| BrainMaster Protocol Design Sheet | ||||||||
| Clinician Name: | ________________________________________________________ | |||||||
| Clinician Address: | ________________________________________________________ | |||||||
| Client Name: | ____________________________ | Folder ID:_________________ | ||||||
| Client Condition: | ________________________________________________________ | |||||||
| Standard Protocol (if any): | _____________________________ | |||||||
| Number of Channels: | ____1 | ____2 | Save EEG? ___yes ___no | |||||
| Scale Factor: _____rms _____p-p | ||||||||
| Act 1:_____ | Ref 1: _____ | Gnd: _____ | Ref 2: ____ | Act 2: _____ | ||||
| Frequency Bands: | THRESH | LO (Std) | HI (Std) | MANUAL | ||||
| (uVolts) | (Hz) | (Hz) | % time (p) | |||||
| Delta | ___GO | ___STOP | ___IGNORE | ________ | _______(1) | _______(3) | _______ | |
| Theta | ___GO | ___STOP | ___IGNORE | ________ | _______(4) | _______(7) | _______ | |
| Alpha | ___GO | ___STOP | ___IGNORE | ________ | _______(8) | _______(12) | _______ | |
| LoBeta | ___GO | ___STOP | ___IGNORE | ________ | _______(12) | _______(15) | _______ | |
| Beta | ___GO | ___STOP | ___IGNORE | ________ | _______(15) | _______(20) | _______ | |
| HiBeta | ___GO | ___STOP | ___IGNORE | ________ | _______(20) | _______(30) | _______ | |
| Gamma | ___GO | ___STOP | ___IGNORE | ________ | _______(38) | _______(42) | _______ | |
| User | ___GO | ___STOP | ___IGNORE | ________ | _______(30) | _______(35) | _______ | |
| Autothresholding: | ____ON | ____OFF | ||||||
| Autothreshold Percents: | GO: _____ | STOP: | _____ | HIBETA: | _____ | |||
| Autoupdate: | ||||||||
| ____NEVER | ____AFTER BASELINE | ____BEFORE EACH RUN | ||||||
| Displays (check components and displays to show): | ||||||||
| __Delta | __Theta | __Alpha | __LoBeta | __Beta | __HiBeta | __Gamma | __User | |
| _____Raw EEG | ___Phase Space | ___Mirror (FFT) | ___Coherence | |||||
| _____Filtered | ___Thermos | ___Mirror (Filt) | ___FFT Spectrum | |||||
| Sounds: | Reward Sounds: | ______ | ||||||
| Component Sounds: | ______ | |||||||
| Pitch (MIDI) Sounds: | ______ | MIDI Voice/Mode(s): ___________________ | ||||||
| Coherence Sounds: | ______ | MIDI Voice/Mode(s): ___________________ | ||||||
| Phase Sounds | ______ | MIDI Voice/Mode(s): ___________________ | ||||||
| Complex Sounds: | ______ | MIDI Voice/Mode(s): ___________________ | ||||||
| Number of Sessions:_____ | Baseline Length:______(min) | |||||||
| Number of Runs:_______ | Run Length:________(min) | |||||||
| Pause between runs? ____yes ____no | ||||||||
| Comments: | _________________________________________________________ | |||||||
| Clinician: | _____________________________ | Date: | _______________ | |||||
| (signature) | ||||||||