AANN Core Curriculum, 7th Edition, Ch. 7 Technology: Digital Version-Chapter 7

Chapter 7

Pdf Summary

This chapter reviews technologies used to assess, monitor, treat, and rehabilitate patients with neurological disorders. These tools complement—rather than replace—clinical and nursing assessment.<br /><br />Intracranial pressure (ICP) can be monitored with ventricular, intraparenchymal, hybrid, or other catheter systems. Ventricular drains also allow cerebrospinal fluid (CSF) drainage. External ventricular and lumbar drains divert CSF for conditions such as hydrocephalus, hemorrhage, CSF leaks, and elevated ICP; careful leveling, aseptic handling, and monitoring are essential to prevent infection, obstruction, and overdrainage. Surgical drains collect postoperative fluid. Implanted shunts divert CSF to locations such as the peritoneum, atrium, or pleural space, with selection and care guided by the patient’s condition and potential complications.<br /><br />Brain oxygenation and perfusion can be assessed globally, regionally, or through imaging. Methods include jugular venous oximetry, invasive brain-tissue oxygen probes, near-infrared spectroscopy, cerebral blood-flow monitors, and transcranial Doppler (TCD). TCD helps assess flow velocity, vasospasm, autoregulation, emboli, and recanalization. Cerebral microdialysis samples brain chemistry—including markers of metabolism, ischemia, and cellular injury—to support individualized treatment.<br /><br />EEG detects seizures, including nonconvulsive seizures, and helps assess cerebral function and treatment effects. Processed EEG technologies, including the bispectral index, estimate sedation or anesthesia depth but require cautious interpretation. Neuromuscular blockade is assessed by peripheral nerve stimulation and measurement of evoked muscle responses.<br /><br />The chapter also describes implantable stimulators for movement disorders, epilepsy, pain, respiratory insufficiency, and bladder or bowel dysfunction, as well as infusion pumps for intrathecal medication delivery. Automated pupillometry provides objective, trendable measurements of pupil size and reactivity. Brain–computer interfaces translate brain signals into commands, while functional electrical stimulation activates nerves and muscles to support movement and other functions. Across technologies, readings should be interpreted alongside neurological findings, with attention to device limitations, safety, and complications.

Keywords

intracranial pressure

ventricular drain

cerebrospinal fluid

transcranial Doppler

electroencephalography

neurological monitoring

brain oxygenation

microdialysis

implantable stimulators

functional electrical stimulation