ZMPCZM019000.12.07 NeuroGraph User's manual

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  • 1. 1 NeuroGraph™ User’s Guide Release 6.0 A NeuroDynamix™ Application From Zynex® NeuroDiagnostics Zynex® NeuroDiagnostics 9990 Park Meadows Drive Lone Tree, CO 80124, USA 303.703.4906 www.zynexneuro.com Zynex® Europe Fælledvej 1, Box 19 BDO DK-5100 Odense C DENMARK © 2012 - All Rights Reserved
  • 2. 2 Table of Contents OVERVIEW AND INTENDED USE 5 NEURODYNAMIX™ SOFTWARE ENVIRONMENT 5 SYSTEM REQUIREMENTS 5 SOFTWARE & HARDWARE INSTALLATION 5 RUNNING NEUROGRAPH™ FOR THE FIRST TIME 7 CHECKING THE INSTRUMENT & INTERFACE BOARD CONFIGURATION SETTINGS FROM SYSTEM OPTIONS 7 PATIENT RECORDS - CONFIDENTIALITY FEATURES 9 PASSWORD PROTECTION 9 Confidentiality Options 10 RUNNING A SESSION 12 SELECTING A PATIENT 12 CREATING A NEW PATIENT ENTRY 13 SELECTING A PROTOCOL 14 PROTOCOL LIST 15 PROTOCOL DESCRIPTION 16 SENSOR ATTACHMENT & SITE LIST 17 Audio Prompts Option 18 SET-UP PERIOD – CHECKING SIGNAL QUALITY 19 STARTING THE SESSION 19 AUTOMATIC TRIAL MARKERS (SCHEDULE MODE) 20 SETTING TRIAL MARKERS (PROTOCOL WITHOUT SCHEDULE) 20 USING THE MEASURE BUTTONS TO HIDE SIGNALS 20 PAUSE FEATURE 22 EXITING 22 A TRIAL SCHEDULE VS. FREE-FORM RECORDING 23 ADJUSTING DISPLAY SETTINGS DURING A SESSION 24 SETTING A TRAINING GOAL / THRESHOLD 25 Changing the Graph Color as Feedback 26 Automatic Goal Adjustment Option 26 Audio Tone Option 27 CHANGING THE DISPLAY TYPE 28 Area Graph 28 Combined Pie 28 Individual Pie 29 Bar Chart 29 STACKING BAR 29 ENDING A SESSION 30 SAVING SESSION DATA 30 SESSION NOTES 31
  • 3. 3 REVIEWING DATA AND PRINTING A REPORT – BASIC FEATURES 32 SESSION SUMMARY GRAPH 33 FULL SESSION GRAPH 35 ZOOM FUNCTION 36 REPLAY BUTTONS 36 TABLE DISPLAYS 37 PRINTING A REPORT FOR THE FIRST TIME 38 Report Type 38 Report Template 38 REPORT OPTIONS SCREEN 39 Opening a Report in MS Word 40 Printing the Report 40 Example Report 41 Inserting Additional Graphs in a Report 42 CREATING REPORTS IN THE FUTURE 43 REVIEWING DATA AND PRINTING A REPORT – DETAILED OPTIONS 44 REVIEWING A SAVED SESSION 44 Delete Session 44 Add / View Session Notes 44 REVIEW SESSION SCREEN 45 Graphs & Tables 45 Color Selections 45 Printing Reports 45 REPORT OPTIONS 46 Report Type 46 Include Notes 46 Include Signature Line 46 Select Graph for Report 46 Graph Location in Report 47 Select Template 47 Include Data Values 47 Select Channels to Include in Report 47 Grouped Analysis 47 REPORT TEMPLATES 49 Template Editor 49 EXPORTING DATA TO OTHER APPLICATIONS 50 NEUROGRAPH™ IN DETAIL – THE MAIN MENU 52 CURRENT SETTINGS 55 PATIENT MANAGEMENT 56 SELECTING A PATIENT 56 CREATING A NEW PATIENT ENTRY 56
  • 4. 4 CREATING & EDITING PROTOCOLS 57 PROTOCOL NAME 58 DESCRIPTION 58 KEY PROTOCOL 58 Sample Rate 59 Display Rate 59 MEASURE SETTINGS. 60 COLOR SETTINGS: STANDARD, LOCAL, AND CUSTOM COLORS 60 DISPLAY MODE 60 PRIVILEGES 60 DISPLAY SETTINGS 61 DISPLAY TYPE 61 BACKGROUND EFFECT 61 DATA DISPLAY MODE 61 Y1/Y2 SCALE 61 LOGARITHMIC PLOTTING 62 GRID LINES 62 SELECT GROUP / MAKE GROUP ACTIVE 62 GOAL/AUDIO SETTINGS 63 THRESHOLD ADJUSTMENT 63 REWARD CRITERION 64 TONE FEEDBACK 64 SAVE SETTINGS 64 CLOSE 64 REAL-TIME DISPLAY SCREEN FEATURES 65 GRAPH SETTINGS 66 Logarithmic (or Linear) Plotting 66 Grid Lines 66 Background Effect 66 Slowing or Speeding-Up the Display 67 Time Scale / Data Points 67 Scale – Y1 & Y2 Max and Min 67 Show Time 67 Display Markers 67 ADVANCED FEATURES - SCHEDULES 68 CREATING A NEW SCHEDULE 69 ADDITIONAL SCHEDULE SETTINGS 71 Example Schedule with Trial Names & Group Assignment 72 SETTING ADVANCED TRIAL FEATURES 73 Important Note on File Names 74 SET-UP PERIOD SETTINGS 75 SAVING THE SCHEDULE 76
  • 5. 5 NeuroGraph™ User’s Guide Release 6.0 Overview and Intended Use NeuroGraph™ works with Zynex® NeuroDiagnostics’instruments to provide dynamic real-time display of physiological signals as well as providing high resolution data collection. It is intended for use in clinical biofeedback, muscle reeducation, and research applications. It is not intended for critical care monitoring applications. NeuroDynamix™ Software Environment NeuroDynamix™ serves as a common interface for a range of software applications from Zynex® NeuroDiagnostics, allowing the user to select the connected instrument, enter clinic and clinician information, create patient records, and select patient records to review. NeuroGraph™ is a real-time physiological monitoring software application that is designed to run within the NeuroDynamix™ software environment. The current version supports up to 8 channels of physiological input and provides extensive options for signal display, data saving, data review, and report generation. The majority of this manual is devoted to the use of the NeuroGraph™ application and the NeuroDynamix™ interface. System Requirements NeuroGraph™ 6.0 software is compatible with WindowsXP, and Windows7. A prerequisite of NeuroGraph™ 6.0 is InstaCal 6.1 provided by Measurement Computing. The InstaCal™ software is provided with the NeuroGraph™ software. If the computer being used has a Sleep or Hibernate power saving mode, it is strongly suggested to disable the sleep and hibernate feature. If a computer enters sleep or hibernate mode while NeuroDynamix™ is running, the connection between the software and hardware will be lost. If this has already happened, disconnect the USB cable, reboot the computer, and reconnect the USB cable. Software & Hardware Installation InstaCal™ software must be loaded before NeuroGraph™ is used. The InstaCal™ software is delivered with the NeuroDynamix™ software. Additional copies of the InstaCal™ installer can be obtained from Zynex® NeuroDiagnostics. Double click the icalsetup.exe installer and follow the prompts. See the NeuroDynamix™ Installation Instructions for complete details. NeuroGraph™ 6.0 is installed with the NeuroDynamix™ Setup package. This is installed by double clicking the NeuroDynamix™ 6.0_Setup….exe file and following the prompts. Note, this installer will install all NeuroDynamix™ applications, and therefore a shortcut for each application will be placed on the desktop. Unwanted NeuroDynamix™ shortcuts may be removed from the desktop by simply deleting them. See the NeuroDynamix™ Installation Instructions for further details.
  • 6. 6 Note1: Some computers have administrative restrictions on installing or uninstalling software. Admin rights are required to install and run NeuroDynamix™ 6.0. If you are not the administrator of your computer, contact the administrator to obtain proper administrative rights. Note2: If the computer has a Sleep or Hibernate power saving mode, it is suggested to disable the sleep and hibernate feature, or extend the time-out period. If a computer enters sleep or hibernate mode while a NeuroDynamix™ session is running (and therefore collecting data from the hardware), the connection between the software and hardware will be lost. If this has already happened, disconnect the USB cable, reboot the computer, and reconnect the USB cable. Note3: The software must be registered within 15 days of install. If not registered, the software will stop working. Contact Zynex® NeuroDiagnostics for registration code. Note4: You are responsible for protecting your client’s private information. Follow the HIPAA privacy and security rules, use a strong Windows login password, use anti-virus/anti-malware protection, and keep your PC in a secure location.
  • 7. 7 Running NeuroGraph™ for the First Time Before running NeuroGraph™, the USB interface card must first be initialized using InstaCal™. With the hardware unit plugged in to the computer’s USB port, run the InstaCal™ software. Wait for the InstaCal™ to auto recognize the data acquisition board, click OK and close InstaCal™ (note, the name of the board varies depending on the hardware unit in use, but most boards are USB-1608FS. Checking the Instrument & Interface Board Configuration Settings from System Options It is very important that the software is set for the correct instrument. If the instrument setting does not match the instrument in use, then the signals from the instrument will not be processed and displayed correctly on the screen. Instrument selection is done when the software is first installed, but it is worth checking to confirm that the setting is correct. • Select the [System Options] button. • Select Instrument Configuration from the menu. • Enter the system password { password entered during initialization (meaning the first time the software was used) }.
  • 8. 8 • Make sure that the Instrument listed matches the hardware unit. The model name for most units is located on the front of the instrument in the lower right hand corner. Check that the Board Selection is correct. The correct board selection is in most cases USB-1608FS, but this depends on the attached hardware. Note: Some custom models or legacy models may have a different board selection; in this case the model will come with a customized user guide. Use the user guide which was provided with the hardware unit.
  • 9. 9 Patient Records - Confidentiality Features Password Protection NeuroDynamix™ supports an option to customize Password Protection of features, including access to patient information and records. • To enable or disable password control options, select the [System Options] button from the Main Menu and select Pass word Control. • The software allows for customized password protection. Password protection can be turned on or off for General Users or Administrators, meaning it can be customized per software function. • If the password level is set to“None”, the user will not be prompted for a password to access the corresponding feature. • If the password level is set to“General”, the user always be prompted for a password to access the corresponding feature, and anyone with a valid password will be granted access. • If the password level is set to“Administrator”, the user always be prompted for a password to access the corresponding feature, and only an Administrator with a valid password will be granted access. • If there are multiple users and features need to be locked out per General or Administrator, in addition to the other desired settings, the settings must be set as such: Log-In = General, Clinical Management = Administrator. The system defaults to this setting. • If password protection is activated for Patient Management, the password screen will appear anytime the Patient Management interface is selected. • Access is gained by entering {password entered during set up}.in the dialog box and selecting [OK].
  • 10. 10 Confidentiality Options • If a patient may be present when the Patient Management screen is visible, the screen can be set to Initials Only if desired. Patients can then be selected from the list using their Full Name, Last Name, ID, or File Number. • The Confidentiality Options settings (within System Options) include an option to display the patient’s initials instead of their full first and last name. This option is selectable for both the Patient Selection screen, and the Main Menu Screen. When this option is selected, initials are displayed in the Patient List and/or in the Current Selected Patient display that appears on the main menu screen.
  • 11. 11 • Patient Selection Initials Only option OFF. • Patient Selection Initials Only option ON. Note also that the system automatically assigns a File Number. Patient records can also be selected using their File Number.
  • 12. 12 Running a Session This section covers the essentials of running a basic monitoring session. This example skips over many of the options and advanced features of the software that are presented in detail in later sections. Selecting a Patient NeuroGraph™ requires a Current Patient to be selected before running a physiological monitoring session. • Select [Patient Management] from the main menu screen. • Select a Patient from the Patient List The software is pre-loaded with a fake patient named“Richard Smithfield”for testing purposes. If the system is being used for the first time, select the sample patient from the list (Richard Smithfield). • Select the [Return to Main Menu] button.
  • 13. 13 Creating a New Patient Entry To create a new Patient Entry, from the Patient Selection screen, select the [Enter New Patient] button to begin a new entry. The minimum requirement is to enter a Birth Date. Additional information is optional and may be entered now or later. The option to enter Medical and Insurance information is available by selecting the [Medical Information] button. This information can also be completed at a later time. • After entering the desired information, select the [Create a Record Using this Information] button to add this patient name to the database. Patient information may also be edited at a later time. • Select the [Close] button.
  • 14. 14 Selecting a Protocol Protocols are preprogrammed instructions that define the basic characteristics of a monitoring session. The Main Menu provides three options: [ Run Current Protocol ] The system remembers the last protocol that was run. This is called the“Current Protocol”and its’name is displayed in the lower right hand side of the screen. Select this button to run the Current Protocol. [ Select Protocol ] Displays a list of pre-programmed protocols. Use this option if to select a protocol other than the cur rent protocol. (Protocols can be edited, added, or removed from the protocol listing using the Edit / Make Protocol option below.) [ Edit / Make Protocol ] Displays the list of protocols and provides options for editing existing protocols, creating new protocols, and deleting unused protocols from the list. • Select the [Select Protocol] button. If a current patient is not selected, the program will require a current patient to be selected now. A patient must always be selected prior to selecting a protocol to avoid this message.
  • 15. 15 Protocol List The Protocol List screen shows the protocols currently installed on the system. (The list on the screen may look somewhat different depending on the selected hardware unit.) • Click on the protocol labeled, EMG Dual Relaxation Manual Goal (or the protocol name that appears most similar). Clicking on a protocol name places that protocol in the Current Protocol window at the top of the screen.
  • 16. 16 Protocol Description The name of a protocol will normally give an indication of what the protocol does. The person who developed the protocol may have also provided a more detailed description of the protocol. To see this description, highlight a protocol name by clicking on it once with the mouse and then select the [Protocol Description] button (see example above). After Reading the Description, click [Close]. For purposes of our demonstration, let’s run the dual channel EMG protocol: • Select the [Run Protocol] button.
  • 17. 17 Sensor Attachment & Site List When this prompt appears, the sensors can be attached to the subject. The location of the EMG 1 and EMG 2 on the measure list above varies depending on the instrument model. The example above is from a NeuroSystem™ 2 places EMG 1 and EMG 2 in the first and third positions respectively. • Attach the sensors. Detailed information on the different sensors included with the system and how they are attached to the patient is provided in the Hardware Manual supplied with the unit. For purposes of this demonstration, the sensors may be left unattached.
  • 18. 18 If site names have been specified in advance for a protocol, they will be displayed in the list window. If these are the correct names for the sites, select [OK], otherwise change them to the sites in use. If no names are displayed, or if the names are not correct, the names can be entered by typing them in the boxes or by selecting names from the pull-down menu. If new names are selected, use the [Save] button then select [OK]. Advanced Note: The Protocol Editor may be used to assign site names to a specific protocol so that the names will automatically appear each time the protocol is used. The Protocol Editor is described in more detail later in this manual. Audio Prompts Option Checking or unchecking the Audio Prompts box enables / disables the playing of any prompts associated with the schedule. (More details on schedules are provided later in the manual.) This feature is most often used in pre-configured assessment protocols that use audio prompts from the computer to instruct the patient / subject / examinee through an assessment procedure.
  • 19. 19 Set-Up Period – Checking Signal Quality The Set-Up Period allows viewing the signals before formally beginning the session (no data is being saved). This provides an opportunity to make sure that the sensors are attached correctly and to adjust the scaling of the display using the [Graph Settings] button. Starting the Session • Select the [Start Session] button when ready to begin. In the display above, the x-axis represents time in seconds. The y-axis displays the magnitude of EMG activity quantified in micro- volts. The numbers under EMG 1 and EMG 2 show the current reading for each.
  • 20. 20 Automatic Trial Markers (Schedule Mode) The relaxation protocol shown below uses a“Schedule”that divides data collection up into 60 second Trials. A vertical marker appears on screen at the start of each Trial and is inserted into the data file. Setting Trial Markers (Protocol Without Schedule) If the protocol is not using a schedule, a mark can be created at a specific time by clicking the [ Start Trial ] button. This can be used to define specific events. The example above is from a recording of the flexor and extensor muscle groups of the left forearm and markers are being used to indicate alternating flexion and extension trials. Using the Measure Buttons to Hide Signals The graphic display for active measures can be turned on or off by clicking on the measure button. When a button is selected (in position), the measure is displayed on the graphics screen. When the button is unselected (out position), the measure is not displayed on the graphics screen. This only applies to measures that are activated by the original protocol settings. If a measure is not set to on by the source protocol, it cannot be turned on after the protocol starts.
  • 21. 21 Advanced Note: Turning the measure’s graphic display on or off has no effect on data collection. Data is collected for all active measures regardless of whether they are displayed graphically or not. In the same way, it does not matter if a graphic signal goes off the screen. Data is always collected at the full range of the instrument regardless of how the graphic display is set-up. Example of Real-Time Screen from NeuroSystem 2 The screen above is from a NeuroSystem 2 showing the Blood Volume Pulse Wave (using a Photoelectric Plethysmograph sensor; PPG), Skin Temperature, Skin Conductance Level (SCL), Skin Conductance Response (SCR), two channels of EMG activity, and the Respiration wave form. Pulse Height, Inter-Beat-Interval (IBI) and Heart Rate data can be extracted from the PPG signal and dis- played on screen (the measurements you collect and available signals may differ depending on the type of hardware).
  • 22. 22 Pause Feature • To pause the display, just select the [Pause] button. The display will pause and the button label changes to [Resume]. Select the button again to resume the session. Exiting • To exit the program, use the [End Session] button in the lower right hand corner of the screen or the in the upper right hand corner of the screen.
  • 23. 23 A Trial Schedule vs. Free-Form Recording As mentioned previously, a protocol can include a schedule that predefines data collection periods or it can run in a“free form” mode. Free-Form means that the data collection trials can be indicated as the session runs by selecting the [Start Trial] button each time a new Trial Marker is desired. In other situations, it may be known ahead of time exactly to structure a session. A protocol may include a script called a“Schedule.” A Schedule predefines the maximum number of Trials to be run and duration for each Trial. Schedules are created and stored per protocol. Schedule management is accessed from the Protocol editor. The EMG dual Relaxation Manual Goal protocol automatically inserts Trial Markers every 60 seconds. This type of schedule is useful during biofeedback assisted relaxation training to divide a session up into equal length trials. A schedule might also be used to predefine a specific assessment / training session consisting of pre-named conditions. For example, a schedule might specify a 2 minute baseline recording followed by a series of alternating trials of 2 second contractions followed 5 second recovery periods. In addition to defining the number and length of Trials, a schedule can assign names to the Trials that appear as on-screen prompts for the clinician and/or the patient, or to be included in printed reports to identify the data collection periods. Other advanced schedule options include the ability to assign audio prompts / stimuli to specific trials as well as the ability to display graphic images on the screen that are triggered by specific trials. (Details on creating schedules are provided later in this manual.) If running a protocol with a schedule, the session can always end a Trial early and advance to the next Trial by selecting the [Start Trial] button. This can be useful in a variety of situations. A physiatrist, physical therapist, occupational therapist or other rehabilitation specialist doing muscle reeducation work might carry out an assessment / training session that includes pre-defined functional movements. A schedule may be constructed that specifies the maximum amount of time that might be required to carry out a specific movement. The patient is then prompted to start the movement and the therapist can advance to the next task using the [Start Trial] button as soon as the movement is completed. A clinician doing biofeedback assisted relaxation training might do this in the context of a structured interview with predefined topics, looking at the level of reactivity associated with each content area. Again, the [Start Trial] button may be used to advance to the next data collection period as soon as the interview shifts from one topic to the next.
  • 24. 24 Adjusting Display Settings During a Session The [Graph Settings] button may be used to adjust the characteristics of the display including: changing the scales for displaying measures, adding grid lines, shifting from linear to logarithmic displays, etc. (Details on these features are provided later in the manual.) The [Clipboard] button can be used to copy the current screen image so it can be“pasted”into a word processor document.
  • 25. 25 Setting a Training Goal / Threshold • To set a training goal (reinforcement threshold) for biofeedback training, select the [Goal / Audio] button. • Change the Threshold Adjustment to Manual. • Use the Channel Selection pull down to select the desired physiological measure. • Select Below Goal to train signals below the Goal (such as lowering EMG levels when doing relaxation training). • Set the Thresh (Threshold Value) by entering a number in the Thresh box. The number corresponds to the physiological value to be used as the training goal. The goal is set to 100 microvolts in this example. The goal level can be adjusted as needed as the session progresses or the goal adjustment can be set to Automatic (see next page).
  • 26. 26 Changing the Graph Color as Feedback • The Change Graph Color option will set the background to light red when the goal is not being met and to light green Automatic Goal Adjustment Option The initial training goal is typically set in the Automatic mode. When Automatic is set, the computer will automatically adjust the goal each trial based on the patient’s performance. A Make Easier setting of 50 means that the goal will be made easier if the patient meets goal less than 50% of time during a trial. A Make Harder setting of 90% means that the goal will only be made more challenging if the patient shows a mastery of the skill by obtaining goal more than 90% of the time. When a new goal is set by the Automatic Goal function, it adjusts the goal proportionally to the amount of change shown by the patient using the following formula:
  • 27. 27 New Goal = (Old Goal + Mean Value for Trial) / 2 This will place the new goal halfway between the old goal and the mean level the patient obtained for the trial that was just completed. Audio Tone Option Selecting the Tone from Computer Speaker option provides a tone that varies in pitch as the physiological signal increases and decreases in numeric value. Normally, the tone increases in pitch as signals increase on screen. The Invert option reverses this logic. The maximum and minimum frequency (pitch) of the audio tone and set the magnitude of signal change required to produce a change in tone can be selected. There are approximately 150 display points on the vertical graphic display. If the setting is left at 1, then the tone will change each time the visual display changes by a display single point. If the value is increased to say, 4, then the display must change 4 points before the tone changes in pitch. Using larger numbers results in more discrete steps in tone change and smaller numbers will produce a more sensitive (but jumpy) tone.
  • 28. 28 Changing the Display Type The previous screens showed the standard Strip Chart display. Click the arrow on the Display Type window on the lower left hand side of the screen. This will display a pull-down menu of alternate display types: Area Graph The Area Graph example above provides a bold display that fills in the signal magnitude with color. Combined Pie The Combined Pie example above can be useful in looking at the relative activity level of two muscles. If the activity level of the two muscles is equal (balanced), then the pie is evenly divided. The Individual Pie display is shown on the next page.
  • 29. 29 Individual Pie Bar Chart Bar displays can be used to emphasize balance or imbalance in real-time. Stacking Bar The Stacking Bar display provides another way of looking at balance.
  • 30. 30 Ending A Session • A session is ended by selecting the [End Session] button that appears in the lower right hand corner of the screen. The options are displayed to: Save Session, Discard Session, or Resume Session. Saving Session Data • Select [Save Session] to save the data.
  • 31. 31 Session Notes A prompt to enter session notes appears when the session ends. If Yes is selected, the Session Notes screen shown below appears. The notes file may be used to save observations that are intended for the clinician’s reference or the file may be used to enter formal notes that are automatically inserted into a printed report. Session Notes can also be entered later by going to Patient Management and View Sessions. • Select [View Session Results] to review the session data or print a report.
  • 32. 32 Reviewing Data and Printing a Report – Basic Features The Review Session screen above provides extensive options for displaying the session results and for generating reports. The most commonly used features are: [Summary Graph] Displays summary data for each Trial. Mean values are plotted by default. Measures may be hidden to highlight particular signals. [Full Session Graph] Condenses the data from an entire session into a single screen. A zoom function can expand and high light any portion of the graph. Measures may be hidden to highlight particular signals. [Add/Edit Notes] Allows entry or edit of session notes. The Display Session Notes check box allows the notes to remain hidden, in the chance the notes are to remain private. Note, this checkbox does not add/remove the comments from the report; this must be done using the report editor (via Set Report Options). The [Print/Edit Report using MS Word] button is used to create a report. The [Set Report Options] button accesses the Report Options screen which allows for customization of the report appearance. If MS Word is not installed on the computer, use the [Report Viewer] button to create a report.
  • 33. 33 Session Summary Graph The [Summary Graph] reduces the data to descriptive statistics for each Trial. In the example above from a relaxation training session, the Mean values for each trial are displayed. The buttons along the left hand side of the screen allows the selection of; Mean, Minimum, Maximum, and Standard Deviation values. The appearance of the graph can be adjusted using theY1 andY2 scale settings; use the [Apply] button after entering the new scale values The [Copy to Clipboard] button is useful for making copies of the graph for PowerPoint presentations and other applications.
  • 34. 34 Chart Type lets selects between line and bar style displays.
  • 35. 35 Full Session Graph The Full Session Graph reduces data from a session so that it fits on a single screen. The [Display Settings] button may be used to adjust scaling and other characteristics of the display. Use the [End Session] button to exit. [Strip Chart] Strip Chart, Bar, Pie, Area and other graph types may be selected to display the data. [Copy Clipboard] copies of the image for pasting into other documents.
  • 36. 36 Zoom Function To use the Zoom function on any of the graphic display screens, move the mouse pointer to a section to enlarge. Hold down the Shift key, click on the left mouse button and, while holding down on the mouse button, drag the mouse pointer across the screen to define the section to enlarge. Releasing the mouse button causes the screen to resize as in the example above. • Press the R key to“Restore”the display Replay Buttons [Replay Scrolling] replays the session like a video tape and [Replay Screen] redisplays the session one screen at a time. All of the functions described for Summary Graph work for the Replay graphs, including the zoom function. Note: If zoomed in on a portion of the summary graph, exit from the summary graph, and then attempt to replay the session using one of the Replay options, the file is not automatically reset to a“zero state”. This can be avoided by using the restore“r”key to reset the summary graph before exiting.
  • 37. 37 Table Displays Summary Table Summarize Trial data for all measures by Mean, Standard Deviation, Minimum, or Maximum values in Table or Graph format. Detail Table Detailed listing by individual measure of Mean, Standard Deviation, Minimum, and Maximum values for each trial in Table or Graph format. In the Summary Table example shown above, the Mean values for each measure (EMG1, EMG2) are shown listed by Trial. Selecting the [Min.] button on the left hand side of the screen will change the Table to a listing of Minimum values for each Trial. If the Detailed Table is displayed, all the descriptive statistics for an individual measure (i.e. EMG1) are displayed for each Trial. Buttons along the left hand side of the screen allow for changing the Table to a listing of data for any given measure. [Graph Data] Calls up the same Summary Graph display that is available from the Review Results screen. [Export Data] Allows for the export of the complete session data to Excel, a statistical analysis program, database, or other program.
  • 38. 38 Printing a Report for the First Time Report Type The Standard Report type includes graphs from the session and tables listing descriptive data. It also allows for insertion of text from Report Templates, insertion of text from the notes file, as well as entering additional text using Microsoft Word. The other ReportTypes are custom reports that assume a specific protocol consisting of predefined sensor placements and requests for patients to go through specific actions. Special calculations are made on the data set and appropriate analyses inserted into the report. Report Template The Basic Report template insets in limited amount of standard text into the report. The EMG dual includes a few comments on EMG. Additional Report Templates are provided with the system for specific applications. • Select the [Set Report Options] button.
  • 39. 39 Report Options Screen The Report Options screen allows for customization of the report appearance. As seen in the screen above, options included specifying inclusion graph, the type of graph, whether text from the session notes file is inserted into the report, if table data is to be included, etc. • Report Option settings are saved and used the next time a report is created. • Select the [Close] button. • Select the [Print / Edit Report in MS Word] button. If Microsoft Word is not installed on the computer, use the [Report Viewer] to view and print reports.
  • 40. 40 Opening a Report in MS Word The screen above shows a report that has been loaded into MS Word. • Since the report is loaded into the MS Word or similar word-processing program, text and be edited. Printing the Report • To print the report“as is”, just select the Printer Icon from the menu bar near the top of the screen or go to the File menu and select Print. An example report is shown on the next page. Although not shown in the example, data tables listing the mean, minimum, maximum, and standard deviation values for each trial for each measure may be included in the report. If trials were assigned to a group, then the grouped statistics can be calculated and inserted into the report.
  • 41. 41 Example Report NeuroGraph Report Patient Maple Jaudke Clinician New Nurse DOB 05/31/2012 Gender Not Entered Session Date 05/31/12 Session Start Time 12:04:49 PM Session End Time 12:07:42 PM Protocol EMG (Dual) Relaxation Training Muscle activity was monitored by non-invasive surface electromyography (EMG) using a Zynex NeuroDiagnostics System/3 instrumentation unit and computer interface. EMG values are quantified in microvolts (RMS). Measures Site Names EMG 1 Left Forearm Extensor EMG 2 Left Forearm Flexor Notes from the Session Notes file can be automatically inserted here or elsewhere in the report. You can also type notes directly into any part of the report. Standard blocks of text can be automatically inserted into various locations using the Template options. Table data will appear in the report if a table is specified in the option settings. An example of the optional signature line is shown below. New Nurse Clinic Director
  • 42. 42 Inserting Additional Graphs in a Report 1. Open a report in MS Word. The standard report interface allows the selected graph to be automatically inserted into the report. 2. Once the report appears in MS Word, (or other word processing program) Minimize the window. 3. The Review Session screen will appear. Select a button for one of the graphic display options (i.e. [Summary Graph], [Full Session Graph], [Replay]). 4. Make any desired adjustments (such as changing scales or hiding one or more of the measures). Then select [Copy to Clipboard]. This will copy an image of the graph into the computer’s“clipboard”memory. 5. Navigate back to the Word document and paste the graph in the desired location.
  • 43. 43 Creating Reports in the Future As mentioned above, the Report Options settings are saved until changed. This means that the next time a report is created, simply selecting the [Print/Edit Report using MS Word] button shown above and the report will be loaded into the default word processing program using the previously entered Report settings.
  • 44. 44 Reviewing Data and Printing a Report – Detailed Options Reviewing a Saved Session • Select the [Reports] button from the Main Menu screen • Select the [View Sessions] button to review the details of a previous session. Delete Session • The [Delete Session] button is used to delete a session. Add / View Session Notes • The [Add/View Session Notes] button allows editing of session notes.
  • 45. 45 Review Session Screen Graphs & Tables As described previously, the session can be reviewed by using the Summary Table, Detailed Table, Summary Graph and other listed buttons. Color Selections Graphic displays are normally generated using the color settings defined for a specific protocol (Protocol Specific Colors). There is also the option to select the system Standard Colors or Local Color settings. Printing Reports If the Report Options settings have previously been set to a desired report layout, then simply select the [Print/Edit Report using MS Word] button to create a report. Some of the advanced features of the data review and report generation interface are discussed below.
  • 46. 46 Report Options The Report Options interface appears when selecting the [Set Report Options] button. It allows report customization. Any settings will be saved for the next time a report is generated. The option names on the interface clearly define their function. Report Type Standard Printed Report should be selected unless the specific assessment protocols listed was run. Include Notes This option allows automatic insert of any text previously entered in the Notes file directly into the report in one of 3 specific locations. Additional comments may be added directly into the report when converted to MS Word format. Include Signature Line The signature line option inserts a line for a signature along with the Clinician’s Name and Title. Select Graph for Report Options are No Graph, Summary Graph, Full Session Graph, and Clipboard Contents. The Summary Graph displays the means for each measure for each trial or condition. Full Session Graph displays the full signal (raw data) for each measure for the entire session condensed into a single graph. Both of these graphs use the scaling and other display settings that were in place when the data was saved and are the same graphs that are displayed using the [Summary Graph] and [Full Session Graph] buttons from the Review Session screen. To adjust how a graph will appear in the report, then go to the graph using the [Summary Graph] or [Full Session Graph] button, adjust the settings, then select the [Copy to Clipboard] button. This will place the modified graph in the computer’s clipboard memory. Then go to Report Options and select the Clipboard Contents option for the Graph Type. This will cause the graph in the clipboard memory to be inserted in the report.
  • 47. 47 Graph Location in Report This option allows selection of where in the report the graph will appear. As described earlier in this manual, once the report is open with a word processor (MS Word), any graphic display screen can be pasted into the report using the [Copy to Clipboard] option. Select Template If the Include Text from Template option is selected, the software will insert text from the specified template into the report. The software comes with several pre-configured templates. Alternatively, the [Edit] option allows for creation of custom report templates. Additional detail is provided later in this section. Include Data Values Options are provided to insert tables into the report that list the Mean, Maximum, Minimum, and Standard Deviation values for each measure for each trial or condition. Select Channels to Include in Report There may be times when it is desired to exclude table data from all the measures that were turn-on during the session. Measurements can be included or excluded from the report by selecting them. Grouped Analysis This section only has meaning if the recorded session included a schedule that assigned one or more trials to numbered groups. A clinician might be interested in grouping together flexion motions and extension motions, or contraction conditions and rest conditions using a grouping variable. Another clinician may carry out an assessment that includes alternating periods of “stressors”and relaxation periods. If data collection was divided into groups by the schedule, the Descriptive Stats option will combine together all of the trials for each designated group and generate descriptive statistics (mean, minimum, maximum, and standard deviation). This means, that in addition to having a table that shows the individual maximum contraction values for each trial, that a mean (averaged) maximum contraction value for all contraction trials can be calculated and displayed in the report. The Ratio Calculations option calculates the ratios of the various data groupings. For example, providing the ratio of extension over flexion for a series of flexion / extension trials. The List Trial Numbers option displays the individual trials that make up each defined group. Any changes made on the Report Options screen are saved for ease of making reports in the future.
  • 48. 48
  • 49. 49 Report Templates Templates are blocks of text that may be inserted into a report. Several generic and assessment specific templates are provided with the software. The Template Editor can be used to make new templates, either by cloning an existing template and editing it or by creating a new template from scratch. Source templates provided by Zynex® NeuroDiagnostics may not be edited directly, but they can be cloned and the clones can be edited. Template Editor To edit or clone an existing template, or to create a new template, from the pull-down template list and select the [Edit] button. Additional text can be added to the template, replace existing text, or copy text from an existing report and paste it into the template. The screen above was opened using the“Basic Template with EMG”template. Since this is a Zynex® NeuroDiagnostics source template, it can not be modified but can be“cloned”by typing in any desired changes. • Enter desired text into the Template Editor. • Select the option to Save Changes to New Template. • Enter a name for the new template. • Select [Save Changes] before leaving the editor. Templates support multiple text blocks. Each subsequent block is inserted lower in the report so that text may be configured to appear as an introduction, before or after a graph, etc.
  • 50. 50 Exporting Data to Other Applications The software supports exporting of both raw data and descriptive statistics. Automatic exporting to MS Excel and other common database and statistical packages is supported. Export options are: Means Mean values for each measure for each Trial / Condition Full Statistics Mean, Min, Max and Standard Deviation values for each measure for each Trial / Condition Raw Data Each individual data point with each measure in a column and each row representing a sample at what ever sample rate was used to collect the data. (There files can be quite large. A sample rate of 100 samples per second will produce a file with 100 lines of raw data per second of collection time.) • From either the Summary or Detailed Data Table, select the [Export Data] button. • Select one of the 4 Export options.
  • 51. 51 • Select the application to open the exported data. The Microsoft Excel option loads the data directly into an Excel spreadsheet. The Notepad loads that data file into Notepad (this will only work for small files). The Custom Tool option provides access to any installed Windows application.
  • 52. 52 NeuroGraph™ in Detail – The Main Menu The Main Menu displays buttons that provide access to all of NeuroGraph’s features: [Select Patient] Select a patient from currently registered Patients. Also has a link to the Patient Management screen. [Patient Management] Select the Current Patient, Enter a New Patient into the database, Edit Patient information, Delete Patients, View Patient Records including data from Physiological Monitoring Sessions. [Reports] Used to access previous sessions per patient. The details of each previously saved session can be accessed, and reports can be created. [Run Current Protocol] The system remembers the last protocol that was run. This is called the“Current Protocol”and its’name is displayed in the lower right hand side of the screen. Select this button to run the Current Protocol. [Select New Protocol] Displays a list of pre-programmed protocols. Use this option to select a protocol other than the current protocol to run. (Protocols can be edited, added, or removed from the protocol listing using the Edit / Make Protocol option below.) [Edit / Make Protocol] Displays the list of protocols and provides options for editing existing protocols, creating new protocols, and deleting unused protocols. [Change User] If there are multiple clinical users registered in the software, this allows for changing users. The current user is signed out, and the software prompts to select the desired user. [Change Application] If multiple NeuroDynamix™ applications are installed on the system, this feature allows the user to switch between applications. [System Options] Select from a list of options.
  • 53. 53 Site Information Edit clinic contact information Clinical Management Edit/Add clinician software Users Password Protection Set or clear levels of password control Title Preferences Select title for Clinicians and Patients Confidentiality Options Set how information is displayed Miscellaneous Settings Background color and audio welcoming Gaze Tracker Settings Adjustments for Real Time Display Measure Site Settings Default anatomical measurement location Color Settings Default color per measurement lead Change Database Change location of database Create a New Database Create a new database location Backup/Restore Create or restore from a database backup Recover Data Recover lost data in current database Import/Export Data Import/Export Patient Session data Import/Export Schedule Import/Export Protocol Schedule data Instrument Configuration Change instrument or board type [Order Supplies] Contains instructions and a printable form for ordering supplies. [Exit] Exit the NeuroDynamix application.
  • 54. 54
  • 55. 55 Current Settings The Current Settings information is displayed in the lower center of the screen. Current Patient – Displays the name of the active patient record if a current patient has been selected. (The term, patient, is used in deference to clinical uses of the system. Obviously, the system may be used with“subjects”in research applications.) Clinician – Displays the name of the individual formally associated with data collection for this patient. Clinician Name may be included in some formal reports generated by the system. Individual sites need to determine if they wish to use“clinician name” to represent the individual actually operating the system or the individual ultimately responsible for the care of the patient. (The term, clinician, is used in deference to clinical uses of the system. The system may be used in research or educational applications where the operator is not a clinician.) Current Protocol – Displays the name of the most recently used or selected protocol.
  • 56. 56 Patient Management Selecting a Patient NeuroGraph™ requires selection of a Current Patient before running a physiological monitoring session. Select a patient by selecting the [Select Patient] button which opens the Select Current Patient screen. • Select [Select Patient] from the main menu screen. • Select a patient name from the list. • Select the [Select] button. • Select the [Return to Main Menu] button. Creating a New Patient Entry If the Current Patient Window is blank, simply start entering information on the new patient in the blanks provided. If a patient name is displayed, select the [Enter New Patient] button to begin a new entry. The minimum requirement is to enter Date of Birth. Additional information is optional and may be entered now or later. • After entering information for the new patient, select the [Create a Record Using this Information] button to add this information to the database then select the [Close] button.
  • 57. 57 Creating & Editing Protocols A protocol is a set of instructions that tells the software which physiological measures are to be monitored, whether data is to be saved, what colors will be used, and other configuration features. • Select [Edit / Make Protocol] button from the Main Menu. • To create a new protocol, select [Create New] button on Protocol Management screen shown above. [Edit Protocol] is used to look at or modify an existing protocol. Select [Create New] to open the NeuroGraph™ Settings screen as shown above. The measure names and number of measures may differ; the example above is from a NeuroDynamix configuration.
  • 58. 58 The NeuroGraph™ Settings screen is used to select the physiological measures (channels) and settings used during the session. These settings are saved as a protocol and can be selected from the Protocol Management window to run future sessions. In the examples below, a protocol name has been entered and descriptive text added. The Key Protocol box has also been checked. These features are explained below. Protocol Name This is a descriptive name that will appear on the Available Protocols list. Description This field allows entry of more detailed characteristics and intended use for the protocol. This could include information on how a session is to be conducted, instructions on how an assessment is to be carried out, etc. Key Protocol The system supports the concept of primary and secondary protocols. A primary or“Key”protocol is a protocol which is used frequently. If Key Protocol is not selected, the protocol will only appear when the Show All Protocols option is selected on the Protocol Management screen.
  • 59. 59 The example below is from a NeuroDynamix™ The Protocol window is divided into 3 tabs (General Settings, Display Settings, Goal/Audio Options). Sample Rate Sample Rate defines how fast (in samples per second) the computer reads data from the instrument. A setting of 20 will collect 20 samples per second per measure. The maximum practical sampling rate for the system will depend on the hardware unit. Sampling rates in the 20 to 100 samples per second range fit most data recording needs. Higher sampling rates are only useful for high resolution IBI measures (NeuroSystem™ & NeuroDynamix™ units). Display Rate Display rate determines how frequently (in seconds) the graphic display screen is updated. A setting of 10 will result in the display screen being updated 10 times a second. Display rates that update the screen at a rate of 5 to 10 times a second are typical for most applications. If the Sample Rate is higher than the display rate (which is likely for high resolution data for research purposes), each display point will represent the mean value for all data collected during the display period. For example, given a sample rate of 100 and a display rate of 10, a total of 10 data points per channel are collected and averaged to produce each display point. If the session is saved to a file, the higher resolution“raw”data is saved to disk, not the averaged values.
  • 60. 60 Measure Settings. Each of the physiological monitoring channels for the unit is represented in the“Measure Colors & Site Names”section. Select the Active checkbox for the desired measures for this monitoring session. To change the display color and anatomical location for a particular measure, select the button for that measure. A dialog for changing the color setting and location will appear. Color Settings: Standard, Local, and Custom Colors Standard colors are assigned to each measure. For example, EMG 1 is typically assigned dark green as a standard display color. Local standard color settings can be created and used by selecting the Local Colors option. Colors can also assigned specific to the protocol using the Measure Color buttons. Local Color settings are set through the System Options button on the Main Menu. Display Mode Allows for selection of“Average”,“Most Recent”, or“Burst”display mode. Average is the recommended setting, with this setting the values are averaged before displayed, resulting in a smooth real-time display. Burst mode displays the datapoints as they are received, resulting in a choppy display. Privileges Allows for selection of“Full Control”,“Change”, or“Read only”Full Control allows the user to full control to modify or delete the protocol once saved. Change control allows the user to change but not delete the protocol. Read only allows the user to use the Protocol but not to modify it.
  • 61. 61 Display Settings Display settings are on the second tab. Display Type Selection of the protocol’s default chart display type. Options are; Area Chart, Bar Chart, Individual Pie Chart, Combined Pie Chart, Strip Chart, and Stacked Bar Chart. Background Effect Selection of the Protocol’s default background. The background can be set to an Image or to a color. Data Display mode Selection of the Protocol’s X-axis display mode. User can set the data points per graph, which directly translates to how many seconds of data are displayed on the graph. The user can also set the protocols x-axis to either a time scale, or number of data points scale. Y1/Y2 Scale In the standard display modes, the Y scale defines the vertical scale of the display. This corresponds to the display range in physiological units The graphic display can support up to two display ranges for physiological units at the same time. Range Y1 is scaled on the left hand side of the display screen and range Y2 is scaled on the right hand side of the display screen. Select the Y2 check box per measurement to assign a measure to the Y2 scale. Multiple scales are generally used when more than one type of physiological measure is monitored at the same time. In the NeuroDynamix™ example, a reasonable scaling for the PPG signal and Skin Conductance Level (SCL) might be from 2 to 10 physiological units (micro-ohms) while scaling for a Temperature (T/R) sensor might be set from 70 to 100 physiological units (degrees F). In this example, SCL is assigned to Y1 and Temperature to Y2. The default setting for any measure is Y1; select the USE Y2 SCALE button to assign a measure to the Y2 scaling.
  • 62. 62 Logarithmic Plotting Allows the user to set the Protocol’s Y1 or Y2 scales to logarithmic plotting. Grid Lines Sets the Protocol’s graph to either show or not show grid lines per X-axis and Y-axis. Select Group / Make Group Active Some protocols have multiple graphs displayed simultaneously. Each graph corresponds to a Group. The Select Group drop down is used to set display parameters per group. The Make Group Active checkbox must be checked for each group which is to be displayed.
  • 63. 63 Goal/Audio Settings Goal settings, including audio goal settings, are on the second tab. Threshold Adjustment Allows user to set protocol’s default Threshold Adjustment to either Manual or Automatic, and set the % levels for“Make Easer” and“Make Harder”. When Automatic is set, the computer will automatically adjust the goal each trial based on the patient’s performance. A Make Easier setting of 50 means that the goal will be made easier if the patient meets goal less than 50% of time during a trial. A Make Harder setting of 90% means that the goal will only be made more challenging if the patient shows a mastery of the skill by obtaining goal more than 90% of the time. When a new goal is set by the Automatic Goal function, it adjusts the goal proportionally to the amount of change shown by the patient using the following formula: New Goal = (Old Goal + Mean Value for Trial) / 2 Thiswillplacethenewgoalhalfwaybetweentheoldgoalandthemeanlevelthepatientobtainedforthetrialthatwasjustcompleted.
  • 64. 64 Reward Criterion Allows the user to set the protocol’s reward criteria. This setting can play music from an external source (not available with all hardware units) and change the back ground color based on meeting all or any goals. Tone Feedback Selecting the Tone from Computer Speaker option provides a tone that varies in pitch as the physiological signal increases and decreases in numeric value. Normally, the tone increases in pitch as signals increase on screen. The Invert option reverses this logic. You can select the maximum and minimum frequency (pitch) of the audio tone and set the magnitude of signal change required to produce a change in tone. There are approximately 150 display points on the vertical graphic display. If the setting is left at 1, then the tone will change each time the visual display changes by a display single point. If the value is increased to say, 4, then the display must change 4 points before the tone changes in pitch. Using larger numbers results in more discrete steps in tone change and smaller numbers will produce a more sensitive (but jumpy) tone. Save Settings Selecting this button will save all changes. Close Selecting this button will close the Settings window.
  • 65. 65 Real-Time Display Screen Features This section goes into detail on selected features of the Real-Time display. [Measure Buttons] PPG, EMG, SCL, etc... – selecting a button makes the graphic display for a measure alternately“disappear” or“appear”on the screen (only works on measures selected in the protocol). Hiding a measure by “unselecting”a button does not affect data collection. Data for that measure is still saved and the numeric values will still display next to the button. [Display Type] Select from a list of display types including Strip Chart, Area Graph, Bar Graph, Pie, Combined Pie [Display Settings] Select this button to access the Chart Options. Allows changes to the display scales and many other features. See next page for details [Goal/Audio] Set Training Goals, support for music feedback, audio tone feedback, Threshold display lines [Pause] Pause the session. Click again to Resume [Start Session] Start current session – button changes to End Session after session is started [Start Trial] Manually advance to the next Trial and place a marker line on the screen and in the data file [End Session] End current session – options to save or delete data are provided [Clipboard] Copy the current graphic screen to clipboard so image can be pasted into a word processing document [Full Screen] Switch to full screen display, button changes to Small screen after pushed and in full screen mode
  • 66. 66 Graph Settings Logarithmic (or Linear) Plotting Defines whether the Y1 and Y2 axis use a linear or logarithmic scaling of data values. Most measures are normally displayed in linear (equally spaced intervals, like a ruler) mode. It is sometimes useful to display EMG values in a logarithmic mode when it is desired to have high resolution at the low end of the scale and wide dynamic range at the upper end of the scale. Grid Lines Supports adding Grid lines on the screen for the Horizontal (for the Y axis) and/or Vertical (for the X axis) axis. These can be set to either Solid or Dots. The color of the grid lines can also be selected Background Effect The background of the graph can either be set to an image or to a color.
  • 67. 67 Slowing or Speeding-Up the Display The time it takes a signal to scroll across the screen is a function of the displayed data points, specified for the screen by the Points per Graph setting. Flow across the screen can be increased by decreasing the number of points specified for the Points per Graph. Flow can be slowed by increasing the number of points to be displayed. Time Scale / Data Points When Time Scale is selected, the axis paralleling the signal is labeled in units of time (seconds). When Data Points is selected, this axis is labeled in terms of data points. Scale – Y1 & Y2 Max and Min This interface allows setting the Minimum and Maximum points for the scaling of the graphic display. In the standard horizontal display, each measure is assigned to either the Left side scale (Y1) or the Right side scale (Y2). Notice that each Measure button has an“ x ”on either the left or right side; this indicates which scale is being used for that measure. Note 1: Data is not lost if a measure goes off the display. Data is always collected across the full range of values. Note 2: Some display types, like Bar and Pie only support minimum values of 0. Other display types, like EMG and T/R allow setting minimum values greater than 0. Show Time When checked, Session Time and Trial Time clocks appear on the screen. These clocks represent elapsed data collection time for the overall session and for the current trial, respectively. Display Markers When a session is running, these settings will turn on/off the Group and Trial Markers, indicating where each occurs on the graph.
  • 68. 68 Advanced Features - Schedules A protocol can call an advanced feature called a“Schedule”. Schedules support a number of advanced features including: • Predefining the Number of Trials to run and the duration of the Trials • Assign Names to the Trials with the option to display them on the screen and save them for use in printed reports • Allows grouping Group Trials together to obtain grouped statistics. • Allows selection of Graphic Images (pictures on screen) as prompts or stimuli for selected Trials • Allows selection of Audio Prompts (sounds or spoken instructions) for selected Trials NeuroGraph™’s Schedules are constructed using the Schedule Editor – no programming knowledge or experience is required. Once a Schedule has been created, it can be used by more than one protocol. Protocol Editor – NeuroGraph™ Settings • Select a protocol from the Protocol Manager screen (or create a new protocol) and go to the Protocol Editor screen (shown above). • Select the [Schedule Settings] button.
  • 69. 69 Creating a New Schedule • To create a new schedule, select the [Create New] button. • Enter a title in the Name box. • (Optional) Enter a description of the schedule in the Description box. • Enter the first Trial time in seconds in the Duration in Seconds box.
  • 70. 70 Defining the First Trial / Condition • Select the [New] button. Selecting the [New] button created the first trial in the schedule listing and assigned the duration in seconds. • If the next trial should have the same duration, select [New] again. • If the next trial should have a different duration to, change the setting in the Duration in Seconds box and then select [New]. • To create multiple trials of the same duration, just keep selecting the [New] button. Continue adding trials until the desired number of trials for this schedule is accomplished. If it is unknown how long a trial is to run, assign a number that is larger than the maximum amount of time likely to be needed. When the session is running, the user can always advance to the next trial early by selecting the [Start Trial] button. • When the desired number of trials is reached, select [Save]. • To set advanced features, such as assigning a name to a Trial, assigning an audio or graphic prompt / stimulus, or to change the duration of a Trial, double click on the Trial number. (This is explained in more detail later in this section.)
  • 71. 71 Additional Schedule Settings Specify Set-Up Period Settings – If this box is checked, then the [Settings] button can be used to define graphic and / or audio prompts for the set-up period. (See next section for more detail.) Audio Prompts – This setting controls whether audio prompts defined in the trial schedule are played. This setting can be changed while running a session using the checkbox on the real-time display screen. Show Signal – When this box is checked, signals are displayed on screen during trials. If this box is unchecked, then signals are not displayed; this is normally done when the display screen is used to present graphic stimuli on screen and physiological data is be- ing recorded in the background. This setting can be changed while running a session using the checkbox on the real-time display screen. Play Wave file once – This setting controls whether wave files for given Trials are played once or as a continuous loop. If an audio file is used as a prompt or instruction to a patient, then this box is normally checked. If the wave file contains music or other stimulus that plays continuously, then“uncheck”this box. [Insert] button may be used to insert additional trials anywhere in a trial list. [Delete] button may be used to remove trials anywhere in a trial list. Save any desired changes with the [Save] button
  • 72. 72 Example Schedule with Trial Names & Group Assignment The example above makes use of a variety of Advanced Schedule features. See next page for details. • To set advanced features, such as assigning a name to a Trial, assigning an audio or graphic prompt / stimulus, or to change the duration of a Trial, double click on the Trial number. (See next page.)
  • 73. 73 Setting Advanced Trial Features Duration Defines the maximum trial duration in seconds Short Name A descriptive name for the trial to be used in the session report (optional) Display Short Name Setting this option allows the Short Trial Name to appear on the bottom of the Trial screen to help the operator follow the flow of the session (optional) Long Name Feature not active in 6.0 Text to Display Text entered here will appear in the center of the screen during the trial and can be used as a prompt for the operator or the patient (optional) Group Associate Trials into Groups by assigning a Group number (1, 2, etc.) (optional). Group Feature - If a schedule involves a series of repetitive movements separated by rest periods, assign all the action Trials to Group 1 and all Rest Trials to Group 2. If the Group feature is used, options are given in reports to generate descriptive statistics for the Grouped data. Graphic Images can be added as prompts or as stimuli to a trial. The current software release supports .bmp format graphic images. Audio Wave files can also be used as prompts or stimuli. The folder (directory) Zynex® NeuroDiagnostics Library contains audio files and some graphic images which may use for constructing schedules. Select from the voice prompts in the Zynex® NeuroDiagnostics Library, download .wav files from the internet, or use a microphone and a sound input program to record custom voice prompts.
  • 74. 74 Important Note on File Names File names for .wav and .bmp files may be of any length, however, only the first 6 characters of the file name are recognized by the schedule interface. If the first 6 characters of two file names are the same, the schedule sees the file names as the same. Therefore, it is important that file names that are saved in the same directory differ by at least one of the first 6 characters. Select the [Close] button when done making changes. Remember to use the [Save] button when returning to the main Schedule screen.
  • 75. 75 Set-Up Period Settings Selecting the Specify Set-Up Period Settings box and the [Settings] button displays the settings interface for the set-up period. The Trial Time is shown as“0”because the length of the set-up period is undefined – it will continue until the [Start Session] button is selected. The Wave File and Graphic Image windows may be used to assign an audio wave file and/or a graphic image to the set-up period. These may be used to provide instructions for the operator or the subject / patient. Browsing to the Zynex® NeuroDiagnostics LibraryImage FilesStandard folder displays several standard set-up period graphic images, including the file SetUpGray.BMP which is the file that provides the text“Set-Up Period”that appears in many protocols.
  • 76. 76 Saving the Schedule • When the schedule is complete, select [Save] and then [Close]. • Select [Close] again when the Schedule Management screen appears. • Select the schedule name from the Select Schedule list. • Check the Enable Schedule box. (If this is not checked, the schedule is not activated for this protocol.) • Select the [Save Protocol] button.
  • 77. 77 Notes
  • 78. 78 NeuroDynamix™ NeuroGraph™ © 2012 - All Rights Reserved PN 400705 · Rev00