Automated sensory nerve conduction testing using fuzzy logic

Nerve conduction studies continue to be an important tool in the evaluation of peripheral nerve disorders but have come under increased scrutiny because of heightened cost control in health care service delivery. In selected clinical settings, automated nerve conduction studies may be a useful clinical tool replacing conventional testing, but existing instruments are limited and have not generally been accepted into clinical practice. Further advancements in nerve conduction automation may be possible by incorporating expert system approaches into nerve conduction measurement and control algorithms. Using fuzzy logic techniques to duplicate the reasoning strategies of experienced electrodiagnostic clinicians, a software controller was developed to automatically perform sensory nerve conduction studies. The fuzzy logic system successfully performed 88% of 97 sensory studies in a mixed group of normal and patient populations. Sensory nerve action potential latency and amplitude measures obtained with automated testing were the same as determined by clinicians. Failures were related to design limitations of the controller, noise, and artifact. The high negative predictive value and sensitivity of fuzzy logic based testing suggest that its utility is in minimizing the need for unnecessary conventional electrodiagnostic studies in patients with normal nerve function. Fuzzy logic appears to be a useful approach to nerve conduction automation that can model expert reasoning and judgment.