| Continued from Page
2
| Shock value |
The term EMG might bring to mind images of electrodes, needles, and sore muscles. But only some electrodiagnostic tests actually involve electric shocks. These tests measure the physicological events of nerve and muscle tissue and provide a real-time video stream, which aid in the diagnosis of many neuromuscular conditions.
|
Prepare the patient
Apprehension about possible pain and an unfavorable outcome describes the mind-set of most patients preparing to undergo any test. Denise Henderson, the rehab clinic nurse at Nassau University Medical Center in East Meadow, N.Y., reports that almost every patient has some anxiety about electrodiagnostic testing. Patients need to be told there will be some degree of discomfort during the test.
“A lot of the patients that are coming for EMGs have already anticipated the pain that will come from it,” Henderson says.
She suggests having patients come in early to the exam so there is plenty of time for nurses to discuss the procedure with patients and address any fears. Henderson explains to patients that the nerve conduction portion of the study is usually done first and involves electrical impulses that vary in intensity.
The impulses are quick, and the patient can request to stop at any time or to have the intensity decreased. It’s important to tell patients, however, that decreasing the intensity might inhibit obtaining critical information needed for a proper diagnosis.
For the EMG portion of the test, Henderson assures the patient that no shocks are involved. As with the NCS, the patient can request the tester to stop at any point or decline to have specific muscles or parts of the body tested if it is too painful.
This, too, can affect whether an accurate diagnosis is achieved.
Contraindications to testing may include anticoagulation therapy, a bleeding disorder, or extensive skin infections. Children and agitated adults can have a mild sedative, but overly sedating people will make it impossible to complete the EMG portion of the test, for which they need to clench their muscles.
Some patients can tolerate only one of the two tests. While this is not ideal, having some information is better than having none, Henderson says.
In the book Easy EMG, coauthor Lyn Weiss, MD, a professor at the State University of New York at Stony Brook School of Medicine, suggests telling patients the study will be stopped at their request: “The patient is always in control of what happens, and the test can be stopped at any time if the patient feels it is too uncomfortable.”3
Henderson agrees that putting patients at ease is important. To alleviate their concerns, she spends a great deal of time explaining why the test is being done, how it works, and what they can expect to feel during the exam. “Most of the time,” she says, “the patients leave feeling a lot better and [say] the test wasn’t as bad as they had anticipated.”
For more information, visit the American Association of Electrodiagnostic Medicine’s website at www.aaem.net.
Regina Silver, RN, BA, is clinical nurse manager, progressive care unit, at Beverly Hospital, Beverly, Mass. Julie Silver, MD, is an assistant professor at Harvard Medical School and a physiatrist at Spaulding Rehabilitation Hospital, both located in Boston. Silver is also one of the authors of the new book Easy EMG, published by Butterworth-Heinemann, a subsidiary of Elsevier Inc.
References
1. Misulis KE. Essentials of Clinical Neurophysiology. Newton, Mass.: Butterworth-Heinemann; 1997.
2. Brown WF, Bolton CF. Clinical Electromyography. Newton, Mass.: Butterworth-Heinemann; 1993.
3. Weiss L, Silver JK, Weiss J. Easy EMG. Oxford, United Kingdom: Butterworth-Heinemann; 2004. |
Reply to Article