Intraoperative Neurophysiological Monitoring Modalities I

Course Information

Course Code


Instruction Method

ONLINE – login information will be emailed on the course start date




12 weeks – 48 credit hours


Francois D. Roy, PhD CNIM

Learner Outcomes

Understand the basic fundamentals of IONM modalities, including:

  • electroencephalography (EEG)
  • brainstem auditory evoked potentials (BAEP)
  • free running and stimulated spinal and cranial nerve electromyography (EMG)
  • F-waves and H-reflexes
  • nerve action potentials (NAP)

Evaluation Method

Online quiz after each module, final multiple choice online exam

Intended For

Health professionals who are or will be working in an intraoperative neurophysiological monitoring role.


Only full CANM members are permitted to register for this course without first applying for the Graduate Certificate.

Text Book

Nuwer, M. Intraoperative Monitoring of Neural Function: Handbook of Clinical Neurophysiology, First Edition, Elsevier, 2008 [Not included in course fee. It is recommended that students obtain this text book prior to starting the course. Students are responsible for acquiring course textbooks.]

Certificate Program

Intraoperative Neurophysiological Monitoring (IONM) Graduate Certificate Program


  • IONM 120
  • Enrolled in the IONM Graduate Certificate Program and/or Full CANM membership – please submit your CANM membership number when registering for the course.

Topics Covered

By the end of this course, learners should be able to:

  • Describe and understand the proper electrode placement required to perform the IONM modalities within this course.  This includes both recording and stimulating electrodes, and, specifically, the 10-20 system of electrode measurement.
  • Describe EEG electrode montage and polarity and understand how to determine the polarity and location of waveforms.
  • Understand in detail how to properly describe EEG waveforms, and how an EEG is generated.
  • Understand the difference between normal and abnormal EEG for both adult and pediatric EEG, and how to identify artifacts.
  • Recognize the effects of anesthetics, and physiological changes on the EEG within the operating room setting.
  • Understand the differences between surface EEG and electrocorticography (direct brain recordings).
  • Assess the depth of anesthesia, or level of consciousness, of a patient during surgery.
  • Identify possible ischemia to the cerebral cortex caused by surgical and/or anesthetic-induced reduction in blood flow.
  • Describe and understand the basic anatomy, generators and normal waveform morphology of the BAEP.
  • Understand the clinical utility of BAEP by recognizing the differences between normal and abnormal BAEP, and be able to interpret significant changes in the perioperative setting.
  • Be able to outline the recording procedure and key features of spontaneous and triggered EMG potentials for both spinal nerve roots and cranial nerves.
  • Explain common mechanisms and criteria of spinal nerve root and cranial nerve injury, and discuss specific alarm criteria.
  • Describe the rationale for assessing functional integrity of nerve during peripheral nerve surgery and how nerves are identified.
  • Describe stimulating and recording parameters, and be able to interpret NAP results in the outpatient setting and during surgery.
  • Describe NAP pitfalls and artifacts.
  • Describe and understand the physiology of the monosynaptic H-reflex and the testing methodology.
  • Describe and understand the mechanisms of the F-wave and the testing methodology.
  • Understand the clinical utility of the F-wave and H-reflex in the perioperative setting and how they behave under conditions of anesthesia.
  • Demonstrate that axons are not static but exhibit remarkable modulation, and describe how axonal modulation can affect the size of a motor response.

IONM IONM130 Intraoperative Neurophysiological Monitoring Modalities I


CodeCourse TitleFormatTuitionDate(s)Register ByAvailability
IONM130-1Intraoperative Neurophysiological Monitoring Modalities IOnline$1,500.00May-01-2017 to Jul-30-2017Apr-21-2017Open