The Do's and Don'ts of QEEG Neurocognitive Testing

Neurocognitive testing is an excellent way to evaluate how well a patient's brain is functioning. In order to collect that information, it requires the use of sensitive medical equipment with proper testing procedures and system maintenance. Also, like most things in life, there is a right way and a wrong way to perform Neurocognitive testing. Below are some tips to get the best results you can, and keep your equipment functioning like new!

The Blunt Tip Syringe:

• Don't: approach a patient's skull with the syringe without first explaining that the tip is totally blunt! Oftentimes a patient will react poorly to this, expecting a painful and scary procedure. “Don’t stab me!”

• Do: emphasize that the syringe tip is not sharp before showing it to the patient! Prove it is not sharp by tapping the tip on the palm of your hand, then on the palm on their hand. Tell the patient: "See? The tip is not sharp. It will not hurt you. We just use this to get gel into the sensors so the cap and software can see your brain working". This will reduce fear and increase patient compliance.

• Don't: use words such as “syringe” and “needle” around the patient. This will sound scary, regardless of the tip being blunt.

• Do: use your words carefully so the patient feels comfortable. How you talk can change an apprehensive and anxious patient into a willing and compliant one. Try using the term "blunt tip" or “applicator tip”.

The Gel:

• Don't: use just any type of medical gel to fill the EEG caps (ie; ultrasound gel).

• Do: use ONLY the provided and manufacturer suggested electro-gel.

  • If you run out, find more on our website: CLICK HERE

• Don't: stick a dirty needle back into the gel if you need a refill. The needles and syringes are disposable, and double dipping is unsanitary!

• Do: replace the blunt tip needle before refilling the syringe if you end up running out of gel before all sensors are filled. This is why 2 tips are included. Always use a new syringe and needle set for each patient.

  • If you run out of syringe packs (test kits), more can be ordered from our website: CLICK HERE

• Don't: prefill the syringe before a patient arrives. A patient does not want “mystery gel” injected onto their scalp.

• Do: fill the syringe in front of the patient so they know exactly what is being put in their hair. After explaining that the tip is blunt (and tapping it on their palm), tell the patient this gel will be put into each sensor in order to see their brain. Emphasize it doesn't hurt and that it will feel a little cool! Then go fill the syringe.

• Don't: make the patient hesitant to have gel in their hair. The gel is obviously not comfortable for most patients, but you do not want anyone refusing to test because of this. Do not make the process sound gross or unfavorable. This isn’t one of those times to sympathize with the patient, but rather downplay the gel.

• Do: keep the administering of the gel a simple and easy part of the test. Downplay the situation so the patient is more compliant. For instance, tell the patient “Don’t worry, we do not need to shave your head. We only need to put a drop of gel in each of these sensors.” Emphasize that it will only be a tiny bit of gel, even if it can end up being a lot more than that. Also, tell the patient you will wipe out most of the gel from their hair after the test is complete, and that any remaining gel easily washes out in the shower.

  • Bonus: Throwing in a silly comment sometimes, such as: “if you want, I’ll style your hair for you when we’re done!” can ease any anxiety related to the gel or the test.

• Don't: remove the neuro cap without being ready to wipe up excess gel from dripping down the patients head and face.

• Do: immediately wipe excess gel when removing the cap. Oftentimes, when the cap is initially removed, gel drips down the patient's head. The two most common areas for this are behind the patients ears and the forehead. This is can be extremely uncomfortable and feel gross. Be ready for this! Have a paper towel ready and the second you take the electrocap off, wipe those 2 key area’s first. Then try to wipe up any residual gel from the patients hair.

Filling the Sensors:

• Don't: randomly apply gel to the sensors without a method.

• Do: start by filling the ground and reference electrodes. (The brainmap in the software with the red lights will not change to green unless you do this first!). These are outlined in GREEN on the cap (down the top/center). Then, fill the remaining sensors in whatever order you find most efficient. Remember to push the gel from the syringe using your pointer finger, hold the patients head steady with your other hand, and use the “tap tap scrap” method to get the gel past the patients hair.

  • Bonus: A lot of technicians, once the GRD and REF sensors are done, will finish the center sensors, then take one side and ‘zig zag’ front to back, and then finish the opposite side.

  • Bonus: Since the patient may be a little uncomfortable during the filling process, have them look at the brain map on the computer and get involved with the gel administering process. Tell the patient: “You’re gonna help me here. Look at the screen, and let me know when you see each sensor turn from red to green/orange!” Participation will keep the patient distracted and involved in the test. They’ll want to help.

• Don't: perform a test if most sensors appear blue or red.

• Do: Try to turn all sensors green. If a few sensors are yellow or purple, this is fine! Maybe a sensor needs a couple extra taps with the blunt tip, or a little extra gel.

Bonus: EEG Cap Color Guide:

Red - no connection

Blue - bad connection

Purple - not good connection (probably ok, but blue is really bad)

Orange- movement artifact

Green - good connection

Washing the Cap:

• Don't: use a dirty cap on a patient. This is unsanitary, and the built-up of gel on the sensors will lead to unnecessary artifact and “dirty data”. This will also decrease the lifespan of the cap.

• Do: wash the cap with warm to cool water (not hot!) after each test. Using a little bit of antibacterial soap, rub each sensor gently under the faucet with your thumbs. The gel is water soluble, so cleaning should only require a few minutes.

  • The electrocaps are reusable, but not permanent. Typically, at 2-3 tests a day, a cap should last about 5 months. Proper maintenance directly affects this.

• Don't: skip an occasional deep clean of the cap and sensors.

• Do: set a day (preferably once a week) to deep clean your caps and sensors more thoroughly than usual. It is helpful to take a tiny straw brush or ‘orange stick’ to clean the inside of the sensors. Make sure the brushes are small enough to gently and comfortably fit through each sensor.

  • This pack of straw brushes has a few sizes that fit into the sensors: AMAZON

  • Additional Caps: CLICK HERE

• Don't: wring out the cap when drying! The cap is very expensive, do not treat it like a dish rag or sponge!

• Do: gently squeeze the cap to release water, then let it air dry.

• Bonus: Buy a wig stand and desk fan to expedite the drying process. Place the cap on the wig stand with the fan blowing it dry. This typically dries the cap in 10-15 minutes!

  • Wig Stand: AMAZON

  • Mini fan: AMAZON

  • Additional Caps: CLICK HERE

Testing a Patient:

• Don't: give the patient the trigger button before the 10 minute Evoked Response portion of the test. When handed the trigger, the patient is likely to start pushing the button, even before instructed to. This will progress the software through the test.

• Do: Only hand the patient the trigger when it is time for the Evoked Response. Make sure they only push the button when they are completing this portion of the test.

• Don't: test a patient in a loud setting.

• Do: Find a quiet room for testing. Some offices even put a sign on the door, such as "Cognitive testing in progress" so other staff members know to be quiet and not to interrupt the room. This will ensure better results!

• Don't: leave a patient alone in a room while being tested. Although the technician does not have to do much after setting up the patient, remain in the room during the test.

• Do: Monitor the patient during the test. Make sure they do not fall asleep, and provide assistance if needed. This will ensure better results!

General System Maintenance:

• Don't: continue to use the laptop without regularly checking for updates - Dell, Microsoft, Manufacturer. Oftentimes, updates don’t automatically run on their own. With any laptop-based equipment, Microsoft Updates can actually start compiling in the background, causing the computer to slow down, and ultimately affecting the ability for the software to communicate with the hardware!

• Do: regularly check for Windows Updates. Most offices will check for Windows Updates every Friday after the last test.

1. Click on the START / WINDOWS icon button on the bottom left corner of the Desktop.

2. Click on the SETTINGS icon (the second on up from the bottom).

3. Click on ‘Update & Security’

4. No matter what the computer says, click ‘Check for updates’.

5. Update, restart when prompted, and repeat this till no updates are available.

• Don't: try to run the software offline.

• Do: keep the laptop online and connected to WiFi. The Cognitive Software is a Cloud-Based software, and as such, cannot process reports without the internet. This also acts as a hard data back-up through the manufacturer.