Neurophysiology is a discipline within Healthcare Science where healthcare practitioners and healthcare scientists measure the function of the nervous system to help in the diagnosis and/or monitor the progress of neurological disorders.
Healthcare practitioners and healthcare scientists perform a range of different tests, in patients of all ages, all of which require a considerable amount of patient contact and also good communication skills as each involves attaching electrodes to the patient and encouraging co-operation before the recordings can be made.
Clinical Neurophysiology departments are usually based in hospitals and linked to neurological centres. Most of the investigations in neurophysiology are recorded in dedicated environments, however they are also performed at the patient’s bedside, in the intensive care and special baby care units and also in the operating theatre.
There are four types of tests which are performed in neurophysiology departments:
The electroencephalogram or EEG is the recording of the function of the cerebral cortex (brain) by applying electrodes to the scalp overlying the various lobes of the brain. The EEG records, over time, the changes in the electrical potentials generated by the cerebral cortex. This investigation has several uses but it main role is in patients suffering from epilepsy.
Evoked potentials (EPs)
Evoked potentials are electrical changes within the nervous system in response to a sensory stimulus (i.e. visual). The main use of evoked potentials are to investigate neurological disorders such as optic neuritis or multiple sclerosis (MS).
Nerve conduction studies
These studies measure the function of the peripheral nerves, those responsible for movement (motor function) and sensation (sensory function). The nerves are tested by applying a small electrical current to them and recording the response. These tests are used in neurological and other conditions that affect the function of the peripheral nerves. These tests are performed by healthcare practitioners and healthcare scientists but also Clinical Neurophysiologists (doctors who specialise in clinical neurophysiology).
Electromyography is performed by doctors who specialise in Clinical Neurophysiology, however healthcare practitioners and healthcare scientists assist during these tests. Electromyography test the function of the skeletal muscle and are used in the diagnosis of neurological conditions which affect the muscles such as motor neurone disease, plexopathy or radiculopathy.
Other specialised techniques are also performed in Neurophysiology departments and these include:
A new training scheme is now in place for all of Healthcare Science, which includes Clinical Neurophysiology, as a result of the Modernising Scientific Careers (MSC) programme introduced by the Department of Health.
Modernising Scientific Careers has four levels of training programmes for all of healthcare science, the entry to the different levels of training depends on qualifications and work experience.
The four levels are:
How I got into the role
As I was studying in my second year of my degree I wanted a change in career and was searching NHS jobs. I stumbled across the clinical apprenticeship in neurophysiology which could possibly lead to the degree to become a fully qualified Physiologist.
My 12-month apprenticeship allowed me to learn the basics of the field and to see if I enjoyed it enough to progress further. In my first year of working within neurophysiology I learnt about electrode placement, the importance of head measuring and the basics of the wave frequencies.
Once I completed my apprenticeship I was fortunate to be accepted onto the degree at the University of the West of England. This is a long-distance degree which is broken down into three block sessions at the university and majority is working within neurophysiology.
My role as a student
As a student, I assist the Physiologists in carrying out the diagnostic tests mainly electroencephalograms (EEGs) which is used to help in the diagnosis of epilepsy. I am currently learning how to head measure using the 10-20 measurement and apply the electrodes whilst being directly supervised. During my degree, I am learning how to carry out both routine and sleep EEGs on adults and will eventually progress onto children and more complex diagnostic procedures such as nerve conduction and evoked potentials.
Best parts of my job
Every day is different with a wide range of people from different backgrounds who are experiencing different symptoms. I work within a great team at Hull Royal Infirmary and learn and adapt my approach for what I think works best.
Future career plans
Hopefully I can complete this degree to a high standard and continue working within neurophysiology and eventually developed the skills and knowledge to perform the more complex tests.
Mike Duke, Undergraduate, Hull Royal Infirmary
The role of an assistant or associate is to undertake task based roles under supervision. The associate will undertake more advanced and complex tasks than the assistant.
Healthcare science assistants work towards a vocational qualification, whilst healthcare associates are commonly trained through a foundation degree or diploma.
The Practitioner Training Programme will lead to an approved and accredited BSc Honours degree in Healthcare Science. Neurophysiology is partnered by Audiology and Ophthalmic and Visual Science under Neurosensory Sciences.
The degree integrates academic learning and workplace based training. The degree will include 50 weeks of workplace-based training over the three years.
Typically at least two if not three A2/A levels, which include science subjects, and a good spread of GCSE’s at A to C grades are required as entry qualifications to these healthcare science degree courses. Equivalent qualifications may be accepted by some universities and you would need to check with each university before applying.
For more information regarding the Practitioner Training Programme click here.
Looking back to when I was choosing a university course, the one thing I distinctly remember was the lack of choice with careers in Healthcare; or rather the lack of information available from college advisors. Everyone was too focussed on wanting to be a doctor, dentist or pharmacist but from an early age I knew that for me, that was never going to be the case. With an eclectic mix of A-level subjects including English Language, Biology, Religion and Philosophy I felt unsure of where I could go in terms of a future career in Healthcare. So when I stumbled upon the Practitioner Training Programme (PTP) Healthcare Science Neurophysiology course, I applied without hesitation.
After passing the interview stage and receiving A, B, C in my respective college subjects, I began studying at Manchester Metropolitan University (MMU) in September 2013.
Three years later I am now a graduate in Healthcare Science - getting to grips with the transition from student to working life as I embark on a new chapter; working as a qualified Clinical Physiologist for Leeds NHS Teaching Hospitals. I am now also more aware of the huge variety of specialisms within the hospital and the different degrees that allow you to enter into them.
For me, the PTP in Neurophysiology provided that gateway and although the journey was tough: it has brought me onto the best career path I could have ever imagined!
Jannat Zulfiqar, BSc(Hons) Healthcare Science (Neurophysiology)
I enrolled on the accredited specialist scientific practice (ASSP) route in October 2014, having secured a position at Derriford Hospital as a Trainee Neurophysiologist. The course involved studying for a Postgraduate Certificate in Neurophysiology at Aston University and sitting two ANS standalone exams; EEG and VEP & NCS in the first and second years, respectively. These standalone exams involve a portfolio, consisting of two folders of evidence gathered throughout the year, and a standalone exam at the end of the year.
The course at Aston University involved three modules: EEG in practice, Professional Practice and Introduction to Healthcare Science. Owing to my previous studies, I was fairly au fait with the latter subject, allowing me time to focus on the EEG aspect of the course, involving EEG in coma, paediatric EEG and sleep EEG. With a limited knowledge of neurophysiology and having never seen a normal EEG, I was initially daunted and overwhelmed. This was soon alleviated when my knowledge developed with experience. It was only at a later stage, when I began to understand more, that I could fully appreciate how fascinating this material was. With the help of my colleagues in the department, I was able to grasp an understanding of EEGs that led to me completing the course in May 2015.
Simultaneously, I was learning the practical aspects of performing EEGs in the department, firstly observing my colleagues, then performing EEGs under supervision and eventually performing EEGs independently. I was presented with a range of clinical scenarios early on, including generalised tonic clonic seizures, strokes and complex partial seizures, which only served to help the learning process and to develop my portfolio. In November 2015, I passed the ANS EEG standalone exam, which was, in no small part, thanks to my colleagues, work-based assessor and mentor who had dedicated their time to help me succeed.
I quickly moved on to the second part of the ASP programme, which involves a single module of the STP course at Aston University, Nerve Conduction and Evoked Potentials, and the ANS VEP & NCS standalone exam. The module at Aston University was assessed by a poster presentation on a literature paper and a two hour essay-style exam, which covered EP, NCS and EMG. The EMG aspect, whilst not directly applicable to Physiologists, was fascinating and enabled me to appreciate the wider picture of Neurophysiology.
Once I had passed the exam in May 2016, I followed a similar route to the previous year – focusing on my portfolio. Whilst only VEP and NCS are assessed in the ANS standalone exam, I also learnt how to perform BAEPs (brainstem auditory evoked potentials), SSEPs (somatosensory evoked potentials), PERGs (pattern electroretinography) and FERGs (flash electroretinography). In the same vein, whilst the NCS aspect of the course focuses mainly on carpal tunnel syndrome, ulnar neuropathies, diabetic neuropathies and diffuse demyelinating neuropathies can be encountered. This variety in the tests performed and the different conditions diagnosed served to improve my exposure to the wide range of situations encountered within neurophysiology. In December 2016, I sat my ANS VEP & NCS exam and was successful, again with thanks to the support and dedication of my colleagues, work-based assessor and mentor.
Neurophysiology is an advancing field, and the ASSP programme allows students to fast-track their way to becoming a competent Clinical Neurophysiologist. This avenue into neurophysiology is something that I would encourage prospective students to pursue; it is demanding and fast paced, but, with the support of colleagues and the ANS, it is thoroughly enjoyable and rewarding.
The Scientific Training Programme (STP) is a post graduate training programme and leads to an accredited Master’s Degree (MSc) and certification of workplace-based training in Neurosensory sciences. Neurosensory sciences also includes audiological science and ophthalmic and vision science.
STP trainees will be employed by an NHS Trust. On successful completion of the training STP graduates will be able to apply for NHS posts as Healthcare Scientists.
The Scientific Training Programme is delivered through approved and accredited three year workplace training in a chosen specialism. The trainees will also be required to undertake a master’s degree in the specialism. Entry qualifications for the Scientific Training Programme is an upper second or better BSc Honours degree in a relevant pure or applied science. The commonly accepted degrees for Neurophysiology are:
To apply for Scientific Training Programme posts there is an annual application cycle which opens every January. More information on this can be obtained from the following website:
For more information regarding the Scientific Training Programme
Visit the Health Education England website.
NHS higher specialist scientific training (HSST) will be a training programme similar to medical consultant training, leading to medical Royal College examination where these exist or may have a doctoral award.
Information changes frequently so please use the link to the (right) to visit the NHS Careers website.
ANS provide these hyperlinks as a service to assist in searching for more information. Sometimes new courses are run and old ones are stopped. It is the individuals' responsibility to determine the suitabiity of any course and to ensure the course will be appropriate for their chosen career path.
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The National School of Healthcare Science has more information - follow this link.
More information is available at from NHS School of Healthcare Science - please follow this link.
As details of this are updated frequently we suggest you get more information from the NHS Careers website.
The National School of Healthcare Science has up to date information - please follow this link.
For further information please contact:
or your local Neurophysiology Department