Cadwell Sierra Wave EMG Guide

Getting Started Guide
Version 10
Table Of Contents
Getting Started - The Basics ........................................................................................................... 1
Turning Equipment On and Off ................................................................................................... 1
Starting the Sierra Wave Program .............................................................................................. 2
Starting a New Exam and entering Patient Information .............................................................. 2
Selecting a Study or Test Protocol.............................................................................................. 5
Description of Screen Layout ...................................................................................................... 7
Using the Study Window ........................................................................................................... 18
NCV - Basic Operation .............................................................................................................. 21
EMG - Basic Operation ............................................................................................................. 28
F/H Basic Operation .................................................................................................................. 38
RNS - Basic Operation .............................................................................................................. 43
Blink - Basic Operation.............................................................................................................. 52
SEP - Basic Operation .............................................................................................................. 57
AEP - Basic Operation .............................................................................................................. 66
VEP - Basic Operation .............................................................................................................. 76
P300 - Basic Operation ............................................................................................................. 85
The TabData Window................................................................................................................ 95
Generating A Report ............................................................................................................... 101
Closing the Patient Exam ........................................................................................................ 105
Closing the Sierra Wave Program........................................................................................... 105
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Getting Started - The Basics
Turning Equipment On and Off
To turn equipment On.
1. Connect the amplifier, stimulators, and other accessories (if not already
connected).
2. Turn equipment on in the following order:
• Sierra Wave base unit
• Monitor (for desktop configuration only)
• Printer
• Computer
If you are using the isolation transformer and cart power switches, you will need
to turn on the cart power switch and then the computer.
To turn the equipment Off.
Do not turn the Sierra Wave instrument base on or off while a patient is
connected.
Turn off equipment in the following order:
1. Close all programs that are running on the computer.
2. On the Windows taskbar, click Start, Shutdown, Turn Off the Computer.
3. Turn off the Sierra Wave base unit, Monitor (for desktop configuration only), and
Printer.
If you are using the isolation transformer and cart power switches, turn off
only the cart power switch after you have shutdown the computer. The monitor,
printer, Wave base unit, and isolation transformer power switches can remain on.
The next time you start the system, turn on the cart power switch and then the
computer.
You do not need to disconnect the amplifier, stimulators, or accessories. You

can leave them connected.
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Starting the Sierra Wave Program

To Start the Sierra Wave program
Start the Sierra Wave software on your computer in one of the following ways:
• Double-click the Sierra Wave icon on the Windows desktop.
• Click the Windows Start button, select All Programs, Cadwell, and then Sierra
Wave.
If you receive a Communication Error message.

Close the Sierra Wave program and make sure the Sierra Wave base unit is turned On,
and that the network cable is attached securely between the computer and the Sierra
Wave base unit. Then, restart the Sierra Wave program.
If you are working on a Reader station (no acquisition hardware attached) the
communication error can be disabled. Click here for instructions on how to do this.
Starting a New Exam and entering Patient Information

To start a New Exam and enter Patient Information use one of the following methods.
• Press F1 - New Exam.

• Select Enter Patient Info from the File Menu.
• Press the Patient key on the Sierra Wave base unit.
• Select a Study or an individual Test Protocol from the Study/Test menu
All of these methods will display the following Patient Information Window.
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Patient Information window
A blinking cursor will automatically be displayed in the Last Name field. You can use
the tab key, mouse, or Knob #1 on the Sierra Wave base unit to move from field to
field.
At a minimum, you should enter a Last Name and First Name, this is what the
Sierra Wave program uses to create the patient's data file.
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The Test Date and Test Time will automatically be entered for you, and can be
modified if needed.
Height can be entered in the following units:
• Feet and Inches
• Centimeters (cm) - required when using the prediction equations in NCV, F

Wave, and H Reflex.
• Text (txt) - for backwards compatibility with older patient data or when using
different measurement units.
Weight can be entered in the following units:

• Pounds (lbs.)
• Kilograms (kg)
• Text (txt) - for backwards compatibility with older patient data or when using
different measurement units.
To use the Custom Information fields, you will need to click the mouse in the field prior
to entering information.
The Report Header can be selected from the drop-down list or by clicking on the
Browse button. The report header can also be selected from within the System Setup
window.
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The following buttons are shown at the bottom of the window:

F1- Load Patient Info: Allows previously entered patient information to be
loaded from a saved patient information file (*.cpi) or from a patient data file
(*.sd).
F2- Close & Save: Allows the entered patient information to be saved in a file, it
can later be retrieved using the Load button.
F3 - Start Exam: Saves the entered patient information and then displays the
Study Menu. You can then select the Study or individual Test protocol that you
would like to use.
F4 - Cancel: Closes the patient information window and discards all information.
The patient information can be edited at any time after starting an exam. Simply
press the Patient key on the Sierra Wave base unit, or select Patient Information from
the Edit menu.
You can also start an exam without entering any patient information. Simply select
F3 - Start Exam and go directly into the Study or Test Protocol and begin testing. If you
do not enter any patient information during the exam, the program will prompt you for it
when you close the patient's exam.
Selecting a Study or Test Protocol

There are various ways to select a Study or individual Test protocol.
From the Patient Information window:
Click the F3 - Start Exam button. The patient information will be saved and the
Study/Test menu will be automatically displayed. Use the mouse, or Knob #1 to
select a Study or an individual Test protocol.
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If a Study is selected, all the tests included in the Study will be displayed in the
Study window and the first test protocol listed in the Study will automatically be
initialized and will be ready for data acquisition.
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If an individual Test is selected, the test protocol will be loaded. If the test uses a
muscle or nerve list, this list will be displayed so you can choose the muscles or
nerves you wish to examine. Once selected, these nerves or muscles will be
displayed in the Study window.
Outside the Patient Information window:
Use the Study/Test menu or the Study keys on the Sierra Wave base unit.
• Click on the Study/Test menu with the mouse and then select the Study or Test
protocol of interest.
• Press the Select key on the Sierra Wave base unit. The Study/Test menu will
be displayed, use the mouse or Knob #1 to select the Study or individual Test
protocol of interest.
• Press the S1, S2, or S3 keys on the Sierra Wave base unit. The Study or Test
Protocol assigned to the key will be loaded.
Description of Screen Layout

The Sierra Wave screen is composed of three main windows; the Trace window, Study
window, and Measurements / Cursor Table window. The Amplifier / Stimulator
controls can be displayed in either a window or toolbar format. An optional Live
Monitor window is available in the NCV, F Wave, H-Reflex, Blink Reflex, and RNS test
protocols.
The bottom of the screen shows the current function key and knob assignments for
the Sierra Wave base unit.
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Sierra Wave Screen showing the Trace, Study, and Cursor Table windows, the Amplifier / Stimulator
Controls toolbar, and Live Monitor window.
The color scheme used throughout the help topics is Factory Default 1. For more
information on changing the Sierra Wave's color scheme go to the Color Editor topic.
Trace Window
The Trace window displays the electromyographic and evoked responses acquired
from the patient.
Live or Averaged traces are displayed in "white" color. Stored traces are displayed
in "purple" color. Traces that have been selected for manipulation are shown in
"yellow" color.
Pressing the View key on the Sierra Wave base unit will maximize the Trace window to
fill the entire screen. To return the Trace window to its original size & position, press the
View key a second time.
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The major divisions of this window are displayed in a white grid or dot pattern. The
Display Gain (vertical scale in microvolts per division) and Sweep Speed (horizontal
scale in milliseconds per division) are shown in the lower left and right of this window
respectively.
NCV Trace window
Trace Window Context Menu

In true Windows fashion, the Trace window supports a Context menu.
The Context menu, also known as the right click menu, is accessed by right
clicking the mouse anywhere over the trace window. The functions that are
available in the context menu will vary depending on the test protocol that is
currently loaded.
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Context menu for NCV Trace window.
Study Window
The Study window has several functions:

• Lists the test protocols that have been pre-selected and grouped into the
selected Study List (e.g., lists the tests for the Right Carpal Tunnel Study).
• Automatically adds to the list other test protocols, not originally part of the
Study list, as they are selected from the Study/Test menu or nerve and muscle
lists.
• Provides an easy way to change from one test protocol to another or go back
and review a previous test.
• Shows which test protocols have been completed by placing a checkmark on
the test protocol's icon.
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Use Knob #1 (Study Item), on the Sierra Wave base unit, to move the highlight up and
down through the Study window. If you stop the highlight on a test protocol for more
than 1.5 seconds, that protocol will be loaded.
Alternatively, click on a test protocol with the left mouse button to load it.
Study window.
Study Window Context Menu

The Study window has a Context menu, also known as the right click menu. It is
accessed by right clicking the mouse over a blank area within the Study window, or
by right clicking over a test protocol name. The functions that are available in the
context menu will vary depending on what you right clicked over.
When right clicking over a blank area, not over a test protocol name:
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When right clicking on a test protocol name:
Over an NCV test. Over an EMG test.
For more detailed information on using the Study Window, see the topic Study Window
Overview.
Controls Window or Controls Toolbar
The Amplifier & Stimulator controls can be configured in either a window or toolbar
format. This preference can be saved on a per test protocol basis. In software version
5.5 or higher, the default format is the Controls Toolbar enabled.
To turn the Controls Toolbar On or Off, select the option called "Test Control Bar" from
the View menu.
Controls Window
The Controls window displays the Amplifier, Averager, and Stimulator settings for
the test protocol. It also contains a Side control and buttons representing the same
Acquisition keys found on the Wave's base unit (i.e., Run/Stop, Single, Store, and
Clear). The current settings for the Footswitch and Programmable buttons on the
electrical stimulator can also be found here.
Blue colored and underlined items can be changed or edited by clicking on them
with the left mouse button. Drop down lists can also be changed by clicking on the
drop down arrow .
There is no Context menu for the Controls window.
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Controls Window for NCV test protocol.
Controls Toolbar
The Controls toolbar displays the Amplifier, Averager, Side, and Stimulator
settings for the test protocol in a toolbar format across the top of the screen. The
current settings for the Footswitch and Programmable buttons on the electrical
stimulator can also be found here.
Blue colored and underlined items can be changed or edited by clicking on them
with the left mouse button. Drop down lists can also be changed by clicking on the
drop down arrow .
Controls Toolbar for NCV test protocol.
Right click over the toolbar to turn Off/On various sections of the toolbar controls
and to change the Font Size.
Using the Toolbar format allows more room for the remaining windows.
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Measurements / Cursor Table Window
The Measurements / Cursor Table window has several functions.

• It displays the values for trace features that have been identified after
placement of the latency and amplitude markers or auto-cursors. The type of
table shown in this window will vary depending on the test protocol that is
currently selected.
• It displays the muscle scoring table in the EMG protocol.
• It displays the IP Analysis plots in the Interference Pattern Analysis mode.
• It displays the MUA Table in the Single Motor Unit Analysis (SMUA) mode.
NCV Tables window.
Measurements / Cursor Table Window Context Menu

In the EMG, NCV, and RNS test protocols the Measurements / Cursor Table window
supports the use of the Context menu.
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EMG Muscle Score Table Context menu.
Live Monitor Window
A Live Monitor window is available in the NCV, F Wave, H-Reflex, Blink Reflex, RNS,
and MUNE test protocols.
When this window is enabled it displays the “Live” activity coming from the recording
electrodes. When electrical stimulation occurs, the window will briefly display a
stimulus-triggered waveform, and then will go back to display “Live” activity after one
second.
This window can be positioned, sized, and saved as part of the default settings for the
test protocol.
To Enable the Live Monitor window:
1. Start the Sierra Wave program.
2. Select a test protocol, NCV for example.
3. From the Edit menu, select Current Test.
4. Click on the General Settings tab.
5. Check the box labeled, “Show Live Monitor”.
6. Click OK.
7. Adjust the size and positions of the windows on the screen.
8. From the Edit menu, select Save Test Parameters to update the default
settings for the test. From now on the test protocol will display the Live
Monitor Window.
The Gain and Sweep Speed of the Live Monitor window are the same as the main
Trace window.
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Function Keys F1 - F4
The bottom left of the screen shows the program functions currently assigned to the F1-
F4 function keys on the Sierra Wave base unit. These functions will vary depending on
the test protocol that is currently selected.
These functions can also change with the status of the test protocol. For example,
when you Stop the EMG trace, by pressing the Run/Stop button, the functions of the F1
& F2 keys change. When you return to Run mode, by pressing the Run/Stop button
again, the functions of these keys go back to their original settings.
In all test protocols, the F4 function key is reserved for TabData. Pressing this key will
display the TabData window which includes a list of all the tests performed on the
patient as well as various summary tables.
Some function keys toggle back and forth between two functions. The currently
selected function is displayed in bold text.
F1-F4 Function Keys for NCV test.
PC Toolbar (Function Keys F5 - F12)
Additional program functions can be accessed using the F5-F12 function keys on the
PC's keyboard. A PC function key toolbar, that shows the current assignments for
these additional function keys, can be enabled from the View menu. Simply select
View, then click on PC Function Key Menu.
The PC function key toolbar is displayed below the F1-F4 function keys on the screen.
PC Function Key Toolbar for the NCV test.
In all test protocols the F5 function key is assigned to Cursors, and the F6 function key
is assigned to Position. The remaining F7-F12 keys will vary depending on the test
protocol that is currently selected.
If you press F5-Cursors or F6-Position to enter these modes, simply press the function
key a second time, or press the OK key on the base unit to exit these modes when you
are finished using them.
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The PC function toolbar does not have to be visible to use the program functions
assigned to it.
Knobs 1 - 4
The bottom right of the screen shows the program functions currently assigned to the
four Knobs on the Sierra Wave base unit. These functions will vary depending on the
test protocol that is currently selected and the status of that test (i.e., running or
stopped).
The functions of the knobs also change if you enter the Cursor or Position mode by
pressing the F5 or F6 function keys.
Many knobs have dual functions. Pressing the knob will toggle back and forth between
the two functions. Once the appropriate function is selected, turn the knob to perform
that function
Initially in all test protocols, Knob #1 is reserved for selecting tests from the Study
window, Knob #4 is reserved for changing Gain and Sweep Speed settings.
Knobs that change parameters such as Gain, Sweep Speed, Intensity, or knobs that
move Cursors will display the associated value on the knob graphic.
Knob functions for NCV test.
All functions that can be done with the knobs can also be done using the mouse.
Pressing the ALT key on the PC keyboard or the Select key on the Wave base unit
will toggle Knob #1 to Select and Knob #2 to Move Left/Right. This allows the
program menus (File, Edit, View, Study/Test) at the top of the screen to be accessed
using these knobs. Press the ESC key on the PC keyboard or F4-Close Menu on the
Wave base unit to exit from this mode.
Knob changes as result of pressing ALT key.
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Using the Study Window

The Study window has several functions:
• Lists the test protocols that have been pre-selected and grouped into the
selected Study List (e.g., lists the tests for the Right Carpal Tunnel Study).
• Automatically adds to the list other test protocols, not originally part of the
Study list, as they are selected from the Study/Test menu or nerve and muscle
lists.
• Provides an easy way to change from one test protocol to another or go back
and review a previous test.
• Shows which test protocols have been completed by placing a checkmark on
the test protocol's icon.
To Select a Test within the Study window:

• Use Knob #1 (Study Item), on the Sierra Wave base unit, to move the highlight
up and down through the Study window. If you stop the highlight on a test
protocol for more than 1.5 seconds, that protocol will be loaded.
• Alternatively, click on a test protocol with the left mouse button to load it.
Study window.
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Study Window Context Menu

The Study window has a Context menu, also known as the right click menu. It is
accessed by right clicking the mouse over a blank area within the Study window, or
by right clicking over a test protocol name. The functions that are available in the
context menu will vary depending on what you right clicked over.
When right clicking over a blank area, not over a test protocol name:
When right clicking on a test protocol name:
Over an NCV test. Over an EMG test.
Test Types within the Study Window:

Each test protocol is indicated by a color coded icon. The Table below summarizes the
available tests and their associated icon.
Test Type: Icon: Description:
EMG Pink color with blue needle hub.
NCV Yellow color with CMAP trace.
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F Wave Green color with F Wave trace.
H Reflex Orange color with H Reflex trace.
RNS Violet color with RNS decrementing trace.
Blink Blue colored eye.
SFEMG Pink color with red needle hub.
SSFEMG (Stim-SFEMG) Pink color with violet needle hub.
Real Time SFEMG Pink color with red needle hub.
Macro EMG Pink color with red needle hub.
SEP Blue with bar electrode.
VEP Blue with checkerboard pattern.
AEP Blue with headphones.
P300 Blue with target.
RR Interval Red Heart
MUNE (MPS and Blue color with CMAP trace.

Incremental)
EMG Guidance Pink color with blue needle hub.
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NCV - Basic Operation

Select the NCV Test:
• If a Study has already been selected, simply click on a nerve name (i.e., Right
Median Motor) within the Study window or turn Knob #1 (Study Item / Site) to
highlight the nerve name.
• If a Study has not been selected, or you don't want to use a Study. Select
the individual NCV test protocol from the Study/Test menu, a nerve list will be
displayed allowing you to pick the nerve or nerves that you will be testing on the
patient.
Once the nerve has been selected. Follow these steps for performing routine
NCV data acquisition:
1. Verify Amplifier Settings
Check the Gain, Hicut, Locut, and Sweep Speed settings and make sure they are
appropriate for the nerve being tested.
Typical Settings
Gain Hicut Locut Sweep

(uV/Div) (Hz) (Hz) Speed
(ms/Div)
Motor Nerves 2k to 5k 10k 10 5.0
Sensory 10 to 20 2k 10 2.0
Nerves
2. Verify Side Setting

Make sure the appropriate side, Right or Left, is selected.
3. Verify Stimulation Sites and Segments
The selected nerve's recording site name, stimulation site names, and defined
segments are shown within the NCV Tables window.
Nerve name and recording site name.
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The Site table displays the stimulation site names, one per row. This table will
display the onset or peak latency, amplitude measurements, duration and area
measurements, and normal values. By default, the first stimulation site's row is
highlighted as soon as the nerve is selected. The name of this site also appears on
the active (white) trace's label.
Site table with Erbs stimulation site selected.
The Segment table displays the segments over which velocity calculations are to be
made. Each row in this table represents one segment. This table has a column for
entering distances and for displaying the calculated and normal velocity.
Segment table.
4. Electrode Placement
Attach the electrodes to the patient.
5. Check Stimulator Polarity
For Nerve Conductions Studies, the Cathode (-) should be oriented closest to the
recording electrodes.
The Cathode (i.e., the negative stimulus probe) can be selected by pressing the
Reverse Polarity (+/-) button on the electrical stimulator handle. A green LED
indicates the probe that is the Cathode.
Clicking on the Polarity field in the NCV Controls window or Controls Toolbar
can also reverse the stimulator polarity. The default (i.e., normal) mode has the
right-side probe as the Cathode (if holding the stimulator with the Stim button facing
you and the probes up); the reversed state will make the left-side probe the
Cathode. The image of the stimulator on the screen updates to indicate the selected
polarity as well.
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In the Normal mode, the electrical stimulator image on the screen will show the
Right-side probe as the Cathode (-). The polarity field on the screen will indicate
Nml.
Controls Window. Controls Toolbar.
Normal mode (right probe is Cathode).
In the Reversed mode, the electrical stimulator image on the screen will show the
Left-side probe as the cathode (-). The polarity field on the screen will indicate Rev.
Reversed mode (left probe is Cathode).
6. Stimulate the first Site

Increase the stimulus intensity level by turning the wheel on the electrical stimulator
handle. The intensity level (in milliamps) is displayed on the screen in a small
pop-up window and also in the Stimulator section. Once you have reached an
appropriate starting intensity apply the stimulator to the patient and deliver the
stimulus by pressing the Stim button on the electrical stimulator handle. The
stimulator light, located next to the intensity level on the Screen, will flash Green and
the patient's response will be displayed.
The Single key on the Sierra Wave base unit can also be used to deliver a
single stimulus. Intensity can also be adjusted using Knob #3 (Intensity / Pulse
Width) on the base unit.
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Continue to increase the intensity level and stimulate until a supra-maximal

response is acquired. If the response is large and "clips" at the top or bottom,
decrease the amplifier sensitivity by adjusting the Gain setting. For example,
change gain from 2k to 5k and re-stimulate. Gain can be adjusted easily by using
Knob #4 (Gain /Sweep) on the Sierra Wave base unit.
8. If necessary, Adjust Auto Cursors
Auto Cursors are placed on the response as soon as it is displayed. The cursors are
Onset (O), Peak (P), Trough (T) and Recovery (R). The configuration of the Site
and Segment tables determines which of the four cursors are placed on the trace.
The positions of these cursors can be adjusted by performing one of the following
actions;
• By using Knob #2 (Sel Cursor / Move Cursor) on the Sierra Wave base unit.
• By clicking on them with the left mouse button and dragging them to their
new position.
For the correct placement of the auto-cursors the response must meet or exceed
certain amplitude and slope criteria. When these criteria are not met the cursors will
be placed on the response in the following pattern.
Pattern of auto-cursor placement when amplitude criteria is not met.
The Peak (P) cursor will be positioned at the third division with the Onset (O) cursor
placed one-quarter division in front and the Trough (T) and Recovery (R) cursors
placed one-quarter and one-half division respectively following it. If you believe that
there is a response present you can move the cursors to their appropriate positions,
or if there really is no response present, you can mark the response as "NR" in the
Site table.
9. Store the Response
To store the response and advance to the next stimulation site, perform one of the
following actions;
• Press the Store button on the Electrical Stimulator handle.
• Press the Store key on the Sierra Wave base unit.
• Press the Footswitch pedal (assuming the pedal has been programmed with
the Store function.)
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• Click the Store button in the NCV Controls window.

When the response is stored the color of the trace changes from white to purple
and the next row in the Site table is automatically highlighted.
If the nerve has only one stimulation site, it is not necessary to store the
response. The Sierra Wave will automatically keep the trace when you change
nerves or test protocols.
10. Stimulate and Store Additional Sites
Continue to stimulate and store additional sites on the nerve.
11. Enter Distance to calculate Velocity
Measure the distances for each segment and enter the values (in centimeters) into
the segment table. There are two ways to enter the distance.
• Press the Distance key on the Sierra Wave base unit or click on the
appropriate distance field with the mouse. The first distance field will
become activated and a small pop-up window is displayed showing the
segment name and a place for the distance measurement, type the
distance value and then press the Enter key. You can also press the
Distance key a second time instead of pressing the Enter key.
Distance pop-up window.
• Press Programmable button #1 on the Electrical Stimulator handle. A

small pop-up window is displayed showing the segment name, distance
value, and velocity. Now, turn the wheel on the stimulator handle to
increase or decrease the distance value in 0.5 cm increments. When
the correct distance value is reached, press Programmable button #1 a
second time or press the Enter key.
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Distance pop-up window.
12. Compare Left vs. Right side Data & Traces (optional)
This feature allows for easy comparison of the latency, amplitude, and velocity
differences between the left and right sides of a nerve. It also allows for a visual
comparison of the traces obtained for each side.
Press the F10 - L/R Cmp function key to view the traces acquired for each side and
a table of difference values.
Normal values can be entered for the side-to-side difference measurements with
abnormal values flagged by the program.
Press the F10 - L/R Cmp function key a second time to return to the standard NCV
display.
13. TabData (optional)
To view a Summary window of all the tests done on the patient, press the F4
(TabData) function key on the Sierra Wave base unit.
The left hand side of the TabData window shows all the tests that were performed
on the patient. It also has entries for Summary Tables (i.e., Motor Summary table,
Anti Sensory table, Muscle Scoring table).
To view the results for an individual test:
Highlight the test by turning Knob #1 (Select / Open) on the Sierra Wave base unit
or by clicking on the test with the mouse. The selected test's traces and cursor
information will be displayed on the right hand side of the window.
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To view a Summary Table:

Highlight the table by turning Knob #1 (Select / Open) on the Sierra Wave base
unit or by clicking on the Summary Table with the mouse. The selected table will be
displayed on the right hand side of the window.
To print a Report:
Click on one of the report buttons at the bottom of the TabData window, or press the
corresponding function key on the Sierra Wave base unit.
14. Next Nerve or Test
To advance to the Next Nerve:
• Use Knob #1 (Study Item / Site) to highlight another NCV nerve in the Study
window.
• Click on another NCV nerve in the Study window using the mouse.
• Press the F3 (Nerve List) function key on the Sierra Wave base unit and
select another nerve from the nerve list.
To change Test Protocols:
• Use Knob #1 (Study Item / Site) to highlight another Test Protocol in the
Study window.
• Click on another Test Protocol in the Study window using the mouse.
• Press the Select key on the Sierra Wave base unit and select a Test
Protocol from the Study/Test menu.
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EMG - Basic Operation

Select the EMG Test:
• If a Study has already been selected, simply click on an EMG muscle name
(i.e., Right Deltoid) within the Study window or turn Knob #1 (Study Item / Site)
to highlight the muscle name. Notice that as soon as any muscle is selected
within the EMG test protocol, all the muscles are automatically added to the
muscle score table.
the individual EMG test protocol from the Study/Test menu, a muscle list will be
displayed allowing you to pick the muscle or muscles that you will be testing on
the patient. Notice that as soon as any muscle is selected, it is displayed within
the Study window and is automatically added to the muscle score table.
The Automatic Muscle Scoring feature can be disabled in the EMG Test
Setup window. When this feature is disabled the muscles in the Study window are
not automatically added to the muscle score table. You will need to use the F2
(Muscle Sel/Score) knob or the Left mouse button to manually add the
appropriate muscles to the scoring table.
Once the muscle has been selected. Follow these steps for performing routine
EMG data acquisition:
appropriate.
Typical Settings for EMG
Gain = 100 or 200 uV/Div
Hicut = 10k Hz
Locut = 10 - 30 Hz
Sweep Speed = 10.0 ms/Div
2. Verify the Side
3. Insert the Needle Electrode
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4. Adjust Volume
Increase or decrease the Sierra Wave's internal speaker by using the Volume Knob
on the left hand side of the base unit.
5. Select Live or Capture Acquisition Mode
Use the F1 (Live / Capture) function key to toggle between these two acquisition
modes.
Live Mode: In Live mode free-running EMG is displayed in the Trace window and a
compressed view of the EMG Live Buffer is displayed below this. A moving blue
marker shows the current position within the buffer. At any time data acquisition can
be stopped and the data in the Live Buffer can be reviewed or played back (see step
#7 below). The EMG protocol always defaults to the Live data acquisition mode.
EMG - Live mode
Live Mode with Raster Display: An optional Raster Display can be enabled by
pressing the F11 (Raster) function key. When this feature is enabled the Trace
window is split into two equal sections; the left half showing the live EMG data and
the compressed buffer, the right half showing consecutively rastered EMG traces.
Click here for more information on the Raster Display option.
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Live EMG mode with Raster Display enabled.
Capture Mode: In Capture mode a voltage level trigger and delay marker are
displayed within the Trace window. The level of the voltage trigger can be adjusted
using Knob #3 (Trigger Lvl). When EMG activity exceeds the trigger level (in either
the negative or positive direction) the sweep is captured momentarily and is
repositioned with the crossing point at the delay marker. This allows for easier
visualization of motor unit potentials. At any time data acquisition can be stopped
and up to 50 captured sweeps can be reviewed (see step #7 below).
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EMG - Capture mode
Capture Mode with Capture Window: An optional Capture Window can be

enabled by pressing the F11 (Cap Wnd) function key. When this feature is enabled
the trace window is split into two sections; the top section shows the live EMG trace
and the trigger level and delay indicator, the bottom section shows a rastered display
of the most recently captured traces. Click here for more information on the Capture
Window option.
31
Capture Mode with Capture Window enabled.
6. Adjust Gain & Sweep

During EMG data acquisition you can easily adjust the Gain and Sweep Speed by
using Knob #4 (Gain / Sweep) on the Sierra Wave base unit. Simply turn the knob
to adjust the gain, to change the sweep speed, press the knob first to toggle it to the
sweep mode, then turn to change the sweep speed.
You can also use the mouse to change these settings in the EMG Controls window
or Controls Toolbar.
7. Stop Data Acquisition and Review (optional)
To stop data acquisition perform one of the following actions;
• Press the Run/Stop key on the Sierra Wave base unit.
32
• Press the Stim button on the Electrical Stimulator handle.

• Press the Footswitch pedal.
• Click on the Stop button in the EMG Controls window.
Stopped Live EMG:
Review the Live Buffer - move backwards and forwards in the Live EMG
buffer by turning Knob #1 (Review / Play-Stop), press the knob to replay the
buffer. You can also review by dragging the blue marker back and forth within
the compressed buffer area using the mouse.
EMG - Stopped Live mode
Store a Snapshot - press the F1 (Store Snap Shot) function key or the Store
key on the Sierra Wave base unit to store the currently displayed sweep. The
stored sweep will be displayed in purple.
Store the entire Live Buffer - press the F2 (Store Live Buffer) function key.
The trace will be displayed in blue indicating that the entire buffer has been
stored.
33
Manual MUP Tool - right click the mouse over the motor unit potential (MUP)
of interest, then select MUP Tool from the pop-up menu. The motor unit
potential is shown centered within a MUP window and quantitative
measurements are shown in the table below. Click OK to save the MUP and
include it in the final report, click Cancel to discard the MUP.
Stopped Capture EMG:
Review Captured Sweeps - use Knob #4 (Trace Sel /Delete) to review
through the captured traces, press the knob to delete the selected trace
(selected trace is displayed in yellow color). Press the F2 (Raster / Overlay)
function key to superimpose all the captured traces.
EMG - Stopped Capture mode
Store Captured Sweeps - press the Store key on the Sierra Wave base unit
or click on the Store button within the EMG Controls window. The stored
traces will be displayed in purple.
Prior to storing any EMG traces, Use Knob #2 (Muscle Sel) to highlight the
correct muscle name in the Study window. This will ensure that the EMG data will
be stored with the correct muscle name.
34
As EMG is stored, you will see a new node appear in the Study window below
the muscle name. This indicates what has been stored for this muscle. The
example below shows a Snapshot stored for the Right Abd Poll Brev muscle, a
Capture run stored for the Right ABD Dig Min muscle, and a Live Buffer stored for
the Right ExtDigCom muscle.
Example of stored EMG nodes in the Study window.
8. Return to Data Acquisition Mode

If you stopped either Live or Captured data acquisition, perform one of the
following actions to resume data acquisition;
• Press the Run/Stop key on the Sierra Wave base unit.
• Press the Stim button on Electrical Stimulator handle.
• Click the Run button in the EMG Controls window.
9. Modify Muscle Scoring
With the Automatic Muscle Scoring feature enabled, as soon as a muscle is
selected in the Study window, or added to the Study window using the F3 (Muscle
List) function key, it is automatically added to the Muscle Scoring Table and is
scored as normal.
To change the muscle scoring for a muscle:
• Turn Knob #3 (Score Table / Modify) until the highlight is over the scoring
field that you want to change, press the knob to pop up a list of choices, turn
the knob to highlight one of the choices and press again to select it.
• Using the left mouse button, click on the scoring field that you want to
change. From the pop up list of choices click again to make a selection.
35
Muscle Scoring Table
Depending on your preferences in System Setup, abnormal values can be

flagged with a red background color, as bold text, as bold text with an asterisk, or
as bold text & background color red.
10. Select Next Muscle
Turn Knob #2 (Muscle Sel / Delete Score) to highlight the next muscle in the Study
window. If the muscle you want to examine is not displayed within the Study
window, press F3 (Muscle List) and select the muscle from the list.
Move the Needle Electrode to the new muscle and repeat the above steps as
necessary.
It is a good idea to turn Off the preamplifier or turn down the Volume when
moving the needle electrode to a new location.
or by clicking on the test with the mouse. The selected tests traces and cursor
36
To print a Report:
12. Next Test
• Use Knob #1 (Study Item) to highlight another Test Protocol in the Study
window.
• Press the Select key on the Sierra Wave base unit and select a Test Protocol
from the Study/Test menu.
37
F/H Basic Operation

Select the F Wave or H Reflex Test:
• If a Study has already been selected, simply click on an F Wave or H Reflex
nerve name (i.e., Right Median) within the Study window or turn Knob #1 (Study
Item / Site) to highlight the nerve name.
the individual F Wave or H Reflex test protocol from the Study/Test menu, a
nerve list will be displayed allowing you to pick the nerve or nerves that you will
be testing on the patient.
Once the nerve has been selected. Follow these steps for performing routine F
Wave or H Reflex (Markers mode) data acquisition:
appropriate for the test being performed.
Typical Settings
Gain Split Hicut Locut Sweep

(uV/Div) Gain (Hz) (Hz) Speed
(uV/Div) (ms/Div)
F Wave 5k 500 10k 20 5.0 or 10.0
H Reflex 2 - 5k 500 10k 20 10.0
For F Wave and H-Reflex Studies, the Cathode (-) should be oriented away from
the recording electrodes (i.e., Cathode proximal, Anode distal).
38
Clicking on the Polarity field in the F/H Controls window or Controls Toolbar can
also reverse the stimulator polarity. The default (i.e., normal) mode has the right-
side probe as the Cathode (if holding the stimulator with the Stim button facing you
and the probes up); the reversed state will make the left-side probe the Cathode.
The image of the stimulator on the screen updates to indicate the selected polarity
as well.
Right-side probe as the Cathode (-). The polarity field on the screen will indicate
Nml.
Left-side probe as the Cathode (-). The polarity field on the screen will indicate
Rev.
5. Stimulate the Nerve

39
stimulator light, located next to the intensity level on the Screen, will flash Green and
the patient's response will be displayed.
The Single key on the Sierra Wave base unit, or the Single button in the F/H
Controls window, can also be used to deliver a single stimulus.
Repetitive stimulation can be delivered by pressing the Run/Stop button on

the Sierra Wave base unit or by clicking on the Run button in the F/H Controls
window.
In general, F Waves are performed with supramaximal stimulus intensity, while H
Reflex maximum amplitude occurs with sub-maximal stimulation intensity.
If the M Wave or F/H response amplitude is large and "clips" at the top or bottom,
change the gain from 2k to 5k and re-stimulate. Gain can be adjusted easily by
using Knob #4 (Gain M / Gain F or H) on the Sierra Wave base unit.
If the F1 (Manual / AutoStore) function key is set to the Manual mode you will need
to store the response by performing one of the following actions;
• Press the Store button on the electrical stimulator handle.
• Press the Store button on the Sierra Wave base unit.
• Click on the Store button in the F/H Controls window.
If the F1 (Manual / AutoStore) function key is set to the AutoStore mode, the trace
will automatically be stored immediately after it is acquired.
Stored traces will be displayed in "purple" color on the screen.
7. Continue to Stimulate and Store until 10 or 20 responses have been acquired.
8. Adjust Latency Marker
To adjust the latency marker, perform one of the following:
• Turn Knob #2 (F/H Lat / M Wave Lat) on the Sierra Wave base unit to move
the F/H latency marker to the minimal F Wave latency or H Reflex onset
latency. Changing the F2 (Raster / Overlay) function key to Overlay mode
can be helpful when positioning the latency marker. The latency value is
displayed in the F/H Table window.
• Press the F8 (Auto F-Lat / Auto H-Lat) function key. The program will
automatically move the latency marker to the earliest onset latency. In
addition, a pop-up window will show the latency value and the wheel on the
40
stimulator handle can be used to adjust the position of the marker. Once the
marker has been positioned, press the F8 function key a second time to exit
this mode.
Example F Wave Trace window.
9. Compare Left vs. Right side Traces (optional)

Press the F10 - L/R Cmp function key to view the traces acquired for each side.
The traces for each side are displayed in separate windows, stacked vertically on
the screen. The top window contains the traces for the current side.
Press the F10 - L/R Cmp function key a second time to return to the standard F/H
display.
on the patient. It also has entries for Summary Tables (i.e., F Wave Markers, Motor
Summary table, Anti Sensory table, Muscle Scoring table).
41

To print a Report:
11. Next Nerve or Test
To advance to the Next Nerve:
• Use Knob #1 (Study Item / Site) to highlight another F/H nerve in the Study
window.
• Click on another F/H nerve in the Study window using the mouse.
• Press the F3 (Nerve List) function key on the Sierra Wave base unit and
select another nerve from the nerve list.
Study window.
42
RNS - Basic Operation

Select the RNS Test:
• If a Study has already been selected, simply click on the RNS muscle name
within the Study window or turn Knob #1 (Study Item / Site) to highlight the test.
the RNS test protocol from the Study/Test menu, a muscle list will be displayed
allowing you to pick the muscle or muscles that you will be testing on the patient.
Once the muscle has been selected. Follow these steps for performing RNS data
acquisition:
appropriate for the test being performed. RNS typically uses the same settings as a
motor NCV.
Active 1 Input: Belly of the muscle.
Reference 1 Input: Tendon of the muscle.
Ground Electrode: On stimulated limb or forehead.
For RNS Studies, the Cathode (-) should be oriented closest to the recording
electrodes.
Clicking on the Polarity field in the RNS Controls window or Controls Toolbar
polarity as well.
43
Right-side probe as the cathode (-). The polarity field on the screen will indicate
Nml.
5. Check the RNS Table

The RNS test protocol supports a preprogrammed stimulus train table. This table
controls the number of stimuli presented in each train, the repetition rate for the
stimuli, the amount of time to pause before proceeding to the next stimulus train, and
it also provides a convenient way to label each stimulus train.
The program allows for either manual or automatic delivery of the stimulus train
table.
44
RNS Table.
If your stimulus train table is undefined, select Current Test from the Edit menu. Fill
in the Sequencer Setup table in the lower left corner of the setup window, then click
OK.
6. Check the General and Stimulator Settings
General Settings
Mode: Choices are Train or Single.
• Train - When the Stim button on the handheld stimulator or the Run/Stop
button is pressed, a train of stimuli, corresponding to the highlighted row in
the RNS Table, will be delivered.
• Single - When the Stim button on the hand held stimulator or the Single
button is pressed, a single stimulus will be delivered. This mode is useful
for determining supramaximal stimulation prior to delivering a train of
stimuli.
Train #: The total number of stimuli that will be delivered to the patient when the
program is set to the Train mode. The typical setting is four to eight. The
maximum setting is 150. This value is updated from the RNS Table.
Spread: This is the distance (in horizontal divisions) that will separate the
individual traces within the train. If this value is set to zero, the traces will be
superimposed upon one another.
Response 1: Select the first response in the train that will be analyzed for
amplitude and area measurements. Typically this is always set to number 1.
Response 2: Select the second response in the train that will be analyzed for
amplitude and area measurements. In addition, the percentage difference
between this response and the trace selected for Response 1 will be computed.
This is typically set to number 4 or 5.
Auto Seq: Allows for either manual or automatic sequencing through the RNS
Table. When set to On, the program will automatically deliver the trains specified
in the RNS table (automatically pausing for the specified time after each train).
45
When set to Off, the user must manually start each train after the appropriate
pause time, by pressing the Run/Stop key for each train.
Stimulator Settings
Pulse Width: Set the electrical stimulus pulse width, also known as pulse
duration, in microseconds (usec).
Rep Rate: Set the repetitive stimulus rate, in pulses per second (Hz). This is
typically set to 3 Hz. This setting only applies when delivering repetitive (i.e.,
Train) stimulation, it does not apply during manual Single stimulus delivery.
7. Check Recording Setup
Press the F1 (Train/Single) function key to select Single mode. Increase the
stimulus intensity level by turning the wheel on the electrical stimulator handle.
The intensity level (in milliamps) is displayed on the screen in a small pop-up
window and also in the Stimulator controls section. Once you have reached an
stimulator light, located next to the intensity level on the Screen, will flash Green
and the patient's response will be displayed.
The Single key on the Sierra Wave base unit or the Single button within
the on-screen RNS Controls window can also be used to deliver a single
stimulus. Intensity can also be adjusted using Knob #3 (Intensity / Pulse
Continue to increase the intensity level and stimulate until a supra-maximal
response is acquired. If the response is large and "clips" at the top or bottom,
change gain from 2k to 5k and re-stimulate. Gain can be adjusted easily by
using Knob #4 (Gain /Sweep) on the Sierra Wave base unit.
8. Deliver Stimulus Trains
Press the F1 (Train/Single) function key to select Train mode. Follow the
instructions below for either Manual or Automatic Stimulus Train delivery.
Manual Stimulus Train Delivery:
Highlight the first row in the RNS Table. Press the Stim button on the electrical
stimulator handle. A train of stimuli will be delivered to the patient and a trace will
be displayed for each stimulus within the train. The traces are stacked in a
horizontal fashion (see Spread setting above).
After the Train is completed the program will automatically store the train and it
will be displayed in a "purple" color.
46
The Run/Stop key on the Sierra Wave base unit or the Run button
within the on-screen RNS Controls window can also be used to deliver a train
of stimuli.
20 milliseconds is acquired after each stimulus. This allows for a

maximum repetition rate of 50 Hz during train stimulation.
After a train is automatically stored, a timer is started. The timer is displayed just
below the side field in the RNS Controls window or at the top of the screen in the
Controls Toolbar.
Use the timer to measure the time elapsed while the patient exercises the muscle
or the time elapsed between successive stimulus trains. Typically, the patient
will exercise the muscle for 30 seconds after the first train is delivered then
another train will be delivered immediately after completion of exercise.
Additional trains are then typically delivered at 1 minute intervals after this.
Press the Run/Stop key again to deliver the second stimulus train. Proceed in
this fashion until all stimulus trains have been acquired.
The timer automatically resets to zero after each train is stored. You can
also manually reset the timer to zero by pressing the F2 (Reset Timer)
function key on the Sierra Wave base unit.
47
Example RNS Traces
Automatic Stimulus Train Delivery:

Change the Auto Seq. control from Off to On. The first row in the RNS Table
will be automatically highlighted.
Press the Stim button on the electrical stimulator handle. A train of stimuli will
be delivered to the patient and a trace will be displayed for each stimulus within
the train. The traces are stacked in a horizontal fashion (see Spread setting
above).
After the Train is completed the program will automatically store the train and it
will be displayed in a "purple" color. At this point the timer is started. The timer
is displayed just below the side field in the RNS Controls window or at the top of
the screen in the Controls Toolbar.
48
Once the timer reaches the preprogrammed pause time for the stimulus train, the
program will automatically deliver the next stimulus train in the RNS Table.
Stimulation will continue in this manner until the last stimulus train is delivered.
You can stop the automatic sequencer at any time by changing the Auto
Seq. control from On to Off.
9. Adjust Cursors (optional)
Onset (O) and Peak (P) cursors are automatically placed on the selected responses
(see Response 1 and Response 2 settings above) as each train is acquired. The
amplitude (onset to peak) and area (negative peak) of each response is calculated
and displayed in the RNS table window.
The positions of these cursors can be adjusted by performing one of the following
actions;
• By pressing the F5 (Cursor mode) function key and then using Knob #1
(Sel Cursor / Move Cursor) on the Sierra Wave base unit.
• By clicking on them with the left mouse button and dragging them to their
new position.
The difference for both amplitude and area, between the two marked responses, is
also automatically calculated and is displayed as a percentage (%). The equation
used for this calculation is as follows;
D = (VR2 - VR1) / VR1 X 100%
Where D = decrement or increment
V = value (amplitude or area)
R1 = response 1
R2 = response 2
A decrement is displayed as a negative number, typically more than a -10%
decrement is considered abnormal. An increment is displayed as a positive number.
Peak-to-Trough amplitude measurements can also be selected in the RNS

protocol's test setup window. In this case, Peak (P) and Trough (T) cursors will be
automatically placed on the responses.
Use the Comment field in the RNS table to enter a notation for the train.
49
RNS Cursor Table

To print a Report:
11. Next Muscle or Test
To advance to the Next Muscle:
• Use Knob #1 (Study Item / Site) to highlight another RNS muscle in the
Study window.
• Click on another RNS muscle in the Study window using the mouse.
50
• Press the F3 (Muscle List) function key on the Sierra Wave base unit and
select another muscle from the muscle list.
Study window.
51
Blink - Basic Operation

Select the Blink Test:
• If a Study has already been selected, simply click on the Blink test protocol
the Blink test protocol from the Study/Test menu.
Once the test has been selected. Follow these steps for performing Blink data
acquisition:
appropriate for the test being performed.
Typical Blink Settings
Gain = 200 uV/Div
Hicut = 5k Hz
Locut = 10 Hz
Connect the electrode leads from the patient’s left side to the Channel 1
inputs on the amplifier, and connect the electrode leads from the right side to the
Channel 2 inputs. Electrodes must be connected to the amplifier in this
configuration to ensure proper display of test data.
Active 1 Input: Belly of the Left orbicularis oculi muscle below the eye.
Reference 1 Input: Left side of nose.
Active 2 Input: Belly of the Right orbicularis oculi muscle below the eye.
Reference 2 Input: Right side of nose.
Ground Electrode: Forehead or cheek.
3. Select Side of Stimulation
Select the side, Left or Right, that will be stimulated first.
52
Trials collected during left-side stimulation are displayed in the top half of the screen
with the response recorded on the ipsilateral side (e.g., Ch1 : L) positioned above
the response recorded on the contralateral side (Ch2 : L).
Responses collected during right side stimulation display in the bottom half of the
screen. Eliminating the need to change electrodes at the amplifier, the Sierra
automatically inverts the order in which trials collected during right side stimulation
are displayed so that the ipsilateral response (Ch2 : R) appears above the
contralateral response (Ch1 : R).
For Blink Reflex Studies, the Cathode (-) should be oriented closest to the
recording electrodes.
Clicking on the Polarity field in the Blink Controls window or Controls Toolbar
polarity as well.
Right-side probe as the cathode (-). The polarity field on the screen will indicate
Nml.
53
5. Stimulate
appropriate starting intensity apply the stimulator to the patient's supra-orbital nerve
and deliver the stimulus by pressing the Stim button on the electrical stimulator
handle. The stimulator light, located next to the intensity level on the Screen, will
flash Green and the patient's response will be displayed.
The Single key on the Sierra Wave base unit can also be used to deliver a
single stimulus. Intensity can also be adjusted using Knob #3 (Intensity / Pulse
To store the response, perform one of the following actions;
• Press the Store button on the electrical stimulator handle.
• Press the Store key on the Sierra Wave base unit.
• Click the Store button in the Blink Controls window.
When the response is stored the color of the trace changes from white to purple
7. Repeat Stimulation & Store additional responses
Generally, two trials are acquired per side.
8. Move Latency Markers (R1, R2i, R2c)
Three latency markers are utilized in the Blink test protocol. R1 is positioned at the
onset of the ipsilateral R1 response. R2i is positioned at the onset of the ipsilateral
R2 response. R2c is positioned at the onset of the contralateral R2 response.
54
Each of the three markers has a different line pattern.

To move the latency markers:
• Use Knob #2 (R1) to move the R1 marker, use Knob #3 (R2i /R2c) to move
the R2i and R2c markers.
• Use the mouse to click and drag the appropriate marker to the desired
location.
9. Change the Side and Repeat steps 4 - 8.
Selecting a different side automatically stores the currently active (white) traces.
Blink Example.
55
The program will automatically calculate the R2i-R2c difference for each side.
It will also calculate the Left minus Right differences for R1, R2i, R2c, and R2i-R2c.
Blink Cursor Table

To print a Report:
11. Next Test
Study window.
56
SEP - Basic Operation

Select the SEP Test:
• If a Study has already been selected, simply click on the SEP test protocol
the SEP test protocol from the Study/Test menu.
Once the SEP test has been selected. Follow these steps for performing data
acquisition:
1. Apply electrodes to the patient and connect to amplifier
Determine the number of channels that will be recorded and the electrodes that will
be required for each channel. Apply the recording electrodes and ground electrode
to the patient and connect to the Sierra Wave amplifier.
appropriate for the selected SEP test.
Typical Settings
Gain Hicut Locut Sweep Speed

(uV/Div) (Hz) (Hz) (ms/Div)
Upper Limb SEP 1 to 5 3k to 500 10 5.0
Lower Limb SEP 1 to 5 3k to 500 10 10.0
A Common Reference (CREF) input is available on the 4 Channel Amplifier. The

status of the CREF input, Off or On for each channel, will depend on the montage
chosen for the test. If the amplifier channel should use its corresponding individual
reference input (i.e., reference 1, 2, 3, or 4) the CREF setting should be set to OFF.
If the channel should not use its individual reference input, but should use the CREF
input in its place, then the CREF setting should be set to ON.
The Notch filter is typically not used during SEP recordings and should remain OFF.
57
Median SEP default Amplifier Settings.
3. Check Impedances
Press the Imped key on the Sierra Wave base unit. The impedance window
displays a picture of the front of the amplifier.
Impedance window. Channels 1, 2 and 3 have the CREF input enabled, channel 4 is turned Off.
The Active (black) and Reference (red) inputs are displayed for each channel as
well as the CREF input (4 Channel Amplifier only). The Ground input is not
included in impedance measurements.
If a Channel is turned Off, no impedance values will be calculated for either the
active or reference inputs and the word "Off" is displayed over the inputs of that
channel.
58
When the CREF input is enabled (i.e., ON) for a channel, that channel's reference
input will not show an impedance value and will have the word "Off" over the
reference input. An impedance value for the CREF input will be displayed.
Impedances less than 5k Ohms (kilo-ohms) are displayed in green. Values between
5.1 and 20 are displayed in yellow. Values greater than 20 are displayed in red.
To close the impedance window, press the Imped key again or click the OK button.
When performing evoked potential studies all impedances should be less than
5k Ohms.
5. Check Stimulator Settings and Polarity
Apply the stimulating electrodes (bar electrode or individual electrodes) to the
patient. Connect the stimulating electrodes to the end of the hand-held electrical
stimulator (remove the probe tips from the end of the stimulator). The proximal
stimulating electrode should be connected to the Cathode (-) and the distal
stimulating electrode should be connected to the Anode (+).
Intensity - start at zero milliamps and after data acquisition is started increase
slowly until a visible muscle twitch is seen.
Pulse Width - typically set to 100 or 200 microseconds.
Rep Rate - typically between 2 to 5 Hz and not directly divisible into 60 (e.g., 2.11,
2.66, 4.77).
Polarity - set to Normal (Nml) mode. The green LED indicates the Cathode (-).
SEP Stimulator Controls
59
6. Verify Averager Settings

Shutoff - This is the number of responses that will be averaged together to produce
the final results. When the shutoff count is reached stimulation will automatically be
stopped.
Reject On / Off - When this feature is turned On the program will monitor the Live
un-averaged data and will not include (i.e., will reject) high amplitude artifacts from
the running average. During data acquisition the percentage (%) of stimuli/sweeps
that have been rejected from the total delivered will be displayed on the screen.
Level - This is the reject sensitivity level, it is shown as a percentage of full amplifier
scale. Choices are 30 to 100 % in increments of 5. 100% equals full scale, smaller
numbers will make the reject more sensitive.
Example SEP Averager settings.
Reject is based on the Live un-averaged data and the Amp Gain setting.
Every channel has 5 divisions above and below its initial baseline. So, if the Amp
Gain is set to 10 uV/Div this means that the Live trace has an amplitude window of
100 microvolts (10 vertical divisions times 10 uV/Div) with 50 uV above the baseline
and 50 uV below the baseline. If the reject level is set to 100% (i.e., full scale), then
the amplitude of the live data must be below +/- 50 uV to be included in the running
average. Should it exceed +/- 50 uV the trace will be rejected from the running
average. If the reject level is set to 50% (i.e., half of full scale), then the amplitude of
the Live data can't exceed +/- 25 uV (2.5 divisions above or below the baseline) or it
will be rejected from the running average. The lower the reject level setting the more
sensitive the program will be in rejecting large artifacts.
You can check the Amp Gain setting by pressing the F1 (Avg / Live) function
key to switch to the Live mode. Press the function key again to return to the Avg
mode and view the Display Gain setting.
7. Acquire Responses
A. Start Data Acquisition.
Press the Run/Stop key to start stimulus delivery and data acquisition. Slowly
turn up the stimulus intensity level until a visible muscle twitch is observed.
The average count (AvgCnt) should start to increment and the traces will begin
to take shape.
Adjust the vertical size of the all traces by turning Knob #4 (Gain). To adjust the
gain of an individual trace, change the corresponding gain setting in the amplifier
section of the EP Controls window.
60
Press the F3 (Smooth) function key during acquisition to remove high frequency
noise from the active (white) traces.
B. Store the first trial.
When the Shutoff count is reached, stimulation will stop automatically. Press the
Store key to store the active (white) traces. A copy of the active traces will
appear on the screen and are displayed in a purple color.
The Store key can be pressed before the Shutoff count is reached. This
will cause the currently active traces to be stored, the average count will be reset
to zero, and stimulation will continue automatically on a new set of traces.
C. Clear the Average Count.
Press the Clear key to reset the average count (AvgCnt) back to zero. The
active (white) traces will be reset to flat lines.
D. Acquire a second Trial
Press the Run/Stop key to start stimulus delivery and data acquisition again.
Generally, two trials should always be acquired when performing evoked
potentials to show replication of the traces.
E. Store second trial and Clear.
After the Shutoff count is reached for the second trial, press the Store key to
store the active (white) traces. Press the Clear key to reset the average count to
zero.
F. Change Side of Stimulation.
To acquire traces for the opposite side, change the Side setting in the EP
Controls window. If you are using the Split Screen feature the active (white)
traces will automatically move to the opposite side of the Trace window.
G. Repeat steps A - E and collect data for the opposite side.
61
Example 3 Channel Median SEP, Left and Right.
8. Trace Positioning (optional)

If the position of the traces needs to be adjusted, follow one of these procedures.
• Using the Mouse - simply click on the Trial you want to move with the left
mouse button and drag the trial to its new location. If you want to move an
individual Trace, not the entire Trial, first right-click the mouse over the
Trace window and remove the check mark in front of "Trial Selection
Mode".
• Using the Knobs - press the F6 (Position) function key on the PC's
keyboard. The program's knob and function keys will change to reflect the
position mode controls. Use Knob #1 (Sel Trial / Move) to select and
move trials. To move individual traces, first press the F4 (Trial / Trace)
function key to change the selection mode.
When positioning is completed, press the F6 (Position) function key again
or press the OK key on the Sierra Wave base unit to exit from Position
mode.
• Using the Trace Position Settings - right-click the mouse over the Trace
window and select Trace Position Settings from the pop-up menu.
Change the settings for Start Position, Trial Offset, and Channel Offset
and click OK.
62
9. Place Auto Cursors

To place Cursors on the important trace features, follow one of these procedures.
• Using the Mouse - simply left-click on a trial to select it, the trial will be
displayed in yellow. Now, right-click the mouse and select Auto Place
Cursors from the pop-up menu. Cursors will be placed on the selected
trial and the values (latency, amplitude, etc.) derived from the cursors will
be displayed in the EP Cursor Table window.
• Using the Knobs - press the F5 (Cursor) function key of the PC's
cursor mode controls. Use Knob #3 (Sel Trial) to select a trial, when
selected the trial will be displayed in yellow. Once the appropriate trial is
selected, press the F2 (AutoPlace Cursors) function key and cursors
will be placed on the selected trial. The values (latency, amplitude, etc.)
derived from the cursors will be displayed in the EP Cursor Table
window.
After cursors have been placed, press the F5 (Cursor) function key again or
press the OK key on the Sierra Wave base unit to exit from Cursor mode.
For information on configuring the Auto Cursors, see the SEP Test Protocol
setup topic.
To Adjust the positions of the Cursors, follow one of these procedures.

• Using the Mouse - simply click on the Cursor you want to move with the
left mouse button and drag the cursor along the trace to its new location.
cursor mode controls. Use Knob #3 (Sel Trial) to select the trial with the
cursors you need to adjust, when selected the trial will be displayed in
yellow. Once the appropriate trial is selected, use Knob #1 (Sel Cursor /
Move) to select and move the desired cursor.
After cursor positions have been adjusted, press the F5 (Cursor) function
key again or press the OK key on the Sierra Wave base unit to exit from
Cursor mode.
63
Example Median SEP Cursor Table.
The program will calculate the left minus right difference values for each
defined measurement after cursors have been placed on one left and one right
side trial.

flagged with a red background color, as bold text, as bold text with an asterisk, or as
bold text & background color red.
To print a Report:
64
11. Next Test

Study window.
65
AEP - Basic Operation

Select the AEP Test:
• If a Study has already been selected, simply click on the AEP test protocol
the AEP test protocol from the Study/Test menu.
Once the AEP test has been selected. Follow these steps for performing data
acquisition:
appropriate for the selected AEP test.
Typical AEP Settings
Gain = 0.2 to 0.5 uV/Div
Hicut = 3k Hz
Locut = 100 Hz
The Notch filter is typically not used during AEP recordings and should remain OFF.
66
2Ch. AEP Default Settings.
3. Check Impedances
Impedance window. Channels 3 & 4 are turned Off. CREF is turned OFF.
channel.
67
5k Ohms.
5. Check Stimulator Settings
Apply the stimulator (headphones or inserts) to the patient, the red headphone/insert
should be placed on the patient's right side, the blue headphone/insert should be
placed on the left. Connect the stimulator to the back of the Sierra Wave base unit.
AEP Stimulator Settings - Controls Window
AEP Stimulator Settings - Controls Toolbar
Mode: Click here to select the auditory stimulus type, choose either Click, Tone,
Pip202, or Pip212.
• Click - this is a 100 microsecond click stimulus.
• Tone - this is a 10-30-10 tone burst stimulus. It has a 10 millisecond rise
time, a 30 millisecond plateau, and a 10 millisecond fall time. This stimulus is
typically used for long latency auditory evoked potentials.
• Pip 202 or Pip 212 - these are also tone stimuli but their rise, plateau, and fall
times are measured in cycles rather than milliseconds. The 2-0-2 Pip has a 2
cycle rise, 0 cycle plateau, and 2 cycle fall. The 2-1-2 Pip has a 2 cycle rise,
1 cycle plateau, and a 2 cycle fall.
68
• Frequency - when Tone, PiP202, or PiP212 are selected a Frequency setting

will be displayed. Click here to select the frequency of the tone/pip. The
choices are 250, 500, 750, 1000, 2000, 3000, 4000, 6000, and 8000 Hz.
Type: Click here to select the type of stimulus delivery hardware, choose either
Phones or Inserts.
When Inserts are selected the program will automatically subtract 1.0
milliseconds from all latency calculations to compensate for the delay produced
by the plastic tubing. The displayed trace is not shifted by 1.0 millisecond.
Polarity: Click here to set the stimulus polarity, the choices vary depending on the
stimulus type.
• For Click - choose either Rarefaction, Condensation, or Alternating
polarity.
• For Tone or Pip - choose either Negative, Positive, or Alternating polarity.
Intensity L-R: Click here to set the starting stimulus intensity value. The first
column is for the left side, the second column is for the right side.
To avoid excessive auditory stimulation, ensure that the stimulus intensity

never exceeds 75 dB above the hearing threshold.
Threshold L-R: Indicates the behavioral threshold value. The first column is for the
left side, the second column is for the right side. During data acquisition the
Threshold values are added to the Intensity values to produce the stimulus at the
headphones/inserts. See step #6 for instructions on determining thresholds.
Intensity Units: Choose either nHL (normalized hearing level) or SPL (sound
pressure level). When SPL is selected the Threshold settings are disabled.
Mask: Click here to set the "white" noise masking as either On or Off and to set the
level for the non-stimulated ear. The amount selected is the number of dB's below
the Intensity value. This is known as differential masking and allows the intensity of
the masking noise to decrease automatically as the intensity of the stimulus is
decreased.
Rep Rate: Click here to set the repetitive stimulus rate, in pulses per second (Hz).
6. Determine Behavioral Threshold Levels (optional)
There are two specially designated knobs for setting the behavioral threshold levels.
Knob #2 (L Thresh/Off) and Knob #3 (R Thresh/Off). To determine the threshold
levels follow these steps.
I. Turn Knob #2. Stimuli will be automatically delivered to the left ear and
the threshold value for the left ear will turn "yellow".
69
II. Continue to turn Knob #2 until the patient can definitely hear the
stimulus.
III. Slowly turn Knob #2 in the reverse direction to decrease the threshold
level. Keep decreasing the level until the patient signals that they can no
longer hear, or can just barely hear, the stimulus.
IV. Press Knob #2 to stop stimulus delivery and set the threshold value for
the left ear.
V. Repeat the above steps for the right ear using Knob #3.
The threshold value is automatically added to the intensity value to obtain the
output level for the stimulator. For example, if the left intensity was set to 70 dB and
the left threshold was determined to be 12 dB, the actual output intensity from the
stimulator would be 82 (70 + 12).
stopped.
AEP Default Averager Settings.
70
Press the Run/Stop key to start stimulus delivery and data acquisition. The
average count (AvgCnt) should start to increment and the traces will begin to
take shape.
zero.
71

Example 2 Channel AEP, Left and Right.

• Using the Mouse - simply click on the Trace you want to move with
the left mouse button and drag the trace to its new location.
position mode controls. Use Knob #1 (Sel Trace / Move) to select and
move traces.
mode.
72
and click OK.
• Using the Mouse - simply left-click on a trace to select it, the trace will
be displayed in yellow. Now, right-click the mouse and select Auto
Place Cursors from the pop-up menu. Cursors will be placed on the
selected trace and the values (latency, amplitude, etc.) derived from the
cursors will be displayed in the EP Cursor Table window.
cursor mode controls. Use Knob #3 (Sel Trace) to select a trace, when
selected the trace will be displayed in yellow. Once the appropriate trace
is selected, press the F2 (AutoPlace Cursors) function key and cursors
will be placed on the selected trace. The values (latency, amplitude, etc.)
window.
For information on configuring the Auto Cursors, see the AEP Test Setup
topic.
cursor mode controls. Use Knob #3 (Sel Trace) to select the trace with
the cursors you need to adjust, when selected the trace will be displayed
in yellow. Once the appropriate trace is selected, use Knob #1 (Sel
Cursor / Move) to select and move the desired cursor.
Cursor mode.
73
AEP cursor table example.
side trace.

To print a Report:
74
12. Next Test

Study window.
75
VEP - Basic Operation

Select the VEP Test:
• If a Study has already been selected, simply click on the VEP test protocol
the VEP test protocol from the Study/Test menu.
Once the VEP test has been selected. Follow these steps for performing data
acquisition:
appropriate for the selected VEP test.
Typical VEP Settings
Gain = 5 uV/Div
Hicut = 200 Hz
Locut = 1 Hz
Sweep Speed = 25 ms/Div
The Notch filter is typically not used during VEP recordings and should remain OFF.
76
Default VEP Amplifier Settings.
3. Check Impedances
Impedance window. Channels 2, 3, & 4 are turned Off. CREF is turned Off for Channel 1.
channel.
77
5k Ohms.
Connect the VEP stimulator to the appropriate connector on the back of the Sierra
Wave base unit. Position the stimulator at the required distance from the patient.
Cover the non-stimulated eye.
VEP Default Stimulator Settings - Controls Window
VEP Stimulator Settings - Controls Toolbar
Mode: Click here to select the type of visual stimulus. Choices are Checks,
Goggles, LED, and Flash.
• Checks - selects a reversing black & white checkerboard pattern. When
checks are selected as the stimulus type the following additional parameters
are available.
o Target - select either On or Off. When turned On a small target is
positioned in the center of the black & white monitor, the patient should
focus on this target during data acquisition.
78
o Checks - click here to select the number of checks displayed across a

horizontal row. The choices are 1, 2, 4, 8, 16, 32, 64, and 128 (default
is 32 checks with monitor positioned about 1 meter from patient).
o Field - click in this area to select the field of stimulation. The choices
are Full Field, Upper Half, Right Half, Lower Half, Left Half, Left Upper
Quarter, Right Upper Quarter, Right Lower Quarter, and Left Lower
Quarter (default is Full Field).
• Goggles - selects the LEG Goggles.
• LED - selects the 3 inch hand held LED checkerboard stimulator.
• Flash - selects the strobe flash stimulator.
Rep Rate: Click here to set the repetitive stimulus rate, in pulses per second (Hz).
stopped.
VEP Default Averager Settings.
79
take shape.
zero.
80

Example VEP, single channel recording, Left & Right.

• Using the Mouse - simply click on the Trace you want to move with the
left mouse button and drag the trace to its new location.
move traces.
mode.
81
and click OK.
window.
For information on configuring the Auto Cursors, see the VEP Test Setup
topic.
Cursor mode.
82
VEP cursor table example.
side trace.

To print a Report:
83
11. Next Test

Study window.
84
P300 - Basic Operation

Select the P300 Test:
• If a Study has already been selected, simply click on the P300 test protocol
the P300 test protocol from the Study/Test menu.
Once the P300 test has been selected. Follow these steps for performing data
acquisition:
To view a common 3 Channel P300 setup, Click here.
appropriate for the selected P300 test.
Typical P300 Settings
Gain = 2.0 uV/Div
Hicut = 30-100 Hz
Locut = 1 Hz
Sweep Speed = 75 - 100 ms/Div
The Notch filter is typically not used during P300 recordings and should remain
OFF.
85
3 Ch. P300 Settings.
3. Check Impedances
Impedance window. Channel 4 is turned Off. CREF is turned ON for Channels 1 & 2 & 3.
channel.
86
5k Ohms.
Clinical recordings of the P300 are generally performed using a binaural auditory
tone stimulus, commonly referred to as the auditory odd-ball paradigm. Typically,
two easily discriminable tones of different pitches are presented in random order.
One of the two tones occurs more often than the other and is designated the
Common tone. The other tone is designated the Rare tone. This outline will
assume that an auditory stimulus will be used for both the Common and Rare
stimuli.
Apply the stimulator (headphones or inserts) to the patient, the red headphone/insert
should be placed on the patient's right side, the blue headphone/insert should be
placed on the left. Connect the stimulator to the back of the Sierra Wave base unit.
P300 Stimulator Controls Toolbar
Common Stim: These settings are used to configure the Common stimulus.
• Type - can be set to Audio, Visual, Electrical, or '.Wav' file. Audio is the
default setting.
• Mode - can be set to Click, Pip 202, Pip 212, or Tone. Tone is the default
setting and it is a 10-30-10 tone burst. It has a 10 millisecond rise time, a
30 millisecond plateau, and a 10 millisecond fall time.
• Int - sets the intensity of the common stimulus in nHL values. 65 dB is the
default setting.
• Frequency - click here to select the frequency of the tone. The default
setting is 1000 Hz.
• Side - can be set to Right, Left, or Bilateral. The default setting is
Bilateral.
87
Rare Stim: These settings are used to configure the Rare stimulus.
• Type - can be set to Audio, Visual, Electrical, or '.Wav' file. Audio is the
default setting.
• Mode - can be set to Click, Pip 202, Pip 212, or Tone. Tone is the default
setting and it is a 10-30-10 tone burst. It has a 10 millisecond rise time, a
30 millisecond plateau, and a 10 millisecond fall time.
• Int - sets the intensity of the common stimulus in nHL values. 65 dB is the
default setting.
• Frequency - click here to select the frequency of the tone. The default
setting is 3000 Hz.
• Side - can be set to Right, Left, or Bilateral. The default setting is
Bilateral.
RepRate: Click here to set the repetitive stimulus rate, in pulses per second
(Hz). The default setting is 0.97.
Rare %: Click here to set the percentage of Rare stimuli that will be delivered.
The default setting is 20 %.
To avoid excessive auditory stimulation, ensure that the stimulus intensity

never exceeds 75 dB above the hearing threshold.
AvgCnt - The second number displayed here is the total number of stimuli
(Common + Rare) that will be delivered. When this number is reached stimulation
will automatically be stopped. The default is 200 (160 Common, 40 Rare).
the running average. During data acquisition the number of stimuli/sweeps that
have been rejected for both the Common and Rare stimuli will be displayed on the
screen.
P300 Default Averager Settings.
88
It is important that the patient attend to the stimuli. This is facilitated by having
the patient keep a mental record of the number of Rare tones (i.e., higher pitched
tones) that are presented during the test. Drowsiness should be avoided, as well
as distracting noises.
take shape.
The P300 program has dual averager banks. The Common stimuli are averaged
in the first averager bank and the corresponding traces are displayed in the left
half of the trace window. The Rare stimuli are averaged in the second averager
bank and the corresponding traces are displayed in the right half of the trace
window.
section of the EP Controls window or Toolbar.
89
Ask the patient how many Rare stimuli they counted. Compare this with the
number shown in the AvgCnt column.
potentials to show replication of the traces. Again, ask the patient to count the
Rare stimuli.
zero.
F. Perform a Grand Average (Optional)
Press the F7 (Grand Avg) function key. Performing a Grand Average can
enhance the principle peaks. A 'blue' trace, representing the grand average of all
traces acquired from that channel, will be shown for each channel in the
montage.
90
Example 3 Channel P300. Cursors have been placed on the Grand Average trace for the Cz-A1A2
channel.

• Using the Mouse - simply click on the Trace you want to move with
the left mouse button and drag the trace to its new location.
move traces.
mode.
and click OK.
91

window.
For information on configuring the Auto Cursors, see the P300 Test Setup
topic.
Cursor mode.
92
P300 cursor table example.

To print a Report:
10. Next Test
Study window.
93
94
The TabData Window

The TabData window provides an overview of all tests completed on the patient as well
as summary tables for test protocols such as NCV, F/H, and EMG. An optional
Sentence Generator is available to create sentences describing the EMG and NCV
results.
To open the TabData window press the F4 (TabData) function key from within any test
protocol or select TabData from the View menu.
Completed test protocols are listed down the left-hand side of the window. To select a
test protocol or summary table perform one of the following actions.
• Turn Knob #1 (Select / Open) to move the blue highlight to the desired test
protocol or table.
• Click the left mouse button on the test protocol or table.
The highlighted entry's results are displayed on the right-hand side of the TabData
window.
TabData window with All NCV summary tables selected.
95
Actions that can be performed in the TabData window:

Adjusting Auto Cursor Positions
Begin by highlighting an individual test protocol, such as Right Median Motor. The
test's traces and cursor table will be displayed on the right-hand side of the window.
Click on a cursor using the left mouse button and drag it along the trace to its new
location. The information in the cursor table will be updated to reflect the new
position.
Trace Context (pop-up) Menu
Whenever traces are displayed in the right-hand side of the TabData window you
can right-click the mouse over the trace area to display the same context menu that
is available during data acquisition.
Use this context menu to delete traces, smooth traces, etc.
Change Muscle Scoring
If an EMG Muscle Scoring Table is selected you can change the muscle scoring
selections for a muscle simply by clicking with the left mouse button within the table.
Sorting Muscle Scoring Table
If an EMG Muscle Scoring Table is selected you can click the mouse at the top of
any of the table's columns to sort the table according to that column's information.
To reverse the sorting, right-click the mouse over the muscle scoring table and
select "Original Sort Order" from the pop-up menu.
NCV Column Setup
When a NCV Summary table or individual nerve test protocol is selected the
Change Columns button is available.
Clicking on Change Columns allows you to specify how the NCV results will be
shown in your reports. This does not change how the results are displayed during
data acquisition.
Click on the nerve type you want to change. To include information in reports, click
at the bottom of the displayed column, or within the column, and then select Insert
from the pop-up menu. Select the value you want to include in the report from the
displayed list of choices. To remove information in reports, click on the value
displayed in the column, then select Delete from the pop-up menu.
96
NCV - Change Columns window.
Swap Sides
When an individual NCV, F Wave, or H Reflex test protocol is selected the Swap
Side button can be used to swap the side parameter of the selected test.
If the side you are swapping to doesn't already exist within the Study window,
then that nerve will automatically be added.
If the side you are swapping to already has stored traces, then a second run will
be automatically added to that existing nerve.
Override an Abnormal Value
When an individual test protocol is selected you can right click over an abnormal
value and then select Set As Normal from the pop-up menu. The abnormal value
flag will be removed from that value. To reset the abnormal value flag, right click
over the value a second time and click on Set As Normal to remove the check mark.
Assign an Abnormal Severity Meaning

If you have the optional integrated sentence generator enabled, you can right click
over an abnormal value to display a list of possible meanings. An asterisk indicates
97
the sentence generator's currently assigned default meaning for the value. You can
override the default meaning by selecting one of the additional meanings from the
list.
Playback an EMG Buffer

When a stored EMG Buffer is selected, the compressed buffer trace will be shown in
the right hand portion of the TabData window. Use the playback controls to replay
the buffer without having to open the EMG test protocol.
View the Custom Fields from the Patient Information window
Clicking on the Patient Info / Report node will display the custom fields from the
patient information window as well as the findings sentences (if enabled). If a
QuickReport Item has been assigned to a custom field, it can be processed in this
view. For more information on using custom fields, click here.
Print a Report
Two buttons, representing the Print and Report keys on the Sierra Wave base unit,
are displayed at the bottom of the TabData window. The name of the report
template that is currently assigned to these buttons is displayed as the button's label.
To initiate a report.
• Click on one of these two buttons with the mouse.
• Press the F2 or F3 function keys.
• Press the Print or Report keys on the Sierra Wave base unit.
Change Report Options
The Report Options button allows you to remove some elements from generated
reports without removing them from the data acquisition screen or the TabData
Summary view.
• Flag Abnormals in Reports - when this box is checked abnormal values
will be indicated in reports, usually as red colored boxes or bolded
numbers.
98
• Show Comments (NCV, F, H) - when this box is checked comments

entered during NCV, F Wave, or H Reflex data acquisition will be
displayed in the data tables of generated reports.
• Show Norm Columns (NCV, F, H) - when this box is checked the normal
value columns for NCV, F Wave, and H Reflex tests will be included in the
data tables of generated reports.
• Show Column Header Shading - when this box is checked the column
headings at the top of each table are shaded gray.
• Show Outside Table Lines - when this box is checked a line is drawn
between each nerve and a box is drawn around the entire table. If this
box is unchecked, only the column heading row will remain underlined.
Open a Test Protocol
To open a test protocol and display the acquisition screen (this would be necessary
to re-stimulate or collect additional traces).
• Highlight the test protocol by turning Knob #1 (Select / Open) and then
press to open.
• Highlight the test protocol and then click the Open Test button.
• Double click on the test protocol with the mouse.
Close the TabData window
To close the TabData window and return to the previous test protocol screen.
• Click on the F4 (Close) button.
• Press the F4 (Close) function key on the Sierra Wave base unit.
• Click on the TabData window's red X .
99
Integrated Sentence Generator for Findings:

The TabData window features an optional Sentence Generator which can build
findings sentences to describe NCV, F Wave, H-Reflex, EMG, and EP data.
To Enable the Sentence Generator:
• Start the Sierra Wave program.
• Select System Setup from the Edit menu.
• Place a check mark in the box labeled "Show Sentence Generator in
TabData".
• Click OK.
When an NCV, F Wave, or H-Reflex table node is highlighted in the TabData
window, the findings sentences for those test protocols will be displayed below the
summary tables.
NCV, F, H findings sentences.
When the EMG Scoring Table is highlighted in the TabData window, the findings
sentences for the muscle scoring will be displayed below the scoring table.
EMG findings sentences.
When an EP node is highlighted in the TabData window, the findings sentences for
that evoked potential protocol will be displayed below the summary tables.
AEP findings sentences.
100
Generating A Report
The Sierra Wave uses a separate program for report generation, this program is called
QuickReport.
To initiate a report you must select a template from within the Sierra Wave
program. Once a template is selected the QuickReport program will start
automatically.
QuickReport is a Microsoft WordTM based application and includes such Word

features as spell check, grammar check, table formatting, and graphics support.
QuickReport can be run stand-alone to edit and create the report templates used
by the program.
To Select a Report Template

From within the TabData window:
• Click on one of the two report buttons shown within the TabData window.
The buttons are labeled with the name of the template currently assigned to
them.
• Press either the Print or Report key on the Sierra Wave base unit.
From within a Test Protocol screen:
• Press either the Print or Report key on the Sierra Wave base unit.
• Use the program's File Menu to select one of the following.
Launch QuickReport & Select Template - this will start the QuickReport
program and allow you to select any report template available on the system.
Print "Template Name" for Print key - the template name currently
assigned to the Print key on the Sierra Wave base unit is displayed here.
Clicking this entry will select this template and start QuickReport.
Print "Template Name" for Report key - the template name currently
assigned to the Report key on the Sierra Wave base unit is displayed here.
Clicking this entry will select this template and start QuickReport.
Description of the Factory Default Report Templates

Current Test - use this template to print the results for the individual Test Protocol
that is currently displayed on the screen. For example, use this to print the results
101
for a single NCV nerve test or a single Evoked Potential test. It also includes the
Chief Complaints, Medications, Physical Exam / History, and Impression custom
fields from the Patient Information window.
Full Report (manual Findings) - this template includes all the test protocols within
the TabData window (tables & traces). It also includes the Chief Complaints,
Medications, Physical Exam / History, Impression, and Recommendation custom
fields from the Patient Information window as well as an interactive Findings item for
manual creation of findings sentences.
Full Report with DataLAB - this template includes all the test protocols within the
TabData window (tables & traces). It also includes the Chief Complaints,
fields from the Patient Information window. A Findings section automatically imports
the text from the Sentence Generator feature of the TabData window. The results of
the DataLAB feature are also included in this report.
Full Report with Sentence Gen - this template includes all the test protocols within
the TabData window (tables & traces). It also includes the Chief Complaints,
the text from the Sentence Generator feature of the TabData window.
Full Report with SG and AV - this template includes all the test protocols within the
TabData window (tables & traces). It also includes the Chief Complaints,
the text from the Sentence Generator feature of the TabData window. The
AnatomyVIEW graphic is also included in this report.
Injection Report - this template to print the injection log table from the EMG
Guidance protocol. It also includes an injection diagnosis and procedure code table.
MMUA Report - this template includes the summary tables and MUP waveforms
from Multi-Motor Unit Analysis. It also includes the Chief Complaints, Medications,
Physical Exam / History, Impression, and Recommendation custom fields from the
Patient Information window.
TabData w/ Traces - this template includes all the test protocols within the TabData
window (tables & traces). It also includes the Chief Complaints, Medications,
TabData w/o Traces - this template includes all the test protocols within the
TabData window (tables only). It also includes the Chief Complaints, Medications,
102
Overview of QuickReport
QuickReport has three main views.
Select Report - the program will go to this view if you select "Launch
QuickReport & Select Template" from the Sierra Wave's file menu. This view
allows you to choose any template on the system. This view is initially displayed
if you start QuickReport outside of the Sierra Wave program. To select a
template, either double click on it or single click on it and then click the Next
button.
Fill In Report - the program will go to this view if you select a report template
that requires user input. For example, the "Full Report (manual Findings)"
template will go directly to this view so that the user can make manual selections
for the Findings section of the report.
Document - this view shows the generated report in Word format. The program
will automatically go to this view if you select a report template that does not
require any user input, the "Current Test", "TabData w/ Traces", and "TabData
w/o Traces" templates are examples. The program will also switch to this view
when all selections are complete on the Fill In Report view.
QuickReport - Select Report view.
103
To Print the Report

From the Document view,
• click on the Printer icon at the top of the screen. The report will be
sent to your default printer.
• select Print from the File menu.
To Save the Report
• click the Finish button, you will be prompted to save the report.
• click on the Diskette icon .

• select Save from the File menu.
The report is saved to the user's Data directory with the filename of
"lastname, firstname, date, time.doc".
To Close QuickReport
• select Exit from the File menu.
• click the Finish button at the bottom left of the screen.
• click the Red X in the top right-hand corner.

If the report has not been saved the program will ask you if you would like to
save the report before exiting.
To get a simple printout of the current test screen, select Print Screen from the
Sierra Wave File menu.
For more detailed information on QuickReport and report templates, see the Help
Topics from within the QuickReport program.
104
Closing the Patient Exam

To close the patient's exam, click on the File menu and select Close Exam.
• The program will automatically display the Patient Information window if you did
not enter a Last Name for the patient prior to starting the exam. Enter the Last
Name in the Patient Information window and click F3-OK to close the exam.
You can also click on the red X in the upper right hand corner. This will
close the patient's exam first, then the Sierra Wave program will be exited.
Closing the Sierra Wave Program

To close the Sierra Wave program.
• Click on the File menu and select Exit.
OR,
• Click on the red X in the upper right hand corner of the screen.
The program will automatically display the Patient Information window if you
did not enter a Last Name for the patient prior to starting the exam. Enter the Last
Name in the Patient Information window and click F3-OK to close the exam. The
Sierra Wave program will then close immediately after this.
105

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Cadwell Sierra Wave EMG Guide

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What are the steps to turn on the equipment?

What are the steps to turn on the equipment?

What are the steps to start a new exam and enter patient information?

What are the steps to start a new exam and enter patient information?

Getting Started Guide

Turning Equipment On and Off ................................................................................................... 1

Starting the Sierra Wave Program .............................................................................................. 2

Starting a New Exam and entering Patient Information .............................................................. 2

Selecting a Study or Test Protocol.............................................................................................. 5

Description of Screen Layout ...................................................................................................... 7

Using the Study Window ........................................................................................................... 18

NCV - Basic Operation .............................................................................................................. 21

EMG - Basic Operation ............................................................................................................. 28

F/H Basic Operation .................................................................................................................. 38

RNS - Basic Operation .............................................................................................................. 43

Blink - Basic Operation.............................................................................................................. 52

SEP - Basic Operation .............................................................................................................. 57

AEP - Basic Operation .............................................................................................................. 66

VEP - Basic Operation .............................................................................................................. 76

P300 - Basic Operation ............................................................................................................. 85

The TabData Window................................................................................................................ 95

Generating A Report ............................................................................................................... 101

Closing the Patient Exam ........................................................................................................ 105

Closing the Sierra Wave Program........................................................................................... 105

To turn the equipment Off.

You do not need to disconnect the amplifier, stimulators, or accessories. You

Starting the Sierra Wave Program

If you receive a Communication Error message.

Starting a New Exam and entering Patient Information

• Press F1 - New Exam.

Patient Information window

• Centimeters (cm) - required when using the prediction equations in NCV, F

Weight can be entered in the following units:

The following buttons are shown at the bottom of the window:

Selecting a Study or Test Protocol

From the Patient Information window:

Outside the Patient Information window:

Description of Screen Layout

NCV Trace window

Trace Window Context Menu

Context menu for NCV Trace window.

The Study window has several functions:

Study Window Context Menu

When right clicking on a test protocol name:

Over an NCV test. Over an EMG test.

Controls Window or Controls Toolbar

There is no Context menu for the Controls window.

Controls Window for NCV test protocol.

Controls Toolbar for NCV test protocol.

Measurements / Cursor Table Window

The Measurements / Cursor Table window has several functions.

NCV Tables window.

Measurements / Cursor Table Window Context Menu

EMG Muscle Score Table Context menu.

Live Monitor Window

F1-F4 Function Keys for NCV test.

PC Toolbar (Function Keys F5 - F12)

PC Function Key Toolbar for the NCV test.

Knob functions for NCV test.