100821-620 Cascade Elite Operator's Manual PDF

Elite Operators Manual
Table Of Contents
© 2014 Cadwell. All rights reserved. ......................................................................................... 3
Disclaimer ...................................................................................................................................... 3
Trademark Notices ....................................................................................................................... 3
Introduction................................................................................................................................... 5
Intent of Operator's Manual .................................................................................................... 5
Overview ................................................................................................................................... 5
Cascade Elite Intended Use ..................................................................................................... 8
Electrical Stimulator Guide ..................................................................................................... 8
Setup Instructions ....................................................................................................................... 11
Hardware Setup...................................................................................................................... 11
Unpacking the System ....................................................................................................... 11
Position Elite Base Unit ...................................................................................................... 12
Elite Base Unit Connections .............................................................................................. 12
Power/Com Module Connections .................................................................................... 13
Elite Cabling Setup Instructions ....................................................................................... 14
Configuring the ES-IX ........................................................................................................ 16
Peripheral Devices and Connections ............................................................................... 23
Cabling Diagram - Elite to Desktop PC ........................................................................... 24
Cabling Diagram - Elite to Laptop PC ............................................................................. 24
Cascade Elite Features & Accessories .............................................................................. 25
Mounting V-Blocks on IV Pole ......................................................................................... 29
Attach Cascade to a Jackson Table ................................................................................... 31
Printer Setup........................................................................................................................ 32
Using the Hardware Simulator ........................................................................................ 32
TCS Setup ............................................................................................................................ 33
Software Setup ........................................................................................................................ 35
Software Setup Overview.................................................................................................. 35
Software Installation Instructions .................................................................................... 35
Configuring Cascade in Windows 7 ................................................................................ 39
Activating Software Licenses ............................................................................................ 48
Creating a Shortcut to a Network Location .................................................................... 51
Minimum Computer Requirements ................................................................................ 55
Editing System Setup ............................................................................................................. 57
System Setup - Overview .................................................................................................. 57
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General Tab ......................................................................................................................... 58

Remote Tab .......................................................................................................................... 60
Chat Tab ............................................................................................................................... 61
Event Filtering Tab ............................................................................................................. 62
Colors Tab ............................................................................................................................ 63
Performance/Operational Recommendations .................................................................... 64
Getting Started - The Basics ...................................................................................................... 67
The Basics................................................................................................................................. 67
Working with Basic Windows® ....................................................................................... 67
Turning Equipment On and Off ....................................................................................... 67
Opening and Closing Cascade Software ......................................................................... 68
Working with Cascade Software .......................................................................................... 68
Cascade Elite Start Page Overview .................................................................................. 68
Working with Cascade Windows..................................................................................... 70
Parts of a Window .............................................................................................................. 73
Toolbar Descriptions .......................................................................................................... 74
Global EP Window ............................................................................................................. 77
Working With Waveforms ................................................................................................ 78
Multi-Modal Stimulator Triggering ................................................................................. 79
Cascade File Extensions ..................................................................................................... 82
Cascade Data Management (DM) ............................................................................................ 85
Data Management within Cascade Application ................................................................ 85
Starting a new procedure .................................................................................................. 85
Procedural Notes ................................................................................................................ 86
Review / Append to an existing procedure .................................................................... 87
Import & Export.................................................................................................................. 88
Local Service Control Panel .................................................................................................. 90
Starting/Running Procedures ................................................................................................... 99
Starting a Procedure ............................................................................................................... 99
TCS Stimulus Triggering ..................................................................................................... 100
TCS Stimulus Intensity Adjustment .................................................................................. 101
Charge Accumulation Recommendation .......................................................................... 102
Checking Impedance............................................................................................................ 103
To check electrode impedance ........................................................................................ 104
Averaging Waveforms ......................................................................................................... 105
Electro-Surgery Detector and Electro-Surgery Reject ..................................................... 106
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Table Of Contents
Working with Cursors ......................................................................................................... 109

Setting Baselines ................................................................................................................... 110
Changing Settings for Multiple Modes ............................................................................. 111
Side-by-Side Comparison of Current and Past EEG ....................................................... 112
Appending to a Procedure .................................................................................................. 113
System Clock Error ............................................................................................................... 113
Exporting Data ...................................................................................................................... 114
Reducing Noise ..................................................................................................................... 115
Cascade Noise Reduction Options ................................................................................. 116
Choosing The Appropriate Repetition Rate 60 Hz ...................................................... 121
Determining Frequency of Noise ................................................................................... 129
Using Menu Options ............................................................................................................ 131
File Menu ........................................................................................................................... 131
Edit Menu .......................................................................................................................... 132
View Menu ........................................................................................................................ 133
Test Menu .......................................................................................................................... 135
Remote Menu .................................................................................................................... 135
Events Menu...................................................................................................................... 136
Window Menu .................................................................................................................. 137
Help Menu ......................................................................................................................... 138
Running NerveGuard .......................................................................................................... 139
NerveGuard Introduction ............................................................................................... 139
NerveGuard Operation.................................................................................................... 139
Determination of Threshold ............................................................................................ 140
Performing Pedicle Screw Threshold Detection .......................................................... 141
Using Continuous Stimulation Mode ............................................................................ 141
Using Fixed Detection Mode .......................................................................................... 142
Making Changes During Testing ................................................................................... 142
NerveGuard and Remote Monitoring ........................................................................... 143
NerveGuard Window ...................................................................................................... 143
Closing NerveGuard ........................................................................................................ 152
Operating the TCS ................................................................................................................ 152
Recording Transcranial Electric Motor Evoked Potentials ......................................... 153
Changing the Stimulus Parameters during a Recording ............................................ 154
Storing and Clearing Traces ............................................................................................ 162
Train Length Limit Warning ........................................................................................... 163
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High-Z Warning ............................................................................................................... 165

Run Mode .......................................................................................................................... 165
Artifact Reject .................................................................................................................... 165
Closing a Procedure ......................................................................................................... 167
Reviewing a Procedure ............................................................................................................ 169
Reviewing a Procedure ........................................................................................................ 169
Procedure Setup........................................................................................................................ 171
Procedure Setup - Overview ............................................................................................... 171
Procedure Setup - Channels ................................................................................................ 173
Modes ..................................................................................................................................... 177
Mode Overview ................................................................................................................ 177
MEP Mode Setup .............................................................................................................. 186
Mode Setup........................................................................................................................ 192
Mode Window Descriptions ............................................................................................... 202
Mode Windows Setup Overview ................................................................................... 202
Mode Controls .................................................................................................................. 202
EP Average Window ........................................................................................................ 203
EP Summary Window ..................................................................................................... 209
MEP Summary Window.................................................................................................. 211
MEP Analysis Window.................................................................................................... 212
EMG Window ................................................................................................................... 213
Stacked EMG Window..................................................................................................... 216
MEP Triggered Window.................................................................................................. 218
Live EEG Window ............................................................................................................ 222
EEG Analysis Window .................................................................................................... 225
3D Trend Window ............................................................................................................ 228
Cursor Trend Window..................................................................................................... 229
Video Window .................................................................................................................. 232
Event Window .................................................................................................................. 233
Waterfall Window ............................................................................................................ 235
TOF (Train of Four) Trace Window ............................................................................... 236
TOF (Train of Four) Analysis Window ......................................................................... 239
View Setup and Mode Windows Setup ............................................................................ 240
Views Overview ............................................................................................................... 240
Mode Control Window Setup......................................................................................... 241
EP Average Window Setup ............................................................................................. 242
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Table Of Contents
EMG Window Setup ........................................................................................................ 245

MEP Window Setup ......................................................................................................... 246
Live EEG Window Setup ................................................................................................. 249
Event Window Setup ....................................................................................................... 251
Summary Window Setup ................................................................................................ 254
Waterfall Trend Window Setup ..................................................................................... 257
Show ................................................................................................................................... 259
Waveforms......................................................................................................................... 259
Cursors ............................................................................................................................... 260
Channels ............................................................................................................................ 260
EP Cursor Trend Window Setup .................................................................................... 260
Live Video Window Setup .............................................................................................. 263
EP Analysis Window Setup ............................................................................................ 264
Stacked EMG Window Setup.......................................................................................... 268
EEG Analysis Window Setup ......................................................................................... 270
TOF Window Setup.......................................................................................................... 274
TOF (Train of Four) Analysis Window Setup .............................................................. 275
3D Trend Window Setup ................................................................................................. 277
Waterfall Window ............................................................................................................ 278
Global Summary Window Setup ................................................................................... 280
Global Waterfall Window Setup .................................................................................... 282
Test Setup .............................................................................................................................. 284
Other Setup............................................................................................................................ 285
Mode Groups .................................................................................................................... 285
Mode Group Cycle ........................................................................................................... 287
NerveGuard Procedure Setup ............................................................................................ 289
Stimulators............................................................................................................................. 293
Electrical Stimulators ....................................................................................................... 293
TCS Stimulators ................................................................................................................ 295
Single-output Transcranial Stimulators (TCS-1/TCS-1000) ........................................ 296
Multiple-output Transcranial Stimulator (TCS-4) ....................................................... 298
Auditory Stimulator ......................................................................................................... 299
Visual Stimulators ............................................................................................................ 300
Paired Stimuli .................................................................................................................... 300
Cascade EEG and EEG Analysis ........................................................................................ 305
Example EEG Analysis Windows .................................................................................. 305
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EEG Windows ................................................................................................................... 310

EEG Analysis Window .................................................................................................... 312
Remote Monitoring .................................................................................................................. 317
Introduction........................................................................................................................... 317
What is Remote Monitoring? .......................................................................................... 317
What can you do on the Remote Reader? ..................................................................... 317
What can't you do on the Remote Reader? ................................................................... 318
Minimum Computer Requirements* ............................................................................. 318
Connection Scenarios ........................................................................................................... 319
Remote Monitoring Connection Diagrams ................................................................... 319
Peer to Peer on a LAN...................................................................................................... 322
VPN into LAN................................................................................................................... 322
Third Party Software ........................................................................................................ 323
Setup Instructions ................................................................................................................. 323
Setup for Remote Reader ................................................................................................. 323
Peer to Peer on a LAN setup ........................................................................................... 324
VPN into LAN setup ........................................................................................................ 332
VPN to VPN setup............................................................................................................ 332
Third Party Software setup ............................................................................................. 332
Starting a Remote Monitoring Session .............................................................................. 333
Initializing a Remote Monitoring Session from the Reader ....................................... 333
Initializing a Remote Monitoring Session from the Cascade ..................................... 334
System Setup on the Remote Reader ............................................................................. 336
Chat Box ............................................................................................................................. 338
Sync with Server ............................................................................................................... 339
Views .................................................................................................................................. 339
Reports ............................................................................................................................... 341
Data Rates for Remote Monitoring ................................................................................ 343
Disconnect ......................................................................................................................... 344
Trouble Shooting .................................................................................................................. 344
Errors .................................................................................................................................. 344
Command Prompt ............................................................................................................ 347
Search for Computer ........................................................................................................ 348
Generating Reports .................................................................................................................. 349
Cascade Report Generation................................................................................................. 349
The Report Generation Process ...................................................................................... 349
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Table Of Contents
Templates/Tokens............................................................................................................. 349
Steps for Report Generation ............................................................................................ 350
Default Report Templates ............................................................................................... 354
Report Templates and the Template Editor Program ..................................................... 355
Appearance of a Typical Template ................................................................................ 355
Opening an Existing Template ....................................................................................... 356
Template Editor ................................................................................................................ 357
Copying Templates .......................................................................................................... 358
Customizing the Appearance of the Template ............................................................. 358
Using a Page Header ........................................................................................................ 359
Customizing the Report Header..................................................................................... 361
Signatures in Reports ....................................................................................................... 362
Cascade Tokens................................................................................................................. 364
Choice Token ..................................................................................................................... 367
Inserting a Token into a Template.................................................................................. 369
Using Specialized Tokens ................................................................................................ 370
Inserting the Contents of RTF/Bitmap Files .................................................................. 379
Saving Templates.............................................................................................................. 380
Closing the Template Editor ........................................................................................... 380
Safety Information .................................................................................................................... 381
General Warnings and Precautions ................................................................................... 381
TCS Warnings and Precautions .......................................................................................... 384
Symbols .................................................................................................................................. 385
Verification of Proper Operation ........................................................................................ 387
Operating Environments & Limits..................................................................................... 388
Transportation & Storage Limits ........................................................................................ 388
Electrical Safety Requirements and Allowable Configurations ..................................... 388
Electromagnetic Compatibility ........................................................................................... 391
Disposal of Equipment ........................................................................................................ 397
TCS Specifications ................................................................................................................ 397
ES-IX Specifications .............................................................................................................. 403
Electrode Current Density Graphs..................................................................................... 403
EMG Needle ...................................................................................................................... 403
EEG Needle ....................................................................................................................... 404
Disposable Bar Electrodes ............................................................................................... 404
Bar Electrodes.................................................................................................................... 405
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Felt-Pad Bar Electrodes .................................................................................................... 405

Electrical Stimulator Characteristics .............................................................................. 406
ES-IX Stimulator Characteristics .................................................................................... 407
Care and Cleaning of Equipment ........................................................................................... 413
General Cleaning .................................................................................................................. 413
Cleaning Cascade Components .......................................................................................... 413
Cleaning Stimulators............................................................................................................ 413
Cleaning Electrodes.............................................................................................................. 414
General Care of TCS Units .................................................................................................. 415
Service and Maintenance ......................................................................................................... 417
Amplifier Calibration ........................................................................................................... 417
Amplifier Diagnostics .......................................................................................................... 418
Impedance Test Arrays & Amplifier Diagnostics ............................................................ 420
ES-IX Diagnostics.................................................................................................................. 422
Routine Maintenance ........................................................................................................... 424
Archiving with Windows 7 built-in burner ...................................................................... 424
Repair ..................................................................................................................................... 427
Software Upgrades ............................................................................................................... 428
Third Party Applications ..................................................................................................... 428
Warranty & Service Contracts ............................................................................................ 429
Limited Warranty ............................................................................................................. 429
Customer Support .................................................................................................................... 433
Using Help Files.................................................................................................................... 433
Cascade Customer Support................................................................................................. 433
Remote Assistance ................................................................................................................ 434
Shipping Equipment ............................................................................................................ 434
Approvals and Standards........................................................................................................ 437
Compliances .......................................................................................................................... 437
Domestic and International Approvals ............................................................................. 437
Frequently Asked Questions................................................................................................... 439
Some Frequently Asked Questions: ................................................................................... 439
Glossary ..................................................................................................................................... 445
Acquisition Sweep ................................................................................................................ 445
Display Sweep....................................................................................................................... 445
Act/Ref.................................................................................................................................... 445
Active Modes ........................................................................................................................ 445
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Table Of Contents
Active Window ..................................................................................................................... 445

Add/Delete/Rename View Buttons .................................................................................... 446
Add Marker ........................................................................................................................... 446
Adjust Latency ...................................................................................................................... 446
All ........................................................................................................................................... 446
All Gain Control ................................................................................................................... 446
All Manual Modes ................................................................................................................ 446
All Auto Modes..................................................................................................................... 446
Amp Chn ............................................................................................................................... 447
Amplifier................................................................................................................................ 447
Amplifier Channel Buttons ................................................................................................. 447
Amplifier Gain ...................................................................................................................... 447
Amplitude Markers .............................................................................................................. 447
As Recorded .......................................................................................................................... 447
As Recorded Gain ................................................................................................................. 447
As Recorded .......................................................................................................................... 448
Audio Controls ..................................................................................................................... 448
Auto Place Cursor On Manual ........................................................................................... 448
Auto Place Cursors ............................................................................................................... 448
Auto Position On-Off ........................................................................................................... 448
Auto Size ................................................................................................................................ 449
Auto Store On Avg Complete ............................................................................................. 449
Auto-Place Cursors on Percent of Average Complete .................................................... 449
Auto Store - (MEP) Mode .................................................................................................... 449
Baseline Trace ........................................................................................................................ 449
Cancel ..................................................................................................................................... 449
Center Marker ....................................................................................................................... 449
Center Marker on Baseline .................................................................................................. 449
Center/Range ......................................................................................................................... 450
Ch 16 Audio Mute ................................................................................................................ 450
Camera Setup ........................................................................................................................ 450
Channel Button ..................................................................................................................... 450
Channel Fields ...................................................................................................................... 450
Channel Labels ...................................................................................................................... 450
Channel Name ...................................................................................................................... 450
Channel Section .................................................................................................................... 450
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Clear ....................................................................................................................................... 450

Clear Button........................................................................................................................... 450
Clear Button........................................................................................................................... 451
Clear Captured Trace ........................................................................................................... 451
Clear Cursors......................................................................................................................... 451
Client List............................................................................................................................... 451
Control Button ...................................................................................................................... 451
Copy Special .......................................................................................................................... 453
CSA ......................................................................................................................................... 453
CSA Scale ............................................................................................................................... 453
Current Procedure Setup ..................................................................................................... 453
Detection Mode ..................................................................................................................... 453
Disp Gain ............................................................................................................................... 454
Display Sweep....................................................................................................................... 454
Division Units ....................................................................................................................... 454
Dot-to-Dot Markers .............................................................................................................. 454
Dot-to-Dot/Table View ........................................................................................................ 454
DSA......................................................................................................................................... 455
DSA Colors ............................................................................................................................ 455
DSA Max Power ................................................................................................................... 455
DSA Max Voltage ................................................................................................................. 455
DSA Smoothing .................................................................................................................... 455
EEG Burst Suppression ........................................................................................................ 455
EEG Drawing Selections ...................................................................................................... 456
EMG Run Modes .................................................................................................................. 456
Enable 16 Ch Reject .............................................................................................................. 456
Enable Auto Capture on Threshold ................................................................................... 457
Enable Bovie Reject .............................................................................................................. 457
Enable Store on Threshold .................................................................................................. 457
Enable Wave/Beep ................................................................................................................ 457
EP Mode Controls................................................................................................................. 457
EP Modes ............................................................................................................................... 457
ES-5 -10 Stim Splitter ............................................................................................................ 458
Event List ............................................................................................................................... 458
Event Text .............................................................................................................................. 458
Events ..................................................................................................................................... 458
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Table Of Contents
Feature.................................................................................................................................... 458
File Names ............................................................................................................................. 458
Freeze ..................................................................................................................................... 458
Freeze Frame ......................................................................................................................... 458
Frequency Range (Hz) ......................................................................................................... 459
Display Gain .......................................................................................................................... 459
Gain ........................................................................................................................................ 459
Grand Average...................................................................................................................... 459
Graticule................................................................................................................................. 459
HiCut, LoCut ......................................................................................................................... 459
Horizontal Trend .................................................................................................................. 459
Impedance ............................................................................................................................. 459
Intensity Bar .......................................................................................................................... 460
Insert Copy Button ............................................................................................................... 460
Invert ...................................................................................................................................... 460
Label Format ......................................................................................................................... 461
Lock Graph ............................................................................................................................ 461
Marker .................................................................................................................................... 461
Max Intensity......................................................................................................................... 461
MEP Mode ............................................................................................................................. 461
MEP Mode Controls ............................................................................................................. 461
MEP Mode Options: ............................................................................................................. 462
Minutes Labels ...................................................................................................................... 462
Mode....................................................................................................................................... 463
EMG Trace Area ................................................................................................................... 463
Print Report Button .............................................................................................................. 463
Norm Percent Change.......................................................................................................... 464
Notch/Audio ......................................................................................................................... 464
Paging Controls .................................................................................................................... 464
Pause EEG Analysis ............................................................................................................. 464
Pause Averager ..................................................................................................................... 465
Play Sound on Stim .............................................................................................................. 465
Print EEG Report .................................................................................................................. 465
Print Procedure Setup .......................................................................................................... 466
Print Screen............................................................................................................................ 466
Pulse Width ........................................................................................................................... 466
xiii
Refresh.................................................................................................................................... 466
Refresh Rate ........................................................................................................................... 466
Reject ...................................................................................................................................... 466
Reject Setting Dialog ............................................................................................................ 466
Remove Stim Artifact From EMG ...................................................................................... 468
Rename Window Button ..................................................................................................... 469
Resolution .............................................................................................................................. 469
Rotate/Tilt .............................................................................................................................. 469
Run.......................................................................................................................................... 469
Run Mode .............................................................................................................................. 469
Select All ................................................................................................................................ 469
Setting Baselines ................................................................................................................... 470
Set Epoch Length .................................................................................................................. 470
Setup Stim .............................................................................................................................. 470
Setup Tables .......................................................................................................................... 470
Show ....................................................................................................................................... 471
Show Baseline ....................................................................................................................... 471
Show Baseline Dot-to-Dot ................................................................................................... 471
Show Burst Suppression Info.............................................................................................. 471
Show Section (Table View):................................................................................................. 471
Show Cursors ........................................................................................................................ 472
Show Events .......................................................................................................................... 472
Show In Trace Windows...................................................................................................... 472
Show Percents ....................................................................................................................... 472
Show Trial Numbers ............................................................................................................ 472
Show Trial Numbers and Time .......................................................................................... 472
Single ...................................................................................................................................... 472
Smooth ................................................................................................................................... 473
Smooth/Unsmooth ............................................................................................................... 473
Sync with Server Button ...................................................................................................... 473
Spectral Edge ......................................................................................................................... 473
Stim Hold/Stim Rep ............................................................................................................. 473
Stim Type ............................................................................................................................... 473
Stimulate ................................................................................................................................ 473
Store ........................................................................................................................................ 473
Store ........................................................................................................................................ 474
xiv
Table Of Contents
Store Image On ..................................................................................................................... 474

Suppress Audio During Stim.............................................................................................. 474
Sweep Delay .......................................................................................................................... 474
Symmetry............................................................................................................................... 474
Take Snapshot ....................................................................................................................... 474
Test.......................................................................................................................................... 474
Threshold Markers ............................................................................................................... 475
Time Bar Event Marks ......................................................................................................... 475
Timer Intervals ...................................................................................................................... 475
TOF Mode Controls.............................................................................................................. 475
Trace Labels ........................................................................................................................... 476
Trace Name ........................................................................................................................... 476
Trace Windows ..................................................................................................................... 476
Train Setup ............................................................................................................................ 476
Trend ...................................................................................................................................... 476
Trend Count .......................................................................................................................... 476
Trend ...................................................................................................................................... 477
Trend Settings ....................................................................................................................... 477
Trend Time ............................................................................................................................ 477
Trial Select ............................................................................................................................. 477
Trigger .................................................................................................................................... 477
View Selection ....................................................................................................................... 477
Voltage, Power, ZScore ........................................................................................................ 477
Waveforms ............................................................................................................................ 477
Waveforms ............................................................................................................................ 478
Window Setup Button ......................................................................................................... 478
Z Score Colors ....................................................................................................................... 478
Zoom Control ........................................................................................................................ 478
Zoom In/Zoom Out .............................................................................................................. 479
Index ........................................................................................................................................... 481
xv
Help File
Operator's Manual
Part Number 100821-620 Rev. 8
Version 2.7
Cadwell
909 North Kellogg Street Kennewick, WA 99336, USA
(+1) 509-735-6481 Fax (+1) 509-783-6503
www.cadwell.com
1
2
Cadwell
Cascade Elite Operator's Manual
© 2014 Cadwell. All rights reserved.

No part of this publication may be reproduced, transmitted, transcribed, stored in a
retrieval system, translated into any language or computer language, in any form, by
any means, electronic, mechanical, optical, chemical, manual, or otherwise without prior
written consent of Cadwell.
Disclaimer
Clinical conclusions and decisions based on the use of this product are the responsibility
of the user. The manual provides an operational summary for the Cascade Elite system.
It does not provide clinical training. It is assumed that the user has adequate clinical
training to perform intraoperative neuromonitoring procedures.
This document may contain technical inaccuracies or typographical errors. Changes are
periodically made to the information herein; these changes will be incorporated in
future revisions of this document. Features and specifications are subject to change
without notice.
Cadwell does not accept any liability for the use or misuse, direct or indirect, of this
product. Users must accept all responsibility for any results obtained by or concluded
from data obtained by the products. The user must accept all responsibility for results
obtained by software from Cadwell.
Lateral Transpsoas Monitoring:

Cadwell’s intraoperative neurophysiological monitoring software and products are not
intended for intraoperative lateral transpsoas monitoring that employs automated
methods of nerve threshold detection (“ILTM applications”). Cadwell disclaims all use
of its intraoperative neurophysiological monitoring software and related products for
any use for ILTM applications. With the exception of support Cadwell has a legal and
ethical obligation to provide, Cadwell does not support or provide assistance for any use
of its intraoperative neurophysiological monitoring software and products for ILTM
applications. The use of Cadwell’s intraoperative neurophysiological monitoring
software and products for ILTM applications is not recommended and at the user’s own
risk.
Trademark Notices
Cadwell is a registered trademark, and Cascade™ and Cascade Elite, and Cascade PRO
are trademarks of Cadwell. Other brand and product names are trademarks or
registered trademarks of their respective holders.
Cadwell reserves the right to modify, delete, extend, or improve features described
herein without notice.
3
4
Introduction
Introduction
Intent of Operator's Manual

This manual is intended as a basic guide to installing and operating your Cadwell
Cascade Elite. Please refer to the following information sources for more detailed
information on operating and servicing your Cadwell Cascade Elite.
• Cadwell Cascade Elite Operator's Manual. Part number 100821-620.
• Cadwell Cascade Elite Help File. Part number 369028-620. Available with
installed Cascade application and at www.cadwell.com
• Cadwell Cascade Technical Manual. Part number 100820-621.
• Cadwell ES-IX Stimulator Setup Guide. Part number 190262-933.
• Configuring Cascade on Windows 7. Part number 369028-626.
• Cadwell website. www.Cadwell.com
• Cadwell Applications & Service Support. See Cascade Customer Support.
Overview
Cascade Elite
The Cascade Elite™ is designed for intraoperative neuromonitoring (IONM) of evoked
potential (EP), transcranial electrical motor evoked potential (TceMEP),
electromyography (EMG), and electroencephalogram (EEG) signals.
Intraoperative neuromonitoring is a means of reducing the risk of permanent injury to
neural structures during surgical procedures. Changes or abnormalities in the recorded
signals may indicate that the surgical procedure is affecting the neural structure.
The Cascade Elite Intraoperative Monitor measures and displays the electrical signals
generated by muscles, the central nervous system and peripheral nerves. It acquires the
data necessary to perform intraoperative monitoring of neural pathways to prevent
damage to neural structures during surgical procedures.
The Cascade Elite product, in its standard configuration, consists of a base unit, power
communication module (power/com), and stimulator splitter or ES-IX stimulator(s).
Software in the unit allows users to create different procedure setup files for various
kinds of surgical cases.
At the beginning of the surgery, the user opens the configured procedure setup file to
begin a recording session. Several modes are run at different intervals during the
surgery, collecting data and displaying that data in different formats. The user can run
the modes individually or all concurrently. After surgery, the data file may be viewed
remotely and the patient data file may be reviewed. Reports can also be created at the
end of the surgery and/or when reviewing the data after surgery.
Components
5
The Cadwell Cascade Elite may include the following:

• The Elite base unit houses two 16-channel amplifiers and electrical, auditory, and
visual stimulators in a durable water resistant metal enclosure.
• Four 16-input amplifier input extender cables (pods) allow you to connect up to
64 recording electrodes for use in creating up to 32 recording channels.
• Power and communication to and from the base unit is provided by a Power
Communication Module (power/com). A single power/com cable runs from the
power/com module to the base unit. A standard 10base-T Ethernet cable
connects the power/com module to your computer.
• There are seven available electrical stim splitters: ES-5-100, ES-5-5, ES-5-20, ES-16,
ES-5-5V, and the linkable ES5-1 STD and ES-5-2 OPT.
• The Cascade Elite can also be enabled to run the ES-IX stimulator.
• The TCS-1/TCS-1000/TCS-4 is an optional device that connects to the Cascade
base unit via an auxiliary port. The TCS-1/TCS-1000/TCS-4 are constant voltage
stimulators that have FDA approval for transcranial electrical stimulation for the
purpose of recording motor evoked potentials. The device provides one constant
voltage output, and in the case of the TCS-4, one of four channels may be
selected as the active output. All of these stimulators include polarity control
within the Cascade software. See below for more information.
• There are four auditory stimulators available as optional devices for the Cascade
Elite. The Insert Earphones are the most commonly used auditory stimulator for
intraoperative neuromonitoring of auditory evoked potentials.
• There are four visual stimulators available as optional devices for the Cascade
Elite. The VEP Goggles are the most commonly used simulator for visual evoked
potentials in the operative theater.
• The ES Detector unit, attached to the base unit via one of the auxiliary ports, is
designed to detect the usage of electrical noise-generating devices such as
electrosurgery units. The ES Detector pauses data collection and audio output
while these noise-generating devices are in use.
TCS-1/TCS-1000/TCS-4 Stimulator
The Cadwell® Transcranial Stimulators (TCS-1/TCS-1000/TCS-4) are constant-voltage
electrical stimulators intended for the performance of Motor Evoked Potential studies
using the Cadwell Cascade® Intraoperative Surgical Monitoring System.
Operation of the TCS-1/TCS-1000/TCS-4 is controlled through the Cascade system
software.
An auxiliary cable connects the TCS-1/TCS-1000/TCS-4 device to one of three auxiliary
ports (Aux 1, 2 or 3) on the Cascade base unit. The TCS-1/TCS-1000 connects to the
patient via one stimulus output pair (consisting of one red and one black DIN electrode
6
Introduction
jack). The TCS-4 provides the ability to connect four stimulating channels to the patient,
but only one output channel can be active at any given point in time.
The “normal” polarity setting delivers stimuli with the red output as anode (+) and the
black output as cathode (-). The “reverse” polarity setting delivers stimuli with the red
output as cathode (-) and the black output as anode (+). For the TCS-4, the anode jack of
the active channel is designated by a solid lit LED.
The following stimulus options are available for the TCS stimulus types:
• Stimulus polarity: Normal or Reverse
• Train Length: The TCS stimulators support multi-pulse train stimulus and single
pulse stimulus. The train length setting specifies the number of stimulus pulses
delivered in each train. The range is 1 to 9.
• Inter Stimulus Interval (ISI): The ISI is the length of time from the start of one
stimulus pulse to the start of the next stimulus pulse within a train. The range is
variable from 1.0 to 9.9 milliseconds (ms).
• Maximum Intensity: The maximum intensity for the TCS-1 is 800 volts, while the
maximum intensity for the TCS-1000 and TCS-4 is 1000 volts. The intensity for
each device is variable in 2-volt increments. The maximum intensity may be set
independently for each mode in the procedure setup file that uses the TCS-
1/TCS-1000/TCS-4.
• Repetition Rate: No repetition rate is needed or available for MEP mode types.
The repetition rate may be set from 0.5 Hz to 1.0 Hz when using a TCS with EP
and EMG mode types.
• Double-Train Stimulation: Delivers two trains of stimulation with a user-
selected inter-train interval.
• Stimulus Pulse Width: 50µs (0.05 ms) fixed on the TCS-1. The stimulus Pulse
Width is adjustable to 50µs or 75µs on the TCS-1000/TCS-4.
• Channel Selection: the TCS-4 also presents the option to select one of the four
output channels as the active output.
NerveGuard
NerveGuard is an extension of the Cascade’s triggered EMG modality and provides a
convenient and easy-to-use interface for automatic pedicle screw stimulation, threshold
determination, and documentation.
You can perform a complete pedicle screw testing protocol in NerveGuard. For
example, you can use the Continuous Mode during pedicle probing and taping as an
early warning of a low threshold; use the Fixed Mode to stimulate the pedicle feeler as
the surgeon feels the inside of the pedicle; use the Continuous Mode again as the
surgeon drives the screw with the screw driver; or use the Screw Threshold mode to
determine the threshold of the screw when in place.
NerveGuard displays triggered EMG activity during screw stimulation and
automatically switches to free-running EMG during periods of no stimulus delivery.
7
Cascade Elite Intended Use

Cascade Elite
The Cascade Elite is an electroneurodiagnostic device designed to measure and display
the electrical signals generated by muscle, peripheral nerves and the central nervous
system. It will acquire the data necessary to perform electroencephalography (EEG),
transcranial electrical motor evoked potential (TceMEP), electromyography (EMG),
nerve conduction velocity (NCV, F wave, and H reflex), evoked potential (EP, brainstem
auditory, visual, somatosensory), and Train of Four (TOF) analysis.
The Cascade Elite is designed for use during the duration of the procedure only.
Use of the Cascade Elite is to be administered under the direction of a trained physician,
surgeon, neurologist, or electrophysiologist in an operating room or clinic.
The Cascade Elite is intended for use during electroencephalography (EEG),
electromyography (EMG), nerve conduction velocity (NCV, F wave, and H reflex),
evoked potentials (EP, brainstem auditory, visual, somatosensory), and Train of Four
(TOF) procedures.
TCS Stimulators
TCS-1/TCS-1000/TCS-4 constant voltage electrical stimulators are intended for
transcranial cortical stimulation. The TCS-1/TCS-1000/TCS-4 is intended for
intraoperative diagnosis of acute dysfunction in corticospinal axonal conduction
brought about by mechanical trauma (traction, shearing, laceration, or compression) or
vascular insufficiency.
The Cadwell TCS-1/TCS-1000/TCS-4 Constant Voltage Stimulators are accessories to the
Cadwell Cascade Intra-operative monitoirng system only. They are not stand-alone
devices nor are they compatible with other systems.
The TCS-1/TCS-1000/TCS-4 system is intended for use by a physician or trained
technician under the supervision of a physician for the generation of Transcranial
Electric Motor Evoked Potentials (TCeMEPs). The intended use environment for the
TCS-1/TCS-1000/TCS-4 is the surgery suite in the hospital or other healthcare facility.
The TCS-1/TCS-1000/TCS-4 is intended for use with electrodes approved by the FDA for
human use.
Electrical Stimulator Guide

For the Cascade Elite, Cadwell offers two generations of electrical stimulators: our latest
ES-IX stimulator, and our legacy generation of electrical stimulator splitters (stim
splitters). The tables below summarize the features of the stimulator options for each
generation of stimulators.
ES-IX Stimulator
The ES-IX stimulator represents a dramatic shift in Cadwell's line of electrical
stimulators. It meets the IP64 standard for drip-proof equipment, and connects to the
8
Introduction
Elite and PRO base units through the Cadwell Peripheral Network (CPN) port. The ES-
IX does not interface with the original 16-channel Cascade.
Stim Model Number Low Current May be Biphasic

of High Current Feedback used in a stimulation
(part number)
Current Maximum Daisy pulses
Outputs Output Chain option?
(Single Application
Output)
ES-IX Standard 8 5 mA, 20 Yes Yes Yes
(190262-200) mA, 5 V,
20 V
High Current Outputs – Each high current output can output from 0 to 100 mA,
400 V maximum, with 0.5 mA resolution below 20 mA and 1 mA resolution
above 20 mA.
Low Current Maximum Output – The low current output is used to provide more
precise adjustment of low level output currents than offered by the high
current outputs. The low output of the ES-IX can be configured to four modes
of operation. The amplitude resolution for each of the four modes is as follows:
- 5 mA constant current (0.01 mA resolution)
- 20 mA constant current (0.1 mA resolution)
- 5 V constant voltage (0.01 V resolution)
- 20 V constant voltage (0.1 V resolution)
Current and Voltage Feedback – The Cascade will display current delivered to
the patient when using the ES-IX in any constant-current mode. The voltage
delivered is displayed for the low output in constant-voltage mode. This
assists the practitioner in assessing the quality of the stimulator to patient
connections.
Daisy Chain – Two ES-IX stimulators may be attached together to provide a total
of 16 high current and 2 low current/voltage outputs. This both provides
additional outputs and allows the placement of an ES-IX near the head and
another near the feet of the patient.
Electrical Stim Splitters

Cadwell's original generation Cascade stim splitters allow a single constant-current
electrical stimulator output from the Cadwell Cascade IOM to be multiplexed between
multiple stimulation sites. There are currently seven different stim splitters being
manufactured by Cadwell for use with the Cascade IOM. Each model features a unique
combination of outputs and features. The following comparison chart presents features
of each stim splitter model.
9
Stim Splitter Model Number of Low Current Current May be

High Maximum Feedback used in a
(part number)
Current Output Daisy
Outputs (Single Chain
Output) Application
Es5-5 CS (190203- 4 5 mA Yes No
200)
Es5-20 CS (190204- 4 20 mA Yes No

200)
ES5-100 CS (190221- 5 None Yes No

200)
ES16 CS (190201- 15 20 mA Yes No

200)
High Current Outputs – Each high current output can output from 0 to 100mA,
370 VDC maximum, with a current resolution of 0.5 mA. (200 steps)
Low Current Maximum Output – The low current output is used to provide more
precise adjustment of low level output currents than offered by the high
current outputs. The output resolution is 0.1 mA or less for the low current
output.
Current Feedback – The Cascade can display current delivered to the patient
when using a splitter with current feedback. This assists the practitioner in
assessing the quality of the stimulator to patient connections.
10
Setup Instructions
Hardware Setup
Unpacking the System
Congratulations on selecting the Cadwell Cascade Elite™ Intraoperative Monitoring
system! It’s time to unpack the contents of your system. As you unpack, please carefully
check to make sure the contents of the shipping box match the packing slip.
NOTE: DO NOT discard any boxes or packing material until all items on the packing list
are accounted for.
You should receive the following as standard items:

• Cascade Elite base unitwith detachable power cord
• Power/communications module, removable power cord, and power/com cable
• Backup Cascade installation software CD
• Two (2) or Four (4), 16-input amplifier extender cables
• If ordered, Laptop or Desktop computer (with built-in Ethernet connection) with
AC adapter and/or AC Power Cord
If you purchased your computer from Cadwell, all necessary Windows® and
Cascade® software is already installed on your computer from the Cadwell
factory and the network card is configured for use. There is no need for you to
install any software. Please put the CDs that came with your system in a safe
place. They are included as a backup copy only. Laptop computers may require
you to make your own backup CDs for the computer.
NOTE: If you purchased your computer form a source other than Cadwell, you must
install software, activate the software licenses, and configure the network card. Please
refer to the Software Setup section of the help file or Operator's Manual.
Please check for any optional items you may have ordered. These may include but are
not limited to the following:
• Electrical Stimulator Module(s). (ES5-100, ES5-5, ES5-20, ES-16, ES5-5V, and ES5-
10 STD and OPT)
• ES-IX electrical stimulator
• TCS-1/TCS-1000 Single Output Constant Voltage Transcranial Stimulator
• TCS-4 Multiple Output Constant Voltage Transcranial Stimulator
• Other EP stimulation devices such as insert earphones and goggles
• ES Detector Module with ES Detector clip(s)
• 2nd Ethernet card (Desktop) or PCMCIA Ethernet card (Laptop) with Network
cable
• Instrument cart with instructions, grounding cable and screw, and any
accessories such as a retractable arm or printer tray
• Printer with cables and instructions
11
• External keyboard
• External mouse
Position Elite Base Unit

The Cascade Elite comes with mounting and cable guide accessories. See Operator’s
Manual or Help Files for more information. The Cascade Elite base unit can be placed
right next to the patient’s bed, reducing cable lengths, improving signal quality and
reducing noise. The Elite may be secured under a Jackson table, clamped on an IV Pole,
placed on the floor, hung on the bedrail, or mounted to the equipment rack. The
Cascade Elite is water and dust resistant. The Quick Connectors are water resistant,
although the Cascade Elite is not designed to be submerged.
Elite Base Unit Connections

The following connections correlate with the peripheral device connection indicated in
the image of the Cascade Elite base below.
1. Amplifier Input Extender Cable Jacks (Amps A, B, C and D)
2. Future Functionality
3. Electrical Stimulator/Stim Splitter Module (ESTIM)
4. Evoked Potential Stimulators (EP)
5. Future Functionality
6. Power/Com Module (Connection to PC)
7. High Voltage Stimulators (TCS), ESD Detector or LED Goggles/Pad
(AUX 1 and 2)
8. Indicator Lights
12
Setup Instructions
When powered on, LED lights on the connector panel will indicate system status:
D - Data: Flashes when there is communication between the main unit and the
computer.
L - Link: Lights when there is a connection established between the main unit and
the computer.
S - Status: Flashes in various patterns to indicate operation and status
information.
P - Power: Lights when power is provided to the main unit.
The Cascade Elite meets IP 66 standards for water and dust resistance. The Quick
Connectors are water resistant, although the Cascade Elite is not designed to be
submerged.
The connectors on the Cascade Elite come standard with Quick Connect fasteners.
Connectors are labeled using text and graphics to indicate the peripheral devices that
connect to each port.
Please refer to the Peripheral Device Connection section for instructions about where
each peripheral device connects.
Power/Com Module Connections
1. Power cord (to isolation transformer).

2. Laptop power cord connection
3. Power/Com cable (to Cascade Elite base unit).
13
4. Ethernet cable (to PC).

5. Grounding post (to PC and trolley cart).
Elite Cabling Setup Instructions

To set up cables between the Cascade Elite, computer, power supplies and accessories:
1. Connect the Cascade Elite base unit to the power/com module: Connect the
female end of the power/com cable to the power/com connector on the Cascade
Elite base unit. Connect the male end of the power/com cable to the amplifier
connection on the power/com unit.
2. Plug all amplifier input extender cables and accessory items (Electrical
Stimulator Splitter, TCS, ES Detector Module, Insert Earphones, Goggles) into
their respective inputs on the connector panel of the Cascade Elite base unit.
3. Connect the power/com module to the computer:
• Laptop: Plug one end of the network cable into the Ethernet connector on
the laptop (usually in the back) and the other end into the connector
labeled Ethernet on the power/com rear panel.
• Desktop: Plug one end of the network cable into the Ethernet connector
on the PC (usually labeled Amp) and plug the other end into the
connector labeled Ethernet on the power/com rear panel.
4. Attach the main power cord to the AC power input on the power/com unit.
14
Setup Instructions
5. Attach the computer's power cord:

• Laptop: Locate the two-pronged laptop power cord coming from the
power/com unit and plug it into the AC adaptor for the laptop. Plug the
AC adapter cable into the power connector on the rear panel of the laptop
labeled DC IN. Set aside the power cable that came with the AC adapter
that normally plugs into the wall.
• Desktop: Locate the desktop PC's power cord and connect the
appropriate end to the back of the PC. Connect the other end to the
isolation transformer or wall outlet.
6. Connect the printer (if supplied) to the laptop or desktop computer's LPT or USB
port. Attach the printer power cord to the power receptacle on the printer.
7. Ground the computer: If necessary, attach the grounding wire screw to the
laptop's external video connector or to a main chassis screw on the desktop PC. If
you are using a cart, follow the instructions included with the cart to ground the
cart to the instrument.
8. Plug all power cords into hospital grade wall outlets or isolation transformers.
Do not plug power cords into common household power strips. If you would
like to power multiple components of your Cascade system from a single power
source, use the Isolation Transformer available from Cadwell. Please see
Electrical Safety Requirements and Allowable Configurations for more
information.
9. Turn the power/com module power on using the power switch on the front of
the module. When the power/com unit is on, the LED on the front of the
power/com unit will light. The Cascade Elite base unit receives power from the
power/com module via the power/com cable. When the base unit is powered on,
an LED next to the letter P on the connector panel will light.
Additional Setup Requirements
! Configure the Network Card: The Cascade communicates with the PC over an
Ethernet link. A dedicated Ethernet network card must be installed in the PC, and the
card must be configured to a specific IP address. See Configuring the Network Card
(Windows XP) for instructions.
! Update the Registry: After installing and configuring the network card, and
installing the Cascade software, you need to update the Windows registry with the
correct IP address for the base unit. From the Windows desktop, click Start, select
Run, then type C:/Cadwell/Cascade/CascadeIP.exe and click OK.
! Set Up the Printer: Depending on the printer, you may be prompted to install printer
software that came with the printer. See the instruction manual that came with the
printer for specific instructions. Set the printer at a 300 or 600 DPI setting for the best
results.
! Install the Cascade Software: For computers not purchased through Cadwell, you will
need to install the Cascade software.
15
1. Insert the Cascade program DVD into the DVD drive of your computer. If
autorun is enabled, the installation file will automatically unzip and Cascade
Setup will begin. Otherwise, within Windows explorer, double-click on the drive
you put the DVD into to begin the process.
2. Follow the on-screen instructions.
Before you can run the program, see the instructions for Activating Software
Licenses about entering a system key.
! Isolation Transformer: Depending on equipment installation, an isolation transformer
may be required to limit unintentional leakage current. System installation must comply
with the requirements of IEC 601-1-1 safety requirements for medical electrical systems.
Refer to the Isolation Transformer Guidelines document 309002-000 if you are unsure
about this requirement.
See also:
Elite Base Unit Connections
Peripheral Devices and Connections
Configuring the ES-IX

Automatically Configure Your Current Setup Files to Work with ES-IX
Included in Cascade 2.6 SP1 is a tool that will convert your standard electrical stimulator
protocols to setup files that utilize the ES-IX. The tool is called the
EsixStimConverter.exe, and is located in C:\Cadwell\Cascade\. Double left-click on
EsixStimConverter.exe to start the tool.
The tool main menu comes up.
16
Setup Instructions
You can select and convert a single file, or select and convert an entire directory of
procedure setup files. If your folder of setup files includes sub-folders (sub-directories),
you will need to convert each directory separately. When the Stim Converter is finished
processing your files, it will create copies of the setup files in the directory with the
prefix "ES-IX". The files with this prefix are the converted setup files. The original files
remain unchanged in the directory. Close the tool after you are finished converting your
files.
ES-IX Configuration Options

The ES-IX stimulator has its own Stim Type in the Mode setup window. The ES-IX has
the same capabilities as previous electrical stim splitters (ES 5-100, ES-16, etc.), and the
options are accessed through the Setup Stimulator button in the Mode Controls, the
same as for the electrical stim splitters. However, the ES-IX includes several new
capabilities that were not available with the stim splitters.
17
Stimulation Outputs Available

The ES-IX has eight 100 mA constant-current output pairs and a single low output that
can be configured to 5 mA, 20 mA, 5 V, and 20 V modes. Two ES-IXs can be daisy-
chained, doubling the number of channels available.
18
Setup Instructions
Daisy-chaining ES-IXs
19
When ES-IXs are daisy-chained, one stimulator becomes outputs High 1-8 and Low 1,
while the other becomes High 9-16 and Low 2. When you start a procedure with two ES-
IXs connected, you will be presented with the following popup. This message will also
appear when you disconnect and reconnect the ES-IXs.
20
Setup Instructions
Choose OK to accept the ES-IX stim output assignments or Switch to swap which ES-IX
is assigned channels 1-8 and which is assigned channels 9-16.
Biphasic Stimulation
The ES-IX can produce biphasic stimulation pulses.
21
In Cascade 2.7, selecting biphasic stimulation causes the stimulating waveform to

change such that the waveform looks like the one below. Both phases of the stimulus
pulse have the same amplitude and pulse width. The pulse width specified in the
stimulator setup is the pulse width for each phase, not the summed pulse width of both
phases.
Multipulse Stimulation
In addition to standard single-pulse reprate stimulation and EMG train stimulation, the
ES-IX can perform repetitive multipulse stimulation.
When the Multipulse Stim box is checked, the multipulse options become available. You
can create multipulse trains up to 10 pulses with interpulse intervals from 0.5 to 10 ms.
22
Setup Instructions
These short trains will be repeated at the Rep Rate specified in the Rep Rate box on the
left side of the ES-IX Stimulator Setup dialogue.
Peripheral Devices and Connections

It is important to attach stimulators and other peripheral devices to the correct connector
on the Cascade Elite.
Peripheral Device Connector Symbol
Amplifier Input Extender Cable Amp A-D

Records amplifier input.
ES-IX Stimulator CPN "CPN"
Stimulus Splitters ESTIM

ES5-100, ES5-5, ES5-20, ES-16, ES5-5V, and ES5-10
STD and OPT
TCS-1/TCS-1000/TCS-4 Aux 1 or 2 "AUX 1", "AUX 2"

Transcranial-electrical motor cortex stimulator is an
FDA-approved high-voltage electrical stimulator.
Audio and Visual Peripherals EP

Headphones, inserts and the pattern reversal monitor
are audio and visual stimulators that must be connected
to the EP cable port.
ES Detector Module Aux 1 or 2 "AUX 1", "AUX 2"

The electro-surgery (ES) detector mutes EMG audio
and pauses EP modes when electro-surgical devices are
being used.
VEP Goggles/LED Pad Aux 1 or 2 "AUX 1", "AUX 2"

The Visual Evoke Potential (VEP) goggles are visual
stimulators used during surgery.
CV-2 Aux 1 or 2 "AUX 1", "AUX 2"
23
This electrical cortical stimulator can be set to output

two (2) 400-volt stimulations.
Cabling Diagram - Elite to Desktop PC

The following connections correlate with the peripheral device connections for use with
a desktop PC, as shown below.
Note: Your desktop PC may have a different connection panel than shown in this
example. Do not use extension cords or power strips.
Cabling Diagram - Elite to Laptop PC

The following connections correlate with the peripheral device connections for use with
a laptop PC, as shown below.
24
Setup Instructions
Note: Your laptop may have a different connection panel than shown in this example.
Do not use extension cords or power strips.
Cascade Elite Features & Accessories

The Cascade Elite was designed to be practical and convenient. Its features and
accessories complement its simplicity, versatility and innovation.
V-Blocks
The Cascade Elite is practical.
25
Four directional V-Blocks on the bottom of the Cadwell Cascade Elite provide
connections for Cascade Elite accessories, including the V-Block Clamp, the Cable Guide
and the Surgical Table Rail Handle.
The accessories each have a corresponding V-Block mount which slides and
automatically locks onto the V-Block for a secure fit. To release the lock, pull the black
pin up and slide the mount off the block.
V-Block Clamp
The Cascade Elite is versatile.
The V-Block Clamp allows the Cascade Elite to suspend from a vertical IV pole or a thick
square or round horizontal bar.
Realigning the screw socket holes on the V-Block Clamp allows for 90°, 180° and 270°
unit rotations on either a vertical or a horizontal post. Turning the knob opens or closes
the clamp, allowing for placement, removal and adjustment of the Cascade Elite across a
rail or up or down an IV pole.
Quick Connect
The Cascade Elite is innovative.
26
Setup Instructions
Cadwell has eliminated the hassle of hooking up thumb-screw cables. The Cadwell
Quick Connect (patent pending) stud and socket set provides secure connections
between cables and the Cascade Elite.
While it is possible to attach the Quick Connect stud and socket with an aligned push, it
is easier to align the male end of the cable with the female end on the Cascade, but
apply more force on one stud and socket end, and then the other. The cable is connected
when both Quick Connect stud pairs audibly click together.
The Quick Connect has a solid linear connection. Try pulling the cable straight out. Now
remove the cable like you installed it: apply torque on one Quick Connect socket end,
and then the other. The Quick Connect comes off in a snap!
While the Quick Connect allows easy detachment, is also important to keep your cables
connected while the Cascade Elite is in use.
Cable Guide
The Cascade Elite is simple.
27
Design specifically for the Cascade Elite in conjunction with Quick Connect, the Cadwell
Cable Guide helps assure cables are not inadvertently disconnected. The Cable Guide's
cable holes align with the rows of cables connected to the Cascade Elite. The Cable
Guide pulls the cables at an angle, helps organize cables, and provides a lifted
suspension when the Elite is sitting horizontally on a counter or floor, allowing cables to
fit underneath the unit and out of the way.
Surgical Table Rail Handle
The Cascade Elite is convenient.
28
Setup Instructions
A foam-padded hand grip allows for comfortable and easy transportation of the
Cascade Elite. The handle’s square-edged groove is also a perfect fit for a surgical table
rail. The handle, like all of these accessories, can be mounted on any of the four V-
Blocks, so you have control over the directional placement of the Cascade Elite and its
cables.
Mounting V-Blocks on IV Pole

The V-Block accessories may be configured in a variety of ways to best suit your
preferences.
Position the Cascade horizontally on an IV Pole
The standard configuration of the V-Block Clamp allows the Cascade Elite unit to be
mounted horizontally on an IV Pole.
29
To configure the Cascade Elite horizontally:

1. Place the Cascade Elite bottom up on a flat surface.
2. Attach the Cable Guide on the end V-Block mount closest to the connections.
3. Attach the Surgical Table Rail Handle to the end V-Block mount closest to the
Cadwell logo.
4. Attach the V-Block Clamp to either side V-Block mount, and open the clamp
fully using the hand knob.
5. Lift the Cascade Elite into place on the IV Pole, and tighten the hand knob until
secure.
Position the Cascade vertically on an IV Pole
For some surgical technicians, it may be easier to move the unit to and from the IV Pole
by placing the unit in a vertical position. This allows an easier grip on the Surgical Table
Rail Handle.
30
Setup Instructions
To configure V-Block accessories for a vertically-positioned Cascade Elite:

1. Place the Cascade Elite unit bottom-up on a flat surface.
2. Remove the V-Block Clamp from the Cascade Elite.
3. Using a Phillips screwdriver, unscrew the Clamp from the sheet metal V-bracket
4. Turn the Clamp sideways so the Clamp hand knob faces away from the V-
bracket (see image above).
5. Using your screwdriver, secure the Clamp to the V-bracket.
6. Attach the V-bracket to one of the side mounts on the Cascade Elite unit.
7. Attach the Surgical Table Rail Handle to the end V-block mount closest to the
Cadwell logo.
8. Attach the Cable Guide to the end V-block mount closest to the connections.
9. Lift the unit by the Surgical Table Rail Handle with one hand, position the V-
Block Clamp on the IV Pole and tighten with the other hand.
Attach Cascade to a Jackson Table

Orient the clamp on the V-block as you did by placing the base vertically on the IV pole.
Attach the V-block on an end of the base, and clap to the end of the table.
31
Printer Setup
All necessary printer drivers and software is already installed on your computer from
the Cadwell factory. There is no need for you to install any additional drivers or
software. Please put the CDs and documentation that came with your printer in a safe
place for future reference.
NOTE: If you purchased your printer from a source other than Cadwell, you must install
printer driver on the PC. Please refer to the instruction manual that came with your
printer for instructions on setting up your printer.
Using the Hardware Simulator

If you don’t have any Cascade hardware (i.e., Cascade base unit, Amplifier, and ES
Stimulator box) hooked up to your computer, you can instruct the software to use a
Hardware Simulator to supply synthesized traces/waveforms, allowing you to run the
program for training and learning purposes.
To turn ON the Hardware Simulator:

1. Open My Computer on the Windows desktop.
2. Open Local Disk (C:).
3. Open the Cadwell folder.
4. Open the Cascade folder.
5. Open the file UseHardwareSimulator.reg.
a. Click Yes in the Registry Editor.
32
Setup Instructions
b. Click OK in the Registry Editor.

6. Close the C:\CADWELL\Cascade folder.
To turn OFF the Hardware Simulator:

1. Open My Computer on the Windows desktop.
2. Open Local Disk (C:).
3. Open the Cadwell folder.
4. Open the Cascade folder.
5. Open the file UseHardware.reg.
a. Click Yes in the Registry Editor.
b. Click OK in the Registry Editor.
6. Open the file RegisterCascade.bat.
a. Allow the data to compile.
7. Close the C:\CADWELL\Cascade folder.
TCS Setup
Unpacking and Setting up TCS System
Unpacking and Equipment Setup
Remove the TCS from the packing material and verify that all components are
present and not visibly damaged. Read all instructions carefully before use.
Cadwell recommends pre-assembly and testing of the system. Verify proper
understanding of the system prior to use.
Setting up the TCS Stimulators
Connect the 14-pin auxiliary cable (supplied) from the Aux 1, 2 or 3 port on the
back of the Cascade to the Auxiliary Connection on the TCS. Screw tight the
connector screws that hold the cable to the port.
TCS Software
The software used to control the TCS is preinstalled on Cascade systems.
Preparing Patient & Equipment for Data Collection

This topic will provide an overview of the steps required to prepare the patient and
equipment for data collection.
NOTE: This topic is intended as a guide to setting up for motor evoked potential
monitoring. This topic is not a substitute for proper training. The Cadwell TCS
stimulators should be used only by qualified medical professionals who have been
thoroughly trained and are experienced in its use.
The following equipment is required to prepare for data collection:

• TCS Stimulating Unit (TCS-1, TCS-1000, or TCS-4)
• Auxiliary Cable
33
• Cascade Surgical Monitoring System

• Stimulating Electrodes
Preparing the Patient
Do not connect TCS output leads to anywhere other than the head. This
eliminates the potential for transthoracic currents in any failure mode.
Prior to testing, place stimulating electrodes on the patient’s scalp according to
your laboratory protocol. Several different configurations of stimulating
electrodes have been reported including stimulation between C1 and C2 using the
International 10-20 standards for EEG electrode placement.1
Next, place recording electrodes according to the location(s) you wish to record
from. Common recording locations include the muscles of Abductor Pollicis
Brevis, Tibialis Anterior, Gastrocnemius, and Abductor Hallucis.
Connecting the Patient to the TCS-1/TCS-1000 unit
In “normal” stimulating mode the red jack is the anode (+) and the black jack is
cathode (-). In “reverse” stimulating mode the red jack is the cathode (-) and the
black jack is the anode (+). For transcranial motor stimulation, the anode electrode
is more effective than the cathode1. Plug the stimulating electrode from the left
side of the patient’s scalp (C1) into the red output jack on the TCS-1/TCS-1000.
Plug the stimulating electrode from the right side of the scalp (C2) into the black
output jack on the TCS-1 /TCS-1000..
Electrode extension cables may be used between the stimulator outputs and the
stimulating electrodes if additional length is needed.
34
Setup Instructions
Confirm the polarity settings of the MEP modes in the procedure setup file.
Confirm that the Left MEP mode is set to Reverse stimulation and that the Right
MEP mode is set to Normal stimulation.
Connecting the Patient to the TCS-4 unit
In “normal” stimulating mode the red jack is the anode (+) and the black jack is
cathode (-). In “reverse” stimulating mode the red jack is the cathode (-) and the
black jack is the anode (+). For transcranial motor stimulation, the anode electrode
is more effective than the cathode. For each output you would like to connect to
the patient, plug the stimulating electrode from the left side of the patient’s scalp
(C1) into the red output jack on the TCS-4. Plug the stimulating electrode from the
right side of the scalp (C2) into the black output jack on the TCS-4.
Electrode extension cables may be used between the stimulator outputs and the
stimulating electrodes if additional length is needed.
Confirm the polarity settings of the MEP modes in the procedure setup file.
Confirm that the Left MEP mode is set to Reverse stimulation and that the Right
MEP mode is set to Normal stimulation.
Connecting the TCS to the Cascade
Connect an auxiliary cable (supplied) from any one of the 3 Aux ports on the back
of the Cascade to the 14-pin Auxiliary connection on the TCS(located on the back
of the TCS unit). When the TCS is properly connected to the Cascade and the
Cascade is powered on, the Power On LED located on the top of the TCS unit to
the left of the Cadwell Cascade logo will light. This LED indicates that the TCS
unit is powered on, connected to the Cascade and ready for use.
Connecting the Patient to the Cascade
Plug the recording electrodes from the patient into the preamplifier of the Cascade
Surgical Monitoring System according to the procedure setup file being used.
Please refer to the Cascade Operator's Manual for detailed instructions on using
the Cascade Surgical Monitoring System.
Software Setup
Software Setup Overview
If you purchased your computer from Cadwell, all necessary Windows ® and Cascade®
software is already installed and the network card is configured for use. You need not
install any Cascade software. Please put the DVDs that came with your system in a safe
place. They are included as a back-up copy only.
NOTE: If you purchased your computer from a source other than Cadwell, you must
install software, activate the software licenses, and configure the network card. Please
refer to Software Installation Instructions and Configuring the Network Card.
Software Installation Instructions
35
Please read all instructions prior to performing the upgrade.

1. Version 2.7 was designed and tested to run on Windows 7.
2. You should be logged in as an administrator on your computer when you
perform the installation.
3. The current version of Cascade should be completely removed before starting
the version 2.7 installation process. Instructions for removing the current
version of Cascade are included in this document.
4. Internet access is recommended during installation.
5. Version 2.7 verifies and/or installs the following applications before
installation:
• Microsoft .NET Framework 4 Client Profile
• 2005, 2008 and 2010 Microsoft C++ redistributable
• Microsoft Windows Media Player 11
• Windows Installer 3.1 or higher
• Cascade DMLocalServer64
New PC Installation Notes:
If you purchased your new PC from Cadwell, the Cascade software is already set up.
If your computer was purchased from a source other than Cadwell, you will need to
follow these instructions to install your Cascade software and then you will need to
configure the network card.
Installation Instructions
First, uninstall the current version of Cascade. This will not remove your unique
procedure setup files, report templates, or patient data files.
1. Click on the Start button (or Start Orb) and select Control Panel.
2. Open Programs and Features.
3. Double click on Cascade and then select Yes when prompted to uninstall Cascade.
4. Follow the instructions on the screen to remove the Cascade application.

5. Close Add and Remove Programs and the Control Panel windows.
Next, remove any leftover application files from the Cascade directory.
7. Click the Start Orb, then place your cursor in the “Search programs and files” text
field.
8. Type in C:\Cadwell\Cascade, Click OK.
9. Leave any folders in this directory such as Patient Data, Setup files, Data, Report
Templates and any other directories (i.e., Folders). Do not remove files from within
these folders. Excluding the folders, highlight any files in this directory and delete
them.
36
Setup Instructions
Keep ALL Folders Delete Files NOT in a Folder, e.g.
10. Close the Cascade folder window.

Now install the applications for Cascade version 2.7. Begin by opening the
installation program on the DVD.
11. If the DVD does not autorun, double click My Computer, Open the Optical Drive,
then double left click on the Install.exe file. Wait for 3-5 minutes while the installer
extracts all of the installation files to:
C:\Cadwell\Cascade_2.7_Files.
This will ensure that all of the installation files, third party software, and drivers are
accessible for future access on your PC. Once the automatic extract is completed, the
Cascade Setup will begin automatically.
12. If .Net 4.0 Client Profile is not already installed on your computer, you will first
need to agree to their end user license agreement. Click Install when you receive the
following prompt regarding installation of the prerequisite applications and
software updates.
13. Microsoft’s .NET installer will install the necessary prerequisite applications and
software updates. This may take several minutes, depending on the number of
updates needed and the speed of your computer.
14. Installing .NET will prompt for a reboot. If prompted to restart your PC, restart, then
open the Cascade version 2.7 installation at:
C:\Cadwell\Cascade_27_Files
Double left click on the setup.exe file. The setup file will begin installing again, but
will skip the .NET 4.0 Client Profile install. After the prerequisite applications and
software updates are installed, the Cascade Setup Wizard will begin automatically.
Click Next.
15. Read the Release Notes. Then click the Next button again.
Note: Cascade automatically copies a documents folder to the C:\Cadwell\Cascade directory. This
folder will contain a copy of the release notes along with other supporting documentation.
16. Confirm or change the destination folders and click the Next button.
37
Note: If
you change the directory to which you install Cascade, you will need to
configure the Cascade registration configure file and re-register the files after
completing the install. Instructions for this process begin at step 21.
17. Confirm that you wish to install Cascade version 2.7 by clicking the Next button.
18. The Cascade application will take several minutes to install. When the installation is
complete, click the Close button to exit the installation process.
19. Start the Cascade program by double clicking the Cascade icon on the Windows
Desktop.
20. Select Start New Procedure. The Device Flash Utility may begin an automatic update
of your base unit firmware version if it is not the latest. When the Firmware update
is complete, power OFF the base unit, wait for 10 seconds, then power ON the base
unit.
21. Verify hardware
version numbers by selecting About Cascade… from the Help menu.
Hardware Cascade Base Junction ESIX Estim

Type Version Version Board SW Board
SW Version SW
16- 2.7 3.27 2.2 N/A 5.8 or

Channel 5.9
Cascade
32- 2.7 3.86 2.2** V 0.11 5.9*

Channel
Cascade
Elite
Cascade 2.7 1.09 2.2** V 0.11 N/A

PRO (16
or 32)
1. 22. Open RegisterCascade.exe.config from your chosen Cascade installation

directory in a plain text editor.
2. 23. Once the text file is open, perform a Find and Replace. You will search for
C:\Cadwell and replace that text with your selected installation directory. The
directory setting should be replaced in 5 locations.
3. 24. As an example, if I changed the installation directory to P:\Cadwell\, I would
open RegisterCascade.exe.config from P:\Cadwell\Cascade. Within the text file,
I would search for C:\Cadwell and replace it with P:\Cadwell.
38
Setup Instructions
4. 25. Open the RegisterCascade tool by double-left clicking on

RegisterCascade.exe.
5. 26. Select Register All.
6. 27. After the registration process completes, close the Register Cadwell tool.
Configuring Cascade in Windows 7
This document will describe how to configure Windows 7 for optimal performance of
the Cascade program. Perform the following steps:
1. Elevate Cascade to “Run as administrator” when entering

the system key for
the Cascade license:
After installing Cascade on Windows 7, right click on the Cascade icon on the
Desktop.
Select Run as administrator.
Enter the system key as given to you by Cadwell support staff.
2. Configure the Network Card:
Click on the Start Orb then the Control Panel. Change back to View by
Category.
Click on “View network status and tasks” under the “Network and Internet”
heading.
39
Then click on “Change Adapter Settings” on the left hand task pane. This will
show all
the network connections available on the computer.
Right-click on the LAN or High-Speed Internet connection that will be used to

communicate to the base unit and click on “Properties.”
40
Setup Instructions
Uncheck all the protocols in the list except for the Internet Protocol Version
4(TCP/IPv4).
Then double-click on that protocol and change the radial button from “Obtain an
IP address automatically” to “Use the following IP address.”
41
Input the default Cadwell® IP address used for all our machines. It is
192.168.113.66. The default Subnet Mask is 255.255.255.0.
Once those addresses are added, click on the Advanced button in the bottom
right-hand corner of the screen. Click on the WINS tab and uncheck the “Enable
LMHOSTS lookup” check box and change the Net-Bios setting from Default to
“Disable NetBios over TCP/IP”.
Click OK three times until it hour-glasses for a little bit and then you should see
your local area connection indicate that it is connected.
42
Setup Instructions
3. Running CascadeIP.exe on Windows 7:
After installation of the Cascade software has been completed, you will need to
run the C:\Cadwell\Cascade\CascadeIP.exe program. The first time you double-
left click on CascadeIP.exe, you will get an error message: “The Cascade
controller was not detected.” Immediately thereafter click OK, and then double-
left click on CascadeIP.exe a second time and the registry will be updated
correctly.
This program updates the system registry with the IP address of the Cascade base
unit. See the graphic below for the correct response of running CascadeIP.exe.
Once this has been done, the network card setup will be complete.
4. Add the Run Command and Printers to the start menu:
Right-click the Start Orb and click “Properties.” In the start menu tab click the
“Customize” button.
43
Check the “Run Command” and “Devices and Printers” boxes and click OK
twice.
5. Fix the New Program Window so that the ReportGen

program will automatically come to the front when launched.
This is per the Microsoft Knowledge Base article #886217:
To resolve this issue, modify the value of the ForegroundLockTimeout registry

entry in Registry Editor. To do this, follow these steps:
1 Click the Start Orb, click Run, type regedit in the Open box, and then click OK.
2 In Registry Editor, locate and then click the following registry subkey:
HKEY_CURRENT_USER\Control Panel\Desktop
3 In the right pane, locate and then double-click ForegroundLockTimeout.
44
Setup Instructions
4 Under Base, click Decimal, type 0 in the Value data box, and then click OK.
Note The default decimal value for the ForegroundLockTimeout registry entry is set as
200000.
5 Quit Registry Editor.
6 Restart your computer.
*This must be done for each User Account on the system.
6. Add the “Computer” and “Network” icons to the desktop:
Right-click on the desktop and click Personalize.

Click on “Change Desktop Icons” under Tasks.
Check all the boxes, for the available icons. (or at least check Computer and
Network).
45
7. Disable password protection on Screen Saver:
Right-Click anywhere on the desktop and click “Personalize.” Click on the

Screen Saver link in the lower right corner.
Then uncheck the “On resume, display the login screen” and click OK.
8. Configure the Power Settings for a Laptop or Desktop:
Click on the Start Orb, then Control Panel. Change the “View by” setting
to Small Icons. In the control panel list click on “Power Options”.
Select the High Performance option. If you don't see this option, click on
Show additional plans.
46
Setup Instructions
Click on the “Change Plan Settings” link under High Performance.
47
Click the dropdown list for both “Turn off the Display” and “Put the Computer to
Sleep” and set them to NEVER.
Next click the “Change Advanced Power Settings” link and set the “Link State
Power Management” setting to OFF. That only needs to be done under the PCI
Express setting. Then click OK out of everything to set all the power settings.
9. Change the default Windows Theme. This fixes the issue

with the L and R side buttons in the mode setup window.
Copy the Cascade.themepack from the installation CD under

Extras\Cadwell\Wallpaper\ to your Desktop.
Double-left click on the Cascade.themepack icon on your Desktop. This will

apply the Cascade themepack and correct the fonts needed to access all of the
Cascade menu options.
Activating Software Licenses
48
Setup Instructions
The Cadwell Cascade Control Panel is used to activate the Cascade software license
using a System Key provided by Cadwell.
To access the Cadwell Cascade Control Panel:
• On the Cascade start page, select System Setup
• Click the Edit Customer Options button on the General tab
The first time the software is installed, a unique "System ID" is generated automatically.
The System ID number uniquely identifies a computer. To authorize operation of the
Cascade software, the correct System Key must be entered. The System Key is specific to
a particular computer and will only work on the system for which it was issued. When
multiple computers are used at a site, a different System Key is required for each
computer.
This control panel also shows the software features enabled on your system in the
Cascade Options area. If your system is not configured for a feature you would like
enabled, please contact our customer support department for software licensing options
(800.245.3001).
Obtaining a System Key
49
System Keys are issued by Cadwell. Instruments ship from the factory pre-configured
with the System Key already entered. If you change the computer used with your base
unit, contact Cadwell by telephone or fax to obtain a new license key. See Cascade
Customer Support for contact information.
When calling by telephone, be prepared to supply the instrument serial number or
customer ID number and the "System ID" number displayed by the Cadwell Cascade
Control Panel. When using a fax, be sure this information is included. Take particular
care to copy the System ID number correctly and clearly.
If requesting keys for multiple computers, be prepared to supply the required
information for each computer.
Keys can be typed in by clicking the Change System Key button. A dialog displays
which allows entry of the System Key number.
Dialog Controls
System ID (Read Only) - The System ID number is generated automatically when the
software is initially installed. The number uniquely identifies the computer on
which the software is installed. When requesting a System Key from Cadwell,
the System ID number must be supplied.
System Key (Read Only) - The current System Key number. The key enables operation
of the Cascade software and controls which optional features are available. The
System Key will only work in combination with its corresponding System ID.
Attempting to re-use the System Key on another computer will not work.
Change System Key - Click the Change System Key button to display the Change
System Key dialog. The dialog allows the entry of a new system key. If an invalid
key is entered, a message displays to indicate that the key is invalid. The key
must either be corrected or the Cancel button can be clicked to exit the dialog
without changing the system key.
Cascade Options - The Cascade options list box displays the status of optional software
features. If the check box is checked the feature is enabled. If a feature is
unavailable, the option will be displayed in gray and it will not be possible to
enable it. Unchecking a box will disable the associated feature.
Enable Features
EMG – Enables EMG data acquisition.
EP – Enables EP data acquisition.
EEG – Enables EEG data acquisition.
Live Video – Enables display of live video from a digital camera.
TOF – Enables Train of Four data acquisition.
Remote Server – Enables a Cascade with data acquisition capability to act as a
server for remote monitoring client computers.
Network Base Control - Enables control of the Cascade Elite base over a LAN
connection.
50
Setup Instructions
Reader License – Enables review of patient data files and remote client
capabilities.
OK - Click the OK button to finalize any changes and exit the control panel application.
Creating a Shortcut to a Network Location

To set up Cascade desktop shortcuts, and to move data files to a networked system,
follow these directions.
Note: The folders used in this example will be different from yours if the Cascade
application is not loaded on the networked system to where the files on the remote
reader system are to be moved.
1. From the Windows desktop, right-click on the Start menu.

2. Select Explore.
3. In the left window pane, single-click on the plus sign next to the Cadwell folder.
NOTE: If the Cascade application is not yet loaded on this system, select the desired
directory to which you wish the Cascade files are to be copied.
4. Single-click on the plus sign next to the Cascade folder.

5. Under the Cascade folder, under Checklists, right-click the data folder.
6. Select Sharing and Security.
7. Click on the Sharing tab.

• Select Share this folder.
• Create a Share name and set security preferences.
• Click Apply.
• Click OK.
51
8. Close Windows Explorer, but leave the computer turned on.

Create the Cascade Shortcut
Turn the Cascade system on.
Note: Both systems must be connected to the network and turned on.
1. From the desktop of the Cascade system, right-click the Start button.
2. Select Explore.
3. In the left window pane, single-click on the plus sign next to the Cadwell folder.
4. Single-click on the plus sign next to the Cascade folder.
5. Right click on the Patient Data folder below Cascade.
6. Select Send To > Desktop (create Shortcut).
52
Setup Instructions
7. Still in the Windows Explorer, scroll down on the left and single-click on the plus
sign next to My Network Places.
8. Single-click the plus sign next to Entire Network.
9. Single-click the plus sign next to Microsoft Windows Network.
10. Single-click the plus sign next to the workgroup or domain where the networked
computer is located. (In this example the remote networked system is in the
Cadwell workgroup).
12. Single-click the plus sign next to the remote system’s computer name. (In this
example we shared the Cadwell folder on the remote system. The Cascade
application will automatically look for data files in the data folder located under
the Cascade folder, under the Cadwell folder).
13. Right click on the data folder (or desired folder) on the remote system and select
Send To> Desktop (create Shortcut).
53
14. Close Windows Explorer.

Rename Files
1. On the computer’s desktop there are two new shortcuts to data. They need to be
named appropriately to be able to differentiate which one is for the Cascade and
which one is for the remote system.
2. Right click on the Shortcut to data folder icon and select Rename.
3. Rename the folder to Cascade Data Folder and press enter to keep the name.
54
Setup Instructions
4. Verify you have the folders named correctly by opening the Remote Data Folder.
• Look in the address line. Systems located elsewhere on the network will
start out with two back slashes in the address line (\\). See example
below.
Move Cascade files to Network

1. Open the Cascade Data Folder on the desktop.
2. Select the files you want to copy (If you wish to select more than one but not all
of the files, hold down Ctrl on your keyboard and single-click each file. If you
wish to select all of the files, single-click in the window and press Ctrl and the A
key).
3. In the Edit pull down menu, select Copy.
4. Close or minimize the Cascade Data Folder.
5. Open the shortcut to the Remote Data folder.
6. In the Edit pull down menu, select Paste.
Note: The remote system must be turned on and connected to the network to move files
to it.
Minimum Computer Requirements
55
The computer used to run the Cadwell Cascade, Elite, or PRO is an integral part of the
neuromonitoring system. For optimum performance of the system use a computer that
meets the following criteria.
Minimum Recommended
Operating 32-bit or 64-bit

System Windows 7
(Please see
Configuring
Cascade for
Windows 7 for
additional setup
instructions,
document
369028-626 on
DVD)
Processor I7, 2.9 GHz

Quad Core
processor,
Cascade 2.6
SP1 will run
much slower
on computers
with single-
core
processors.
Hard Disk Drive 80 Gigabytes 40 GB free

Capacity, 5 GB space
free-space
Memory 8 GB
(DRAM)
Archive Device Any Windows

supported
device
Graphics 1024 x 768 1600 x 900; 64

resolution; 16 MB
MB, 32-bit (recommended)
color depth ATI Graphics
(supported,
but not
56
Setup Instructions
recommended)
Base Unit 10 Base-T

Communication Ethernet
connection
Network Second
Connectivity Ethernet
connection
(e.g., Ethernet
card) required
for
simultaneous
connection to
base unit and
network
Regulatory U.S. and

Requirements Canada:
Equipment
must meet
UL1950 or
IEC950
European
Union:
Equipment
must meet
EN60950
Editing System Setup

System Setup - Overview
System settings are settings that apply to the Cascade software at a system level and are
the same regardless of the procedure setup file being run. System settings can be set
differently for each username logged in to Windows.
Five tabs comprise the system settings.
Tab Name Description
General tab Allows you to set the Data and Setup files directory paths, select the
frequency of the notch filter and turn on the Title Bar. It also
provides buttons for setting up the Report Header and for changing
Customer Options.
Remote tab Used to specify connection speed, and select how to handle view
57
changes on the remote reader.
Chat tab Used to configure Chat Box options. The chat box is used to send
text messages back and forth between the remote monitoring client
and the acquisition (Server) Cascade.
Event Used to select which event marks will be displayed along the time
Filtering Tab line of the procedure.
Colors tab Used to select the colors for the window background, traces,
cursors, trace labels, etc.
To edit the system setup: From the Edit menu, select System Setup to display the
System Setup window. Make any necessary changes to the selected tabs.
General Tab
Select specifications in the General tab:
Data Files - Enter the directory location for all data files (.smd).
NOTE: Your computer must have access to the directory location indicated in the Data
file Directory filed in order to start a procedure.
Setup Files - Enter the directory location for all setup files (.smp), and amplifier input
files (.amp).
Report Header - Edit the header template that is included at the top of all reports.
Edit Customer Options - Display the Cadwell Cascade Control Panel, from which you
can enter the System Key for an instrument and control enabling of optional
software components. A System Key is required to enable the Cascade software on a
particular computer and to configure which optional features will be available. See
Activating Software Licenses topic for more information.
Show Title Bar - When this box is checked the Cascade application will respond to the
Windows Tile feature. The Windows Tile feature allows you to have multiple
sessions of Cascade running at right click on the Task Bar to select one of the two
Tile Windows options. This will equally layout the open applications on the screen.
58
Setup Instructions
Tiled Cascade sessions.
59
Remote Tab
Select specifications in the Remote tab:
Remote Computers: Select remote servers.
Add: Select a remote computer from the network and add it to the server field. One
server can be viewed by three clients simultaneously.
Delete: Remove a server from the list.
Connection Speed: Select speed of network connection. When checked, "Maintain View
Sync with Server" verifies reader system will always show the same view as the
acquisition system. The reader may configure the content and layout of the views to be
different than the acquisition system. There is no EMG when using a slow connection
like modem to modem.
60
Setup Instructions
Chat Tab
Select specifications in the Chat tab:
Auto Send Message on Enter Key - Pressing the Enter key after typing a chat message
sends the message to the recipient.
On Message Auto Popup and Beep - When a new message is received, the message can
automatically display and/or your system can sound a beep.
Save to Log - Records all chat messages to a text file. Using the Chat feature can be done
without interrupting data acquisition. This option must be active at the beginning of
a monitoring session to take effect.
61
Event Filtering Tab

Select specifications in the Event Filtering tab:
Event Type - Select the type of events which will appear on the procedure timeline.
Priority - Select the events which will appear on the procedure timeline by their priority.
User Event Type - When reviewing a procedure use this area to remove user events
from the timeline that are entered from user comments.
62
Setup Instructions
Colors Tab
Select color specifications in the Colors tab:
• Click on the box corresponding to the item you want to change
• Select a new color from the color palette
Colors can be changed before, during, or after a recording.
You may use the folder icon to load a factory default color profile or to load a custom
color profile.
Use the diskette icon to save the current selections to either the Custom 1 or Custom 2
profile.
63
Performance/Operational Recommendations
To get the most out of your Cascade Elite , follow these recommendations:
Impedance Measurement – in order to measure impedance there must be a valid
active, reference, and ground electrode connected to the amplifier. Each
amplifier requires one ground electrode to be placed on the patient. Pods A
and B go to Amplifier 1. Pods C and D go to Amplifier 2. In order to measure
the ground impedance correctly, the impedance of the active and reference
electrodes must be between 0.2 ohms and 50.0 kOhms.
Common Mode Rejection Ratio – if a defined amplifier channel is not being used
in any acquisition mode, you should delete this channel from the test montage
and channel settings for each mode the amplifier channel is used in, for the
greatest CMRR and reduced noise.
Low Current Electrical Stimulator (Low1 and Low2) – for maximum output, the
impedance across the cathode (-) and anode (+) must be less than 8 kOhms.
64
Setup Instructions
Amplifier Input Extender Pods – for best performance, run both the active and
reference inputs for a channel through the same extender pod. Also, use short
electrode lead wires.
Turn OFF Special Effects in Windows —
1. Right click on the Windows desktop and select Properties.
2. Select the Appearance Tab
3. Click on the Effects button
4. Un-check the box labeled "Use the following transition effect for menus
and tooltips."
5. Un-check the box labeled "Show window contents while dragging."
6. Click OK in the Effects window.
7. Click OK in the Display Properties window.
Set Windows Theme for Windows 7 To Cadwell
1. Click on the Start button. Type the following in the box above the start
button, C:\Cadwell\Cascade\Cascade.themepack.
2. Click the X in the upper right hand corner to close the Personalize
window.
Securely ground the Laptop or Desktop PC – ground the laptop or desktop (via
a grounding wire) to the back of the Cascade Elite Power/Com Module. If the
Cascade Elite is sitting on a metal cart, ground the cart to the back of the
Cascade Elite Power/Com Module as well.
65
Getting Started - The Basics
The Basics
Working with Basic Windows®
The Cascade Elite application works within the Microsoft® Windows 7 operating system
environment.
The Cascade Help file helps answer questions about how to use Cascade software.
For information specifically about using Windows functions outside the Cascade
software, refer tot he Microsoft Windows Help and Support Center.
To open the online Help file for Windows
1. On the Windows taskbar, click Start.
2. Click Help & Support.
Turning Equipment On and Off

Do not turn the instrument base on or off while a patient is connected.
To turn the equipment on
1. Connect the power/com module, amplifier input extender cables, stimulators,
and accessories (if not already connected).
2. Turn equipment on in the following order:
o Power/com module (also powers the Cascade Elite base unit)
o Computer
o Monitor (desktop units only)
o Printer (if connected)
NOTE: If you are using the isolation transformer, you only need to turn on the isolation
transformer power switch.
To turn the equipment off

1. Close all programs that are running on the computer.
2. On the Windows taskbar, click Start, Shut Down, select the Shut down option,
and click OK.
3. Turn off equipment in the following order:
o Power/com module (also powers the base unit)
o Computer
o Monitor (desktop units only)
o Printer
NOTE: If you are using the isolation transformer switches, turn off only the power
switch. The monitor, printer, and power/com switches can remain on. The next time you
start the system, turn on only the power switch.
NOTE: You do not need to disconnect the power/com, amplifier input extender cables,
stimulators, or accessories. You may leave them connected.
67
Opening and Closing Cascade Software

To open Cascade Elite
With the Cascade Elite equipment turned on, start the Cascade software from your
computer by:
o Double-click the Cascade icon on the Windows desktop, or
o From the Windows toolbar, click Start, All, Programs, Cadwell, and then
Cascade.
To close Cascade Elite
When you close a patient file or exit from Cascade while in a patient file, all data is
automatically saved to the patient's file.
o To close a patient file without exiting from Cascade: From the File menu,
click Close Procedure.
o To exit from Cascade: From the File menu, click Exit. You can also click
the Red 'X' in the upper right corner. Click Yes to close the Cascade
software.
Working with Cascade Software

Cascade Elite Start Page Overview
The start page is the first page displayed when you open the Cascade program. There
are nine actions to choose from, or you may select the Help option to access the Cascade
Elite Help files.
Record Data
Start New Procedure allows you to access settings files in

Cascade Elite testing. You may select a procedure setup file for
the surgery, enter patient information and begin running
modes and monitoring data.
Append To Procedure allows you to open patient data files

that already exist in Cascade Elite testing and supplement them
with additional data (traces). This feature is often used if a pre-
surgery screening was completed before the patient entered the
operating room.
68
Read Data
Review Procedure allows you to access patient data files and

analyze existing information from the Cascade Data File dialog
box. The arrows on the time bar may be used to jump to events
in the data file. Data is displayed for that time during the
surgery; you may move around in the file and review the
trends, video and trace data at any time during recorded
surgery.
Remote Monitor allows you to connect a remote unit to the

Cascade server. You may choose from the options available or
browse the network to find your connection.
Manage Records
Delete Records allows you to delete patient records from the

database.
Export Record allows you to export patient records from the

database.
Import Record allows you to import records into the database.
Utilities
New Procedure Setup accesses the Procedure Setup page,

where you may specify what amplifier inputs will be used and
assign them to amplifier channels, specify the order of modes,
assign amplifier channels to each mode, and select what types
of windows to display during the procedure. For more
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information, please see Procedure Setup - Overview.
Amplifier Diagnostic is used for diagnosing the amplifier. For

more information, please see Amplifier Diagnostics.
Amplifier Calibration is used to check the calibration of the

amplifier. For more information, please see Amplifier
Calibration.
Edit Procedure Setup allows you to access and make changes

to procedure setup files. For more information, please see
Editing Procedure Setup File.
System Setup allows you to set time bar event marks based on
priorities of events and specify where your data files will be
stored. You may also add or delete remote servers and set up a
message function between the client PC and the Acquisition
Cascade. For more information, please see System Setup -
Overview.
Working with Cascade Windows

The Cascade windows environment contains several unique features created to make
neuromonitoring faster and data easier to interpret. From within a procedure, the
following features and options are available:
Mode Windows
Each arrow below indicates a window within a procedure. Each acquisition mode
has a set of specially designed windows from which you may choose. Each
available window type is identified by its title bar and displays data acquired by
that mode in a unique way. This allows you to view the same data in a variety of
ways using the window type most appropriate for your needs at any given point
in surgery.
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You can have several window types open in Cascade at the same time.
You can maximize (enlarge) a window so that it fills the entire desktop and then
restore it to its former size and reposition or minimize the window. The name of
the minimized window can be viewed in a tool tip text box by placing the mouse
over the minimized window. You can move windows around in Cascade and
change their size and shape.
You only work in one window at a time: the active window. You make the
window active by clicking the title bar of that window or by clicking anywhere
inside the window. You know that the window is active when the title bar appears
highlighted (a darker blue than the title bars of the other windows).
Sometimes there is more information than can fit in a window (either horizontally
or vertically. When this is the case, scroll bars let you tilt or pan the view to see the
hidden information.
Mode windows are configured in the window setup dialog for each window
accessed from the right-click menu or the procedure setup file.
Views
Views are groups of mode windows. Views allow you to preconfigure a set of
windows. This gives you the ability to view data the way you want it when you
want it with two mouse clicks. You can have twenty unique views, each with a
different set of mode windows.
Dragging/Resizing Windows
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Once you have selected the mode windows you want in each view, you can setup
how you want the mode windows arranged and sized. Left-click the edge or a
corner of a window and hold it as you drag and resize the window. You can
maximize a window by clicking the enabled maximize button in the upper right-
hand corner of the window. You can restore the window by clicking the Restore
button in the upper right hand corner of the window. You can minimize a
window by clicking on the minimize button in the upper right-hand corner of the
window. Minimized windows are sent to the bottom left of the screen and remain
there until restored. The name of the minimized window can be viewed in a tool
tip text box by placing the mouse over the minimized window.
Right-click functionality
Right-click on a window for a list of menu options available for that window. This
list is called a context menu.
Auto size
Select this option from the Window menu to automatically adjust the size of all
windows concurrently as you resize or move a single window.
Lock windows
Select this option from the Window menu to lock all windows in place. You are
not able to resize or move windows while the windows are locked. Uncheck this
option to release the lock. Locking widows allows more room for data on screen.
Parts of a Window
These window options are available after you have started a procedure from the start
page. The desktop is made up of four basic parts: the menu bar, toolbar, windows, and
status bar.
Menu bar:
While performing a procedure or reviewing a procedure, a row of options is

displayed across the top of the desktop. This row of options is the menu bar. The
items in the menu bar are names of menus. Left clicking a menu name displays a
list of commands relating to the name of the menu . To close a menu, left click off
the menu option. Refer to the Menus section for detailed information on each of
the menu options.
Toolbar:
The buttons on the toolbar are a graphical representation of some of the options
available from the menu bar. The function of each tool button on the tool bar is
described on the status bar (see below) and in the mouse pointer tool tip when the
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cursor is over the tool button. Please refer to the Toolbar Descriptions section for
descriptions of the function of each of the toolbar options.
Windows:
Please refer to the Working with Cascade Windows section for more information.
Status bar:
The status bar is a bar at the bottom of the Cascade application window that
contains status messages. Status bar shows current (clock) time and elapsed time,
the name of the procedure setup file being used and computer name and IP
address of the computer on the network.
Please refer to Cascade Elite Start Page Overview and Starting a Procedure for more
detailed information.
Toolbar Descriptions
The buttons on the toolbar are a graphical representation of some of the options
available from the menu bar.
Save Current Setup

Saves changes you make to the acquisition parameters while running a procedure
setup file. Changes may be made in the Procedure Setup window or using the
context menu for the individual modes. Choosing the Save Current Setup option
will overwrite the procedure setup file. The name of the procedure setup file
being used is listed in the status bar at the bottom of the Cascade window. A
warning dialog will be displayed asking you to confirm that you would like to
overwrite the procedure setup file. To save the current settings as a new
procedure setup file, open the procedure setup file and choose save as from the
file menu.
Print Report
Select this option to specify a template and generate a report.
When viewing modes, generating a report is based on all windows that are
currently displayed. Only fields from the displayed windows are available for the
report. The templates used for reports are "remembered" so that you don’t need to
select a template very often. Templates are "remembered" by window type so if
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you print from one EP window, the same template will be used in another EP
Window.
Current Procedure Setup

Opens the Procedure Setup window to make any changes to the current
procedure setup file. Most setting changes can be made while running a
procedure without stopping data acquisition. The current procedure setup
window must be used to change amplifier settings such as input labels, channels
assignments, acquisition sweep, and changing filters, gains, and audio settings.
This option is only available when a procedure file is open.
Channel Setup
Opens the Channel Setup page of the Procedure Setup window. The Channel
Setup page allows you to perform most of the actions that cannot be performed
while continuing to collect data such as label the inputs of the amplifier input
extender pods, assign the inputs to amplifier channels, name the amplifier
channels, and set the filter, gain, and audio settings. Selecting okay or cancel from
the Channel Setup window when accessed using this option will return you to the
data collection page.
View Controls
This set of controls allows you to select views quickly and easily using two
command types. The left and right arrows cycle through the views you defined in
the setup file. The view label box indicates the current view. The drop-down
arrow displays the complete list of views and allows you to choose the view to
display. See View Setup for more information on how to set up these views.
Lock Windows
Select this option to lock all windows in place. With this option on, the windows
cannot be resizes or moved. This prevents inadvertent rearranging of windows
and increases the amount of screen space available for wave forms. Select the
Lock Windows option again to deselect it and release the lock.
Auto Size
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Select this option to resize surrounding windows as you resize or move one
window. This option prevents windows from overlapping and makes it easier to
arrange windows.
Live Mode
The default position for this option is on. When the option is on, the button turns
bright green as seen above. This indicates the machine is in live mode. When this
option is unchecked, you are in Review mode. In review mode, you can monitor
data from earlier in the procedure. The scroll box follows the event markers in the
time bar. To exit review mode and return to the current time in the procedure,
click the Live Mode button or drag the scroll bar on the time bar all the way to the
right.
Impedance
This button launches the impedance window. Impedance is the resistance to
current flow. It can affect the signals from the recording electrodes. You should
check impedance before the start of every recording and during the recording if
there is reason to suspect poor contact between the electrode and the patient.
Impedance levels below 5 kiloOhms (kOhms) are acceptable for most tests. The
following colors are used to indicate the impedance level for each electrode pair:
Green < 5k Ohms Verification Circle
Yellow 5 - 15k Ohms Open Input/bad

electrode
Red > 15k Ohms Referenced to bad
electrode
Go To
This option opens the Events window, in which a list of the events entered for the
current procedure is displayed. To go into review mode and jump to the time in
the procedure corresponding to a given event, highlight an event and click the Go
To button.
You may also edit, print or delete events, show event history, and access the
procedure records at the time which the event occurred. To exit review mode and
return to the current time in the procedure, click the Live Mode button or drag the
scroll bar on the time bar all the way to the right.
In current mode, the time lapse scroll bar will be gray. In review mode, the time
lapse scroll bar will be mustard yellow (as shown).
Auto-Play Review
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This buttons launches the Auto-Play Review toolbar and is only available when in
review mode. The Auto-Play Review options allows you to automatically play
back procedures as recorded or move through a review manually using the Jump
to Next/Previous Stored Data buttons. Review mode is accessible by scrolling
back along the time bar or clicking the Live button when monitoring a procedure
or by opening a previously recorded procedure in review mode.
• Begin Auto-play by clicking the play button.

• Select the playback speed using the Speed drop down box to the left of
the play button.
• Jump to the next or previous set of stored data by clicking the Jump to
Next/Previous Stored Data buttons. This option ignores events. To jump
to the next or previous event, click the left or right arrows at either end of
the time bar.
• Pause playback by clicking the pause button.
Global EP Window
This displays the Global EP Settings window (see Global EP Window). You can
change most of the EP window display settings, either for all EP modes or selected
EP modes, from this one window.
NerveGuard
Opens NerveGuard software. For more information, please see Running
NerveGuard.
Sync with Server Button

During a remote monitoring session, click on this button to cause the Reader to
sync to the same view as that currently displayed on the Cascade. This option is
only available when a remote connection is active. This option is only available on
the reader system.
Help File
Opens the Cascade Help File.
Global EP Window
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This displays the Global EP Settings window, where you can change most of the EP
window display settings for selected or all EP modes. These features are also accessible
in the right-click menu on EP trace windows.
Setup Reject Info links you to the Setup Reject Info window.
Working With Waveforms

Repositioning Waveforms
To reposition waveforms on the screen, resize waveforms, adjust cursor latencies, reset
baselines, or create grand averages, you must select the waveform on which you would
like to take action. There are various selection and deselection methods using the left
click mouse key. Selecting a waveform is different depending on whether or not the
Trial Select option is turned on in the right-click menu.
With Trial Select Off:
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To select a single waveform, single-click any waveform. To select all waveforms in a

channel, double-click. To deselect all selected waveforms in a channel when all
waveforms in a trial are selected, double-click any waveform in the channel.
With Trial Select On:
To select all waveforms in a trial, right-click and choose Trial Select (Linked). To select
all the waveforms in a trial, single-click any one of the waveforms in the trial once. To
select all waveforms in a channel, double-click. To deselect all selected waveforms in a
channel when all waveforms in a trial are selected, double-click any waveform in the
channel.
NOTE: Traces will automatically be deselected whenever a trial is stored for a mode if
Trial Select is off for the EP Window. This helps manage waveform selection and
deselection.
Resizing Waveforms
The gains of most traces can be resized using the scroll wheel on your mouse. To do
this, select the traces you wish to resize and spin the scroll wheel up or down to increase
or decrease the size of the waves on screen. All traces in the EEG Window are resized
together when none are selected. You may also resize waveforms using the Window
Setup option in the right-click menu. Please refer to the Windows Setup section for
more information.
Multi-Modal Stimulator Triggering

The Cascade surgical monitoring system uses a stimulus trigger table to control the
timing of stimuli. An algorithm running on the host computer is used to generate the
table and download it to the DSP controller in the Cascade base unit. The table is
recomputed any time the run status of a mode changes.
When the stimulator is triggered at a constant frequency very good cancellation of

steady state sine wave noise can be achieved provided the noise frequency is close to an
exact harmonic of the repetition rate. The old method of generating multi-modal trigger
tables allows the instantaneous repetition rate to vary to prevent collisions between
modes while attempting to maintain an average repetition rate which is as close as
possible to the requested rate. The new method requires the repetition rates be adjusted
so that the instantaneous repetition rate for each mode can remain constant. This can
only be achieved by synchronizing the repetition rates for all of the running modes.
The following rules are used in generating the table:
Rules 1 – 5 apply to both methods
1. Only one EMG mode may run its stimulator at any given time. When the
stimulator is started in an EMG mode, an automatic shut down will be
performed if a stimulator is running in any other EMG mode.
• Anytime a triggered EMG mode is running at the same time as an EP
mode, the EP mode will run at an integer multiple of the EMG rep rate.
This means that if the triggered EMG is set to run at 3.11 Hz, the EP will
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run at 3.11, or 6.22, or 9.33 Hz. If you add another EP mode, it too will
run at an integer multiple of the triggered EMG rate. If you then change
the rate on the triggered EMG, the rates on the EPs will change.
• The reason for this rule is that triggered EMG modes are used by the
surgeon to stimulate delicate neural tissue and are therefore given stim
rate priority.
2. An EMG stimulator always runs at the requested repetition rate.
• The Cascade sets the rep rate for the EP as the integer multiple closest to
the requested rep rate. For example, if the ABR mode is set to 8.73, the
SEP mode is set to 2.87, and the EMG mode is set to 3.11, the Cascade will
run the ABR at 9.33 and the SEP at 3.11 because those are the closest
integer multiples of the triggered EMG rate.
• The reason for this rule is that setting the EPs (SEP, ABR, VEP) to an
integer multiple of each other assures the best reduction of synchronous
noise such as 60 Hz and other periodic noise sources.
3. If the sweep length for an EP mode is longer than the inter-stimulus interval for a
running EMG mode, the EP mode will be inhibited and will not run at all until
the EMG mode stimulator is turned off.
4. EP mode may be run concurrently. Sweeps are always triggered sequentially and
the sweep must be complete before the next mode can be triggered. A fixed
interval of 5 milliseconds is added to the sweep interval to allow time for
stimulus setup. If a positive sweep delay is in effect, this is also added to the
sweep interval.
5. Retriggering the stimulator during a sweep is not allowed when multiple modes
are running. This may be done, however; when only one mode is running.
Rules 6 – 8 Apply to the "Optimize Random Noise Reduction" Method
6. To avoid sweep collisions when multiple EP modes are running, the repetition
rate will be slowed when necessary. The repetition rate is never increased. This
is true for the instantaneous peak rate as well as the average repetition rate.
7. When repetition rates must be slowed an attempt is made to maintain equal
repetition rate ratios for all modes (except EMG modes). Deviations from
precise values occur for two reasons. a) The length trigger table is 128 entries.
This sets a limit on the accuracy of repetition rate ratios for any two modes
specified in the table. b) The algorithm stops at the end of the table without
attempting any adjustments. Two modes having identical repetition rates may
not receive exactly the same number of stimuli in the table.
8. The actual repetition rate displayed by the program is an average repetition rate.
It is computed by counting the number of stimuli in the table for a mode and
dividing by the time required to cycle through the complete table.
Rules 9-10 Apply to the "Optimize Synchronous Noise Reduction" Method
9. Repetition Rates are adjusted as follows:
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r’m = r’max ÷ n
r’m is the actual repetition rate for mode m.

r’max is the maximum actual repetition rate.
n is a whole number in the range 1 to 16.
The value is chosen to minimize the absolute value of the difference r’m –
rm
rm is the requested repetition rate for mode m.

rmax is the maximum repetition rate for all rm
rmin is the minimum repetition rate for all rm
remg is the requested repetition rate for the EMG mode.
In certain cases it may be necessary to adjust r’max to a value other than rmax. If an
EMG mode is running with a stimulator on, the EMG repetition rate remg remains
fixed and other repetition rates are adjusted as follows:
r’max = remg × n
n is a whole number in the range 1 to 16 and is chosen to minimize the

absolute value of the difference r’max – rmax.
If r’max ÷ rm > 16 for any mode the mode will be shut off.
In the case where an EMG mode is not running with a stimulator on, r’max is set as
follows:
r’max = Minimum(rmax, rmin × 16)
In either case, if the sweeps for the modes are too long to fit, r’max is reduced as
much as necessary to allow time for the sweeps without any overlap between
modes.
10. In complex setups with many modes at different repetition rates, it may not be
possible to fit the required trigger table into the maximum length allowed. If this
occurs, the system will first attempt to resolve this by reducing the number of
choices for the value of the repetition rate divisor “n”. If this strategy fails to
produce a useable trigger table, modes will be shut off starting with the slowest
repetition rate until a usable trigger table is obtained.
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Keyboard Accelerator Commands (Hot keys)

Up / Down Arrows: Increases or decreases the stimulus intensity of the selected mode
control. For standard electrical stimulators, changes occur in increments of 0.10 mA. For
the TCS-1 stimulator, changes occur in 2 volt increments.
Left / Right Arrows: Move from event to event along the time bar.
Page Up / Page Down: Increases or decreases the stimulus intensity of the selected mode
control. For standard electrical stimulators, changes occur in increments of 1.0 mA. For
the TCS-1 stimulator, changes occur in 20 volt increments.
Plus / Minus: Audio volume up and volume down.
Ctrl-Space: Smooth all active traces in all EP modes in the current view.
Ctrl- C : Enter comment.
Ctrl- M : Mute and un-mute the audio.
Ctrl- P : Print report. (Same as File | Print).
Ctrl- R : All Run and All stop.
Ctrl- S : All store.
Ctrl- V : Next view.
Ctrl- 1 through Ctrl- 0 : Used to the select the first 10 events in the event list.
Alt - 1 through Alt - 0 : Used to select the second 10 events in the event list.
Esc: Panic key (shuts off all modes, and mutes the audio).
Shift+Esc: Resume Run Hot Key: Used to restart the stimulator, data acquisition, and
audio for all modes that were running at the time the Esc key was clicked.
Ctrl - Shift - P : Sends the image of the screen to the default printer.
Cascade File Extensions

These file types are located in the C:\Cadwell\Cascade\Data folder.
File Extension File Type

.iomdata v2.6 Patient data file
.smp Procedure setup file
.smd V2.5 Patient data file
.amp Amplifier input file
.csf Cursor setup file (cursor setup dialog)
.rtf Report file
.rpt Report template file
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.evt Event list file
.txt Chat log file
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Cascade Data Management (DM)
Introduction
The Cadlink Data Management system is an integral part of managing patients and data
recorded by the Cascade software. This new feature allows you to search for a either a
record or a patient by name, date, surgeon, or any other data entered into the patient
info screen.
Data Management within Cascade Application
Starting a new procedure

Both record and patient demographics are stored in the data management system. This
allows Cascade advanced search capabilities for selecting a record or selecting a patient.
After selecting the type of procedure you wish to run, Cascade will request more
information about the patient.
Patient Creation
As typically surgical patients are not repeat customers, Cascade will automatically ask
for new patient information. By filling out this form and pressing OK, you are creating a
new patient in the database. Last Name and First Name are required fields.
Patient Selection
If the patient is already in the database, you can re-use the existing patient information
by pressing the “Change Patient” button. By re-using patient information, all previously
entered patient data is automatically associated with this new recording. The data fields
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below Height and Weight in the Edit Patient Information window are specific to the
recording.
The patient selection dialog is a searchable list of all patients. It defaults to showing all
the patients and showing all the searchable columns. The search fields are not case
sensitive and matches are based on whether or not the field contains the provided value.
The “Clear” button provides a quick way of clearing the search conditions and will
update the displayed list to show all patients again. A patient can be selected by either
double clicking on the patient in the list or by selecting the patient in the list and clicking
on the “Select” button. To create a new patient, press the “Create New Patient” button
and it will return you to the patient creation dialog.
Procedural Notes
Cascade v2.7 and later use data management (DM). With DM the patient information
screen is split into two sections. The top portion of the window contains information
specific to the patient and stays with the patient in the database for new exams.
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The bottom half of the window, Procedure Information is specific to the recording and is
populated just for that record. The Procedure information can be filled out when the
recording is started, or by clicking on Edit >Patient Info after the recording has started.
Review / Append to an existing procedure
When selecting a record to reviewing or append, Cascade now allows you to search for a
particular record based on the patient or procedure information that was provided in
the “Edit Patient Info” dialog.
Record Selection
The record selection dialog is a searchable list of recorded procedures. It defaults to
showing all records and having columns for recorded data, patient first name, patient
last name, and patient middle initial. All patient and procedure demographics are
searchable, and, if provided, will include that field in the displayed columns. A patient
is selected by the patient selection dialog. To clear a patient selection, use the red delete
button to the right of the patient field. To select a patient, use the browse button to the
right of the patient field. These fields are not case sensitive. Matches are based on if the
field contains the provided value. The “Clear” button provides a quick way of resetting
to no search conditions and will update the displayed list to show all recorded
procedures again. A record can be selected by selecting the record in the list and clicking
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on the Select button. To cancel a record selection, click on the close window button (X) at
the top right of the dialog.
Import & Export
All files that are tracked by Cascade v2.7 will be shown in the Review Procedure list and
the Append To Procedure list. Files not recorded on the current machine can be
imported using the Import Record tool and exported using the Export Record tool, each
selectable on the main menu.
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Export
Exporting a record brings up the Record Selection dialog. Once a record is selected, the
standard Windows Save File dialog will be shown, allowing selection of the destination
path of the exported file. The default filename is based on the patient’s name and the
date of the record. While the record is being exported a wait dialog will be displayed.
This dialog will also be displayed when the recording file is closed indicating the
recording is being exported.
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Automatic Exporting
The Cascade software will automatically export records when they are closed. They are
exported to the configured patient data folder in System Settings, on the General tab.
Their file name is in the format of [last name, First name, recorded date], with a
*.iomdata file extension.
Import
Importing a record brings up the standard Windows File Selection dialog and allows the
selection of both the new file format (*.iomdata) and the legacy file format (*.smd). The
import process will pull in all the information connected to the procedure when it was
exported, including data files, procedure demographics, and patient demographics.
If a particular record is already in the database when trying to perform an import, then
the following dialog will be displayed:
This can happen when trying to import a record into the same machine where it was
recorded and exported from. Selecting No will cancel the import process and leave the
record unchanged. It should be opened for review through Cascade by selecting Review
Procedure in the main menu. Selecting Yes will update the existing record with the
imported data files and procedure information. It will not overwrite any patient
demographics. Chances are the data is exactly the same in the exported file as the record
in the database.
Importing a legacy data file (*.smd) will bring up the “Create New Patient” screen to
allow associating the new record with a patient for the database. This is because the
patient demographics cannot be pulled out of old *.smd files like it can be from the new
*.iomdata files. The “Select Patient” button can also be selected to associate the *.smd
data to an existing patient in the database.
Local Service Control Panel

Cadwell Local Service Control Panel
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Status
This tool starts up without the need to log in. The initial screen shows the current
synchronization status between the local service and the central service. The central
server feature is not available in v2.7. From this screen you can force a synchronization
and get a more detailed log. Also you can go into the more advanced configurations of
the local service.
Advanced Configuration
By pressing the “Advanced” button, you will enter the advanced configuration section.
This section of the local service control panel requires that the user provides login
credentials with the permissions for administrative access. The default user name
Admin is configured with administrative access. The default password is admin.
The advanced window is broken down into four tabs: Settings, File Management,
Databases, and Rollback. Each tab contains specific user interface related to those
sections.
Rollback
This tab is used to revert a record back to a previous version of the files. This allows
reverting back to a previous version in cases like corruption or other cases relating to
data integrity. Select the Patient and click OK or double left click on the patient listing.
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Selecting a record to rollback can be done in two ways; it can be double clicked in the list
or clicked on in the list then hit the Select Rollback button. Either method will bring up
the version selection dialog.
This dialog allows you to select a version of files based on a list of changes checked into
the Cadlink system. Select the desired version in the list and then click OK to accept the
rollback. Rollback is done by checking in the specified version over top of the existing
version. This maintains the version history adding the rollback as another version.
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Settings
There are two groups of settings values; one for the local storage and one for the
synchronization with a central server.
Local Storage
The local storage is a set of values configured for the data management client being run
on the current system. It contains settings for the databases and the file storage for the
individual files that comprise a recorded procedure.
Database Folder is the location of the data management system patient and procedure
detail storage. This can be relocated to a location that can easily be backed up either on
the same computer or to a network path location. It is important to make sure the
databases shipped with the Cascade software are placed in the specified location
otherwise the data management system will not function.
Database Search pattern is the filter used in discovering additional databases provided
by products or for additional information to be associated to a patient or procedure.
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File Storage Folder is the location of files that are checked into the data management
system. These may include the data files, reports, and logs relating to a recorded
procedure.
Synchronization and Central Server

The Central Server is an additional product that provides for synchronization across a
network between several client machines.
Central Server URL is the UNC based machine name and port to communicate with the
Central Server.
Synchronization Interval is the time in seconds between requests for any changes
managed by the Central Server.
Synchronization Log Capacity is the maximum entries the log will keep, once the
maximum entries are reached the oldest entries are removed from the log as new entries
are added.
Synchronization Batch Size is the number of changes per update that the system should
transfer between the Central Server and the Local Server or from the Local Server to the
Central Server. This is a useful setting for managing the bandwidth usage of the
synchronization. The larger the batch size the more bandwidth will be consumed by the
Central Server synchronization.
The logging checkbox is used to turn on or off logging.
File Management
This tab is used for administration of files on the current local system. There are options
to add a file to an existing record, force a file to be checked in, and to force a file’s check
out to be undone. All of these options should be used with caution as they can be used
to put the record in an unintended state.
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Add New File

This option allows you to associate a new file with an existing recorded procedure. This
can be used to associate data with a procedure or to repair a procedure that is no longer
associated with the data files. The standard file selection dialog from Windows is used
to select the specific file.
There is an option to keep the file being added checked out, allowing it to still be locked
to the current user until later checked in.
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The list of all records is shown with some basic information about the record. Select a
record from the list and click the Select button to add the file to the record.
Check In File
This option takes the currently selected file and causes the file to be uploaded to the
local service’s data file location and the procedure to be updated with the new version.
Any attempts later to check in that file will fail unless it is first checked out again.
Undo Checkout
This option removes the current association of the checked out file, leaving the stored
file unchanged. Any attempts later to check in that file will fail unless it is first checked
out again.
Databases
This tab is used to view and print the list of databases currently loaded and being used
by Cadlink.
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Print Database List

This produces a print out list stating the name of the system and the current list of
loaded databases.
Rollback
This tab is used to revert a record back to a previous version of the files. This allows
reverting back to a previous version in cases like corruption or other cases relating to
data integrity.
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The base display will show all recorded records, but can be filtered using the filter
section below the list.
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Starting/Running Procedures
Starting a Procedure
Open a configured setup file to begin running modes, collecting data and displaying
that data in different formats.
See Verification of Proper Operation to check equipment setup and operation before
beginning any surgical procedure.
1. From the File menu, select Start New Procedure.
2. Select a setup file from the Open dialog box.
3. Click OK. Complete the fields in the Patient Information window. A patient
name is required to start a procedure.
4. Click OK. The mode windows display based on how the procedure setup file
was configured. For information on how to work in these windows, see Mode
Windows Setup Overview.
5. When ready to run the mode controls, click the toggle switch (as seen below
under ALL AUTO MODES) or right-click in an EMG or Average window and
select Run, for a specific mode or for all modes.
NOTE: Click the Run button in the All Auto Modes section to turn all auto modes on and,
click it again to turn all modes off.
6. To make any changes to the procedure setup for certain conditions (i.e.
electrodes falling off), go the Edit menu, and select Current Procedure Setup.
Make any necessary changes to the amplifier inputs, modes, channels, or views.
Click OK to close the Procedure Setup window.
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NOTE: Right-click on EMG and Average windows, and select Mode Setup or Window
Setup to access frequently changed parameters.
To start a procedure using a TCS (TCS-1, TCS-1000, or TCS-4)

1. With the Cascade and TCS plugged-in and setup for monitoring, choose the
'Start New Procedure' option from the File menu on the main Cascade page.
2. Double click the name of the procedure setup file you want to use from the list
and enter the patient information. You will need to enter at least a first and last
name. Patient information may be changed or updated later.
3. Click OK to start recording.
4. Check impedance of the recording electrodes by clicking the icon with a "Z" on it
on the toolbar at the top of the screen. When you are satisfied with the
impedance levels, close the impedance window.
5. You are now ready to record transcranial electric motor evoked potentials.
TCS Stimulus Triggering

Triggering the TCS-1/TCS-1000/TCS-4 stimulator in the MEP mode type may be
achieved using the Single Trigger button in the Mode Controls window. For EP and
EMG mode types, the TCS-1/TCS-1000 stimulator may also be triggered using the
mode’s Run or Single buttons (Fig 6).
NOTE: Right clicking over the MEP trace window can also access The Single Trigger,
Run, and Single functions.
When a TCS is triggered, the voltage/current value will momentarily flash ‘yellow’
within the Mode Controls window (Fig 7) and the Cascade software will display the
resulting waveforms in the appropriate mode window replacing all active waveforms
displayed. The active waveforms are erased upon triggering a new trial unless the data
is stored before triggering occurs. Data may be auto stored or manually stored.
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When a TCS is triggered, the voltage/current value flashes yellow.
TCS Stimulus Intensity Adjustment

Stimulus intensity (voltage) is adjusted using the stimulus intensity knob in the Mode
Controls window. Each mode using the
TCS-1/TCS-1000/TCS-4 stimulus type contains a single intensity knob in the Mode
Controls window. The delivered intensity is adjustable in two-volt increments from zero
to the pre-set maximum (as defined by the user in the Setup Stim dialog or the Mode
Setup dialog) using the stimulus intensity knob.
The stimulus intensity may be adjusted up or down in 20 volt increments using the
“Page Up” and “Page Down” keys on the computer keyboard, similarly the up and
down arrow keys can be used to adjust in 2 volt increments. The “Home” key on the
computer keyboard will return the stimulus intensity knob to zero.
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Single Train Stimulus Double Train Stimulus
Charge Accumulation Recommendation

Charge accumulation popup reminds user to keep current at levels that are less likely to
cause tissue damage. The popup appears as you increase the stimulation amplitude
during a procedure. The scale of the popup is in Coulombs/hour, and is a function of the
stimulus amplitude, pulse width, rep rate, and stim ON time. Electrodes with smaller
surface areas are more likely to cause charge accumulation-related tissue damage. The
popup serves as a recommendation and disappears automatically after 3 seconds. The
popup does not appear for modes with biphasic stimulator(s). There is also a check box
to "Never show me this again" if it is desirable to keep the box from appearing at all.
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Checking Impedance
Impedance is the resistance to current flow. It can affect the signals from the recording
electrodes. Check impedance before the start of every recording and during the
recording if there is reason to suspect poor contact between the electrode and the
patient. Checking Impedance also resets the amplifiers.
Impedance measurements are automatically saved in the data file. Upon review, the
impedance measurements can be re-displayed by going to the Impedance Event (use the
Go To feature in the Event menu), then clicking on the Z toolbar button.
You can check electrode impedance at any time during a test. In order for the impedance
routine to work properly you must have at least two Active, two Reference, and one
Ground electrode connected to the amplifier (5 electrodes).
Impedance levels below 5 kiloOhms (kOhms) are acceptable for most tests. The
following colors are used to indicate the impedance level for each electrode pair:
Green < 5k Ohms
Yellow 5 - 15k Ohms
Red > 15k Ohms
Verify Bad Electrode
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Verify Bad Reference
To check electrode impedance

1. Make sure the amplifier is on and electrode leads are inserted into the amplifier
jacks. The ground electrodes must be connected. The Cascade Elite & Pro
systems require two ground electrodes; one for each amplifier. Pods A & B
require one ground. Pods C & D require one ground.
2. Click the Impedance button on the toolbar to display the impedance box.
3. Make sure the appropriate channels are turned on in the procedure setup file.
The Cascade impedance algorithm introduced in v2.2 looks at all channels used
in any montage for the calculation. Version 2.3 and later allows users to deselect
channels they do not connect to the patient for that recording, allowing the user
to get an accurate impedance calculation. Simply right click on the pod you want
to exclude channels from, uncheck the boxes for those channels to be removed
from the impedance calculation. Then click OK. This will exclude those inputs
from the impedance calculation for the remainder of the recording.
4. When the verify indicator is displayed next to an impedance value Cascade is

indicating that there is not enough information for it verify the value displayed is
accurate. When you get a reading with a high impedance

value and the verify indicator is displayed next to it, this is most likely
a bad or disconnected electrode. When you get a reading with a low impedance
value and a verify indicator is displayed next to it, this is most likely
an electrode that has lost it’s reference electrode in the impedance calculation.
Such a reference electrode would display an impedance of . The
electrodes with the high impedance listing and the verify indicator displayed
next to it should be replaced or reapplied first then the impedance test should be
executed again. Even though the robust impedance algorithm has redundancy
built in for references and grounds if too many electrodes are bad or unplugged
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the verify indicator lets the technician know the Cascade system does not have
enough information to display an accurate value for those inputs. Also make
sure to deselect any inputs not connected to the patient.
5. To close the impedance box, click Quit.
Please see Impedance Test Arrays for more information on testing the impedance of
your hardware.
Averaging Waveforms
Averaging is used when the amplitude of the response is small. Signal averaging helps
to define the response and pull it out from the background noise. The epoch of data
following each stimulus is averaged point-for-point to produce an averaged waveform.
Deflections that are time-locked to the stimulus are reinforced, while signals that vary
randomly with respect to the stimulus are reduced.
The final averaged response is based on the number of stimulus presentations that you
set. When the test has collected the given number of sweeps, it automatically stops the
averaging and displays the final waveform.
Every sweep of the averager starts with the presentation of a stimulus. However, when
reject is being employed, every sweep might not be included in the actual average. The
reject function detects the condition when the input is larger than an allowable range.
Under these circumstances, the input is peak clipped and therefore distorted. When the
artifact reject function detects the input over-scale condition, it does not allow the sweep
to be included in the average. This means that when the average is completed, more
stimulations might have been delivered than total sweeps in the average.
To turn averaging on and off

By default, to begin averaging and evoke potential mode, click the Run/Stop toggle
switch. To stop averaging, click Run/Stop again.
To store averaging
You can store traces from the averaging both when the averager is running and when it
is stopped. If the averager is already running when data is stored, it is cleared and
continues to run after the store operation is complete. Averaging might be temporarily
suspended to ensure the integrity of the stored data.
To store the averaged waveforms, right-click on the Average window, and click Store.
To clear and reset averages
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You can clear the averager both when it is running and when it is stopped. If you clear
while running, the data is cleared, and the averager continues to run. If you clear while
it is stopped, the active waveform is cleared, and the averager resets to zero. Right-click
on the Average window, and click Clear to reset the average count to zero.
Pause Averager
There are some testing procedures such as clinical testing where it is advantageous to
pause the averaging of responses while leaving the stimulator running. To do this,
choose the Pause Averager option from the right-click menu of any EP mode. When
checked on, the Pause Averager option pauses the averager while allowing the user to
control the stimulator as normal. The default state is for the Pause Averager option to
be unchecked. When the Pause Averager option is selected on, the Average count in the
Mode Control Windows and in the Date windows will show “Paused.” The mode will
remain in Pause Averager mode until the option is unchecked.
Electro-Surgery Detector and Electro-Surgery Reject
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By monitoring the activity of electro-surgery devices, the ES Detector:

• Mutes audio during use of electro-surgery devices
• Stops "Store on Auto Capture" function
• Pauses the EMG stimulator
Using the ES Detector

On the hardware:
1. Attach the ES Detector to the base unit using an auxiliary cable.
2. Attach the ES Detector Clip to the ES Detector's Channel 1 port. If two Electro-
surgery devices are being used, attach a second clip to the Channel 2 port.
3. Run all Electro-surgery hand piece lead wires from one Electro-Surgery device
through the gap in the ES Detector Clip. If two ES devices are being used, run all
ES hand-piece wires from the second ES device through the second ES Detector
Clip.
Within the Cascade software:
1. Edit the Procedure Setup,
a. Within the Mode Settings section, verify "General" is selected from the
Setup drop-down menu.
b. Checkmark the Bovie Mute option.
c. Click the OK button to close the Procedure Setup file.
2. In the View menu option, select Reject Settings...
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a. Verify that the reject sensitivity sliders on Channels 1 and 2 are at the
lowest settings.
b. Click the Done button.
3. Continue with electro-surgery procedures.
Access Mute Audio Settings

To access EMG Mode Setup and adjust mute audio settings, go to the Mode Settings
section of the Procedure Setup window for an EMG Mode Type, and select the General
Setup.
These options may also be accessed during a procedure by right-clicking on the EMG
trace window and selecting Mode Setup<General.
Channel 16 Mute Audio

Enable Channel 16 Reject: This amplifier channel can be used as a reject channel. Select
this option for EMG mode type in the Procedure Setup file to pause all data collection
and mute the audio when the data on this channel exceeds the threshold. When deciding
where to record from for channel 16, choose a site off of the torso and away from the
muscle being recorded for EMG.
Bovie Mute Audio

Enable Bovie Reject: Up to four electrocautery detection probes can be connected to
detect the use of a Bovie device. Select this option so that data is not collected during
periods of electrocautery use.
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For more information, see Setup Reject Info.
Adjust Mute Audio Sensitivities

To access the sensitivity of Channel 16 and Bovie mute audios, click View in the toolbar,
and select Reject Settings. Adjust the sensitivity by sliding the threshold slider up or
down for each channel. If you do not have any activity in the channel 16 reject settings
or the activity is larger than full scale, adjust the amplifier gain of channel 16 in the
procedure setup. Increasing the gain will reduce the level seen in the reject settings.
Working with Cursors

Auto cursors are used in the EP modes to label waveforms with latency and amplitude
measurements. You can define separate cursor setups for each mode in the Setup dialog.
You can change the defaults to meet individual testing needs. You can have up to
sixteen individual cursors for each EP mode.
You can apply auto cursors during or after waveform acquisition. If placed while data is
being acquired, they remain in that position regardless of changes in the waveform’s
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shape as additional sweeps are collected. You can manually position waveforms to any
location on the graticule. Click Store to record waveforms in the patient file.
• To view or hide cursors, right-click on the Average window, and check or
uncheck the Show Cursors option.
• To move cursors, use the mouse pointer and drag the cursor across the trace.
• Auto Place Cursors: If no traces are selected (yellow) then cursors are
automatically placed on the live traces (white). Otherwise they get placed on the
selected trace. Right-click on the Average window, and check the Auto Place
Cursors option.
Self Adjusting Latency Ranges for Auto-Cursors: The Cursor Setup table in the
procedure setup file can be quickly and easily adjusted while collecting data without
using the procedure setup file.
1. Select the Autoplace Cursors option in the right click menu to place cursors on
your waveforms.
2. With the Trial Select option selected on in the right-click menu, select a trial in
the EP Average window. Be sure that only one trial is selected (only one
waveform per channels is selected)
3. Adjust the latencies of the cursors on the waveforms to the correct latencies by
dragging and dropping the cursors with your mouse.
4. Click the Adjust Latency option from the right-click menu. The start and end
latency values for all cursors will be adjusted to +/- 10% of the current positions
of the auto-cursors with the midpoint located at the latency that the cursor is
placed at.
Setting Baselines
Sets the currently selected trace as the baseline if no trials are selected. Note that
baselines are set on a "per-mode" basis so if you set the baseline in a 3D window or an
Average window, the trial associated with the trace will show up in all other windows
that display baselines and are connected to the same mode.
Baselines can also be reset selectively rather than as a group. This is useful when one or
more channels in a mode show poor morphology when the initial baselines are set and
the waveforms for that channel or channels have improved. Instead of resetting
baselines for all channels, you can now reset baselines for just the channels of your
choosing.
To selectively reset baselines, select the waveform or waveforms you wish to use as the
new baseline and select the Set Baseline option in the right-click menu of the mode. The
Trial Select option will need to be turned off in order to select waveforms without
selecting all waveforms in a trial. When setting or resetting baselines, only one
waveform per channel may be selected.
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As always, if no baseline is set when you select the Set Baseline option, the system will
use the last stored trial as baseline. If no trial has been stored, the system will store the
average trial and set it as baseline.
Changing Settings for Multiple Modes

Click the EP button on the top toolbar to access Global EP Setup.
From the Global EP Settings window, you can change most of the EP window display
settings, either for all EP modes or selected EP modes.
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Side-by-Side Comparison of Current and Past EEG

Splits the Live EEG window into two sections. The section on the right will continue to
show the live EEG traces. The section on the left can be used to review back through the
EEG by using the horizontal scroll bar.
The dividing line between the two sections can be dragged to increase or decrease the
size of either section.
The Elapsed Time is indicated at the top left of the review section.
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Paging Toolbar
Use these toolbar buttons to go forwards/backward by one

page or one division within the review section.
Appending to a Procedure
This feature allows users to append additional data (traces) to an existing data file.
Typical usage of this option would be when a pre-surgery screening was done before the
patient enters the operating room.
To make changes to an existing procedure file

1. From the File menu, select Append to Procedure to display the Open dialog box.
2. Select the data file you want to edit, and click Open to display the views.
3. Make any necessary changes to the procedure file, such as patient information,
current procedure setup, event list, comments, or to append additional data.
System Clock Error

To help prevent data file corruption Cascade will display the following error message
when it detects that the system date and/or time has been changed since the recording
has started. The message is triggered when an Event is entered such as stored EP trials
or a user comment if the system clock or date has been changed by the user since the
recording started. .
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When this message pops up it is recommended that you close this procedure and start a
new file. The message will only pop up once in the same recording file. The message will
not stop the recording or keep the user from adding events. If a new file is not started
when the message appears the users runs the risk of having a corrupted data file that
cannot be opened and reviewed later.
Exporting Data
You may output a waveform in a numeric format (ASCII) for analysis and research.
This option is available in EP Average, Waterfall, Summary and EMG Stack windows.
To generate an ASCII format of one or more live or averaged waveforms from an EP
Average window, simply select the waveform(s) you wish to output to ASCII format,
right click and select Output Traces to ASCII. A Save As dialog will open allowing you
to specify where to save the file and what name to give the file. The ASCII file can be
opened using any program that can handle comma separated values (.csv) file types.
To generate an ASCII format of one or more averaged waveforms from a Waterfall,

Summary or EMG Stack window, select the trials or trial you wish to export then right
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click on the window. It is not necessary to select a trial or trials. The export dialog will
give you the option to export all trials.
In the ASCII Output dialog, name the file you wish to create, choose a save path, chose
your options and choose your trace selection then click Save Traces.
The default file name prefix gives you three indicators to help identify the CSV file: an
abbreviation for the window type, the mode name and the channel name. Following the
filename prefix in the stored filename is a time stamp with the date and time. When
exporting from a summary window or EMG stack window, a separate file will be
created for each channel. A separate ASCII Output dialog will be presented for each
channel.
The three check boxes in the Options group allow you to
1. Include a column in the CSV file to label the fields
2. Include a history of the stimulus delivered for each trial
3. Select how you would like the columns and rows formatted.
The Trace Selection option allows you to categorically select which traces to output. The
Selected traces option will only output those traces that are highlighted in the window.
The All traces showing in window option will only output the traces showing in the
window regardless of whether they are selected. The All recorded traces option will
output all traces for the entire window including those from an earlier or later time
period not shown in the window.
Reducing Noise
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Cascade Noise Reduction Options

To reduce noise from electrical noise sources:
Use the ES Detector (Electro-Surgery Detector and Electro-Surgery Reject).
Check all cable connections.
• Make sure there are no bent pins in the amplifier cable and the input extender
cables.
• Make sure all cables are securely connected.
• See Elite Base Unit Connections
Verify that the Procedure Setup is correct.
• Make sure that the appropriate amplifier inputs are assigned to the channels in
the test montage.
• Make sure that the channels from the test montage have been assigned to the
acquisition modes correctly.
• Verify that the appropriate gain and filter settings are being utilized.
• Verify that the appropriate sweep speed is being utilized for each acquisition
mode.
• Delete unused channels from the test montage.
• See Procedure Setup
Check Electrode Impedances.
• Make sure all electrode impedances are below 5k Ohms and are well balanced.
• See Checking Impedance
Location of Ground Electrode.
• Each amplifier requires one ground electrode on the patient. Because the Cascade
Elite has two amplifiers, it requires the use of two ground electrodes. The ground
electrodes should be plugged into the ground jack on the amplifier input
extender pods. Place one ground electrode on the patient’s head near the evoked
potential recording electrodes. Place another ground electrode on the patient
near the majority of electrodes for that amplifier.
Twist Lead Wires together and bundle.
• Try to twist the electrode lead wires together and bundle all of them together if
possible. For example, twist and bundle the SEP electrode leads together, and do
the same for the EMG leads from the Left leg and Right leg.
• Try to use short electrode lead wires in combination with the input extender
cables.
Position main Amplifier.
• Move the amplifier away from potential noise sources. Moving it 1-2 feet from its
current location can sometimes make a difference.
• Moving the electrode lead wires a few inches can also make a difference.
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Check grounding of Laptop or desktop PC and Cart.

• Make sure that the Laptop or desktop PC is grounded. A wire should be attached
from the Laptop or PC to the ground connector on the back of the Cascade base
unit.
• If the Cascade is sitting on a metal cart, use a second wire to ground the cart to
the same ground connector on the back of the Cascade base unit.
Connect power directly to wall outlet, bypass power strips or isolation transformers.
• If the Cascade’s power cord is plugged into a power strip or isolation
transformer with other devices, try plugging the Cascade directly into the wall
outlet.
Determine the Frequency of the Noise
A. If the noise is 60 Hz, try using the Notch Filter.
B. Change the Repetition Rate to an integer multiple of the noise source plus an
additional ½ period. See explanation that follows.
To Determine the Frequency of the Noise (additional methods are found in
Determining Frequency of Noise):
1. Right click on one of the EP Average windows.
2. Select the LIVE option from the pop-up menu.
3. Stop the mode so that the LIVE trace will be frozen within the window.
4. Right click on the window again and use the Time Marker option to place
two vertical time markers on the window.
5. Place the markers so that you can measure the Peak to Peak interval of
the noise.
6. Divide the resulting Peak to Peak interval (in milliseconds) into 1000. The
result is the frequency of the noise. The following two examples illustrate
this for 60 and 180 Hz noise.
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To Determine the Optimal Repetition Rate to Use:

Mathematical modeling shows that the best repetition rate to use for steady
state noise is one that when divided into the noise frequency results in an
integer multiple of the noise source plus an additional ½ period (i.e., 0.5).
For example, if you use a repetition rate of 2.72 with 60 Hz noise:

60 / 2.72 = 22.059
This would not be a good repetition rate to use.
But, if you use a repetition rate of 2.79 with 60 Hz noise:
60 / 2.79 = 22.505
This would be a good choice to use since the result is almost exactly
an integer plus 0.5.
When using the wrong repetition rate the noise will wax and wane during
averaging. That is, it will start to average out and then will appear to grow
back into the response.
When using the correct repetition rate the noise should progressively be
reduced during averaging and should not return.
The following tables list some suggested repetition rates to use with varying
frequencies of noise. You can obtain a complete Excel spreadsheet of
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repetition rate vs. noise frequency by contacting Cadwell (see also Choosing
Appropriate Repetition Rate).
Use the Digital Smoothing Filters

• Right click on the EP Average window and select Mode Setup. Try applying the
Digital Smoothing filters in the order that they are listed. The SF filters remove
high frequency noise from the traces, SF1 the least amount, SF5 the most. The
ABR1 and ABR2 filters are designed to specifically enhance the peaks of the ABR
response.
Change the system to the “Optimize For Synchronous Noise Reduction” stimulus
triggering mode.
• From the Edit menu select System Setup. On the General tab select the option
Optimize For Synchronous Noise Reduction. Click OK. You will need to stop
and restart all data acquisition after making this change.
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• Again, determine the frequency of the noise source and choose an appropriate
repetition rate.
NOTE: There are more restrictions on the attainable repetition rates when using the
Optimize For Synchronous Noise Reduction triggering mode.
• Try to start and stop all running modes synchronously, it may help to use the
Synch Start 1 setting in the Run Mode field.
Choosing The Appropriate Repetition Rate 60 Hz

The following table is a reference on repetition rates you can set to eliminate specific
frequencies of noise and harmonics of that frequency. To eliminate noise contamination
in your signal, first determine the frequency of noise. Set the stimulus repetition rate to
one of the values listed in the following table under the appropriate frequency.
NOTE: The FFT marker in Reject Settings can be used to determine the dominant
frequency in any EP channel. See Determining Frequency of Noise.
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122
123
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125
126
127
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Determining Frequency of Noise

The FFT marker in Reject Settings can be used to determine the dominant frequency in
any EP channel.
1. While running a procedure, click on the Global EP Setup icon
2. Click Setup Reject Info
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3. Select a channel to view

4. Click and drag the grips to define reject area
5. At the bottom of the Reject Settings window, click and drag the FFT Marker to
the peak of the dominant waveform
6. To determine the stimulus repetition rate which eliminates noise from your
signal, cross-reference the frequency of noise found with the FFT Marker to the
Noise Frequency vs. Repetition Rate table in the Choosing Appropriate
Repetition Rate section.
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Using Menu Options
File Menu
Start New Procedure
Opens the Procedure Setup File dialog box, where you select a procedure setup
file for surgery, enter patient information, and begin running modes and
monitoring data.
Append to Procedure
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Opens the Cascade Data File dialog box, where you can select an existing data file
and append additional data (traces) to that file. This feature is often used if a pre-
surgery screening was completed before the patient entered the operating room.
Review Procedure
Opens the Cascade Data File dialog box, where you can select a patient data file
for viewing information. Use the arrows on the time bar to jump to events in the
data file. Data is displayed for that time during the surgery. That is, you can move
around in the file and review the trends, video, and trace data at any time during
the surgery.
Close Procedure
Closes the procedure windows that you are viewing. This option is only available
if you have a procedure file already open.
Save Current Setup

Saves changes you make to the acquisition parameters in the procedure setup file,
typically when you start a new procedure and make changes using the Edit
Current Procedure Setup. You can save these changes to the original setup file.
Create New Procedure Setup File

Opens the Cascade-Procedure Setup window, where you can set up a procedure
file before surgery. You specify what amplifier inputs will be used and assign
them to amplifier channels, specify the order of modes and assign amplifier
channels to each mode, and select which types of windows to display during the
procedure.
Edit Procedure Setup File

Opens the Procedure Setup File dialog box, where you can select an existing setup
file that you want to edit or review.
File Names
Displays a list of the four most recently viewed files. Each file name is unique and
generated by the system with the patient’s name, and the date and time the file
was created.
Exit
Exits the Cascade application.
NOTE: When running a procedure, the Print Report and Print Screen options are
available from this menu.
Edit Menu
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Patient Info
Opens the Patient Information form, where you can edit patient information, such
as patient name and ID, procedure information, such as surgeon and assistant
names, and diagnosis.

Opens the Procedure Setup window to make any changes to the current
procedure setup file. This is used for certain conditions, such as when electrodes
fall off. You can make any necessary changes to the amplifier inputs, modes,
channels, or views. This option is only available when a procedure file is open.
View Setup
Opens the View Setup dialog box, where you can change the composition of
existing Views or create new Views. This allows you to change the procedure’s
Views without having to stop the procedure and enter the Edit Current Procedure
Setup window.
System Setup
Opens the System Setup dialog box, where you can set up time bar event marks
based on priorities of events, and allows you to specify where your data files will
be stored.
You can also add and delete remote servers, and set up a chat box that is used to
send messages back and forth between the client PC and the Acquisition Cascade.
Amp Input List

Allows you to edit the pop-up list of commonly used input labels. Right click to
insert or delete entries from the list. Use the Move Up/Down arrows to change the
order of the labels in the list.
View Menu
Most of these menu options are only available when a procedure file is open.
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Status Bar
Displays or hides the status bar at the bottom of the screen. A check mark appears
next to this command when the status bar is active. This software application uses
the status bar to display information messages.
Live Mode
When this option is unchecked, you are in Review mode, where you can monitor
data from earlier in the procedure. The scroll box follows the event markers in the
time bar. When this option is checked, you are in live mode, where you can
monitor current data. The scroll box is set at the far right of the time bar.
Reject Settings
Displays the Reject Settings Window where you can monitor and adjust the
thresholds for the Channel 16 reject and the four Bovie Reject detection lines. Red
lights indicate that the activity in that line is causing the system to stop data
acquisition and speaker output. Green lights indicate the line is detecting activity
that does not exceed the reject level, and the system will acquire data and output
to the speaker. A yellow indicator displays in the Mode Control area for as long as
any rejection is occurring.
Channel 16: this amplifier channel can be used to pick up excessive noise or
electrocautery and, when the threshold is exceeded, will cause the Cascade to
pause all evoked potential data acquisition and will mute the audio for the
duration of the reject condition.
Bovie Channels: up to four detector probes can be placed inline with the
electrocautery unit power cord. When the unit is in use and the threshold is
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exceeded, the Cascade will pause all evoked potential data acquisition and will
mute the audio for the duration of the reject condition.
Next View
Cycles through the views you defined in the setup file. See View Setup for more
information on how to set up these views.
View Selection
The items at the bottom of this menu are the names of the views from your setup
file. The radio mark shows which view is currently selected. Selecting any of these
items takes you to the corresponding view.
Test Menu
Tests define an Amplifier setup or Montage. Multiple Tests can be used in order to
reduce the DSP Utilization of each test. When you switch tests, you are changing the
amplifier setup (montage) and the available acquisition modes that have been enabled
for the test. You must have more than one test set up for this menu option to be enabled.
This menu option is only available when a procedure file is open.
Next Test
Cycles through the tests you defined in the setup file.
List of Tests
Displays the list of tests you defined in the setup file. Select a test from the list to
view that test. A radio button displays next to the test that is active.
Remote Menu
Connect to Cascade (Server)
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Displays a list of Cascade servers (i.e., Cascade Acquisition Stations), and allows
you to search for and connect to a Cascade server to begin remote viewing of
monitoring a surgery.
Disconnect
Disconnect from the remote computer.
Connect to Reader (Client)

Displays a list of possible Client computers (i.e., Cascade Remote Reader Stations),
and allows you to search for and connect to a Remote Reader to begin remote
viewing of the surgery.

During a remote monitoring session, click on this button to cause the Reader to
sync to the same view as that currently displayed on the Cascade.
Show Chat Toolbar
Hide or show the remote monitoring chat toolbar.
Reset Chat Window
Sends the chat window to the upper left corner of the monitoring screen. This is
useful if the chat window is hidden behind windows or is positioned off screen.
Client List
Displays a list of remote "viewing" computers that are currently connected to a
Cascade server by their computer name.
See also:
Remote Monitoring
Connection Scenarios
Events Menu
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Event List
The event list is created in the procedure setup file as a list of possible events that
will be encountered during surgery. This list is an example that might be used.
Select an option from this event list to enter it in the Event Window. The current
time and most recent traces are also entered in the Event window when you select
an event.
Comment
Opens the Event Log where you can enter comments and select a priority of the
comments. The time and date is entered automatically when you enter comments.
Go To...
Opens the Events window where you can select an event, click the Go To button,
and view data at that event.
Edit Event List

Opens the User Events window where you can modify the priority of each event
in the event list, or reset the list to its default values.
Window Menu
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Lock Windows
Select this option to lock all windows in place. You are not able to resize the
windows or move them while they are locked. Select the Lock Windows option
again to deselect it and release the lock.
Auto Size
Select this option to resize surrounding windows as you resize or move one
window, in order to continue to view all of the windows concurrently.
Cascade
This command displays all open windows on the screen in a cascading order.
Tile
This command displays all open windows on the screen as the same size of
window.
Active Window
This list displays all open windows on the screen. The checked window name is
the active window. You can also make a window active by clicking the title bar on
the window or anywhere in the window. You know that the window is the active
one because the title bar appears highlighted (darker than the title bars of the
other windows).
Help Menu
or
Cascade Help Topics

Displays the Cascade 16 channel system help file.
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Cascade Elite Help Topics

Displays the Cascade 32 channel system help file.
About Cascade...
Displays the hardware, software and firmware versions of hardware components
as well as copyright information.
Running NerveGuard
NerveGuard Introduction
NerveGuard is an extension of the Cascade’s triggered EMG modality and provides a
convenient and easy-to-use interface for automatic pedicle screw stimulation, threshold
determination, and documentation.
You can perform a complete pedicle screw testing protocol in NerveGuard. For
example, you can use the Continuous Mode during pedicle probing and taping as an
early warning of a low threshold; use the Fixed Mode to stimulate the pedicle feeler as
the surgeon feels the inside of the pedicle; use the Continuous Mode again as the
surgeon drives the screw with the screw driver; use the Screw Threshold mode to
determine the threshold of the screw when in place.
NerveGuard displays triggered EMG activity during screw stimulation and
automatically switches to free-running EMG during periods of no stimulus delivery.
NerveGuard Operation
Follow the steps below to run NerveGuard. See NerveGuard Procedure Setup for setup
instructions.
1. Start the Cascade program and begin a procedure in the normal fashion.
2. Start NerveGuard by clicking on the NerveGuard icon in the main Cascade
toolbar.
3. Carefully read the contents displayed in the NerveGuard Checklist window:
• Electrode Placement
Recording electrodes must be placed in muscle groups corresponding to

then pedicle screws being stimulated. Incomplete coverage of myotomes
may result in inaccurate testing and/or excessive stimulus intensities.
• Muscle Relaxant
Patient muscle relaxant levels must be low enough to allow for repetitive
evoked EMG activity. Complete or partial muscle blockade may result in
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inaccurate testing and/or excessive stimulus intensities. A Train of Four

test may be used to measure muscle relaxant levels.
• Detection Thresholds
EMG thresholds must be set at levels that will accurately detect evoked
EMG activity. Evoked responses below the detection thresholds will not
be detected and may result in inaccurate testing and/or excessive stimulus
intensities.
• Stimulator Setup
The stimulating probe (cathode) and the return (anode) must be intact and
properly connected to the stimulator box. An incomplete circuit will result
in a failure to auto start stimulation.
• Current Shunting
Appropriate measures must been taken to prevent current shunting. The

surgical field should be dry and all muscle and soft tissue should be
retracted off of the pedicle screw and stimulating probe.
4. Click OK. The main NerveGuard window will be displayed. Click Cancel to
abort NerveGuard.
NOTE: The Show options Always or Once, displayed at the top left hand corner of the
NerveGuard Checklist window, indicates whether the checklist window is displayed
every time NerveGuard is started or only the first time it is started on each patient.
5. NerveGuard begins in free-run mode. The data window displays the text "Free-
Run" in the upper left corner of the data window. The free-run data window has
the same options as in the standard Cascade including right-click functions.
6. Click the Control button labeled "Click to Activate Autostart" to enable
Autostart. With NerveGuard in Autostart mode, the system will switch to
triggered-EMG when the surgeon touches the probe to the patient.
7. When the probe is lifted from the patient, NerveGuard will automatically switch
back to free-run mode.
Determination of Threshold
Screw Test Mode
A stimulus threshold value is achieved when an above-threshold triggered EMG
response is captured three times consecutively for the lowest intensity at which the
EMG waveform is above threshold
Continuous Mode
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The intensity increases until a triggered EMG response is captured, at which point
the intensity decreases until the response is lost. The stimulator intensity then
increases until the response is captured again. This process repeats as long as the
mode is active and current is flowing (it will stop when “High Z” is detected).
Performing Pedicle Screw Threshold Detection

Outline of Steps:
1. Confirm that ‘Screw Test’ detection mode is selected.
2. Confirm that the Audio Controls are configured appropriately.
3. Click on the Spine Graphic to choose the level & side. The selected region will be
colored in grey.
4. Click on the Control button to change from Standby mode to Ready To Stimulate
mode.
5. Have the surgeon touch the stimulus probe to the pedicle screw. The High-Z
indicator should clear automatically and the program will change from free
running to triggered EMG.
6. The stimulus intensity will automatically increment at the steps defined in the
Setup window.
7. When the threshold level is detected, the stimulus intensity will automatically
return to the starting point and the threshold value will be indicated (in green,
yellow, or red background) in the Control button area. The text “Threshold
Detected for side & level” will be shown and if the Threshold Tones check box is
enabled, the threshold tone will be played. If no response is detected at
maximum stimulus intensity, the letters "NR" will be shown. A unique audio
tone will be presented when a threshold is found or no response is reported.
8. Have the surgeon remove the stimulus probe from the pedicle screw, the High-Z
indicator will return and the program will switch back to free running EMG
traces after about 1 second.
9. Choose next level & side to be stimulated by clicking on the Spine Graphic.
10. Repeat steps 5 through 8 to test the next screw.
Returning to Standby mode:

To return to Standby mode, click on the Control button.
Using Continuous Stimulation Mode

Although it can also be used during fusion procedures, continuous mode is typically
used during screw hole tapping, pedicle screw placement, or when persistent
stimulation of surgical instruments and response detection is desired.
In continuous mode, stimulation does not stop when a threshold is detected. Instead the
system continues to track the changing threshold levels.
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Outline of Steps:
1. Set the Detection mode to ‘Continuous’.
2. Confirm that the Audio Controls are configured appropriately.
3. Attach the stimulus cable to the surgical probe or instrument.
4. Change from Standby mode to Ready To Stimulate mode by clicking on the
Control button
5. Continuous stimulation and threshold detection begins when the probe makes
contact with the patient and the High-Z indicator is not shown under the
Intensity scale.
6. When the EMG activity exceeds threshold settings, the program will indicate the
threshold value (in green, yellow, or red background) in the Control button area.
The text “Threshold Detected” will be shown with the stimulus intensity that
generated the response. If the Threshold Tones check box is enabled, the
threshold tone will be played.
7. The program will continue to stimulate and will continuously monitor for
threshold activity and update the threshold value.
8. To return to Standby mode, click the Control button.
NOTE: The Spine Graphic is typically not used in Continuous mode.
Using Fixed Detection Mode

The Fixed mode is used to deliver a fixed intensity to a probe or surgical tool.
To use the Fixed Detection Mode in NerveGuard, select the Fixed Detection Mode
button in the upper right corner of the NerveGuard window, set the intensity slider to
the desired intensity and click the Control Button to turn off standby. The intensity
slider can be controlled by dragging the slider on screen using the mouse, using the up
and down arrow keys on the computer keyboard and by rolling the scroll wheel on your
mouse.
The control button displays in real time the actual stimulus intensity being delivered. If
no evoked EMG is detected, the background of the control button is gray. When an
evoked EMG is detected, the control button displays the color corresponding to the
stimulus intensity as set in the NerveGuard setup. If Threshold Tones are turned on,
your computer will play the tone corresponding to the stimulus intensity delivered.
Evoked EMG events detected in Fixed Detection Mode are logged and displayed in the
pedicle screw stim report. Waveforms are stored only if the Store on Autocapture
option is turned on in mode setup.
Making Changes During Testing

Changing NerveGuard Setup:
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To change NerveGaurd settings such as Stimulus Start Intensity or Threshold Intensity

Color Scales, click on the Setup button in the NerveGuard window. Refer to page 12 for
a description of the available settings.
Adjusting Threshold Settings

NerveGuard determines a threshold value for a pedicle screw by monitoring for EMG
activity that exceeds a preset value. This value, or threshold setting, is set in microvolts
for each EMG channel being recorded. As such, EMG thresholds must be set at levels
that will accurately detect evoked EMG activity. Evoked responses below the detection
thresholds will not be detected and may result in inaccurate testing and/or excessive
stimulus intensities. By the same token, baseline EMG activity or stimulus artifact that is
above the detection threshold levels will result in inaccurate testing.
To adjust the EMG threshold levels, follow these steps:
• Right click over the EMG trace area.
• Select the General submenu from the Mode Setup from the context menu.
• Click on the Setup Thresholds button.
• Adjust the threshold levels for each channel.
• Click OK
See the section on EMG Threshold for more information.
Changing Stimulus Settings (rep rate, pulse width):

To change stimulus settings, right click over the Trace Area and select NerveGuard from
the Mode Setup submenu list. Make the desired changes and click OK.
NerveGuard and Remote Monitoring

NerveGuard automatically opens, runs, and closes on remote reader system when the
Cascade in surgery opens, runs and closes NerveGuard. The remote reader sees the
elements in the NerveGuard program change as they change on the machine in surgery.
NerveGuard Window
NerveGuard Window
Shown below is the main NerveGuard window. Refer to the individual sections of the
help file for detailed information on operating NerveGuard and on each of the areas of
the screen.
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Using the Graphical Site Selector

The NerveGuard graphic site selector allows users to quickly and easily note the
stimulated level, side and type of tool (if desired).
Select a Level
At any time before threshold detection, click on the level and side of the spine graphic
corresponding to the level being stimulated. If you have populated the site list in the
NerveGuard setup dialog, the selections from your list will be available when you first
click on the spine graphic. Double click on the spine graphic to bypass the site list.
When NerveGuard finds the stimulus threshold, the system will display the threshold,
time and site (if selected) in the tool tip text box.
No Level Selected – what happens?:
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If no side & level are selected on the Spine Graphic prior to threshold detection, the
system will log the threshold as Not Specified.
Editing a Threshold:
Instrument type, level and side can be assigned or reassigned after a threshold has been
recorded. To edit a threshold entry, right click on a spinal level that has a threshold
event assigned to it. Follow the submenu pop-out menus to select a tool, cut and paste
the threshold to a new level or delete the threshold event all together. Cutting a
threshold event will allow you to reassign that threshold event to a different side and
level.
Repeating a Level:
To repeat a threshold detection session, simply reselect the appropriate area on the
Spine Graphic. This area will be colored grey and a new threshold will be determined as
soon as stimulus delivery is completed.
The pedicle screw report will show all thresholds found for a selected level. All
recorded thresholds for a level may be viewed in a mouse tool tip text box by placing the
mouse over the level of interest. The tool tip will show the threshold intensity, time and
tool type (if selected) for every threshold detection session.
Clearing a Level:
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To erase or clear the threshold for a pedicle screw, right click over the appropriate area
on the Spine Graphic, choose the appropriate threshold from the list if multiple
thresholds were recorded and then select Delete. This should be done with the Control
button set to the Standby mode.
Selecting Spinal Levels above T12
A Zoom control is provided at the top of the graphic that allows viewing of the Full
Spine or zoom-in of the Lumbosacral, Thoracic, or Cervical segments.
Control Button
The main control button is always initiated in the Standby mode. Clicking on this large
button switches the program to Detecting mode. In Detecting mode the program will
automatically increase the stimulus intensity and determine threshold as soon as the
stimulating device detects a complete electrical circuit such as when the stimulus probe
makes contact with the pedicle screw or patient.
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If the maximum stimulus intensity is reached without obtaining a threshold value, the
letters “NR” will be displayed to indicate No Response was detected.
Detection Mode
This control determines how the NerveGuard program functions when a threshold is
detected.
Screw Test - When stimulus threshold is detected the program stops stimulus
delivery, and reports the stimulus intensity threshold.
Continuous - When threshold is detected the program will continue to stimulate
and will constantly report stimulus intensity levels.
Fixed - To use the Fixed Detection Mode in NerveGuard, select the Fixed
Detection Mode button in the upper right corner of the NerveGuard window, set
the intensity slider to the desired intensity and click the Control Button to turn off
standby. The intensity slider can be controlled by dragging the slider on screen
using the mouse, using the up and down arrow keys on the computer keyboard
and by rolling the scroll wheel on your mouse.
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EMG Trace Area

During stimulus delivery this area displays triggered EMG traces. The most recent
sweep is displayed (typically in white) as well as the last sweep to exceed the threshold
criteria (typically in purple).
When stimulation is not being delivered, this area displays free running EMG traces at a
fixed sweep speed of 100 msec/division.
NOTE: Right click over the trace area to access functions such as Mode Setup
(including the NerveGuard Setup Submenu) and Window Setup.
NerveGuard Setup Submenu

Choosing the Nerve Guard submenu from the EMG Mode Setup window will display
the following dialog.
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• Intensity Criteria – determines the color displayed in the control box and sets
the start and max stim levels.
o Start - sets the stimulus intensity that NerveGuard starts at.
o Red-Yellow Boundary – sets the upper limit of the red threshold
boundary and the lower limit of the yellow threshold boundary.
o Yellow-Green Boundary – sets the upper limit of the yellow threshold
boundary and the lower limit of the green threshold boundary.
o Max - sets the maximum stimulus intensity the NerveGuard software
will deliver and the stimulus intensity at which NerveGuard will report
NR (no response).
Using the settings in the above example:
Thresholds between 20-10 mA will be displayed in green.
Thresholds between 9-5 mA will be displayed in yellow.
Thresholds between 4-0 mA will be displayed in red.
• NerveGuard Rep Rate - Sets the repetition rate of stimulation in NerveGuard.
NerveGuard always uses the repetition rate set here regardless of the setting in
the EMG mode.
• Starting Zoom State – determines what image the Spine Graphic will display.
Options are Lumbosacral, Full Spine, Thoracic and Cervical.
• Stimulus Intensity Increment – determines the increments (in milliamps, mA)
that the program will use when it increases the stimulus intensity.
• Detection Mode – sets the program to run in “Screw Test”, “Continuous” or
"Fixed" mode.
• Start and Max - sets the start and maximum intensities when running in Fixed
stim mode.
NOTE: Please refer to the NerveGuard Operation Section in the Starting/Running
Procedures section for complete instructions on how to setup and operate NerveGuard.
Intensity Bar
This region of the NerveGuard window indicates that the stimulus intensity if
increasing and also shows the “High Z” impedance symbol.
The “High Z” symbol is displayed when the circuit between the stimulating probe
(cathode) and the return electrode (anode) is incomplete. When the circuit is completed,
such as when the stimulus probe makes contact with the pedicle screw, the “High Z”
symbol will be cleared and the program will automatically begin to increase the
stimulus intensity. The red, yellow and green bars will ramp up as the intensity of the
stimulator increases.
When the stimulus probe is removed from the pedicle screw, the “High Z” symbol will
return and the stimulus intensity is immediately returned to the starting value.
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Print Report Button

Click this button to generate a summary report listing the levels stimulated and their
corresponding threshold values.
Use the report template called, “Pedicle Screw Stim Report”.
Below is an example of the report summary table.
NOTE: If no side & level are selected on the Spine Graphic prior to stimulation the
summary report will include a row with a site name entry of “Not Specified”.
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NOTE: If the maximum stimulus intensity is reached without obtaining a threshold value
the summary report will indicate “No Response Detected at Max Stim” for that site.
Zoom Control
Click the drop down arrow to view the Full Spine or zoom-in on the Lumbosacral,
Thoracic, or Cervical segments.
Audio Controls
This area contains four check boxes and an Audio intensity dial that determine what is
heard during NerveGuard operation.
EMG Volume - Controls the volume of the Triggered Raw and Free Run Raw
audio. The volume of the Threshold Tones and the Free Run Tones is controlled
using the audio controls on your computer or external PC speaker.
Threshold Tones - When enabled, a unique tone is played when the stimulus
threshold level is detected.
Triggered Raw - When enabled, the raw audio for the triggered EMG traces is
heard during periods of stimulation.
Free Run Tones - When enabled, the wav files assigned to the EMG channels will
be played if the free-run EMG activity exceeds threshold during periods of free
running EMG.
Free Run Raw - When enabled, the raw audio for the EMG traces is heard during
periods of free running EMG.
NOTE: The Mute check box in the Mode Control Window on the main Cascade page
mutes all audio regardless of the audio settings in the NerveGuard window. To use the
audio functions in NerveGuard, be sure the Mute option is unchecked in the Mode
Control window on the main Cascade page.
Closing NerveGuard
To close the NerveGuard program, click on the red “X” in the upper right hand corner of
the screen.
If you close NerveGuard by accident, click on the NerveGuard icon again in the Cascade
toolbar. The program will be redisplayed and all threshold values for completed screws
will be recalled.
Operating the TCS
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Recording Transcranial Electric Motor Evoked Potentials

The Mode Controls window on the main monitoring page contains stimulus controls for
all of the modes created for the test you are running. Access the stimulus intensity knob,
store button, clear button, train length setting, interstimulus interval setting, and
polarity button by clicking in the mode box in the Mode Control window.
The Single Trigger button (shown below) will trigger the TCSand is available without
expanding the mode box. Be aware that TcEMEP stimulation may cause patient
movement. Care should be taken to trigger the TCS only when there is no risk that
patient movement could cause injury to the patient or surgical team.
TCS-1 800 Volts Max TCS-100/TCS-4 1000 Volts

Max at 50 us PW
To generate a TcEMEP, begin by setting the stimulus intensity to the desired level using
the stimulus intensity knob, the Page Up and Page Down keys, or the up and down
arrow keys on the computer keyboard.
• Click and hold the stimulus intensity knob while moving the mouse to rotate the
intensity knob up and down. Single clicking on either half of the intensity knob
will move the knob up or down in a stepwise manner in 2 Volt steps.
• Pressing the Page Up and Page Down Buttons on the computer will move the
knob up or down in 20 Volt steps.
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• Pressing the up or down arrow keys on the computer will increase or decrease
the stimulus intensity in 2 volt steps. Use the Home button on the computer
keyboard to return the stimulus to zero.
With the stimulus set at the desired intensity, trigger the TCS using the Single Trigger
button in the Mode Control window for the appropriate mode. Again, be aware of the
effect of patient movement as transcranial electric stimulation may cause the patient to
jump.
When the TCS is triggered, the voltage/current value will momentarily flash ‘yellow’
within the Mode Controls window and the Cascade software will display the resulting
waveforms in the appropriate mode window replacing all active waveforms displayed
at the time. Unstored data will be lost. Data may be auto stored or manually stored as
described in Chapter 1.
• If you have selected the “Autostore” option in the procedure setup file, the
computer will automatically store all waveforms at the time the waveforms are
generated.
• If you have de-selected the “Autostore” option in the procedure setup file, the
computer will display the triggered waveforms but will not automatically store
the waveforms. To manually store the triggered waveforms, use the “Store”
button in the Mode Controls window. To manually clear the triggered
waveforms use the “Clear” button in the Mode Controls window.
The TcEMEP traces generated can be controlled (rescaled, moved, set as baselines,
exported to reports, etc.) using the same controls as other evoked potential traces. Like
other evoked potential modes, the MEP mode waveforms can be viewed in a summary
window, waterfall window, cursor trend widow, 3D trend and analysis window. To add
these windows to a view, choose the ‘View Setup’ option in the Edit menu.
Changing the Stimulus Parameters during a Recording

During a recording, the stimulus polarity may be toggled by clicking the polarity ‘toggle
button’ in the Mode Control window (Fig 3). The “normal” polarity setting delivers
stimuli with the red output as anode (+) and the black output as cathode (-). The
“reverse” polarity setting delivers stimulus with the red output as cathode (-) and the
black output as anode (+).
The stimulus intensity, train length, and interstimulus interval can also be changed here
without having to go into the procedure setup file. In Cascade versions 2.2 and greater,
the TCS-1000 is supported. In Cascade version 2.5, the TCS-4 is also supported. The TCS-
4 is capable of all of the changes herein described for the TCS-1000, with the added
capability of changing the stimulation output channel. The pulse width on the TCS-
1000/TCS-4 can also be adjusted between 50us & 75us. With the TCS-1000/TCS-4
running Cascade version 2.2 or later you can also increase the stimulus intensity up to
1000V. Cascade will automatically sense the TCS-1/TCS-1000/TCS-4 hardware version to
make the appropriate settings available.
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MEP Mode Controls TCS-1 Software Versions 1.3 & 1.4 MEP Mode Controls TCS-
1000 Software Versions 2.0
Polarity and stimulus parameters can also be adjusted in the Mode Setup dialog (Fig 4).
Right click over the MEP trace window and then select Mode Setup from the context
menu to access this dialog.
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Mode Setup dialog w double-train stimulation
The TCS-1 utilizes a fixed 50 microsecond, monophasic square wave stimulus pulse in
hardware versions 1.3 and 1.4. This parameter can’t be changed in those hardware
versions. TCS-1000 hardware version 2.0, running Cascade version 2.2 or later can adjust
the stimulus pulse duration between 50us & 75us. TCS-1 stimulators hardware versions
1.3 & 1.4 would have to be sent back to Cadwell and be modified to a TCS-1000
hardware version 2.0 to use the increased stimulus parameters. You can check the
hardware version of your TCS stimulator in the About Cascade window under the Help
menu.
TCS-1 Hardware Version 1.3 and Software Version 1.03 only support
a single train and has a fixed stimulus pulse duration of 50us, with a
train count of 9 and maximum intensity of 800 Volts.
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TCS-1 Hardware Version 1.4 and Software Version 1.04 support double
trains and has a fixed stimulus pulse duration of 50us, with a
train count of 9, for one or two trains and maximum intensity of 800 Volts.
The train count may be limited as the intensity is increased.
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TCS-1000 Hardware Version 2.0 and Software Version 2.0 supports stimulus pulse
durations of 50us & 75us and 1000 Volts maximum intensity for all 9 pulses train
pulses. Combined dual train count ≤ 9.
Double-Train Facilitation for Transcranial Electrical Stimulation

Double-train transcranial electrical stimulation has been shown to produce larger
amplitude motor evoked potentials than single-train transcranial electrical stimulation
when responses to single train stimulation are low amplitude (Journee HL et. al,
Improved neuromonitoring during spinal surgery using double-train transcranial electrical
stimulation, Medical and Biological Engineering and Computing, 2004 Jan, 42(1):110-3).
The Cadwell Cascade is now capable of delivering double-train transcranial electrical
stimulation using a single TCS-1 transcranial electrical stimulation unit and a single pair
of stimulating electrodes.
To use this feature, simply turn on the Double Train Stimulation feature in the
Stimulator Setup window for the TCS-1 stim type. With Double Train Stimulation
turned on, the Cascade will deliver two stimulus trains at the indicated stimulus
settings. By default, the setting for train two are the same as the settings for train one.
The system may be setup to deliver stimulus setting for train two different than settings
for train one (see below). Inter-train interval is the time in milliseconds from the start of
the first pulse of the first train to the start of the first pulse of the second train. The
default ITI is 30msec. You may type or select an inter-train interval (ITI) as high as
250msec. The total train count across both trains must be ≤ 9 and the pulse train safety
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cutoff limits of the current TCS-1/TCS-1000 apply (see Cascade Operator's Manual or
Help file).
TCS-1 Hardware Version 1.4
The minimum ITI depends on the ISI of the first train and polarity of the second train.
When the polarity of train one and train two are the same, the ITI must be at least as
long as the duration of the first train. To calculate the minimum ITI when using the same
polarity, simply multiply the number of pulses by the ISI. The system will alert you if
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the ITI is too short and will allow you to choose to have the system adjust the ITI to the
shortest allowable length.
To set stimulus parameters for the second train different than stimulus parameters of the
first train, turn off the Use Train 1 Settings for Train 2 option.
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When the polarity of the second train is different than the polarity of the first train, the
ITI must be at least 5msec longer than the duration of the first train in order to allow the
TCS-1 to switch polarity. To calculate the minimum ITI when using different polarities,
simply add 0.5msec to the duration of train one. The system will alert you if the ITI is
too short and will allow you to choose to have the ITI adjusted to the shortest allowable
ITI.
If an invalid ITI is entered in the mode controls during run time, the system will deliver
the last valid ITI and change the setting in the mode controls to the last valid ITI used.
When Double Train Stimulation is turned on, the stimulus summary in the Mode Setup
window shows the stimulus parameters for both polarities.
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A hardware and firmware upgrade to the TCS-1 must be installed by Cadwell in order
to use this feature. TCS-1 units without the upgrade will work with version 1.9.29
software and the Double-Train feature is disabled. The correct TCS-1 firmware for the
upgraded TCS-1 is 1.04, TCS-1000 is 2.0 as seen in the About Cascade window accessed
from the Help menu. TCS-1 units upgraded with the double-train hardware upgrade
have a sticker on the back of the unit indicating the unit has been upgraded. TCS-1 units
built with the Double-Train feature can be identified by the 02 rev in the serial number
(ex: xxxxCXxx-02-xx). Please contact Cadwell service department at 800-245-3001 for
pricing and scheduling to upgrade your TCS-1 stimulator.
NOTE: Upgraded TCS-1 units can only be used with v1.9.29 or higher and will not work
on Cascades running v1.8.11 or earlier.
Storing and Clearing Traces

If the user has selected the “Autostore” option in the procedure setup file, the computer
will automatically store all waveforms at the time the waveforms are recorded and
displayed.
If the user has deselected the “Autostore” option in the procedure setup file, the
computer will display the triggered waveforms but will not automatically store the
waveforms.
The user may manually store the triggered waveforms using the “Store” button in the
Mode Controls window. The user may manually clear the triggered waveforms using
the “Clear” button in the Mode Controls window. The system will automatically clear
the active waveforms when the device is triggered.
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Right click on MEP trace window and select Mode Setup

Mode Tab in Procedure Setup file
Train Length Limit Warning
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To improve the safety of cortical stimulation, the TCS-1 Hardware Versions 1.3 & 1.4
automatically limits the pulse train length delivered at high intensities.
If the user chooses a combination of voltage and train length that is outside established
safety limits, the computer will display a warning icon (Fig 8) in the Mode Controls
window.
If the Train Length Limit warning is displayed and the user triggers the TCS-1, the TCS-
1 will deliver the voltage requested, but will limit the number of pulses to the
predetermined safe values. A chart showing the relationship between pulse train length
limits vs. voltage is shown below (Fig 9). The TCS-1000 does not have this limitation.
Chart of Pulse Train vs. Stimulus Intensity
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High-Z Warning
In the event that the TCS-1 is triggered when the stimulating electrodes for the TCS-1
have a calculated impedance greater than 10,000 Ohms, the Cascade system will display
a High-Z warning icon in the Mode Control window.
Run Mode
The MEP mode offers no Run-mode options. It will always be an Independent run mode
type. The EP and EMG mode types offer the following Run-modes: Manual,
Independent, Auto, Sync Start 1, Sync Start 2, Timer 1, Timer 2.
Artifact Reject
Artifact Reject is available for all mode types using the TCS-1/TCS-1000/TCS-4. The reject
setting is selectable from the Mode Setup dialog. It is recommended that the user turn
the artifact reject off when recording myogenic MEP responses.
Reject Setting Dialog

The Artifact Reject Dialog allows for quick and easy adjustment of reject levels, allows
reject to be turned off for individual channels, displays the frequency components of a
selected channel and allows for turning on/off the Bovie Reject and Channel 16 reject
features.
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• Channel Reject Indicator: When one or more channels in a mode are setting off
artifact reject, a Reject icon will appear next to the channel or channels that are
setting off the artifact reject. The user may adjust the reject levels or turn off
Artifact Reject by accessing the Reject Settings dialog.
• There are four ways to access the Reject Settings dialog
o Click the Reject icon .
o Select the Reject Settings option from the right-click menu in the EP
mode.
o Click the Setup Reject Info from the EP Global controls dialog located on
the tool bar.
o Click the Setup Reject Info from the Procedure Setup dialog.
• When the Reject Settings dialog is accessed via the Reject icon, the dialog will
default to highlighting the channel associated with the icon that was clicked to
access the Reject Settings dialog. When the Reject Settings dialog is accessed in
any other way, the dialog will default to highlighting the first channel in the list.
• The threshold data window displays reject level bars indicating the upper and
lower limits of the threshold window. Live, free-running data for the
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highlighted channel is displayed in the threshold data window if the mode is

running.
• Adjust the artifact reject level to the desired setting by clicking on the squares on
the reject level bars and dragging the bars to the desired position.
• Reject numeric artifact reject levels for each channel are listed in the fourth
column of the channel list. The reject levels are displayed as percent of total gain
and as micro Volts.
• To adjust the artifact reject limits for other channels in the mode, click on the
channel name and adjust the reject level bars.
• To increment the reject limits for of all channels at the same time, click the
up/down arrows on the All spinner control.
• To turn off artifact reject for one or more channels, deselect the check box for the
appropriate channel in the Reject column of the channel list.
• The Noise Analysis sub-window at the bottom of the dialog displays the FFT
analysis of the live data for the selected channel. This allows users to identify the
dominant frequencies of the live data for the selected channel.
• Changes made in the Reject Settings dialog are applied immediately. The
averager continues to run when exiting the Reject Settings dialog.
Enable Bovie Reject
Up to four electrocautery detection probes can be connected to detect the use of a Bovie
device. Select this option so that data is not collected during periods of electrocautery
use.
Enable Channel 16 Reject
This channel can be used as a reject channel. Select this option to pause all data
collection and mute the audio when the data on this channel exceeds the threshold.
Reject On
Check the Reject option to eliminate excessive movement artifacts or other sources of
noise from the running average. This reject is based on a pre-programmed percentage
(usually 50%) of the amplifier’s full bandwidth setting. The total number of sweeps that
are rejected is displayed in the Mode Control window as a percentage. This option
automatically enables artifact rejection on all channels assigned to the mode. You can
disable the feature for individual channels by entering the Reject Settings Dialog and
removing the check mark next to the appropriate channel in the Reject column. When
artifact rejection is completely disabled for all channels, every collected sweep is
included in the running average. In the Mode Control window, the reject status is
indicated as OFF.
Closing a Procedure
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When you have completed testing, simply store unsaved data and choose the Close
Procedure or Exit options from the File menu. You may now turn off your computer and
Cascade base unit as normal. The TCS-1/TCS-1000/TCS-4 does not have its own power
switch. Turning off the Cascade base unit turns off the TCS-1/TCS-1000/TCS-4.
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Reviewing a Procedure
Reviewing a Procedure
Use the arrows on the time bar to jump to events in the data file. Data is displayed for
that time during the surgery. That is, you can move around in the file and review the
trends, video, and trace data at any time during the surgery.
To review a procedure
1. From the File menu, select Review Procedure to display the Open dialog box.
2. Select the data file you want to view, and click Open to display the mode views.
3. You can review the data of any event during surgery.
Changes made to the display properties of a procedure during review are saved to the
patient file.
When selecting a patient file located on a CD or other read-only media, the system will
allow you to create a copy of the file on your computer in order to allow the display
changes to be saved. By default, the copy of the patient file will be created in the
Cascade data folder. The default name of the file will indicate that the file is a copy.
Changes made to the patient file while reviewing are saved to the copy of the patient
file and not to the patient file on the CD.
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Procedure Setup
Procedure Setup - Overview

Procedure Setup is the template editor for the settings used to perform testing. You must
select an existing or create a new procedure setup file before you begin a monitoring
session.
Components
Procedure Setup consists of five sections: Channels, Modes (see Mode Overview),
Views, Test Setup, and Other Setup.
To open new Procedure Setup file

To open a blank Procedure Setup from the Start page:
Click New Procedure Setup. The Procedure Setup template editor will open.
A text balloon will direct you to Channel Setup. See Channels to continue
setup.
To open a blank Procedure Setup from within a procedure
From the File menu, click Create New Procedure Setup File... The Procedure
Setup template editor will open. A text balloon will direct you to Channel
Setup. See Channels to continue setup.
To open formatted Procedure Setup file
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To open an existing Procedure Setup from the Start page:

Click Start New Procedure OR click Edit Procedure Setup. See Step 1 below
to continue.
To open an existing Procedure Setup from within a procedure
From the File menu, click Edit Procedure Setup File. See Step 1 below to
continue.
To open the current Procedure Setup from within a procedure
To change the recording parameters of a test while running a procedure:
From the Edit menu, click Current Procedure Setup or use the toolbar link
shown below. Changes made will affect only the file you are currently
recording, or you can save those changes as a permanent change to the
settings file for future cases. See Step 1 below to continue.
1. An Open dialogue will appear.

2. A list of preformatted procedure setup files will appear. Choose one. The
factory-installed procedure files include:
3. Double-click a procedure setup file in the list or select one and click
Open.
4. The Procedure Setup template editor will open. A text balloon will direct
you to Channel Setup. See Channels to modify setup.
Procedure Setup- Menu Options

At the top left hand side of the Procedure Setup file is a pair of menu options: File and
Test. The options include:
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Procedure Setup
NOTE: Changes made to a procedure setup file while the procedure is running will take
place immediately.
At the bottom right hand side of the Procedure Setup file is a set of buttons: Print
Procedure Setup, OK, and Cancel. These options include:
Print Procedure Setup

Generates a report that contains the procedure setup information. You may
use the default template or click Select to browse for a different template.
Click the Print button to open the report generator and print and save the
report. Click the Edit button to open the report generator and make changes
to the report, then you may print manually. Click the Cancel button to
return to the Procedure Setup.
OK
Click the OK button to save changes and close Procedure Setup. If you
accessed Procedure Setup from the Start menu, you will return to the Start
menu. If you accessed Procedure Setup from an open procedure, you will
return to that procedure.
Cancel
Click the Cancel button to close the window without saving any changes
made to the file.
Procedure Setup - Channels

The Channel Setup allows you to assign input labels to amplifier channels, adjust
settings, set impedance references and exclude EMG channels from common mode.
To open Channel Setup

To access Channel Setup from the Start page, open New Procedure Setup or Edit
Procedure Setup.
To access Channel Setup from within an open procedure, open the Edit menu and
select Channel Setup, or use the toolbar link shown below.
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To begin creating or modifying a procedure setup, click the Channel Setup button.
Open or Save Input Settings
Click the open folder button at the top left-hand side of the page to access
existing input settings. Click the disk button to save the input settings to a new
file.
Assign Input Settings

1. Edit Amplifier Inputs: The Channel Setup window will open. In pod A, double-
click in the first text field, type in a text field or use the drop-down arrow to
access a list of commonly used input labels. Assign input labels to amplifier
channels as needed in pods A, B, C, and D.
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Procedure Setup
NOTE: Click the Default button on the bottom left-hand side of the screen to
automatically assign input labels to all of the amplifier channels. Click the Clear All
button to erase all input label entries from the amplifier channels. Click the Default
button at the top of the Channels section to automatically assign input to amplifier
channels. Click the Clear 1-16 button or the Clear 17-32 button to erase all channel
fields.
2. Assign Inputs to Channels: Click the numbered buttons to the left of each input
to which you will assign an acquisition mode. This will add the input to the Act
and Ref fields of the Channels section on the right side of the screen. Select
inputs until every channel you will be using is assigned.
• Act/ Ref: Each channel on the amplifier has an active (ACT) and reference
(REF) connection. The active connection corresponds to the inverting (-)
input and the reference connection to the non-inverting (+) input. When
negative voltage is applied to the active input, or when positive voltage is
applied to the reference input, an upward deflection is produced on the
display. Use the active input for the recording electrode and the reference
input for the reference or inactive electrode for a negative up convention.
For a positive up convention, reverse the electrode connections.
3. Set the Filters: The Name, Gain, HiCut and LoCut fields are automatically
generated. Change these fields according to the type of testing for which each
channel will be used. Gain, filter, notch and audio settings can be set for an entire
bank of channels using the All options at the bottom of the channel list. To delete
a channel, right-click on a channel row and select Delete Channel.
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• Name: A channel name is automatically generated based on the amplifier

inputs you have entered for the channel (i.e. if an active input of a channel
is T12 and the reference input is T10, the name will be T12-T10). Changes
made in either the Test table or the Channel Settings section will be saved
in both.
• Gain: The amplifier gain is the gain at which the amplifier hardware is set.
EP modes use an amplifier gain of 10 or 20.
• HiCut, LoCut: Adjust the settings as needed according to the situation and
type of signal you are measuring. Filters may be set independently in each
channel. Values are in hertz (Hz). HiCut filter cuts off all frequencies above
the filter setting. The LoCut filter cuts off all frequencies below the filter
setting.
To adjust settings for channels 1-16, use the All section options in the
middle of the Channels section. To adjust the settings for channels 17-32,
use the All section options at the bottom of the Channels section.
4. Specify Notch Filter and Audio settings: Check the Notch box to reduce
unwanted interference from power lines for that channel. Notch frequency is
determined in the System Setup window and can be 60 or 50 Hz. Adjusting the
Notch filters will reduce the overall capability of the program to run multiple
modalities simultaneously, so do so sparingly. Applying a notch filter to an EP
mode may induce ringing into the averaged signal. Check the Audio box to output
the channel's signal to the computer speakers. This is most commonly used for
EMG channels. The channels you create are displayed in the Channels area of the
main Procedure Setup page.
5. Exclude EMG Channels from Common Mode: Click this option at the bottom of
the channels section when the test includes EMG channels that should be
excluded from the Common Mode rejection calculation of the amplifier. This
improves the quality of the EP responses. MEP modes are always excluded from
the Common Mode to improve signal quality.
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Procedure Setup
6. Click OK.
Modes
Mode Overview
The mode setup is used to program stimulating and recording parameters for channels
selected from the montage list. There are five types of modes used in this application EP,
EMG, MEP, EEG, and TOF. Each mode type offers a set of options unique to the type of
testing. For each mode, you can configure default settings for certain parameters
(generally, those that require one-time or infrequent adjustment). You can also configure
features that are unique to the different modes.
Access Mode Setup and Window Setup from within a procedure:
Right-click a mode, and click Mode Setup or Window Setup. You can also open the Edit
menu, select View Setup, highlight the window you want to edit and click the Window
Setup button. Mode Setup allows you to adjust stimulus and cursor settings for that
mode. Window Setup allows you to adjust view settings for that mode. You can also use
the Global EP Window to make view changes to all EP modes at one time.
Access Mode Setup from Procedure Setup:
1. Create the Acquisition Modes: Click the Add Mode button in the lower left
corner of the Mode area. Name the mode and specify a type of mode from the
drop-down list. Click OK.
2. Select Channels to be Monitored: In the Channels area on the far left side of the
window, add inputs to the mode by clicking the enumerated buttons to the left of
the channels in the list. This will add the channels to the Mode Channels.
For EP and MEP mode types, the Channel Settings group has three columns of
settings:
The Amp Chn column lists the montage name from the montage list and amp
channel number.
The Name column lists the trace label name that will appear on screen during data
acquisition.
The Invert column allows you to invert the waveform on screen.
The Side column, available only in EMG mode types, can be toggled left or right to
determine in which side of the EMG window the trace will be displayed when the
EMG window is split vertically or horizontally into two sections.
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3. Create Additional Modes: Click the Add Mode button. Repeat steps 5 and 6
above to create additional acquisition modes. Each new mode created has a tab
folder assigned to it. Click the name on the tab to access the specified mode.
NOTE: You can save time in some of the steps by clicking Add Mode and selecting
Copy Mode Setup and Copy Cursor Table. The program will copy these settings from
the previously created mode. You may also select Copy Channels, Copy Channel
Names and Copy Stim but you would then need to remember to change the first channel
in the Channel Settings and change the stimulus from 1 to 2.
4. Define Mode Settings:

• EP - Evoked Potential. This mode type is used to record somatosensory,
auditory, and visual evoked potentials. Motor evoked potentials can also
be recorded using the EP mode type. It is recommended, however, that
the MEP mode type be used for motor evoked potentials. See EP Mode
Setup.
• EMG - Electromyography. This mode type is used to record free-run and
stimulated or triggered-EMG. See EMG Mode Setup.
• MEP - Motor Evoked Potentials. This mode type is used to record motor
evoked potentials from transcranial electrical stimulation. See MEP Mode
Setup.
• EEG - Electroencephalography. This mode is used to record free-running
EEG and quantified EEG such as CSA, DSA, Symmetry, Trending and
Burst Suppression. See EEG Mode Setup.
• TOF - Train of Four. This mode is used to quantify the level of muscle
relaxation at the target muscle when performing EMG. See Train of Four
Mode Setup.
EP Mode Setup
When you select a mode for EP, the Mode Settings options include:
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Procedure Setup
Acquisition
Acquisition Sweep Acquisition sweep, or sweep speed, sets the time base in
milliseconds per division (ms/div). This is the length of the epoch the system records
with each sweep. The acquisition sweep may be set at a different speed than the Display
Sweep. There are always 10 divisions across the display. Therefore: sweep speed x 10 =
total timebase.
Note: You can set sweep speed only at one of the preset values. If you enter a value not included
in the list, the closest preset value is used.
Sweep Delay determines the start of the sweep relative to the onset of the stimulus. A
pre-stimulus sweep delay (negative value) is useful for acquiring pre-stimulus or
baseline-level activity. A post-stimulus sweep delay (positive value) can be used to
remove stimulus artifact from the display. The value can be set to -1.0, 0.0, or 1.0
division. Sweep duration is always 10 divisions long.
Average Count A counter that shows the number of sweeps collected during waveform
averaging.
Autostore on Avg Complete Check this option to have the Cascade automatically store
the traces when the average count is reached. This option is ignored for Modes that have
the Run Mode set to ‘Manual’.
AutoPlace Cursors on % of Avg Complete When this setting is enabled the program
will automatically place cursors on the active traces when the specified percentage of the
total average count is reached. These cursors will be saved to the stored waveform
when the active trace is saved. Autocursors on Percent of Average in the EP mode setup
can be toggled off entirely. When Autocursors are turned off, the system will not place
cursors on the live waveform when running in auto or manual run mode. When
179
Autocursors are turned on the system will place cursors on the stored waveforms.
When Autocursors are turned off, the system will not place cursors on stored
waveforms with in manual run mode.
Run Mode: This setting defines how a mode reacts to the Run All, Store All and Clear
All buttons. The option is available for each mode setup tab within the Procedure Setup
screen, and also in the Mode Control window. The option affects how the mode behaves
when the "All" buttons are pressed. The following selections are available.
Manual: The Run All, Store All and Clear All buttons at the top of the Mode Controls
window do not affect the mode. This mode will respond to the All Manual Mode
controls, and is usually used from EMG.
Auto: The system automatically stores and places auto cursors when the Average Count
is reached for this mode. When the average count is reached, the trial is stored, cursors
are placed on it, and the averager is cleared and restarted. If this selection is applied to
an EMG mode, it simply means that the mode will be affected by the Run All and Store
All buttons. The Clear All button will never affect an EMG mode.
SyncStart1/SyncStart2: When a mode has SyncStart1 specified, averaging is not
restarted until all other modes with SyncStart1 selected have reached their average
count. As each mode reaches its average count, the trial is stored, cursors are placed, and
the averager is cleared. SyncStart2 behaves the same way, but provides a means for
having two different groups of modes. These selections are not available for EMG
modes.
Timer1/Timer2: Two timers allow modes to start on a specified interval. The interval
can be set in the main setup dialog or from the mode control view. These timer values
are stored in the setup file. For example, if Timer1 interval is set to 60 seconds, and the
Run All button is clicked, the modes run until their average count is reached. The trial is
stored, cursors placed, and the averager cleared. When 60 seconds has elapsed from
when the last mode in the group has completed, the modes start again. If the Run All
button is turned off, the timers are paused. A Clear Timer function is available in the
Mode Control View. These selections are not available for EMG modes.
Independent: Modes with this setting do not respond to the All Mode Controls or the
All Manual Mode Controls. This is a good choice for MEP modes.
Digital Filter See Digital Filters for more information.
EMG
Remove Stim Artifact from EMG For stimulated EMG modes, select this option to
remove the stimulus artifact from the display and audio output. When this is selected
for an EP mode, which is using an electrical stimulator (i.e., Rt Median SEP), it will
enable the stimulus artifact to be removed from EMG traces. The system zeros the data
during stimulus delivery and for a user-selectable time period between 0.5 to 5.0
milliseconds after the stimulus.
Stimulator
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Procedure Setup
Stim Type Click the drop-down arrow and select or . Default parameters will appear in
the box above. To change these parameters, click on the Setup Stim button. Choose a
Repetition Rate (Rep Rate), then select the Stim Channel (either 1 - 16 for high current, or
Low 1 for low current). The Stim Channel number corresponds to the numbered
outputs on the electrical stimulus splitter box. Click OK.
Note: The ES-IX only works on the Cascade Elite and PRO.
Note: The Cascade PRO can use only the ES-IX stimulator, and not any of the electrical stim
splitters.
Note: The Paired Stimuli stim type only works on the Cascade Elite and PRO. Modes
configured with Paired Stimuli stim type will be disabled. The mode will be enabled when the
stim type is changed.
Note: The high-frequency train used with any of the constant-current Estims only works on the
Cascade Elite. Modes configured with high-frequency train used with any of the constant-
current Estims will be disabled. The mode will be enabled when the train stim is disabled. The
TCS tceMEP stimulators will work on the Cascade, Cascade Elite, and Cascade PRO.
Setup Stim Click to set up stimulator specifications, such as rep rate, label name,
stimulator number, pulse width, and maximum intensity.
Note: Select Stim Type TCS-1 to assign a TCS to a mode. Open Stim Setup and edit stimulus
parameters. The starting polarity (normal or reverse) can be programmed for each mode in the
procedure setup file. The default polarity is normal.
Setup
See Setting Setting Up Trace Labels, Setting Up Cursor Tables and Setup Reject Info for
more information.
EMG Mode Setup

The EMG Mode Setup window has four submenu options: General, Stimulator, Trace
Labels, NerveGuard, and EMG Comments. Select the submenu to work with by
choosing the submenu from the Setup list in the upper right corner of the EMG Mode
Setup window. When the Mode Setup window is opened from the right-click menu
during data acquisition, the window includes sweep, and gain options. When switching
between these submenus, the display settings on the left side of the window remain the
same. When accessing the Mode Setup area in the procedure setup file, the sweep and
gain controls can be found in the Window Setup for the EMG window.
General Setup
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Sweep Specifies sweep length of the traces. Units are milliseconds per division and
always ten divisions total therefore:
sweep speed x 10 = total timebase
Sweep Delay Sweep delay determines the start of the sweep relative to the onset of the
stimulus. A pre-stimulus sweep delay (negative value) is useful for acquiring pre-
stimulus or baseline-level activity. A post-stimulus sweep delay (positive value) can be
used to remove stimulus artifact from the display. The value can be set to -1.0, 0.0, or 1.0
division.
Use Display Gains allows channels used for both MEP and EMG recordings to be set at
an MEP gain in the channel setup window for MEPs and then set a display gain in the
EMG window to display data correctly in the EMG and TEMG windows.
Channel 16 Mute Audio Mutes the audio, prevents auto-storing, and pauses stimulation
when Channel 16 reject is triggered.
Bovie Mute Audio Mutes the audio, prevents auto-storing, and pauses stimulation
when Bovie reject is triggered.
Wave/Beep on Threshold plays a selected *.WAV file when that EMG recording channel
crosses the set threshold.
Autocapture on Threshold captures and displays the trials where one or more EMG
channels crosses threshold.
Store on Autocapture stores EMG waves that are Autocaptured on Threshold.
Store Timelock Stim stores TEMG up to 5 Hz. Timelock Stim must be selected in the
TEMG mode controls box in the acquisition screen. While the Store Timelock Stim is
running SEP,TOF and EEG modes will be paused. EMG data is stored continuously
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Procedure Setup
while the mode is running. The faster the hard drive can spin the better it will perform.
Autocapture on Threshold and Store on Autocapture are automatically disabled when
Store Timelock Stim is selected. Selecting Autocapture on Threshold or Store on
Autocapture will automatically disable Store Timelock Stim. The more data that is
captured the more the process of writing to the computer hard drive taxes the system. It
is recommended that you use a computer hard drive that spins at 7200 rpm or faster to
effectively use this feature.
Setup Thresholds You can set a threshold level, in microvolts, for each channel in the
EMG mode only. See Setup Thresholds for more information.
Run Mode sets the run mode type. Manual Mode is linked to the All Manual modes
control box in the Mode Controls box in the acquisition screen. Auto Mode is linked to
the All Auto modes control box in the Mode Controls box in the acquisition screen.
Independent runs the mode independently from the All Auto and All Manual global
mode control box.
• Manual run mode responds to the to the All Manual Modes run/stop
controls.
• Independent run mode does NOT respond to the to the All Manual Modes
or All Auto Modes run/stop controls.
• Auto run mode responds to the to the All Auto Modes run/stop controls.
Stimulator Setup
183
Play Sound on Stim Plays a selected sound file when the stimulus probe makes contact.
Suppress Audio During Stim Select this option to suppress the sound of the stimulus
artifact from the audio while that mode is running.
Remove Stim Artifacts Select this option to remove electrical stimulus artifacts from the
EMG traces. Not only will stimulus artifact related to the EMG mode’s stimulator be
removed but it will also remove stimulus artifact coming from EP modes that have
"Remove Stim Artifact from EMG" enabled in their mode setup options.
Stim Mode Select this option to start the mode in stim mode "Hold", "Repetitive" or
"None". See the EMG Stim Controls section for a description of the stim modes.
Stim Type The Cascade ElitePRO uses electrical, ES-IX, audio, visual, TCS, and CV-2
stimulators. Select a stimulator type from the drop-down list. Click the Setup Stim
button for various options to set up each stimulator type. To trigger an external device,
select External Trigger. A special external trigger interface box is required for this
implementation.
NOTE: The Paired Stimuli stim type only works on the Cascade Elite and PRO. Modes
configured with Paired Stimuli stim type will be disabled. The mode will be enabled when the
stim type is changed.
NOTE: The high-frequency train used with any of the constant-current Estims only works on the
Cascade Elite. Modes configured with high-frequency train used with any of the constant-
current Estims will be disabled. The mode will be enabled when the train stim is disabled. The
TCS tceMEP stimulators will work on the Cascade, Cascade Elite, and Cascade PRO.
stimulator number, pulse width, and maximum intensity.
NOTE: To monitor Live EMG or EEG, create a mode in the same manner but do not assign a
stimulator to the mode. For Stimulated or Triggered EMG, you must assign an electrical
stimulator to the mode.
NOTE: Select Stim Type TCS-1 to assign a TCS to a mode. Open Stim Setup and edit stimulus
parameters. The starting polarity (normal or reverse) can be programmed for each mode in the
procedure setup file. The default polarity is normal.
Trace Labels Setup

See Setting Up Trace Labels.
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Procedure Setup
NerveGuard Setup
See NerveGuard Procedure Setup.
EMG Comments Setup
185
Use this submenu to create a preset list for SIDE, LEVEL, and SITE. These fields are
displayed in the EMG Mode Control area. When an EMG sweep is stored these
comments are automatically tagged with the traces. One example of where these
comments could be useful is during Pedicle Screw stimulation. You can also type new
entries in any of these fields in the Mode Controls area after the procedure has started.
EMG Stim Controls

The mode control dialog for EMG modes with a stimulator assigned will have the
following controls: Single button, Repetitive check box, Hold check box, and Train
button. An EMG mode may be preconfigured in the Mode Setup to start with the
Repetitive or Hold check boxes checked. Selecting the stim mode as none will
effectively start the EMG mode in free-run mode with no stimulus being delivered.
The following table describes the behavior of the Run and Single buttons based on the
running state and the state of the two check boxes:
MEP Mode Setup
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Procedure Setup
When you select a mode for MEP, the Mode Setting options include:
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188
Procedure Setup
Acquisition
Acquisition Sweep Acquisition sweep, or sweep speed, sets the time base in
milliseconds per division (ms/div). This is the length of the epoch the system
records with each sweep. The acquisition sweep may be set at a different speed
than the Display Sweep. There are always 10 divisions across the display.
Therefore: sweep speed x 10 = total timebase.
NOTE: You can set sweep speed only at one of the preset values. If you enter a value not
included in the list, the closest preset value is used.
Sweep Delay Sweep delay determines the start of the sweep relative to the onset
of the stimulus. A pre-stimulus sweep delay (negative value) is useful for
acquiring pre-stimulus or baseline-level activity. A post-stimulus sweep delay
(positive value) can be used to remove stimulus artifact from the display. The
value can be set to -1.0, 0.0, or 1.0 division. Sweep duration is always 10 divisions
long.
Autostore Check this option to have the Cascade automatically store the traces
after the stimulus train is delivered.
Digital Filter This digital smoothing filter is used to improve the quality of the
evoked potential waveform by applying a digital filter to the averaged waveform.
For more information, please see Digital Filters.
EMG
Remove Stim Artifact from EMG For stimulated EMG modes, select this option
to remove the stimulus artifact from the display and audio output. When this is
selected for an EP mode, which is using an electrical stimulator (i.e., Rt Median
SEP), it will enable the stimulus artifact to be removed from EMG traces. The
system zeros the data during stimulus delivery and for a user-selectable time
period between 0.5 to 5.0 milliseconds after the stimulus.
Stimulator
Stim Type Click the drop-down arrow and select a stimulus type. Stimulus types
available in the MEP mode include
TCS-1 (which includes the TCS-1000 and TCS-4), CV-2, External Trigger,
Electrical, Visual and Paired Stimuli. Default parameters will appear in the box
above. To change these parameters, click on the Setup Stim button.
NOTE: The Paired Stimuli stim type only works on the Cascade Elite. Modes configured with Paired Stimuli stim type will be
disabled. The mode will be enabled when the stim type is changed.
NOTE: The high-frequency train used with any of the constant-current Estims only works on the Cascade Elite. Modes
configured with high-frequency train used with any of the constant-current Estims will be disabled. The mode will be enabled
when the train stim is disabled. The TCS-1/TCS-1000/TCS-4 tceMEP stimulator will work on the Cascade and Cascade Elite.
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stimulator number, pulse width, and maximum intensity. For the stimulus type
Electrical, check the Train box to deliver a train stimulus.
NOTE: Select Stim Type TCS-1 to assign a TCS to a mode. Open Stim Setup and edit
stimulus parameters. The starting polarity (normal or reverse) can be programmed for each
mode in the procedure setup file. The default polarity is normal.
Output Channel The output channel for a TCS-4 can be specified within the Setup
Stim menu or from the Mode Controls window. In the Mode Controls window, the
selected output channel is written in parentheses.
Setup
See Setting Up Trace Labels, Setting Up Cursor Tables and Setup Reject Info for
more information.
NOTE: There is no Run Mode setting for MEP Modes. These types of modes do not
respond to the All Mode controls or to the All Manual Mode controls, they only respond to
their individual controls (i.e. the Single Trigger button).
MEP mode controls in Procedure Setup File

Right Click on MEP trace Window>Mode Setup
Train of Four Mode Setup

When adding or updating a TOF mode, the following options are available:
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Procedure Setup
Auto Store on Train Complete: When this box is enabled the program will auto-store
the run after delivery of the fourth stimulus. At this time the auto-cursors will be placed
on the stored run.
Remove Stim Artifact from EMG: When this box is enabled the stimulus artifact from
the TOF stimulator will be removed from the live EMG traces. The system zeros the data
milliseconds after the stimulus. The Remove Stim Artifact option must also be checked
in the EMG mode.
Run Mode This setting defines how a mode reacts to the Run All, Store All and Clear
All buttons in the Mode Controls while running a procedure. The option is within the
Procedure Setup screen, and in the Mode Control window. The following selections are
available:
• Manual: The Run All, Store All and Clear All buttons in the All Auto box of the
Mode Controls window do not affect the mode. This mode will respond to the
All Manual Mode controls.
• Independent: Modes with this setting do not respond to the All Mode
Controls or the All Manual Mode Controls. This is a good choice for MEP
modes.
• Timer1/Timer2: Two timers allow modes to start on a specified interval. The
interval can be set in the main setup dialog or from the mode control view. These
timer values are stored in the setup file. For example, if Timer1 interval is set to
60 seconds, and the Run All button is clicked, the modes run until their average
count is reached. The trial is stored, cursors placed, and the averager cleared.
When 60 seconds has elapsed from when the last mode in the group has
completed, the modes start again. If the Run All button is turned off, the timers
are paused. A Clear Timer function is available in the Mode Control View. These
selections are not available for EMG modes.
Stim Type Click the drop-down arrow and select Electrical or ES-IX. Default parameters
will appear in the box above. To change these parameters, click on the Setup Stim
button.
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stimulator number, pulse width, and maximum intensity. Choose a Repetition Rate
(Rep Rate), then select the Stim Number (either 1 - 4 for high current, or Low 1 for low
current). The Stim Number corresponds to the numbered outputs on the electrical
stimulus splitter box.
For best results, stimulate the patient's posterior tibial nerve at the ankle or median
nerve at the wrist. This stimulating electrode pair can be the same pair being used in
one of the EP modes. When stimulating the posterior tibial nerve, record from an
active electrode in the adductor hallucis referenced to a quiet, non-muscular reference
on the foot. When stimulating the median nerve, record from an active electrode in the
abductor pollicus brevis referenced to a quiet, non-muscular reference on the hand. The
surface of the skin should be well prepped and dried before placing surface electrode for
recording or stimulating.
Mode Setup
Digital Filters
The digital smoothing filter is used to improve the quality of the evoked potential
waveform by applying a digital filter to the averaged waveform.
Seven digital smoothing filters can be enabled for evoked potential acquisition modes.
The filters are named SF1, SF2, SF3, SF4, SF5, ABR1, and ABR2. The SF1 filter provides
the least amount of filtering, the SF5 provides the most. The ABR1 and ABR2 filters are
designed for use with short latency auditory evoked potentials. Digital Filters can be
preprogrammed on a per mode basis in the Edit Procedure Setup window or they can be
selected after the procedure has been started by right clicking on the appropriate EP
Average window and selecting Mode Setup.
When enabled, these filters will automatically smooth the active trace as well as every
stored trace that has been acquired for the selected mode. The filters are completely
reversible and can be disabled at any time by selecting NONE as the filter selection.
SF Filters The SF smoothing filters are reversible FIR filters that have a very steep
roll-off. The –6db point of the filters will change according to the sweep speed.
The table below shows the –6db point frequency (the frequency at which the
amplitude is reduced by 50%, indicated as 0.5 on the graph) for each filter at four
different sweep speed settings.
1.0 ms/div 2.0 ms/div 5.0 ms/div 10.0 ms/div
SF1 4000 2000 800 400
SF2 3000 1500 600 300
SF3 2000 1000 400 200
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Procedure Setup
SF4 1500 750 300 150
SF5 1000 500 200 100
ABR Filters The ABR1 and ABR2 filters work differently. At sweep speeds of 1.0
ms/div., the ABR1 filter boosts frequencies around 1000 Hz and then rolls off
steeply on either side of this. This filter is supposed to enhance all five peaks of
the ABR response: it will reduce amplitude slightly and does not affect the peak
latencies. The ABR2 filter boosts frequencies around 750 Hz and rolls off steeply
to either side. This filter is supposed to enhance waves I, III, and V only. The
ABR2 filter will reduce the amplitude of the response by 20-30% and will cause
latencies to shift in an earlier direction by .1-.3 ms. When the sweep speed is
changed from 1.0 to 1.5 ms/div the frequencies that these filters are boosting shift
to slightly slower frequencies, around 750 Hz for the ABR1 filter and 500 Hz for
the ABR2 filter.
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Setup Reject Info

The Artifact Reject Dialog allows for quick and easy adjustment of reject levels for EP
recording channels. It allows the reject to be turned off for individual channels, displays
the frequency components of a selected channel and allows for turning on/off the Bovie
Reject and Channel 16 reject features, as well (see Electro-Surgery Detector and Electro-
Surgery Reject).
Reject On
Within a procedure, right-click in a mode and select Reject On to eliminate excessive
movement artifacts or other sources of noise from the running EP average. This reject is
based on a pre-programmed percentage (usually 50%) of the amplifier’s full bandwidth
setting. The total number of sweeps that are rejected is displayed in the Mode Control
window as a percentage.
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Procedure Setup
This option automatically enables artifact rejection on all EP channels assigned to the
mode. You can disable the feature for individual channels by entering the Reject Settings
Dialog and removing the check mark next to the appropriate channel in the Reject
column. When artifact rejection is completely disabled for all channels, every collected
sweep is included in the running average. In the Mode Control window, the reject status
is indicated as OFF.
NOTE: If you are going to perform myogenic TcEMEPs (recording from muscles) it is
recommended that you leave the Reject Info option in its default Off position for the
TCEMEP modes.
Reject Settings
When one or more channels in a mode are setting off the artifact reject, a Reject icon will
appear next to the channel or channels that are setting off the artifact reject.
The user may adjust the reject levels or turn off Artifact Reject by accessing the Reject
Settings dialog.
There are four ways to access the Reject Settings dialog
• Click the Reject icon in the waveform display.
• Select the Reject Settings option from the right-click menu in the EP mode.
• Click the Setup Reject Info from the EP Global controls dialog located on the tool
bar.
• Click the Setup Reject Info from the Procedure Setup dialog.
When the Reject Settings dialog is accessed via the Reject icon, the dialog will default to
highlighting the channel associated with the icon that was clicked to access the Reject
Settings dialog. When the Reject Settings dialog is accessed in any other way, the dialog
will default to highlighting the first channel in the list.
The threshold data window on the left displays reject level bars indicating the upper and
lower limits of the threshold window. Live, free-running data for the highlighted
channel is displayed in the threshold data window if the mode is running.
Adjust the artifact reject level to the desired setting by clicking on the squares on the
horizontal reject level bars and dragging the bars up or down to the desired level.
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The reject numeric artifact reject levels for each channel are listed in the fourth column of
the channel list on the right. The reject levels are displayed as percent of total gain and
as micro Volts for each channel.
To adjust the artifact reject limits for other channels in the mode, click on the channel
name and adjust the reject level bars for that channel.
To turn off artifact reject for one or more channels, deselect the check box for the
To increment the reject limits for of all channels at the same time, click the up/down
arrows on the All spinner control.
The Noise Analysis sub-window at the bottom of the dialog displays the FFT analysis of
the live data for the selected channel. This allows users to identify the dominant
frequencies of the live data for the selected channel by moving the EFT marker over the
dominant peak on the trace being displayed.
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Procedure Setup
Changes made in the Reject Settings dialog are applied immediately. The averager
continues to run when exiting the Reject Settings dialog.
Setting Up Cursor Tables

The EP modes use auto cursors to mark important waveform features. The
measurements that the cursors represent are used to calculate latency, inter-latency, and
amplitude values. For each, you can configure the following:
• Names of the cursors and the mode channels they are associated with.
• Specific feature for which each cursor searches (peak or trough).
• Start and end latency or midpoint and range search times.
• Which cursors you want to use to calculate latency, interpeak latency, amplitude,
and interamplitude measurements.
• Trace Mode or Trial Mode cursors.
Features
The features available to trend are defined in the Cursor Table for each EP mode. They
are the Latencies, Amplitudes and Inter-Latencies defined from the cursors that are
selected for that EP mode. Click the drop down arrow to select the desired feature to
trend. Up to four features can be trended for each Cursor Trend Window. If there are
additional features that need to be trended for an EP mode, a copy of the Cursor Trend
Window will be required.
Channels
The recording channel can be selected or changed in the EP Cursor Trend Window setup
only if the Trial Mode Cursors box is not selected in the cursor table for the EP mode.
To configure auto cursors
Setup Cursor Table can be accessed from the Mode Settings section of a Procedure Setup
file.
1. Click the Setup Cursor Table button to display the Cursor Table window
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2. Complete the Cursor Table Fields. The table below describes each field and how
to use each field.
Name Up to 15 names of cursors. A cursor must be given a name to be

positioned on a waveform. All cursor names must be unique.
You may use capitalization to create uniqueness between
cursors with the same name.
Feature Waveform feature you want each cursor to search for:

Peak—To locate the highest point within the start and end
latency time period (a negative value).
Trough—To locate the lowest point within the start and end
latency time period (a positive value).
Onset—To locate the beginning of a trace on its way up to the
peak.
Start Lat. / Specify the start and end latency, in milliseconds. These
End Lat. determine the time range in which the cursor may be placed to
identify the actual feature.
Mid Point / Specify the expected midpoint (mean) value for the cursor and a
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Procedure Setup
Range range (+/-) to either side of this value in which the cursor may be
placed to identify the actual feature.
Mode channel When specified, the cursor is placed only on traces acquired
# associated from that channel. Enter as many channels as needed.
with the cursor
Amplitude Up to 10 sets of cursors that you want to use for calculating

voltage difference. You can also enter a normal (Norm) value for
the measurement.
InterAmplitude Type of calculation for interamplitude: Diff—To show the

difference between two amplitudes, calculated by subtracting
the second Amplitude cursor from the first. Ratio—To show the
ratio of two amplitudes, calculated by dividing the first
Amplitude cursor by the second cursor. You can also enter a
normal (Norm) value for the measurement.
Latency Up to 15 cursors that you want to use for latency calculations.

For each cursor, you can enter a normal value for the
measurement.
InterLatency Up to six sets of cursors that you want to use for interpeak
latency calculations. For each pair, you can enter a normal value
for the measurement.
Trial Mode Group of traces where you can specify on which channels each cursor
Cursor will be placed. When the Trial Mode Cursor check box is un-checked,
Trace Mode cursors will be used. With trace cursors, all cursors are on
a single trace; you are not able to select channels for the cursors.
o click the Default button to select from a list of available tables.

o click the Clear button to clear all fields and enter new data.
o click the Store button to save data to a file.
o click the Retrieve button to open an existing cursor file and use that data
for the current procedure setup file.
3. Click OK to save your changes.
See also:
Working with Cursors
EP Cursor Trend Window Setup
Setting Up Trace Labels

The trace label consists of up to three fields, separated by either a dash, colon, space, or
carriage return.
Click the drop-down arrow for a field and select from the following list:
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• None - no label appears in the field.

• Trial# - displays the trial number on stored runs.
• Ch. Name - displays the channel name.
• Gain - displays the amplifier gain (for EMG channels) or the display gain (for EP
channels).
• Intensity - displays the stimulus intensity.
• Time - displays the time of day.
• Amplitude - displays the peak-to-peak amplitude of the trace, this label is only
available for EMG modes and only for triggered, manually stored, auto-
captured, or auto-stored traces.
• Peak Lat. - displays the peak latency of the trace, this label is only available for
EMG modes and only for triggered, manually stored, auto-captured, or auto-
stored traces.
• Stim Params - displays all the stimulus settings for the mode; intensity,
repetition rate, pulse width, etc.
For EP and MEP modes:
For EMG modes:
The top row is used to set the trace labels for the Live EMG traces. The second
row is used to set the trace labels for Auto-Captured, Auto-Stored, and Manually
Stored EMG traces.
NOTE: The Amplitude and Peak Latency labels will produce some slowing of the
EMG trace update rate during triggered-EMG. The slowing increases as more channels
are added to the mode. If you are planning to stimulate at a high repetition rate (> 5 Hz)
then you may want to turn off these trace labels.
Setup Thresholds
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Procedure Setup
You can set a threshold level, in microvolts, for each channel in the EMG mode. When
the threshold is exceeded the PC will play the sound file that has been assigned to that
channel. Several default sound files are installed for you to choose from. The sounds are
played through the laptop or desktop PC’s speakers, not through the speaker in the
Cascade base unit. To adjust the volume of the sound, use the volume control on the
laptop or desktop PC.
Wave / Beep
Checking this box causes the Cascade to play the assigned sound file when a
channel exceeds its threshold setting. Remember, the sounds are played through
the laptop or PC’s speakers, not through the Cascade base unit. To adjust the
volume of the sounds, change the laptop or PC’s sound volume.
NOTE: In order to keep the system from beeping due to stimulus artifacts you will need
to enable the "Remove Stim Artifact From EMG" feature.
Autocapture on Threshold
Checking this box causes the Cascade to hold the EMG sweep on the screen until a
new threshold crossing occurs. The held sweep is colored "purple" on the screen
and is positioned slightly above the Live EMG traces. The triggering sweep is
offset by 3 divisions so that any threshold activity which occurs at the end of the
sweep can be seen in its entirety.
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When performing stimulated EMG using the HOLD mode, the auto-captured
traces are not offset by three divisions.
Store on Autocapture
Checking this box causes the Cascade to automatically store each EMG sweep that
crosses the threshold. Sweeps can be stored at a rate of one sweep every 3 seconds.
The EMG Comment dialog is disabled for auto-stored EMG.
Setup EMG Threshold options:
• Threshold (uV) – sets the threshold voltage level, in microvolts. The threshold
value is measured from baseline to peak, not peak to peak.
• Phase – can be set to trigger on the Upward, Downward or Both phases of the
response.
• Clear – clears the assigned sound file.
• Sound – shows the path to the selected sound file.
• Select button – click here to assign a sound file to the channel. Default sounds
are located in the C:\Cadwell\Cascade\Wavs folder.
• Test button – click to play the sound you have selected.
NOTE: You can record your own sound files using WAV recording software. The sounds
need to be relatively short so that the system can play them rapidly during threshold
crossing.
Mode Window Descriptions

Mode Windows Setup Overview
Each mode window in the View list can be customized using the Mode Window Setup
dialog. You may access this dialog three ways. When in Procedure Setup, highlight the
window you would like to edit and click the Windows Setup button. While running a
procedure, right click on the window you would like to edit and choose the Window
Setup option. While running a procedure, choose View Setup from the Edit menu,
highlight the window you would like to edit and click the Windows Setup button.
Mode Controls
The Mode Controls window turns the data acquisition on and off, stores data, and
provides other options. The Mode Controls Window controls which mode run and
when. The mode controls window allows you to run the modes individually or all
concurrently, except for MEP modes. You may also group modes to allow you to control
groups of mode together. By default, the Mode Control window is available in every
view. You may remove the Mode Controls window from a view using the View Setup
options.
The Mode Controls window provides controls for each of the acquisition modes. The
controls allow you to run the acquisition modes at different intervals or concurrently.
If the Cascade cannot deliver the requested repetition rate for a mode, the Repetition
Rate warning symbol will be displayed. The actual repetition rate that the system is
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Procedure Setup
delivering to the patient is displayed next to the warning symbol. In order to remove
the RR warning, you may need to adjust the repetition rates or sweep speeds of other
acquisition modes.
EP Average Window
The Average window displays Averaged, Live, and Stored traces from an EP mode. It
allows you to display 0 to 10 stored trials in a trend fashion. You can also place and
move cursors on traces and display time and amplitude markers. The Average window
also allows you to set baseline trials.
TIP: You can change the trace gains by selecting a trace and spinning the mouse
wheel.
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Right-clicking on the window will display the functions that can be performed on this
window.
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Procedure Setup
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Run Starts and stops acquisition for the mode.

Single Fires the assigned stimulator once.
Store Stores the current average.
Clear Clears the current average.
Reject When artifact reject is enabled, the reject percentage value is displayed in the
window. If the amplifier gain setting is 10 uV/division this means that the Live trace has
an amplitude window of 100 microvolts (10 vertical divisions times 10 uV/div.) with 50
uV above baseline and 50 uV below baseline. If the reject level is set to 50%, then the
amplitude of the Live trace can’t exceed +/- 25 uV or it will be rejected from the running
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Procedure Setup
average. The lower the reject level setting the more sensitive the program will be in
rejecting large artifacts.
Mode Setup Please see Mode Setup Overview
Add Time Marker Adds a time marker. Cursors display in different colors based on
which side of the marker they are on. To remove a marker, drag it to the far right or left
edge of the window.
Amplitude Markers Shows or hides the amplitude markers. The amplitude value
displayed is based on the currently selected trace.
Set Baseline Sets the currently selected trace as the baseline if no trials are selected. Note
that baselines are set on a "per-mode" basis so if you set the baseline in a 3D window or
an Average window, the trial associated with the trace will show up in all other
windows that display baselines and are connected to the same mode.
choosing.
Auto Place Cursors If no traces are selected (yellow) then cursors are automatically
placed on the live traces (white). Otherwise they are placed on the selected trace.
Show Cursors Shows or hides the cursors on the trace lines in these windows. Cursors
mark important latency and amplitude features on waveforms. See Working with
Cursors for more information.
Clear Cursors Clears the cursors from the selected trial/trace.
Adjust Latency Available after a trial has been selected. Takes the values for the current
positions of the auto-cursors on the selected trial and resets the auto-cursor Start Latency
to -90% and the End Latency to +110% of these values.
Grand Average Allows stored trials to be averaged together. This function is only
available when more than one stored trial has been selected in the window. The
resulting grand average traces, for each channel, are displayed in 'green' color and the
trace label will contain the letters 'GA'.
Live When checked, the live, unaveraged traces are displayed. When unchecked, the
averaged traces are displayed. Note that this does not affect the display of the stored
traces.
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Trial Select On When this option is checked, clicking on a trace selects or clears all the
traces for a trial. When unchecked, traces are selected individually.
Smooth Select Smooth to smooth selected traces in EP Windows.
Unsmooth Select Unsmooth to reverse smoothing selected traces in EP Windows.
Delete Trials Selected trials will no longer be displayed in the Average view.
Restore Deleted Trials Restores all deleted trials.
Auto Position (On-Off) When this feature is turned OFF moving the active "white"
traces will not automatically re-position the stored or baseline traces, nor will exiting
from the Average window’s Setup dialog. The default setting is auto-position turned
ON. To turn OFF this feature, click on this entry on the right-click pop-up menu.
Select All This function selects are trials that are currently displayed within the
window.
Deselect Traces Returns all selected traces, displayed in "yellow", to their original color.
As Recorded Gain When this feature is turned ON the appropriate display gain will be
shown for the Average window as you move back through the recording timeline.
When this feature is turned OFF, the display gain will not change but will remain at its
current setting when moving back through the timeline. The default setting is As
Recorded Gain turned ON. To turn OFF this feature, click on this entry on the right-click
pop-up menu.
Reset Trial Positions Will reset the trial positions of the data back to a default position
on the screen.
Window Setup Please see EP Average Window setup
Global EP Setup This displays the Global EP Settings window, as shown below. You
can change most of the EP window display settings, either for all EP modes or selected
EP modes, from this one window.
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Procedure Setup
Copy Copies the window view to the clipboard as a .bmp file where you can paste it
into other Windows applications.
Copy Cursor Table Copies a text version of the cursor table information to the Windows
clipboard. The information can be pasted into a word processor or spreadsheet. The
table includes cursor values for each of the stored trials, displayed in the Average
window.
Print Select this option to specify a template and generate a report.
When viewing modes, generating a report is based on all windows that are currently
displayed. Only fields from the displayed windows are available for the report. The
templates used for reports are "remembered" so that you don’t need to select a template
very often. Templates are "remembered" by window type so if you print from one EP
window, the same template will be used in another EP Window.
Output Traces to ASCII Please see the Exporting Data section in the Starting/Running
Procedure section.
EP Summary Window
This window allows all the traces for an EP or MEP mode to be displayed, not just the
traces that are closely associated with an event, like the Event Window. This should
provide a convenient way to review and print all the traces for a procedure.
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If you do not want a trial to be included in a Summary Window report, un-check the box
associated with that trial.
Add Marker
Adds a time marker. Cursors display in different colors based on which side of the
marker they are on. To remove a marker, drag it to the far right or left edge of the
window.
Amplitude Markers
Shows or hides the amplitude markers. The amplitude value displayed is based
on the currently selected trace.
Window Setup
Please see Summary Window Setup
Global Window Setup
Please see Global Summary Window Setup
Deselect Traces
Returns all selected traces, displayed in "yellow", to their original color.
Copy
Copies the window view to the clipboard as a .bmp file where you can paste it
Print Report
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Procedure Setup
Window.
Output to ASCII
Please see the Exporting Data section in the Starting/Running Procedure section.
MEP Summary Window

This window allows all the traces for an EP or MEP mode to be displayed, not just the
traces that are closely associated with an event, like the Event Window. This should
provide a convenient way to review and print all the traces for a procedure.
Add Marker
window.
Amplitude Markers
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Window Setup
Please see Summary Window Setup
Global Window Setup
Please see Global Summary Window Setup
Deselect Traces
Copy
Print Report
Window.
Output to ASCII Please see the Exporting Data section in the Starting/Running Procedure
section.
MEP Analysis Window
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Procedure Setup
EMG Window
The EMG window displays EMG data for an EMG mode. The window displays data in a
continuous, non-triggered sweep. If the stimulator is enabled, the window displays
sweeps triggered by each stimulus. Right-click on the EMG window for a menu list. See
below for a description of each of the menu items.
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Run
Starts and stops acquisition for the mode.
Single
Fires the assigned stimulator once.
Store
Stores the current average.
Stim Hold/Stim Rep
Stim Rep (Stimulate Repetitive): Turns repetitive stimulation on/off.
Stim Hold (Stimulate Hold): Turns Stim & Hold mode on/off. When on, the EMG
mode fires the stimulator at the specified reprate and displays single sweeps
triggered by each stimulus. When unchecked, the EMG mode runs in the default,
free run mode. When this box is checked, the Repetitive checkbox is automatically
checked and disabled.
Mode Setup...
Displays the Mode Setup window for the EMG mode. Allows you to change all
functions of the EMG mode. Refer to the Mode Setup section for more
information.
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Procedure Setup
Threshold Setup
Opens the EMG Threshold Setup dialog.
Trace Labels
When checked, channel labels are displayed next to the traces.
Add Marker
window.
Amplitude Markers
Threshold Markers
When enabled, the threshold setting for each channel is indicated by yellow
markers.
Deselect Traces
Clear Captured Trace
Resets the auto-captured trace to a flat line.
Window Setup
Allows you to set window options for the EMG window. Refer to the Windows
Setup section for more information.
Copy
When the EMG window is selected, an EMG toolbar will be shown at the top of
the screen.
Print Report
Window.
Output Traces to ASCII
Pane Selection
Click the drop down arrow to select Single Pane, Vertical Split, or Horizontal Split.
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• Single Pane - all EMG traces are displayed in one window.

• Vertical Split - traces for left side muscles are displayed on the left half of
the window, traces for right side muscles are displayed on the right half
of the window.
• Horizontal Split - traces for the left side muscles are displayed on the top
half of the window, traces for the right side are displayed on the bottom
half of the window.
NOTE: To specify whether a trace should be Left or Right, see Channel Settings under
EMG Mode Setup.
EMG Buffer
When the EMG mode is stopped, you can review back through a buffer of the last
20 sweeps by clicking along the timeline at the bottom of the window.
Stacked EMG Window
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Procedure Setup
This window displays a list (stack) of every stored EMG sweep. The list along the right
side of the window shows the time and stimulus intensity for each triggered EMG.
To access the Stacked EMG Window, open a procedure which includes EMG. On the
toolbar, click Edit, then select View Setup. Under the AVG/EMG tab, click the box next
to EMG: Stacked EMG.
A "trial number" is assigned to each EMG waves as it is stored. The trial number can be
displayed on the window as bracketed numbers (see Stacked EMG Window Setup for
more display options).
If you do not want a trial to be included in a Summary Window report, un-check the box
associated with that trial.
The right click menu for the stacked EMG window is similar to that of the EP summary
window.
Add Marker Adds a time marker. Cursors display in different colors based on which side of the
marker they are on. To remove a marker, drag it to the far right or left edge of the window.
217
Amplitude Markers Shows or hides the amplitude markers. The amplitude value displayed is
based on the currently selected trace.
Window Setup Please see Summary Window Setup
Check All Trials Selects all of the stored EMG traces for a report.
Uncheck All Trials Deselects all of the stored EMG traces for a report. Allows you to select just
the trials you want on your report.
Copy Copies the window view to the clipboard as a .bmp file where you can paste it into other
Windows applications.
Print Select this option to specify a template and generate a report.
Window.
Output Traces to ASCII Please see the Exporting Data section in the Starting/Running
Procedure section.
MEP Triggered Window

The MEP Triggered window displays Live, and Stored traces from an MEP mode. It
allows you to display 0 to 10 stored trials in a trend fashion. You can also place and
move cursors on traces and display time and amplitude markers. The MEP Triggered
window also allows you to set baseline trials.
Tip: You can change the trace gains by selecting a trace and spinning the mouse wheel.
218
Procedure Setup
Trigger
Causes the assigned MEP stimulator to deliver one stimulus train.
Store
Clear
Clears the current average.
Reject
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When artifact reject is enabled, the reject percentage value is displayed in the
window.
If the amplifier gain setting is 10 uV/division this means that the Live trace has an
amplitude window of 100 microvolts (10 vertical divisions times 10 uV/div.) with
50 uV above baseline and 50 uV below baseline. If the reject level is set to 50%,
then the amplitude of the Live trace can’t exceed +/- 25 uV or it will be rejected
from the running average. The lower the reject level setting the more sensitive the
program will be in rejecting large artifacts.
Add Time Marker
window.
Amplitude Markers
Set Baseline
baselines are set on a "per-mode" basis so if you set the baseline in a 3D window
or an Average window, the trial associated with the trace will show up in all other
Baselines can also be reset selectively rather than as a group. This is useful when
one or more channels in a mode show poor morphology when the initial baselines
are set and the waveforms for that channel or channels have improved. Instead of
resetting baselines for all channels, you can now reset baselines for just the
channels of your choosing.
To selectively reset baselines, select the waveform or waveforms you wish to use
as the new baseline and select the Set Baseline option in the right-click menu of the
mode. The Trial Select option will need to be turned off in order to select
waveforms without selecting all waveforms in a trial. When setting or resetting
baselines, only one waveform per channel may be selected.
As always, if no baseline is set when you select the Set Baseline option, the system
will use the last stored trial as baseline. If no trial has been stored, the system will
store the average trial and set it as baseline.
Auto Place Cursors
If no traces are selected (yellow) then cursors are automatically placed on the live
traces (white). Otherwise they are placed on the selected trace.
Show Cursors
Shows or hides the cursors on the trace lines in these windows. Cursors mark
important latency and amplitude features on waveforms. See Working with
220
Procedure Setup
Clear Cursors
Clears the cursors from the selected trial/trace.
Adjust Latency
Available after a trial has been selected.
Takes the values for the current positions of the auto-cursors on the selected trial
and resets the auto-cursor Start Latency to -90% and the End Latency to +110% of
these values.
Grand Average
Allows stored trials to be averaged together. This function is only available when
more than one stored trial has been selected in the window.
The resulting grand average traces, for each channel, are displayed in 'green' color
and the trace label will contain the letters 'GA'.
Live
When checked, the live, unaveraged traces are displayed. When unchecked, the
averaged traces are displayed. Note that this does not affect the display of the
stored traces.
Trial Select On
When this option is checked, clicking on a trace selects or clears all the traces for a
trial. When unchecked, traces are selected individually.
Smooth/Unsmooth
Select Smooth to smooth selected traces in EP Windows. Select Unsmooth to
reverse smoothing.
Delete/Restore Trials
Delete Trials: selected trials will no longer be displayed in the Average view.
Restore Deleted Trials: restores all deleted trials.
Auto-Position On/Off
When this feature is turned OFF moving the active "white" traces will not
automatically re-position the stored or baseline traces, nor will exiting from the
Average window’s Setup dialog. The default setting is auto-position turned ON.
To turn OFF this feature, click on this entry on the right-click pop-up menu.
Select All
This function selects are trials that are currently displayed within the window.
Deselect Traces
As Recorded Gain
When this feature is turned ON the appropriate display gain will be shown for the
Average window as you move back through the recording timeline. When this
feature is turned OFF, the display gain will not change but will remain at its
current setting when moving back through the timeline. The default setting is As
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Recorded Gain turned ON. To turn OFF this feature, click on this entry on the
right-click pop-up menu.
Window Setup
See MEP Window Setup
Copy
Copy Cursor Table
Copies a text version of the cursor table information to the Windows clipboard.
The information can be pasted into a word processor or spreadsheet. The table
includes cursor values for each of the stored trials, displayed in the Average
window.
Print Report
Window.
Live EEG Window

The Live EEG Window displays live EEG data in a sweeping fashion from left to right
across the window. When this window is active, the EEG toolbar is displayed at the top
of the screen. The toolbar has controls for changing the Display Gain and the Sweep
Speed of the window (the Display Gain units are in microvolts per vertical division and
the Sweep Speed units can are in milliseconds per horizontal division).
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Procedure Setup
Run
Set Epoch Length
CSA/DSA epoch length may be adjusted by right clicking in the main EEG data
window and selecting the desired epoch length from the Epoch length sub menu.
Users can select from choices of 2, 4, 8, 16, and 32 seconds.
EEG Window Setup
Controls in this window are used to turn the trace labels, burst suppression
calculation, graticule, or division units on or off. The sweep speed and the channel
display gain settings can also be adjusted. Please refer to the EEG Window Setup
Section for more information.
Scrolling Options
The EEG window can draw the EEG traces in one of four methods.
10 Divisions - creates 10 equal horizontal divisions across the width of the EEG
window, no matter what the sweep speed setting is.
10 mm/sec - draws the EEG at a rate of 10 millimeters per second. The number of
horizontal divisions is dependent on the width of the EEG window and the sweep
speed setting.
speed setting.
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speed setting.
Trace Labels
Deselect Traces
EEG Lookback
Splits the Live EEG window into two sections. The section on the right will
continue to show the live EEG traces. The section on the left can be used to review
back through the EEG by using the horizontal scroll bar. Please refer to the EEG
Lookback page in the Starting/Running Procedures section for more information.
Copy
Print
Select this option to generate an EEG report.
Select Print Current window to generate a report with just the traces from the
current EEG window.
Select Print range to generate a report that includes all the EEG traces over a
specified time range.
Output Traces to ASCII
EEG Toolbar:
Paging Controls
224
Procedure Setup
Use these toolbar buttons to go forwards/backward by one page or by one half

page. Click on the middle button to return the display to Live EEG.
EEG Analysis Window

The EEG Analysis window displays analyzed EEG data in several different formats.
Below is data displayed in CSA, DSA, Symmetry, Trend and Burst Suppression views.
EEG analysis windows display event ticks vertically along side the data. The event ticks
are the same event ticks that show up in the time bar at the bottom of the Cascade
window. A text box is displayed containing the text of the event when the mouse is
rolled over the event tick.
The current spectral edge frequency is displayed at the top of each channel window.
The spectral edge frequency of the baseline epoch is represented by a yellow tick mark
at the bottom of each channel window
The epoch length of the EEG analysis may be adjusted by right clicking in the EEG
Analysis window and selecting the desired epoch length from the Epoch length sub
menu. Users can select from choices of 2, 4, 8, 16, and 32 seconds.
NOTE: You can make a copy of the Analysis window and have one window set up to
display DSA data and have the other window set up to display CSA data simultaneously
in the same View: see the CSA/DSA views.
225
226
Procedure Setup
227
3D Trend Window
The 3D Trend windows display a selected trace from an EP mode in order to monitor
changes in the response over the course of the surgery. The Z-axis is based on time. You
can change the orientation of the graticule by dragging the upper left or lower right
corners.
Add Marker
window.
Set Baseline
228
Procedure Setup
Freeze
The Z-axis depicts the last n minutes of data. Normally, you will see traces "walk"
up the display. When this option is checked, the traces are frozen in place and do
not move.
Window Setup
Please see 3D Trend Window Setup
Copy
Print Report
Window.
Cursor Trend Window

The Cursor Trend window allows you to display a histogram of up to 4 cursor
measurements for an EP Mode. The measurements that you can display are based on the
cursor table setup for the mode (see Setting Up Cursor Tables). The window displays the
stored trial/trace cursor values in either a graphical Dot-To-Dot format or in a scrolling
Table format. You can toggle between the two display types at any time by using the
right click menu. The current baseline values are displayed all the time at the bottom of
the window, and the percentage difference between the baseline and most recent data
point is calculated and displayed.
Below are two examples of the Cursor Trend window: the Table view and the Dot-to-
Dot view. Please refer to the Glossary for descriptions of each of the menu items below.
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Table view
Dot-to-Dot/Table View
Dot-to-Dot/Graph View: Dots mark the cursor values with a straight line between
them. This view tracks the Time Bar repositioning.
Table View: This option displays a continuously updated table of values for each
feature selected. The table contains all values that have been collected, baseline
values, events, and the time, value, and percent difference from the baseline for
each cursor value. This view also tracks the Time Bar repositioning.
Show Baseline
This option for each column in a Cursor Trend window shows the current baseline
value for the feature being trended, and is displayed as a line at the bottom of the
display.
When the "Display Baseline Value" option is turned on, a value is displayed which
is the difference between the baseline value and the most recent value. This value
is displayed as a percentage. For example, if the baseline value is 5.0 and the
current value is 4.0, the value displayed will be -20.0%. If the current value is 7.5,
the value displayed will be 50.0%.
Show Events
Select this option to display the event text in the Cursor Trend window.
Show Percents
Select this option to display the percent change, or the percentage difference
between the baseline and most recent data point, in the Cursor Trend window.
Window Setup
Please see Setting up Cursor Tables. EP Cursor Trend Window Setup
230
Procedure Setup
Copy
Print Report
Window.
Dot-to-Dot view (vertical trend)
NOTE: Normal dots are displayed in the same color specified for EP Cursors in System
Setup. The line connecting the normal dots is the same as the color specified for the
Stored Trials. The color of the baseline dot is the same as that specified for the
Baseline Trace. Abnormal dots are always displayed as red squares.
Dot-to-Dot/Graph View: Dots mark the cursor values with a straight line between
them. This view tracks the Time Bar repositioning.
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feature selected. The table contains all values that have been collected, baseline
values, events, and the time, value, and percent difference from the baseline for
each cursor value. This view also tracks the Time Bar repositioning.
Horizontal Trend
When enabled, the Dot-to-Dot trend is drawn horizontally rather than
vertically.
Show Baseline Dot-to-Dot
This option for each column in a Cursor Trend window shows the current baseline
value for the feature being trended, and is displayed as a 'blue dot' at the bottom
of the display.
When the "Show Baseline" option is turned on, a value is displayed which is the
difference between the baseline value and the most recent value. This value is
displayed as a percentage. For example, if the baseline value is 5.0 and the current
value is 4.0, the value displayed will be -20.0%. If the current value is 7.5, the value
displayed will be 50.0%.
Dot-to-Dot Markers
Center Marker on Baseline: centers a vertical time marker on the baseline value.
Center Marker: centers a vertical time marker within the x-axis of the trend.
Place Marker at x% of Baseline: positions a vertical marker at +10% (latency
trend) or -50% (amplitude trend) of the baseline value.
Zoom In/Zoom Out
Use these options to quickly modify the range of values displayed in the graph.
Copy
Print Report
Window.
Video Window
The Video Window displays live video from a camera connected to the computer.
Various settings allow you to specify when video images are stored to the data file for
later review.
232
Procedure Setup
Continuous video is not stored to the file; only "snapshots" are stored based on these
settings. You can use multiple video windows, if more than one camera is available.
Take Snapshot
Stores the current video image to the file. A Comment box displays each time a
snapshot is taken.
Refresh
Updates the image in the window.
Window Setup
Please see Live Video Window Setup
Copy
Print Report
Window.
Event Window
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The Event Window displays up to four traces from the available EP or MEP modes.
When you enter an event, the event text shows up in the Event Window along with the
stored traces for the time of the event. The result is a summary of responses at key points
during surgery. Note that the event text is always displayed, but duplicate traces are
not.
Tip: You can change the trace gains by selecting a trace and spinning the mouse wheel.
Add Marker
window.
Amplitude Markers
Window Setup
Please see Event Window Setup
Copy
Copy Special
Applies filtering to the Copy command. You can select only the data you want to
see based on priority, type of event, and individual events.
Print Report
234
Procedure Setup

Window.
Waterfall Window
The Waterfall Window displays the stored traces for a determined amount of time (trend
time), in a two-dimensional stack. Time (in minutes) is displayed on the Y axis. The
sweep speed is on the X axis. The traces can be trended in ascending or descending
modes. The ascending mode, the most recent stored trace appears at the bottom of the
graph and moves upward as new traces are added to the stack. The descending mode,
the most recent stored trace appears at the top of the graph and move downward. The
current time of day is displayed at the top (descending mode) or bottom (ascending
mode) of the Y axis.
Add Marker
window.
Amplitude Markers
235
Window Setup
Please see Waterfall Trend Window Setup
Global Window Setup
Please see Global Waterfall Window Setup
Set Baseline
Copy
Print Report
Window.
Output to ASCII
TOF (Train of Four) Trace Window
236
Procedure Setup
This window displays each response in the stimulus train and shows the peak and
trough cursors on each trace. Besides showing the most recently acquired train it can
also trend up to 10 previously stored trains and can also display a baseline train.
By right-clicking on the window you can perform various functions including accessing
the Mode Setup and window Setup.
Options
Run Starts and stops acquisition for the mode.
Single Fires the assigned stimulator once.
Store Stores the current average.
237
Clear Clears the current average.

Mode Setup Accesses frequently changed parameters for the mode.
Add Time Marker Adds a time marker. Cursors display in different colors based on
which side of the marker they are on. To remove a marker, drag it to the far right or left
edge of the window.
Amplitude Markers Shows or hides the amplitude markers. The amplitude value
displayed is based on the currently selected trace.
Set Baseline Sets the currently selected trace as the baseline if no trials are selected. Note
that baselines are set on a "per-mode" basis so if you set the baseline in a 3D window or
an Average window, the trial associated with the trace will show up in all other
choosing.
Auto Place Cursors If no traces are selected (yellow) then cursors are automatically
placed on the live traces (white). Otherwise they are placed on the selected trace.
Show Cursors Shows or hides the cursors on the trace lines in these windows. Cursors
mark important latency and amplitude features on waveforms. See Working with
Clear Cursors Clears the cursors from the selected trial/trace.
Window Setup Please see TOF (Train of Four) Analysis Window.
Copy Copies the window view to the clipboard as a .bmp file where you can paste it
Print Select this option to specify a template and generate a report. When viewing
modes, generating a report is based on all windows that are currently displayed. Only
fields from the displayed windows are available for the report. The templates used for
reports are "remembered" so that you don’t need to select a template very often.
Templates are "remembered" by window type so if you print from one EP window, the
same template will be used in another EP Window.
238
Procedure Setup
TOF (Train of Four) Analysis Window
By right-clicking on the analysis window you can switch between the table or histogram
view, turn On/Off various calculations, enter the setup window, and create a report.
Table View: Displays a numeric trend of a the measures selected in the Shoe area of the
window setup.
Histogram View: Displays select data in a graphical form
Show Count: Displays a count of the number of responses in the train of four.
Amplitude: Calculations of TOF% and T1% are based on the amplitude of the
responses.
Area: Calculations of TOF% and T1% are based on the area under the curve of the
responses
TOF% = amplitude or area increment or decrement between the first and the
fourth response in the train. If no fourth response is detected this value will
always be 0%.
T1% = amplitude or area increment or decrement between the first response in the
most recent train to the first response in the baseline train.
Show Baseline: Displays the baseline traces in the window.
Window Setup
239
Displays view options that can be changed. Most of which are in the context (right
click) menu.
Copy
Print Report
Window.
View Setup and Mode Windows Setup

Views Overview
View Setup Overview
A view is a collection of mode windows. There will always be at least one view. You
may display as many mode windows per view as you like. View Setup defines which
windows to display, the window sizes, and window positions. You can define as many
views as needed and create copies of mode windows and have two mode windows
showing the same data in slightly different ways.
For example, you may set up a view which shows only the Average windows for each
EP mode and another view which shows the Cursor Trend windows. During surgery,
you can switch to the Cursor Trend view to monitor trending. Data collection continues
even though the Average windows are not displayed.
The View Setup dialog is available in the procedure setup and edit current procedure
setup dialogs and Edit menu using the View Setup option.
Windows for each view are listed based on the modes you have defined in the Mode
section. Each mode window in the View list can be customized using the Mode Window
Setup dialog. See the Mode Windows Setup Overview section for options available
when setting up each mode windows type.
240
Procedure Setup
Views
Views are groups of Windows. You can have multiple Views each with a different
set and arrangement of Windows.
Add/Delete/Rename View Buttons
Click the Add View button to enter an additional view.
Click the Delete View button to delete the active View.
Click the Rename View button to rename the active View.
Layout Windows Button
Click the Layout Windows button to view the layout and set the default positions
of all of the checked windows in the view list. You can move windows and change
the size of the windows. Left-click and hold on the edge or a corner of a window
and drag to resize the window. Left-click and hold on the title bar to move the
window. See the Window Menu for more information on window options.
Re-arrange Views
To re-arrange the order of the Views, simply click on the appropriate view's tab
and drag to a new location. A black line indicates where the view will be moved
to when the mouse button is released.
Mode Windows Setup Overview

Each mode window in the View list can be customized using the Mode Window Setup
dialog. You may access this dialog three ways. When in Procedure Setup, highlight the
window you would like to edit and click the Windows Setup button. While running a
procedure, right click on the window you would like to edit and choose the Window
Setup option. While running a procedure, choose View Setup from the Edit menu,
highlight the window you would like to edit and click the Windows Setup button.
Mode Control Window Setup

The Mode Control window behaves much like any other window. The Mode Control
window can be omitted from a view and like any other window and you may select the
elements to show in the Mode Control window.
241
To omit the Mode Control window from a view, simply uncheck the Mode Control
window in the View Setup dialog. Refer to the Cascade user manual or help file for
instructions for using the Vie Setup option.
To select which elements to show in the Mode Control window, select Window Setup
from the View Setup window, by right clicking the Mode Control window name in the
view list or by right clicking the Mode Control window while running a procedure. By
default the all mode controls are shown in the Mode Control window and the Mode
Control window is turned on. Mode group controls will always be shown in the Mode
Control window and cannot be omitted from the Mode Controls window. Be aware that
stimulus intensity controls are available only in the controls for the individual modes.
EP Average Window Setup

To access Average Window Setup, scroll down through the Available Windows in the
Views section of Procedure Setup, highlight the "Average" window, and click Window
Setup.
242
Procedure Setup
The Window Setup options include:
Show
Baseline Trace
Shows/Hides the baseline trace. When baselines are selected they are
automatically placed at the bottom of the selected trend window.
Trace Labels
Graticule
When checked, the graticule or grid is visible in the selected window.
Division Units
243
When checked, the current sweep setting is displayed in the lower right corner of
the window. The current gain setting is also displayed in the lower left corner if all
traces have the same gain setting.
Average Count
A counter that shows the number of sweeps collected during waveform
averaging.
Reject
window.
Waveforms
Display Sweep
Specifies sweep length of the traces. The Display Sweep may be set to a different
setting than the Acquisition Sweep. Units are milliseconds per division and
Trend Count
Specifies the number of stored trials to display. Stored trials are displayed in a
trend fashion with the most recent trial at the bottom.
Cursors
Allows you to show/hide specific cursors. When checked, cursors are displayed (if
available) on the traces. Select a cursor label option for the selected cursors:
• All Off: no cursors are displayed.
• Crosshair Only: the crosshair (+) is displayed without a label
• Label and Crosshair: both the label and crosshair are displayed
• Value and Crosshair: the latency value and the crosshair are displayed,
amplitude values are bracketed
• Show on Baseline Only: the selected cursors are only displayed on the
baseline traces.
Auto Position On-Off
244
Procedure Setup
Trial Select
Channel
Channel Section
Allows you to set the display gain for traces and turn them on or off.
Show Cursors
EMG Window Setup

To access EMG Window Setup, check and then highlight the EMG Available Window in
Views and click Window Setup.
245
Show
Graticule:
Select or deselect to show graticule.
Left/Right
• Single Pane - all EMG traces are displayed in one window.
• Vertical Split - traces for left side muscles are displayed on the left half of the
window, traces for right side muscles are displayed on the right half of the
window.
• Horizontal Split - traces for the left side muscles are displayed on the top half of
the window, traces for the right side are displayed on the bottom half of the
window.
Display Gain
Use Display Gains:
Select Use Display Gains to adjust the display gain knob.
Channel
Channel:
To temporarily remove a channel from the window, un-check the corresponding
box. The channel is still included in the mode. It is simply not shown in the
window. This is important when running NerveGuard. NerveGuard will trigger
off any channel in the mode regardless of whether or not that channel is turned on
in the Window setup.
You can record and display EMG data at different gains for the same EMG
channels in different EMG modes without duplicating EMG channels in the
montage list. For example, you may want to use the same set of EMG channels to
perform pedicle screw stimulation at 200µv/div, record free-run EMG at 50µV/div
and record train of four recordings at 500 µv/div.
To use this feature, turn on the Use Display Gain option in the Window Setup or
in the Mode Setup window of the EMG mode and set the channels to the desired
display gain. When Display Gains are on, the amp gain dial is grayed out. When
the Display Gains are off, the display gain dial is grayed out. The Mode Setup
window will show the amplifier gain when the display gains are turned on.
Because the display gain is based on the amplifier gain, it is recommended that
amplifier gains be set no lower than the largest display gain in any mode. For
example, if you are running free-run EMG at 50uV/div and triggered EMG at
200uV/div, the amplifier should be set to 200uV/div.
The Use Display Gains box is also available in the Mode Setup window.
MEP Window Setup
246
Procedure Setup
On an MEP mode window, right-click and select Window Setup to display the setup
dialog.
Show
Baseline Trace
Trace Labels
Graticule
Division Units
247
Average Count
A counter that shows the number of sweeps collected during waveform
averaging.
Reject
window.
Waveforms
Display Sweep
Trend Count
Cursors
baseline traces.
248
Procedure Setup
Trial Select
Channel
Show Cursors
Live EEG Window Setup

Controls in this window are used to turn the trace labels, burst suppression calculation,
graticule, or division units on or off. The sweep speed and the channel display gain
settings can also be adjusted.
Show
Trace Labels
249
EEG Burst Suppression

The Cascade has three options for computing and display EEG Burst
Suppressions.
• Suppression Ratio (%) - the percentage of time spent in suppression
during the previous minute.
• Bursts Per Minute (b/m) - number of bursts that began during the
previous minute.
• Burst : Suppression - the ratio of time not in suppression to the time in
suppression during the previous minute.
Definitions
Suppression - an interval of at least 1 second during which there is no activity
above threshold.
Burst - a period of time in which the threshold is exceeded with a specified degree
of frequency.
Algorithm
The EEG data is filtered using an 8 Hz locut filter. The algorithm then begins
looking for bursts and periods of suppression using the following rules:
• A burst is a segment more than 700 msec long that exceeds 8 uV in
amplitude. If the burst is less than 700 msec, it is considered a noise
spike.
• Bursts must be separated by at least 150 msec, or they are counted as a
single burst.
• If the flat area between bursts is at least 1 second long, then that time is
counted as suppression.
The Burst Count and Suppression % are calculated for each individual 10-second
epoch. The values that are displayed in the EEG window are the total count for
the last minute, or the average suppression % for the last minute. If the
Suppression % is less than 25%, then the program assumes that the patient is not
yet in burst suppression, and doesn't display the value.
The EEG Analysis window shows yellow dots (trend view) for values that are
calculated from less than a minute of data (which can occur if the mode is stopped
and restarted).
Graticule
Division Units
Waveforms
250
Procedure Setup
EEG Drawing Selections

• 10 Divisions - creates 10 equal horizontal divisions across the width of
the EEG window, no matter what the sweep speed setting is.
• 10 mm/sec - draws the EEG at a rate of 10 millimeters per second. The
number of horizontal divisions is dependent on the width of the EEG
window and the sweep speed setting.
Display Sweep
setting than the Display Sweep. Units are milliseconds per division and always
ten divisions total therefore:
Channel
Channel Section
Show Burst Suppression Info
Enables the display of burst suppression calculations for the channels that are
checked.
All Gain Control
Use the up/down buttons to change the display gain of all channels at one time.
Event Window Setup

To access Event Window Setup, select and highlight Event Window in the Views section
of Procedure Setup, or, on the Event Window, right-click and select Setup.
251
Trace Windows
Trace Window 1-4 specifies which trace to display, if any. The drop-box lists all
traces from all EP modes.
Display Sweep
Display Gain
The display gain is the input sensitivity of the instrument when data is being
collected. This sensitivity determines the vertical scale of the input as displayed on
the test screen when set to view the input signal during acquisition. You can
adjust gain settings (as well as sweep speed) to ensure proper display of the
signal. You can adjust the gain setting independently in each channel. Gain is
measured in microvolts per division (uV/div).
Show Cursors
Show In Trace Windows
Graticules: Shows/Hides the graticule in the trace display windows.
Trial Numbers: Shows/Hides the trial number in the trace display windows.
Division Units: When checked, the current sweep setting displays in the lower
right corner of the window. The current gain setting also displays in the lower left
corner if all traces have the same gain setting.
‘Mode Trace‘ Labels: Shows/Hides labels of mode trace names.
Baselines: Shows/Hides baselines. When baselines are selected they are
Event Text
252
Procedure Setup
Show: Shows/Hides display of the event text

Time: Specifies whether to show the elapsed time, real time (time of day), or no
time, when displaying event text.
Setup Filter
From the Event Window Setup window, click the Setup Filter button to display a
list of filters. The default option shows all priorities and event types, but you can
deselect any items that you don’t want to display.
Cursor
baseline traces.
Setup Tables
Select the cursors that will be included in the reports, and select whether you want
to include baseline information.
Default Button
Sets the first Trace Window to the first channel of the first mode. It sets the sweep
to Default, which tracks the mode’s sweep setting, and sets the gain to 2.
When waveforms are turned off in the Event Window, the event text is automatically
adjusted to the full width of the window, the text is wrapped and the text is spaced to
the row height of the longest event text. This allows you to customize the event window
size while presenting text in a compressed, space-saving manner. This is especially
useful when logging long entries such as anesthesia data and conversations with the
surgical team.
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To setup an event list like the one shown above, create a copy of an Event Window
using the View Setup dialog accessed from the Edit menu. Rename the new window
“Event List.” Turn off all waveforms in the Window Setup dialog and click okay.
Resize the window to the desired size.
Summary Window Setup

The summary window setup dialog allows you to adjust the visible properties of your
summary window, choose your channels, adjust your display gain, and change the
cursor labels and trend time.
To access the Summary Window Setup, select and highlight the Summary window in
the Views section of Procedure Setup, and click Window Setup.
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Procedure Setup
Show
Baseline Trace
Graticule
Division Units
Events
Enter specific data for the event list you will use during the procedure.
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Trial Number
When enabled every fourth trial number will be displayed on the traces.
All Trial Times
When enabled the trial times will be displayed in the far right-hand column.
Channel Names
When enabled the channel names will be displayed in the top left of each trace
window.
Waveforms
Sweep
always ten divisions total, therefore:
Trend
Specifies the number of minutes to display in the window. If the window size is
not large enough to accommodate the full trend time, a scroll bar will be presented
allowing the user to scroll through the entire trend time.
Spacing
Specifies the space between traces.
Cursors
baseline traces.
Channels
On
Display Gain
Sets the display gain for each channel.
Show Cursors
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Procedure Setup
All Gains
Allows you to adjust the gain of every channel within the window setup.
Waterfall Trend Window Setup
Show
Minutes Labels:
Shows/Hides the minutes labels.
• Graticule: Shows/Hides the values for all three axes.
• Baseline: Shows/Hides the baseline trace. When baselines are selected
they are automatically placed at the bottom of the selected trend window.
Baseline Trace
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Trace Name:
Shows/Hides the label of the trace displayed.
Graticule
Division Units
Waveforms
Trace:
Selects which traces are displayed.
Sweep:
Specifies at what sweep to display the traces. Note that this value does not effect
the mode sweep setting. Select Default if you want the sweep to track the mode
sweep setting.
Gain:
Specifies the display gain for the trace.
Trend:
Specifies how many minutes the Z-axis displays. This is the amount of past time
the window displays.
Order:
Determines whether the time is ascending or descending. Ascending order
displays the most recent traces at the bottom of the window with the oldest traces
at the top of the window. Descending order displays the most recent traces at the
top of the window with the oldest traces at the bottom of the window.
Cursors
baseline traces.
Channels
On
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Procedure Setup
Allows you to turn channels them on or off. This setting only determines which
traces are displayed. When channels are turned off, the mode continues to record
from that channel.
Show Cursors
Global Summary Window Setup

Use the selections in this window to change common settings for all Summary windows
at one time. This window is accessible from the right-click menu in the summary
window while running. This window is not accessible from the procedure setup screen.
Show
Baseline Trace
Graticule
Division Units
Events
Trial Number
All Trial Times
Channel Names
window.
Waveforms
Display Sweep
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Cursors
baseline traces.
Channels
Show Cursors
EP Cursor Trend Window Setup

Access
From Procedure Setup: In the Views section of the Procedure Setup file, select and
highlight the Cursor Trend window for a given EP mode and click the Window
Setup button to the right.
From a Procedure: Within an open procedure, right-click in the Cursor Trend
Window for an EP mode and select Window Setup from the menu.
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Procedure Setup
Display Mode
Choose Table View or Dot to Dot Graph for displaying the cursor trend
information in your procedure. They can be selected in the right-click menu while
running the procedure or in the Cursor Trend Window Setup. You may also
change the display mode of the Dot to Dot Graph to stacked windows by checking
the Horizontal Trend box in the Cursor Trend Setup.
Trends
Feature: Click the drop-down arrow to select the desired feature to trend for up to
four features. The features available to trend are defined in the Cursor Table for
each EP mode, and are the Latencies. Amplitudes and Inter-Latencies are defined
from the cursors you select for that EP mode. If additional features need to be
trended for an EP mode, insert a copy of the mode in the Views section of the
Procedure Setup and make necessary changes.
Channel: Select or change the recording channel only if the Trial Mode Cursors
box in the Cursor Table is not selected in the cursor table for the EP mode.
Center: Defines the center point for latency and amplitude shifts in the Dot to Dot
Graph display mode.
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Range: Defines the display axis for the trend feature selected in the Dot to Dot
Graph display mode. The Trend Time defines the other axis.
Marker: Check this option for the ability to place a marker in the Cursor Trend
window of Dot to Dot Graph display mode. Right-click within an open procedure
to place a marker.
LockGraph: Locks the X/Y axes in place in the Dot to Dot Graph. When
deselected, the X/Y axis can be click-and-dragged within the Cursor Trend
Window. The latency range on the Y axis can also be changed with a click-and-
drag.
Norm%Change: This is the warning flag setting. When the selected trend exceeds
the acceptable change form the baseline, the text in the Cursor Trend Table
display mode will appear in red as an alert.
Show
Show Baselines: If selected, a time stamp will be displayed with trend values in
the Cursor Trend Table display mode. This option can also be turned on and off in
the right-click menu of the EP window in a procedure.
Show Events: If selected, a time stamp will be displayed with a comment in the
Cursor Trend Table display mode. This option can also be turned on and off in the
right-click menu of the EP window in a procedure.
Show Percents: If unselected, the %Change columns will no longer be displayed
in the Cursor Trend Table display mode. This option can also be turned on and off
in the right-click menu of the EP window in a procedure.
Time, Elapsed or Real: In Cursor Trend Table, time can be displayed in Elapsed
or Real time. In the Dot to Dot Graph, time is displayed in trend time and its
increments can be adjusted.
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Procedure Setup
Live Video Window Setup

The Live Video Window Setup allows you to change the refresh rate at which your
images are stored.
Access or Add Live Video Window to View

From a procedure:
1. Open the Edit toolbar menu and click Edit Views.
2. Checkmark the Live Video option.
3. Click Window Setup to access the Live Video Window Setup.
4. Adjust your option settings.
5. Click OK.
6. Click OK to add Live Video Window to the procedure view.
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Options
Source Select: Select a camera from the drop-down menu.
Refresh Rate: Choose a refresh rate. This visual option gives a higher quality
when a higher frames per second (fps) is selected.
Image Type: For a faster frame rate, use I420. For color correctness, use IYUV.
Resolution: Set pixels between 160x120 to 640x480. The higher the resolution, the
better the image will appear.
Store Image On...
Interval: Set how often the data is stored to file, from 12 frames per minute (fpm)
to 6 frames per hour (fph).
Event: Automatically capture an image when an event occurs within the
procedure.
EP Average: Automatically capture an image when the evoked potential averages
and stores data.
EMG Store: Automatically or manually capture an image when you store traces
for EMG.
Default: This option sets the refresh rate and interval. The image type and resolution
will remain as manually set.
OK: Save and close Video Window Setup.
Cancel: Close Video Window Setup without saving changes.
NOTE: If you make a copy of the Video Window in the Views section of Procedure
Setup and select a different camera in its Source Select, you may operate and
monitor two cameras at once during a procedure.
EP Analysis Window Setup
The EP Analysis window is used to perform Digital Filtering and FFT analysis on stored
evoked potential traces. This window can be added to any existing View by selecting
View Setup from the Edit menu.
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Procedure Setup
Features:
Each Evoked Potential acquisition mode, in the procedure setup, will have an EP
Analysis window available.
Channel Select
The user must select the Channel from a drop-down control. The analysis is
automatically performed on the most recently stored trial for the selected channel
and mode, and automatically updates as new trials are acquired and stored. In
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order to go back and re-perform analysis on earlier traces the user can simply go
back anywhere along the procedure’s timeline.
Trace Scaling
Click the mouse within the trace area and use the mouse wheel to change the
display gain.
Digital Filter Section:

Locut and Hicut
As soon as a stored trace is available for the selected Mode a copy of the stored
trace is automatically drawn in the Digital Filter window (original) along with a
second trace that is digitally filtered (filtered) according to the Locut and Hicut
filters that have been specified. The user can change the Locut and Hicut settings
at any time and the filtered trace is redrawn. The Locut and Hicut default settings
are programmable and can be specified in the window’s setup menu.
Perform Area & RMS On
User can specify that either the “Original” or “Filtered” trace be used for the RMS
and Area calculations.
Area and RMS
The Area under the curve and Root Mean Square voltage are both calculated for
the specified trace. The units for Area are uVms (microvolt milliseconds) and the
units for RMS are uV (microvolts). The user can change the From and To values in
order to perform the calculations on selected portions of the trace. The From and
To values always default to the entire timebase of the selected trace.
Expand Feature
The user can click on the upper and lower sweep settings and change the values.
This will expand the trace to the new settings. This does not affect the FFT graph,
the FFT is always computed on the entire length of the selected trace.
FFT Section:
Perform FFT On
The user can select either the “Original” or “Filtered” trace for FFT analysis.
Window
User can specify “None”, “Blackman” or “Hanning” for the time domain
windowing algorithm.
X-Axis (frequency)
The maximum frequency that can be resolved will be half of the trace’s sample
rate (Nyquist rule). At 1.0 millisecond per division this would be 32,000 Hz. At 100
milliseconds per division this would be 320 Hz. The x-axis defaults to display
between zero and the maximum frequency allowed. The user can at any time
change the upper and lower frequency values in order to “zoom in” on the FFT. If
either of the frequency values change, the FFT is automatically redrawn.
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Procedure Setup
Y-Axis (voltage or power)

Either voltage (uV) or power (uV2) can be displayed on the vertical axis. The user
can switch units simply by clicking on the unit field. Initially the FFT is drawn so
that the highest peak in the FFT is viewable. The user can change the maximum
for the Y-axis and the FFT is automatically redrawn.
FFT Cursor
When the mouse is positioned over the FFT a “pop-up” will display the frequency
and voltage/power of the data point nearest to the mouse pointer. See example
below.
FFT Marker
By right clicking over the FFT the user can enable an FFT Marker. The marker can
be positioned anywhere within the FFT simply by dragging it with the mouse, it
always displays the frequency and voltage/power at its location. See example
below.
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FFT Resolution:
The Cascade stores 640 points per trace. In order to perform the FFT the number of
points needs to be reduced to 512 or increased in powers of 2. We have chosen to
artificially increase the FFT resolution by adding points to the data. What this does
is pad the sample with additional data points thereby increasing the resolution of
the FFT. The window defaults to 1024 points and can be changed to 2048 points.
Reports:
Right click on the EP Analysis window and select Print. Use the “EP Analysis.rpt”
template. An example of the EP Analysis report is shown below.
Stacked EMG Window Setup

The stacked EMG window displays stored EMG traces is a stacked format similar a
summary window. Trace time stamps and event comments may be displayed in the
margin of the window. EMG comments are not displayed in the stacked EMG window.
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Procedure Setup
To access the stacked EMG window setup, select then highlight Stacked EMG in the
Views section of Procedure Setup and click Window Setup.
Show
Graticule
Division Units
269
Intensity
When checked, the stimulus intensity used with triggered EMG traces is displayed in the
margin of the stacked EMG window.
Events
Trial Numbers
All Trial Times
Channel Names
window.
Waveforms
Sweep
always ten divisions total, therefore:
Trend
Specifies the number of minutes to display in the window. If the window size is
not large enough to accommodate the full trend time, a scroll bar will be presented
allowing the user to scroll through the entire trend time.
Spacing
Specifies the space between traces.
Channels
On
Allows you to turn channels them on or off. This setting only determines which
traces are displayed. When channels are turned off, the mode continues to record
from that channel.
Display Gain
Sets the display gain for each channel. T
All Gains
Allows you to adjust the gain of every channel within the window setup.
EEG Analysis Window Setup
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Procedure Setup
Frequency and power information for analyzed EEG data can be displayed in a variety
of formats. The Setup window is used to configure this format. Below is the EEG
Analyze setup window with menu options. Click on a field below for more information.
General
EEG Analysis View
Select one of the following trends for the data presentation type:
CSA: Compressed Spectral Array
DSA: Density Spectral Array
Symmetry: DSA trends with symmetry trends plotted down the middle of
the display
Trend: Power trends
Frequency Range (Hz)
Select the low and high frequency limits for the horizontal axis. The lowest setting
is 1.0 Hz and the highest setting is 30 Hz.
Trend Time
Determine the amount of data displayed in the vertical axis; for example, the last
10 minutes of data.
Channel Labels
Shows/Hides the channel labels in the window.
Spectral Edge
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Shows/Hides the spectral edge indicator and selects the spectral edge frequency
value (50, 90, 95, 97 or 99 %). Spectral edge is always determined for the total
frequency band of 1 – 30 Hz.
Voltage, Power, ZScore
Select one of the following options:
Voltage: Changes the analysis window to display voltage (microvolts).
Power: Changes the analysis window to display power (pW or microvolts
squared). Power is the most common setting to use for CSA and DSA displays.
Z Score: Changes the analysis window to display the difference (in z-score units)
between the trended data and the most recently selected baseline. This is most
commonly used with DSA displays. A Z-score of 1 corresponds to a difference of 1
standard deviation.
Reject
Shows/Hides the artifact reject algorithm and selects the threshold level for the
reject in picowatts (pW). The reject is based on the total power contained in the
sampled epoch. If the total power in the epoch exceeds the reject level, then the
data for the epoch is not displayed and is replaced by a small "yellow" dash for
that point in time in the window.
DSA Smoothing
Select to smooth selected traces in EEG Windows. This function is only available
when the DSA view has been selected.
DTAB (DSA)
This setting causes the DSA trends to be displayed in discrete frequency bands of
Delta (1-3.5), Theta (3.5-7.5), Alpha (7.5-12.5), Beta (12.5-25), and High Beta (25-30)
Hz. This option is only available when the DSA view has been selected and DSA
smoothing is off.
Scale
CSA Scale
Increase or decrease the height of the CSA plots.
DSA Max Voltage
Set the top level of the color scale when displaying DSA Voltage trends.
DSA Max Power
Set the top level of the color scale when displaying DSA power trends.
Channel Selection
Use the check boxes to add or remove channels from the display.
When the Symmetry View is selected you can specify the channels that are to be
compared. Click and drag the appropriate channel label to the desired location to
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Procedure Setup
create the pairs that will be analyzed for symmetry. To remove a channel from a
pair, drag the channel label to the trash bin.
NOTE: Symmetry is a trend showing the absolute difference between the channel on the
left vs. the channel on the right.
DSA Colors
When the DSA View is selected, these controls can be used to select the color scale.
Z Score Colors
When the DSA View and the Z Score items are selected, the Z Score controls can
be used to select the Z Score color scale.
Trend
When the Trend View is selected, these controls can be used to select the type of
data to be trended. Select from Total Power, Absolute Power, or Relative Power.
When either Absolute or Relative power are selected, the frequency band can also
be selected (Delta, Theta, Alpha, Beta, Delta+Theta, or Alpha+Beta).
Range (pW): Sets the maximum limit for the horizontal (x-axis) of the trend
displays.
Burst Suppression
The Cascade has three options for computing and display EEG Burst
Suppressions.
Suppression Ratio (%) - the percentage of time spent in suppression during
the previous minute.
Bursts Per Minute (b/m) - number of bursts that began during the previous
minute.
Burst : Suppression - the ratio of time not in suppression to the time in
Definitions:
Suppression - an interval of at least 1 second during which there is no
activity above threshold.
Burst - a period of time in which the threshold is exceeded with a specified
degree of frequency.
Algorithm:The EEG data is filtered using an 8 Hz locut filter. The algorithm
then begins looking for bursts and periods of suppression using the
following rules:
• A burst is a segment more than 700 msec long that exceeds 8 uV in
amplitude. If the burst is less than 700 msec, it is considered a noise
spike.
• Bursts must be separated by at least 150 msec, or they are counted as
a single burst.
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• If the flat area between bursts is at least 1 second long, then that time
is counted as suppression.
• The Burst Count and Suppression % are calculated for each
individual 10-second epoch. The values that are displayed in the
EEG window are the total count for the last minute, or the average
suppression % for the last minute. If the Suppression % is less than
25%, then the program assumes that the patient is not yet in burst
suppression, and doesn't display the value.
• The EEG Analysis window shows yellow dots (trend view) for
values that are calculated from less than a minute of data (which can
occur if the mode is stopped and restarted).
TOF Window Setup

The TOF (Train Of Four) mode allows for monitoring the patient’s degree of
neuromuscular blockade. A train of four stimulations are delivered to the patient and
the program automatically records the responses to each stimulus and determines the
amplitude and area of each response, if present. Stimulus artifact in the Train of Four
mode is suppressed for two milliseconds for each stimulus in the train.
Show
Baseline Trace
Graticule
Division Units
274
Procedure Setup
Waveforms
Display Gain
Sets the gain level for the waves displayed on screen.
Sweep
Trend Count
Cursors
• Value and Crosshair: the latency value and crosshairs are displayed,
baseline traces.
• Setup Tables: allows you to choose the data to include in reports and
whether or not to include baselines.
Channel
Channel Section
Show Cursors
TOF (Train of Four) Analysis Window Setup
275
The analysis window can be used to display a trend of a variety of numeric measures of
the train of four responses such as Response Count, TOF%, and T1%. The window can
also be switched to show a Histogram view of the last acquired train.
Create TOF Analysis

1. In Procedure Setup, add a mode with the mode type Train of Four and name it.
2. In the View section, or from View Setup in the Edit menu of an open procedure,
checkmark the new mode Train of Four Analysis option.
3. To make changes to its default options, click Window Setup.
Options
Display Mode
Table View: Displays a numeric trend of the measures selected in the Shoe area of
the window setup.
Histogram View: Displays select data in a graphical form
Show
Count: A count of the number of responses in the train of four.
Amplitude: Calculations of TOF% and T1% are based on the amplitude of the
responses.
Area: Calculations of TOF% and T1% are based on the area under the curve of the
responses
TOF% = amplitude or area increment or decrement between the first and the
fourth response in the train. If no fourth response is detected this value will
always be 0%.
T1% = amplitude or area increment or decrement between the first response in the
most recent train to the first response in the baseline train.
Baseline: Displays the baseline traces in the window.
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Procedure Setup
3D Trend Window Setup

On a 3D mode window, right-click and select Setup to display the setup dialog for this
window. Click the Default button to set the Trace to the first channel in the mode. This
sets the sweep to default, which tracks the mode’s sweep setting, and sets the Gain to 2.
Show
The Show section allows you to select the following options:
• Labels: Shows/Hides the axis unit labels.
• Trace Name: Shows/Hides the label of the trace displayed.
• Graticule: Shows/Hides the values for all three axes.
• Baseline: Shows/Hides the baseline trace. When baselines are selected
they are automatically placed at the bottom of the selected trend window.
Waveforms
The Waveforms section allows you to select the following parameters:
• Trace: Selects which trace is displayed.
277
• Sweep: Specifies at what sweep to display the traces. Note that this value
does not affect the mode sweep setting. Select Default if you want the
sweep to track the mode sweep setting.
• Gain: Specifies the display gain for the trace.
• Trend: Specifies how many minutes the Z-axis displays.
• X/Y/Z Divisions: Specifies how many divisions each axis displays.
Rotate/Tilt
Lock Position: If checked, you cannot change the graticule orientation by
dragging the corners.
Rotate/Tilt: Allows you to change the orientation of the graticule.
Cursor
baseline traces.
Waterfall Window
The Waterfall Window displays the stored traces for a determined amount of time (trend
time), in a two-dimensional stack. Time (in minutes) is displayed on the Y axis. The
sweep speed is on the X axis. The traces can be trended in ascending or descending
modes. The ascending mode, the most recent stored trace appears at the bottom of the
graph and moves upward as new traces are added to the stack. The descending mode,
the most recent stored trace appears at the top of the graph and move downward. The
current time of day is displayed at the top (descending mode) or bottom (ascending
mode) of the Y axis.
278
Procedure Setup
Add Marker
window.
Amplitude Markers
Window Setup
Please see Waterfall Trend Window Setup
Global Window Setup
Please see Global Waterfall Window Setup
Set Baseline
279
Copy
Print Report
Window.
Output to ASCII
Global Summary Window Setup

Use the selections in this window to change common settings for all Summary windows
window while running a procedure, and is not accessible from the procedure setup
screen.
280
Procedure Setup
Show
Baseline Trace
Graticule
Division Units
Events
281
Trial Number
All Trial Times
Channel Names
window.
Waveforms
Display Sweep
Cursors
baseline traces.
Channels
Show Cursors
Global Waterfall Window Setup

Use the selections in this window to change common settings for all Waterfall windows
window while running a procedure, and is not accessible from the procedure setup
screen.
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Procedure Setup
Show
Minutes Labels
Shows/Hides the axis minutes labels.
Baseline Trace
Trace Name
Trace Name or Feature Label displays the name of the feature within the graph.
Graticule
Division Units
Waveforms
• Trace: Selects which trace is displayed.
283
• Sweep: Specifies at what sweep to display the traces. Note that this value
does not affect the mode sweep setting. Select Default if you want the
sweep to track the mode sweep setting.
• Gain: Specifies the display gain for the trace.
• Trend: Specifies how many minutes the Z-axis displays.
• Order (time): The traces can be trended in ascending or descending
mode. In ascending mode, the most recent stored trace appears at the
bottom of the graph and moves upward as new traces are added to the
stack. In descending mode, new traces appear at the top of the graph and
move downward. The current time of day is displayed at the top
(descending mode) or bottom (ascending mode) of the Y-axis.
Cursors
baseline traces.
Test Setup
Tests define an Amplifier setup. When you switch tests, you are changing the amplifier
setup and the available acquisition modes. While running a procedure, the user may
only run the modes that are active for the test being run. In procedure setup, the user
may only edit modes that are active for the test they are setting up.
Access
Test Setup can be accessed from the top of the Procedure Setup page or from within the
Channel Setup page. Within the Channel Setup, you may change the System Type from
the Cascade Elite to the Cascade DSP-100 or the Cascade DSP 150, if need be.
Options
Test Setup allows you to choose the active modes and default start view, and add or
rename a test. Unchecking a mode makes it inactive and removes that mode from the
DSP utilization checking.
To add a test:
1. Click Add Test.
2. Name the test.
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Procedure Setup
3. Copy channels and names if desired.

4. Click OK.
5. Specify Active Modes and Default Start View.
6. Click OK.
Other Setup
System Type The DSP Speed drop-down box allows you to select the speed grade of the
DSP processor. The resource utilization is computed based on the selected DSP speed.
All new Cascades come with the DSP-150. Set the system type to Cascade Elite .
Channels 17-32 and the 16-input pods are only available when the system type is set to
Cascade Elite. The software automatically detects the system type when starting a new
procedure.
Edit Groups
Edit Events Add or edit event descriptions and priority. To use an event not listed, enter
comments with the necessary event information during the procedure. Click OK.
Timer Intervals Two timers allow modes to start on a specified interval. The interval can
be defined in Procedure Setup or from the mode control view, and its value is stored in
the Procedure Setup file. For example, if Timer1 interval is set to 60 seconds, and the
Run All button is clicked, the modes run until their average count is reached. The trial
will be stored, cursors placed, and the averager cleared. When 60 seconds has elapsed
from when the last mode in the group has completed, the modes start again. If the Run
All button is turned off, the timers are paused. A Clear Timer function is available in the
Mode Control View. These selections are only available for EP modes.
Mode Groups
You can group modes together and perform common functions such as start, stop, store
and clear on several modes at once. When a mode group is setup, a Mode Control box
for that group will be available in the Mode Control window. When you select start,
stop, store or clear for a group, it is the same as performing the selected function on all
of the modes in that group.
Modes in groups continue to run according to their Run Mode type as set in the mode
control box. Modes set to the Automatic run mode type will automatically store data,
285
clear the active traces and restart data acquisition when the group cycles. Modes set to
the Manual run mode type will simply stop data acquisition when the group cycles.
To setup a mode group, select the GrpSetup button in the Mode Controls window while
running a procedure or choose the Edit Groups option in the Mode Groups menu in
while in Procedure Setup.
Begin by clicking the Add Group button. Name the new group and select the modes to
be included in the group by placing check marks next to the name of the mode in the
Modes Included in Group area. Modes using the MEP mode type may not be added to
groups.
The system can be setup to automatically change views when a group is started. Select a
view from the list in the Default Start View drop down menu. The default option is for
the system to not change views when a groups starts.
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Procedure Setup
DSP Utilization Meter

If the resource utilization meter is below 100%, the procedure can be used on any
DSP. If the resource meter is 100% or greater for the DSP-100, but less than 100%
for the DSP-150, the procedure can only be used on units equipped with the
Cascade DSP-150 or the Cascade Elite.
If you attempt to start a procedure which requires the Cascade DSP-150 on an
instrument equipped with the Cascade DSP-100, the procedure will not be started,
and an error message displays: "This procedure cannot be run. Please make sure
that the DSP software is up-to-date and the procedure’s DSP utilization is less
than 100%. The DSP utilization can be reduced by using fewer modes and
channels, increasing sweep speeds, and turning off notch filters. To edit the
procedure’s setup file, click OK."
You can determine the DSP speed grade by selecting About Cascade from the
Help menu. The first row in the device list displays the DSP information. It will
display either "Cascade DSP-100" or "Cascade DSP-150."
The DSP Utilization meter indicates whether the DSP (digital signal processor) is
capable of performing the requested procedure. When the limit of 100% is
reached, you must eliminate channels, change sweep speeds, or turn off notch
filters before the procedure can be saved.
NOTE: The Cascade Elite uses the DSP type of the actual hardware that is plugged in
when a procedure is started, regardless of the DSP type that was used when the file
was created. The current hardware has no bearing on a setup file that is being created,
and the setup dialog is unaware of the hardware, so the combo box cannot be changed
to match the hardware. The default value is DSP 150. Whenever a DSP type is selected
explicitly by the user or implicitly by starting a procedure (which selects the hardware
that is plugged in), the new value is stored in the registry and opens by default the next
time the setup dialog is opened.
Mode Group Cycle

The Cascade can be setup to automatically cycle from one mode group to another
allowing you to spend more time monitoring and less time manually operating controls.
For example, the Cascade can be set up to automatically cycle through a four-limb SEP
group, a bilateral BAEP group and a train-of-four group while automatically displaying
the view appropriate for the running group. When running in cycle mode, the system
simply starts and stops a group. The run mode properties of the individual modes
continue to be observed.
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Once programmed, starting fully automatic data acquisition using the Mode Group
Cycle feature is as simple as clicking the Cycle button in the Mode Controls window.
To set up the Mode Group Cycle, simply include a group in the cycle by checking the
Include Group in Cycle check box.
The Mode Group Cycle feature also allows you to customize the trigger for moving from
one group to the next – the Cycle Condition. By default, the Cascade cycle condition is
to advance to the next group when the average count for all modes in the group reaches
completion. To change the cycle condition that advances the system from one group to
the next, change the settings in drop-down boxes in the Group Cycle Properties area.
See below for examples of different group cycle conditions.
To set the view to be displayed when the system switches to a group, select the name of
the view in the Default Start View drop down box. The default setting, “No Change,”
will leave the view unchanged during run time when the cycle moves from one group to
the next.
To change the order of the groups the system cycles through, click the Set Group Cycle
Order button. In the Group Cycle Order Setup dialog, move a group up or down in the
order by highlighting the group and selecting Move Up or Move Down respectively.
Reset the order of the groups to the order the groups were created by selecting the Reset
Order option.
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Procedure Setup
NerveGuard Procedure Setup

In the EMG Mode Setup During Data Acquisition:
Set EMG threshold levels - NerveGuard determines screw threshold by detecting
activity in the triggered EMG channels based on the EMG thresholds set by the
user. Because the baseline amplitude of the EMG signal will vary from patient to
patient, EMG thresholds should be adjusted relative to the baseline EMG for each
patient prior to testing. EMG thresholds should be set just above the level of the
baseline activity. The Threshold Setup option is available in the right-click menu
of EMG mode. A visual indication of the threshold levels can be turned on using
the Threshold Markers option in the right click menu of the EMG.
A threshold setting too near to the baseline amplitude of the EMG will give false
positive readings. A threshold setting too large will result in high thresholds.
NOTE: The threshold setting numbers in the Setup EMG Threshold window are baseline
to peak as opposed to peak to peak.
These tips will help you create a procedure setup file that will perform accurate, easy
and swift pedicle screw threshold testing:
In the Procedure Setup File:

1. Click Channel Setup.
2. Assign Channels. Set Gains to a level appropriate for the amplitude of the
baseline EMG activity. An amp gain setting of 50uV is ideal for quiet, low-
noise EMG recordings. Click OK. (To change display gain, see step 8).
3. Add a Mode.
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4. In the Mode Settings Setup, choose Stimulator.

a. Select a triggered EMG mode.
b. Assign an appropriate electrical stimulator to the triggered EMG mode. (A
stimulator that supports current sensing is required: ES-5-20, ES-16 or ES-500).
c. To avoid false positives from stimulus artifact:
i. Check Suppress Audio During Stim
ii. Set the Duration to 10 mSec
iii. Check Remove Stim Artifacts
5. In the Mode Settings Setup, choose NerveGuard.
a. Set the Intensity Criteria by selecting the colors used to indicate threshold
ranges. Intensity Criteria determines the color displayed in the control box
and sets the start and max stim levels.
• Max - sets the maximum stimulus intensity the NerveGuard
software will deliver and the stimulus intensity at which
NerveGuard will report NR (no response). This should be less
than or equal to the maximum stimulus intensity set in the stim
setup above.
• Yellow-Green Boundary – sets the upper limit of the yellow
threshold boundary and the lower limit of the green threshold
boundary.
• Red-Yellow Boundary – sets the upper limit of the red threshold
boundary and the lower limit of the yellow threshold boundary.
• Start - sets the stimulus intensity at which NerveGuard starts.
• Starting Zoom State Determines what image the Spine Graphic will
display. Options are Lumbosacral, Full Spine, Thoracic and
Cervical.
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Procedure Setup
• Intensity Increment Determines the increments (in milliamps, mA)

that the program will use when it increases the stimulus intensity.
• Detection Mode Sets the program to run in “Screw Test”,
“Continuous” or "Fixed" mode.
• Start and Max Sets the start and maximum intensities when
running in Fixed stim mode.
b. Choose an appropriate NG Rep Rate (repetition rate) for the stimulator.
Typically 8 Hz is utilized for NerveGuard pedicle screw stimulation.
However, if you plan to leave your SEP modes running while using
NerveGuard you should choose a repetition rate that matches the rate used
by the SEP modes, such as 2.66, 2.79, 2.92, 3.63, or 4.13 Hz.
c. Verify that the maximum current setting in the stim setup is as high as, or higher,
than the maximum intensity on the NerveGuard intensity criteria.
6. In the Mode Settings Setup, choose Trace Labels.
a. Set every Field to None to turn off amplitude and peak latency trace labels
to ensure the fastest threshold detection. If left on, these labels can slow
down the program.
7. In the Mode Settings Setup, choose General.

a. Set the Sweep of the Triggered EMG mode to the desired setting. A sweep
speed of 8-10 msec/div is typical.
8. In the Views section, highlight Live: EMG and click Window Setup.
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Verify that all channels are checked on (Hidden channels will cause false
positive results).
Click Use Display Gains and use the dial to change display gains.
NOTE: To access EMG Window Setup from a procedure, right-click a mode and
click Window Setup.
Other Helpful Tips:
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Procedure Setup
• To hear free-running or triggered EMG audio and threshold tones, make sure
the Mute box is un-checked at the top of the Mode Controls window and that
the volume knob is adjusted to an appropriate level.
• Set the EMG amplitude threshold setting to an appropriate level. See Running
NerveGuard for more information.
• If you will be using a high output stimulus (i.e., up to 100 mA maximum), you
should limit the maximum intensity setting to 25 or 30 mA.
• The following settings, Wave/Beep on Threshold and Autocapture on
Threshold, are active in NerveGuard and do not need to be turned on in order
for NerveGuard to work properly. If you want to utilize these features
outside of the NerveGuard program then they should be enabled.
• The Autostore on Threshold feature is not needed for NerveGuard to
function. NerveGuard always stores one triggered EMG waveform for each
threshold event. However, if you would like the triggered EMG traces
collected during the free-run EMG in NerveGuard or in standard Cascade to
be automatically stored upon threshold crossing, then you should enable this
feature.
Stimulators
Electrical Stimulators
ES-IX Stimulator (Cascade PRO and Elite only)
ES-IX stimulators are available for EP, MEP, TOF, and Triggered EMG modes. See
Configuring the ES-IX for additional details about setting up the ES-IX.
The following options are available in some or all mode types:
• Rep Rate: repetition rate in Hz. The number of times per second the stimulator
will fire.
• Label: stimulator label, such as Lt Tibial
• Stim Number: stimulator number, such as Channel 1 to 16, and Low Output 1 or
2. Channels 9-16 and Low Output 2 are only available when two ES-IX
stimulators are connected to the base unit.
• Pulse Width: range is 50 to 1000 usec.
• High Current Outputs – Each high current output can output from 0 to
100mA, 400 V maximum, with 0.5 mA resolution below 20 mA and 1
mA resolution above 20 mA.
• Low Current Maximum Output – The low current output is used to
provide more precise adjustment of low level output currents than
offered by the high current outputs. The low output of the ES-IX can be
configured to four modes of operation. The amplitude resolution for
each of the four modes is as follows:
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• - 5 mA constant current (0.01 mA resolution)

• - 20 mA constant current (0.1 mA resolution)
• - 5 V constant voltage (0.01 V resolution)
• - 20 V constant voltage (0.1 V resolution)
• Train Stimulation (Available only on the Cascade Elite. Modes with this
option checked on will be disabled until the train stimulation is unchecked)
o Train length (# of pulses): the length of the train in number of pulses.
o ISI (ms): the interstimulus interval between stim pulses. Measured in
milliseconds.
• Train (available only in the EMG mode type)
o Rep Rate: the frequency of the train in Hz.
o Duration: the duration of the train in seconds.
• Multipulse Stimulation
o In addition to standard single-pulse reprate stimulation and EMG train
stimulation, the ES-IX can perform repetitive multipulse stimulation
1.
o When the Multipulse Stim box is checked, the multipulse options become
available. You can create multipulse trains up to 10 pulses with interpulse
intervals from 0.5 to 10 ms. These short trains will be repeated at the Rep
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Procedure Setup
Rate specified in the Rep Rate box on the left side of the ES-IX Stimulator
Setup dialogue.
Current and Voltage Feedback – The Cascade will display current delivered to
the patient when using the ES-IX in any constant-current mode. The voltage
delivered is displayed for the low output in constant-voltage mode. This
assists the practitioner in assessing the quality of the stimulator to patient
connections.
Daisy Chain – Two ES-IX stimulators may be attached together to provide a total
of 16 high current and 2 low current/voltage outputs. This both provides
additional outputs and allows the placement of an ES-IX near the head and
another near the feet of the patient.
Electrical Stim Splitters

Electrical Stimulators are available for EP, MEP, TOF, and Triggered EMG modes.
The following options are available in some or all mode types:
• Rep Rate: repetition rate in Hz. The number of times per second the stimulator
will fire.
• Label: stimulator label, such as Lt Tibial
• Stim Number: stimulator number, such as 1 to 16, Low1, or Low2
• Pulse Width: range is 50 to 1000 usec.
• Max Intensity: range is 25 to 100 mA for high current outputs. Range is 0-5, 0-10,
or 0-20 mA for low current outputs depending on the type of splitter box being
used.
• Train Stimulation (Available only on the Cascade Elite. Modes with this
option checked on will be disabled until the train stimulation is unchecked)
o Train length (# of pulses): the length of the train in number of pulses.
o ISI (ms): the interstimulus interval between stim pulses. Measured in
milliseconds.
• Train (available only in the EMG mode type)
o Rep Rate: the frequency of the train in Hz.
o Duration: the duration of the train in seconds.
TCS Stimulators
The TCS stimulators are constant voltage electrical stimulators intended for the
performance of Motor Evoked Potential studies. Connection to the Cascade is made via
an auxiliary cable connected from one of the auxiliary ports (Aux 1, 2 or 3) on the back of
the Cascade to the TCS device. Operation of the TCS is controlled through the Cascade
system software.
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Do not connect TCS output leads to anywhere other than the head. This eliminates
the potential for transthoracic currents in any failure mode.
Single-output Transcranial Stimulators (TCS-1/TCS-1000)

The TCS-1/TCS-1000 connect to the patient via one stimulus output pair consisting of
one red and one black DIN electrode jack. The “normal” polarity setting delivers
stimuli with the red output as anode (+) and the black output as cathode (-). The
“reverse” polarity setting delivers stimuli with the red output as cathode (-) and the
black output as anode (+).
TCS-1
The following stimulus options are available for the TCS-1 stimulator:
• Train Length: The TCS-1 supports multi-pulse train stimulus and single pulse
stimulus. The train length setting specifies the number of stimulus pulses delivered in
each train; the range is 1 to 9.
• Inter Stimulus Interval (ISI): The time from the start of one stimulus pulse to the start
of the next stimulus pulse within a train. The range is variable from 1.0 to 9.9
milliseconds (ms).
• Maximum Intensity: 800 volts; variable in 2 volt increments. The maximum intensity
may be set independently for each mode in the procedure setup file that uses the TCS-1.
• Repetition Rate: No repetition rate is needed or available for MEP mode types. The
repetition rate may be set from 0.5 Hz to 1.0 Hz when using the TCS-1 with EP and EMG
mode types.
• Stimulus Pulse Width: 50µs (0.05 ms) fixed.
• Double-Train Stimulation: Delivers two trains of stimulation with a user-selected
inter-train interval.
The built in safety limits on the TCS-1 limit the stimulus parameters to combinations of
train length and intensity described in the chart below.
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Procedure Setup
All of the stimulus settings (except Pulse Width and double-train) can be changed within
the Mode Controls window.
TCS-1 TCS-1000
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TCS-1000
The following stimulus options are available for the TCS-1000 stimulator:
• Train Length: The TCS-1000 supports multi-pulse train stimulus and single
pulse stimulus. The train length setting specifies the number of stimulus pulses
delivered in each train; the range is 1 to 9. There is no train length/voltage
limitation on the TCS-1000.
• Inter Stimulus Interval (ISI): The time from the start of one stimulus pulse to the
start of the next stimulus pulse within a train. The range is variable from 1.0 to
9.9 milliseconds (ms).
• Maximum Intensity: 1000 volts; variable in 2 volt increments. The maximum
intensity may be set independently for each mode in the procedure setup file that
uses the TCS-1000.
• Repetition Rate: No repetition rate is needed or available for MEP mode types.
• Stimulus Pulse Width: 50µs (0.05 ms) & 75µs (0.075ms).
• Double-Train Stimulation: Delivers two trains of stimulation with a user-
selected inter-train interval.
Multiple-output Transcranial Stimulator (TCS-4)

The TCS-4 connects to the patient via up to four stimulus output pairs, each consisting of
one red and one black DIN electrode jack. The “normal” polarity setting delivers
stimuli with the red output of the active channel as anode (+) and the black output of the
active channel as cathode (-). The “reverse” polarity setting delivers stimuli with the red
output as cathode (-) and the black output as anode (+). The anode jack of the active
channel is designated by a solid lit LED.
Always connect channel 1 of the TCS-4. This channel has the patient static
equalization circuit for the stimulator. Failure to connect the patient to the anode jack
on channel 1 of the TCS-4 may result in electrostatic discharge just prior to the
stimulation pulse, which may cause excessive stimulation artifact.
TCS-4 Options
The stimulus options for the TCS-4 stimulator are the same as for the TSC-1000, but with
four user-selectable channels. While the TCS-4 provides the ability to connect four
stimulating channels to the patient, only one output channel can be active at any given
point in time. For the TCS-4, all of the stimulus settings, including the output channel
number (except Pulse Width and double-train) can be changed within the Mode
Controls window.
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Procedure Setup
TCS-4 LEDs
There are eight multi-purpose LEDs on the side faceplate of the TCS-4, one for each
output jack.
There are four potential states for the LEDs, each of which is detailed here.:
1. All LEDS off: no active TCS-4 channel. If an MEP mode is not active, none of the
channel LEDs will be on, even if the TCS-4 is connected to the base and the
power LED of the TCS-4 is on.
2. Each LED blinks once in sequence from left to right as the TCS-4 conducts a
brief self-test. This self-test is initiated automatically each time an MEP mode
becomes active after a period of inactivity (e.g., when a Test containing an MEP
mode is selected or when coming out of Mode or Channel setup menus).
3. A single solid LED indicates the anode of the active output channel.
4. Indicators for an Anode/Cathode pair blink three times rapidly when this
channel is triggered.
Auditory Stimulator
Auditory Clicks are available for EP modes. The click stimulus is generated using a fixed
pulse width of 100 microseconds. The following options are available:
Polarity: The polarity may be set for rarefaction, condensation, or alternating
phase clicks.
Intensity Range: -10 to 100 DB NHL.
Side: Select Left, Right, or Both.
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White Noise Masking: Noise masking may be turned on and off by the operator.
Only differential mode masking is implemented in auditory protocols. Differential
masking is set for the ear contralateral to the stimulated ear.
Masking Level: The masking level is determined by subtracting the differential
masking level from the stimulus level. The range is 0 to 60 dB.
Start Intensity: The range is -10 to 100 dB; the default is 80.
Inserts: When this option is selected, 1 ms is subtracted from cursor latency values
throughout the system.
Only the intensity is available in the Mode Control Dialog. In the popup Mode Setup
dialog the RepRate, Polarity, Masking on/off, and Mask intensity is available.
If two or more modes are running (interleaving) with clicks in different sides, masking is
turned off.
Visual Stimulators
Two types of visual stimulators are available for EP modes only.
Goggles
Goggles have LED’s (lights) can flash on the right side, left side, or both sides at
once. You can select Left, Right, or the Both option for this stimulator.
LED Checks
This is a 3-inch, hand-held, red/black, reversible checkerboard pattern.
Video Checks
This is for use with a black and white video monitor. Check size is selectable. Must
be a CRT monitor.
Paired Stimuli
Paired stimuli are available for EP, EMG and MEP modes. The first stimulation primes a
muscle for motor cortex stimulation. In MEPs, paired stimuli allow TceMEP Peripheral
Facilitation, and are used to perform “Andersson” and “Tetanic” peripheral
stimulations. Paired Stimuli cannot be used with the Cascade 16 channel base. The DSP
(digitial signal processor) does not support it.
Set Up Paired Stimuli

1. From an active patient file, open Edit Procedure Setup or Current Procedure
Setup.
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Procedure Setup
2. In the Mode Settings, Stimulator section, choose Paired Stimuli from the Stim
Type drop-down list.
3. Click on the Setup Stim button. The Paired Stimuli Setup will open.
With the Peripheral Facilitation selected, the Rep Rate and Stim Types are static.
Paired Stimuli defaults to Electrical and TCS-1 stim types.
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Uncheck the Peripheral Facilitation box to change the Stim Types using the drop-
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Procedure Setup
down lists.
4. Click on the Setup Stim button for Stim 1 to access the stimulator setup window.
See examples for stim types below.
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5. Click the OK button to save and exit stim setup.

6. Repeat steps 4 & 5 for Stim 2.
7. Click the OK button to save and exit Paired Stimuli Setup.
8. In the toolbar, open the File menu and select Save.
9. Click the OK button to save and exit Edit Procedure Setup.
10. Proceed with the recording.
Use Paired Stimuli in Mode Type

The stims will appear in the Mode Controls window.
The dual intensity knobs, pulse number, pulse width, ISI and ITI controls will be set
according to the options programmed during stim setup.
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Procedure Setup
For the fields in the Mode Controls and the options in the stim setup dialogs, use the
following ranges:
Frequency control: 50 - 1000 Hz
Estim ISI: 2 – 15 msec
Estim Pulse Count: 1 - 10
TCS-1 and CV-2 ISI: 1 - 9.9 msec
TCS-1 and CV-2 Pulse Count: 1 - 9
Number of seconds: 1 – 20 msec
ITI control: 1 – 100 msec
Pulse width: 50 - 1000 msec
Some combinations may result in later stim pulses that do not deliver full stimulation. A
notification will automatically pop up during setup. If overridden, and if stim pulses are
not at full intensity, this yellow icon will appear in the Mode Control during the
procedure.
Cascade EEG and EEG Analysis
Example EEG Analysis Windows
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CSA with 97% Spectral Edge

This example shows 8 channels of EEG displayed in a CSA format. The trend time is 5
minutes, the frequency range is 1.5 to 30 Hz. The Spectral Edge is plotted as a yellow
line.
DSA, rainbow color scale:

8 channel DSA display using the rainbow color scale. Trend time is 10 minutes,
maximum DSA power scale is 10 pW. Frequency range is 1.0 to 20.0 Hz. Note the
increased Alpha frequencies in the temporal and parietal-occipital channels over the last
4 minutes.
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Procedure Setup
DSA with Symmetry

Symmetry is shown down the middle of the display. The absolute difference between
each channel on the Left and its corresponding channel on the Right is calculated for
each frequency bin (Left minus Right). The Symmetry trend is always shown with a
Red-Black-Blue color scale. Red indicates that the channel on the Left has more power at
the corresponding frequency than the channel on the Right. Blue would indicate that the
channel on the Right has more power at that frequency than the channel on the Left.
In this example, the P3-O1 channel has more power in the alpha frequencies than the P4-
O2 channel.
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Z-Score
This display shows the Zscore values for 8 channels. The Zscore is a comparison of the
current EEG epochs to the most recent Baseline. Red colors indicate frequencies that are
increased compared to the baseline. Blue colors indicate frequencies that have decreased
compared to the baseline. A Z score of 1 corresponds to a difference of 1 standard
deviation between the current epoch and the most recent Baseline.
In this example, Alpha and Beta frequencies have shown an increase over the last 4
minutes in the temporal and parietal-occipital channels.
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Procedure Setup
Trend
This display shows a 5 minute trend of Relative Alpha Power for each channel. The
trend shows an increase in alpha power in the temporal and parietal-occipital channels.
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EEG Windows
EEG Windows:
When an EEG mode is added to a procedure setup, the View window list is
automatically updated to include the Live EEG window and the EEG Analysis window.
Live EEG Window
This window displays the Live EEG data in a sweeping fashion from left to right
across the window. When this window is active, the EEG toolbar is displayed at
the top of the screen. The toolbar has controls for changing the Display Gain and
the Sweep Speed of the window.
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Procedure Setup
Display Gain units (microvolts per vertical division)

Sweep Speed units (milliseconds per horizontal division)
Live EEG Right-click menu
Run – starts and stops the EEG traces.

Window Setup - see below
Trace Labels – turns Off/On the channel labels, i.e., P4-O2.
Setup – displays the EEG mode setup window (see below).
Copy – copy the window to the clipboard so it can be pasted into other Windows
applications.
Print – displays the Print Report menu.
Live EEG Setup menu
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Controls in this window are used to toggle the trace labels, graticule or division units
Off or On. The sweep speed can be adjusted as well as the individual channel display
gain settings.
EEG Analysis Window

The EEG Analysis window displays analyzed EEG data in several formats. When the
Live EEG mode is running the EEG data is sampled every 10 seconds. An FFT (fast
fourier transform) is performed on the sampled epoch and the resulting frequency and
power information can be displayed in a variety of formats. The Setup menu is used to
determine the type of display format.
NOTE: You can make a copy of the Analysis window and have one window setup to
display DSA data and have the other window setup to display CSA data simultaneously
in the same View.
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Procedure Setup
EEG Analysis Setup Menu
EEG Analysis Setup menu

General and Scale Settings:
View – select CSA, DSA, Symmetry or Trend for the data presentation type.
Frequency Range (Hz) – select the low and high frequency limits for the
horizontal axis. The lowest setting is 1.0 Hz, the highest setting is 30 Hz.
Trend Time – determines the amount of data that is displayed in the
vertical axis, i.e., the last 10 minutes.
Channel Labels – turns the channel labels On or Off in the window.
Spectral Edge – turns the spectral edge indicator On or Off and selects the
spectral edge frequency value (50, 90, 95, 97 or 99 %). Spectral edge is
always determined for the total frequency band of 1 – 30 Hz.
Reject – turns the artifact reject algorithm On or Off and selects the
threshold level for the reject in picowatts (pW). The reject is based on the
total power contained in the sampled epoch. If the total power in the
epoch exceeds the reject level then the data for the epoch is not
displayed and is replaced by a small “yellow” dash for that point in time
in the window.
DSA Smoothing – only functions when the DSA view has been selected.
DTAB (DSA) – only available when the DSA view has been selected and
DSA smoothing is Off. This setting causes the DSA trends to be
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displayed in discrete frequency bands of Delta (1-3.5), Theta (3.5-7.5),

Alpha (7.5-12.5), Beta (12.5-25), and High Beta (25-30) Hz.
Voltage – changes the analysis window to display voltage (microvolts).
Power – changes the analysis window to display power (pW or microvolts
squared). Power is the most common setting to use for CSA and DSA
displays.
Zscore – changes the analysis to display the difference (in z-score units)
between the trended data and the most recently selected baseline. Most
commonly used with DSA displays. A Z score of 1 corresponds to a
difference of 1 standard deviation.
As Recorded – when this box is checked, the display will be shown exactly
as it was setup during the recording. When this box is unchecked, you
can change the setup choices and review the data differently than it was
originally recorded.
CSA Scale – used to increase or decrease the height of the CSA plots.
DSA Max Voltage – used to set the top level of the color scale when
displaying DSA Voltage trends.
DSA Max Power – used to set the top level of the color scale when
displaying DSA power trends.
Channel Settings:
Use the check boxes to add or remove channels from the display.
When the Symmetry View is selected you can specify the channels that are to be
compared. Simply click & drag the appropriate channel label to the desired
location to create the pairs that will be analyzed for symmetry. To remove a
channel from a pair, drag the channel label to the trash bin.
Note: Symmetry is a trend showing the absolute difference between the channel
on the left vs. the channel on the right.
Trend Settings:
Trend - when the Trend View is selected these controls can be used to select
the type of data to be trended. Select from Total Power, Absolute Power,
or Relative Power. When either Absolute or Relative power are selected
the frequency band can also be selected (Delta, Theta, Alpha, Beta,
Delta+Theta, or Alpha+Beta).
Range (pW) – sets the maximum limit for the horizontal (x-axis) of the trend
displays.
DSA Colors:
When the DSA View is selected these controls can be used to select the color scale.
Z Score Colors:
When the DSA View + Zscore item is selected these controls can be used to select
the Zscore color scale.
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Procedure Setup
EEG Analysis Right click menu:
DSA – toggles the analysis window to show DSA (Density Spectral Array) trends.
CSA – toggles the analysis window to show CSA (Compressed Spectral Array)
trends.
Symmetry – toggles the analysis window to show DSA trends with symmetry
trends plotted down the middle.
Trend – toggles the analysis window to display power trends.
Set Baseline – used to enter an EEG Baseline event. When selected a comment box
will appear that allows a short comment to be tagged to the baseline event.
Setup – displays the EEG Analysis setup window.

As Recorded – when checked, sets the display to the same settings that were used
during the recording.
Copy – copy the window to the clipboard so it can be pasted into other Windows
applications.
Print – displays the Print Report menu.
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Remote Monitoring
Introduction
What is Remote Monitoring?
Remote Monitoring is an optional program feature that allows a remote Reader station
to simultaneously view the same data that is being acquired and displayed on the
Cascade in the operating room. The remote Reader can be located within the same
building, it can be located across town, or it can be located in another state. One Reader
station can remotely view up to three different Cascades at one time.
Remote monitoring is a server/client application and uses the DCOM (Distributed COM)
architecture that is built-in to the Windows(TM) operating system. The Cascade acts as a
server while the Reader acts as a client and periodically requests updated information
from the Cascade.
Cascade program features that are supported on the remote Reader are described below,
as well as a few that are not. The next section briefly describes some of the possible
connection scenarios that can be used to accomplish remote monitoring.
What can you do on the Remote Reader?

With the Cascade’s built-in Remote Monitoring, the Remote Reader can do the
following:
1. Change Views independent of the acquisition Cascade. For example, the Reader
can look at trending windows while the technologist in the OR (Cascade) is
viewing EP Average windows.
2. Change trace display gain, trend counts, resize windows, etc. without affecting
the acquisition Cascade or the original data.
3. Review the procedure being monitored. The Reader can click anywhere along
the timeline and reset the display to show the data for that point of the
procedure.
4. Chat. A chat box can be used to send messages back and forth between the
Reader and the Cascade. This can be done without interrupting data acquisition.
5. Generate reports. The Reader has full report generation capability.
6. View Live EMG. With a fast connection, (i.e., across a local area network), the
EMG is essentially ‘real time” on the Reader. With a slow connection, (i.e.,
modem), EMG cannot be viewed on the Reader.
7. View Live Video. With a fast connection, (i.e., across a network), the Video is sent
about one frame every three seconds. With a slow connection, (i.e., modem), the
Video is only sent when the Reader requests a new frame.
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8. Connect to more than one Cascade. The Reader can monitor more than one
Cascade at a time, depending on the connection speed and system resources.
Three is the maximum number of Cascades that can be monitored on one Reader.
9. Change the display properties. The Reader can change window and trace colors
independently without affecting the acquisition Cascade or the original data.
10. Review previously recorded cases. The Reader systems may also review
procedures that have already been recorded by opening that file in the review
mode. The file can be copied to the local hard drive of the Reader system or
viewed over a LAN. Cascade files with a Read Only attribute, such as files on a
CD, cannot be read from either the Cascade system or the Reader system. They
must be copied from the CD back to the hard drive and have the Read Only
attribute removed.
What can't you do on the Remote Reader?

Some things the Remote Reader cannot do:
1. The Reader cannot take control the Cascade. For example the Reader cannot
make the Cascade start or stop data acquisition.
2. The Reader cannot make changes to original acquisition parameters, (i.e., filters,
or test montages).
3. The Reader cannot move cursors on the traces. However, the Reader can use the
time and amplitude markers independent from the Cascade.
4. The Reader cannot edit or change the patient information.
5. The Reader cannot view Live EMG on a slow connection, (i.e., 56k modem
connection).
6. No Audio. The Reader cannot listen to EMG activity regardless of the connection
speed.
Minimum Computer Requirements*

The computer used to run the Cadwell Cascade system is an integral part of the Cascade
neuromonitoring system. For optimum performance, use a computer that meets the
following criteria. Standard computers purchased from Cadwell will meet the listed
requirements.
• US and Canada regulatory requirements. Computer and information
technology equipment connected to the Cascade must be third-party certified to
UL1950 or IEC950.
• European Union regulatory requirements. Computer and information
technology equipment connected to the Cascade must be third-party certified to
EN60950.
• Performance requirements. These requirements represent the minimum
computer performance requirements necessary to run the Cascade. Your Cascade
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equipment will run better when used with a computer with a faster processor and
more RAM than listed here:
Operating System Windows 7. Note: Cascade v2.7 has not been tested on
Windows Vista or Windows Server.
Processor 2.7 GHz Dual Core, I7 processor
Hard Disk Drive 80 Gigabytes
Memory (DRAM) 4 GB
Archive Device Any Windows supported device
Graphics 1600 x 900 (1200); 64 MB (recommended); 1024 x 768 resolution; 16
MB, 32-bit color depth (supported, but not recommended), ATI Graphics
preferred
Network 10 Base-T Ethernet card; Second card (10/100 Base-T) required for
remote monitoring
Cascade remote connections will work on Windows 7 Professional. Cascade systems use
proprietary software to encrypt the data between the two computers for security.
Windows 7 Professional is the preferred operating system for Cadwell Cascade systems.
Windows 7 home edition does not have all the networking components automatically
installed. Cadwell tests Cascade software on Windows 7s Professional and recommends
using that operating system for Cascade systems.
*Excerpted from 300014-000 Minimum Computer Specifications and Requirements for

Cadwell Instruments
Connection Scenarios
Remote Monitoring Connection Diagrams
The following diagrams display connection scenarios known to work for Cascade
Remote Monitoring.
Cascade’s built-in remote monitoring feature was designed to be used on a Local Area
Network (LAN). On a LAN both the Cascade and Remote Reader systems are part of the
same network and can communicate with each other using their unique network IP
address or computer name. A very simple LAN can be created using a direct Dial-Up
connection between the two systems.
A Virtual Private Network (VPN) client can be used to connect one system, located
outside the network, to the network the other device is located on, thereby making it
seem that both systems are actually on the same network. The VPN client creates a
secure ‘tunnel’ through the Internet and the firewall/router at the network location,
thereby allowing the remote system to access the IP addresses of other computers on the
network. For obvious security reasons, a router/firewall typically hides the IP addresses
of network computers from the internet. Systems that are outside the LAN and do not
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use a VPN client to join that network may have trouble making a remote monitoring
connection.
Once the Cascade and Remote Reader are part of the same network, remote monitoring
can be initiated. There are two ways to initiate a remote monitoring session.
• Remote Reader connects to the Cascade – on the Remote Reader system start the
Cascade program and select “Connect to Cascade (server)” from the Remote
pull-down menu. Enter the Cascade’s IP address or computer name and click
OK.
• Cascade connects to the Remote Reader – this option requires software version
2.5 or higher. On the Cascade, start a procedure and then select “Connect to
Reader (client)” from the Remote pull-down menu. Enter the Reader’s IP
Address or computer name and click OK. Using this connection option requires
additional DCOM configuration settings on the Remote Reader.
Software firewalls, internet security programs, or virus protection software can also
block or interfere with Cascade Remote Monitoring connections. Please review the
Cascade Remote Monitoring document, in the Documents folder on the Cascade
installation CD, for configuration details.
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Peer to Peer on a LAN

Method #3: Network (Peer To Peer on existing LAN)
The Cascade and Reader can be connected in their own peer-to-peer network (using a
network cables and a hub connected directly between the two computers) or, they can
each login to a local area network within the same building. This method requires that
the Cascade have (2) network cards installed. Once the connections are established on
the LAN the user of the Cascade must determine it’s unique connection IP address and
provide this to the Reader. This is done using a Windows utility called WINIPCFG for
Windows 98 and IPCONFIG for Windows XP. The Reader can then connect to the
Cascade by entering this IP address in the Connect To Server menu. On a LAN the
Reader can often use the computer name of the Cascade system as well.
VPN into LAN
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Method #4 Via Internet using Virtual Private Networking (VPN)

The Cascade and Reader communicate over the Internet using a secure, encrypted,
communication protocol. This is established with the VPN (Virtual Private Networking)
connection. The Reader computer needs to have a VPN protocol installed and
configured, the type of protocol usually depends on the type of “firewall/router” that is
being used at the Cascade’s location. The VPN Reader software is provided by the
administrator for the LAN you are trying to access.
The Reader makes a connection to an Internet Service Provider (using a standard
modem, or cable/DSL modem), then, a VPN connection is established with the
“firewall/router” where the Cascade is located. Once the connection is established the
Reader can initiate a remote monitoring session with the Cascade.
Third Party Software

Method #5 Third Party Remote Software
Other programs such as PC Anywhere, NetMeeting, VNC, or Windows Messenger can
also be utilized. There are several disadvantages when using third party software
compared to Cadwell’s built-in solution, most notably, 1) the remote Reader PC is
restricted to only one view of the data, 2) the remote Reader has no ability to “look back”
through the record, and 3) the remote Reader PC has no ability to generate reports. 4)
Cadwell does not test third party remote connection software packages for reliability
and stability. It is recommended to use the Cascade built in remote monitoring software.
Setup Instructions
Setup for Remote Reader
1. Open the Network Connections window.
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2. Double click on the Create a new connection task located at the upper left
portion of the window. The Create New Connection Wizard will be started.
Click the Next button.
3. For the Network Connection Type, select Connect to the network at my
workplace. Click Next.
4. For the Network Connection, select Dial-up Connection. Click Next.
5. Enter a name for this dial-up connection. The name of the Cascade you are
calling (i.e., Cascade1) is recommended. After typing the name, click Next.
6. Enter the phone number for the Cascade you will be calling. If you need a “1”
for long distance or a “9” for an outside line, enter these as well. Click Next.
7. On the Completion window, check the box labeled “Add a shortcut to this
connection to my desktop”. Click Finish. The Dial-up Connection window will
open up automatically, just Cancel it for now.
When you are ready to make a connection, make sure both the Cascade and remote
Reader systems have the phone line plugged into the systems modem. Double click on
the connection shortcut on the remote Reader system desktop. Click on the Connect
button. Once the connection is established you can open the Cascade program on the
remote Reader system and open the case through the Remote pull down menu. See
Starting a Remote Monitoring Session for more details.
Peer to Peer on a LAN setup

Cascade 2nd Network Card & Reader Network Card
A Peer to Peer network is two or more computers connected together configured to
share resources and files. LAN, or Local Area Network is a several computers connected
together and configured to share resources and files. The rule of thumb is to set IP
addresses up in the same format on all systems in your network. If the remote Reader
system is configured to “Obtain and IP address automatically”, then the Cascade system
should be configured the same way. If an IP address is specified on one system then the
other systems should use similar IP addresses. Large facilities use a DHCP server to
automatically assign a computer’s IP addresses on their network.
Cascade 2nd Network Card & Reader Network Card
The Cascade system uses one network card to communicate with the Cascade hardware.
That network card is dedicated to this task. It is configured at Cadwell before the system
is shipped. For configuration instructions on this network card reference the “Network
Card Setup in Windows XP.doc“ document on the Cascade installation CD in the
Documents folder.
The second network card on the Cascade system, and the network card on the remote
Reader system are configured for a LAN and/or High Speed Internet connection. The
remote Reader will connect to the Cascade either through a LAN or an IP address on the
Internet. On a Cascade laptop computer this network card is usually a PCMCIA or PC
Express card that is inserted into the side of the laptop. In a small peer-to-peer network a
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specific IP Address needs to be assigned to the card. This address can either be manually
assigned or dynamically assigned by using a DHCP (Dynamic Host Configuration
Protocol). A DHCP server dynamically assigns the IP address to the card when the
computer boots and is connected to the network. The DHCP server assigned network
addresses can change over time. Follow the steps on the next page to manually assign an
IP address to a network card.
1. Start>Control Panel>Network Connections to open the Network Connections
window. Find the icon that corresponds to network card #2 on the Cascade
system.
2. Right-click on the Local Area Connection icon and select Properties.
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3. Make sure all of the check boxes are checked. Highlight the Internet Protocol
(TCP/IP) and then click the Properties button.
4. Select Use the following IP address. On the Cascade system for the IP address
enter 192.168.0.1 and 192.168.0.23 for the remote Reader system as an example,
click anywhere within the Subnet mask area and it will fill in automatically with
255.255.255.0. For systems using DHCP the “Obtain an IP address automatically”
would be used.
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5. When done entering the IP address click on the Advanced button.

6. Click on the WINS tab. In the NetBIOS setting area, select the Default option.
7. Click OK, click OK, click OK . Close the Network Connections window.
Internet Protocol (TCP/IP) properties needs to be configured on both the remote Reader
system and the Cascade system. Connecting the remote Reader system to the Cascade
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works best if they are on the same network. For this example the IP address the Cascade
systems IP address is 192.168.0.1 and the remote Reader system would be set to
192.168.0.2. With a subnet mask of 255.255.255.0 on both systems.
In a simple networking scheme the subnet numbers should match on all systems. Use
the subnet mask, 255.255.255.0. The last digit place (octet) in the IP address needs to be
different for each system. That is the number on the far right in the IP address. You can
use any numbers between 1-254. The other three octets should be identical on all
systems. Then both systems will have unique IP address on the same network. Both
system should be members of the same Workgroup and each system needs to have a
unique computer name.
Either the computer name or its IP address can be used to connect to the Cascade or the
remote Reader systems. The Browse button in the connection window looks for the
computer name on the network. If the IP address of the system you are making a
Cascade connection to is known, it can be used instead of the computer name to
establish a remote connection.
DCOM Configuration
Running on the Windows XP operating system requires specific settings to allow the
Cascade and the Remote Reader system to have different user names and passwords.
Follow these instructions to setup a Cascade system running Windows XP for remote
monitoring. Note there are extra settings for system running Windows XP service pack
2. The same settings apply to remote Reader systems if you are using the Connect to Reader
option.
Cascade uses distributed com to share its application. DCOM does not support SSL
firewalls.
Option A:
1. Click on the start button and select Run.
2. Type in C:\Cadwell\Cascade\Cascade DCOM Settings.reg
3. Click OK.
4. Click on the start button and select Run.
5. Type in C:\Cadwell\Cascade\DCOM My Computer.reg
6. Click OK.
These files are ran automatically during the Cascade software installation with
Cascade version 2.1.85 and later. Some times the settings need to be configured
manually to correct a DCOM error. In extreme cases you may need to go into the
C:\Cadwell\Cascade folder, double click on a file called "regsvr.reg". Click Yes
then click OK. Then right click on the file "Cascade.exe" and select Unregister
COM Server. Then right click again on Cascade.exe" and select Register COM
Server. The last step would be to follow the steps in Option B to manually
configure the DCOM settings.
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Option B:
1. From the Start menu, click Control Panel.
2. If the display is set to Category View, click “Switch to Classic View.”
3. In the Control Panel open “Administrative Tools.”
4. Open “Component Services.”
5. Double-click on “Component Services." It may take the system a moment to
respond.
6. Double-click on the "Computers" folder in the left window pane.
7. Right-click on the "My Computer" icon in the Component Services window and
select "Properties."
8. Click on the "Default Properties" tab.

a. Check the box to “Enable Distributed COM on this computer.”
b. Set the “Default Authentication Level” to None.
c. Set the “Default Impersonation Level” to Identify.
Note: Normally no changes are required on this tab. Some PCs will have a different
value for Default levels, which may interfere with report generation.
9. Click on the COM Security tab.

a. Click on the "Edit Limits" button under Access Permissions.
b. Select the listing for Anonymous Logon.
c. Check the Allow box for the "Local Access" and the "Remote Access"
boxes.
d. Select the listing for “Everyone”.
e. Check the Allow box for the “Local Access” and the “Remote Access”
boxes.
f. Click OK.
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Note: If the selection of Everyone and/or Anonymous is missing from the top add that
listing. (To add a user or users to one of the permissions windows click the Add button.
Then click the Advanced button. Next click the Find Now button. Locate and select the
user you want to add in the list that appears below. Click the OK button. If you need to
add another user to the list click Advanced then Find Now again and select them from
the list and click OK. After selecting the user(s) click OK again to return to the
permissions section.) Check all Allow boxes for all users in this window.
10. On Server Pack 2 Systems only, click the "Edit Default" button in the Access
Permissions section.
a. Select the listing for "Self.”
b. Check the "Allow" box for the “Local Access.”
c. Check the "Allow" box for the “Remote Access.”
d. Select the listing for "System."
e. Check the "Allow" box for the “Local Access.”
f. Check the "Allow" box for the “Remote Access.”
g. Click OK.
Note: If the selection of Self and/or System is missing from the top add that listing. (To
add a user or users to one of the permissions windows click the Add button. Then click
the Advanced button. Next click the Find Now button. Locate and select the user you
want to add in the list that appears below. Click the OK button. If you need to add
another user to the list click Advanced then Find Now again and select them from the list
and click OK. After selecting the user(s) click OK again to return to the permissions
section.) Check all Allow boxes for all users in this window.
11. Under Launch and Activation Permissions, click the "Edit Limits" button .
a. Select the listing for “Everyone.”
b. Check the "Allow" boxes for the “Local Launch”, “Remote Launch”,
“Local Activation” and “Remote Activation."
c. Click OK.
Note: If the selection of Self and/or System is missing from the top add that listing. (To
add a user or users to one of the permissions windows click the Add button. Then click
the Advanced button. Next click the Find Now button. Locate and select the user you
want to add in the list that appears below. Click the OK button. If you need to add
another user to the list click Advanced then Find Now again and select them from the list
and click OK. After selecting the user(s) click OK again to return to the permissions
section.) Check all Allow boxes for all users in this window.
12. Under Launch and Activation Permissions, click the "Edit Defaults" button .
a. Select each user in the list one at a time.
b. Check the "Allow" box for the “Local Launch”, “Remote Launch”, “Local
Activation” and “Remote Activation."
c. Click OK.
Note: If the selection of Administrator, Interactive and/or System is missing from the top
add that listing. (To add a user or users to one of the permissions windows click the Add
button. Then click the Advanced button. Next click the Find Now button. Locate and
select the user you want to add in the list that appears below. Click the OK button. If you
need to add another user to the list click Advanced then Find Now again and select
them from the list and click OK. After selecting the user(s) click OK again to return to the
13. Click Apply and OK to close the My Computer Properties window.

Note: To apply the changes made in Computer Properties, you must reboot the
computer.
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14. In the Component Services window, click on “My Computer."

15. Double-click on the “DCOM Config” folder.
16. Right-click on the “Cascade” icon and select “Properties."
17. In the General tab set the “Authentication Level” to None.

18. Open the Location tab and select “Run application on this computer.”
19. Open the Security tab set the “Launch and Activation Permissions” to
Customize, and then click the Edit button.
a. Select the listing for “Everyone”.
b. Check the Allow boxes for “Local Launch”, “Remote Launch”, “Local
Activation” and “Remote Activation.”
c. Select the listing for each user in the list, and repeat step 19.b.
For systems running Windows XP service pack 2 add the user of Anonymous
Logon, check all the allow boxes and click OK.
If the selection of Everyone, Interactive, Anonymous and/or System is missing from the
top add that listing. (To add a user or users to one of the permissions windows click the
Add button. Then click the Advanced button. Next click the Find Now button. Locate and
select the user you want to add in the list that appears below. Click the OK button. If you
need to add another user to the list click Advanced then Find Now again and select
them from the list and click OK. After selecting the user(s) click OK again to return to the
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d. Set the “Access Permissions” to “Use Default.”

e. Set the “Configuration Permissions” to “Customize.”
20. Click on the “Identity” tab.
a. Select “The interactive user.”
b. Click “Apply.”
c. Click “OK.”
21. Close the Component Services window. Changes made to the DCOM settings for
Cascade properties take effect when the Cascade application is restarted.
VPN into LAN setup

A VPN (Virtual Privet Network) connection into a LAN is very similar to the Peer to
Peer connection. A VPN client, which is a software package provide by the facility you
are trying to access, allows you to logon to that facility's LAN and get through their
Internet firewall. The Cascade system or the remote Reader system can use a modem to
dial into the Internet, through an ISP (Internet Service Provider), and access the facilities
LAN. Or use DSL or cable modem to connect to the Internet and access the facilities
LAN. An Internet connection from another facilities LAN, such as a T1 or T3 line can
also be used. Modem connections are slow and limit the data being sent. They should
only be used as a last resort.
VPN to VPN setup

In a VPN to VPN connection both the Cascade system and the remote Reader system are
using a VPN client to connect to a LAN. Once both systems are connected to the LAN
the systems can see each other and the Cascade procedure can be viewed remotely.
Some additional rules may need to be added to the facility firewall software. If the two
VPN client systems cannot ping each other when connected to the LAN, add a rule to
allow any and all VPN to VPN communication.
Third Party Software setup

Third party software, such as PC Anywhere, VNC, and Microsoft Net Meeting can be
used to allow one computer see another computer using the same roadways to connect
two systems as used by the built in Cascade remote monitoring software. The phone
lines, the Internet and/or a LAN connection. The same network IP address and/or
modem connection configuration apply to these software packages as well.
Each third party software package will require configuration within the software
program. Follow the manufactures instructions. Each relies on the computer name
and/or IP address to connect the two systems. The software will need to be loaded on
each system.
Be careful to configure the Cascade system so that Remote Reader systems cannot take
control of the Cascade system when using third party software.
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Starting a Remote Monitoring Session
Initializing a Remote Monitoring Session from the Reader

Before you begin
• Both systems must be turned on and logged into the same network, or a modem-
to-modem connection must be established. (See connection scenarios and setup
instructions).
• Cascade uses Distributed Com (DCOM) to share its application. DCOM does not
support SSL firewalls.
• You must know the computer name and/or the IP address of the Cascade system
you are connecting to. Cascade systems running version 1.8.11 or later will have
their computer name and IP address of that system displayed at the bottom
center of the Cascade application.
Computer Name & Workgroup

1. Right click on the My Computer Icon on the desktop, or from Windows Explorer,
and select Properties.
2. Click on the Computer Name tab. Locate and write down the “Full computer
name” and “Workgroup” listings in the middle of the window. Connecting the
remote Reader system to the Cascade works best if both systems are part of the
same Workgroup.
Connection IP Address
1. To determine a system’s IP address click with your left mouse button once, on
the far left of the dual computer monitor icon in the system tray, next to the
system clock. There will be an icon there for every network and modem
connection that is active on the system.
2. This will open a status window for that connection. For LAN connections click
on the Support tab. This will only show the IP address for the system you are on.
Write down the IP address. Click the Close button when you are done.
3. For modem connections click on the Details tab to display both the Cascade
system (Server) and the Remote Reader system (Client) IP addresses. The Client
always connects to the Server. The Reader always calls the Cascade.
Initializing a Remote Monitor Session from the Reader
The Cascade system must be running a procedure.
1. Start the Cascade program on the Reader system. Click the “Remote Monitor”
button.
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2. From the Connect to Server window, do one of the following then click OK:
a. Type in the computer name of the Cascade system.
b. Type in the IP address of the Cascade system.
c. Select the computer name or IP address of the Cascade system from the
list on the history tab.
d. Select the computer name or IP address of the Cascade system from the
list on the IOM Portal tab. Please note that the IOM Portal tab is only
active for Cascade Elite systems with the Network Base Control license
enabled.
e. Click the Browse button and select the computer name from the list of
computers available on the network. If the computer you are looking for
does not appear on the list, this means the computer is not on the
network.
2. Wait for the connection window.

a. After a few seconds either a connection will be established or an error
message will be displayed. See the Troubleshooting section for
descriptions of possible error messages and their solutions.
4. Connection established.
a. The Reader will initially see the same view as the Cascade.
b. See the section on Remote Monitoring Features for description of what
the Reader system can do during a remote monitoring session.
Initializing a Remote Monitoring Session from the Cascade

Before you begin
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• Both systems must be turned on and logged into the same network, or a modem-
to-modem connection must be established. (See connection scenarios and setup
instructions.)
• You must know the computer name and/or the IP address of the Reader system
to which you are connecting. Cascade systems running version 1.8.11 or later will
have their computer name and IP address of that system displayed at the bottom
center of the Cascade application, as DAVIDMXP (10.1.1.123) is shown here:
Computer Name & Workgroup

1. Right click on the My Computer Icon on the desktop, or from Windows Explorer,
and select Properties.
2. Click on the Computer Name tab.
3. Locate and write down the “Full computer name” and “Workgroup” listings in
the middle of the window. Connecting the Cascade system to the remote Reader
works best if both systems are part of the same Workgroup.
Connect IP Address
1. To determine a system’s IP address, single-click the dual computer monitor icon
in the system tray, next to the system clock. There is an icon for every network
and modem connection that is active on the system.
2. This will open a status window for that connection. For LAN connections click
on the Support tab. This will only show the IP address for the system you are on.
Write down the IP address. Click the Close button when you are done.
3. For modem connections the Details tab to display both the Cascade system
(Server) and the Remote Reader system (Client) IP addresses. The Client always
connects to the Server. The Reader always calls the Cascade.
Initializing a Remote Monitoring Session from the Cascade
The Cascade system must be running a procedure.
1. From the Remote Menu in the Cascade program select “Connect Reader (client)”.
2. From the Connect to Server window, do one of the following then click OK:
a. Type in the computer name of the Reader system.
b. Type in the IP address of the Reader system.
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c. Select the computer name or IP address of the Reader system from the
list.
d. Click the Browse button and select the computer name from the network.
3. Wait for the connection window. After a few seconds either a connection will be
established or an error message will be displayed. See the Troubleshooting
section for descriptions of possible error messages and their solutions. Note this
only works if the reader system is not currently viewing a procedure. If the remote
reading system is already watching one or more Cascades then the remote connection
must be initiated from the remote reader system.
4. Connection Established
a. The Reader will initially see the same view as the Cascade.
b. See the section on Remote Monitoring Features for description of what
the Reader system can do during a remote monitoring session.
System Setup on the Remote Reader

From the Edit menu, select System Setup. Then select the Remote tab.
Remote Tab
Maintain View Synch with Server

Check this box on the Remote Reader system to automatically change views on
the Remote Reader system when the Cascade system in the OR changes views. So
both systems are always in the same view.
Connection Speed
Used to specify the connection speed of the remote Reader client PC. Slow
connections are not able to view live EMG, EEG, or Video. Each selection is
labeled with its connection type.
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Chat Tab
Auto Send Message
“On Enter Key” when this box is checked, chat messages will be sent when the
Enter key is pressed.
On Message
Auto Popup – when this box is checked, the chat message box will automatically
be displayed when you receive a message.
Beep – when this box is checked, you will hear a beep when a message is sent to
you.
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Save Log – used on the Cascade system, not the remote Reader system, to save the
chat session as a *.txt document. Selecting this option on the remote Reader system will
have no effect.
Chat Box
To send a message to the Cascade or remote Reader system click on the system chat box
icon in the tool bar. It will have the computer name or IP address of the system that is
connected. The Cascade will see a box for each reader that is connected. The remote
Reader will only see a box for the Cascade system. The remote reader will see the IP
address or computer name and the patient name in the title bar of the chat window. Use
the Chat tab in the Edit>System Setup window or click the Settings button in the Chat
window to change your Chat box options.
Type your message in the lower portion of the Chat box. Press the Enter key on the
keyboard or click on the Send button to send the message to the other system. Read the
messages from the top portion of the Chat box. Move your Chat box to a desired
location on the screen by using your mouse and grabbing the Chat window on the title
bar. Close the Chat box by clicking the Close button.
Chat Log
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The option to save a chat log functions only on the Cascade acquisition system. By
default the “Auto Send Message On Enter Key”, “Auto Popup” and “Beep” are selected.
The Option to “Save to Log” is not. In order for the Chat log to be saved to a text file this
box must be checked on the Cascade system. Checking this box on the Reader system
will have no effect.
Sync with Server
Use the Sync with Server button to re-establish the same view and parameters that
are currently being used on the acquisition Cascade. The Sync with Server button is used
to advance the Cascade application on the Reader system to the current live acquisition
time. When looking back in time in an active procedure the acquisition appears to stop. The scroll
bar at the bottom of the screen will turn yellow. Click on the Sync with Server button to
advance the window to live acquisition time on the remote reader system. This also
refreshes the chat window.
Views
Views are a combination of windows grouped together to organize data. Available
options for creating views on the Cascade system are dependent on the active modes in
the procedure file that is being used. Views can be changed independently on the remote
Reader system from the Cascade system. Both systems can rearrange windows within
the view, switch views and add or remove windows within a view independently.
Click the View button to advance to the next available view in the procedure file.
It will cycle through all of the available views in the procedure.

The View drop-down menu may also be used to select another view.
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Use the Edit> View Setup option to add and remove windows from within a view.
When you look back on the time line in a procedure use the Sync with Server
button to take your view back to current time.
The trace and background colors can also be changed independently on both systems.
Go to Edit>System Setup and select the Colors tab.
Looking back along the time line
Along the bottom of the Cascade application window there is a time scroll bar. Moving
the gray block from the far right to the left will change the time you are looking at in the
procedure from live time to the past.
The time scroll bar across the bottom of the screen will also turn yellow to let you know
you are looking back in time and not viewing what is currently being recorded. There is
also an absolute and real time display popup when you move the gray block in the time
scroll bar to use as a reference.
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To go back to view the data that is currently being recorded in the case move the gray
block in the time scroll bar all the way to the right, click the Live button or click the
Sync with Server button or Sync with Server button Live Mode
button.
Reports
Reports can be created independently on both the Cascade system and the remote
Reader system. The report is generated from the data in the current view. The report
template selected needs to match the windows that are in the current view. Selecting the
Summary Window report template for an Average window will only generate patient
information. The EP Window report template must be selected to produce the table and
waveform data for an Average window view. The information that is pulled into the
report is only for the time frame you are currently viewing.
For best results use the File pull down menu and select Print Report. Select the All
Windows.rpt report template. This will print tables and waveforms for all windows
present in the view at that point in time. For an overall study text report select IOM
Report - SSEP and EMG.rpt
The ReportGenerator application is used for generating reports. It uses templates that
are stored as .rpt files. Templates for each window type are "remembered" so that you
do not need to select a template every time. Templates are "remembered" by window
type, so if you print from one EP window, the same template will be selected by default
for another EP Window.
1. Acquire new responses or open an existing file for review
Reports can be generated both during the monitoring session and later in review.
To open a file for review, select Review Procedure from the File drop-down menu.
2. Select the appropriate view
The Report Generator creates reports with the data from the currently displayed
View. Therefore, it is important to select the appropriate View and Elapsed Time
in the record prior to initiating a report.
3. Initiate a report (select print)
There are three methods that can be used to start a report.
• Method 1: Right-click the mouse on any window, and select Print from
the menu.
• Method 2: Select Print Report from the File drop-down menu.
• Method 3: Click the Printer button at the top of the screen.
4. Select a report template
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The Print Report window allows you to select the template that will be used to
generate the report. If the Template field is blank, click the Select button to display
a list of possible report templates. If you started the report process by right-
clicking on an EP Average window, choose the template called EP Window. This
will generate a report that includes the report header, patient information, traces,
and cursor measurements from the window you selected. Once a template has
been selected, click either the Print or Edit buttons (see step 5).
The Cascade comes with several pre-installed templates. A template is a file that
contains specific commands that tell the Report Generator what to include in the
report. Basically, there is one template for each window type and also a template
that prints all the windows in the current View.
You can modify the pre-installed templates or create your own templates using
the Template Editor application.
5. Choose print or edit
Click the Edit button to start the Report Generator and display a window similar
to a word processor program. You can make additions or changes to the report
prior to actually printing it. Click the Print button to bypass the editing (word
processor) mode, and send the report directly to the printer.
6. Report Generator program window
If you clicked on the Edit button in Step 5, the Report Generator window will be
displayed on top of the Cascade window. This window can be resized using the
normal Windows controls.
7. Make Choice or Option selections depending on the template
The Report Generator reads the report template file and inserts the requested
Cascade data into the report. Depending on what the report template contains, the
report generator will sometimes prompt the user to select various choices from a
list, or it may display a list of pre-programmed options that can be used to
complete appropriate sections of the report. After the report template has been
completely processed, the entire report document is displayed.
8. The report document
The finished report document contains all the information specified in the report
template. Usually, the document will start with a header that contains the address
for the hospital or business. Next, the patient information is displayed followed by
the graphics and data tables.
Anything on the screen can be edited. Click the mouse where you want to make a
change, and the blinking cursor will appear. Use the backspace key to delete the
text then re-type the text the way you want it. To add to the report, click on a
blank line then type the text you want to enter.
If you want to delete an entire row from a table, like the cursor values table, click
the mouse anywhere in the row you want to delete. The blinking cursor will
appear. Then select "Delete Line" from the Table menu at the top of the screen. The
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selected line will be removed. If you make a mistake, select "Undo" from the Edit
menu.
To move a page-break, click the mouse above the current page-break on the line
where you want the new page-break to start. Then, select "Page Break" from the
Insert menu.
Use the formatting toolbar to make changes to the text size, add bolding or italics,
or change the font style.
9. Save the Report (optional)
The report can be saved as an RTF (rich text format) document. This is done by
clicking on the appropriate toolbar button or by using the Save As (RTF) option in
the File drop-down menu. The name of the document is automatically generated
using the patient’s last and first names, (Last name, First name.rtf). Saved reports
can be opened later using the Report Generator program or another word
processing program.
If you do not save the report and attempt to close the Report Generator, the
program will automatically prompt you to make a choice. Select YES if you want
to save the report, or NO if you don’t want to save the report.
10. Print the Report
To print the report click on the printer toolbar button or select Print from the File
drop-down menu to display the Print window.
11. Close the Report Generator
Close the Report Generator by clicking on the "X" in the upper right corner of the
report generator window or by selecting Close or Exit from the File drop-down
menu.
Data Rates for Remote Monitoring
% of Client Bandwidth Used

Modem DSL Ethernet
56k bits/sec 256 bits/sec 10M bits/sec
7k bytes/sec 32k 1250k
DATA Bits/sec Bytes/sec bytes/sec bytes/sec
EPs live (4 modes 200k 25k 400% 80% 2%
with 3 traces, stored
at 1k per trace)
EMG (8 channels, 120k 15k 300% 50% 1%
200ms/div sweep)
Video (30k per frame) 300k+ 37.5k 600% 120% 3%
All of the above 620k 77.5k 1100% 250% 7%
For Real-Time monitoring <= 100%
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Disconnect
When the remote Reader system is ready to disconnect from the Cascade before the case
is over click on the Remote menu and select Disconnect. This option is only active on
the remote Reader system. It will be grayed out on the Cascade system. Once the
Cascade system closes the procedure the remote Reader system will automatically be
disconnected.
Trouble Shooting
Errors
Remote Connection Failed
If the remote connection fails you will get an error. Reference the errors listed below to
resolve your connection issue. In most cases, the DCOM settings only apply to the
Cascade system unless you are using the Connect to Reader feature.
Failed to connect to server. Result: 80070005
This is a DCOM configuration issue. Check the DCOM and Windows Firewall
settings on both systems. Use the DCOM and Windows Firewall settings sections
located in the help file to verify the Cascade system configuration. Note that
Windows Firewall may not be the only firewall loaded on the system. Many virus
protection software packages come with their own firewall.
Failed to connect to server. Result: 800706ba
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Remote Monitoring
This error could mean several different things. Either the system is not available
on the network, or DCOM is being blocked by a firewall, or the NetBIOS name
(computer name) is not being resolved to an IP address on the network, or a
router/switch is blocking communication in one or both directions, or you need to
open TCP port 135 on the network firewall. Try browsing to, searching for
computer name. Try pinging the systems you are trying to connect to in each
direction, both by NetBIOS name and IP address. Verify the Anonymous user is
listed and all the allow boxes are checked for that user in steps 12 & 21 of the
DCOM settings.
It is also important to verify there is communication between the two systems
using the ping command. The Remote Reader should be able to ping the Cascade
and the Cascade should be able to ping the Remote Reader. When pinging you
want four replies. If you get one or more responses, “Request Timed Out”, repeat
the ping again. If you consistently get four responses, “Request Timed Out” or
“Destination Host Unreachable”, then there is an issue with both systems being on
the same network or having bidirectional access to each other. If the ping
command gives you four replies and there are no virus protection
software/firewalls interfering with the Cascade and the Remote Reader then the
DCOM configuration may need to be reset.
An invalid argument was encountered
There is a Software version mismatch between the Cascade system and the
Remote Reader system. Check the Cascade software version on both systems
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under Help>About Cascade. They must both be running the same version of
Cascade software.
Failed to create the remote client object. Class not registered.
This refers to an incorrect registration of the Cascade.exe file in the system

registry. Right click and select Register Com Server on the
C:\Cadwell\Cascade.exe file on both the remote Reader system and the Cascade
system, then reboot both systems to correct the problem.
The remote machine is not licensed to be a server.
There is no license for the Remote Server option on the Cascade system. Contact
your sales person to purchase this option. If the Cascade system is licensed to be a
Remote Server, reboot the Cascade system and try the connection again.
The remote machine has not installed the option to be a server.
The Remote Server license is not enabled on the Cascade system under
Edit>System Setup> Edit Customer Options. Check the Remote Server box. If you
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cannot check the Remote Server box then the license is not enabled and will need
to be purchased.
Report Errors
Errors in report generation can be caused incorrect DCOM settings. This will cause the
report generator not to function correctly. The messages below may appear, but no
report will be created. To correct this issue change Default Distributed Com
Authentication Level setting to “None” or “Connect”. See DCOM Configuration.
This is caused by an incorrect DCOM setting. This will cause the report generator not to
function correctly. To correct this issue change Default Distributed Com Authentication
Level setting to “None” or “Connect”. See page 21 Step #8.
Command Prompt
The Command Prompt is a text based window used to type in commands in the
Windows environment. The ping command is a TCP/IP utility used to test connectivity
between two networked systems. To use the ping command:
1. Click on the Start menu button and select Run.
2. Type in CMD
3. Click the OK button. This opens the command prompt window.
4. Type in the word ping followed by a space then the IP address or computer
name of the system with which you are testing the connection. (ping
192.168.0.11)
5. Press the Enter key on the computer keyboard.
You will get four (4) replies if there is a connection. You will get four (4) requests timed
outs if there is a problem with the connection.
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To determine the network card IP address of a system in Windows XP:

1. Use the IPCONFIG command at the prompt line.
2. These commands will display the IP address and Subnet Mask for every network
card and modem working on the system.
3. Type in IPCONFIG
4. Press Enter.
5. The IP address and subnet mask of the network card used for Cadwell hardware
is 192.168.113.66 with a subnet mask of 255.255.255.0. This network card settings
should not be changed.
Search for Computer

The Search for Computer command function looks for computers out on the network. It
is very similar to searching for files. You can use the wild card characters of “*” & “?” in
the search parameters. Example to search for all computer names that start with a “c”
use “c*” as the computer you are searching for. You can also search for a computer by
it’s IP address.
To use the Search for Computer function:
1. Right-click on the My Network Places icon on the desktop or under Windows
Explorer
2. Select Search for Computer.
3. Enter the Computer name or IP address of the computer for which you are
searching.
4. Click Search.
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Cascade Report Generation

The Report Generation Process
Templates/Tokens
What is a Template? What are Tokens?
A template is a file that contains specific commands, called tokens, which tell the Report
Generator program the specific data to obtain from the Cascade program and include in
the final report document. The template can also contain normal "text," like labels such
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as "Patient:" or "DOB:" or even entire paragraphs for things like normal results or
conclusions.
The order of the tokens and text in the template is important because the printed
information will also appear in this order on the created document. So, if the first part of
the template contains patient information tokens and then is followed by the token for
waveforms this is how it will appear in the report document as well.
The formatting of the tokens and text is also important. If the patient information tokens
are "bolded" then this information will be bolded on the created document. If the cursor
table token is set to a font size of 10 pt., then the cursor tables in the created document
will be seen as 10 pt.
Steps for Report Generation

The ReportGenerator application is used for generating reports. It uses templates that
are stored as .rpt files. Templates for each window type are "remembered" so that you
do not need to select a template every time. Templates are "remembered" by window
type, so if you print from one EP window, the same template will be selected by default
for another EP Window.
Step 1 Acquire New Responses or Open an Existing File for Review.
Reports can be generated both during the monitoring session and later in review.
To open a file for review, use the Review Procedure option in the File pull-down
menu. To review a file that is not yet open, click Review Procedure on the Start
Page.
Step 2 Select the Appropriate View

The Report Generator creates reports with the data from the currently displayed
View. It is important to select the appropriate View and Elapsed Time in the
record prior to initiating a report.
Step 3 Initiate a Report (Select Print)
There are three methods that can be used to start a report.
Method #1: Right click the mouse on any window and select Print from the pop
up menu. The Print Report window will be displayed.
Method #2: Select Print Report from the File pull-down menu. The Print Report
window will be displayed.
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Method #3: Click on the Printer Icon at the top of the screen. The Print Report
window will be displayed.
Step 4 Select a Report Template
The Print Report window allows you to select the template that will be used to
generate the report. If the Template field is blank, click on the Select button, and a
list of possible report templates will be displayed. If you started the report process
by right clicking on an EP Average window, choose the template called EP
Window. This will generate a report that includes the report header, patient
information, traces, and cursor measurements from the window you originally
right clicked upon. Once a template has been selected, click on either the Print or
Edit buttons (see step #5).
The Cascade comes with several pre-installed templates. A template is a file that
contains specific commands that tell the Report Generator what to include in the
report. Basically there is one template for each window type and also a template
that prints all the windows in the current View.
You can modify the pre-installed templates or create your own templates using
the Template Editor application.
Please see Template Editor in the Help File on the installation CD for more
information.
Step 5 Choose Print or Edit
Clicking on the Edit button will start the Report Generator and will display a
screen similar to a word processor program. You can make additions or changes
to the report prior to actually printing it. Clicking on the Print button will bypass
the editing (word processor) mode and will send the report directly to the printer.
A window will pop up asking you where to save the report.
Step 6 Report Generator Program Window
If you clicked on the Edit button in Step #5, the Report Generator window will be
displayed on top of the Cascade window. This window can be resized or
minimized using the normal windows controls.
Step 7 Make Choice or Option selections depending on the template.
The Report Generator reads the report template file and inserts the requested
Cascade data into the report. Depending on what the report template contains, the
report generator will sometimes prompt the user to select various choices from a
list, or it may display a list of pre-programmed options that can be used to
complete appropriate sections of the report (see examples below). After the report
template has been completely processed the entire report document is displayed.
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Example of an Option selection window
Example of Choice selection window

Step 8 The Report Document
The finished report document contains all the information specified in the report
template. Usually, the document will start with a Header that contains the address
for the hospital or business. Next, the patient information is typically displayed
followed by the graphics and data tables.
Anything on the screen can be edited except the graphics. Graphics cannot be cut
and pasted.. Simply click the mouse where you want to make a change, the
blinking cursor will appear. Use the backspace key to delete the text then re-type
the text the way you want it. To add to the report, click on a blank line, then type
the text you want to enter.
If you want to delete an entire row from a table, like the cursor values table, click
the mouse anywhere in the row you want to delete. The blinking cursor will
appear. Now, select “delete line” from the Table menu at the top of the screen. The
selected line will be removed. If you make a mistake, select “Undo” from the Edit
menu.
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Generating Reports
To move a page-break, click the mouse above the current page-break on the line
where you want the new page-break to start. Then, select “Page Break” from the
Insert menu.
Use the formatting toolbar to make changes to the text size, add bolding, or italics,
or change the font style.
Step 9 Save the Report (optional)

The report can be saved as an RTF (rich text format) document. This is done by
clicking on the appropriate toolbar button or by using the Save As (RTF)

option in the File pull-down menu. The name of the document is automatically
generated using the patient’s last and first names, (i.e., Lastname, Firstname.rtf).
Saved reports can be opened later using the Report Generator program or another
word processing program.
NOTE: If you save more than one report for a case, you will need to change the file
name for each additional report saved.
If you do not save the report, when you close the Report Generator the program
will automatically prompt you to make a choice. Select YES if you want to save
the report, or NO if you don’t want to save the report. Clicking cancel will leave
the report open.
Step 10 Print the Report
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To print the report click on the printer toolbar button or select Print from the
File pull-down menu.
Step 11 Close the Report Generator.
Close the Report Generator by clicking on the red “X” in the upper right of the
report generator window or by selecting Exit from the File pull-down menu.
Default Report Templates

Below is a list of the factory default report templates, including their names and
descriptions. Reports can be saved as RTF files and can be opened for review using the
Report Generator application or other word processing applications like Microsoft®
Word®.
EP Window – prints the contents of the selected EP Average window, including
all currently displayed traces and a table of cursor values for those traces.
MEP Window - prints the contents of the selected MEP Triggered window,
including all currently displayed traces.
Waterfall Window – prints the currently displayed traces of the selected Waterfall
window.
3D Trend Window – prints the currently displayed traces of the selected 3D
Trend window.
Cursor Trend Window – prints the contents of the selected Cursor Trend
window, including the Dot-To-Dot graph and the Table of currently
displayed cursor values.
EMG Window – prints currently displayed traces of the selected EMG window.
Video Window – prints the currently displayed Video image.
Event Window – prints the contents of the selected Event window, including all
traces and a table of cursor values for those traces. The contents of the
cursor table can be modified using the Setup Tables button in the Event
Window Setup window. This report provides a summary of the important
events that occurred during the procedure.
Summary Window – prints the contents of the selected Summary window,
including all traces and a table of cursor values for those traces. The
contents of the cursor table can be modified using the Setup Tables button
in the Summary Window Setup window. This report is used to print all the
traces acquired for a mode during the procedure.
All Stored EMG – prints a report which contains all the stored EMG windows
that were saved during the procedure. A table of comments is also
included for each stored EMG window.
Pedicle Screw Stim Report w Waveforms - will automatically display the
waveforms captured for each threshold event along with a table of
stimulation locations, stimulus threshold values, and times of stimulation.
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This report is available from within NerveGuard and when not in

NerveGuard.
All Windows – prints contents of all the windows in the currently selected View.
PageHeader – this template is used by all of the other templates; it inserts the
patient’s name and page number at the top of each page.
Amplifier Setup – prints the layout of the amplifier inputs.
Procedure Setup – prints a complete report of the procedure setup file, including
amplifier setup, test montage, mode setups, channel settings, and views.
CSA – prints the CSA analysis window.
DSA – prints the DSA analysis window.
EEG Traces – prints the Live EEG traces window.
EEG Trends – prints the Trends analysis window.
Symmetry – prints the Symmetry analysis window.
IOM Report, SEP, and EMG – this is an example narrative template that contains
Options and Choices, which are used to fill in the report sections.
Pedicle Screw - prints a table of all the pedicle screw thresholds that were
detected. Also includes EMG traces.
Report Templates and the Template Editor Program
Appearance of a Typical Template

Select the EP Window template, and click Open.
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Tokens are the basic building blocks of a template and are bracketed by a less-than
symbol "<" on the left side and by a slash "/" and greater-than symbol ">" on the right. On
a color screen, tokens are displayed in blue. The token for the test date will appear as
follows:
<DATA "CASCADE.TESTDATE" />
The token for the Cursor table results appears as follows:
<DATA"CASCADE.EPWINDOWCURSORTABLE"/>.
If you accidentally remove the < or the /> the token becomes inoperable.
Text that is entered into the template appears normally without any symbols bracketing
it on either side. In the EP Window template, the words Current Date: are text that were
simply typed into the template.
Special tokens, like Option tokens, appear in green color on the screen.
Opening an Existing Template

To open an existing template, click the Open toolbar button or select Open from the File
drop-down menu. The Open Template window will display. Click on the template in
the list to highlight it, and then click the Open button. The contents of the template you
selected will be displayed on the screen.
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Template Editor
The Template Editor program is used to create or edit report templates. The Template
Editor is similar in appearance to a word processing program.
Starting the Template Editor:
The Template Editor application is located in the C:\Cadwell\Quickmed folder
on the hard disk drive. Double click on the file “TemplateEdit.exe” to start the
program.
NOTE: You can create a shortcut to the Template Editor program on your desktop by
following these steps:
1. Right click on a blank area of the Windows Desktop.

2. Select New from the pop-up menu, then select Shortcut.
3. Click the Browse button.
4. Double click on the Cadwell folder.
5. Double click on the Cascade folder.
6. Double click on the file TemplateEdit.exe.
7. Click the Next button, then click the Finish button.
The Template Editor program opens with a blank report template. To maximize the
window, click on the middle button (maximize button) of the three buttons
shown in the top right corner.
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There are two rows of toolbar buttons at the top of the Template Editor window. The
first set of buttons are the standard buttons used for opening and saving templates.
The second set of buttons in the first row are used to select character style and size, and
to format text.
The second row of buttons are used to insert special command tokens into the template..
The name of the template you are working on will be displayed in the title bar of this
window.
Copying Templates
The report templates can be easily copied from one Cascade to another. Copy the
templates from the C:\Cadwell\Cascade\Data folder of the first Cascade onto a floppy
diskette. Then, copy the templates from the floppy diskette into the
C:\Cadwell\Cascade\Data folder of the second Cascade.
Customizing the Appearance of the Template

Formatting a token
Formatting allows the data that the token represents to appear in a specific font
style or size in the report. Highlight the token by clicking and dragging the mouse
across it. Now, select the font style “i.e., Times Roman” and the character size “i.e.,
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Generating Reports
12” from the formatting toolbar at the top of the screen. The highlighted token will
change its appearance on the screen to reflect the formatting you have selected.
Now, click somewhere else to remove the highlight.
NOTE: The EPWindowCursorTable data usually appears best in the Arial style at a size
of 9 or 10 point.
Changing the alignment of a token

This allows the data to be centered on the line, or left justified, or
right justified. Click the mouse at the beginning of the line to
position the blinking cursor. Next, click on the appropriate alignment button in
the formatting toolbar. The program inserts a token representing the alignment
you selected. For example, if you selected the align center button, the token
<ALIGN "Center"/> is inserted. All the lines in the template beginning with this
one will be center justified. To return the alignment to the left edge of the page
you will need to insert a Left Justify token on a line further down in the template.
Inserting a blank line into the template
You can separate sections of the report by inserting blank lines. Simply click the
mouse on a line to get the blinking cursor, then press the Enter key on the
keyboard once for each blank line you want to insert.
Inserting a manual Page Break into the template
Go to the line in the template where you want the page break to occur. Click the
mouse on this line to position the blinking cursor. Now, right click the mouse and
a pop-up menu of available procedures will be displayed. Select “Add Page
Break” from this menu. A bold red line will be displayed in the template, this
shows where the page break will occur.
Entering plain text into a template
In addition to tokens, any plain text that you type into the template will appear in
the final report. For example, if you are going to create a section for the
Impression you might want to create a label in large bold letters called
“Impression:”. Another example would be a signature line in the report. You
could go to the bottom of the template and type your name as you want it to
appear on the final report, “David Smith, MD”.
If you have complete sentences or paragraphs of information that you always
want to be included in your report you can type this as well.
Removing tokens and text
The easiest way to remove tokens or text from a template is to position the cursor
at the end of the information you want to remove and then use the “Backspace
key” to delete it. Alternatively, you can use the mouse to highlight the information
you want to remove and then press the “Delete” key.
Using a Page Header

A page header is used to print specific information at the top of all printed pages, except
the first page. This usually includes the patient name, test date, and page number. To
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use the Page Header feature, you must first create a page header template (containing
the information you want in the page header), and insert this new template at the top of
your existing report templates.
To create a Page Header template
1. Start the Template Editor program.
2. The program opens with a blank template.
3. Insert the tokens representing the information you want included in the page
header (lastname, firstname, testdate, etc.). See the example of tokens used for a
page header.
4. To insert the page number, right-click the mouse, and select Insert Page Number
from the menu.
5. Select the appropriate font style and size (Arial 10 pt. works well).
6. From the File menu, select Save As.
7. Type a name for the page header, such as "PageHeader," in the File Name field.
8. Verify that the Save In field is set to the Data folder
(C:\Cadwell\Cascade\Data).
9. Click the Save button.
To insert a Page Header template into an existing report template
1. Start the Template Editor program.
2. From the File menu, select Open.
3. Select the template that you want to insert the Page Header into, and click Open.
4. Click the mouse at the end of the first line in the template. The blinking cursor
will appear at that position.
5. Right-click the mouse, and select Page Header from the menu. The Open
window displays, listing all Cascade templates.
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6. Select the PageHeader template, and click OK.

7. Select Save from the File menu to save the changes to the template.
8. Exit the Template Editor.
.
Example “EP Window” template with a page header inserted on second line.
Customizing the Report Header
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The report header is an RTF (rich text format) file that is created in the Cascade’s System
Setup window. The Cascade saves this information in a file called "ReportHeader.rtf."
To customize the Report Header
1. Start the Cascade program.
2. From the Edit menu, select System Setup.
3. Click the Report Header button.
4. Depending on the software installed on your computer, the report header file
will be opened either with WordPad or Word 97/2000.
5. Change the information in the report header as needed. You can use bold text
and different character sizes. All the lines should be "left justified" in this file. In
order to center justify the report header, the report template must contain an
Align Center token. See Customizing the Appearance of the Template.
6. To close the file, click on the "X" in the top right of the window. Select YES to
save your changes, and to return to the System Setup window.
7. The System Setup window is re-displayed on the screen. Click “OK” to exit this
menu.
Signatures in Reports
Below is the important syntax that is in the report template. There are two sections for
signatures in this example. Text color is not really important. Syntax is very important.
The label “Clinical Neurophysiologist” will appear on the report followed by the
signature for the selection you make.
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Generating Reports
<PROMPT starts your list of selections

/PROMPT> ends that section.
You can add, remove or modify the OPTIONS. A box will appear showing each label,
John Wright, M.D + others listed. <INSERT FILE
"C:\Cadwell\Signature\JohnWright.rtf"/> goes to an RTF file (this must be in *.rtf
format) The files must be located in the path indicated in the text. In the RTF file,
example JohnWright.rtf there is syntax to point to a BMP or graphic file. This is the
signature. Example of JohnWright.rtf file.
<ALIGN "Left"/><INSERT FILE "C:\Cadwell\Signature\Wright.bmp"/>
John Wright, M.D
The graphic must be in *.BMP format to work. The graphic must also be in the location
listed in the path in the JohnWright.rtf file. You can choose your own folder structure or
copy the one in this example.
Example
Clinical Neurophysiologist<PROMPT LBL "Neurophysiologist"
<OPTION LBL "John Wright, M.D" TEXT<INSERT FILE
"C:\Cadwell\Signature\JohnWright.rtf"/> /OPTION>
<OPTION LBL "David M. Thompson, M.D" TEXT<INSERT FILE
"C:\Cadwell\Signature\DavidThompson.rtf"/> /OPTION>
<OPTION LBL "Ramon Henderson, M.D." TEXT<INSERT FILE
"C:\Cadwell\Signature\RamonHenderson.rtf"/> /OPTION>
<OPTION LBL "Stacie Cho, M.D." TEXT<INSERT FILE
"C:\Cadwell\Signature\StacieCho.rtf"/> /OPTION>
<OPTION LBL "Marie Midthun, M.D." TEXT<INSERT FILE
"C:\Cadwell\Signature\MarieMidthun.rtf"/> /OPTION>
<OPTION LBL "James Rhodes, M.D." TEXT<INSERT FILE
"C:\Cadwell\Signature\JamesRhodes.rtf"/> /OPTION>
<OPTION LBL "Keith Chapman, M.D." TEXT<INSERT FILE
"C:\Cadwell\Signature\KeithChapman.rtf"/> /OPTION>
<OPTION LBL "Neil Young, M.D." TEXT<INSERT FILE
"C:\Cadwell\Signature\NeilYoung.rtf"/> /OPTION>
<OPTION LBL "Drew Breeze, M.D." TEXT<INSERT FILE
"C:\Cadwell\Signature\DrewBreeze.rtf"/> /OPTION>
/PROMPT>
IONM Practitioner<PROMPT LBL "Practitioner"

<OPTION LBL "James Smith, MA, CNIM" TEXT<INSERT FILE
"C:\Cadwell\Signature\JimSmith.rtf"/> /OPTION>
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<OPTION LBL "Steven Chase, MA, CNIM" TEXT<INSERT FILE

"C:\Cadwell\Signature\StevenChase.rtf"/> /OPTION>
/PROMPT>
You can copy the syntax from this topic into a report template. Change the LBL text to
match the correct names you will be using. Use the either IONM Practitioner or Clinical
Neruophysiologist sections. Create an RTF file for each signature that points to the
signature BMP file. You can copy the <OPTION lines to add more selections before the
/PROMPT>
You may need to adjust the image size of the signature BMP file. Use the MS Paint
program to do this.
• Start>All Programs>Accessories>MS Paint.
• Always start with a copy of the original file so you can make several attempts at
changing the image size until you find the correct one.
• Image pull down menu>Stretch and Skew. Adjust the % size of the image.
• Again make a copy of the original. Modify the copy.
• Once you figure out the correct adjustment you can save the image. Modify the
images from the correct folder listed in the rtf file. That is, put the image file copy
in the new C:\ Cadwell\Signatures folder.
• You will have to run the report to check the graphic size.
Note: the names used in this example are fictitious.
Cascade Tokens
Listed below are the Cascade tokens (as of version 1.6) and a description of what they
insert into the report.
NOTE: There are other token groups that are not used by the Cascade Report
Generator. These are the Easy EEG, Easy Sleep, and Sierra tokens. These tokens will
not be discussed in this document.
Token Name: Description of Token's function:

3DTrendTraces Inserts the selected 3D Trend waveform graphic.
Age Inserts the patient's age in years.
Inserts cursor table information for All windows in the
AllTables
currently displayed View.
Inserts waveform graphics for All windows in the currently
AllWaves
selected View.
Inserts the procedure setup file's amplifier input labeling
AmpSetup*
scheme.
Anesthesiologist Inserts the text from the Anesthesiologist field in the patient
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Generating Reports
information window.
Inserts the text from the Assistant field in the patient
Assistant
information window.
Inserts the waveform graphics for the Amplifier Calibration
Calibration
window.
Inserts the text from the Comments field in the patient
Comments
information window.
CursorTrendWindowGraphs Inserts the selected Dot To Dot cursor trend graphic.
CursorTrendWindowTables Inserts the selected Cursor Trend Tables.
Inserts the test from the Diagnosis field in the patient
Diagnosis
information window.
Diagnostics Inserts the results for the Amplifier Diagnostics.
DOB Inserts the patient's date of birth.
EEGAnalysisCSA Inserts the CSA graphic.
EEGAnalysisDSA Inserts the DSA graphic.
EEGAnalysisSymmetry Inserts the DSA Symmetry graphic.
EEGAnalysisTrend Inserts the trend graphic.
EEGWindowTraces Inserts the EEG waveform graphic.
EMGComment Inserts the EMG Comment.
Used with the EMGWindowTracesAll token, it inserts the
EMGCommentTable
event text table for all the stored EMG.
Inserts a table of the pedicle screw stimulus intensity
EMGWindowPedicleTable threshold values that were detected using the NerveGuard
feature.
EMGWindowTraces Inserts the selected EMG window waveform graphic.
Inserts the waveform graphics for all stored EMG from the
EMGWindowTracesAll
selected EMG window.
EPWindowCursorTable Inserts the cursor table for the selected EP Average window.
Inserts the waveform graphic for the selected EP Average
EPWindowTraces
window.
Inserts a high-resolution, large graphic for the selected EP
EPWindowTracesLarge
Average window.
Inserts a table of the Event log for the procedure including the
EventLog
priority.
EventWindowTables Inserts the cursor table for the selected Event window.
EventWindowTraces Inserts the waveform graphic for the selected Event window.
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Inserts the text from the Firstname field in the patient

Firstname
information window.
Gender Inserts either the Male or Female gender text.
Inserts the text from the Height field in the patient
Height
information window.
Inserts the text from the LastName field in the patient
LastName
information window.
Inserts the text from the Middle Initial field in the patient
MidInitial
information window.
Inserts the information for each acquisition Mode in the
ModeSetups* procedure setup file including channel assignments, cursor
setups, and stimulus parameters.
Inserts the text from the OR Room field in the patient
ORRoom
information window.
Inserts the text from the Patient ID field in the patient
PatientID
information window.
Inserts all the setup information for the procedure setup file
Setup* including amplifier labels, test montage, mode settings, and
views.
SetupFileName* Inserts the name of the procedure setup file.
Inserts the waveform graphic for the selected Stacked EMG
StackedEMGTraces
window.
Inserts the cursor table for the selected EMG Stim History
StackedEMGStimHistoryTables
window.
SummaryTable Inserts the cursor table for the selected Summary window.
Inserts the waveform graphic for the selected Summary
SummaryTraces
window.
Inserts the text from the Surgeon field in the patient
Surgeon
information window.
Inserts the text from the Surgical Procedure field in the
Surgical Procedure
patient information window.
Inserts the text from the Technician field in the patient
Technician
information window.
TestDate Inserts the date on which the procedure was started.
Inserts the date and time of day when the procedure was
TestDateTime
started.
TestDuration Inserts the duration of the procedure from start to close.
TestElapsedTime Inserts the current elapsed time in the procedure.
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Generating Reports
TestEndTime Inserts the time of day when the procedure was closed.
TestSetups* Inserts the Test parameters of the procedure setup file.
TestTime Inserts the time of day when the procedure was started.
TodaysDate Inserts the current date.
TodaysDateTime Inserts the current date and time of day.
TodaysTime Inserts the current time of day.
Inserts the cursor table for the selected TOF Analysis
TOFAnalysisTable
window.
Inserts the waveform graphic and cursor table for the selected
TOFTraces
TOF Traces window.
UserEvents* Inserts a table of the Event list for the procedure setup file.
VideoComment Inserts the Video Comment.
VideoImage Inserts the selected Video Image.
ViewSetups* Inserts a table of the View setups for the procedure setup file.
WaterfallTraces Inserts the selected Waterfall window waveform graphic.
Inserts the text from the Weight field in the patient
Weight
information window
* These tokens can only be used when printing the Procedure Setup File from within the Edit or
Create New Procedure Setup window.
Choice Token
A choice token allows the user to make a choice between several words or short phrases.
For example, you could have a sentence in your template that says, "Bipolar surface
stimulating electrodes were placed over the surface of the ---- at the wrist". The possible
choices could be "left ulnar nerve," "right ulnar nerve," or "bilateral ulnar nerves."
Insert a choice token into a template

1. Type the sentence leaving a blank space where the choice will occur. Now, go
back and click the mouse on the blank space to get the blinking cursor.
2. Click on the Choice button (third from the left) in the special tokens toolbar.
3. The Set Choices window is displayed. Type the first choice on line one, the
second choice on line two, etc. Each choice must be on its own line. After typing
all the choices click on the OK button. Note: Check the “Allow Multiple Choices” box
if you want to be able to select more than just one choice to complete the sentence.
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4. The Choice token will appear in the report template like the example below.
Don’t worry that the choices are each on their own line. When the Choice token
is processed the entire sentence will all be on one line.
Bipolar surface stimulating electrodes were placed over the surface of the
<CHOICE
left ulnar nerve
right ulnar nerve
bilateral unlar nerves
/> at the wrist.
During the generation of the report the Select Choices menu will be displayed on
the screen.
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Generating Reports
To select a choice, click the mouse on the choice that you want. Click on the Done
button after making your selection.
Inserting a Token into a Template

First, you need to be able to view all of the available tokens. By default the template
editor does not show the Cascade tokens. To turn "on" this group of tokens, go to the
View menu, and click on Cascade in the list. You have to do this each time you start the
template editor.
Steps for inserting tokens for patient information or Cascade data
1. Click the mouse on the line where you want the token to be inserted. The
blinking cursor should appear.
2. Click on the "Add Data" button in the special Tokens toolbar.
3. Select the Cascade token group from the left-hand column, then select the
specific token from the right-hand column, and click OK. See the Cascade Token
List window below.
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4. The token is inserted into the template. Repeat the above steps to insert other
tokens. Remember to separate tokens with spaces or commas, if needed.
Using Specialized Tokens

Using Specialized Tokens
A comment token will cause the report generator to pop-up a text-entry window during
the creation of the report. These tokens can be used as an alternative to the fields in the
Patient Information screen for entering additional patient comments, symptoms, or
impressions. Shown below is the result of using a Comment token to enter Patient
Symptoms into the report.
NOTE: Comments cannot be pre-entered like the fields in the patient information
window. They can only be entered during report generation.
To insert a comment token into a template:

1. Enter a text label for the comment (i.e., Symptoms:) on the line where the
comment token will be inserted. See entering plain text in the Customizing the
Appearance of the Template topic.
2. Click the mouse just after the label you entered or on the next line down. The
blinking cursor will appear on the line.
3. Click on the Insert Comment button in the special tokens toolbar.
4. The Add Comment window will be displayed. You need to type a message that
will be displayed during the report generation. For example, if this comment
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Generating Reports
token is being used for the Patient Symptoms section you could type “Enter
Patient Symptoms” for the prompt. If it was for the Supplies Used section, you
could type “Enter the Supplies Used”. Then, click OK.
5. The comment token is entered into the template and would look similar to this
example.
NOTE: If you Cancel the comment during report generation the text label “Symptoms:”
will still be displayed in the report.
Prompt/Option Token
This type of token is used to pre-enter two or more sentences or paragraphs of text into
the template. During the report generation, the user can choose which pre-entered
option they want to use in the report. If none of the options are appropriate the user has
the ability to type something different.
As an example, you might want to have two different impression statements. The first
can be the normal statement "SEP recordings showed no significant changes during the
procedure." The second can be the abnormal statement "SEP recordings showed a
significant change during this procedure with incomplete recovery before closing."
To insert the above Prompt/Option combination into a template
1. Enter a text label for the section (i.e., Impressions:) on the line where the
prompt/option token will be inserted. See entering plain text in the Customizing the
3. Click on the Prompt button in the special tokens toolbar.
4. The insert prompt window will be displayed. Use the mouse to put a check mark
in the box “Allow More Than One” and another check next to the “Show Text
Box”. Ignore the section called Separators. This is not used.
5. In the Instructions field, type “Select the Impression Option”. During the
generation of the report this will be displayed for the user instructions.
6. Next, click on the “OK+Add Option” button at the bottom of the window. The
Insert Option window will be displayed.
6. The first option will be the normal statement. In the Label field type “Normal
SEPs”. Now, type the body of the statement in the text field. See example below.
7. To add the abnormal statement click on the “Add Another Option” button. Do
Not Click on the OK button, this will take you out of the insert option window.
8. In the Label field type “Abnormal SEPs”. Now, type the body of the statement in
the text field.
9. Since all the options have been entered you can now click on the OK button.
10. The Prompt/Option tokens will appear like this in the report template.
Impression:
<PROMPT LBL "Select the Impression Option." MANY LOOP
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<OPTION LBL "Normal SEPs" TEXTSEP recordings showed no significant

changes during the procedure./OPTION>
<OPTION LBL "Abnormal SEPs" TEXTSEP recordings showed a significant
change during this procedure with incomplete recovery before
closing./OPTION>
/PROMPT>
During the generation of the report the following menu will be presented to the user.
To select an option, click on it with the mouse. The selected option will appear in blue
color and the contents of the option will be displayed at the top of the window. Click OK
to continue processing the remainder of the report
Choice Token
A choice token allows the user to make a choice between several words or short
phrases. For example, you could have a sentence in your template that says,
"Bipolar surface stimulating electrodes were placed over the surface of the ---- at
the wrist". The possible choices could be "left ulnar nerve," "right ulnar nerve," or
"bilateral ulnar nerves."
Insert a choice token into a template
1. Type the sentence leaving a blank space where the choice will occur. Now, go
back and click the mouse on the blank space to get the blinking cursor.
2. Click on the Choice button in the special tokens toolbar.
3. The Set Choices window is displayed. Type the first choice on line one, the
second choice on line two, etc. Each choice must be on its own line. After typing
all the choices click on the OK button. Note: Check the “Allow Multiple Choices” box
if you want to be able to select more than just one choice to complete the sentence.
4. The Choice token will appear in the report template like the example below.
Don’t worry that the choices are each on their own line. When the Choice token
is processed the entire sentence will all be on one line.
Bipolar surface stimulating electrodes were placed over the surface of the
<CHOICE
left ulnar nerve
right ulnar nerve
bilateral unlar nerves
/> at the wrist.
During the generation of the report the Select Choices menu will be displayed on the
screen. To select a choice, click the mouse on the choice that you want. Click on the Done
button after making your selection.
Choices within Options
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Generating Reports
A very powerful feature is the ability to embed Choices within an Option. This allows you
to use an Option for many different scenarios. Shown below is the previous example of
two simple Options; Normal SEPs and Abnormal SEPs.
By inserting choices into the text for the Abnormal SEPs option you can make this option
fit many different scenarios.
Comment Token
A comment token will cause the report generator to pop-up a text-entry window during
the creation of the report. These tokens can be used as an alternative to the fields in the
Patient Information screen for entering additional patient comments, symptoms, or
impressions. Shown below is the result of using a Comment token to enter Patient
Symptoms into the report.
The person generating the report can type the symptoms into the space provided or they
could click the Cancel button to skip this comment and leave it blank.
NOTE: Comments cannot be pre-entered like the fields in the patient information
window. They can only be entered during report generation.
To insert a comment token into a template:

1. Enter a text label for the comment (i.e., Symptoms:) on the line where the
comment token will be inserted. See entering plain text in the Customizing the
3. Click on the Insert Comment button (light bulb, second from right) in the special
tokens toolbar.
4. The Add Comment window will be displayed. You need to type a message that
will be displayed during the report generation. For example, if this comment
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token is being used for the Patient Symptoms section you could type “Enter
Patient Symptoms” for the prompt. If it was for the Supplies Used section, you
could type “Enter the Supplies Used”. Then, click OK.
Add Comment window

5. The comment token is entered into the template and would look similar to this
example.
Conclusions:
<COMMENT LBL "Enter Patient Symptoms:" />
NOTE: If you Cancel the comment during report generation the text label “Symptoms:”
will still be displayed in the report.
Prompt/Option Token
This type of token is used to pre-enter two or more sentences or paragraphs of text into
the template. During the report generation, the user can choose which pre-entered
option they want to use in the report. If none of the options are appropriate the user has
the ability to type something different.
As an example, you might want to have two different impression statements. The first
can be the normal statement "SEP recordings showed no significant changes during the
procedure." The second can be the abnormal statement "SEP recordings showed a
significant change during this procedure with incomplete recovery before closing."
To insert a Prompt/Option combination into a template
1. Enter a text label for the section (i.e., Impressions:) on the line where the
prompt/option token will be inserted. See entering plain text in the Customizing the
3. Click on the Prompt button (far left) in the special tokens toolbar.
4. The insert prompt window will be displayed. Use the mouse to put a check mark
in the box “Allow More Than One” and another check next to the “Show Text
Box”. Ignore the section called Separators. This is not used.
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Generating Reports
5. In the Instructions field, type “Select the Impression Option”. During the
generation of the report this will be displayed for the user instructions.
6. Next, click on the “OK+Add Option” button at the bottom of the window. The
Insert Option window will be displayed.
7. The first option will be the normal statement. In the Label field type “Normal
SEPs”. Now, type the body of the statement in the text field. See example below.
375
8. To add the abnormal statement click on the “Add Another Option” button. Do
Not Click on the OK button, this will take you out of the insert option window.
9. In the Label field type “Abnormal SEPs”. Now, type the body of the statement in
the text field. See example below.
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Generating Reports
10. Since all the options have been entered you can now click on the OK button.
11. The Prompt/Option tokens will appear like this in the report template.
Impression:
<PROMPT LBL "Select the Impression Option." MANY LOOP
<OPTION LBL "Normal SEPs" TEXTSEP recordings showed no significant
changes during the procedure./OPTION>
<OPTION LBL "Abnormal SEPs" TEXTSEP recordings showed a significant
change during this procedure with incomplete recovery before
closing./OPTION>
/PROMPT>
During the generation of the report the following menu will be presented to the user.
377
To select an option, click on it with the mouse. The selected option will appear in blue
color and the contents of the option will be displayed at the top of the window. Click OK
to continue processing the remainder of the report.
Choices within Options

A very powerful feature is the ability to embed Choices within an Option. This allows
you to use an Option for many different scenarios. Shown below is the previous
example of two simple Options; Normal SEPs and Abnormal SEPs.
Simple Options
Abnormal Option expanded with Choices

By inserting choices into the text for the Abnormal SEPs option you can make this option
fit many different scenarios.
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Generating Reports
Inserting the Contents of RTF/Bitmap Files

The contents of an RTF (rich text format) file or a bitmap can be included in a template.
An RTF file is a text file that is created with a word processor program such as WordPad
or Word97. In fact, the customized report header that appears at the top of every report
is placed at the top of the template by inserting the RTF file "ReportHeader.rtf" as the
first line in each template.
Bitmap files can also be inserted into a template. For example, you might want to insert a
picture of your company logo into your report.
To insert an RTF file or bitmap file into a template
1. Click on the line in the template where the RTF or bitmap file should be inserted.
The blinking cursor displays.
2. Right-click the mouse, and select Insert File from the menu.
3. If necessary, change the Look In and File Type fields until you find the
appropriate RTF or Bitmap file.
4. Select the file, and click Open.
5. The Insert File command is placed into the template.
6. Select Save from the File menu to save the changes to the template.
.
379
NOTE: To center the header or bitmap, place an Align Center token at the beginning of
the line. Make sure to insert an Align Left token on the next line.
Saving Templates
Saving changes to a template
To save changes to the template, select "Save" from the File menu or click the Save
button at the top of the screen.

Saving as a new template
To save the template as a new report template, select Save As from the File menu. Enter
a name for the template in the File Name field. Verify that the Save In field is set to the
Data folder (C:\Cadwell\Cascade\Data). Click the Save button.
Closing the Template Editor

To close the Template Editor, click on the "X" in the upper right-hand corner of the
window or select Exit from the File menu.
380
Safety Information
General Warnings and Precautions

Warnings and Precautions
U.S. Federal law restricts the use of this system by, or under the supervision of,
a physician.
This unit is not waterproof. Do not immerse the base unit,

power/communications module, stimulus splitters, VEP goggles, auditory
stimulators, flash stimulator, system cables, or any other system components in
liquid.
Do not try to service unit. Service is to be done by Cadwell and other

authorized bodies only.
Adhere to the unit cleaning instructions. Always disconnect equipment from

power source and patient before cleaning.
Connection of patient to high frequency electrosurgical equipment and

electroneurodiagnostic equipment simultaneously may result in burns at the site
of the electrical stimulator and/or amplifier electrodes, and possible damage to
the electrical stimulator and/or amplifier.
Inspect cables before and after each use. Discard and replace cable if insulation
is damaged or if the cable or connectors are loose or damaged in any manner.
The operator must be trained to be able to recognize the difference between

signal artifacts and valid biosignals caused by movements, interference, or
misplacement of sensors or electrodes.
The proper use of this device for its intended purpose can only be assured once
all instructions have been read and understood. If there are any questions
regarding the operation of the Cascade Elite system, contact Cadwell.
The manual provides an operational summary for the Cascade Elite system. It
does not provide clinical training. The user must have adequate clinical training
to perform procedures.
Place system components where they are safe from contact with spilled fluids.
Wrapping or covering the base unit may cause excessive heat buildup leading to
amplifier failure.
Patient movement may occur during stimulation leading to inadvertent neural

injury. Take adequate steps to avoid stimulation when patient movement could
cause injury.
381
When delivering stimulation that may cause jaw movement, use bite blocks to
minimize the risk of tongue-biting injuries and mandibular fracture. Routinely
check bite blocks for displacement.
The system is not designed to operate in an explosive environment or in the

presence of flammable anesthetics.
The system is designed to be used on one patient at a time. Do not connect

multiple patients to one amplifier.
Avoid accidental contact between electrodes connected to patient and other

conductive parts, including earth ground.
Avoid accidental contact between unapplied electrodes connected to the

amplifier and other conductive parts, including earth ground.
Review TCS amplitude-pulse train safety chart prior to performing TCeMEPs.
Keep anode and cathode stimulating sites in close proximity.
The Cascade Elite amplifier inputs are Type BF rated. BF rating ensures that no
current higher than 50uA flows to or from the applied part if mains voltage is
inadvertently connected to the patient.
Transcranial cortical stimulation may not be appropriate for use on patients

with a history of skull fracture or neurosurgical procedures to the head. Skull
defects could provide high local current densities.
Cortical stimulation may induce seizures and memory problems in those with a
history of epilepsy and other disorders with predisposition to seizures (e.g.
alcoholism). Ensure that necessary medical precautions are taken in case of such
an episode.
Display EEG data during cortical stimulation such that seizure activity can be
easily detected.
Otherwise unexplained intraoperative seizure and/or arrhythmia are indications

to abort transcranial or direct cortical stimulation.
The safety of pulse train frequencies below 250 Hz (interstimulus interval above
4 ms) for cortical stimulation has not been studied in clinical literature.
Operation in close proximity to short wave or microwave therapy equipment

may produce instability in the electrical stimulator output.
This system is not MRI compatible.
The system is not defibrillator proof.
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Safety Information
The Cadwell flash stimulator must be at least 12 inches (30 cm) away from the
patient’s eyes. If used on an anesthetized patient a means should be provided to
ensure that the eye lids remain closed.
The use of the Cadwell flash stimulator may induce seizures in epileptics or
people prone to epilepsy. Persons who are photosensitive to light may have
convulsions, seizures, or a myoclonic reaction to the photic stimulator. The
operator must be trained to recognize EEG waveforms and patient symptoms
that are consistent with a patient’s reaction to photic stimulation. The operator
must follow laboratory medical policies and procedures when using the flash
stimulator to care for the patient undergoing photic stimulation.
When attaching the Cascade Elite system to a recording subject, verify that the
subject will not become entangled in the wires. Do not allow the electrode wires
to wrap around the subjects neck.
Do not clean Cascade before turning off power supply and disconnecting all
Cascade components.
Do not clean Cascade components before turning off power supply and
disconnecting the amplifier.
Do not attempt to service or repair damaged or inoperable equipment.
Some of the warnings listed above are referenced from Safety Standards EN 60601-1and
EN 60601-2-40.
There are applications in which the benefits of the test should be weighed against
possible adverse effects. This judgment is best left to a skilled clinician familiar with the
characteristics of the device. These applications include the following:
• Use of high current stimulator with intramuscular EMG needle electrodes
• Use of high current stimulator for direct nerve stimulation
• Use of current densities for any electrode exceeding 2mA r.m.s./sq. cm
• Prolonged, rapid, high current stimulation at any site, especially with long pulse
durations
• Transthoracic stimulation
• Stimulation with needles having extremely small surface areas that easily exceed
2mA r.m.s./sq. cm. when stimulated
• Use during pregnancy
• Direct nerve stimulation and direct stimulation of the spinal cord, muscle, and
brain
• Transcranial and direct electrical stimulation of the brain
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TCS Warnings and Precautions

Read this carefully before use. This topic will help you understand the general warnings
and cautions associated with the TCS-1/TCS-1000/TCS-4 system. It is important that the
user/operator understand all warnings and cautions associated with the system.
Sections marked with an exclamation mark should be read carefully before using the
TCS system.
Warnings and Cautions

Federal law restricts the sale of this system to, or on the order of, a physician.
High levels of static discharge can cause a momentary pause in data collection.
No user serviceable parts inside. Service by Cadwell Laboratories, Inc. and other
authorized bodies only.
Do not connect leads to anywhere other than the head. This eliminates the potential
for transthoracic currents in any failure mode.
Always connect channel 1 of the TCS-4. This channel has the patient static
equalization circuit for the stimulator. Failure to connect channel 1of the TCS-4 may
result in electrostatic discharge just prior to stimulation which may cause excessive
stimulation artifact.
Inspect all cables before and after each use. Discard cable if insulation is damaged
or if the cable or connectors are damaged in any manner.
Do not immerse any TCS unit in liquid. Do not attempt to use the system if it has
been immersed in liquid. The system is neither water resistant nor splash proof.
Contact of liquids with the internal parts and connectors of Cadwell TCS systems
should be avoided at all times.
Cortical stimulation may not be appropriate for use on patients with a history of
skull fracture or neurosurgical procedures to the head because the skull defects
could provide high local current densities.
Cortical stimulation may induce seizures and memory problems in those with a
known history of epilepsy and other disorders with a predisposition to seizures
(e.g. alcoholism). Ensure that necessary medical precautions are taken in case of
such an episode.
Use bite blocks in the patient due to the risk of tongue biting injuries and
mandibular fracture. Routinely check bite blocks for proper placement.
Patient movement may occur during stimulation, leading to inadvertent neural

injury. Take adequate steps to avoid stimulation when patient movement could
384
Safety Information
cause injury.
Review TCS amplitude-pulse train safety chart prior to performing TCeMEPs.
The safety of pulse train frequencies below 250 Hz (interstimulus interval of 4 msec)
has not been studied in clinical literature.
Cleaning instructions in this manual need to be strictly adhered to.
Otherwise unexplained intraoperative seizures and possible arrhythmias are

indications to cease use of any TCS.
TCS outputs must be connected to the stimulating electrodes only. Unintentional

misconnection of the outputs to ground electrodes could result in current being
dangerously applied to organs other than the cerebral cortex.
The system is not designed to operate in an explosive environment. Not for use in
the presence of explosive atmosphere or flammable anesthetics.
Do not autoclave.
Display EEG data on a separate monitor than that used to display SEP or EMG,
such that seizure activity can be easily detected.
Studies by Calancie et al. relied upon to demonstrate safety and effectiveness of the
device employed threshold level monitoring to increase patient safety by
minimizing energy delivered.
Connection of patient to high frequency electrosurgical equipment and

electroneurodiagnostic equipment simultaneously may result in burns at the site of
stimulation and possible damage to the electrical stimulator.
Due to possible adverse effects, such as chemical and heat burns, stimulation with
current density greater than 2mA r.m.s./cm2 may require the special attention of the
operator.
Contraindications
Comprehensive relative contraindications include epilepsy, cortical lesions, convexity
skull defects, raised intracranial pressure, cardiac disease, proconvulsant medications or
anesthetics, intracranial electrodes, vascular clips or shunts, and cardiac pacemakers or
other implanted biomedical devices.
Symbols
Symbol Title/Meaning Reference
385
Attention, consult accompanying documents. IEC 348
Dangerous voltage IEC 878

, or
Power ON IEC 878

, or
Power OFF IEC 878
Equipotentiality IEC 878
Type BF equipment. Isolated patient connection. IEC 878
Output IEC 878
, or
Input IEC 878
Variability in steps IEC 878
Plus; positive polarity IEC 878
Minus; negative polarity IEC 878
Cadwell
Direction of nerve depolarization
convention
Cadwell
Visual Evoked Potential Display
convention
Temperature IEC 878
Foot switch IEC 878
Headphone IEC 417
386
Safety Information
Cadwell
Amplifier
convention
Reduction of Hazardous Substance Compliant RoHS
Cadwell
Link
convention
Cadwell
Status
convention
Cadwell
Data transferring
convention
Cadwell
Trigger
convention
EMG/EP/EEG equipment with respect to electric

shock, fire, and mechanical hazards only in
ITS
accordance with UL 2601-1 and CAN/CS A
C22.2 No. 601-1 (XXXXX)
Declaration of compliance with the provisions of

council directive 93/42/EEC concerning medical
KEMA Medical
devices (applies only to equipment so marked
Notified Body
and only in the countries stated on the
declaration of conformity for the device).
Waste Electrical and Electronic Equipment

Do not throw in standard garbage. Recycle or
WEEE
dispose of equipment according to regulatory
requirements of your country
Verification of Proper Operation

Proper operation of equipment must be verified prior to surgical procedure. A pre-
operative evaluation is performed to verify proper setup and operation prior to the
administration of anesthesia or muscle relaxants. This check is performed to verify that
387
equipment is operating properly and that the system is set up correctly for the upcoming
procedure. During this pre-op check, verify the integrity of all system and electrode
connections, and double-check the setup. Next, check electrode impedance, and measure
nervous system responses. This will establish a baseline response to which responses
obtained during the procedure can be compared.
Operating Environments & Limits

The operating environment for this product should meet the following criteria:
1. An ambient temperature range of 50°F to 104°F (10°C to 40°C).
2. A relative humidity range of 30 percent to 95 percent non-condensing
3. An atmospheric pressure range of 700 hPa to 1060 hPa.
Transportation & Storage Limits

Do not expose to temperatures Below -4°F (-20°C) or Above 149°F (65°C) .
Do not expose to relative humidity below 10 percent or above 95 percent (non-
condensing).
Do not expose to atmospheric pressures below 500 hPa or above 1060 hPa.
P/N 823014-000
Electrical Safety Requirements and Allowable Configurations

Cadwell electrical safety requirements and allowable IEC 60601-1-1 System
Configurations
GENERAL DISCUSSION
The application of modern electronic technologies in medical practice has led to systems
of medical and non medical electrical equipment being used together for the diagnosis
and monitoring of patients.
Medical Electrical equipment complying with IEC 60601-1 such as Cadwell equipment
and accessories are often connected to other, non medical electrical equipment such as
computers and printers. Non-medical electrical equipment may fully meet the
requirements applicable in their specific field, but may not comply with isolation or
leakage requirements for MEDICAL ELECTRICAL EQUIPMENT and thereby impact
the safety of the entire MEDICAL ELECTRICAL SYSTEM.
The following configurations ensure that combinations of Cadwell devices and non-
medical electrical equipment comply with the electrical safety requirements for
MEDICAL ELECTRICAL SYSTEMS.
ALLOWABLE CADWELL SYSTEM CONFIGURATIONS

1. All Cadwell equipment and accessories are permissible in the PATIENT
ENVIRONMENT without incorporating a SEPARATING TRANSFORMER.
388
Safety Information
2. A double insulated Laptop Computer powered from Cadwell equipment is

permissible in the PATIENT ENVIRONMENT without incorporating a
SEPARATING TRANSFORMER.
3. Other computing devices (i.e. desktop computer, monitor, printer, camera, IR

illuminator etc.) are NOT allowed in the PATIENT ENVIRONMENT unless a
SEPARATING TRANSFORMER is used to power those devices.
4. Non medical devices (examples in #3 above) may be used outside the PATIENT
ENVIRONMENT within the MEDICALLY USED ROOM without incorporating
a SEPARATING TRANSFORMER, provided each individual device is plugged
into a FIXED MAINS SOCKET OUTLET. Otherwise a SEPARATING
TRANSFORMER must be incorporated.
5. MULTIPLE PORTABLE SOCKET OUTLETS (power strips) are not permitted in

a MEDICALLY USED ROOM unless connected to the output of a SEPARATING
TRANSFORMER.
6. Connection to hospital networks is allowed without incorporating a

SEPARATING DEVICE as long as the network server and the MEDICAL
ELECTRICAL SYSTEM are connected to circuits powered from and grounded to
the same electrical service entrance.
7. Cascade PRO shall be used only with Cadwell Cascade PRO Power Supply
229038-000.
SYSTEM REQUIREMENTS
1. Non medical electrical equipment used in MEDICAL ELECTRICAL SYSTEMS
must meet their respective IEC electrical safety requirements, i.e. IEC 950 for
computing devices.
2. ENCLOSURE LEAKAGE must not exceed 500uA in any SINGLE FAULT

condition within the PATIENT ENVIRONMENT.
3. ENCLOSURE LEAKAGE must not exceed 100uA in normal condition.
4. EARTH LEAKAGE must not exceed 500uA in any single fault condition within
the PATIENT ENVIRONMENT.
5. The MEDICAL ELECTRICAL SYSTEM must provide a minimum of 1500 volts

isolation between patient and earth.

isolation between patient applied parts and mains voltage.

isolation between non-patient contact parts of the SYSTEM and mains voltage.
389
GENERAL WARNINGS AND PRECAUTIONS

1. DO NOT place ISOLATION TRANSFORMERS or MULTIPLE PORTABLE
SOCKET OUTLETS on the ground.
2. DO NOT connect MULTIPLE PORTABLE SOCKET OUTLETS (power strips) to

the system, unless connected downstream of an isolation transformer.
3. DO NOT connect items which are not specified as part of or for use with the
SYSTEM.
4. DO NOT exceed the medical isolation transformer placarded maximum load.
5. DO NOT use medical isolation transformer provided with the system to power
non-system components as this can overload the transformer, or defeat the
separation by providing additional leakage sources.
6. DO NOT plug non-medical electrical equipment intended for use in the

PATIENT ENVIRONMENT directly into a wall outlet as this can potentially
result in excessive leakage current present in the patient environment.
DEFINITIONS
1. MEDICAL ELECTRICAL EQUIPMENT: Electrical equipment, provided with not
more than one connection to a particular supply mains and intended to diagnose,
treat, or monitor the patient under medical supervision and which makes
physical or electrical contact with the patient and/or transfers energy to or from
the patient and/or detects such energy transfer to or from the patient.
2. MEDICAL ELECTRICAL SYSTEM (SYSTEM): combination of items of

equipment, at least one of which must be MEDICAL ELECTRICAL
EQUIPMENT and interconnected by functional connection or an ISOLATION
TRANSFORMER.
3. PATIENT ENVIRONMENT: any volume of space (area) in which intentional or

unintentional contact can occur between PATIENT and parts of the SYSTEM or
between PATIENT and other persons touching parts of the system. For practical
purposes this is an area 1.5 meters or 5 feet beyond reach of the patient.
4. MEDICALLY USED ROOM: the room in which the PATIENT ENVIRONMENT

is located.
5. SEPARATING TRANSFORMER: medical ISOLATION TRANSFORMER

designed to limit transfer of unwanted leakage current and allow non-IEC 60601-
1 devices to be located in the PATIENT ENVIRONMENT.
6. SEPARATING DEVICE: a component or arrangement of components with input

parts and output parts that, for safety reasons, prevent a transfer of unwanted
voltage or current between parts of the MEDICAL ELECTRICAL SYSTEM.
390
Safety Information
7. FIXED MAINS OUTLET: permanently installed (hard wired) grounded outlet in

a facility.
8. MULTIPLE PORTABLE SOCKET OUTLET (power strips): a combination of two

or more socket-outlets intended to be connected to, or integral with, flexible
cables or extension cords.
9. SINGLE FAULT: Condition in which a single means for protection against a

safety hazard in the SYSTEM is defective or a single external abnormal condition
is present.
Contact Cadwell Quality/Regulatory department at 509.735.6481 with any questions

regarding these requirements.
P/N 309002-000 Rev03
Electromagnetic Compatibility
This medical electrical equipment needs special precautions regarding Electromagnetic
Compatibility (EMC) and needs to be installed and put into service according to the
EMC information provided below.
Portable and Mobile RF communications equipment can affect medical electrical
equipment.
Use of accessories and cabling other than those specified in below, with the exception of
those sold by Cadwell as replacement parts, may result in increased emissions or
decreased immunity of the Cascade Elite system.
Cascade Elite unit – 190239- Cable, Cascade ES-5 – 355292-

200 200
Cascade base unit – 100820- Cable, MES-10 / SII Interface –
200 199232-200Stimulator, CV-2
Cascade PRO base unit – dual constant voltage –
190197-200
PRO power supply -
229038-000 Stimulator, TCS-1 transcranial
– 190227-200
Cascade Software – 369028-
200 Stimulator, TCS-1000
transcranial – 190258-200
Input extender, 6 meter –
362041-000 Stimulator, TCS-4 transcranial
– 190261-200
Input extender, 3 meter –
362040-000 Electro surgery detector, 4
input – 190198-200
Impedance test array –
360048-200 Electro surgery current sensor
– 190199-200
Impedance test array –
391
360049-200 ES detector module – 190235-

Impedance test array - 200
190267-200 ES detector clip – 190236-200
Amp, 8 channel – 190193- Electro surgery detector, 4
200 input – 190198-200
Amp, 16 channel – 190194- Electro surgery current sensor
200 – 190199-200
Cascade PRO Amp, 16 TDH-39 adult headphones –
channel - 190265-200 199219-200
Input extender, 6 meter – TDH-39 lightweight
199233-200 headphones – 199220-200
Input extender, 3 meter – Insert earphones – 291151-000
199231-200 Cable, insert earphone quick
Input extender, 6 meter – connect – 355322-200
199261-200-003 Bone Vibrator – 199224-200
Input extender, 3 meter – Headphone extension cable –
199261-200-006 355295-200
Amp cable, 3 meter – VEP LED module – 199217-
362031-000 200
Amp cable 25’ – 362029-000 Quick Connect LED goggles –
Amp cable, 9" - 199262-200 199253-200
Impedance test array – LED goggles – 199218-200
197212-200 Power com module – 190240-
ES-IX Stimulator – 200
Stim splitter, ES-5-1 – Flash stimulator – 190182-200
190195-200 Flash stimulator (LED) –
Stim splitter, ES-5-2 – 190228-200
190196-200 Isolation transformer –
Stim splitter, ES16-20 – 197205-200
190201-200 Cable, aux. 25’ extension –
190203-200 Cable, 10’ aux quick connect –
190204-200 Cable, 25’ aux quick connect –
Stim Splitter, ES5-5V – 355325-200
190205-200 Cable, 15 pin auditory stim
Stim Splitter, ES5-100 – extension – 355326-200
190221-200 Cable, 25’ power/com –
Cable, ES-IX, 3 meter - 362042-000
392
Safety Information
362049-200-003 Cable, 3” LED Sierra – 355281-

Cable, ES-IX, 6 meter - 200
362049-200-006 Cascade PRO Amp Holder -
Cable, Daisy Chain, ES-IX - 197245-200
199269-000 Cascade PRO Tray - 3361448-
ES-IX Test Array - 190268- 000
200
Cable, Elite, ES, 10’ –
355319-200
Cable, Elite, ES, 25’ –
355324-200
Cable, Elite, ES-5 5ft.
interconnection – 355294-
200
Guidance and manufacturer’s declaration – electromagnetic emissions

The Cadwell Cascade Elite IOM system is intended for use in the electromagnetic environment specified below. The
customer or the user of the Cascade Elite should assure that it is used in such an environment
Emissions test Compliance Electromagnetic environment - guidance
RF Emissions Group 1 The Cascade Elite uses RF energy only for its
CISPR 11 internal function. Therefore, its RF emissions
are very low and are not likely to cause any
interference in nearby electronic equipment.
RF Emissions Class A The Cascade Elite IOM system is suitable for
CISPR 11 use in all establishments other than domestic
and those directly connected to the public
Harmonic Emissions Not Applicable as low voltage power supply network that
IEC 61000-3-2 device draws less supplies buildings used for domestic
than 50 watts. purpose.
Voltage fluctuations/ Cadwell declares
flicker emissions the Cascade Elite
IEC 61000-3-3 does not produce
voltage
fluctuations/
flicker emissions
393
The Cascade Elite should not be used adjacent to or stacked with any other equipment.
If adjacent or stacked use is necessary, performance of the Cascade Elite should be
observed to verify normal operation in the configuration in which it will be used.
Guidance and manufacturer’s declaration – electromagnetic immunity

The Cadwell Cascade Elite IOM system is intended for use in the electromagnetic environment specified below. The customer or the
user of the Cascade Elite should assure that it is used in such an environment
Immunity test IEC 60601 test Compliance Electromagnetic environment - guidance

level level
Electrostatic ±6 kV contact ±6 kV contact* Electrostatic discharge at ANY level will

±8 kV air*
discharge ±8 kV air produce noise glitches on the Cascade display
(ESD) screen. These noise glitches are easily
IEC 61000-4-2 differentiated from biopotential input signals.
ESD noise is unavoidable in high static
environments due to the high input
sensitivity of the equipment. To minimize
electrostatic effects, floors should be wood,
concrete or ceramic tile. If floors are covered
with synthetic material, the relative humidity
should be at least 30%.
Large Electrostatic discharge may trigger
stimulator error dialogue box. A mouse click
is required to reset the dialogue box. This is
an intentional error message so there is no
possibility of ESD unintentionally triggering
the stimulator.
Electrical fast ±2 kV for power ±2 kV for power EFT’s may cause events in the display
supply lines supply lines
transient/burst waveforms. This is an unavoidable
±1 kV for ±1 kV for phenomenon due to the high input sensitivity
IEC 61000-4-4 input/output lines input/output lines
of the equipment. These waveform
disturbances can be differentiated from
physiological events. To minimize these
effects, mains power quality should be that of
a typical commercial or hospital environment.
High level EFT’s may trigger a stimulator
error dialogue box. A mouse click is required
to reset the dialogue box. This is an
intentional error message so there is no
possibility of ESD unintentionally triggering
the stimulator.
394
Safety Information
Surge ±1 kV differential ±1 kV differential Mains power quality should be that of a

mode mode*
IEC 61000-4-5 typical commercial or hospital environment.
±2 kV common ±2 kV common
mode mode*
High level surge disturbances may trigger
stimulator error dialogue box. A mouse click
is required to reset the dialogue box. This is
an intentional error message so there is no
possibility of surge disturbances
unintentionally triggering the stimulator.
Voltage dips, <5 % UT (>95 % dip in Complies at Mains power quality should be that of a
UT ) for 0.5 cycle
short all line input typical commercial or hospital environment.
40 % UT (60 % dip in
interruptions UT) for 5 cycles voltages If the user of the Cascade Elite requires
and voltage Complies at continued operation during power mains
variations on 70 % UT (30 % dip in 240 V 50 Hz. interruptions, it is recommended that the
power supply UT) for 25 cycles Turns off at Cascade Elite be powered from an
input lines <5 % UT (>95 % dip 120 V 60 Hz. uninterruptible power supply.
in UT) for 5 sec
IEC 61000-4- Complies at
11 all line input
voltages
Cascade Elite
turns off.
Restart of
software
required.
Power 3A/m Power frequency magnetic fields should be at
frequency levels characteristic of a typical location in a
(50/60 Hz) typical commercial or hospital environment.
magnetic field
NOTE UT is the a.c. mains voltage prior to application of the test level.
Portable and mobile RF communications

equipment should be used no closer to any part
of the Cascade Elite, including cables, than the
recommended separation distance calculated
from the equation applicable to the frequency of
Conducted 3 Vrms V1 = 3 V
the transmitter.
RF 150 kHz to 80 Recommended separation distance
IEC 61000-4- MHz
6 E1 = 3 V/m
3 V/m
Radiated RF 80 MHz to 2.5
IEC 61000-4- GHz
395
Where P is the maximum output power rating of

the transmitter in watts (W) according to the
transmitter manufacturer and d is the
recommended separation distance in meters (m).
Field strengths from fixed RF transmitters, as
determined by an electromagnetic site survey, a
should be less than the compliance level in each
frequency range. b
Interference may occur in the vicinity of
equipment marked with the following symbol
Note 1 At 80 MHz and 800 MHz, the higher frequency applies.

Note 2 These guidelines may not apply in all situations. Electromagnetic propagation is affected
by absorption and reflection from structures, objects and people.
a. Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios,
amateur radio, AM and FM radio broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic
environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the
location in which the Cascade Elite is used exceeds the applicable RF compliance level above, the Cascade Elite should be observed to
verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as reorienting or
relocating the Cascade Elite.
b. Over the frequency range 150 kHz to 80 MHz, field strengths should be less than [v1] V/m.
Recommended separation distances between portable and mobile RF communications

equipment and the Cadwell Cascade Elite
The Cascade Elite is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled.
The customer or the user of the Cascade Elite can help prevent electromagnetic interference by maintaining a minimum
distance between portable and mobile RF communications equipment (transmitters) and the Cascade Elite as recommended
below, according to the maximum output power of the communications equipment
Rated maximum output Separation distance according to frequency of transmitter

power of transmitter m
396
Safety Information
W 150 kHz to 80 MHz 80 MHz to 800 800 MHz to 2.5

MHz GHz
0.01 d = 0.12 m d = 0.12 m d = 0.23 m

0.1 d = 0.38 m d = 0.38 m d = 0.73 m
1.0 d = 1.2 m d = 1.2 m d = 2.3 m
10 d = 3.8 m d = 3.8 m d = 7.3 m
100 d = 12 m d = 12 m d = 23 m
For transmitters rated at a maximum output power not listed above, the recommended
separation distance d in meters (m) can be estimated using the equation applicable to the
frequency of the transmitter, where P is the maximum output power rating of the
transmitter in watts (W) according to the transmitter manufacturer.
NOTE 1 At 80 MHz and 800 MHz, the separation distance for the higher frequency range
applies.
NOTE 2 These guidelines may not apply in all situations. Electromagnetic propagation is
affected by absorption and reflection from structures, objects and people.
NOTE 3 Stated separation distances will assure safe operation of the Cascade Elite.
However, some noise may present on displayed waveforms.
Disposal of Equipment
At the end of product life, please take care to appropriately decontaminate the
equipment before decommissioning or sending in to Cadwell for service or
maintenance.
Please dispose of equipment under the regulatory requirements of your country.
TCS Specifications
Stimulus TCS-1 TCS-1000 TCS-4

Output
Maximum Voltage 800 volts 1000 volts 1000 volts
Maximum Current 1000 milliamps 1000 milliamps 1000 milliamps
Output Connectors One pair, 1.5mm One pair, 1.5mm Four pair, 1.5mm
fully shrouded fully shrouded fully shrouded
"touch-proof" "touch-proof" "touch-proof"
397
inputs inputs inputs
Stimulus Pulse Train Parameters
Pulse Width 50 microsecond 50 or 75 50 or 75

fixed square microsecond microsecond
wave fixed square fixed square
wave wave
Maximum 1 pulse train per 1 pulse train per 1 pulse train per
Repetition Rate second second second
Max # of Pulses per 9 9 9

Train
Minimum 1.0 ms 1.0 ms 1.0 ms

Interstimulus
Interval (rising
edge to rising edge)
User Selectable Parameters
Output Voltage 0-800 Volts 0-1000 Volts 0-1000 Volts

adjustable in 2- adjustable in 2- adjustable in 2-
volt increments volt increments volt increments
via digital control via digital control via digital control
Interstimulus 1.0-9.9 ms in 0.1 1.0-9.9 ms in 0.1 1.0-9.9 ms in 0.1

Interval ms increments ms increments ms increments
Pulses Per Train 1-9 1-9 1-9
Output Polarity Normal or Normal or Normal or

Reversed Reversed Reversed
Indicators
Power Green LED lights Green LED lights Green LED lights
when power ON. when power ON. when power ON.
Trigger/Polarity Green LED lights Green LED lights Green LED lights
when unit is when unit is when unit is
triggered; triggered; triggered;
indicates polarity indicates polarity indicates polarity
by showing by showing by showing
which output jack which output jack which output jack
is the Anode (+). is the Anode (+). is the Anode (-).
Error An error message An error message An error message

is sent to the is sent to the is sent to the
398
Safety Information
controlling controlling controlling

device2 when device2 when device2 when
stimulus stimulus stimulus
repetition rate or repetition rate or repetition rate or
pulses per train pulses per train pulses per train
exceed safe limits. exceed safe limits. exceed safe limits.
Requested Voltage The user controls The user controls The user controls
and observes the and observes the and observes the
requested voltage requested voltage requested voltage
from the from the from the
device. The device. The device. The
controlling device controlling device controlling device
sends requested sends requested sends requested
voltage value to voltage value to voltage value to
the TCS-1. the TCS-1000. the TCS-4.
Peak Delivered TCS-1 reports TCS-1000 reports TCS-4 reports

Current delivered current delivered current delivered current
(in milliamps) of (in milliamps) of (in milliamps) of
the first pulse to the first pulse to the first pulse to
device. device. device.
Safety Provisions
Delivered stimulus Redundant Redundant Redundant

voltage * time hardware hardware hardware
integrators inhibit integrators inhibit integrators inhibit
the output when the output when the output when
the voltage * the voltage * the voltage *
stimulus time stimulus time stimulus time
reaches the reaches the reaches the
maximum maximum maximum
allowed value. allowed value. allowed value.
Maximum The repetition The repetition The repetition

Repetition Rate rate is limited in rate is limited in rate is limited in
hardware to no hardware to no hardware to no
more than 1 pulse more than 1 pulse more than 1 pulse
train per second. train per second. train per second.
If more than one If more than one If more than one
pulse train per pulse train per pulse train per
second is second is second is
399
requested, an requested, an requested, an

error is signaled error is signaled error is signaled
and hardware and hardware and hardware
prevents a trigger prevents a trigger prevents a trigger
from being from being from being
recognized for recognized for recognized for
two seconds. two seconds. two seconds.
Pulses per Train A hardware A hardware A hardware

circuit counts circuit counts circuit counts
pulses per train pulses per train pulses per train
and inhibits the and inhibits the and inhibits the
output if more output if more output if more
than 9 pulses are than 9 pulses are than 9 pulses are
requested. If requested. If requested. If
more than 9 are more than 9 are more than 9 are
selected, an error selected, an error selected, an error
is signaled and is signaled and is signaled and
hardware hardware hardware
prevents a trigger prevents a trigger prevents a trigger
from being from being from being
recognize for two recognize for two recognize for two
seconds. seconds. seconds.
Minimum Hardware Hardware Hardware

Interstimulus inhibits stimulus inhibits stimulus inhibits stimulus
Interval pulses that are pulses that are pulses that are
requested at less requested at less requested at less
than the than the than the
approved approved approved
minimum minimum minimum
interstimulus interstimulus interstimulus
interval. interval. interval.
Trigger Control
External Trigger Digital trigger Digital trigger Digital trigger

Input signal sent from a signal sent from a signal sent from a
device. device. device.
Environmental Conditions
Operating 5°C to 40°C (41°F 5°C to 40°C (41°F 5°C to 40°C (41°F
to 104°F) @ 10% - to 104°F) @ 10% - to 104°F) @ 10% -
90% RH non- 90% RH non- 90% RH non-
400
Safety Information
condensing condensing condensing
Transport and -40°C to 60°C (- -40°C to 60°C (- -40°C to 60°C (-

Storage 40°F to 140°F) @ 40°F to 140°F) @ 40°F to 140°F) @
10% - 90% RH 10% - 90% RH 10% - 90% RH
non-condensing non-condensing non-condensing
Power Requirements
Power 12 volts DC, 1 12 volts DC, 1 12 volts DC, 1

watt max. watt max. watt max.
Supplied from Supplied from Supplied from
Cadwell Cascade Cadwell Cascade Cadwell Cascade
Elite base unit. Elite base unit. Elite base unit.
Mechanical 9.5"W x 6.25"D 9.5"W x 6.25"D 9.5"W x 6.25"D

x1.9"H x1.9"H x1.9"H
(24cmW x 16cmD (24cmW x 16cmD (24cmW x 16cmD
x 5cmH) x 5cmH) x 5cmH)
1 lb. (0.45 kg) 1 lb. (0.45 kg) 1 lb. (0.45 kg)
I/O Connections
Electrode 2 outputs (1 pair) 2 outputs (1 pair) 8 outputs (4 pair)
System 1 Auxiliary cable 1 Auxiliary cable 1 Auxiliary cable

Interconnect
Safety/Regulatory Approvals
UL 60601-1 Medical electrical Medical electrical Medical electrical

equipment - Part equipment - Part equipment - Part
1: General 1: General 1: General
requirements for requirements for requirements for
safety safety safety
CSA 601.1: 1990 Medical electrical Medical electrical Medical electrical

CE 0344 XXXX KEMA Medical KEMA Medical KEMA Medical

Notified Body Notified Body Notified Body
EN 60601-1: 2003 Medical electrical Medical electrical Medical electrical

401

EN 60601-1-1: 1993 Medical electrical Medical electrical Medical electrical

safety - Collateral safety - Collateral safety - Collateral
standard: Safety standard: Safety standard: Safety
medical electrical medical electrical medical electrical
systems systems systems

safety - 2. safety - 2. safety - 2.
Collateral Collateral Collateral
standard: standard: standard:
Electromagnetic Electromagnetic Electromagnetic
compatability - compatability - compatability -
Requirements Requirements Requirements
and tests. and tests. and tests.

2-40: Particular 2-40: Particular 2-40: Particular
the safety of the safety of the safety of
electromyographs electromyographs electromyographs
and evoked and evoked and evoked
response response response
equipment. equipment. equipment.
EN 60601--4: 1996 Medical electrical Medical electrical Medical electrical

1-4: General 1-4: General 1-4: General
safety - Collateral safety - Collateral safety - Collateral
standard: standard: standard:
Programmable Programmable Programmable
electrical medical electrical medical electrical medical
systems. systems. systems.
The controlling device is connected to the TCS-1/TCS-1000/TCS-4 via a
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Safety Information
custom serial port, which offers two-way communications and a dedicated

trigger wire. This controlling device is typically a Cadwell Cascade
Surgical Monitoring System. Parameters and triggers are sent from the
controlling device to the TCS-1/TCS-1000/TCS-4. Status and error messages
are sent from the TCS-1/TCS-1000/TCS-4 to the controlling device.
ES-IX Specifications
Minimum Multipulse
Operating Maximum Maximum Intensity Reprate (max Pulse
Mode Current Voltage Increment Reprate 10 pulses) Width
50-1000
100 mA CC 100 mA 400 V 0.5 mA 0-67 Hz 100 - 2000 Hz us
50-1000
50-1000
50-1000
20 V CV 35 mA 20 V 0.1 V 0-67 Hz 100 - 2000 Hz us
50-1000
5 V CV 15 mA 5V 0.01 V 0-67 Hz 100 - 2000 Hz us
The ES-IX can be configured through software to deliver either monophasic or biphasic
symmetric stimulation waveforms on all outputs and in all operating modes. Running
the ES-IX stimulator with monophasic stimulation waveforms will result in a net DC
current.
Electrode Current Density Graphs

EMG Needle
403
EEG Needle
Disposable Bar Electrodes
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Safety Information
Bar Electrodes
Felt-Pad Bar Electrodes
405
Electrical Stimulator Characteristics
406
Safety Information
ES-IX Stimulator Characteristics
407
408
Safety Information
409
410
Safety Information
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Care and Cleaning of Equipment
General Cleaning
Turn off and disconnect all Cascade components before cleaning. Do not attempt to
service or repair damaged or inoperable equipment.
The Cascade Elite is designed to be water resistant. To maintain water resistance, do not
remove or loosen the Cascade Elite's connector panel screws.
Perform cleaning and sterilization procedures on a periodic basis to ensure the safe
operation of your Cascade system. As you clean, visually inspect the instrument and its
components for damage or wear. Contact Cadwell if you notice damage to the exterior
of the instrument. See Cascade Customer Support for more information.
Cadwell recommends that you refer to the AAMI Standards and Recommended
Practices for Sterilization, Volume 1: Good Hospital Practices, and Volume 2: Hospital
Equipment and Industrial Process Control or equivalent standard text for detailed
sterilization instructions. These texts may be ordered by calling the Association for
Advancement of Medical Instrumentation at 1-800-332-2264, ext. 217 in the U.S.
Cleaning Cascade Components

Disconnect the base unit, stimulators, and AC Power before cleaning. Keep all cleaning
fluids away from electrical connectors. Do not let solutions seep inside the base unit,
stimulators, recording electrode inputs or power/com module. Do not use abrasive
cleansers.
If sterile electrode packaging is damaged, do not use the electrode. Discard according to
hospital standard operating procedure for sharps disposal.
Cleaning Components
To clean components, use a soft cloth to wipe away any dust that has collected on the
instrument casing. Use a dry cloth or one that is slightly dampened in a mild soap-and-
water solution or ammonium based surface disinfectant such as Envirocide® (active
ingredients - Diisobutylphenoxyethoxyethyl dimethyl benzyl ammonium chloride 0.28%
Isopropanol 17.20%). Isopropyl Alcohol may also be used to clean the exterior of the
unit.
A soft brush or pressurized air duster can also be used to remove dust from hard-to-
access areas, such as between connectors on the connector panel. To clean dust from the
printer or the monitor’s screen, wipe it with a soft cloth.
Cleaning Stimulators
Turn off and disconnect stimulators before cleaning. Keep all cleaning fluids away from
electrical connectors. Do not let solutions seep inside the stimulators. Do not use
abrasive cleansers.
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The ES-IX meets IP64 standard for drip proof equipment; however, the Electrical Stim
Splitter family does not.
Cleaning Stimulators
Visually inspect each stimulator for unusual wear or damage prior to each use. If you
notice damage, disconnect the stimulator immediately, and contact Cadwell. See
Cascade Customer Support for contact information.
Use a soft cloth to clean stimulator parts that come in contact with the patient after each
use (e.g., electrical stimulator probes, earphones, and LED goggles). Properly dispose of
the foam tips used with the insert earphones after each use. The cloth may be slightly
dampened in a mild soap-and-water solution or ammonium based surface disinfectant
such as Envirocide® (active ingredients - Diisobutylphenoxyethoxyethyl dimethyl
benzyl ammonium chloride 0.28% Isopropanol 17.20%). Isopropyl Alcohol may also be
used to clean the exterior of the unit.
Visually inspect the interface cables and power cords that are used with components,
stimulators, and accessories. If you notice unusual wear or breakage, disconnect the
cable or cord immediately, and contact Cadwell for replacement.
Cleaning Electrodes
The quality of signal acquisition is affected by the condition of your recording
electrodes. Routine inspection, careful handling, frequent cleaning, and proper storage
are essential practices for properly maintaining them.
Maintaining non-specialized electrodes

1. Inspect electrode leads for breaks, rust, corrosion, and debris prior to use.
2. Handle electrodes carefully, and do not pull on the leads.
3. Clean electrodes in warm water, using a toothbrush to scrub the surface of the
electrode. If necessary, soak electrodes to loosen debris. (Using a file or steel
wool to scrub electrodes may lead to contamination of electrode metal. This can
result in signal artifact.)
4. For proper sterilization techniques, refer to the electrode manufacturer's
instructions.
5. If necessary, dry electrodes thoroughly to prevent corrosion from hard water
deposits.
6. Store electrodes in a clean, dry place.
7. Do not tangle or kink electrode leads.
8. Properly discard disposable electrodes after each use (e.g., disposable needle
electrodes and disposable surface electrodes).
9. Never attempt to use an electrode with damaged packaging or if sterility may
have been compromised.
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Care and Cleaning of Equipment
NOTE: Specialized electrodes are often more complex and require special care.
Anyone using them should consult the electrode manufacturer for proper maintenance
and handling techniques.
Examples of specialized electrodes:

• EEG Grid Electrodes - for direct placement on the exposed cortex of the brain
• Micro-electrodes - for pallidotomy and thalamotomy procedures
• St. Mark's Pudendal Electrode
• Nasopharyngeal Electrodes
• Piezo-electric Thermocouples, Airflow Sensors, Movement Sensors
• Cotton-wick Electrodes - for direct placement on nerves
General Care of TCS Units

TCS stimulators should be stored in a clean, dry place. Handle the system with care. TCS
stimulators are not waterproof, splash proof or dirt proof.
Factory Calibration, Preventive Inspection, Maintenance

The TCS system is calibrated at Cadwell. No additional hardware calibration is needed.
Inspect all cables before and after each use. Discard cables if insulation is damaged or if
the cable or connectors are damaged in any manner. Contact the Cadwell Service
department if any errors are reported using the TCS system.
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Service and Maintenance
Amplifier Calibration
When this is selected a window will be displayed containing all 16 amplifier channels.
Clicking on the Run button will input a calibration signal in all of the channels. The
calibration signal is 100 uV peak to peak and is presented at a frequency of 100 Hz.
Checking the overlay traces box will superimpose all the traces on top of each other.
Amplifier Calibration window.
You can right-click on the calibration window to add time or amplitude markers and to
print a report that contains the calibration signals. When printing a report, select the
Calibration template.
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To close the Calibration window, click on the X in the upper right hand corner.
Amplifier Diagnostics
When this is selected the following amplifier diagnostics window will be displayed.
Several different types of amplifier diagnostic tests can be run from this window. The
type of test is selected from the pull-down menu in the upper left hand corner. Once the
type of test has been selected, click on the Run button to perform the test. To view the
results of the test, click on the Report button.
Test Types:
Gain: a 100 Hz sine wave is run through the three amplifier gain stages of 100,
1000, and 10,000 uV/div. The peak to peak amplitude of the signal is taken
from 10 different sweeps and averaged. The resulting amplitude must be
within +/- 10% in order to pass.
Locut: a sine wave is run through the four amplifier hardware locut filters, these
are 0.5, 10, 30, and 100 Hz. The test checks to see that the amplitude of the
calibration signal is 50% reduced at the filter frequency. The peak to peak
amplitude of the signal is taken from 10 different sweeps at each locut
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setting and is averaged. The amplitude of the signal must be within +/-
15% in order to pass.
Hicut: a sine wave is run through the 5000 Hz hicut filter setting. The test checks
to see that the amplitude of the calibration is 50% reduced at the filter
frequency. The peak to peak amplitude of the signal is taken from 10
different sweeps and is averaged. The amplitude of the signal must be
within +/- 30% in order to pass.
Noise: in this test all active and reference inputs are connected internally to
ground and the maximum peak to peak amplitude of the noise over
several sweeps is calculated. This is a two part test with measurements
being taken in both EMG and an EP modes. The noise level in each channel
should be less than 5 uV in order to pass.
Impedance: a special impedance array is used for this test. This array is plugged
into each extender pod input and the values are checked against known
inputs. A different resistence value is used for each pod input. As each row
is checked the impedance values for the inputs in that row are displayed
and are colored green when they pass the test. Please see Impedance Test
Arrays for more detailed information.
Montage: a calibration signal is passed through several different montage types to
test the input switching capability of the amplifier. Four hard coded
montages are always tested and the user can add other montages to the
test list by clicking on the Add Montage button. If the appropriate
calibration signal is measured in each channel the channel passes the test.
ALL: When this is selected the program performs the Gain, Locut, Hicut, and
Noise tests in sequence.
Reports:
Clicking on the Reports button will display the reports table.
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Amplifier Diagnostics Report window
The results for the Gain, Locut, Hicut, and Noise tests are listed on the first tab. The
repeat count indicates how many times the test was run and the number listed for each
channel indicates how many times that channel passed the test. A reading of –1 indicates
the test was not performed. A reading in the channel columns less than the repeat
count indicates that the amp failed the test at least once.
The Impedance tab shows the results for the impedance test, the Montage tab shows the
results of the montage test.
You can click on the Print Report button to generate a report with all the diagnostic test
results included. Use the Diagnostics template for this report.
To close the Diagnostics window, click on the X in the upper right hand corner.
Impedance Test Arrays & Amplifier Diagnostics

Impedance Test Arrays are devices with known impedances that can be plugged into
amplifiers to test or verify proper impedance function. They can also be used to
troubleshoot hardware for continuity of connection issues.
To test amplifier impedances:
1. From the Cascade Elite Start Page, click Amplifier Diagnostic.
2. Select Impedance from the drop-down menu.
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3. Plug one Impedance Test Array into each extender pod input on the connector
panel of the amplifier, then click OK on the Test Editor pop-up screen.
4. As the impedance of each row is checked, the impedance values for the inputs in
that row are displayed and are colored green when they pass the test. The test
uses a different impedance value on each pod input.
• Impedance ranges are as follows:
5. After testing all inputs, click Done in the bottom of the Impedance window.
From the Amp Diagnostic window, you can view and print a diagnostic report
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by clicking Report, then selecting the Impedance tab on the Diagnostic Report
window.
6. Click OK to exit the Diagnostic Report.

7. Click the red X to exit Amp Diagnostic.
ES-IX Diagnostics
Included in the Amp Diagnostics routines are the ES-IX Diagnostics.
When ES-IX Diagnostic is selected from the Amp Diagnostics dropdown, the following
menu appears:
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Standard tests for the ES-IX are the Level 2 & 3 self tests. Level 2 Self Test is initiated by
simply pressing the Level 2 Self Test button. Level 3 Self Test is initiated by simply
pressing the Level 3 Self Test button. Level 3 self test requires the use of the ES-IX Test
Array (190268-200), which should have shipped with your ES-IX. Plug the test array into
the ES-IX when prompted to apply the 3.48 kOhm test load by the software. The results
of all tests are shown in the bottom panel, and the results summary is included in the
middle panel.
ES-IX Diagnostic results are not included in the Amp Diagnostics reports. Rather, they
are stored in C:\Cadwell\Cascade\Logs. A report log is written to this directory every
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time an ES-IX Diagnostic test is performed. The files are designated with the "ES-IX Test
Log" file prefix.
The Leakage test is initiated by simply pressing the Leakage Test button. This test
requires the ES-IX Test Array and a multimeter. The DC voltage across each output must
be measured manually using a multimeter.
Routine Maintenance
Backup of patient data
Establish a regular routine for backing up Cascade patient data. Back up onto media that
has enough storage space to contain the data, such as CDs or Zip disks. (There is not
enough space on a floppy disk.)
1. Locate the folder C:\Cadwell\Cascade\PatientData. This is the default directory.
This folder is where patient data is stored and can be moved or renamed.
2. Copy the procedure data files to the backup media. (The procedure data files end
with the .smd extension.)
Please see Archiving with Windows 7 CDR/DVDR burner for more information.
Remove laptop computer

1. Press the power switch on the front of the instrument base to the off position.
2. Press the laptop power switch to off.
3. Close the laptop.
4. Remove the PCMCIA card by pushing on the release button. Pull the card
completely out of the slot.
5. Disconnect all cables from the back of the laptop.
6. Gently lift the laptop off the instrument base.
Laptop battery
Refer to laptop computer manufacturer’s instructions for information on battery use and
care.
Archiving with Windows 7 built-in burner

1. Browse to the C:\Cadwell\Cascade\PatientData folder.
2. Right click on a data file to be put on disc and select Send To. Then Select the CD
drive.
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3. Insert a blank CDR or DVDR disc into the drive when prompted. You can write to a
CD more than once.
4. Insert a blank CD-R into the CD-R drive. Select "With a CD/DVD player..
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5. Notice the balloon by the system tray indicating you have files waiting to be burned to
disc. Click in the balloon or open Computer and select the CD drive.
6. Click the Burn to Disc button.
7. Click Next.
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8. The files will be written to the disc. The disc will eject when complete. Click Finish.
Repair
Recommended Factory Service Interval
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In general, Cadwell recommends yearly factory service and calibration verification to

help assure continued top performance from the equipment. However, the service
interval may be lengthened or shortened as device performance history dictates. Refer to
your facility’s in-house equipment calibration policies and procedures for further
guidance on this subject.
Field service information

This information will be made available to qualified personnel. There is a charge for
documents and a non-disclosure agreement must be signed. Contact Cadwell Service
department for details. See Cascade Customer Support for more information.
Software Upgrades
Upgrade the software on your Cadwell Cascade is easy and reliable. Upgrading
software will not cause you to loose patient data or procedure files. Only the software
changes.
When software upgrades for your Cadwell Cascade are available, simply follow the
installation instructions. There are typically two parts to a software upgrade: upgrading
the software and upgrading the firmware. A firmware upgrade requires that you cycle
the power on your base unit. When upgrading software and firmware from CD, you
will be reminded to cycle the power on the base unit after installing the new firmware.
This step is required in order for the new software to run properly.
If somehow the firmware and the software get out of match, the Cascade system will
alert you and allow you to choose to have the DSP firmware updated automatically.
After automatically updating the firmware, the system will remind you to turn off the
base unit as described above.
NOTE: Cascade users with the optional trigger-in hardware modification to the base
(DTS192-200) should always manually install the DSP firmware from the CD. DTS192-
200 users should not choose the automatic firmware update mentioned above nor the
automatic firmware installation option when installing from CD.
Third Party Applications
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It is not recommended to install any and every third party application you desire to use
on your Cadwell Cascade system. The Cascade is a medical device that is ran on a
computer. Third party applications can cause undesirable results with medical
equipment such as Cascade. It is impossible for medical equipment manufactures to
tests every possible combination of software that might be loaded onto a device. Only
install applications that are absolutely necessary on your Cadwell Cascade systems.
Warranty & Service Contracts
Limited Warranty
Cadwell warrants for a period of one year from the date of purchase, the system listed
against defects in material and workmanship. Notice of a defect and an explanation of
circumstances concerning any claim that the system has proven defective in material or
workmanship shall be given to Cadwell within two (2) working days of the discovery of
the defect in the system. Upon such notice, Cadwell will follow the company service
procedures outlined on page 1 (of the warranty).
Cadwell agrees to retrofit equipment. If the company makes standard improvements to
components of the equipment covered under this agreement during the term of the
warranty and if such improvements are compatible with the equipment located on the
customer’s premises, then Cadwell will retrofit such physical equipment at no
additional charge. Cadwell reserves the right to make changes in specifications,
construction or design of its products at any time in such a manner as it may consider
necessary or advisable.
Preventative Maintenance
When equipment is delivered at customer’s expense during the term of the warranty to
Cadwell, Cadwell will take the action necessary to insure performance to specifications,
including cleaning as necessary, checking, calibrating, and verifying operation.
Preventative maintenance must be scheduled with Cadwell.
Warranty Exclusion
• Except as expressly set forth herein, there is no warranty, expressed or implied as
to fitness for any particular purpose, nor to anything else unless contained on the
face of this Agreement. All other warranties, expressed or implied, including, but
not limited to, any IMPLIED WARRANTY OF MERCHANTABILITY OR
FITNESS FOR ANY PARTICULAR USE, ARE HEREBY DISCLAIMED.
• Cadwell shall be under no obligation to furnish, repair or replace any part which
has been damaged, abused or misused through no fault of Cadwell, or if
unauthorized attempts to modify, repair or service equipment have impaired the
performance of the equipment.
Oral Statements Do Not Constitute Warranties
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Representatives of Cadwell are not authorized to make warranties about the

merchandise described in this Agreement. These representatives’ ORAL STATEMENTS
DO NOT CONSTITUTE WARRANTIES, shall not be relied upon by the customer and
are not part of the contract. The entire contract is embodied in this writing and NO
OTHER WARRANTIES are given beyond those set forth in this contract. This writing
constitutes the final expression of the parties’ agreement, and it is a complete and
exclusive statement of the terms of that agreement.
Sole Purpose
The sole purpose of the exclusive remedy shall be to provide the customer with free
repair and/or replacement of defective parts in the manner provided herein. This
exclusive remedy shall not be deemed to have failed of its essential purpose so long as
the company is willing to repair or replace defective parts in the prescribed manner.
Indemnification
Customer agrees to indemnify Cadwell and hold it harmless from any and all demands
or claims of any nature whatsoever arising out of the use of the equipment, including
product liability or physical injuries to person or property, loss of life, or other claims or
damages.
Business Use
Except as expressly provided by Cadwell in writing, all goods sold hereunder are
intended for the ultimate use by a commercial user and for operation by persons trained
and experienced in the use and maintenance of such equipment. Cadwell’s warranty
does not extend to any consumer. Customer acknowledges that it is purchasing the
equipment for a business use and for no other.
Exclusive Remedy and Limitations of Damages

The parties agree that the customer’s SOLE AND EXCLUSIVE REMEDY against
Cadwell shall be for repair and/or replacement of defective parts as provided herein.
Customer agrees that NO OTHER REMEDY SHALL BE AVAILABLE to them and that
the company shall not, in any event, be liable for incidental damages or consequential
damages, including loss of income, loss of time, lost sales, injury to person or personal
property, liability customer had with respect to any other person, or for any other type
of formal consequential damage or economic loss.
Severability
If any provision or clause of this Contract or the application thereof to any person or
circumstance is held invalid or unconscionable, such invalidity or unconscionability
shall not affect other provisions or applications of the Contract which can be given
without the invalid or unconscionable provision or application, and to this end the
provisions of this Contract are declared to be severable.
Cost of Legal Action
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In the event any action shall be instituted for the failure to perform the terms and
conditions of this Agreement, the prevailing party shall be entitled to recover costs,
including attorney’s fees.
Time Limit on Customer Commencing Legal Actions

An action by the customer for breach of this Agreement or any other action by customer
otherwise arising out of this transaction must be commenced within one year from the
date the right, claim, demand or cause of action shall first accrue, or be barred forever.
No Waiver
If Cadwell at its option agrees to a waiver of any of the terms and conditions recited
herein, such waiver shall not for any purpose be construed as a waiver of any
succeeding breach of the same or any other terms or conditions of this Agreement; nor
shall such a waiver be viewed as a course of performance.
CUSTOMER AGREES TO BE BOUND BY ALL OF THE ABOVE TERMS AND
FURTHER AGREES THAT THEY CONSTITUTE THE COMPLETE AND EXCLUSIVE
STATEMENT OF THE AGREEMENT BETWEEN THEM WHICH SUPERSEDES ALL
PROPOSALS, ORAL OR WRITTEN AND ALL OTHER COMMUNICATIONS
BETWEEN THEM RELATING TO THE SYSTEM AND WARRANTY THEREON.
THIS AGREEMENT WILL BE GOVERNED BY THE STATE OF WASHINGTON AND
SHALL NOT BE MODIFIED, AMENDED OR OTHERWISE AFFECTED EXCEPT BY A
WRITING SIGNED BY BOTH PARTIES.
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Customer Support
Using Help Files

By accessing the Cascade Help files you can get the same information about the
operation, terminology, and capabilities of the Cascade Elite as are found in the
Operator's Manual.
The Help files can be accessed during operation of the Cascade Elite software. From the
Help pull-down menu, select Cascade Elite Help Topics.
An electronic copy of the Operator's Manual is available on the software installation CD
included with your Cascade Elite system. To access the file, insert the CD into the CD
reader on your computer. An installation menu should appear. Click Explore CD. Open
the Documents folder and select Cascade Elite Help File. If the installation menu does
not appear after inserting the CD, open Windows Explorer, right click on the CD icon,
choose Explore and double click the Cascade Elite Help File icon.
Cascade Customer Support

Contact Information
www.cadwell.com
Domestic customers:
Phone: 800-245-3001 or 509-735-6481
Fax: 509-783-6503
International customers:
Please contact your distributor (listings available at www.cadwell.com) or
email International@cadwell.com
Support hours
Service department support: Monday through Friday from 6:30 am to 5 pm PST
Application support: Monday through Friday from 6:30 am to 5 pm PST, Early am OR
support starts at 4 am PST
When to contact Cascade Customer Support

Contact customer support if:
• You continue to experience difficulty after troubleshooting a problem. Cadwell
has a rapid, cost-effective method for troubleshooting and servicing equipment.
Most problems can be diagnosed over the telephone, and repairs can be
performed by sending in the defective part.
• You wish to order optional equipment.
To contact Cadwell for a problem
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1. Have your customer identification number and serial number near the phone.
Have a person who runs the equipment be prepared to speak to a service
technician. This person should be able to provide an accurate description of the
problem. It is best if the person calling is in front of the equipment when they
call.
2. Call the customer support number, and ask for the service department. The
Cadwell service technician will determine if an exchange or repair of parts is
necessary and instruct you on appropriate shipping arrangements.
Remote Assistance
Application Support
The Application Support Department is professionally staffed to help you through
specific application-related issues pertaining to your Cadwell equipment. Phone support
is provided free-of-charge for the life of your instrument.
Service Support
For Service related help with Cadwell instruments, you can contact Cadwell's staff of
professionally trained service technicians. Phone support is provided free-of-charge for
the life of your instrument.
Remote Assistance
Remote assistance and troubleshooting is available for systems under warranty or
service contract. With your permission, a support technician can establish a secure
connection to your Cadwell instrument via the internet.
Please call the service department or application support department at the phone
numbers listed in Cascade Customer Support. A support or service technician will verify
your account information and guide you through the steps to begin a remote assistance
session.
Shipping Equipment
Federal Express is the authorized shipping agent for returning equipment to Cadwell.
Contact Cascade Customer Support if you have questions about packing and shipping
equipment.
To return equipment
1. Place the item in the original shipping box or other appropriate shipping
container.
2. Write the Return Merchandise Authorization (RMA) number on the left corner of
the box. The RMA number is on the shipping paperwork you received with the
new part, as well as on the Federal Express air bill.
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Customer Support
3. Complete the return address information (section 1) on the air bill. Keep all
copies together.
4. Call Federal Express to arrange for pickup.
5. Use the plastic pouch that the Federal Express driver gives you to enclose the air
bill form, and attach it to the sealed box. Be sure to note the Federal Express air
bill number for your records.
Exchanging and returning parts for repair

Most problems can be diagnosed over the telephone. Those that cannot may require that
you ship the defective part to Cadwell for service or repair.
Repairs are usually made by sending an exchange/repair part. Every effort is made to
ship the part the same day the problem is identified. Parts are sent by second-day air
service. Overnight and Saturday services are available for an additional charge.
If you are returning any item for repair, Cadwell issues a return merchandise
authorization (RMA) number. Refer to this number when requesting information about
the repair.
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Approvals and Standards
Compliances
Domestic and International Approvals
Cascade, Cascade Elite, and Cascade PRO are cleared for use by the FDA.
Cascade, Cascade Elite, and Cascade PRO are Health Canada approved.
Cascade and Cascade Elite are EU/CE approved.
Cascade Elite meets the following internationally recognized safety standards for Medical Electrical
Equipment:
IEC 60601-1 : General Requirement for Safety

IEC 60601-1-1 / EN60601-1-1 : Collateral Standard – Safety requirements for medical
electrical systems
IEC 60601-1-2 / EN60601-1-2 : Collateral Standard – Electromagnetic compatibility
IEC 60601-1-4 : Collateral Standard – Programmable electrical medical systems
IEC 60601-2-40 : Particular requirements for the safety of electromyographs and evoked
response equipment.
UL 60601-1 : General Requirement for Safety
CSA 601-1 : General Requirement for Safety
Regulatory Classification Information

United States: Class II
Canada: Class II
European Union: Class IIB (annexes III & V)
Type of Protection Against Electric Shock

Class I Equipment (with Safety Ground)
Degree of Protection Against Electric Shock

Type BF Equipment (Floating Inputs)
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Degree of Protection Against Ingress of Solids and Liquids

IP 65 (Dust and splash resistant)
ES-IX Stimulator meets IP 64 (Dripproof)
Mode of Operation
Continuous
European Legal Entity

CEpartner4U, Esdoornlaan 13
3951 DB Maarn
The Netherlands
Tel: +31 6 516 536 26
URL: www.cepartner4u.nl
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Frequently Asked Questions
Some Frequently Asked Questions:

1. How to change the display gain of traces in the EP Average window.
 To change the display gain of all traces at once:
• Click on the EP Average window with the left mouse button. The window
will be activated and its corresponding toolbar will be displayed at the top of
the screen. In the toolbar, click the up/down arrows next to the display gain
field to change all the displayed traces.
 To change the display gain of only a selected Trial or Trace:
• Click on the desired trial or trace with the left mouse button. The selected trial
or trace will be displayed in yellow. You can change the display gain by two
methods, 1) turn the wheel on the mouse, or 2) click the up/down arrows keys
in the EP Average window toolbar. After you have changed the display gain,
click on the selected trial or trace a second time to de-select it (yellow color is
removed).
2. How to change the Setup of the Waterfall, 3D Trend, Cursor Trend or

Event windows
(i.e., change the trend time, display gain, turn Off/On labels).
• Move the mouse over the window you want to change. Click the right mouse
button. From the pop-up menu, select Setup. The window’s setup menu will
be displayed. Make the appropriate changes and click OK.
3. How to Save Parameter Changes that were made during acquisition as

the new default parameters for the procedure.
• From the File pull-down menu, select Save Current Setup.
4. How to change Filter settings or Amplifier Inputs for a channel during a

procedure.
• From the Edit pull-down menu, select Edit Current Procedure Setup. The
Procedure Setup window is displayed. Make the appropriate changes to the
filter settings or amplifier inputs. Click OK to return to the acquisition mode.
**Entering Procedure Setup will stop all data acquisition, you will need to
restart your acquisition modes after clicking OK.**
5. How to Add or Delete a Window from a View during a procedure.

• From the Edit pull-down menu, select Edit Current Procedure Setup. The
Procedure Setup window is displayed. Move to the View area in the lower
left-hand corner of this window. Click on the tab corresponding to the View
you want to change. The available windows are listed with a check box next
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to each one. The windows that are currently enabled for this View will have a
check mark next to them. To add a window to this View, simply click on the
check box next to the window that you want to add. To remove a window
from this View, click on the check box and remove the check mark next to the
window you want to remove. Click OK to return to the acquisition mode.
NOTE: If you added a new window to a View you will need to position and size the
window to your liking. Initially new windows are just floating in the middle of the View.
6. How to perform Stimulated (Triggered) EMG.

• First, create an acquisition mode in your procedure setup and select EMG for
the mode type. Then, for the Stim Type, select Electrical. Use the Stim Setup
window to select the electrical stimulator output number, the repetition rate,
and pulse duration. Next, assign the appropriate channels to the EMG mode.
• During the procedure, use the buttons in the EMG Mode Controls area to start
& stop the live EMG, stimulate repetitively, stimulate and hold the trace,
perform a single stimulation, and to adjust the electrical stimulator intensity.
7. How to display both Live EMG and Stimulated (Triggered) EMG windows
at the same time during acquisition.
• In the Procedure Setup file, create two identical EMG modes (identical means
that they have the same amplifier channels assigned to them). For the Live
EMG mode, do not select a Stim Type, leave this as None. For the Triggered
EMG mode, select Electrical as the Stim Type, and then program the
stimulator number, repetition rate, and pulse duration. You can have
different sweep speeds for the two modes, however, the gain setting must be
the same in each mode.
• During the procedure you will have separate controls for each EMG mode.
The Live EMG mode will only have a Run/Stop control. The Triggered EMG
mode will have Run/Stop, Repetitive stim, Single Stim, Hold, and a stimulus
intensity knob. Start both modes running, when you are ready to stimulate
check the Hold box for the Triggered EMG mode.
8. What does the RR Warning label indicate in the EP Mode Control area.
• If the Cascade cannot deliver the requested repetition rate for a mode, the
Repetition Rate warning symbol will be displayed. The actual repetition rate
that the system is delivering to the patient is displayed next to the warning
symbol. In order to remove the RR warning, you may need to adjust the
repetition rates or sweep speeds of other acquisition modes.
9. How to move auto-cursors on a trace.

• Simply move the mouse over the cursor of interest then click the left mouse
button and drag the cursor to its new position. All windows that display this
trace will display the new cursor position.
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10. How to insert latency or amplitude markers in a window.

• Latency Marker – move the mouse over the window of interest and click the
right mouse button. From the pop-up menu select Add Time Marker. A
vertical time marker will be inserted into the window. To move the time
marker, position the mouse over the marker then click the left mouse button
and drag the marker to where you want it. The latency of the marker is
displayed at the top of the window, (Time1 = x msec). If you need more than
one latency marker, right click the mouse and select Add Time Marker a
second time. The second latency marker is designated as Time2. The
difference between the two latency markers is also displayed.
• Amplitude Marker – move the mouse over the window of interest and click
the right mouse button. From the pop-up menu select Amplitude Markers.
Two horizontal markers will be inserted into the window. To move the
markers, position the mouse over a marker then click the left mouse button
and drag the marker to where you want it. The amplitude is measured
between the two markers and is displayed at the top of the window.
11. How to remove Latency or Amplitude markers from a window.

• For latency markers, drag the markers off the left edge of the window. For
amplitude markers, drag one of the markers off the top edge of the window.
12. How to pick a Baseline Trial/Trace.

• Select the appropriate trial/trace by clicking on it with the left mouse button.
When selected, the trial/trace is displayed in a “yellow” color. Now, click the
right mouse button and select Set Baseline from the pop-up menu. A copy of
the selected trial/trace is positioned below the active channels and are
displayed in a “blue” color. The baseline trial/trace will remain in the
window until a new baseline is selected or a channel is removed from the
window setup.
13. How to change the Gain or Sweep of an EMG window during a

procedure.
• Gain – right click the mouse over the EMG window. From the pop-up menu
select Mode Setup. The EMG Mode Setup window will be displayed. The
gain can be changed individually or for all channels at once. To change the
gain of one channel, select the channel by clicking on it with the left mouse.
Now click and drag the Gain Knob to the desired setting. To change the gain
of all channels at once, select all the channels by clicking with the left mouse
and dragging the mouse over the top of all the channels. All the channels will
be selected. Now, click and drag the Gain Knob to the desired setting. Click
OK.
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• Sweep – right click the mouse over the EMG window. From the pop-up
menu select Mode Setup. The EMG Mode Setup window will be displayed.
Simply click and drag the Sweep Knob to the desired setting. Click OK.
14. How to change the Setup of an EP Average Window during a procedure

(i.e., turn off the cursors, turn off the trace labels, change the stored trace count,
remove a channel).
• Position the mouse over the EP Average window and click the right mouse
button. From the pop-up menu, select Setup. The EP Average Setup window
is displayed. Make the appropriate changes to the settings in this window
and then click OK.
15. How to check electrode impedances.

• Click on the Z toolbar button at the top of the display. The Impedance
window will be displayed showing the measured impedance of all amplifier
inputs. Click Done to close the impedance window and continue the
procedure.
16. How to reposition traces in the EP Average Window.

• Positioning a Trial – to move all the traces in one trial, click the left mouse
button over one of the traces in the trial. All the traces in that trial will be
colored “yellow”. Now, click the left mouse button and drag the trial to its
new location and then release the left mouse button. Click the left mouse
button on one of the traces in the trial again to de-select the trial.
• Positioning an individual Trace – right click the mouse and select Trial Select
from the pop-up menu. This will turn Off the Trial Select mode (i.e., removes
the check mark). Now, click the left mouse button on the trace you want to
move, the selected trace will be displayed in “yellow”. Click the left mouse
button on the selected trace and drag the trace to its new location. Click the
left mouse button on the trace again to de-select the trace. To return the
window to the default Trial Select mode, right click the mouse and then click
on Trial Select in the pop-up window.
• Positioning all Traces at once – if you move one of the Active traces (colored
“white” on the screen) the system will also move all the stored traces that go
with it. You will notice that each time an active trace is moved the Cascade
applies an auto-positioning routine to keep the traces separated adequately on
the screen.
17. How to change the Repetition Rate of a mode during a procedure.

• Move the mouse over the EP Average window or Stimulated EMG window of
interest. Click the right mouse button. From the pop-up menu, select Mode
Setup. Change the repetition rate and then click OK.
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18. How to view LIVE non-averaged data in an EP Average Window.

• Move the mouse over the EP Average window of interest and click the left
mouse button anywhere within this window. This ensures that the window is
selected. Now, click on the AVG button in the toolbar at the top of the
display. You will notice the while this button is pushed-in the word LIVE is
displayed on the button. This means that the window is displaying the non-
averaged data for each channel. To return to viewing the running average,
click on the LIVE button and it will return to the AVG mode.
19. How to Copy and Paste a Cascade window into another Windows
Application
• Move the mouse over the window of interest and click the right mouse
button. Select Copy from the pop-up menu. Now, go the Windows Start
button and start the application you are going to paste the copied window
into (i.e., Word, Paint). Once the application is ready, select Paste from the
Edit pull-down menu.
20. How to interleave multiple acquisition modes.

• The Cascade automatically interleaves all running acquisition modes that
have an assigned stimulus type. The user doesn’t need to make any special
parameter selections. For example, if you have two SEP modes they are
automatically interleaved as soon as both modes are started.
21. How to adjust the electrical stimulus intensity in fine increments.

• To increase the stimulus intensity - click the left mouse button on the right-
half of the stimulus intensity knob. The intensity should increment by one
step. To decrease the stimulus intensity - click the left mouse button on the
left-half of the stimulus intensity knob. The intensity should decrease by one
step. The size of the steps will vary and is directly related to the maximum
intensity level of stimulator.
• You can also use the Page Up/Page Down keys to change the setting in 1.0
mA increments. The Left/Right Arrow keys can be used to change the setting
in 0.1 mA increments.
22. How to make a copy of a window.

For example, you might want two waterfall windows for a particular acquisition
mode so that you can stack two different channels at the same time. For example,
have one waterfall of the cortical potentials and the other waterfall with the sub-
cortical potentials.
• In the View area of the Procedure Setup window, highlight the window you
want to make a copy of by clicking on it. For example, highlight the Rt.
Median Waterfall window. Click on the Insert Copy button. There will now
be two Rt. Median Waterfall windows in the list.
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• Use the Rename Window button to give each window a unique name, for
instance Rt Median Cortical and Rt. Median Sub-Cortical. Use the Window
Setup button to configure the default parameters for each window, including
the trace that each window will be stacking.
23. How to create Multiple Test Montages.

This would be necessary when the DSP utilization is exceeded because there are
too many active Modes in one Test. By creating a second Test (or sub-test) you
can assign some of the Modes to the first Test and the rest of the Modes to the
second Test.
• Right click anywhere over the Test area in the Procedure Setup window.
Select Add from the pop-up menu. The Create New Test window is
displayed. Enter a name for the Test, you can also use the check boxes to
Copy the Channels and Channel Names from the first Test montage.
• In the Active Modes area, below the Test montage, select the acquisition
Modes that you want to assign to each Test. While running the procedure,
use the Test pull-down menu to ‘switch’ from one Test to another. When you
change Tests the corresponding mode controls assigned to that Test, will be
enabled in the Mode Controls window.
24. Where are the Patient Data Files stored?

• The Cascade data files are stored in the location specified in the System Setup
window. The System Setup window can be displayed by selecting System
Setup from the Edit pull-down menu.
• The default location is C:\Cadwell\Cascade\Patient Data.
• You should periodically Copy or Archive the patient data files to an
appropriate backup media.
NOTE: The Procedure Setup files, Event files, Cursor Table files, Amplifier Input files,
and Report Templates are also stored in the Data folder. Be careful not to move or
delete these files from the folder.
25. How to Copy Procedure Setup Files.

• The Cascade Procedure Setup files are stored in the location specified in the
System Setup window. The System Setup window can be displayed by
selecting System Setup from the Edit pull-down menu.
• The default location is C:\Cadwell\Cascade\Setup Files.
• Use Windows Explorer to navigate to the folder mentioned above. Once you
are there, use the Copy and Paste commands in the Edit pull-down menu to
copy the files to another drive (like the floppy drive) or to another location on
the hard disk.
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Glossary
Acquisition Sweep
Acquisition sweep, or sweep speed, sets the time base in milliseconds per division
(ms/div). This is the length of the epoch the system records with each sweep. The
acquisition sweep may be set at a different speed than the Display Sweep.
There are always 10 divisions across the display. Therefore:
Note: You can set sweep speed only at one of the preset values. If you enter a value not
Display Sweep
Display sweep, or sweep speed, sets the time base in milliseconds per division (ms/div)
of the data displayed in the mode window. The display sweep may be set at a different
speed than the Acquisition Sweep.
There are always 10 divisions across the display. Therefore:
Note: You can set sweep speed only at one of the preset values. If you enter a value not
Act/Ref
Each channel on the amplifier has an active (ACT) and reference (REF) connection. The
active connection corresponds to the inverting (-) input and the reference connection to
the non-inverting (+) input. When negative voltage is applied to the active input, or
when positive voltage is applied to the reference input, an upward deflection is
produced on the display. Use the active input for the recording electrode and the
reference input for the reference or inactive electrode for a negative up convention. For a
positive up convention, reverse the electrode connections.
Active Modes
The Active Modes table lists all modes that you have programmed. The check boxes
indicate whether those modes will be available for use when the Test is activated. You
can turn these modes on or off by checking the box next to each mode.
Active Window
This list displays all open windows on the screen. The checked window name is the
active window. You can also make a window active by clicking the title bar on the
window or anywhere in the window. You know that the window is the active one
because the title bar appears highlighted (darker than the title bars of the other
windows).
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Add/Delete/Rename View Buttons

Click the Add View button to enter an additional view.
Click the Delete View button to delete the active View.
Click the Rename View button to rename the active View.
Add Marker
window.
Adjust Latency
Available after a trial has been selected.
Takes the values for the current positions of the auto-cursors on the selected trial and
resets the auto-cursor Start Latency to -90% and the End Latency to +110% of these
values.
All
The All row allows you to select a value for all channels. For example, if you select a
number in the All row for the Gain column, that number is entered as the Gain for all
channels. You can then change one or more channel specifications as needed.
All Gain Control

Use the up/down buttons to change the display gain of all channels at one time.
All Manual Modes

The All Manual Modes section allows you to control all manual acquisition modes concurrently.
The following options are available:
• Run button: Runs all manual modes concurrently. Click the Run button while it is
active to stop all manual modes. Note that if any manual modes are started
individually, the Run button is activated.
• Store: Stores the current average for all manual EP modes and the current trace
for all manual EMG modes.
• Clear: Clears the current average for all manual EP modes.
All Auto Modes

The All Auto Modes section allows you to control all non-manual modes concurrently. The
following options are available:
• Run button: Runs all modes concurrently. Click the Run button while it is active
to stop all modes. Note that if any modes are started individually, the Run button
is activated.
• Store: Stores the current average for all EP modes.
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Glossary
• Clear: Clears the current average for all EP modes.

• Audio dial: Turns up the speaker volume. Click and drag the Audio dial to adjust
the volume. Only channels with audio enabled output to the speaker (see
Creating New Procedure Setup File, the Test Montage section).
• Mute: Turns off the audio sound through the speaker when checked.
• Timers: Timer Intervals
Amp Chn
The amplifier channel field is automatically generated when you click the Channel
button in the Test table.
Amplifier
The amplifier has three functions:
To provide gain. Since the voltages in the tissues are in the microvolt range,
amplification is required to boost the levels.
To provide an impedance match between the tissue and the instrument. The tissue is not
a powerful source of voltage and care must be taken to not load down the source, which
could distort the potential being measured.
To provide for the rejection of common mode noise. To accomplish this, differential
amplification is used.
Amplifier Channel Buttons

Click the amplifier channel buttons to insert the input into the highlighted ACT or REF
field in the Test Montage section.
Amplifier Gain
The amplifier gain is the gain at which the amplifier hardware is set. For example, if you
have an Amplifier Gain of 10, and the display gain for an Average Window set to 5
uV/div, the traces are displayed at the average window setting. EP modes use an
amplifier gain of 10 or 20.
Amplitude Markers
Shows or hides the amplitude markers. The amplitude value displayed is based on the
currently selected trace.
As Recorded
When checked, this option sets the display to the same settings that were used during
the recording.
As Recorded Gain
When this feature is turned ON the appropriate display gain will be shown for the
Average window as you move back through the recording timeline. When this feature is
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turned OFF, the display gain will not change but will remain at its current setting when
moving back through the timeline. The default setting is As Recorded Gain turned ON.
As Recorded
When this box is checked, the display is shown exactly as it was set up during the
recording. When this box is unchecked, you can change the setup choices and review the
data differently than it was originally recorded.
Audio Controls
This area contains four check boxes and an Audio intensity dial that determine what is
heard during NerveGuard operation.
EMG Volume - Controls the volume of the Triggered Raw and Free Run Raw
audio. The volume of the Threshold Tones and the Free Run Tones is controlled
using the audio controls on your computer or external PC speaker.
Threshold Tones - When enabled, a unique tone is played when the stimulus
threshold level is detected.
Triggered Raw - When enabled, the raw audio for the triggered EMG traces is
heard during periods of stimulation.
Free Run Tones - When enabled, the wav files assigned to the EMG channels will
be played if the free-run EMG activity exceeds threshold during periods of free
running EMG.
Free Run Raw - When enabled, the raw audio for the EMG traces is heard during
periods of free running EMG.
NOTE: The Mute check box in the Mode Control Window on the main Cascade page
mutes all audio regardless of the audio settings in the NerveGuard window. To use the
audio functions in NerveGuard, be sure the Mute option is unchecked in the Mode
Control window on the main Cascade page.
Auto Place Cursor On Manual

When selected, the program will automatically place cursors on runs that are stored
manually.
Auto Place Cursors

If no traces are selected (yellow) then cursors are automatically placed on the live traces
(white). Otherwise they are placed on the selected trace.
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Glossary
When this feature is turned OFF moving the active "white" traces will not automatically
re-position the stored or baseline traces, nor will exiting from the Average window’s
Setup dialog. The default setting is auto-position turned ON. To turn OFF this feature,
click on this entry on the right-click pop-up menu.
Auto Size
Select this option to resize surrounding windows as you resize or move one window, in
order to continue to view all of the windows concurrently.
Auto Store On Avg Complete

This allows the auto-store feature to be disabled when the average count is reached.
When disabled, the program will not automatically store the run, it will instead simply
clear the averager and start over without storing. The default for this setting is On
(enabled).
Auto-Place Cursors on Percent of Average Complete

When this setting is enabled the program will automatically place cursors on the active
traces when the specified percentage of the total average count is reached.
Auto Store - (MEP) Mode

When enabled, this feature will automatically store the results after the stimulus train is
delivered.
Baseline Trace
Shows/Hides the baseline trace. When baselines are selected they are automatically
placed at the bottom of the selected trend window.
Cancel
Click the Cancel button to close the window without saving any changes made to the
file.
Center Marker
Centers the marker within the graph. First, set a baseline trial in one of the average
windows, collect some data, store a trial, right-click in an Average window and select
"Set Baseline." A cyan colored trial displays, which is the "Baseline."
Center Marker on Baseline

First, set a baseline trial in one of the average windows, collect some data, store a trial,
right-click in an Average window and select "Set Baseline." A cyan colored trial displays,
which is the "Baseline." In the Cursor Trend window, a cyan colored dot displays, which
represents the cursor value from the baseline trial. "Center Marker on Baseline" moves
the marker on top of the baseline dot.
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Center/Range
Specifies the range of values to be displayed in the graph. Center defines the value that
is displayed at the center of the graph. Range specifies the range of values to display
across the width of the graph. For example, if you set the Center to 10 and the Range to
10, values between 5 and 15 display.
Ch 16 Audio Mute
When enabled, the audio from the mode will be muted if the signal in Channel 16
exceeds its reject limit.
Camera Setup
Displays a dialog to select which video camera to use in this window if you have more
than one camera available.
Channel Button
After completing amplifier inputs for each channel, click each Channel button you want
to assign to an acquisition mode.
Channel Fields
Sets the display gain for traces. Channel drop-downs are only enabled when "Trace
Mode" cursors are being used. When creating/editing a procedure setup, select "Cursor
Setup" for an EP mode and un-check the "Trial Mode Cursors" item.
Channel Labels
Shows/Hides the channel labels in the window.
Channel Name
The Name field, or Channel Name, is automatically generated based on the amplifier
inputs you have entered for the channel. For example, if the Active input for a channel is
T12 and the Reference input for that channel is T10, the name would be T12-T10. You
can change this name or leave it with the default name. If you change the name for a
channel in either the Test table or the Channel Settings section, the name will be changed
in both places.
Channel Section
Clear
Clears the current average.
Clear Button
Click the Clear button to clear all channel fields and enter new data.
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Glossary
Clear Button
Click the Clear button to clear all values from the table.
Clear Captured Trace

Resets the auto-captured trace to a flat line.
Clear Cursors
Clears the cursors from the selected trial/trace.
Client List
Displays a list of remote "viewing" computers that are currently connected to a Cascade
server.
Control Button
The main control button is always initiated in the Standby mode. Clicking on this large
button switches the program to Detecting mode. In Detecting mode the program will
automatically increase the stimulus intensity and determine threshold as soon as the
stimulating device detects a complete electrical circuit such as when the stimulus probe
makes contact with the pedicle screw or patient.
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Glossary
If the maximum stimulus intensity is reached without obtaining a threshold value, the
letters “NR” will be displayed to indicate No Response was detected.
Copy Special
Applies filtering to the Copy command. You can select only the data you want to see
based on priority, type of event, and individual events.
CSA
Shows/Hides CSA (Compressed Spectral Array) trends in the analysis window.
CSA Scale
Increase or decrease the height of the CSA plots.

Opens the Procedure Setup window to make any changes to the current procedure setup
file. This is used for certain conditions, such as when electrodes fall off. You can make
any necessary changes to the amplifier inputs, modes, channels, or views. This option is
only available when a procedure file is open.
Detection Mode
This control determines how the NerveGuard program functions when a threshold is
detected.
Screw Test - When stimulus threshold is detected the program stops stimulus
delivery, and reports the stimulus intensity threshold.
Continuous - When threshold is detected the program will continue to stimulate
and will constantly report stimulus intensity levels.
Fixed - To use the Fixed Detection Mode in NerveGuard, select the Fixed
Detection Mode button in the upper right corner of the NerveGuard window, set
the intensity slider to the desired intensity and click the Control Button to turn off
standby. The intensity slider can be controlled by dragging the slider on screen
using the mouse, using the up and down arrow keys on the computer keyboard
and by rolling the scroll wheel on your mouse.
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Disp Gain
Use the spinner buttons to increase or decrease the display gain for traces. All traces will
be changed if no traces are selected. Otherwise, only the selected traces are changed. A
gain value is displayed only if all traces have the same gain setting. The spinner buttons
are always active.
Display Sweep
Specifies sweep length of the traces. The Display Sweep may be set to a different setting
than the Acquisition Sweep. Units are milliseconds per division and always ten
divisions total therefore:
Division Units
When checked, the current sweep setting is displayed in the lower right corner of the
window. The current gain setting is also displayed in the lower left corner if all traces
have the same gain setting.
Dot-to-Dot Markers
Center Marker on Baseline: centers a vertical time marker on the baseline value.
Center Marker: centers a vertical time marker within the x-axis of the trend.
Place Marker at x% of Baseline: positions a vertical marker at +10% (latency trend) or -
50% (amplitude trend) of the baseline value.
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Glossary
Dot-to-Dot/Graph View: Dots mark the cursor values with a straight line between them.
This view tracks the Time Bar repositioning.
feature selected. The table contains all values that have been collected, baseline values,
events, and the time, value, and percent difference from the baseline for each cursor
value. This view also tracks the Time Bar repositioning.
DSA
Shows/Hides DSA (Density Spectral Array) trends in the analysis window.
DSA Colors
When the DSA View is selected, these controls can be used to select the color scale.
DSA Max Power

Set the top level of the color scale when displaying DSA power trends.
DSA Max Voltage

Set the top level of the color scale when displaying DSA Voltage trends.
DSA Smoothing
Select to smooth selected traces in EEG Windows. This function is only available when
the DSA view has been selected.
EEG Burst Suppression

The Cascade has three options for computing and display EEG Burst Suppressions.
• Suppression Ratio (%) - the percentage of time spent in suppression during the
previous minute.
• Bursts Per Minute (b/m) - number of bursts that began during the previous
minute.
• Burst : Suppression - the ratio of time not in suppression to the time in
Definitions:
Suppression - an interval of at least 1 second during which there is no activity
above threshold.
Burst - a period of time in which the threshold is exceeded with a specified degree
of frequency.
Algorithm:
The EEG data is filtered using an 8 Hz locut filter. The algorithm then begins looking for
bursts and periods of suppression using the following rules:
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o A burst is a segment more than 700 msec long that exceeds 8 uV in amplitude. If
the burst is less than 700 msec, it is considered a noise spike.
o Bursts must be separated by at least 150 msec, or they are counted as a single
burst.
o If the flat area between bursts is at least 1 second long, then that time is counted
as suppression.
The Burst Count and Suppression % are calculated for each individual 10-second epoch.
The values that are displayed in the EEG window are the total count for the last minute,
or the average suppression % for the last minute. If the Suppression % is less than 25%,
then the program assumes that the patient is not yet in burst suppression, and doesn't
display the value.
The EEG Analysis window shows yellow dots (trend view) for values that are calculated
from less than a minute of data (which can occur if the mode is stopped and restarted).
EEG Drawing Selections

• 10 Divisions - creates 10 equal horizontal divisions across the width of the
EEG window, no matter what the sweep speed setting is.
EMG Run Modes

Manual: The Run All, Store All and Clear All buttons at the top of the Mode Controls
window do not affect the mode. This mode will respond to the All Manual Mode
controls.
Auto: If this selection is applied to an EMG mode, it simply means that the mode will be
affected by the Run All and Store All buttons. The Clear All button will never affect an
EMG mode.
Independent: Modes with this setting do not respond to the All Mode Controls or the
All Manual Mode Controls. This is typically used for MEP modes.
Enable 16 Ch Reject
When this box is checked, the program will pause data acquisition for the mode when
the signal in channel 16 exceeds the reject limit.
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Glossary
Enable Auto Capture on Threshold

Checking this box causes the Cascade to hold the EMG sweep on the screen until a new
threshold crossing occurs. The held sweep is colored "purple" on the screen and is positioned
slightly above the Live EMG traces. The triggering sweep is offset by 3 divisions so that any
threshold activity which occurs at the end of the sweep can be seen in its entirety.
When performing stimulated EMG (i.e., triggered EMG) using the HOLD mode, the auto-captured
traces are not offset by three divisions.
Enable Bovie Reject

When this box is checked, the program will pause data acquisition and mute the audio
for this mode when the Electrosurgery Detector box signals that the bovie is in use.
Enable Store on Threshold

Checking this box causes the Cascade to automatically store each EMG sweep that crosses the
threshold. Sweeps can be stored at a rate of one sweep every 3 seconds. The EMG Comment
dialog is disabled for auto-stored EMG.
Enable Wave/Beep
Checking this box causes the Cascade to play the assigned sound file when a channel exceeds
its threshold setting. Remember, the sounds are played through the laptop or PC’s speakers, not
through the Cascade base unit. To adjust the volume of the sounds, change the laptop or PC’s
sound volume.
Note: In order to keep the system from beeping due to stimulus artifacts you will need to enable
the "Remove Stim Artifacts" feature. It is also necessary to enable "Suppress Audio During Stim".
EP Mode Controls
Information and options displays for each EP mode. The mode name displays to identify which
controls work with each mode.
• Run button: Starts/stops acquisition for the mode.
• Reject: Displays the current reject percentage, which is the percentage of the
total number of sweeps that have been rejected.
• Channel Reject Indicator: When one or more channels in a mode are setting
off artifact reject, a Reject icon will appear next to the channel or channels
that are setting off the artifact reject. The user may adjust the reject levels or
turn off Artifact Reject by accessing the Reject Settings dialog.
• AvgCnt: Displays the current average count and the shutoff count.
• EStim Intensity: Intensity knob changes the intensity of the electrical
stimulator assigned to the mode. Click on the right or left half of the knob to
decrease or increase the current in small increments.
EP Modes
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EP modes can use any type of stimulator. Responses are usually averaged for this type
of test in order to unmask the tiny evoked potentials from background noise that might
obscure them. However, you can view the live unaveraged data using the Live/Avg
control. Cursors mark important latency and amplitude features on waveforms.
ES-5 -10 Stim Splitter

This stim splitter provides four standard and one low current output. The ES-5-10
stimulator splitter can be configured as a primary splitter and secondary splitter. The
primary stim splitter is always at the physical end of the cable. The secondary splitter is
used when more than one splitter is needed, and provides a connection for the primary
stim splitter, allowing the two splitters to be "daisy chained" together. The ES-5-10 does
not support current sensing. Current sensing is required for use of the NerveGuard
software.
Event List
The event list is created in the procedure setup file as a list of possible events that will be
encountered during surgery. This list is an example that might be used. Select an option
from this event list to enter it in the Event Window. The current time and most recent
traces are also entered in the Event window when you select an event.
Event Text
Show: Shows/Hides display of the event text
Time: Specifies whether to show the elapsed time, real time (time of day), or no time,
when displaying event text.
Events
Edit: Enter specific data for the event list you will use during the procedure.
Feature
Specifies which cursor feature to trend. Each feature will have a separate graph.
File Names
Displays a list of most recently viewed files. Each file name is unique and generated by
the system with the patient’s name, and the date and time the file was created.
Freeze
The Z-axis depicts the last n minutes of data. Normally, you will see traces "walk" up the
display. When this option is checked, the traces are frozen in place and do not move.
Freeze Frame
Freezes the live video update.
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Glossary
Frequency Range (Hz)

Select the low and high frequency limits for the horizontal axis. The lowest setting is 1.0
Hz and the highest setting is 30 Hz.
Display Gain
The display gain is the input sensitivity of the instrument when data is being collected.
This sensitivity determines the vertical scale of the input as displayed on the test screen
when set to view the input signal during acquisition. You can adjust gain settings (as
well as sweep speed) to ensure proper display of the signal. You can adjust the gain
setting independently in each channel. Gain is measured in microvolts per division
(uV/div).
Gain
Specifies the display gain for the trace.
Grand Average
Allows stored trials to be averaged together. This function is only available when more
than one stored trial has been selected in the window.
The resulting grand average traces, for each channel, are displayed in 'green' color and
the trace label will contain the letters 'GA'.
Graticule
HiCut, LoCut
Each channel can be configured with default HiCut and LoCut filter settings. You can
adjust the settings as needed according to the situation and type of signal you are
measuring. You can set the filters independently in each channel. Values are in hertz
(Hz).
Horizontal Trend
When enabled, the Dot-to-Dot trend is drawn horizontally rather than vertically.
Impedance
Impedance is the resistance to alternating current flow. It can affect the signals from the
recording electrodes. You should check impedance before the start of every recording
and during the recording if there is reason to suspect poor contact between the electrode
and the patient. Impedance levels below 5 kilo Ohms (kOhms) are acceptable for most
tests. The following colors are used to indicate the impedance level for each electrode
pair:
Green < 5 kOhms
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Yellow 5 - 15 kOhms
Red > 15 kOhms
Intensity Bar
This region of the NerveGuard window indicates that the stimulus intensity if
increasing and also shows the “High Z” impedance symbol.
The “High Z” symbol is displayed when the circuit between the stimulating probe
(cathode) and the return electrode (anode) is incomplete. When the circuit is completed,
such as when the stimulus probe makes contact with the pedicle screw, the “High Z”
symbol will be cleared and the program will automatically begin to increase the
stimulus intensity. The red, yellow and green bars will ramp up as the intensity of the
stimulator increases.
When the stimulus probe is removed from the pedicle screw, the “High Z” symbol will
return and the stimulus intensity is immediately returned to the starting value.
Insert Copy Button

Click the Insert Copy button to copy the selected window in the view list. For example,
the Waterfall window stacks the traces for a particular channel. You may want more
than one Waterfall window in order to stack traces from another channel at the same
time.
Invert
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Glossary
Check the Invert box to flip channel polarity, such as when sharing channels between
modes.
Label Format
Select whether you want the trials/traces labeled with the trial name or with the time of
day (TOD).
Lock Graph
If this option is checked, the dots on the histogram window, which represent the cursor
value from the baseline trial, are locked in place. If "Lock Graph" is un-checked, you can
drag the "dots" around in the histogram window to center them.
Marker
Shows/Hides a vertical marker to provide a reference point for the graph. You can use
this marker to quickly determine if the values are above or below a particular value.
Max Intensity
Sets the intensity upper limit for the electrical stimulator assigned to this mode. When
running the procedure the electrical stimulus intensity knob will not dial past this
setting.
MEP Mode
Similar to an EP mode in function but this type of mode does not have a Run/Stop
control (only Single, Store, and Clear), and it does not respond to the All Mode Controls
or the All Manual Mode Controls. Instead of a Run/Stop control, MEP modes have a
"Single Trigger" button.
Stimulus types are TCS-1, CV-2, Flash (old external trigger), External Trigger, or
Electrical.
MEP Mode Controls
Single Trigger - initiates one TCS-1 or CV-2 stimulus train, or one external trigger pulse.
Store - stores the responses.
Clear - clears the active traces.
Intensity knob - changes the intensity of the TCS-1 or CV-2 stimulator assigned to the
mode. Click on the right or left half of the knob to decrease or increase the voltage in
small increments.
Note: There is no Run Mode setting for MEP Modes, these types of modes do not
respond to the All Mode Controls or to the All Manual Mode Controls, they only respond
to their individual controls (e.g., the Single Trigger button).
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TCS-1 Mode Controls
MEP Mode Options:

Autostore: Check this option to have the Cascade automatically store the traces after the
stimulus train is delivered.
Setup Reject Info:
Enable Bovie Reject: Up to four electrocautery detection probes can be connected
to detect the use of a Bovie device. Select this option so that data is not collected
during periods of electrocautery use.
Enable Channel 16 Reject: This channel can be used as a reject channel. Select this
option to pause all data collection and mute the audio when the data on this
channel exceeds the threshold.
Reject: Check the Reject option to eliminate excessive movement artifacts or other
sources of noise from the running average. This reject is based on a pre-
programmed percentage (usually 50%) of the amplifier’s full bandwidth setting.
The total number of sweeps that are rejected is displayed in the Mode Control
window as a percentage. This option automatically enables artifact rejection on all
channels assigned to the mode. You can disable the feature for individual
channels by removing the check mark next to the appropriate channel in the
Channel Settings section. When artifact rejection is completely disabled for all
channels, every collected sweep is included in the running average. In the Mode
Control window, the reject status is indicated as OFF.
Remove Stim Artifact from EMG: For stimulated EMG modes, select this option to
remove the stimulus artifact from the display and audio output. When this is selected
for an EP mode, which is using an electrical stimulator (i.e., Rt Median SEP), it will
enable the stimulus artifact to be removed from EMG traces. The system zeros the data
milliseconds after the stimulus.
Minutes Labels
Shows/Hides the axis minutes labels.
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Glossary
Mode
Add: Add one or more modes
Delete: Delete the active mode.
Rename: Rename the active mode.
AutoName: Changes the channel name to reflect the Act-Ref values.
EMG Trace Area

During stimulus delivery this area displays triggered EMG traces. The most recent
sweep is displayed (typically in white) as well as the last sweep to exceed the threshold
criteria (typically in purple).
When stimulation is not being delivered, this area displays free running EMG traces at a
fixed sweep speed of 100 msec/division.
NOTE: Right click over the trace area to access functions such as Mode Setup
(including the NerveGuard Setup Submenu) and Window Setup.
Print Report Button

Click this button to generate a summary report listing the levels stimulated and their
corresponding threshold values.
Use the report template called, “Pedicle Screw Stim Report”.
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Below is an example of the report summary table.
NOTE: If no side & level are selected on the Spine Graphic prior to stimulation the
summary report will include a row with a site name entry of “Not Specified”.
NOTE: If the maximum stimulus intensity is reached without obtaining a threshold value
the summary report will indicate “No Response Detected at Max Stim” for that site.
Norm Percent Change

Enter the percent change from baseline that is normally allowed for the cursor value.
Latency values are considered abnormal when they exceed this entry (i.e., +10%),
amplitude values are considered abnormal when they are decreased by the amount
entered (i.e., -50%).
Abnormal values are indicated by red text in the table format and by red squares in the
dot-to-dot format.
Notch/Audio
Check the Notch box to reduce unwanted interference from power lines for that channel.
The notch frequency is determined in the System Setup window, it can be either 60 or 50
Hz.
Check the Audio box to output the channel to the speakers.
Paging Controls
Use these toolbar buttons to go forwards/backward by one page or by one half page.
Click on the middle button to return the display to Live EEG.
Pause EEG Analysis
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Glossary
Stops EEG Analysis. Live EEG continues to be recorded. When the EEG Analysis is
paused, 'red' tick marks will be displayed in the trend plots.
Pause Averager
When selected on, the Pause Averager option pauses the averager while allowing users
to control the stimulator as normal. The default state is for the Pause Averager option to
be unchecked. To turn the Pause Averager on, right click in the data window of an EP
Average or Triggered window and select the Pause Averager option. When the Pause
Averager option is selected on, the Average count in the Mode Control Windows and in
the Date windows will show “Paused.” The mode will remain in Pause Averager mode
until the option is unchecked.
Play Sound on Stim

When this box is checked the program will play a brief sound (WAV file) whenever
stimulus current is delivered to the patient.
Use the folder icon to browse to the WAV file you want to assign to this feature.
Use the speaker icon to test the WAV file you have selected.
The icon for this feature is only available if a stimulator has been selected for the mode.
Note: The WAV file is played through the PC's speakers, not through the Cascade Base
Unit's speaker.
Print EEG Report

Select this option to generate an EEG report.
Select Print Current window to generate a report with just the traces from the current
EEG window.
Select Print range to generate a report that includes all the EEG traces over a specified
time range.
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Print Procedure Setup

Click the Print button in the Procedure Setup window to generate a report that contains
the procedure setup information. There are two factory default templates provided for
this:
Amplifier Setup.rpt: Prints just the amplifier input labels.
Procedure Setup.rpt: Prints the entire procedure setup, including amplifier inputs, test
montage, mode setups and channel settings, view setups, and event list.
Print Screen
Selecting this option from the File menu sends a picture of the current screen to the
default printer. The screen print includes the status bar which contains the current
(clock) time and the elapsed time.
Pulse Width
Sets the duration of the electrical stimulus pulse. The pulse width is measured in
microseconds (usec).
Refresh
Updates the image in the window.
Refresh Rate
Specifies how often the image in the window is updated.
Reject
When artifact reject is enabled, the reject percentage value is displayed in the window.
amplitude window of 100 microvolts (10 vertical divisions times 10 uV/div.) with 50 uV
above baseline and 50 uV below baseline. If the reject level is set to 50%, then the
amplitude of the Live trace can’t exceed +/- 25 uV or it will be rejected from the running
average. The lower the reject level setting the more sensitive the program will be in
rejecting large artifacts.
Reject Setting Dialog

The Artifact Reject Dialog allows for quick and easy adjustment of reject levels, allows
reject to be turned off for individual channels, displays the frequency components of a
selected channel and allows for turning on/off the Bovie Reject and Channel 16 reject
features.
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Glossary
• Channel Reject Indicator: When one or more channels in a mode are setting off artifact
reject, a Reject icon will appear next to the channel or channels that are setting off the
artifact reject. The user may adjust the reject levels or turn off Artifact Reject by
accessing the Reject Settings dialog.
• There are four ways to access the Reject Settings dialog
- Click the Reject icon .
- Select the Reject Settings option from the right-click menu in the EP mode.
- Click the Setup Reject Info from the EP Global controls dialog located on the tool bar.
- Click the Setup Reject Info from the Procedure Setup dialog.
• When the Reject Settings dialog is accessed via the Reject icon, the dialog will default
to highlighting the channel associated with the icon that was clicked to access the Reject
Settings dialog. When the Reject Settings dialog is accessed in any other way, the dialog
will default to highlighting the first channel in the list.
• The threshold data window displays reject level bars indicating the upper and lower
limits of the threshold window. Live, free-running data for the highlighted channel is
displayed in the threshold data window if the mode is running.
• Adjust the artifact reject level to the desired setting by clicking on the squares on the
reject level bars and dragging the bars to the desired position.
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• Reject numeric artifact reject levels for each channel are listed in the fourth column of
the channel list. The reject levels are displayed as percent of total gain and as micro
Volts.
• To adjust the artifact reject limits for other channels in the mode, click on the channel
name and adjust the reject level bars.
• To increment the reject limits for of all channels at the same time, click the up/down
arrows on the All spinner control.
• To turn off artifact reject for one or more channels, deselect the check box for the
• The Noise Analysis sub-window at the bottom of the dialog displays the FFT analysis
of the live data for the selected channel. This allows users to identify the dominant
frequencies of the live data for the selected channel.
• Changes made in the Reject Settings dialog are applied immediately. The averager
continues to run when exiting the Reject Settings dialog.
Enable Bovie Reject: Up to four electrocautery detection probes can be connected to

detect the use of a Bovie device. Select this option so that data is not collected during
periods of electrocautery use.
Enable Channel 16 Reject: This channel can be used as a reject channel. Select this option
to pause all data collection and mute the audio when the data on this channel exceeds
the threshold.
Reject On: Check the Reject option to eliminate excessive movement artifacts or other
sources of noise from the running average. This reject is based on a pre-programmed
percentage (usually 50%) of the amplifier’s full bandwidth setting. The total number of
sweeps that are rejected is displayed in the Mode Control window as a percentage. This
option automatically enables artifact rejection on all channels assigned to the mode. You
can disable the feature for individual channels by entering the Reject Settings Dialog and
removing the check mark next to the appropriate channel in the Reject column. When
artifact rejection is completely disabled for all channels, every collected sweep is
included in the running average. In the Mode Control window, the reject status is
indicated as OFF.
Remove Stim Artifact From EMG

Checking this box in the EP Mode Setup window will remove the stimulus artifact
related to the EP stimulator from the Live EMG traces.
The system zeroes the data during stimulus delivery and for a user selectable time
period between 0.5 to 5.0 milliseconds.
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Glossary
To remove the stim artifact and suppress the audio, turn on Remove Artifact From
EMG in the SEP mode and turn on the Remove Stim Artifact option in the live EMG
mode. The Suppress Audio During Stim option in EMG only applies to the EMG stim.
For example, if you have an SEP and a live EMG and want to eliminate the visible stim artifact
and the audio stim artifact in the EMG, turn on Remove Stim Artifact From EMG in the SEP
mode. In the EMG mode, turn on the Remove Stim Artifact.
The Remove Artifact From EMG option available in SEP modes will always mute the
audio in the EMG mode during stim artifact from the SEP. This is the only way to mute the
SEP artifact. The Remove Stim Artifact option in EMG modes will simply remove the
visible stim artifact; but only if Remove Artifact From EMG is on in the SEP mode.
If you want to mute SEP artifact in EMG but still see the artifact, turn on Remove
Artifact From EMG in the SEP mode and turn off Remove Stim Artifact option in EMG
modes.
Rename Window Button

Click the Rename Window button to enter a new name for the selected window in the
view list.
Resolution
Specifies the resolution of the image acquired from the camera. The image is always
stretched to fit the window.
Rotate/Tilt
Lock Position: If checked, you cannot change the graticule orientation by dragging the
corners.
Rotate/Tilt: Allows you to change the orientation of the graticule.
Run
Run Mode
Select Manual or Auto for the Run Mode (the default is set to Manual).
Manual: The mode can be started and stopped by clicking on the individual Run button
for the mode. The Run All, Store All, and Clear All buttons do not affect the mode.
Auto: The mode can be started and stopped using the All Mode controls.
Select All
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This function selects are trials that are currently displayed within the window.
Setting Baselines
baselines are set on a "per-mode" basis so if you set the baseline in a 3D window or an
Average window, the trial associated with the trace will show up in all other windows
that display baselines and are connected to the same mode.
choosing.
Set Epoch Length

CSA/DSA epoch length may be adjusted by right clicking in the EEG Analysis window
and selecting the desired epoch length from the Epoch length sub menu. Users can
select from choices of 2, 4, 8, 16, and 32 seconds.
Setup Stim
For EP, MEP, TOF, or Triggered EMG modes, click Setup Stim to set up stimulator
specifications, such as rep rate, label name, stimulator number, pulse width, and
maximum intensity.
Setup Tables
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Glossary
Select the cursors that will be included in the reports, and select whether you want to
include baseline information.
Show
The Show section allows you to select the following options:
Labels: Shows/Hides the axis unit labels.
Trace Name: Shows/Hides the label of the trace displayed.
Graticule: Shows/Hides the values for all three axes.
Baseline: Shows/Hides the baseline trace. When baselines are selected they are
Show Baseline
This option for each column in a Cursor Trend window shows the current baseline value
for the feature being trended, and is displayed as a line at the bottom of the display.
When the "Display Baseline Value" option is turned on, a value is displayed which is the
difference between the baseline value and the most recent value. This value is displayed
as a percentage. For example, if the baseline value is 5.0 and the current value is 4.0, the
value displayed will be -20.0%. If the current value is 7.5, the value displayed will be
50.0%.
Show Baseline Dot-to-Dot

This option for each column in a Cursor Trend window shows the current baseline value
for the feature being trended, and is displayed as a 'blue dot' at the bottom of the
display.
When the "Show Baseline" option is turned on, a value is displayed which is the
difference between the baseline value and the most recent value. This value is displayed
as a percentage. For example, if the baseline value is 5.0 and the current value is 4.0, the
value displayed will be -20.0%. If the current value is 7.5, the value displayed will be
50.0%.
Show Burst Suppression Info

Enables the display of burst suppression calculations for the channels that are checked.
Show Section (Table View):

Events: Shows/Hides display of the event text.
Baseline: Shows/Hides baseline. When baselines are selected they are
Percent: Shows/Hides the percentage difference between the baseline and most
recent data point in the Cursor Trend window.
Time: Specifies whether to show the elapsed time or real time (time of day) when
displaying event text.
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Show Section (Dot-to-Dot View):

Labels -Shows/Hides the minutes labels.
Baseline - Shows/Hides the baseline dot and % change value.
Feature Name -Shows/Hides the cursor value being trended, i.e. N20.
Trend (min) - Specifies the amount of time to show in the trend.
Show Cursors
Shows or hides the cursors on the trace lines in these windows. Cursors mark important
latency and amplitude features on waveforms. See Working with Cursors for more
information.
Show Events
Select this option to display the event text in the Cursor Trend window.
Show In Trace Windows

Graticules: Shows/Hides the graticule in the trace display windows.
Trial Numbers: Shows/Hides the trial number in the trace display windows.
Division Units: When checked, the current sweep setting displays in the lower right
corner of the window. The current gain setting also displays in the lower left corner if all
‘Mode Trace‘ Labels: Shows/Hides labels of mode trace names.
Baselines: Shows/Hides baselines. When baselines are selected they are automatically
placed at the bottom of the selected trend window.
Show Percents
Select this option to display the percent change, or the percentage difference between the
baseline and most recent data point, in the Cursor Trend window.
Show Trial Numbers

Select to display the trial numbers in the trace label.
Show Trial Numbers and Time

Trial Number : When enabled every fourth trial number will be displayed on the traces.
Trial Times: When enabled the trial times will be displayed in the far right-hand
column.
Channel Names: When enabled the channel names will be displayed in the top left of
each trace window.
Single
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Glossary
Fires the assigned stimulator once.
Smooth
Click this button to smooth the selected trial/trace. If no trial/trace is selected the active
traces will be smoothed.
Smooth/Unsmooth
Select Smooth to smooth selected traces in EP Windows. Select Unsmooth to reverse
smoothing.

During a remote monitoring session, click on this button to cause the Reader to sync to
the same view as that currently displayed on the Cascade.
Spectral Edge
Shows/Hides the spectral edge indicator and selects the spectral edge frequency value
(50, 90, 95, 97 or 99 %). Spectral edge is always determined for the total frequency band
of 1 – 30 Hz.
Stim Hold/Stim Rep

Stim Rep (Stimulate Repetitive): Turns repetitive stimulation on/off.
Stim Hold (Stimulate Hold): Turns Stim & Hold mode on/off. When on, the EMG mode
fires the stimulator at the specified reprate and displays single sweeps triggered by each
stimulus. When unchecked, the EMG mode runs in the default, free run mode. When
this box is checked, the Repetitive checkbox is automatically checked and disabled.
Stim Type
The Cascade uses electrical, ES-IX, audio, visual, TCS-1, and CV-2 stimulators. Select a
stimulator type from the drop-down list. Click the Setup Stim button for various options
to set up each stimulator type.
To trigger an external device, select "External Trigger". A special external trigger

interface box is required for this implementation.
Stimulate
When checked, the EMG mode will fire the stimulator and the specified rep rate and
display single sweeps triggered by each stimulus. When unchecked, the EMG mode
runs in the default, free run mode.
Store
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Store
Stores the current average. Stores the currently displayed data to the Event log. This
event will display on the timebar and in the Go To dialog, but will not show up in the
Event Window. When the file is reviewed, the last stored data will be displayed.
Each time you click Store for an EMG event, a Comment box displays for you to enter
additional information.
Store Image On
These controls specify when a video image is stored to the data file. Care should be
taken when selecting these setting since video images can greatly increase the size of a
data file.
Interval: When checked, images are stored on the specified interval.
Event: When checked, an image is stored whenever an event is entered.
EP Average Done: When checked, an image is stored when a new trial is stored in any
EP mode.
EMG Store: When checked, an image is stored whenever an EMG sweep is either
manually or auto-stored.
Suppress Audio During Stim

Select this option to suppress the sound of the stimulus artifact from the audio while
that mode is running.
Sweep Delay
Sweep delay determines the start of the sweep relative to the onset of the stimulus. A
pre-stimulus sweep delay (negative value) is useful for acquiring pre-stimulus or
baseline-level activity. A post-stimulus sweep delay (positive value) can be used to
remove stimulus artifact from the display. The value can be set to -1.0, 0.0, or 1.0
division.
Sweep duration is always 10 divisions long.
Symmetry
Shows/Hides DSA trends with symmetry trends plotted down the middle in the analysis
window.
Take Snapshot
Stores the current video image to the file. A Comment box displays each time a snapshot
is taken.
Test
Add: Add a test when you need more than 16 amplifier channels.
Delete: Delete the active test.
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Glossary
Rename: Rename the active test.

AutoName: Changes the channel name to reflect the Act-Ref values.
Threshold Markers
When enabled, the threshold setting for each channel is indicated by yellow markers.
Time Bar Event Marks

Select priority specifications for the time bar event marks.
Do not show if priority less than: If you select Medium from this drop-down list, events
with a priority less than medium will not display in the time bar.
Skip when jumping from event to event if priority is less than: If you select Medium
in this drop-down list, the scroll box will skip event markers if the event has a priority
less than medium.
Timer Intervals
Two timers allow modes to start on a specified interval. The interval can be set in the
main setup dialog or from the mode control view. These timer values are stored in the
setup file.
For example, if Timer1 interval is set to 60 seconds, and the Run All button is clicked, the
modes run until their average count is reached. The trial will be stored, cursors placed,
and the averager cleared. When 60 seconds has elapsed from when the last mode in the
group has completed, the modes start again. If the Run All button is turned off, the
timers are paused. A Clear Timer function is available in the Mode Control View. These
selections are only available for EP modes
TOF Mode
The TOF (Train Of Four) mode allows for monitoring the patient’s degree of
neuromuscular blockade. A train of four stimulations are delivered to the patient and
the program automatically records the responses to each stimulus and determines the
amplitude and area of each response, if present. Stimulus artifact in the Train of Four
mode is suppressed for two milliseconds for each stimulus in the train.
TOF Mode Controls

• Run button: Starts/stops acquisition for the mode.
• Single Button: Fires the assigned stimulator once.
• Store Button: Stores the current average.
• Clear Button: Clears the current average.
• Reject: Displays the current reject percentage, which is the percentage of the
total number of sweeps that have been rejected.
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• Channel Reject Indicator: When one or more channels in a mode are setting
off artifact reject, a Reject icon will appear next to the channel or channels
that are setting off the artifact reject. The user may adjust the reject levels or
turn off Artifact Reject by accessing the Reject Settings dialog.
• Stim Intensity Knob: Intensity knob changes the intensity of the electrical
stimulator assigned to the mode. Click on the right or left half of the knob to
decrease or increase the current in small increments.
• Run Mode This setting defines how a mode reacts to the Run All, Store All
and Clear All buttons in the Mode Controls while running a procedure. The
option is within the Procedure Setup screen, and in the Mode Control
window. The following selections are available:
• Manual: The Run All, Store All and Clear All buttons in the All Auto box
of the Mode Controls window do not affect the mode. This mode will
respond to the All Manual Mode controls.
• Independent: Modes with this setting do not respond to the All Mode
Controls or the All Manual Mode Controls. This is a good choice for
MEP modes.
• Timer1/Timer2: Two timers allow modes to start on a specified interval.
The interval can be set in the main setup dialog or from the mode
control view. These timer values are stored in the setup file. For
example, if Timer1 interval is set to 60 seconds, and the Run All button
is clicked, the modes run until their average count is reached. The trial is
stored, cursors placed, and the averager cleared. When 60 seconds has
elapsed from when the last mode in the group has completed, the
modes start again. If the Run All button is turned off, the timers are
paused. A Clear Timer function is available in the Mode Control View.
These selections are not available for EMG modes.
Trace Labels
Trace Name
Trace Name or Feature Label displays the name of the feature within the graph.
Trace Windows
Trace Window 1-4 specifies which trace to display, if any. The drop-box lists all traces
from all EP modes.
Train Setup
Used to program the duration (in seconds) and the repetition rate (in Hz) of the EMG
train stimulus.
Trend
Specifies how many minutes of data the graph will display.
Trend Count
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Glossary
Specifies the number of stored trials to display. Stored trials are displayed in a trend
fashion with the most recent trial at the bottom.
Trend
Shows/Hides power trends in the analysis window.
Specifies how many minutes of data the graph will display.
Trend Settings
Trend: When the Trend View is selected, these controls can be used to select the type of
data to be trended. Select from Total Power, Absolute Power, or Relative Power. When
either Absolute or Relative power are selected, the frequency band can also be selected
(Delta, Theta, Alpha, Beta, Delta+Theta, or Alpha+Beta).
Range (pW): Sets the maximum limit for the horizontal (x-axis) of the trend displays.
Trend Time
Determine the amount of data displayed in the vertical axis; for example, the last 10
minutes of data.
Trial Select
When this option is checked, clicking on a trace selects or clears all the traces for a trial.
When unchecked, traces are selected individually.
Trigger
Causes the assigned MEP stimulator to deliver one stimulus train.
View Selection
The items at the bottom of this menu are the names of the views from your setup file.
The radio mark shows which view is currently selected. Selecting any of these items
takes you to the corresponding view.
Voltage, Power, ZScore

Select one of the following options:
Voltage: Changes the analysis window to display voltage (microvolts).
Power: Changes the analysis window to display power (pW or microvolts squared).
Power is the most common setting to use for CSA and DSA displays.
Z Score: Changes the analysis window to display the difference (in z-score units)
between the trended data and the most recently selected baseline. This is most
commonly used with DSA displays.
Waveforms
477

Trace: Selects which trace is displayed.
Sweep: Specifies at what sweep to display the traces. Note that this value does not effect
the mode sweep setting. Select Default if you want the sweep to track the mode sweep
setting.
Gain: Specifies the display gain for the trace.
Trend: Specifies how many minutes the Z-axis displays.
X/Y/Z Divisions: Specifies how many divisions each axis displays.
Waveforms
Trace: Selects which trace is displayed.
Sweep: Specifies at what sweep to display the traces. Note that this value does not effect
the mode sweep setting. Select Default if you want the sweep to track the mode sweep
setting.
Gain: Specifies the display gain for the trace.
Trend: Specifies how many minutes the Z-axis displays.
Order (time): The traces can be trended in ascending or descending mode. In ascending
mode, the most recent stored trace appears at the bottom of the graph and moves
upward as new traces are added to the stack. In descending mode, new traces appear at
the top of the graph and move downward. The current time of day is displayed at the
top (descending mode) or bottom (ascending mode) of the Y-axis.
Window Setup Button

Each type of window (Average, 3D Trend, etc.) has its own unique setup dialog specific
to the operation of that window. Click the Window Setup button to set up various
specifications such as Trend Count, Trend Time, or Display Gain.
Z Score Colors
When the DSA View and the Z Score items are selected, the Z Score controls can be used
to select the Z Score color scale.
Zoom Control
Click the drop down arrow to view the Full Spine or zoom-in on the Lumbosacral,
Thoracic, or Cervical segments.
478
Glossary
Zoom In/Zoom Out

Use these options to quickly modify the range of values displayed in the graph.
479
Index
3 Auto Size 70, 449
3D Trend 228, 277 Auto Smooth 192
3D Trend Window 228 Auto Store 449
3D Trend Window Setup 277 Autostore 186
3D Window Setup 277 Average Window 203
A Averaging Waveforms 105
ABR Filters 192 B
Acquisition Sweep 186 Bar Electrodes 405
Act/Ref 445 Baseline 110, 470, 471
Activating Software Licenses 48 Baseline Trace 449
Active Modes 445 Bovie Reject 106, 194
Active Window 445 C
Add Marker 446 Cabling Diagrams
Add View Button 446 Elite Base Unit Connections 12
Adjust Latency 446 Cabling Diagrams 24
All 446 Cabling Setup Instructions 14
Amplifier 417, 418, 447 Calibration 417
Amplifier Calibration 68 Camera Setup 450
Amplifier Diagnostic 420 Cancel 449
Amplifier Diagnostics 68 Cascade Customer Support 433
Amplifier Input Extender Cable 23 Cascade File Extensions 82
Amplitude Markers 218, 447 Cascade Tokens 364
Append to Procedure 68 Center 449, 450
Appending to Procedure 113 Ch 16 Audio Mute 450
Approvals 437 Channel 450
Archiving 424 Channel 16 Reject 194
Artifact Reject 165, 466 Channels 173
As Recorded 447, 448 Charts 403, 404, 405, 406
Audio 450 Chat Box 338
Audio Controls 152, 448 Chat Log 338
Auditory Stimulator 299 Checking Impedance 103
Auditory Stimulators 299 Choice Token 367
auto cursors 197 Choices within Options 378
Auto Place Cursors 109, 449 Choosing Appropriate Repetition Rate
Auto Position On-Off 448 121
481
Cleaning Customizing the Appearance of the

Cleaning Electrodes 414 Template 358
Cleaning Equipment 413 Customizing the Report Header 361
Cleaning Stimulators 413 D
Cleaning 413 Data Rates for Remote Monitoring 343
Clear 450, 451 DCOM Configuration 328
Client List 451 Default Report Templates 354
Close 167, 380 Delete View Button 446
Colors tab 63 Determining Frequency of Noise 129
Command Prompt 347 Digital Filter 192
Comment 373 Digital Filters 192
Comment Token 373 Disconnect 344
Compliances 437 Display Gain 439
Computer Requirements 55 Display Sweep 445
Configurations 388 Disposable Bar Electrodes 404
constant voltage stimulator 5 Disposal of Equipment 397
Contact Cascade 433 Dot-to-Dot 471
Control Panel 48 DSA 455
Copy 358 DSA Max Power 455
Copy Special 453 DSA Max Voltage 455
Copying Templates 358 DSA Smoothing 455

DSP Utilization Meter 285
Copyright and E
Trademarks 3 Edit Events 285
Creating a Shortcut to a Network Edit Menu 132, 453
Location 51 Edit Procedure 68
CSA 453 Edit Report Templates 357
CSA Scale 453 Editing Procedure 113
Current Procedure Setup 453 Editing System Setup 57, 63
Cursor Table 197 EEG
Cursor Tables 197 Burst Suppression 455
Cursor Trend Window 229 EEG Drawing Selections 456
Cursors 109, 229, 448, 449 EEG Needle 404
Customer Support EEG Analysis
Help File Access 433 EEG Analysis Window 225, 305
Customer Support 433 EEG Analysis Window Setup 270
482
Index
EEG Analysis Window 225 EP Mode Setup 154, 178

EEG Analysis Window Setup 270 EP Summary Window 209
Electrical Safety 388 Epoch Length 470
Electrical Stim Splitter Family Guide Error Messages 344
Current Feedback 8 Event Window 233
Daisy Chain 8 Event Window Setup 251
High Current Outputs 8 Events Menu 136
Low Current Maximum Output 8 Example EEG Analysis Windows 305
Electrical Stim Splitter Family Guide 8 Exporting Data 114
Electrical Stimulator 293 F
Electrical Stimulator Characteristics 406 Features & Accessories
Electrode Current Densities Bedrail Handle 25
Bar Electrodes 405 Cable Guide 25
Disposable Bar Electrodes 404 Quick Connect 25
EEG Needle 404 V-Block Clamp 25
Electrical Stimulator Characteristics V-Blocks 25
406 Features & Accessories 25
EMG Needle 403 Felt-Pad Bar Electrodes 405
Felt-Pad Bar Electrodes 405 FFT Marker 129
Electromagnetic Compatibility 391 File Extensions 82
electrosurgery detect unit 5 File Menu 113, 131
Electro-Surgery Reject 106 Flash 300
Elite Cabling Setup Instructions 14 Frequency of Noise 129
EMG Frequently Asked Questions 439
EMG Run Modes 456 G
EMG Window Setup 245 General Care of TCS-1 415
EMG Needle 403 General Cleaning 413
EMG Pane Selection 213 Global EP Settings 111, 129
EMG Window 213 Global Summary Window Settings 280
EMG Window Setup 245 Global Summary Window Setup 280
EP 203 Global Waterfall Window Setup 282
EP Analysis Window Setup 264 Goggles 300
EP Average Window 203 H
EP Average Window Setup 242 Hardware Setup 11, 12, 23, 24
EP Button 111 Hardware simulator 32
EP Cursor Trend Window Setup 260 Help File Access 433
483
Help Menu 138 Test Menu 135

Help with Windows 67 View Menu 133
High-Z Warning 165 Window Menu 137
How to Edit Report Templates 357 MEP Mode
I MEP Mode Setup 186
IEC 60601-1-1 388 MEP Mode 461
Impedance 103 MEP Mode Controls 154, 461
Impedance Test Arrays 420 MEP Mode Options 462
Initializing a Remote Monitoring MEP Mode Setup 186
Session from the Cascade 334 MEP Triggered Window 218
Initializing a Remote Monitoring MEP Window Setup 246
Session from the Reader 333
Minimum Computer Requirements 55
Inserting the Contents of RTF/Bitmap
Mode Control Window Setup 241
Files 379
Mode Controls 153, 202
Installation Instructions 35
Mode Group Cycle 285
Intended Use
Mode Groups 285
Cascade 7
TCS-1 Stimulator 7 Mode Setup
L
EP Mode Setup 178
LAN 324
MEP Mode Setup 186
LED Check 300
Mode Setup 165, 177
License Key Requirements 48
Mode Windows Overview 202
Live EEG Window
Mode Windows Setup Overview 202
Side-by-Side Comparison of Current
Modes 111, 445
and Past EEG 112
Moving windows 70
Live EEG Window Setup 249
Mute 106, 450
Live Video Window Setup 263
N
Lock Windows 70
NerveGuard
Look Back 112
Closing NerveGuard 152
M
Dertimination of Threshold 140
Menu Bar 73
Fixed Detection Mode 142
Menu Options
Making Changes during testing
Edit Menu 132
Stimulus Settings 142
Events Menu 136
Threshold Settings 142
File Menu 131
Making Changes during testing 142
Help Menu 138
Remote Menu 135
143
484
Index
NerveGuard Introduction 139 TCS-1 Stimulator 5

NerveGuard Operation 139 Overview 5
NerveGuard Setup Submenu 149 P
NerveGuard Window Parts of a Window 73
Audio Controls 152, 448 Pause Analysis 464
Control Button 146, 451 Pause Averager 465
Detection Mode 148, 453 Peer to Peer 324
EMG Trace Area 149, 463 Performance/Operational
Intensity LED 150, 460 Recommendations 64
Print Report 151, 463 Peripheral Devices and Connections 23
Setup Submenu 149 Phone Numbers 433
Using the Spine Graphic 144 Print 32, 465, 466
Zoom Control 152, 478 Procedure 169
NerveGuard Window 143 Procedure Setup 171

R
Pedicle Screw Threshold Detection
141 Recording TcEMEPs 153
Starting a New Procedure 99 Reducing Noise 116, 121
NerveGuard 139 Reject 194
NerveGuard Procedure Setup 289 Reject Setting Dialog 466
NerveGuard Window 143 Remote Menu 135
NerveGuard/Continuous Stimulation Remote Monitoring

Mode 141 Cascade 2nd Network Card & Reader
Network Card 324 Network Card 324
Network Location 51 Cascade Start Page Overview 68
New Procedure 68 Connection Scenarios
Noise Reduction 116, 121, 129 Peer to Peer on a LAN 322
Noise vs Rep Rate 121 Third Party Software 323

O VPN into LAN 322, 332
On/Off 67 VPN to VPN setup 332
Opening An Existing Template 356 Connection Scenarios 319
Opening and Closing Cascade 68 Data Rates for Remote Monitoring 343
Other Setup 285 Initializing a Session from the
Overview Cascade 334
Cascade 5 Initializing a Session from the Reader

333
Components 5
NerveGuard 5
143
485
Remote Monitoring 317 SF Filters 192

Remote Reader 317, 318, 323, 336, 344 Shipping Equipment 434
Remove Stim Artifact 186 Show Baseline Dot-to-Dot 471
Remove Stim Artifact From EMG 468 Side-by-Side Comparison of Current &
Rename View Button 446 Past EEG 112
Rep Rate 121 Signatures in Reports 362
Repair 427 Snyc with Server Button 473
Report Generation Process 349 Software Installation Instructions 35
Report Generator 349, 350 Software Setup Overview 35
Report Header 361 Software Upgrades 428
Report Templates 357 Stacked EMG Window 216
Reports 341, 350, 362 Stacked EMG Window Setup 268
Resizing windows 70 Standards 437
Review Procedure 68 Start New Procedure 68
Reviewing a Procedure 169 Start Page Overview 68
Right-click Functionality 70 Starting a New Procedure 99
Routine Maintenance 424 Status Bar 73
Run Mode 165, 456 Stim Splitter 5
S Stimulator Triggering 79
Safety Information Stimulators 293, 299, 413
Operating Environments & Limits 388 Stimulus Intensity Adjustment 101
TCS-1 Warnings and Cautions 384 Stimulus Paramaters 154
Train Length Limit Warning 163 Stimulus Splitters 23
Warnings and Cautions 381 Stimulus Trigger Table 79
Saving Templates 380 Stimulus Triggering 100
Screens 213, 228, 235, 278 Store Image On 474
Search for Computer 348 Storing and Clearing Traces 162
Select Source 450 Summary Window 209
Set Baseline 110, 470 Summary Window Setup 254
Set Epoch Length 470 Sweep 445
Setting Baselines 110, 470 Sweep Delay 186
Setting Up Cursor Table 197 Sweep Speed 445
Setting Up Cursor Tables 197 Symbols 385
Setting up Trace Labels 199 Sync with Server 339
Setup Reject Info 194 System Key 48
Setup Thresholds 200 System Setup
486
Index
Chat Tab 61 Inserting a Token into a Template 369

Colors Tab 63 Prompt/Option Token 374
Event Filtering Tab 62 Templates/Tokens 349
General Tab 58 Using Specialized Tokens 370
Remote Tab 60 Tokens 364
System Setup 48, 57, 68 Tool Bar 73
System Setup on the Remote Reader 336 Toolbar Description 74
T toolbars 70
TcEMEP 153 Trace Labels 199
TCS-1 33, 154, 165, 295, 397 Traces 162
TCS-1 Stimulator 295 Train Length Limit Warning 163
Template Editor 380 Transportation & Storage Limits 388
Templates Troubleshooting 344
Editing Report Templates 357 Turning Equipment On and Off 67
Inserting a Token into a Template 369 U
Inserting RTF/Bitmap Files 379 Unpacking the System 11, 33
Opening An Existing Template 356 Using a Page Header 359
Templates 349, 354, 355, 358, 359, 361, V
373, 380 Verification of Proper Operation 387
Test Menu 135 Video Checks 300
Test Setup 284 Video Window 232
Third Party Software 332 View Menu 133
Threshold 140 View Windows 213, 228, 229, 232, 235,
Thresholds 200 278
Timer Intervals 285 Viewing a Procedure 169
TOF (Train of Four) Analysis Window Views 339
239 Visual Stimulators 300
TOF (Train of Four) Trace Window 236 VPN into LAN 322, 332
TOF Analysis Window 239 VPN to VPN setup 332
TOF Mode 475 W

Warranty 429
TOF Mode Controls 475
Waterfall Window 235, 278
TOF Window 236
Waveforms 78, 105, 477
Tokens
Web Help 434
Choice Token 367
Window Descriptions
Choices within Options 378
Event Window 233
Comment Token 373
Live EEG Window 222
487
Window Descriptions 70, 73 MEP Window Setup 246

Window Menu 137, 449 Mode Control Window Setup 241
Window Setup Stacked EMG Window Setup 268
EMG Window Setup 245 Summary Window Setup 254
EP Analysis Window Setup 264 Window Setup 240
EP Average Window Setup 242 Windows 98 vs Windows XP
EP Cursor Trend Window Setup 260 Professional 318
Event Window Setup 251 Working with Basic Windows 67
Global Summary Window Setup 280 Working with Cascade Windows 70
Global Waterfall Window Setup 282 Working with Cursors 109
Live EEG Window Setup 249 Working With Waveforms 78
Live Video Window Setup 263
488

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Elite Operators Manual

General Tab ......................................................................................................................... 58

Working with Cursors ......................................................................................................... 109

High-Z Warning ............................................................................................................... 165

EMG Window Setup ........................................................................................................ 245

EEG Windows ................................................................................................................... 310

Felt-Pad Bar Electrodes .................................................................................................... 405

Active Window ..................................................................................................................... 445

Clear ....................................................................................................................................... 450

Store Image On ..................................................................................................................... 474

Part Number 100821-620 Rev. 8

© 2014 Cadwell. All rights reserved.

Lateral Transpsoas Monitoring:

Intent of Operator's Manual

The Cadwell Cascade Elite may include the following:

Cascade Elite Intended Use

Electrical Stimulator Guide

Stim Model Number Low Current May be Biphasic

Electrical Stim Splitters

Stim Splitter Model Number of Low Current Current May be

Es5-20 CS (190204- 4 20 mA Yes No

ES5-100 CS (190221- 5 None Yes No

ES16 CS (190201- 15 20 mA Yes No

You should receive the following as standard items:

Position Elite Base Unit

Elite Base Unit Connections

Power/Com Module Connections

1. Power cord (to isolation transformer).

4. Ethernet cable (to PC).

Elite Cabling Setup Instructions

5. Attach the computer's power cord:

Configuring the ES-IX

The tool main menu comes up.

ES-IX Configuration Options

Stimulation Outputs Available

In Cascade 2.7, selecting biphasic stimulation causes the stimulating waveform to

Peripheral Devices and Connections

Peripheral Device Connector Symbol

Amplifier Input Extender Cable Amp A-D

ES-IX Stimulator CPN "CPN"

Stimulus Splitters ESTIM

TCS-1/TCS-1000/TCS-4 Aux 1 or 2 "AUX 1", "AUX 2"

Audio and Visual Peripherals EP

ES Detector Module Aux 1 or 2 "AUX 1", "AUX 2"

VEP Goggles/LED Pad Aux 1 or 2 "AUX 1", "AUX 2"

CV-2 Aux 1 or 2 "AUX 1", "AUX 2"

This electrical cortical stimulator can be set to output

Cabling Diagram - Elite to Desktop PC

Cabling Diagram - Elite to Laptop PC

Cascade Elite Features & Accessories

Mounting V-Blocks on IV Pole

To configure the Cascade Elite horizontally:

To configure V-Block accessories for a vertically-positioned Cascade Elite:

Attach Cascade to a Jackson Table

Using the Hardware Simulator

To turn ON the Hardware Simulator:

b. Click OK in the Registry Editor.

To turn OFF the Hardware Simulator:

Preparing Patient & Equipment for Data Collection

The following equipment is required to prepare for data collection:

• Cascade Surgical Monitoring System

Software Installation Instructions

Please read all instructions prior to performing the upgrade.