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