1. Should be on Up to hear patient button presses Down to mute. In either case the #1 and #2 lights should light with each button press. Leave the 5 to the right alone. If I hear a sound this means that the patient is pressing the button hard enough. Should be on Left switch up Middle switch down Right switch is for reset Always reset if the left or middle switch is changed Red button is for patient’s volume. Adjust for patient. Base treble balance usually can be left alone. Controls the speakers in the control room, i.e. to monitor what the subject hears. Press to speak with patient Toggle down for computer audio. Middle would turn off. These 3 should be off. Scan Trigger button fMRI Console

2. USB cable connecting computer to patch panel. Lower right on computer Lower left on control panel Cabling L & R audio cables from patch panel to back of fMRI console

3. Subject Setup All scans are at MR1. Technologist will screen subject for MR safety. Copy of signed consent required. Technologist will position subject in scanner – 32 channel head coil. Standard piezoelectric audio headset required. Two button boxes required – button 1 in left hand, button 2 in right hand. Assign subject a number and add name and number to table. You may want to have the tech use this number in the Subject Name field on the scanner. Technologist will load your Examcard titled “User Defined 1/Lesser/Math_Spell”. The technologist will run the Survey scan, SENSE Reference scan and MPRAGE anatomical scan. You can proceed to login to the PC and start up the Mental Arithmetic paradigm if not already done. Hold at the “Test Sound Buttons?” prompt (see next slide).

4. 1.Login to the computer: user icon Ronald Lesser, password as set. 2.On the computer desktop double click MentalArithmetic. 3.Enter the Subject Number – assign new number to each subject, keep a table matching subject name and subject number 4.Enter Session Number – usually 1. If same subject comes back, use same Subject Number and next Session Number. 5.Test Sound & Buttons? Yes for first try to allow sound test and verify buttons work. No for subsequent runs when you are sure sounds and buttons are set. Wait here until the initial scans are complete. 6.When scans are done, instruct the subject to listen and press OK 2 3 4 5 Run Mental Arithmetic

5. Sound and Button Test Display above appears and sound plays with test math problem. Ask subject whether they heard the sound. If not, turn up the volume using the large red control on the console. Have subject press button 1 in left hand. Sound will play again if the button press is detected. If no new sound, check button switches, connections and whether subject is pressing hard enough. When button is detected and sound plays, verify again that it is loud but comfortable and adjust if necessary. Have subject press button 2 in right hand. Sound will play. Verify button 2 was detected. Repeat button presses and sound checks until all is operating properly. You can trigger sounds yourself by pressing button 1 or 2 on the fMRI console. Press the Scan Trigger button or button 6 to finish the test and verify trigger is working. It should advance to the “Wait for the test to begin” screen.

6. Never push this button. It would be used only if the life of a person was in danger due to being trapped by a large metal object against the scanner. Pushing results in thousands of dollars in repairs and downtime. Push the Scan Trigger button or this button (#6) when done with the sound and button press practices and then “Wait for the test to begin” appears on the screen in the fMRI room.

7. Mental Arithmetic Test Startup After pressing the Scan Trigger button, the paradigm is ready to begin. It waits for the trigger to come from the scanner. Have the technologist start the scan MentalArithmetic. Watch for a button 6 press after about 10 seconds of scanner sounds. This is the scanner trigger – the paradigm should begin with instructions for 5 seconds followed by the first audio math problem and 2 answers on screen. Watch that the subject is responding with button presses. The entire test will run without any interaction. “The End” will appear and scanning should end simultaneously. Press any keyboard key to finish the test.

8. 8 Easy problems 5 sec each, 40 sec 8 Hard problems 5 sec each, 40 sec 8 odd/even problems 5 sec each, 40 sec Scan trigger starts the paradigm 5 sec Repeats 2 more times Press key to end Total time 405 sec 6:45 Mental Arithmetic Flow 135 sec/block 2:15

9. 1.On the computer desktop double click Spelling. 2.Enter the Subject Number – use the same number as used for the Mental Arithmetic. 3.Enter Session Number – usually 1. If same subject comes back, use same Subject Number and new Session Number. 4.Test Sound & Buttons? You may want to skip the tests if the subject could hear well and buttons were working during the Mental Arithmetic. If you skip the test, the “Wait for test to begin” screen comes up. Run Spelling

10. Spelling Test Startup After skipping the sound & button tests or pressing the Scan Trigger button to end the tests, the paradigm is ready to begin. It waits for the trigger to come from the scanner. Have the technologist start the scan Spelling. Watch for a button 6 press after about 10 seconds of scanner sounds. This is the scanner trigger – the paradigm should begin with instructions for 5 seconds followed by the first audio spelling problem and 2 answers on screen. Watch that the subject is responding with button presses. The entire test will run without any interaction. “The End” will appear and scanning should end simultaneously. Press any keyboard key to finish the test.

11. 8 Easy problems 5 sec each, 40 sec 8 Hard problems 5 sec each, 40 sec 8 cons/vowel problems 5 sec each, 40 sec Scan trigger starts the paradigm 5 sec Repeats 2 more times Press key to end Total time 405 sec 6:45 Spelling Flow 135 sec/block 2:15

12. Extra pictures - ignore