolation of the operating voltage from the electri-
cal installations of the building. The system should therefore not be operated without
the power supply unit included in the scope of supply. The three-core mains cable
with earth-contact connector automatically provides for safe earthing.
Do not connect any devices not included in the scope of the system to the outlet
socket strip of the power supply unit! Contact your specialist dealer if you wish to con-
nect other devices or equipment to the NEUROWERK EMG system.
The NEUROWERK EMG system is provided with a connection fixture which enables the
isolating transformer to be connected to the equipotential bonding busbar of the
room by way of the supplied equipotential bonding cable.
B NEUROWERK EMG
L
CAUTION:
Never use the gas or water piping for equipotential bonding. Always con-
nect the cable to the proper equipotential bonding connection.
B.2.3 Connecting electrodes and peripherals

Connect the tracing electrodes at the corresponding sockets of the electrode input
box.
The stimulation electrode is connected at stimulator output socket 1 on the right-hand
side of the central unit. If the optional second stimulator is also to be used, it is con-
nected correspondingly at stimulator output socket 2. The headphones are connected
at the headphones socket on the right-hand side of the central unit. The output socket
for the optional goggles is similarly to be found on the right-hand side of the central
unit.
The rear of the central unit provides connectors for the VEP stimulation monitor, the
amplifier box, the foot switch and the external trigger inputs and outputs. The LAN
socket for connection of the data and control lines to the PC is also to be found on the
rear of the central unit.
The EMG monitor speakers are connected to the sound card output of the PC.
B.2.4 Switching on the equipment

Make sure that the electrode input box, central unit and any other peripherals, such as
monitors, printer and possible external stimulators, as well as all mains cables, are
connected correctly.
To switch on the equipment, use the mains switch on the front side of the power sup-
ply unit. Note that certain peripherals, such as monitors and printers, may have to be
switched on separately.
The program is loaded from the built-in hard disk and the three LEDs on the front of
the central unit show that the system is being initialised. Initialisation is also indicated
by a corresponding message on the monitor. Once the complete program has been
loaded, the system is ready for use.
B.2.5 Switching off the equipment

End all examinations, save the data, if necessary, and shut down the computer in the
proper manner. If the system is simply switched off while running, this may result in
the loss of data.
Once the operating system has shut down, the PC switches itself off automatically. You
can now turn off the main switch on the power supply unit to disconnect all the com-
ponents of the NEUROWERK EMG system from the mains power.
If the PC is switched off inadvertently before the operating system has shut down, or if
the operating voltage is interrupted by a mains power failure, a backup/restore pro-
gram will be initiated automatically after restarting the computer in order to rectify
any errors. This process, however, requires considerable time and does not provide a
guarantee that all errors can be rectified completely in every case.
NEUROWERK EMG D
Electrodes and Accessories Page 31
C Software Installation
This chapter describes the initial installation of the NEUROWERK EMG software on a PC.
This installation is only necessary if the system is supplied without a PC (system kit).
If the system is supplied together with a PC, the NEUROWERK EMG software is already
installed.
C.1 Installation of the NEUROWERK EMG software

To be able to install the NEUROWERK EMG software, the operating system Windows XP
Professional must already be installed on the PC.
Insert the supplied NEUROWERK EEG set-up CD into the CD or DVD drive of your PC.
Copy the "Neurowerk" folder from the CD to drive C:\ .
Create drive S:\ (by mapping a network drive from the server or a 2nd partition).
Copy the "Pro_Data" folder from the CD to drive S:\
Install the operating data acquisition module (BDE).
Start the set-up program under C:\Neurowerk\Neurowerkcenter\Tools\BDEENU\.
If you have any questions regarding the settings of the BDE module, do not hesitate to
contact SIGMA Medizin-Technik
D NEUROWERK EMG
Page 32 Electrodes and Accessories
D Electrodes and Accessories

Use exclusively genuine accessories from SIGMA Medizin-Technik. Use the accessories
only as specified! Observe the notes provided by the accessory manufacturer, as well
as all notes regarding care and sterilisation given in this chapter "Electrodes and Ac-
cessories".
D.1 (EMG) needle electrodes

Connecting and applying needle electrodes
1) Use alcohol or another appropriate disinfectant to clean the patient's skin.
2) Take the sterile electrode in its protective sheathing and insert the electrode
into the socket of electrode connection cable.
3) Remove the protective sheathing.
4) The electrode can now be applied. The electrode should pierce the skin with a
single push.
5) Use the program as instructed.
L CAUTION:
Never perform impedance measurements with the needle electrodes in use!
After use, remove the electrode from the connection cable and clean it carefully with
alcohol or a medical cleansing solution, e.g. to prevent blood drying on the electrode.
Then slide the protective sheathing over the electrode again.
D.2 (NCV/EP) surface electrodes

Affixing the surface electrodes
1) Clean the skin in the area in which the electrode is to be affixed using an abra-
sive cleansing paste.
2) Apply a little electrode paste to the surface electrode and press the electrode
onto the skin with gentle pressure.
3) Cover the electrode with gauze and press this down gently. In areas without
body hair, it is recommended to fix the electrode additionally with a medical
adhesive tape.
4) Connect the electrode cables to the electrode input box or to the supplied bus
cable.
5) To interconnect input sockets for certain required configurations (e.g. com-
mon reference potential), use the signal bridge cables.
6) Check the electrode impedance (see the section "Measuring the impedance".
7) After use, clean the electrode carefully under running water. Use a small brush
(toothbrush) for cleaning. For further information, please refer to the notes
provided by the accessory manufacturer.
NEUROWERK EMG D
Electrodes and Accessories Page 33
D.3 Earth electrode

Affixing the earth electrode:
1) Dampen the earth electrode with water.
2) Fix the electrode firmly to the appropriate extremity.
3) Connect the electrode cables to the electrode input box.
4) Clean the earth electrode with water after use and allow it to dry to avoid oxi-
dation of the metal parts.
D.4 Stimulation electrodes

Affixing and connecting motor nerve stimulation electrodes:
1) Soak the felts with physiological salt solution.
2) Connect the cable to the stimulator socket on the right-hand side of the stimu-
lator box.
3) Insert the soaked felts into the electrode.
The + mark on the electrode indicates the anode. The opposite pole, the cathode,
should be positioned over the nerve to be stimulated in the direction of the trace elec-
trode (exception: F response, where the opposite applies).
After use, the felts should be removed from the electrode to allow them to dry com-
pletely. Clean also the stimulation electrode under running water.
Affixing and connecting finger stimulation electrodes
1) Dampen the loops of the stimulation electrode to keep the contact resistance
as low as possible. Low stimulation electrode resistances help to reduce unde-
sirable stimulation artefacts.
2) Pull the widened loops over the fingers one by one. The black loop serves as
the active (minus) electrode. Make sure that the skin in the area between the
loops is not moistened with electrode gel, as this could otherwise produce a
parallel connection, i.e. the stimulation current will flow partially not through
the finger, but through the electrode gel. If necessary, wipe away any excess
electrode gel using a cloth.
3) If the electrode is to be used for stimulation (e.g. orthodromic sensory NCV),
connect the electrode to the stimulator socket on the right-hand side of the
central unit. If, on the other hand, you are using the electrode for tracing, con-
nect it to the input socket on the electrode input box (e.g. antidromic sensory
NCV).
4) After use, rinse the loops off under running water and dry the electrode with a
cloth.
D.5 Headphones
Headphones suitable for use with the NEUROWERK EMG system:
Type DT 48 200 Ohm
L Note: Only these headphones are to be used with the NEUROWERK EMG sys-
tem!
D NEUROWERK EMG
Page 34 Electrodes and Accessories
Putting on and connecting the headphones
1) Put the headphones on the patient such that the ear-pieces enclose the ears
completely.
2) Connect the headphones cable to the headphones socket on the right-hand
side of the central unit. Make sure that the left and right-hand ear-pieces of the
headphones sit on the correct ear. The headphones are marked with the let-
ters L for left and R for right.
Cleaning
If required, clean the headphones with a damp cloth. Do not use solvents.
D.6 VGA monitor for VEP stimulation

Connect the VGA cable of the monitor to the socket for the VEP stimulation monitor on
the rear side of the central unit and switch on via the separate mains switch (see the
section "Control elements and connector panels").
NEUROWERK EMG E
E General Handling of the System
E.1 Screen structure
E.1.1 General screen
Control
System designation Menu bar functions
Program version
On-line
Raw data parameters
window
Sequence
information
Trace window
Numerical
Cursor informa- results window
tion
Quick method
selection
Graphic results
display
Report window
E NEUROWERK EMG
E.1.2 Screen for EMG
Results table
Trace window
MU MUAP
Analysis
window
Selected MUAP
Selected MUAP
NEUROWERK EMG E
When evaluating, select When evaluating, select Open notebook to descri-

the examined muscle "spontaneous", "voluntary" be EMGs
or "maximal innervation"
E NEUROWERK EMG
E.1.3 Individual elements of the main screen
E.1.3.1 Menu bar
The buttons can be selected either by clicking with the mouse or by way of the func-
tion keys on the PC keyboard.
Patient
selection Method
selection
Help menu
Patient Method
display display
Create a trace
report
Quit the
NEUROWERK EMG
program
E.1.3.2 Control functions
The buttons can be selected either by clicking with the mouse or by way of the func-
tion keys on the PC keyboard. For certain functions, it is also possible to use the op-
tional remote control unit or the foot switch. The use of the individual control ele-
ments is explained under the corresponding method descriptions.
Stimulation-
synchronous Print out the
display measure-
Save the ex- ments
amination
Raw data End the exami-

display nation Report
Preparation menu Averaging / Next measu-

sequential ring sequence
stimulation
NEUROWERK EMG E
E.1.3.3 On-line parameters
Here, you can select the stimulation mode. You can work with single stimuli or cyclic
stimulation, and can also set the pulse width for the stimulation.
The buttons can be selected either by clicking with the mouse, by using the cursor
keys of the PC keyboard, or by way of the optional remote control unit.
Using the mouse: Click on the parameter, move the mouse over the parameter box
and change the parameter value with the aid of the up and down hand symbols.
The sensitivity and time basis can be modified simultaneously for all tracks by pressing
the [SHIFT] key together with the left mouse button.
Using the cursor keys: Select the parameter with the Right/Left Arrow keys, and then
change the parameter value with the Up/Down Arrow keys.
Using the remote control unit: Select the parameter with the outer wheel, and then
change the parameter value with the left/right handwheel.
On-line parameters for electrical stimulation
Time resolution
(per division) Single stimulus /
cyclic stimulation
Stimulation pulse
Amplitude resolu- width (electrical
tion (per division) stimulation only)
Number of avera-
ged/discarded
sequences
Distance specifica- Stimulation
tion (only for NCV) intensity
On-line parameters for acoustic stimulation
Sound pressure,
Sound pressure,
right ear
left ear
E NEUROWERK EMG
On-line parameters for visual stimulation
Single stimulus /
cyclic stimulation
Sequence information
After clicking on the trace point (A), stimulation point (R) or additional information (Z),
it is possible to change the corresponding entries.
Trace point Stimulation point Additional infor-

mation on stimula-
tion point
Moving curves
Position the mouse pointer on the currently active curve such that the mouse arrow is
displayed as a vertical double arrow. The curve can be moved up and down by press-
ing and holding down the left mouse button.
Keyboard assignments
Key Assignment Key Assignment

F1 Help Esc Stop
F2 Patient management Arrow Right/Left Parameter or cursor selec-

tion
F3 Method selection Arrow Up/Down Change value
F4 Preparation A Enter trace point
F5 Monitor mode R Enter stimulation point
F6 Trigger mode Z Enter additional text
F7 Analysis S Save
NEUROWERK EMG E
F8 Stop Tab Next sequence
F9 Create report N Next sequence
F10 Print Pos 1 Display 1 or 2 trace win-

dows
F11 Setup Space Sound on/off
F12 Exit (quit EMG software) Ins Inserts an additional se-

quence
[ALT]+F10 Summary Report Del Deletes the currently

active sequence
Keys Smooth curves

1- 0 1 = non-smoothed;
10 = smoothed 10-fold
Patient database
The patient database window is used to select a patient for an examination
or to open an existing examination for a particular patient.
The patient database is displayed automatically when the program is started.
If the display presently shows the main screen in which examinations are performed,
the patient database can be called with:
Patient database
Mouse Keyboard
"F2"
E NEUROWERK EMG
Creating a new patient
New patient
New patient
Mouse Keyboard
Enter the patient data

NEUROWERK EMG E
Saving the patient data
Saving the patient data
Mouse Keyboard
Searching for an existing patient

To search for an existing patient in the patient database, enter the surname of the pa-
tient in the first field of the database. Already when you enter the first letter, the
marker will jump to the patients whose names begin with this letter.
Once the desired patient is highlighted in the list, you can perform new examinations
for this patient.
Performing a new examination
New examination
Mouse Keyboard
F3
The method selection window is displayed automatically (see the section "Method se-
lection")
Loading a saved examination

If the selected patient is highlighted in the patient list, you can switch the right-hand
screen side from "Method selection" to "Evaluation" using the key "Evaluation F6".
Loading a saved examination
Mouse Keyboard
F6
The saved examinations of this patient are listed on the right-hand side of the screen.
Click on an entry in the list to display the corresponding measurement.

E NEUROWERK EMG
E.2 Method selection

The method selection window lists all the examination programs which are supplied
together with the system. The programs are grouped according to methods. Examina-
tion programs created by the user are displayed with a grey background.
The method selection window is displayed if you select a patient and then select the
"Method F3" button in the patient database window.
First select the required method.
Method selection
Mouse Keyboard
"F3"
The method selection window is displayed automatically if you select a patient and
then select the "TRACE" button in the patient database window.
First select the required method.
NEUROWERK EMG E
Selecting a method
Mouse Keyboard
Click on the "plus" sign in Arrow Right
front of the method
then
Arrow Up/Down
or
first letter
then
Arrow Right and Arrow
Up/Down
Now select one of the listed examination definitions.
Selecting an examination definition
Mouse Keyboard
Double-click on the examina- Arrow Right
tion definition
then
Arrow Up/Down
or
first letter
then
Arrow Right and
Arrow Up/Down
Confirm the selection with
Enter
Once the examination program has been selected, the actual starting of the program
will vary according to the current configuration (see the section "Examination pro-
grams").
E.3 Preparation
Optionally, you can choose to precede an examination sequence with a number of
preparation steps (see the section "Setup").
Possible settings which can be made under "Preparation", depending on the selected
examination, are:
1. Trace point and additional text: Choose a name from the list or else enter a new
text of your own. You can add remarks as information on the particular sequence.
2. Stimulation point: Choose a name from the list or else enter a new text of your
own.
3. Impedance measurement: An impedance measurement is performed automati-
cally for the active channels of the examination sequence. The results are dis-
E NEUROWERK EMG
played as a colour-coding and as a measured value. Press START to commence

measurement and STOP to end the measurement.
4. Hearing threshold: For examinations with acoustic click stimulation, you can de-
termine the patient's hearing threshold (see the section "AEP")
5. Electrode map: To assist with the placing of electrodes,
You can move from step to step through the preparation with:
Preparation
Mouse Keyboard Foot switch

"NEXT" or "BACK" ENTER Brief tap
(next step only) (next step only)
E.4 Monitor
In monitor mode, the quality of the incoming signal can be assessed before starting
the measurement.
E.5 Trigger
The trigger mode serves to display stimulation-triggered signals. Measurements, e.g.
motor neurography, can be performed with either single stimuli or cyclic stimulation.
This mode is also used to determine the current strength and the position of the
stimulation electrode for measurements involving an averager or cascaded display.
E.6 Analysis
This mode is used to display the signals as appropriate for the selected examination
(e.g. averaging, cascaded display).
E.7 Inserting/removing sequences

Use the Ins/Del keys to remove the currently active sequence (displayed yellow) or to
insert an additional sequence.
Inserting a sequence
Mouse Keyboard
-- "Ins"
Removing a sequence
Mouse Keyboard
-- "Del"
NEUROWERK EMG E
E.8 Printing measurement results

You can print out the results of an examination with:
Print

"F10" ---
A selection window is displayed. You can here define the information to be included in
the print-out.
Starts printing
Opens a preview
window
Cancels the prin-

ting process
Summarise measurements
for printing
Printing
Display Explanation
Traces as on screen Print-out with or without traces
Traces as displayed on the screen
Detail table Print-out with or without traces
Trace information Creates an additional table with

"Sensitivity/time base/trace text"
E NEUROWERK EMG
Analysis screen Table with the measurement results
Individual trace Only the trace displayed in yellow in the

trace window is printed
EMG notebook The EMG notebook is printed

EMG Table - Random Prints the results of a random innervation
Prints the results of a maximum innervation
EMG Table - Maximum
Report The report is also printed
A click with the left mouse button on Edit report opens the report you have created
for further editing.
The default setting is to print the traces, trace information and the screen analysis.
You can vary the contents of the print-out by clicking on the corresponding check
boxes with the left mouse button to activate/deactivate the options.
Clinic/practice header
Patient ID
Traces as on the
screen
Trace information
Analysis screen
E.8.1 Summary Report

A summary report is created as follows:
NEUROWERK EMG E
Creating a Summary Report

"F10" ---
A selection window is displayed.
Select "Summary Report".
Operator controls

"F8" ---
A selection window is displayed.

E NEUROWERK EMG
Displays all measurements of the

day.
Further selections can be specified

here.
Editing of a summary
report
Starts printing Opens a preview Cancels the

window printing pro-
When the selection window is opened, all measurements are selected.

You can modify the selection by clicking on the corresponding check boxes with the
left mouse button to activate/deactivate the options.
"EP Report" selects EP traces only.

"CTS Report" and "PNP Report" are areas which can be defined freely and set in the
"Setup".
If you remove the tick from the With curves checkbox, only the result tables are
printed.
Prints the summary report
Writing a report in the "Editor" window

You can use the "Edit report" button to enter a summary report if no WORD for
WINDOWS is installed on your system.
The preview of the summary report is then possible using WORD Viewer.
Writing a report in WORD for WINDOWS

(Option: not included in the standard scope of supply)
If the "Report" field is selected in the "Summary Report" selection window, you can en-
ter a summary report with a double-click at the end of the summary report.
NEUROWERK EMG E
->
Subsequently, the report can be printed from "Word".
Existing summary reports can be called directly from the NEUROWERK CENTER data-
base.
A new summary report is created each time the "Print"/"Summary" function is used. In
this way, it is also possible to create several different versions of the summary report
(e.g. with and without curves, different examinations) from the examinations of a pa-
tient.
E.9 Current stimulator
L
Note: If the contact resistance at the stimulation electrode is too high, the
yellow lamp STIM1 or STIM2 on the central unit will light permanently in the
case of electrical stimulation and, in addition, the
symbol is displayed on the screen in the title bar. This may have the follow-
ing reasons:
- the stimulation electrode is not connected to the patient;
- the transition resistance from the stimulation electrode to the skin is too
high;
- the stimulation electrode is defective (cable broken), and a stimulus is trig-
gered.
E.10 Temperature sensor

If a temperature sensor (available as an option) is connected, the temperature is ac-
cepted automatically during the measurement.
NEUROWERK EMG F
Method selection Page 53
F Examination programs
F.1 NCV – Nerve Conduction Velocity
F.1.1 Motor NCV

This examination program is preconfigured to record the motor action potential fol-
lowing electrical stimulation at a distal and a proximal stimulation point, and to calcu-
late the nerve conduction velocity (NCV) for two nerves (e.g. left and right N. me-
dianus).
Patient selection
The patient selection window is displayed automatically when the program is started.
Otherwise, you can switch to patient selection with:
Patient selection
Mouse Keyboard
"F2"
F NEUROWERK EMG
Page 54 Method selection
After you have selected a patient (see Section B "Patient Database"), activate the
method selection if it is still hidden.
Method selection
Mouse Keyboard
"F3"
Selecting a method
The method selection window is displayed. Here, you must first select the required
method.
Method selection
Mouse Keyboard
front of the method
then
Arrow Up/Down
or
first letter
then
Up/Down
Examination definition
Mouse Keyboard
Double-click on the examina- Arrow Up/Down
tion definition
or
Motor
first letter
then ENTER
NEUROWERK EMG F
Preparation
The first examination sequence starts with the "Preparation" function.
This offers you the following possibilities:
a. Selection of the trace point (muscle) and entering of an additional text
b. Specification of the stimulation point (nerve)
c. Electrode positioning map (if activated in the setup)
Preparation

ENTER Brief tap
(next step only)
After the last preparation step, the "Continue" button takes you to the first examina-
tion sequence. The first examination sequence is started in the "Trigger" mode.
Check the stimulator parameters (current, pulse width) and modify, if necessary, in the
control bar:
F NEUROWERK EMG
Example: Current
Changing the Settings
Mouse Keyboard
Position the mouse pointer Select parameter
over the "Current" parameter
Arrow Left/Right
Over the upper half, the
Change parameter
mouse pointer shows a
Arrow Up/Down
" + " symbol
Use the left mouse button to
increase the current.
Over the lower half, the
" – " symbol
reduce the current.
Note: If the transition resistance at the stimulation electrode is too high, the
yellow lamp STIM1 or STIM2 on the central unit will light permanently in the
case of electrical stimulation and, in addition, the
symbol is displayed on the screen in the title bar. This may have the follow-
ing reasons:
- the stimulation electrode is not connected to the patient;
- the transition resistance from the stimulation electrode to the skin is too
high;
- the stimulation electrode is defective (cable broken), and a stimulus is trig-
gered.
Trigger the stimulation

- "Q" Brief tap
Increase the current until a supramaximal stimulation response is obtained.

NEUROWERK EMG F
End of the measurement
Stop the measurement

"F8" or Esc
Next sequence
Next sequence

"N" Long tap
Positioning the cursors

Check the automatic positioning of the cursors and correct, if necessary.

Hold the left mouse Select cursor with Ar- ---
button pressed and row
shift the cursor on the
Left/Right
trace
Shift the cursor with
or
Arrow Up/Down
Move the mouse
pointer over a cursor
field
Over the upper half,
the mouse pointer
shows a Note:
" + " symbol Beyond the left and

rights ends of the
Pressing the left mouse cursor line, the pa-
button moves the rameter line is acti-
cursor to the right. vated.
Over the lower half,
the mouse pointer
shows a
" – " symbol
Pressing the left mouse
button moves the
cursor to the left.
Specify the measuring distance

Measure the distance between the distal and proximal stimulation points.
Enter this value either in the Dist column of the proximal track in the "Results" window
or in the grey field alongside the word "Distance".
F NEUROWERK EMG
Confirm the input with "Enter".

The NCV is calculated automatically in the results window.
The values entered here
are automatically as-
signed to the currently
active track (displayed
yellow).
Here you can assign the

distance directly to a
track.
Entering the temperature

Manual input: Enter the temperature in the grey field alongside the word Tempera-
ture.
Save the measurements

"S" ---
Before you end the examination, you will always be asked whether or not the traces
are to be saved.
Print
Printing the examination results

"F10" ---
Further information on print-outs is to be found in the section "Reports and printing".
F.1.2 Sensory NCV

This examination program is preconfigured to record the sensory action potential fol-
lowing electrical stimulation at a distal stimulation point, and to calculate the nerve
conduction velocity (NCV) for two nerves (e.g. left and right N. medianus).
NEUROWERK EMG F
Method selection
Mouse Keyboard
"F3"
Selecting a method
The method selection window is displayed. First select the required method.
Method selection
Mouse Keyboard
front of the method
then
Arrow Up/Down
NCV or
first letter
then
Up/Down
F NEUROWERK EMG
Mouse Keyboard
Double-click on the method Arrow Up/Down
Sensory or
first letter
then ENTER
Mouse Keyboard
tion definition
or
first letter
then ENTER
Preparation
a. Selection of the trace point (muscle) and entering of an addi-
tional text
Preparation

ENTER Brief tap
NEUROWERK EMG F
tion sequence.
The first examination sequence is started in the "Trigger" mode.
Check the stimulator parameters (current, pulse width)
Modify the parameters in the control bar
Example: Current
Changing the Settings
Mouse Keyboard
Arrow Left/Right
Change parameter
Arrow Up/Down
" + " symbol
" – " symbol
reduce the current.

"Q" Brief tap
Start measurement with the averager

If no sufficient response is visible with a single stimulus, you can switch to averaging.
F NEUROWERK EMG
Measuring with averager
Mouse Keyboard
Click on "F7"
A sequence of 10 cyclic stimuli is triggered at a stimulation frequency of 1 Hz and then

stopped automatically. Further averaging measurements can be added by pressing
the "F7" key once more to repeat the cyclic stimulation

After 10 averaging cycles, the measurement is automatically stopped.

"F8" or Esc Brief tap
Next track
Next track

"N" or Tab Long tap

You can use the Page Page keys to activate either the parameter or cursor
line.

Left/Right
trace
or
Arrow Up/Down
Move the mouse
field
the mouse pointer
shows a Note:

NEUROWERK EMG F
Pressing the left mouse rights ends of the

button moves the cursor line, the pa-
cursor to the right. rameter line is acti-
vated.
the mouse pointer
shows a
" – " symbol
button moves the
cursor to the left.

Measure the distance between the distal and proximal stimulation points.
Enter this value either in the Distance column of the proximal track in the "Results"
window or in the grey field alongside the word "Distance".
The NCV is calculated automatically in the results window.
The values entered here are

automatically assigned to the
currently active track (dis-
played yellow).
Here you can assign the

distance directly to a
track.
Entering the temperature

Manual input: Enter the temperature in the grey field alongside the word Temperature.

"S" Long tap
Before you end the examination, you will always be asked whether or not the traces
are to be saved.
Print
F NEUROWERK EMG
Print

"F10"
F.1.3 Myasthenia test

This examination program is preconfigured to record the motor action potential fol-
lowing electrical stimulation at a frequency of 3 Hz to determine a decrement.
Patient selection
Patient selection
Mouse Keyboard
"F2"
NEUROWERK EMG F
Method selection
Mouse Keyboard
"F3"
Selecting a method
Selecting a method
Mouse Keyboard
Click on the "plus" sign in Arrow Up/Down
front of the method
then
Arrow Right
NCV or
first letter
then
Arrow Right
Mouse Keyboard
tion definition
or
Myasthenia test first letter, then ENTER
Preparation
F NEUROWERK EMG
A map is displayed to aid electrode positioning (if activated in the setup).
Preparation

Brief tap
tion sequence.
Check the stimulator parameters (current, pulse width)
Modify the parameters in the control bar
Example: Current
Changing the settings
Mouse Keyboard
Arrow Left/Right
Change parameter
Arrow Up/Down
" + " symbol
" – " symbol
reduce the current.

--- "Q" Brief tap
Set the current and the stimulation point, then:

NEUROWERK EMG F
Start measurement in cascade mode
Start measurement
Mouse Keyboard
"F7"
A sequence of 9 stimuli is triggered at a stimulation frequency of 3 Hz.

Measurement stops automatically after 9 stimuli, otherwise:

Next track
Next track

"N" or Tab Long tap

line.
F NEUROWERK EMG

Left/Right
trace
or
Arrow Up/Down
Move the mouse
field
the mouse pointer
shows a Note:

rights ends of the
the mouse pointer
shows a
" – " symbol
button moves the
cursor to the left.
The decrement calculation is performed automatically and shown in the results win-
dow.
The loss of amplitude between the first and fifth muscle responses is calculated and
displayed in graphic form.
Note: If you select a track with the left mouse button and then press the right
L mouse button, a context-sensitive menu appears and you can modify the
display.
Cascade vertical
Cascade overlaid
Cascade overlapping
NEUROWERK EMG F

"S"
Print
Print

"F10"
F.1.4 F response
Patient selection
Patient selection
Mouse Keyboard
"F2"
F NEUROWERK EMG
Method selection
Mouse Keyboard
"F3"
Selecting a method
method.
NEUROWERK EMG F
Method selection
Mouse Keyboard
front of the method
then
Arrow Right
NCV or
first letter
then
Arrow Right
Mouse Keyboard
tion definition
or
F wave
first letter
then ENTER
Preparation
a. Selection of the trace point (muscle) and entering of an additional text
Preparation

ENTER Brief tap
tion sequence. The first examination sequence is started in the "Trigger" mode.
control bar:
F NEUROWERK EMG
Example: Current
Mouse Keyboard
Arrow Left/Right
Change parameter
Arrow Up/Down
" + " symbol
" – " symbol
reduce the current.

- "Q" Brief tap
Increase the current until a supramaximal stimulation response is obtained.
Now switch to the Analysis mode
Start measurement

" F7 " Long tap
Manually trigger 10 stimuli. The measurement will then stop automatically.

NEUROWERK EMG F
Stopping the measurement manually

"F8" -
Specify the measu-

ring distance

The cursors for the motor latencies are set automatically.
You must yourself set the cursors for the F response latencies and amplitudes.
F min, F max, F mean and the persistence are displayed in the results table.
F NEUROWERK EMG

Left/Right
trace
or
Arrow Up/Down
Move the mouse
field
the mouse pointer
shows a Note:

rights ends of the
the mouse pointer
shows a
" – " symbol
button moves the
cursor to the left.

Enter the value in the Distance column of the results window.
The F response NCV is calculated automatically in the results window.
Selecting different views

Click with the right mouse button on a track of the measurement.
Move the mouse to the menu item View. A window is displayed for you to select
whether to display the cascade vertically overlaid or overlapping.
NEUROWERK EMG F

"S" ---
Print

"F10" ---
Further information on print-outs is to be found in the section "Reports and

printing".
F NEUROWERK EMG
F.2 Magnetic stimulation

Patient selection
Patient selection
Mouse Keyboard
"F2"
Method selection
Mouse Keyboard
"F3"
Selecting a method
method.
NEUROWERK EMG F
Selecting a method
Mouse Keyboard
front of the method
then
Arrow Right
MEP or
first letter
then
Arrow Right
Selecting examination definitions
Mouse Keyboard
tion definition
or
Lower extremities
first letter
then ENTER
All definitions are configured for a trigger signal from the Neurowerk EMG system to
trigger the magnet stimulator.
Order of measurement:
Cortex left
Nerve root stimulation
Cortex right
Nerve root stimulation
You are now in the monitor mode.

F NEUROWERK EMG
Monitor
In monitor mode, you can assess the quality of the incoming signal and the patient can
practice the tensing of the muscles before the actual measurement is started. The EMG
signal can be muted or turned back on using the spacebar.
End the monitor mode
End the monitor mode

" F6 " Brief tap
You are now in the trigger mode. This mode serves to determine the stimu-
lation intensity and the stimulation position.
Trigger

ENTER Brief tap

- "Q" Brief tap
Starting the measurement in cascade mode

" F7 " Long tap

NEUROWERK EMG F
Next track
Next track

"N" Long tap
Repeat the measuring procedure for the next tracks.


Left/Right
trace
or
Arrow Up/Down
Move the mouse
field
the mouse pointer
shows a Note:

rights ends of the
the mouse pointer
shows a
" – " symbol
button moves the
cursor to the left.

Click with the right mouse button on a track of the measurement.
whether to display the cascade vertically, overlaid or overlapping.
F NEUROWERK EMG

"S" ---
Print

"F10" ---
Further information on print-outs can be found in the section "Setup".

NEUROWERK EMG F
F.3 SEP – Somatosensorially evoked potentials
F.3.1 SEP
This examination program is preconfigured to record the SEPs at cortical
trace points on the left and right following electrical stimulation of the N.
medianus, first with stimulation on the right.
A trace for a medianus SEP is taken as an example.
Patient selection
The patient selection window is displayed automatically when the program
is started.
Patient selection
Mouse Keyboard
"F2"
Selecting a method
Mouse Keyboard
"F3"
F NEUROWERK EMG
Selecting a method
method.
Selecting a method
Mouse Keyboard
front of the method
then
Arrow Right
SEP or
first letter
then
Arrow Right
Mouse Keyboard
tion definition
or
Medianus 1 channel
first letter
then ENTER
NEUROWERK EMG F
Preparation
Electrode map
A The electrode map is displayed automatically (if activated in the setup).
Place the tracing electrodes such that tracing is first possible on the left hemisphere af-
ter stimulation on the right-hand side.
Quit the electrode map
Mouse Keyboard
ENTER
Measure the impedance

The window is opened to enable you to check the electrode contact resistance; the
impedance values are displayed in numerical and graphic form.
Note: Correct the electrodes if the contact resistance exceeds 10 kOhm and
L the graph block is displayed red. If the impedance is less than 10 kOhm, the
graph block is green. The absolute impedance values should be as low as
possible. Ensure also that the values of the active (A) and reference elec-
trodes (R) are approximately the same.
Low impedance values are an important prerequisite for a good signal qual-
ity.
F NEUROWERK EMG
End the impedance measurement

Press STOP
Mouse Keyboard
ENTER
The first examination sequence is started in the "Trigger" mode. Check the signal qual-
ity and position the stimulation electrode.
Setting the stimulus strength

The electrical stimulation starts with a cyclic stimulus at the preset stimulation fre-
quency. Increase the current until the patient is able to feel the stimulation. This stimu-
lation intensity is the sensory threshold. Now increase the current intensity further, un-
til a distinct response of the thenar muscle (APB) is to be detected. You have now de-
termined the motor threshold. If necessary, you can also modify the pulse width. In-
crease the stimulation intensity to three times the sensory threshold or twice the mo-
tor threshold.
Once the stimulation point and the stimulus strength have been determined, fix the
stimulation electrode.
Setting the stimulus strength

--- "Q" or "F6" Brief tap
Modify the current with:
Varying the strength of the current
Mouse Keyboard
Position the mouse pointer Arrow Up/Down
" + " symbol
NEUROWERK EMG F

" – " symbol
reduce the current.
Start averaging
Start averaging

"F7" Long tap
The averaging begins with cyclic electrical stimulation.

All definition-specific parameters are automatically preset to the correct values.
The averaged signal is built up until the counter reaches the preset number of cycles
(default: 200 cycles). The program then switches to the next track and starts a new
measurement.
After completion of 200 accepted cycles, the active track changes to tracing on the left.
The impedance measurement window is displayed once more. Move the active elec-
trode from the left hemisphere to the right hemisphere and repeat the following steps:
Impedance measurement
Determine the stimulation point and stimulation intensity
Start averaging
Save the measurement

"S"
Manual operation

"F8" or Esc ---
F NEUROWERK EMG
Next sequence
Next sequence

"N" Long tap
Start measurement
Start measurement

"F7" Long tap
in the TRIGGER mode
Save
Save

"S"
Reset averaging
To restart averaging from the beginning, press the button shown below during aver-
aging:
Reset averaging

"F7"
Interrupting the averaging

You can interrupt a running averaging process. To this end, press:

"F8" or Esc -
Continue averaging
If you have interrupted the averaging and you are in the STOP mode, you can continue
the averaging by pressing:
NEUROWERK EMG F
Continue averaging

"F7"
Now you can also reset this averaging (see above).

line.
F NEUROWERK EMG

Left/Right
trace
or
Arrow Up/Down
Move the mouse
field
the mouse pointer
shows a Note:

rights ends of the
the mouse pointer
shows a
" – " symbol
button moves the
cursor to the left.
Writing a report
You can enter a text with report pertaining to the current measurement.
Writing a report

"F9"
A window is displayed for you to enter a text.

Complete the input with "OK" or "F9".
This text can be printed together with the measurement results.
NEUROWERK EMG F
Print
Print

"F10"

Further information on the functions of the report editor is to be found in the section
"Report editor".
F NEUROWERK EMG
F.4 AEP – Acoustically evoked potentials
F.4.1 FAEP
This examination program is preconfigured to record the early, acoustically evoked
potentials at cortical trace points on the right and left following acoustic stimulation of
the corresponding ear, first with stimulation on the right.
Patient selection
Patient selection
Mouse Keyboard
"F2"
Selecting a method
Mouse Keyboard
"F3"
NEUROWERK EMG F
Selecting a method
Selecting a method
Mouse Keyboard
front of the method
then
Arrow Right
AEP or
first letter
then
Arrow Right
Mouse Keyboard
tion definition
or
FAEP alternating
first letter, then ENTER
Electrode map
The electrode map is displayed automatically (if activated in the setup). Connect the
electrodes to the bus cable as shown on the electrode map and plug the bus cable
into the circular connector on:
• channel 1 in the case of 2-channel devices (NEUROWERK EMG2)
• channel 2 in the case of 4-channel devices (NEUROWERK EMG4)
F NEUROWERK EMG
Mouse Keyboard
ENTER


ENTER Brief tap
ity.
NEUROWERK EMG F
Hearing thresholds
You are taken automatically to the determination of the hearing threshold.
With the aid of the threshold determination function, you can determine the patient's
individual subjective hearing threshold for the left and right ears.
Determination of the hearing threshold
Mouse Keyboard
Hold left mouse button Tab switches between
pressed and shift the slide bar
left and right ear
Arrow Up/Down changes the
volume
The current volume is displayed in dB SPL under the headings "Left" and "Right".
Gradually increase the acoustic stimulation until the patient is able to hear the stimu-
lus. In this way, you can determine the individual hearing threshold for the patient –
separately for left and right.
F NEUROWERK EMG
Quit the hearing threshold determination
Quit the hearing threshold determination
Mouse Keyboard
ENTER
Note: The individual values from the hearing threshold determination are
L
saved automatically. The standard examination definition for AEP contains
the specification that the stimulation is to be performed at 70 dB above
threshold for the actual examination. In other words, the stimulation vol-
ume during the actual measurement is 70 dB above the individually deter-
mined hearing threshold.
Since the maximum volume is limited to 100 dB SPL for safety reasons, the
device reduces the stimulation volume automatically once the total of hear-
ing threshold and stimulation volume exceeds this value.
Start measurement to commence the actual examination.
Start averaging
Start averaging
Mouse Keyboard
"F7"

The measurement begins with stimulation and recording on the right ear. The aver-
aged signal is built up until the counter reaches the preset number of cycles (default:
2,000 cycles). The program then switches to the next track and starts a new measure-
ment.
NEUROWERK EMG F
After completion of 2,000 accepted cycles, the active track changes to tracing on the
left; the stimulation side of the headphones and the amplifier inputs are switched ac-
cordingly.
The procedure repeats itself until measurement is stopped automatically at the end of
the left channel after similarly 2,000 accepted cycles.

"S"
Manual operation

"F8" or Esc ---
Next sequence
Next sequence

"N" Long tap
Start measurement
Start measurement

"F7" Long tap
in the TRIGGER mode
Save
Save

"S"
F NEUROWERK EMG
Reset averaging
aging:
Reset averaging

"F7"


"F8" or Esc -
Continue averaging
Continue averaging

"F7"

You can use the Page Page keys to activate either the parameter or cursor line.

Left/Right
trace
or
Arrow Up/Down
Move the mouse
field
NEUROWERK EMG F
the mouse pointer Note:

shows a
Beyond the left and
" + " symbol rights ends of the
the mouse pointer
shows a
" – " symbol
button moves the
cursor to the left.
Writing a report
Writing a report

"F9"
A window is displayed for you to enter a text.

Print
Print

"F10"

"Report editor".
F NEUROWERK EMG
F.4.2 P300
This examination program is preconfigured for the recording of an event-related AEP.
The patient will hear a rare target stimulus (high tone) and a frequent standard stimu-
lus (low tone). The patient will be asked to concentrate his attention on the high tone
(e.g. by counting, pressing the placebo button).
Patient selection
Patient selection
Mouse Keyboard
"F2"
Method selection
Mouse Keyboard
"F3"
Selecting a method
method.
NEUROWERK EMG F
Method selection
Mouse Keyboard
front of the method
then
Arrow Right
AEP or
first letter
then
Arrow Right
Mouse Keyboard
tion definition
or
P300
first letter
then ENTER
Placing the electrodes: The ear electrodes are connected to each other to
serve as the reference electrodes.
Position the active electrode on "Pz".
Connect the electrodes to channel 1. The software will detect whether the standard or
the target stimulus has been offered and will assign the result to the corresponding
track.

F NEUROWERK EMG
ity.

Press STOP.

ENTER Brief tap
Start averaging
Starting the averaging
Mouse Keyboard
"F7"
Stimulus: Binaural 60dB SPL

Target stimulus: 2 kHz, frequency 20%
Standard stimulus: 1 kHz, frequency 80%
NEUROWERK EMG F
The averaged signal is built up until the target stimulus reaches the preset number of
cycles (default: 40 cycles).

"S"
Manual operation

"F8" Brief tap
Next sequence
Next sequence

"N" Long tap
Start measurement
Start measurement

"F7"
F NEUROWERK EMG
Save

"S"
Reset averaging
To return averaging to the beginning again, restart measurement with
Reset averaging

"F7"
NEUROWERK EMG F


Left/Right
trace
or
Arrow Up/Down
Move the mouse
field
the mouse pointer
shows a Note:

rights ends of the
the mouse pointer
shows a
" – " symbol
button moves the
cursor to the left.
Report
Report

"F9"
A window is opened for you to enter your text.

F NEUROWERK EMG
Print
Print

"F10"

"Report editor".
NEUROWERK EMG F
F.5 VEP – Visually evoked potentials
F.5.1 VEP
This examination program is preconfigured to record the visually evoked potentials at
a cortical trace point following visual stimulation of the right and left eyes, first with
stimulation on the right and with the left eye covered.
Position the patient or the stimulation monitor such that the distance between the pa-
tient's eyes and the monitor is approx. 1.40 m (VEP 60’, 19" TFT display).
The distance depends both on the dimensions of the monitor and on the desired view-
ing angle when viewing the pattern. The distance must be calculated using the for-
mula below depending on the monitor type used,
Edge _ length _ of _ box _(cm)
Dist _(cm) =
tan α
where the following applies for VEP 60’ with a 19" TFT display:
tanα=tan60’=tan1°=0.017455
Edge length=2.4cm
For the examination, the patient is to focus on the fixation point on the monitor. The
examination room must be darkened. The examination should be performed with any
visual aids. It is recommended to determine the patient's acuteness of vision (visus).
Patient selection
Patient selection
Mouse Keyboard
"F2"
F NEUROWERK EMG
Selecting a method
Mouse Keyboard
"F3"
Selecting a method
NEUROWERK EMG F
Selecting a method
Mouse Keyboard
VEP then
Arrow Right
or
first letter
then
Arrow Right
Mouse Keyboard
VEP60’ or
Electrode map
The electrode map is displayed automatically (if activated in the setup).
Position the electrodes so that, after stimulation, the trace is taken on the left.
Mouse Keyboard
ENTER

F NEUROWERK EMG
ity.

Press STOP, then
Mouse Keyboard
ENTER
Start averaging
Start averaging
Mouse Keyboard
"F7"
Visual stimulation begins on the stimulation monitor.

The measurement begins with stimulation of the right eye. The averaged signal is built
up until the counter reaches the preset number of cycles (default: 100 cycles). The
program then switches to the next track and starts a reference measurement.
NEUROWERK EMG F
After completion of 100 accepted cycles, the active track changes to tracing on the left.
Now switch the eye cover to the right eye.
Start measurement for the left eye
Starting measurement
Mouse Keyboard
"F7"
The procedure repeats itself until measurement is stopped automatically at the end of
the left reference track after similarly 100 accepted cycles.

"S"
Manual operation

"F8" or Esc ---
Next sequence
Next sequence

"N" Long tap
Start measurement
Start measurement

"F7" Long tap
in the TRIGGER mode
F NEUROWERK EMG

"S"
Reset averaging
aging:
Reset averaging

"F7"


"F8" or Esc -
Continue averaging
Continue averaging

"F7"

line.
NEUROWERK EMG F

Left/Right
trace
or
Arrow Up/Down
Move the mouse
field
the mouse pointer
shows a Note:

rights ends of the
the mouse pointer
shows a
" – " symbol
button moves the
cursor to the left.
Report
Report

"F9"
The report window is opened for you to enter your text.

F NEUROWERK EMG
Print
Print

"F10"

"Report editor".
NEUROWERK EMG F
F.6 EMG – Electromyography
F.6.1 Needle EMG trigger

This examination program is preconfigured to record the intramuscular potentials for
any chosen muscles using concentric needle electrodes.
The program is divided into 3 steps: Measurement of spontaneous activity, voluntary
activity and maximal response to muscle innervation.
Patient selection
Mouse Keyboard
"F2"
Method selection
Mouse Keyboard
"F3"
F NEUROWERK EMG
Selecting a method
Method selection
Mouse Keyboard
front of the method
then
EMG
Arrow Right
or
first letter
then
Arrow Right
Mouse Keyboard
Needle EMG trigger or
1. Spontaneous activity
The first examination sequence (spontaneous activity) is started in the "MONITOR"
mode. In monitor mode, the EMG is traced continuously.
In the info bar, you can see the letters A, R and Z. The info bar also displays the selected
examination sequence (spontaneous, voluntary, maximal) under "R". This should not
be modified.
NEUROWERK EMG F
Spontaneous activity
Mouse Keyboard
"A"
Entering a muscle name

First select the muscle to be examined.
Mouse Keyboard
Left-click on the muscle name. Arrow Up/Down
or
first letter
then
Arrow Up/Down
Specifying the page of the tracing location

F NEUROWERK EMG
Specifying the page of the tracing location
Mouse Keyboard
Left-click on Key "F11"
or
key "F12"
Now you can perform the tracing for the spontaneous activity. It is possible to save
several measurements (sequences). To this end, the measurement must first be
stopped:
Stopping the measurement

"F8" Brief tap
Now you can decide whether you wish to save the displayed measurement or discard
your changes without saving.
Saving the measurements
Saving the measurements

"S" Long tap
Discard changes without saving

"F5" Brief tap
Several measurements (sequences) can be saved by repeating the steps "Stop meas-
urement" and "Save measurement" as often as necessary.
The curves are displayed as a cascade (5 tracks one beneath the other) when tracing
for the spontaneous activity is performed. This can be switched using the key combi-
nation [CTRL]+X while the measurement is running.
NEUROWERK EMG F
Switch to voluntary activity and then to maximal innervation

To switch from the examination step "Spontaneous activity" to "Voluntary innerva-
tion", perform the following in the MONITOR mode:
Switch
"N" Long tap
The set muscle is accepted.
2. Voluntary activity
The examination sequence is started in the "Monitor" mode. The EMG is recorded con-
tinuously.
Trigger
Thanks to an adjustable amplitude trigger, it is possible to display individual muscle
action potentials in the centre of the screen and to accept them for an analysis.
It is also possible to disable the trigger.
Trigger
Mouse Keyboard
over the "Trigger" field.
Arrow Left/Right
Change parameter
Arrow Up/Down
" + " symbol
The trigger window is dis-
abled when the left mouse
button is pressed.
Setting trigger position and trigger range

In addition, it is possible to match the trigger parameters to the incoming signal pro-
vided that the trigger is enabled.
F NEUROWERK EMG
Example for the trigger range:
Operator controls
Mouse Keyboard
over the "Trigger range" field.
Arrow Left/Right
In the upper half, the mouse
Change parameter
pointer shows a
Arrow Up/Down
"+" symbol.
The trigger window is maxi-
mised when the left mouse
button is pressed.
In the lower half, the mouse
pointer shows a
" – " symbol.
The trigger window is mini-
mised when the left mouse
button is pressed.
The last 5 incoming MUAPs are dis-

played in the "Analysis" window on
the left-hand side, and the motoric
units (MUs) averaged so far on the
right-hand side.
As already described with the spontaneous activity, you have the following options:
NEUROWERK EMG F

"F8" Brief tap

Long tap in the "Stop"
mode

Short tap in the "Stop"
mode
Switching to the maximal innervation

To switch from the examination step "Voluntary activity" to "Maximal innervation", per-
form the following in the MONITOR mode:
Switching
"N" Long tap in

monitor mode
3. Maximal innervation
The examination sequence is started in the "Monitor" mode. The EMG is recorded con-
tinuously.
Contrary to the measurement of the spontaneous and light voluntary activity, the time
base is set to 100ms/Div, and the sensitivity to 1mV/Div.
F NEUROWERK EMG

"F8" Brief tap
The trace screen now displays 1 second of maximal innervation. In the results table,
the numerical values of the turns-amplitude analysis are listed to accompany the
graphic representation of the analysis.
Activity ms/s A measure for the density of the

activity pattern.
Turns per second 1/s Number of turns during the
analysis period
Amplitude per mV Sum of all amplitudes between
turn the turns, divided by the num-
ber of turns.
Now you can select between the following options:

"S" Long tap
NEUROWERK EMG F

"F5" Brief tap
Calling the notebook for reporting

You can use the notebook to very quickly enter a complete EMG examination report
for a muscle.
Reports
Mouse Keyboard
---
The properties are highlighted when clicked. A new notebook is created for each mus-
cle examined. Complete your input with OK.
Switching to the next muscle

To examine a further muscle starting with spontaneous activity, select the following in
the MONITOR mode of the maximal innervation:
Switching
"N" Long tap in

monitor mode
End measurement
Important!!
To be able to complete and - if desired - print the measurement, it is IMPERATIVE to
save the examination.
F NEUROWERK EMG
End measurement

"S" --
When you quit the EMG examination, whether by selecting a different examination or
a different patient, the window shown below is displayed automatically.
Print
Print

"F10"

NEUROWERK EMG F
F.6.1.1 Later evaluation
Loading a saved measurement

Recalling saved EMG traces
Traced muscles Mode
Left-click opens a list with Click with the left

the traced muscles. mouse button on the
EMG mode and select
the trace.
Click with the left

mouse button on
the name of the
muscle.
F NEUROWERK EMG
After you have selected both the muscle and the appropriate mode, you will see the
EMG curves.
With the voluntary activity, you can view the corresponding raw data by left-clicking
on
A) sequence;
B) the results line in the table;
C) the motoric unit.
Trace window MUAP MU win-

window dow
Manual analysis of the voluntary activity

You can assign the saved motor unit action potentials (MUAP) to a motoric unit (MU)
and subsequently measure them.
Position the mouse pointer on the tip of a potential and click with the right mouse
button.
NEUROWERK EMG F
Now you can select with a mouse click:

o Create MUAP in MU (the MUAP will be assigned to an MU);
o MUAP into new MU (the MUAP will be assigned to an MU generated automatically
by the system)
Cursors
Check the automatically set cursors for start, end, maximum and minimum in the "MU"
window and change them as necessary with:
Set cursors

Hold the left mouse Select cursor with Ar-
Left/Right
trace
Arrow Up/Down
Left-click on the appropriate MUAP in the left MUAP window; then click on the right-
hand mouse button.
• Delete MUAP (removes the active MUAP from the MU);
• Move MUAP to MU (moves the MUAP to another existing MU);
• MUAP into new MU (moves the MUAP to a new MU generated by the system auto-
matically)
Edit MUs (motoric units)

Select the motoric unit in the MU window; then, press the left mouse button.
• Delete MU (deletes the assignment of the MUAPs to the MU and the calculated signal);
• Move MU to MU (moves all MUAPs of the selected MU to another existing MU);
• New MU analysis;
• Sort MUAP.
Save
Upon completion of your changes or after a manual analysis, save your examinations
with:
Save

"S" Brief tap
Now you can print the results.

F NEUROWERK EMG
Print
Print

"F10" ---
F.6.2 EMG tremor analysis
F.6.2.1 Tremor
Patient selection
Mouse Keyboard
"F2"
Patient selection
Mouse Keyboard
"F3"
NEUROWERK EMG F
Selecting a method
Method selection
Mouse Keyboard
front of the method
then
EMG Arrow Right
or
first letter
then
Arrow Right
Mouse Keyboard
Tremor or

Use the left mouse button to select track 1.
Mouse Keyboard
"A"
F NEUROWERK EMG
Then select the 2nd track and also enter a muscle name here.
Start measurement
Start measurement

"Q" Brief tap
The measurement stops automatically after 2s.
Track 1: Envelope curve of channel 1

Track 2: Raw data of channel 1
Track 3: Envelope curve of channel 3
Track 4: Raw data of channel 4
Setting the cursor

The markers "Lat1" to "Lat6" can now be positioned on the wave peaks of the tracks 1
and 3. Subsequently, the mean frequency is calculated in the results table.
Setting the cursor

Left/Right
trace
or
Arrow Up/Down
Move the mouse
field
NEUROWERK EMG F
the mouse pointer Note:

shows a
Beyond the left and
" + " symbol rights ends of the
the mouse pointer
shows a
" – " symbol
button moves the
cursor to the left.

"S" Long tap
Print
Print

"F10"

F NEUROWERK EMG
F.7 Reflex examinations
F.7.1 OOR
Patient selection
Patient selection
Mouse Keyboard
"F2"
Method selection
Mouse Keyboard
"F3"
Selecting a method
method.
NEUROWERK EMG F
Method selection
Mouse Keyboard
front of the method
then
Arrow Right
Reflexes or
first letter
then
Arrow Right
Mouse Keyboard
tion definition
or
OOR
first letter
then ENTER
Trigger
control bar:
F NEUROWERK EMG
Example: Current
Mouse Keyboard
Arrow Left/Right
Change parameter
Arrow Up/Down
" + " symbol
" – " symbol
reduce the current.

- "Q" Brief tap
Increase the current until a stimulation response is obtained.
Start measurement

"F7" Long tap

"F8" or Esc Long tap
NEUROWERK EMG F
Next track
Next track

"N" Long tap
Now repeat the measuring process for the next tracks to stimulate the left-hand N.
trigeminus.

Left/Right
trace
or
Arrow Up/Down
Move the mouse
field
the mouse pointer
shows a Note:

rights ends of the
the mouse pointer
shows a
" – " symbol
button moves the
cursor to the left.

Click with the right mouse button on a tracks of the measurement.
whether to display the cascade vertically, overlaid or overlapping.
F NEUROWERK EMG

"S" ---
Print
Print

"F10" ---

NEUROWERK EMG G
Technical Data Page 135
G Technical Data
G.1 EMG/NCV/EP hardware – Technical data for standard configura-

tion
Mains power supply: 230 V +/- 10%, 50-60 Hz

Connected load: max. 400 VA
Classification: Class IIa to MDD, Annex IX, Rule 10
Quality standard: EN 60601-1, class of protection I, type BF
EN 60601-1-2
EN 60601-2-40
Personal computer: Intel >2.5 GHz
(standard configuration) 1 GB RAM
160 GB HD
Network 100/1000 (RJ45)
CD-RW or DVD-RW*)
19” TFT monitor (min. 1280x1024)
Archiving/Backup: Integrated DVD-RW drive or via network
on server or any logical drive
Remote diagnostics*): Remote service via Internet
Interfaces (PC): Power input
Audio output (for additional multimedia speakers)
LAN Ethernet 1 (interface to processor unit)
LAN Ethernet 2 (network interface)
Keyboard, mouse, monitor
Interfaces (central unit): Power input
LAN Ethernet (interface to PC)
Amplifier/AD converter
2x external Trigger In/Out
Headphones
VEP monitor
Goggles
Current stimulator (2nd current stimulator *))
Foot switch
PAL
G NEUROWERK EMG
Page 136 Technical Data
Operating system (PC): WINDOWS XP Professional

Equipment trolley: with integrated isolating transformer, keyboard
drawer, steerable castors (two of which lockable), rear
panelling, support arm for amplifier box
Printer: MS WINDOWS-compatible inkjet or laser
printer *)
Amplifier:
Sampling rate 50 kHz/channel
A/D converter 24 bit
Resolution 10 nV/d
Channels 2, 4 *)
5-pin DIN connector (270°) and shock-hazard-
protected DIN 42802 socket per channel
Max. input voltage 25 mV
Noise < 1 µV pp at 2 Hz–10 kHz, short-circuited
Input impedance > 110 MOhm
CMRR > 110 dB
Lower limit frequency 0.02 Hz to 1000 Hz in 15 steps
0.02, 0.05, 0.1, 0.2, 0.5, 1, 2, 5, 10, 20, 50, 100, 200, 500,
1000 Hz); 6 dB/octave
Upper limit frequency 20 Hz to 15 kHz in 11 steps
(20, 50, 100, 200, 500 Hz, 1, 2, 3, 5, 10, 15 kHz);
6 dB/octave
Notch filter 50/60 Hz
Calibration signal 1 Hz rectangular/10 Hz sine
Temperature measurement 20-40 °C, temperature sensor *)
Impedance measurement: 0-100 kOhm at 10 Hz in 0.1 kOhm steps
Numerical and colour-coded display
Electrical stimulator:
Number: 1 or 2 *) integrated electrical stimulators; external
stimulators*)
Stimulus strength: 0 - 100 mA; set in steps of 1 mA
Stimulation duration: 50 µs – 1 ms; set in steps of 50 µs
Stimulus types: Single, double, train
Stimulus frequency: Manual, 0.1 - 100/s depending on examination pro-
gram
Parameter setting: Stimulation intensity set via keyboard, mouse or func-
tion keys *)
Display: Screen display of stimulation intensity, pulse width
and stimulation mode
NEUROWERK EMG G
Technical Data Page 137
Acoustic stimulator:
Stimulation mode: Click, click-clack; stimulation duration can be set from
50 µs to 1 ms
Stimulus strength: 0 to 124 dB SPL, set in steps of 5 dB

Stimulation polarity: Condensation, rarefaction, alternating
Masking: White noise, intensity adjustable
Stimulus frequency: Manual, 1 - 100/s depending on examination pro-
gram
Parameter setting: Stimulus strength set via keyboard, mouse or func-
tion keys *)
Visual stimulator:
Stimulation mode: Checkerboard reversal, pattern flash, onset/offset,
image stimulation (640*480,16 colours), visual P300
*)
Pattern: Checkerboard, vertical and horizontal stripes, images;
size can be set from 1' to 500' (minutes of arc)
Stimulation fields: Full, half and quarter fields
Fixation point: Various fixation points, coloured bitmaps, freely posi-
tionable
Pattern colours: Black, white, 16 grey scales
Monitor: 17" VGA CRT monitor
LED goggles*): Left eye, right eye, both eyes
Ambient conditions for operation and transport
Operation: +15 to +40°C, relative humidity 20 to 80%, non-
condensing
Transport: -20 to +60°C, relative humidity 20 to 80%, non-
condensing
NEUROWERK EMG H
Annex Page 139
H Annex
H.1 EMC guidelines

Notes:
• Medical electrical devices are subject to special precautions regarding elec-
tromagnetic compatibility (EMC). It is imperative to observe the following
notes in respect of the EMC when installing and starting up the device.
• Please note that portable and mobile HF communication devices may influ-
ence medical electrical devices.
Guidelines and manufacturer's declaration – Electromagnetic emissions
Neurowerk EMG is intended for use in environments as specified below. The customer or the user of Neu-
rowerk EMG should ensure that the device is only used in such an environment.
Emitted-interference Compliance Electromagnetic environ-

measurement ment - Guideline
Emitted HF-interference to Group 1 Neurowerk EMG uses HF energy exclusively
for its internal functions. Therefore, its
CISPR 11 emitted HF interference is very low, and it is
unlikely that adjacent electronic devices
will be disturbed.
Emitted HF-interference to Class B Neurowerk EMG is suitable for use in all

types of facility, including those located in
CISPR 11 residential areas and also those connected
directly to a public utility system supplying
also buildings used for residential purposes.
Emission of harmonics to Class A

IEC 61000-3-2
Emission of voltage fluctuations / Compliant

flickers to IEC 61000-3-3
H NEUROWERK EMG
Page 140 Annex
Guidelines and manufacturer's declaration – Electromagnetic interference immu-

nity
Neurowerk EMG is intended for use in environments as specified below. The customer or the user of Neurowerk
EMG should ensure that the device is only used in such an environment.
Interference IEC 60601-1 Level of Electromagnetic en-

immunity test level compliance vironment - Guide-
test lines
Electrostatic discharge +- 6kV contact discharge +- 6kV contact discharge The floors should be of wood or
(ESD) to concrete or covered with ceramic
+- 8kV air discharge +- 8kV air discharge tiles. If the floor is coated with
IEC 61000-4-2 synthetic material, the relative
humidity must be at least 30 %.
Emitted HF interference +- 2 kV for mains lines +- 2 kV for mains lines The quality of the supplying volt-
to CISPR 11 age should comply with the stan-
+- 1 kV for I/O lines +- 1 kV for I/O lines dards for a typical business or
hospital environment.
Surge voltages to IEC +- 1 kV for normal-mode +- 1 kV for normal-mode The quality of the supplying volt-
61000-4-5 voltages voltages age should comply with the stan-
dards for a typical business or
+- 2 kV for common- +- 2 kV for common- hospital environment.
mode voltages mode voltages
Voltage dips, short-time <5 % for 5s <5 % for 5s The quality of the supplying volt-
interruptions and fluctua- age should comply with the stan-
tions of the supplying <5 % for 0.5 periods <5 % for 0.5 periods dards for a typical business or
voltage to IEC 61000-4-11 <40 % for 5 periods <40 % for 5 periods hospital environment. If the Neu-
rowerk EMG user also requires
<70 % for 25 periods <70 % for 25 periods continued functioning if the power
supply is interrupted, it is recom-
mended to power the Neurowerk
EMG from an uninterruptible
power supply or a battery.
Magnetic field at the 3 A/m 3 A/m Magnetic fields at the mains fre-
supply frequency quency should comply with the
(50/60Hz) to IEC 61000-4- typical values as to be found in
8 business or hospital environments.
NEUROWERK EMG H
Annex Page 141
Guidelines and manufacturer's declaration – Electromagnetic interference immu-

nity
Neurowerk EMG is intended for use in environments as specified below. The customer or the user of Neurowerk
EMG should ensure that the device is only used in such an environment.
Interference IEC 60601-1 Level of Electromagnetic en-

immunity test level compliance vironment - Guide-
test lines
Portable and mobile wireless
transmitting sets should not be
used at a distance to the Neu-
rowerk EMG including its cables
which is less than the recom-
mended safe distance calculated
according to the equation applied
for the transmission frequency.
Recommended safe distance:
Conducted HF interfer- 3 Veff 3V d= 1.17 * root(P/W)

ence
150 kHz ... 80 MHz
to IEC 61000-4-6
Emitted HF interference 3 V/m 3 V/m d= 1.17 * root(P/W) for 80 MHz ...

800 MHz
to IEC 61000-4-3 80 MHz ... 2.5 GHz
d= 2.33 * root(P/W) for 800 MHz ...

2.5 GHz
REMARK 1: The higher frequency range applies for 80 MHz and 800MHz.
REMARK 2: These guidelines may not apply in all cases. The propagation of electro-
magnetic interference is influenced by the absorption and reflexion of buildings, ob-
jects and humans.
The field strength of stationary transmitters, such as base stations of radio telephones
and mobile farming radio systems, amateur radio transmitters, AM and FM radio and
TV transmitters cannot be predetermined exactly theoretically.
To be able to determine the electromagnetic environment in respect of the stationary
transmitters, the user is recommended to make a study of the location. If the measured
field strength at the location at which Neurowerk EMG is used, exceeds the compli-
ance levels specified above, the Neurowerk EMG should be observed to verify its use as
intended. If abnormal functioning is observed, additional measures may be required,
such as a changed alignment or a different location of the Neurowerk EMG
The field strength in the frequency range between 150kHz and 80 MHz should be less
than 3 V/m.
H NEUROWERK EMG
Page 142 Annex
Recommended safe distances between portable and mobile HF telecommunica-

tion devices and the Neurowerk EMG
Neurowerk EMG is intended for use in an electromagnetic environment with controlled HF interference. The
customer or the user of the Neurowerk EMG may contribute to the avoidance of electromagnetic interference by
observing a minimum distance between portable and mobile HF telecommunication devices (transmitters) and
the Neurowerk EMG, depending on the output power of the communication device, as specified below.
Safe distance in m depending on the transmission frequency
Nominal power 80 MHz ... 800 800 MHz ... 2.5 150 kHz ... 80
of the transmit- MHz GHz MHz
ter P in W
d= 1.17 * root(P/W) d= 2.33 * root(P/W) d= 1.17 * root(P/W)
0.01 0.12 0.23 0.12
0.1 0.37 0.74 0.37
1 1.17 2.33 1.17
10 3.70 7.37 3.70
100 11.70 23.30 11.70
For transmitters whose maximum nominal power is not specified in the table above,
the recommended safe distance d in metres (m) can be determined using the equation
given in the appropriate column, where P is the maximum nominal power of the
transmitter manufacturer.
REMARK 1: The higher frequency range applies for 80 MHz and 800MHz.
REMARK 2: These guidelines may not apply in all cases. The propagation of electro-
magnetic interference is influenced by the absorption and reflexions of buildings, ob-
jects and humans.
The compliance levels in the ISM frequency bands between 150 kHz and 80 MHz and
in the frequency range between 80 MHz and 2.5 GHz are intended to reduce the prob-
ability of mobile/portable communication equipment causing interference if it is inad-
vertently brought into the vicinity of the patient. For this reason, the additional factor
10/3 is applied for calculation of the recommended safe distances in these frequency
ranges.
These guidelines may not apply in all cases. The propagation of electromagnetic inter-
ference is influenced by the absorption and reflexion of buildings, objects and hu-
mans.
NEUROWERK EMG H
Annex Page 143
H.2 Cables/lines/electrodes
Central unit connection cables
Designation Connections Length

Power connection for IEC applicance connec- 1.8 m
the central unit tor/socket
Interconnecting cable DVI 1.8 m

between central unit
and electrode input
box
Goggle cable (coiled 4-pin DIN 1.8 m

cable)
Crossover network RJ45 1m

cable for connection to
the PC
VEP monitor cable 15-pin HD 1.8 m
Headphones (coiled 6.3mm cinch 1.1 m

cable)
Foot switch Hollow connector with 1.9 m

internal pin
PC connection cables

Power connection for IEC connector/socket 1.8 m
PC and monitor
Keyboard cable PS/2 1.6 m
Mouse cable USB 1.8 m
Monitor cable 15-pin HD 1.8 m
Printer cable USB 1.8 m
USB remote control USB 1.5 m
EMG monitor speaker USB 1.3 m
Network cable RJ45 1.9 m

H NEUROWERK EMG
Page 144 Annex
Electrode cables (standard accessories for initial equipment)

1-channel electrode 270° 5-pin DIN connec- 1.5 m
cable tor to 3x1.5mm DIN
socket
Gold-cup adhesive DIN connector 0.5 m

electrodes
Stimulation electrode 5-pin circular connec- 2m

NN for adults tor 270°
Finger-toe stimulation Multi-plug system 0.15 m

electrode
Snap-fastener connec- DIN connector/snap- 1.5 m

tion cable for earth fastener
electrodes
Pair of alligator clips Multi-plug system 0.15 m

for one-way stick-on
electrodes
Needle connection 5-pin/270° connector / 2.0 m

cable multi-plug system
Our standard accessories are merely a selection of accessories we recommend keeping

in stock to be able to perform all possible examinations. This scope of accessories can
be amended and extended by the user at any time.

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NEUROWERK EMG A

NEUROWERK EMG is a product of

SIGMA Medizin-Technik GmbH

Copyright © 2007-2010 SIGMA Medizin-Technik GmbH

B.2.5 Switching off the equipment ..................................................................................................... 30

F.5 VEP – Visually evoked potentials................................................................................................................ 79

A.1 Field of application, indications/contraindications

A.2 Warnings and notes

A.3 Electrical safety

A.4 Safety notes on the EMC regulations

A.5 Safety notes on the electrical stimulator

A.6 Further safety notes

A.8 Equipotential bonding

A.8.1 Place of installation

Operating temperature: 15°C to 40°C

A.8.2 Combination with other equipment

A.8.3 Using a defibrillator

A.8.4 Using high-frequency surgical devices

A.9 Conditions for proper use

A.9.1 Before getting started

A.9.2 When working with the equipment

A.9.3 After finishing work

A.9.4 Inspection and maintenance

A.9.5 Hygiene and care of the equipment

A.9.6 Cleaning and sterilisation of electrodes

Reusable EMG needle electrodes

NCV/EP surface electrodes

L Pulling or bending may damage the cable. If a cable break is suspected,

A.9.7 General notes

A.9.8 Environmental protection

A.9.9 Symbols used and their meaning

NOTE: Observe the accompanying documents

Type BF applied part

CAUTION: Hazardous voltage!

Connection for LED goggles

Connection for headphones

Connection for PC network

Connection for VEP monitor

Connection for foot switch

Connection for amplifier

Central unit status display

Stimulator 1 status display

Stimulator 2 status display

Connection for active electrode

Connection for reference electrode

Connection for earth electrode

Connection for bus cable, channel 1

Connection for bus cable, channel 2

Connection for bus cable, channel 3

Connection for bus cable, channel 4

Connection for trigger input

Connection for trigger output

B Design and Installation

B.1.1 Technical description

B.1.1.1 Description of the central unit

LEDs in the Central Unit

Green LED Stimulator 1 Stimulator 2

Flashing Flashing Flashing Reboot

Is lit OFF OFF Booted, but not con-

Is lit OFF OFF Connected to the PC

A foot-switch connection is provided for remote-controlling the PC software. To this

B.1.2 System components:

Legend Designation Description