1
|
Harris C, Tang Y, Birnbaum E, Cherian C, Mendhe D, Chen MH. Digital Neuropsychology beyond Computerized Cognitive Assessment: Applications of Novel Digital Technologies. Arch Clin Neuropsychol 2024; 39:290-304. [PMID: 38520381 DOI: 10.1093/arclin/acae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 03/25/2024] Open
Abstract
Compared with other health disciplines, there is a stagnation in technological innovation in the field of clinical neuropsychology. Traditional paper-and-pencil tests have a number of shortcomings, such as low-frequency data collection and limitations in ecological validity. While computerized cognitive assessment may help overcome some of these issues, current computerized paradigms do not address the majority of these limitations. In this paper, we review recent literature on the applications of novel digital health approaches, including ecological momentary assessment, smartphone-based assessment and sensors, wearable devices, passive driving sensors, smart homes, voice biomarkers, and electronic health record mining, in neurological populations. We describe how each digital tool may be applied to neurologic care and overcome limitations of traditional neuropsychological assessment. Ethical considerations, limitations of current research, as well as our proposed future of neuropsychological practice are also discussed.
Collapse
Affiliation(s)
- Che Harris
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
- Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Yingfei Tang
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
- Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Eliana Birnbaum
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Christine Cherian
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Dinesh Mendhe
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Michelle H Chen
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
- Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| |
Collapse
|
2
|
Panzavolta A, Cerami C, Caffarra P, De Vita D, Dodich A, Fonti C, L'Abbate F, Laganà V, Lavorgna L, Marra C, Papagno C, Pellegrini FF, Stracciari A, Trojano L, Iaquinta T, Ravizza A, Sternini F, Pandolfi R, Sanzone S, Calore M, Cappa SF. A digital teleneuropsychology platform for the diagnosis of mild cognitive impairment: from concept to certification as a medical device. Neurol Sci 2024:10.1007/s10072-024-07403-0. [PMID: 38378904 DOI: 10.1007/s10072-024-07403-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Innovative digital solutions are shaping a new concept of dementia care, opening additional venues for prevention, diagnosis, monitoring and treatment. Hereby, we report the development of a tablet-based teleneuropsychology platform (Tenèpsia®), from concept to certification as Medical Device (MD) Class IIA, as per new MD regulation 745/2017. METHODS The platform was designed for the remote cognitive evaluation and created thanks to the effort of a collaborative working group including experts from three Italian scientific societies and Biogen Italia S.r.l. (hereafter "Biogen"), and developers from Xenia Reply and Inside AI. The development strategy was guided by converting traditional paper-and-pencil tests into digital versions while maintaining comparable neuropsychological features and optimizing patient accessibility and user experience. The experts focused on the choice and adaptation of traditional neuropsychology measures for a 45-min teleneuropsychology assessment. RESULTS The developers created a web and a mobile interface, respectively, for the professional (neuropsychologist) and non-professional (patient and caregiver) use. Recording of voice, drawing and typing information was enabled. Instant dashboards provide a quick overview of the patient's condition. Simulation activities were performed to obtain MD certification, valid across Europe. CONCLUSION Neuropsychology services will benefit from the implementation in clinics of harmonized digital tools with adequate scientific and technological standards. The use of digital cognitive testing for the diagnosis of mild cognitive impairment is expected to enhance patient and clinician outcomes through simplified, digital objective data collection, sparing of time and resources, with a positive impact on healthcare costs and access to treatments, reducing inequalities and delays in diagnosis and cure.
Collapse
Affiliation(s)
- Andrea Panzavolta
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Di Studi Superiori IUSS, Piazza Della Vittoria 15, 27100, Pavia, Italy
| | - Chiara Cerami
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Di Studi Superiori IUSS, Piazza Della Vittoria 15, 27100, Pavia, Italy.
- Dementia Research Center, Mondino Foundation IRCCS, Pavia, Italy.
| | - Paolo Caffarra
- Membro esperto Tavolo permanente sulle demenze del Ministero della Salute, Rome, Italy
| | - Dalila De Vita
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Alessandra Dodich
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy
| | - Cristina Fonti
- IRCCS, Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federica L'Abbate
- Neurology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Valentina Laganà
- Associazione Per La Ricerca Neurogenetica Odv, Lamezia Terme, Italy
| | - Luigi Lavorgna
- Clinica Neurologica I, Azienda Ospedaliera Universitaria, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Camillo Marra
- Neurology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Costanza Papagno
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy
| | | | - Andrea Stracciari
- Membro esperto Tavolo permanente sulle demenze del Ministero della Salute, Rome, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | | | | | - Federico Sternini
- InsideAI, Bologna, Italy
- PolitoBIOMed Lab, Politecnico Di Torino, Turin, Italy
| | | | | | | | - Stefano F Cappa
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Di Studi Superiori IUSS, Piazza Della Vittoria 15, 27100, Pavia, Italy
- Dementia Research Center, Mondino Foundation IRCCS, Pavia, Italy
| |
Collapse
|
3
|
Brown AD, Kelso W, Eratne D, Loi SM, Farrand S, Summerell P, Neath J, Walterfang M, Velakoulis D, Stolwyk RJ. Investigating Equivalence of In-Person and Telehealth-Based Neuropsychological Assessment Performance for Individuals Being Investigated for Younger Onset Dementia. Arch Clin Neuropsychol 2024:acad108. [PMID: 38251841 DOI: 10.1093/arclin/acad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/24/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE Given the rapid shift to in-home teleneuropsychology models, more research is needed to investigate the equivalence of non-facilitator models of teleneuropsychology delivery for people with younger onset dementia (YOD). This study aimed to determine whether equivalent performances were observed on neuropsychological measures administered in-person and via teleneuropsychology in a sample of people being investigated for YOD. METHOD Using a randomized counterbalanced cross-over design, 43 participants (Mage = 60.26, SDage = 7.19) with a possible or probable YOD diagnosis completed 14 neuropsychological tests in-person and via teleneuropsychology, with a 2-week interval. Repeated measures t-tests, intraclass correlation coefficients (ICC), and Bland Altman analyses were used to investigate equivalence across the administration conditions. RESULTS No statistical differences were found between in-person and teleneuropsychology conditions, except for the Hospital Anxiety and Depression Scale Anxiety subtest. Small to negligible effect sizes were observed (ranging from .01 to .20). ICC estimates ranged from .71 to .97 across the neuropsychological measures. Bland Altman analyses revealed that the Wechsler Adult Intelligence Scale-Fourth Edition Block Design subtest had slightly better overall performance in the in-person condition and participants reported higher levels of anxiety symptoms during the teleneuropsychology condition; however, average anxiety symptoms remained within the clinically normal range. Participants reported a high level of acceptability for teleneuropsychology assessments. CONCLUSIONS These results suggest that performances are comparable between in-person and teleneuropsychology assessment modalities. Our findings support teleneuropsychology as a feasible alternative to in-person neuropsychological services for people under investigation of YOD, who face significant barriers in accessing timely diagnoses and treatment options.
Collapse
Affiliation(s)
- Aimee D Brown
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Wendy Kelso
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Samantha M Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Sarah Farrand
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
| | | | - Joanna Neath
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
| | - Mark Walterfang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
| | | | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| |
Collapse
|
4
|
Salvadori E, Pantoni L. Teleneuropsychology for vascular cognitive impairment: Which tools do we have? Cereb Circ Cogn Behav 2023; 5:100173. [PMID: 37457663 PMCID: PMC10299844 DOI: 10.1016/j.cccb.2023.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
The halt of clinical activities imposed during the COVID-19 pandemic forced clinicians to find alternative strategies to provide continuity of care and services, and led to a renewed interest in use of teleneuropsychology (TNP) to remotely assess patients. Recent TNP guidelines recommend maximizing the reproduction of standard in-person assessment, particularly through videoconferences. However, consistency of the adaptations of usual cognitive tests to videoconference needs further elucidation. This review aims at critical reviewing which cognitive tests could be recommended for a remote evaluation of patients with vascular cognitive impairment (VCI) among those widely recognized as reference standards. Current evidence supports the use of global cognitive efficiency (MMSE and MoCA), verbal memory (Revised Hopkins Verbal Learning Test), and language tests (phonemic and semantic verbal fluencies, Boston Naming Test), while there is a lack of strong validity support for measures of visuospatial functions (Rey-Osterreith Complex Figure), and executive functioning and processing speed (Trail making Test, and Digit symbol or Symbol digit tests). This represents a major limitation in the evaluation of VCI because its cognitive profile in often characterized by attention and executive deficits. At present, a videoconference TNP visit appears useful for a brief evaluation of global cognitive efficiency, and to 'triage' patients towards a second level in person evaluation. In future, hybrid models of TNP based on data collected across multiple modalities, incorporating both adaptation of usual cognitive tools and new computerized tools in the supervised videoconference setting, are likely to become the best option for a comprehensive remote cognitive assessment.
Collapse
Affiliation(s)
- Emilia Salvadori
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Leonardo Pantoni
- Neuroscience Research Center, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | | |
Collapse
|
5
|
Duricy E, Durisko C, Dickey MW, Fiez JA. Comparing the Reliability of Virtual and In-Person Post-Stroke Neuropsychological Assessment with Language Tasks. Arch Clin Neuropsychol 2023; 38:557-569. [PMID: 36537281 PMCID: PMC10202548 DOI: 10.1093/arclin/acac100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE Neuropsychological testing is essential for both clinical and basic stroke research; however, the in-person nature of this testing is a limitation. Virtual testing overcomes the hurdles of geographic location, mobility issues and permits social distancing, yet its validity has received relatively little investigation, particularly in comparison with in-person testing. METHOD We expand on our prior findings of virtual testing feasibility by assessing virtual versus in-person administration of language and communication tasks with 48 left-hemisphere stroke patients (21 F, 27 M; mean age = 63.4 ± 12; mean years of education = 15.3 ± 3.5) in a quasi-test-retest paradigm. Each participant completed two testing sessions: one in their home and one in the research lab. Participants were assigned to one of the eight groups, with the testing condition (fully in-person, partially virtual), order of home session (first, second) and technology (iPad, Windows tablet) varied across groups. RESULTS Across six speech-language tasks that utilized varying response modalities and interfaces, we found no significant difference in performance between virtual and in-person testing. However, our results reveal key considerations for successful virtual administration of neuropsychological tests, including technology complications and disparities in internet access. CONCLUSIONS Virtual administration of neuropsychological assessments demonstrates comparable reliability with in-person data collection involving stroke survivors, though technology issues must be taken into account.
Collapse
Affiliation(s)
- Erin Duricy
- Learning Research and Development Center, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA 15213, USA
| | - Corrine Durisko
- Learning Research and Development Center, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Michael Walsh Dickey
- Center for the Neural Basis of Cognition, Pittsburgh, PA 15213, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA
| | - Julie A Fiez
- Learning Research and Development Center, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA 15213, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA 15260, USA
| |
Collapse
|
6
|
Vaccaro R, Aglieri V, Rossi M, Pettinato L, Ceretti A, Colombo M, Guaita A, Rolandi E. Remote testing in Abbiategrasso (RTA): results from a counterbalanced cross-over study on direct-to-home neuropsychology with older adults. Aging Clin Exp Res 2023; 35:699-710. [PMID: 36710319 PMCID: PMC9884598 DOI: 10.1007/s40520-023-02343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/10/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND The SARS-CoV-2 pandemic forced to rethink teleneuropsychology, since neuropsychological assessments started to be performed by phone or videoconference, with personal devices and without direct assistance from the clinician, a practice called "Direct-To-Home NeuroPsychology" (DTH-NP). AIMS The present study, employing a counterbalanced cross-over design, was aimed at evaluating (1) the feasibility and (2) the acceptability of DTH-NP in Italian older adults without previously diagnosed neurocognitive disorder, (3) the comparability between remote and face-to-face administration of selected neuropsychological tests. METHODS Fifty-eight community-dwelling older adults (65-85 years) were randomly assigned to one of two groups performing a complete neuropsychological assessment remotely (via phone call and videoconference) and face-to-face, in a counterbalance order, 8 weeks apart. The study recruitment rate was calculated, and the number of uncompleted tests and acceptability questionnaire responses were compared between the two administration modalities. Comparability was defined as good reliability of DTH-NP (intraclass correlation coefficient) and agreement between remote and face-to-face scores (Bland-Altman plots). RESULTS Recruitment rate was 81%, with a preference for telephonic contact (79%). The acceptability analysis did not reveal any issues related to the DTH-NP assessment, even if most participants would rather repeat it face-to-face. Tests assessing short-term memory, language, and reasoning showed good comparability. DISCUSSION AND CONCLUSION Our results point out to a good recruitment rate in a DTH-NP study in an Italian population of older adults (mean age = 80), satisfying acceptability of DTH-NP and remote-face-to-face comparability of certain verbally mediated tests. Further studies including larger samples in videoconference modality, and outpatients, could better clarify its strengths and limits.
Collapse
Affiliation(s)
- Roberta Vaccaro
- Golgi Cenci Foundation, Corso San Martino, 10 20081, Abbiategrasso, Milan, Italy
| | - Virginia Aglieri
- Golgi Cenci Foundation, Corso San Martino, 10 20081, Abbiategrasso, Milan, Italy.
| | - Michele Rossi
- Golgi Cenci Foundation, Corso San Martino, 10 20081, Abbiategrasso, Milan, Italy
| | - Laura Pettinato
- Golgi Cenci Foundation, Corso San Martino, 10 20081, Abbiategrasso, Milan, Italy
- Camillo Golgi Geriatric Institute, Abbiategrasso, Milan, Italy
| | - Arcangelo Ceretti
- Golgi Cenci Foundation, Corso San Martino, 10 20081, Abbiategrasso, Milan, Italy
| | - Mauro Colombo
- Golgi Cenci Foundation, Corso San Martino, 10 20081, Abbiategrasso, Milan, Italy
| | - Antonio Guaita
- Golgi Cenci Foundation, Corso San Martino, 10 20081, Abbiategrasso, Milan, Italy
| | - Elena Rolandi
- Golgi Cenci Foundation, Corso San Martino, 10 20081, Abbiategrasso, Milan, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
7
|
Levy S, Dvorak EM, Graney R, Staker E, Sumowski JF. In-person and remote administrations of the symbol digit modalities test are interchangeable among persons with multiple sclerosis. Mult Scler Relat Disord 2023; 71:104553. [PMID: 36764285 PMCID: PMC10073281 DOI: 10.1016/j.msard.2023.104553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/17/2023] [Accepted: 02/04/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Remote administration of the Symbol Digit Modalities Test (SDMT) requires validation. OBJECTIVES Examine interchangeability of remote and in-person SDMT administrations in persons with MS. METHODS After in-person baseline administration, follow-up administration was either performed in-person (n = 72) or remotely via videoconferencing (n = 143). We examined whether raw score change from baseline to follow-up differed between in-person and remote follow-up modalities. RESULTS SDMT raw score change did not differ between in-person and remote follow-up modalities (-0.1 ± 5.9 vs -0.2 ± 6.2, p = 0.995, d = 0.008), and correlations between baseline and follow-up were comparable across modalities (0.86 vs 0.88). CONCLUSIONS Remote and in-person SDMT administrations appear interchangeable.
Collapse
Affiliation(s)
- Sarah Levy
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Department of Neurology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1138, New York, NY 10029, United States.
| | - Emily M Dvorak
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Department of Neurology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1138, New York, NY 10029, United States
| | - Robin Graney
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Department of Neurology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1138, New York, NY 10029, United States
| | - Erin Staker
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Department of Neurology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1138, New York, NY 10029, United States
| | - James F Sumowski
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Department of Neurology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1138, New York, NY 10029, United States
| |
Collapse
|
8
|
Sumpter R, Camsey E, Meldrum S, Alford M, Campbell I, Bois C, O'Connell S, Flood J. Remote neuropsychological assessment: Acceptability and feasibility of direct-to-home teleneuropsychology methodology during the COVID-19 pandemic. Clin Neuropsychol 2023; 37:432-447. [PMID: 35505636 DOI: 10.1080/13854046.2022.2056922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the acceptability and feasibility of telephone and video-conference calls to complete cognitive assessments during the COVID-19 pandemic. METHOD In rapid response to the pandemic, evidence-based adaptations were made to routine face-to-face (FTF) practice, delivering teleneuropsychology (TNP) within a National Health Service (NHS) Scotland neuropsychology service. Caldicott guardian approval was obtained to complete a six month study (April to October 2020) from the early stages of the first United Kingdom (UK) lockdown. Assessments were completed with patients in their own homes (direct-to-home) via remote connections. Neuropsychology clinicians, service-users and referring agents were approached for structured feedback and qualitative comment. RESULTS Data was captured for 212 referrals assessed by seven clinical psychologists; with responses from 70 (33%) service-users and 14 (58%) referring agents. 94% of referrals were assessed remotely and discharged. TNP reduced defaulted appointment discharge rates. Gender, socioeconomic deprivation and age did not affect access to information technology (IT) equipment.Clinicians agreed that remote assessment allowed them to complete initial interview (96%) and formulate (77%) cases appropriately. Service-users agreed they were comfortable with equipment (84%), the process was straightforward (74%), and would recommend TNP to others (68%). Referring agents were satisfied with the service provided (100%). Limitations included evidence-based remote test availability, technical issues and home distractions. CONCLUSIONS Study findings evidence the acceptability and efficiency of TNP; increasing service accessibility, while reducing infection risk, defaulted appointments and travel. The results advocate for a post-pandemic mixed model of service delivery encompassing both FTF and TNP approaches.
Collapse
Affiliation(s)
| | | | | | - Max Alford
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | | | | | | | - John Flood
- NHS Greater Glasgow & Clyde, Glasgow, UK
| |
Collapse
|
9
|
Rizzi E, Vezzoli M, Pegoraro S, Facchin A, Strina V, Daini R. Teleneuropsychology: normative data for the assessment of memory in online settings. Neurol Sci 2023; 44:529-538. [PMID: 36197578 PMCID: PMC9533275 DOI: 10.1007/s10072-022-06426-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has forced significant changes in clinical practice. Psychologists and neuropsychologists had to modify their settings to assess patients' abilities, switching from an in-person modality to a remote setting by using video calling platforms. Consequently, this change brought about the need for new normative data tailored to remote settings. AIM AND METHODS The study aimed to develop normative data for the online assessment of neuropsychological memory tests and to compare it with the published norms obtained in standard settings. Two hundred and four healthy Italian volunteers performed three verbal memory tests through the Google Meet platform: the Digit Span (Backward and Forward), the Rey Auditory Verbal Learning, and the Verbal Paired Associated Learning Test. RESULTS This research provides specific norms that consider the influence of demographic characteristics. Their comparison with published norms shows a medium to high agreement between systems. The present study provides a reference for the clinical use of neuropsychological instruments to assess verbal memory in a remote setting and offers specific recommendations.
Collapse
Affiliation(s)
- Ezia Rizzi
- Department of Social and Human Science, University of Salento, Studium 2000, Via di Valesio, 73100 Lecce, Italy ,Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Michela Vezzoli
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Sara Pegoraro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Alessio Facchin
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Veronica Strina
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Roberta Daini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
10
|
Thompson JL, Matchanova A, Beltran-Najera I, Ridgely NC, Mustafa A, Babicz MA, Hasbun R, Giordano TP, Woods SP. Preliminary Validity of a Telephone-Based Neuropsychological Battery in a Consecutive Series of Persons with HIV Disease Referred for Clinical Evaluation. Arch Clin Neuropsychol 2022; 38:570-585. [PMID: 36566509 DOI: 10.1093/arclin/acac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The COVID-19 pandemic necessitated use of remote assessments by clinical neuropsychologists. Telehealth was particularly important for vulnerable groups, including persons living with HIV (PLWH); however, limited internet access can be a serious barrier to care. This study examined the preliminary validity of a telephone-based neuropsychological assessment in a clinical sample of PLWH. METHOD A consecutive series of 59 PLWH were assessed via telephone at an HIV clinic in the southern U.S. between April 2020 and July 2022. The battery included auditory-verbal neuropsychological tests of memory, attention, and executive functions, and questionnaires assessing self-reported mood and activities of daily living (ADL). RESULTS Study measures demonstrated acceptable internal consistency. PLWH demonstrated worse neuropsychological performance compared with expectations derived from the normal curve and an HIV-seronegative adult sample (N = 44). PLWH assessed via telephone demonstrated similar impairment rates to that of a consecutive series of PLWH (N = 41) assessed in-person immediately prior to the pandemic. Higher telephone-based global neuropsychological scores were related to younger age, more education, better fund of knowledge, White race/ethnicity, fewer medical conditions, and fewer depression symptoms. Global neuropsychological impairment was strongly and independently associated with greater dependence in ADL domains, particularly for instrumental activities. CONCLUSIONS Although telephone-based approaches to neuropsychological assessment are not ideal, these data provide support for the feasibility, internal consistency, and preliminary validity of this method in a consecutive clinical series of PLWH. The direct comparability of telephone-based and in-person neuropsychological assessments remains to be determined by prospective, counterbalanced study designs examining both PLWH and seronegative individuals.
Collapse
Affiliation(s)
| | | | | | | | - Andrea Mustafa
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michelle A Babicz
- Department of Psychology, University of Houston, Houston, TX, USA.,Mental Health and Behavioral Science Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Rodrigo Hasbun
- Department of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Thomas P Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Center for Innovation in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | | |
Collapse
|
11
|
Serrano-Juárez CA, Reyes-Méndez C, Prieto-Corona B, Seubert-Ravelo AN, Moreno-Villagómez J, Cabañas-Tinajero JÁ, Yáñez-Téllez MG, Quezada-Torres RA, Téllez-Rodríguez M, Barrera-Rodríguez B, Soto-Jiménez MP, González-Gutiérrez FA, Castillo-Tejeda E. A Systematic Review and a Latin American Clinical Model for Teleneuropsychological Assessment. Arch Clin Neuropsychol 2022; 38:283-300. [PMID: 36196778 PMCID: PMC9619713 DOI: 10.1093/arclin/acac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this study is to propose a TeleNP model for remote assessment and offer practical recommendations for clinical practice with patients in Mexico and Latin America, based on a systematic literature review and clinical experience. METHOD A systematic review of studies from 2011 to 2021 in English and Spanish used TeleNP, teleneuropsychology, telepsychology, online, assessment, teleneuropsicología, and evaluación for the search; the databases examined included PubMed, BiDi UNAM, ScienceDirect, Google Scholar, and Wiley One Library; the Oxford Centre for Evidence-Based Medicine system was used to grade the levels of evidence. The experience of the last two years of students and faculty in the Master's and Doctoral Programs in Psychology, Clinical Neuropsychology Residency Program, was also used as a basis for this guide. RESULTS We propose a clinical model for TeleNP assessment in Mexico and Latin America based on the review of 31 articles and the practice of professors and students of clinical neuropsychology. CONCLUSION The proposed model describes a procedure and adaptations for home-to-home clinical practice in the neuropsychological assessment of Mexican patients that could also be used in other Latin American countries. Its reliability remains to be assessed, but this model and the suggestions proposed could be used in future studies and clinical trials for Mexican and Latin American populations.
Collapse
Affiliation(s)
- Carlos Alberto Serrano-Juárez
- Corresponding author at: Residencia de Neuropsicología Clínica, División de Investigación y Posgrado, Facultad de Estudios Superiores Iztacala, UNAM, Av. De los Barrios #1, Los Reyes Ixtacala, Edo de México, México. E-mail address: (C.A. Serrano-Juárez.)
| | - Carolina Reyes-Méndez
- Residencia de Neuropsicología Clínica, División de Investigación y Posgrado, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla de Baz, México
| | - Belén Prieto-Corona
- Residencia de Neuropsicología Clínica, División de Investigación y Posgrado, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla de Baz, México
| | - Ana Natalia Seubert-Ravelo
- Residencia de Neuropsicología Clínica, División de Investigación y Posgrado, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla de Baz, México
| | - Julieta Moreno-Villagómez
- Residencia de Neuropsicología Clínica, División de Investigación y Posgrado, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla de Baz, México
| | - José-Ángel Cabañas-Tinajero
- Residencia de Neuropsicología Clínica, División de Investigación y Posgrado, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla de Baz, México
| | - Ma Guillermina Yáñez-Téllez
- Residencia de Neuropsicología Clínica, División de Investigación y Posgrado, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla de Baz, México
| | - Rocío Alejandra Quezada-Torres
- Residencia de Neuropsicología Clínica, División de Investigación y Posgrado, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla de Baz, México
| | - Marybeth Téllez-Rodríguez
- Residencia de Neuropsicología Clínica, División de Investigación y Posgrado, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla de Baz, México
| | - Bárbara Barrera-Rodríguez
- Residencia de Neuropsicología Clínica, División de Investigación y Posgrado, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla de Baz, México
| | - Martha Paola Soto-Jiménez
- Residencia de Neuropsicología Clínica, División de Investigación y Posgrado, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla de Baz, México
| | - Fátima Aideé González-Gutiérrez
- Residencia de Neuropsicología Clínica, División de Investigación y Posgrado, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla de Baz, México
| | - Elena Castillo-Tejeda
- Residencia de Neuropsicología Clínica, División de Investigación y Posgrado, Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla de Baz, México
| |
Collapse
|
12
|
Gnassounou R, Defontaines B, Denolle S, Brun S, Germain R, Schwartz D, Schück S, Michon A, Belin C, Maillet D. Comparison of Neuropsychological Assessment by Videoconference and Face to Face. J Int Neuropsychol Soc 2022; 28:483-93. [PMID: 34027851 DOI: 10.1017/S1355617721000679] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare the administration of neuropsychological tests by teleneuropsychology (TeleNP) and face to face (F-F) in order to determine the feasibility and reliability of TeleNP. METHOD At the inclusion visit, all participants underwent a traditional F-F neuropsychological assessment as part of their standard care. Four months after inclusion, they were randomized to undergo an additional neuropsychological assessment either by F-F administration or by TeleNP. RESULTS A total of 150 adults with cognitive complaints, but with no major cognitive or sensorial impairment were included. At 4 months, 69 participants were randomized in the F-F arm and 71 in TeleNP arm (10 lost in the follow-up). The overall satisfaction was high: 87.1% in the TeleNP arm were "very satisfied", and 82.9% indicated no preference between F-F and TeleNP. In agreement with previous data from the literature, neuropsychological assessments gave similar results across both administration conditions for a large majority of tests [Mini-Mental State Examination (MMSE), Free and Cued Selective Reminding Test (FCSRT) French version, Mahieux gestural praxis battery, Frontal Assessment Battery (FAB), time of completion of the Trail making Test (TMT) A and B, number of errors of the TMT B, Rey complex figure test, categorical et phonological verbal fluency tests] and minor differences for others [80-picture naming test (DO-80), FAB, Digit Span forward and backward and number of errors in the TMT A]. CONCLUSIONS TeleNP is a promising method to be able to test patients as an alternative to F-F condition. Before this procedure can be generalized, it is now necessary to standardize the adaptation of certain tests and to test them in populations with more significant cognitive disorders.
Collapse
|
13
|
Gagnon C, Olmand M, Dupuy EG, Besnier F, Vincent T, Grégoire CA, Lévesque M, Payer M, Bérubé B, Breton J, Lecchino C, Bouabdallaoui N, Iglesies-Grau J, Gayda M, Vitali P, Nigam A, Juneau M, Hudon C, Bherer L. Videoconference version of the Montreal Cognitive Assessment: normative data for Quebec-French people aged 50 years and older. Aging Clin Exp Res 2022; 34:1627-1633. [PMID: 35178685 PMCID: PMC8853900 DOI: 10.1007/s40520-022-02092-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
Abstract
Background The COVID-19 pandemic forced health professionals to rapidly develop and implement telepractice and remote assessments. Recent reviews appear to confirm the validity of a wide range of neuropsychological tests for teleneuropsychology and among these, the Montreal Cognitive Assessment (MoCA), a cognitive screening test widely used in clinical settings. The normative data specific to the context of videoconference administration is essential, particularly that consider sociodemographic characteristics. Aims This study had for objective to develop French-Quebec normative data for videoconference-administration of the MoCA that consider sociodemographic characteristics. Methods A total of 230 community-dwelling adults aged 50 years and older taking part in clinical trials completed the MoCA by videoconference. Regression analyses were run with sex, education, and age as predictors of the total MoCA scores, based on previously published norms. As an exploratory analysis, a second regression analysis was also run with cardiovascular disease as a predictor. Results Regression analyses revealed that older age and lower education were associated with poorer total MoCA scores, for medium effect size (p < 0.001, R2 = 0.17). Neither sex nor cardiovascular disease, were significant predictors in our analyses. For clinicians, a regression equation was proposed to calculate Z scores. Discussion This study provides normative data for the MoCA administered via videoconference in Quebec-French individuals aged 50 years and over. Conclusions The present normative data will not only allow clinicians to continue to perform assessments remotely in this pandemic period but will also allow them to perform cognitive assessments to patients located in remote areas. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02092-1.
Collapse
Affiliation(s)
- Christine Gagnon
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada.
| | - Miloudza Olmand
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
- Department of Psychology, Université de Montréal, Montréal, Canada
| | - Emma Gabrielle Dupuy
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Florent Besnier
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Thomas Vincent
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
| | - Catherine-Alexandra Grégoire
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
| | - Marianne Lévesque
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
- Department of Psychology, Université de Montréal, Montréal, Canada
| | - Marie Payer
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, H1N 3M5, Canada
| | - Béatrice Bérubé
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, Canada
| | - Juliana Breton
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
| | - Catia Lecchino
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
- Department of Psychology, Université de Montréal, Montréal, Canada
| | - Nadia Bouabdallaoui
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Josep Iglesies-Grau
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Mathieu Gayda
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Paolo Vitali
- Research Centre for Studies on Aging, McGill University, Montréal, Canada
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, Canada
| | - Anil Nigam
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Martin Juneau
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Carol Hudon
- École de Psychologie, Université Laval, Québec, Canada
- Centre de Recherche CERVO, Québec, Canada
| | - Louis Bherer
- Centre ÉPIC and Research Center, Montreal Heart Institute, 5055 rue St Zotique Est, Montréal, QC, H1T 1N6, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| |
Collapse
|
14
|
Van Den Broek SR, Bagot KL, Arthurson L, Cadilhac DA, Stolwyk RJ. Investigating Clinician Experiences of Teleneuropsychology Service Implementation within Rural Inpatient Rehabilitation Settings: A Mixed Method Approach. Arch Clin Neuropsychol 2021; 37:775-788. [PMID: 34747438 DOI: 10.1093/arclin/acab086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to understand clinicians' experiences of teleneuropsychology service implementation within rural inpatient rehabilitation settings and the variability of those experiences across rural settings and clinical disciplines. METHOD Clinicians (n = 56 from four rehabilitation settings) who were involved in a hub-and-spoke teleneuropsychology service completed surveys throughout service implementation. A purposive sample of 16 clinicians then completed semi-structured interviews at the conclusion of the service implementation period. Quantitative data were analyzed descriptively and qualitative data were analyzed using thematic analysis, prior to the results being converged. RESULTS Four themes characterizing clinicians' experiences were identified. Pre- and early-implementation considerations included factors such as early collaboration and consultation, which were identified as important for service integration into rural settings. Facilitators/barriers included factors such as technology usability, which positively or negatively influenced service implementation. Benefits and outcomes included perceptions on the impact of the service, such as improved equity and quality of care in rural settings. Finally, future applications encapsulated what the clinicians envisaged for the future of teleneuropsychology services, such as hybrid teleneuropsychology/in-person services. Some differences were identified in clinicians' experiences across rural settings and disciplines, including preferences for technology infrastructure and satisfaction with teleneuropsychology sessions. CONCLUSIONS Most clinicians reported positive experiences and acceptability of the teleneuropsychology service. Facilitators and barriers, which can guide the successful establishment of future teleneuropsychology services, were identified. These findings may be used to contribute to improving equity and quality of care for people living with neuropsychological impairments, especially those living in rural areas.
Collapse
Affiliation(s)
- Sian R Van Den Broek
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Kathleen L Bagot
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Lauren Arthurson
- Inpatient Rehabilitation, Echuca Regional Health, Echuca, Australia
| | - Dominque A Cadilhac
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
| |
Collapse
|
15
|
Abstract
Use of telehealth to deliver neuropsychological services has proven to be a feasible approach, however, there is limited research which has examined the reliability of home-based assessment models using a comprehensive intelligence test. The aim of this study was to examine the reliability and feasibility of a home-based videoconferencing administration of the Wechsler Adult Intelligence Scales-4th Edition (WAIS-IV). Thirty healthy participants (aged 18-40 years) completed the WAIS-IV both in-person and via home-based videoconferencing utilizing a randomized counter-balanced methodology to attempt to control for an order effect. Paper record forms for Coding/Symbol Search and Blocks were sent and returned via tamper proof courier packs. Participants completed an online survey of their experiences of TNP following completion of their assessments. Group mean comparisons, intra class correlation coefficients (ICCs) and Bland-Altman measures of bias were calculated. Findings from both modalities were highly concordant across all WAIS-IV subtests and indices, with all ICCs rated as "excellent," (≥0.9). There were no significant mean group differences and no evidence of proportional bias. The majority of participants were very satisfied with the use of videoconferencing as an application for cognitive assessment and high levels of participant compliance were observed. In this non-clinical cohort home-based videoconference administration of the WAIS-IV was feasible, reliable and acceptable. TNP may offer an alternative for those consumers where there are challenges in accessing a face-to-face service delivery model, thereby improving equity, and enabling continuation of service delivery. Future research is needed with a larger and more ethnically diverse clinical population.
Collapse
Affiliation(s)
- Susan Mahon
- TBI Network, Auckland University of Technology, Auckland, New Zealand
| | - James Webb
- TBI Network, Auckland University of Technology, Auckland, New Zealand.,Webb Psychology, Auckland, New Zealand
| | - Deborah Snell
- University of Otago Christchurch, Christchurch, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
16
|
Fox-Fuller JT, Rizer S, Andersen SL, Sunderaraman P. Survey Findings About the Experiences, Challenges, and Practical Advice/Solutions Regarding Teleneuropsychological Assessment in Adults. Arch Clin Neuropsychol 2021; 37:274-291. [PMID: 34564721 PMCID: PMC8513402 DOI: 10.1093/arclin/acab076] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE In the wake of the coronavirus pandemic, teleneuropsychology utilization has increased. There is a need to characterize the first-hand experiences of individuals using teleneuropsychology, identify the common teleneuropsychology challenges, and devise practical strategies for mitigating/resolving these challenges. METHOD Survey data were collected from U.S. based neuropsychologists and other individuals (e.g., graduate students and research assistants) who were engaged in remote cognitive assessment with adults (n = 87). Frequency analyses were conducted to examine: how respondents used teleneuropsychology (e.g., duration of use, types of measures and devices/technology platforms used); challenges that were encountered with different technology platforms and teleneuropsychology use; and advice for navigating these challenges. RESULTS Most respondents began using teleneuropsychology relatively recently in the context of the coronavirus pandemic, with home-to-home or clinic-to-home settings being the most frequently reported teleneuropsychology settings. Zoom®, Doxy.Me®, and MyChart® were the most frequently used platforms, largely due to workplace mandates and/or Health Insurance Portability and Accountability Act-compliant features. Common challenges with teleneuropsychology included internet connection issues and environmental distractions in examinees' homes, and examinees having limited-to-no access to technologies requisite for teleneuropsychology. Providing clear instructions to the examinee prior to the teleneuropsychology visit was the most common advice for ensuring a successful teleneuropsychology evaluation. Similar response patterns were generally noted for those who used TeleNP for clinical or research purposes. CONCLUSIONS These survey results reflect common experiences and challenges with teleneuropsychology and identify priority targets for increasing its feasibility, reliability, and validity. Findings provide context for the development of formal teleneuropsychology competencies.
Collapse
Affiliation(s)
- Joshua T Fox-Fuller
- Boston University, Department of Psychological and Brain Sciences, Boston, MA, USA
| | - Sandra Rizer
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
| | - Stacy L Andersen
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA.,Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
17
|
Chapman JE, Gardner B, Ponsford J, Cadilhac DA, Stolwyk RJ. Comparing Performance Across In-person and Videoconference-Based Administrations of Common Neuropsychological Measures in Community-Based Survivors of Stroke. J Int Neuropsychol Soc 2021; 27:697-710. [PMID: 33292916 DOI: 10.1017/S1355617720001174] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Neuropsychological assessment via videoconference could assist in bridging service access gaps due to geographical, mobility, or infection control barriers. We aimed to compare performances on neuropsychological measures across in-person and videoconference-based administrations in community-based survivors of stroke. METHOD Participants were recruited through a stroke-specific database and community advertising. Stroke survivors were eligible if they had no upcoming neuropsychological assessment, concurrent neurological and/or major psychiatric diagnoses, and/or sensory, motor, or language impairment that would preclude standardised assessment. Thirteen neuropsychological measures were administered in-person and via videoconference in a randomised crossover design (2-week interval). Videoconference calls were established between two laptop computers, facilitated by Zoom. Repeated-measures t tests, intraclass correlation coefficients (ICCs), and Bland-Altman plots were used to compare performance across conditions. RESULTS Forty-eight participants (26 men; Mage = 64.6, SD = 10.1; Mtime since stroke = 5.2 years, SD = 4.0) completed both sessions on average 15.8 (SD = 9.7) days apart. For most measures, the participants did not perform systematically better in a particular condition, indicating agreement between administration methods. However, on the Hopkins Verbal Learning Test - Revised, participants performed poorer in the videoconference condition (Total Recall Mdifference = -2.11). ICC estimates ranged from .40 to .96 across measures. CONCLUSIONS This study provides preliminary evidence that in-person and videoconference assessment result in comparable scores for most neuropsychological tests evaluated in mildly impaired community-based survivors of stroke. This preliminary evidence supports teleneuropsychological assessment to address service gaps in stroke rehabilitation; however, further research is needed in more diverse stroke samples.
Collapse
|
18
|
Abstract
OBJECTIVE Recent teleneuropsychology (TeleNP) models provide some degree of guidance in the application of telecommunication technologies toward the practice of neuropsychology. However, there remains a paucity of peer-reviewed data on TeleNP practices with culturally diverse patients, including Asian patients. This manuscript describes the challenges related to TeleNP practices with Asian patients and offers practical recommendations to complement existing TeleNP guidelines. METHOD Based on extant literature on multicultural applications of neuropsychology, weprovide recommendations for TeleNP services with Asian patients that pertain to specific components of a TeleNP evaluation, such as a) pre-evaluation preparation, b) determining the appropriateness of the referral, c) determining language proficiency, d) working with interpreters, e) informed consent and confidentiality issues, f) conducting a culturally sensitive clinical interview, g) behavioral observations and communication, h) test selection, and i) interpreting data and writing reports. CONCLUSIONS Our recommendations for TeleNP services with Asian patients highlight the need for flexibility to accommodate cultural differences and commitment to the complex nature of working with patients requiring interpretation services, while also recognizing the importance of preserving the validity of neuropsychological methods. Moving forward, it is imperative that the field of neuropsychology increases the training and accessibility of neuropsychologists who are knowledgeable in providing TeleNP services to Asian patients, and promotes research on the validation of TeleNP for Asian and other ethnic minority groups.
Collapse
Affiliation(s)
- Christopher M Nguyen
- Department of Psychiatry & Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alexander Tan
- Department of Psychology, Children's Hospital of Orange County, Orange, CA, USA
| | - Ann Nguyen
- Department of Psychology, School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA
| | - Grace J Lee
- Department of Psychiatry & Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Wei Gabriel Qi
- Department of Medical Psychology, School of Health Humanities, Peking University, Beijing, China
| | - Nicholas S Thaler
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA, USA
| | - Daryl Fujii
- Veterans Affairs Pacific Island Health Care Services, Honolulu, HI, USA
| |
Collapse
|
19
|
Abstract
With the evolution of the COVID-19 pandemic in the United States in March 2020, most ambulatory care environments rapidly pivoted to extensive use to telehealth to protect patients and providers while continuing to provide care. This shift resulted in the expansion of telehealth platforms and workflows. Many behavioral health services can be provided in a telehealth format. The case example in this article illustrates that transition to telehealth is feasible and sustainable. Limitations include preoperative psychological assessments and certain neuropsychological tests requiring material manipulation. Careful consideration of risk factors should be exerted for more vulnerable patient populations.
Collapse
Affiliation(s)
- Mary J Wells
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health System, PO Box 980677, Richmond, VA 23298, USA.
| | - Paul Dukarm
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health System, PO Box 980677, Richmond, VA 23298, USA
| | - Ana Mills
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, PO Box 980206, Richmond, VA 23298-0206, USA
| |
Collapse
|
20
|
Postal KS, Bilder RM, Lanca M, Aase DM, Barisa M, Holland AA, Lacritz L, Lechuga DM, McPherson S, Morgan J, Salinas C. Inter Organizational Practice Committee Guidance/Recommendation for Models of Care During the Novel Coronavirus Pandemic. Arch Clin Neuropsychol 2021; 36:17-28. [PMID: 32997103 PMCID: PMC7543271 DOI: 10.1093/arclin/acaa073] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective The Inter Organizational Practice Committee (IOPC) convened a workgroup to develop guidance on models to provide neuropsychological (NP) care during the COVID-19 pandemic while minimizing risks of novel coronavirus transmission as lockdown orders are lifted and ambulatory clinical services resume. Method A collaborative panel of experts from major professional organizations developed provisional guidance for models of neuropsychological practice during the pandemic. The stakeholders included the American Academy of Clinical Neuropsychology/American Board of Clinical Neuropsychology, the National Academy of Neuropsychology, Society of Clinical neuropsychology (Division 40) of the American Psychological Association, the American Board of Professional Neuropsychology, and the American Psychological Association Services, Inc. Results This guidance reviews the risks and benefits of conducting NP exams in several ways, including standard in-person, mitigated in-person, in-clinic teleneuropsychology (TeleNP), and in-home TeleNP. Strategies are provided for selecting the most appropriate model for a given patient, taking into account four levels of patient risk stratification, level of community risk, and the concept of stepped models of care. Links are provided to governmental agency and professional organization resources as well as an outline and discussion of essential infection mitigation processes based on commonalities across recommendations from diverse federal, state, local, and professional organization recommendations. Conclusion This document provides recommendations and guidance with analysis of the risks relative to the benefits of various models of NP care during the COVID-19 pandemic. These recommendations may be revised as circumstances evolve, with updates posted continuously on the IOPC website (https://iopc.online/).
Collapse
Affiliation(s)
- Karen S Postal
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
| | - Robert M Bilder
- Psychiatry & Biobehavioral Sciences and Psychology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Margaret Lanca
- Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Boston, MA, USA
| | - Darrin M Aase
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Mark Barisa
- Performance Neuropsychology, Frisco, TX, USA.,University of North Texas, Denton, TX, USA
| | - Alice Ann Holland
- Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA.,Children's Medical Center of Dallas, Dallas, TX, USA
| | - Laura Lacritz
- Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - David M Lechuga
- Neurobehavioral Clinic and Counseling Center, Lake Forest, CA, USA
| | | | | | - Christine Salinas
- Neuropsychology Concierge, Indialantic, FL, USA.,College of Medicine, University of Central Florida, Orlando, FL, USA
| |
Collapse
|
21
|
Harder L, Hernandez A, Hague C, Neumann J, McCreary M, Cullum CM, Greenberg B. Home-Based Pediatric Teleneuropsychology: A validation study. Arch Clin Neuropsychol 2020; 35:1266-1275. [PMID: 33210719 DOI: 10.1093/arclin/acaa070] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/21/2020] [Accepted: 08/03/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate home-based teleneuropsychology in a pediatric cohort to determine if assessment via in-person and home-based videoconference yield similar results. The second objective was to determine the level of satisfaction with videoconference-based assessment among participants and caregivers. METHOD Fifty-eight participants, aged 6-20 years, were recruited through specialty programs for pediatric demyelinating disorders. Each participant was administered the same brief neuropsychological battery of common measures twice, once during an in-person session and once during a remote home-based videoconference session. Order of sessions was counterbalanced and time between assessments ranged from 1 to 50 days. It was hypothesized that results obtained through in-person vs. remote videoconference sessions would not be significantly different and that most participants and caregivers would rate the experience with teleneuropsychology as satisfactory. RESULTS Mann-Whitney U tests showed no significant differences in results obtained in the in-person first vs. remote videoconference first sessions or the change in performance across sessions. Satisfaction ratings by participants and caregivers were largely favorable for the use of the videoconference testing format. CONCLUSIONS The current study is the first to validate home-based teleneuropsychology and is the first to validate teleneuropsychological assessment in a pediatric sample. Future studies should replicate these findings as well as expand on sample size, diversity of populations evaluated, and the assessment tools administered. Careful consideration of ethical and practical factors should be given before providing pediatric teleneuropsychology services.
Collapse
Affiliation(s)
- Lana Harder
- Children's Health, Children's Medical Center, Dallas, TX, USA.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ana Hernandez
- Children's Health, Children's Medical Center, Dallas, TX, USA
| | - Cole Hague
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
| | - Joy Neumann
- Children's Health, Children's Medical Center, Dallas, TX, USA.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Morgan McCreary
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin Greenberg
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
22
|
Salinas CM, Bordes Edgar V, Berrios Siervo G, Bender HA. Transforming pediatric neuropsychology through video-based teleneuropsychology: an innovative private practice model pre-COVID-19. Arch Clin Neuropsychol 2020; 35:1189-1195. [PMID: 33159508 PMCID: PMC7717133 DOI: 10.1093/arclin/acaa101] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/12/2022] Open
Abstract
Objective In pediatric neuropsychology multiple barriers such as long wait times until an appointment, insurance coverage, and limited providers who are bilingual/bicultural or who sub-specialize in pediatric neuropsychology, often slow families from receiving diagnoses and interventions in a timely and affordable manner. This paper focuses on increasing accessibility through the development of a video-based, pediatric teleneuropsychology (TeleNP) practice model that was developed in a private practice 2 years before the COVID-19 pandemic. Method ‘Design thinking’ methodology to problem-solving was utilized to innovate the traditional neuropsychology practice model in under-served areas who may have limited financial and healthcare resources. The practice model approach to include a virtual diagnostic clinic with increased patient and provider efficiency was created to enhance accessibility for patients and sustainability for providers. Results Video-based TeleNP screenings were conducted for 67 children with developmental (i.e., attention deficit hyperactivity disorder, autism spectrum disorder) and language disorders, as well as concussion and psychiatric diagnoses. Additional comorbidities were identified in 65.6% of children. Follow-up data approximately 2 months later revealed 98.5% of children were receiving new interventions as a result of the video-based TeleNP assessment. Conclusion Video-based TeleNP benefits the consumer as it can reduce wait times, decrease family financial burden (i.e., travel and parent time off work), expedite referrals for interventions, and provide geographically under-served populations access to providers who are linguistically and culturally responsive. For providers, this model revealed improvements with direct implications for cost-saving, thereby facilitating long-term economic sustainability within a private practice healthcare marketplace.
Collapse
Affiliation(s)
| | - Veronica Bordes Edgar
- Departments of Psychiatry and Pediatrics, The University of Texas Southwestern Medical Center, Dallas, FL, USA
| | | | - Heidi A Bender
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
23
|
Carlew AR, Fatima H, Livingstone JR, Reese C, Lacritz L, Pendergrass C, Bailey KC, Presley C, Mokhtari B, Cullum CM. Cognitive Assessment via Telephone: A Scoping Review of Instruments. Arch Clin Neuropsychol 2020; 35:1215-1233. [PMID: 33106856 PMCID: PMC7665291 DOI: 10.1093/arclin/acaa096] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Telephone-based cognitive assessment (TBCA) has long been studied but less widely adopted in routine neuropsychological practice. Increased interest in remote neuropsychological assessment techniques in the face of the coronavirus 2019 (COVID-19) pandemic warrants an updated review of relevant remote assessment literature. While recent reviews of videoconference-based neuropsychological applications have been published, no updated compilation of empirical TBCA research has been completed. Therefore, this scoping review offers relevant empirical research to inform clinical decision-making specific to teleneuropsychology. METHOD Peer-reviewed studies addressing TBCA were included. Broad search terms were related to telephone, cognitive, or neuropsychological assessment and screening. After systematic searching of the PubMed and EBSCO databases, 139 relevant articles were retained. RESULTS In total, 17 unique cognitive screening measures, 20 cognitive batteries, and 6 single-task measures were identified as being developed or adapted specifically for telephone administration. Tables summarizing the identified cognitive assessments, information on diagnostic accuracy, and comparisons to face-to-face cognitive assessment are included in supplementary materials. CONCLUSIONS Overall, literature suggests that TBCA is a viable modality for identifying cognitive impairment in various populations. However, the mode of assessment selected clinically should reflect an understanding of the purpose, evidence, and limitations for various tests and populations. Most identified measures were developed for research application to support gross cognitive characterization and to help determine when more comprehensive testing was needed. While TBCA is not meant to replace gold-standard, face-to-face evaluation, if appropriately utilized, it can expand scope of practice, particularly when barriers to standard neuropsychological assessment occur.
Collapse
Affiliation(s)
- Anne R Carlew
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Hudaisa Fatima
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Julia R Livingstone
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Caitlin Reese
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Laura Lacritz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Cody Pendergrass
- Mental Health Department, VA North Texas Health Care System, Dallas, TX 75216, USA
| | - Kenneth Chase Bailey
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Chase Presley
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Ben Mokhtari
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Colin Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| |
Collapse
|
24
|
Sherwood AR, MacDonald B. A Teleneuropsychology Consultation Service Model for Children with Neurodevelopmental and Acquired Disorders Residing in Rural State Regions. Arch Clin Neuropsychol 2020; 35:1196-1203. [PMID: 33124658 PMCID: PMC7665470 DOI: 10.1093/arclin/acaa099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Accessing neuropsychological services, which are often centralized in urban regions, poses unique challenges to children and families in rural regions. In 2017, urban neuropsychologists and a pediatrician practicing in a rural region of New Mexico started to develop a teleneuropsychology (TeleNP) consultation service model to efficiently triage and determine a clinical course of action. This pilot project, aimed at expanding clinical access to specialized pediatric services in rural areas, evolved over the course of 2 years prior to the coronavirus disease 2019 pandemic. METHOD Providers earned the trust of the local community, gained understanding of pertinent sociocultural factors, and acquired knowledge of the clinical and educational concerns for the children residing in the rural community. The application of a culturally informed approach that highlights the importance of community participation and collaboration steered the decision to implement a TeleNP consultation model. By widening access to neuropsychology, this service helped to determine whether neuropsychological testing procedures were medically indicated. RESULTS We summarize the distinct processes that needed to occur at each location to support the implementation of telemedicine. We propose a clinical service decision tree with specific criteria to help guide providers on how to triage cases in order to increase access to specialized healthcare. CONCLUSION The success of implementing a TeleNP consultation service hinges upon ongoing care coordination between providers, clerical staff, patients, and families with clear goals and expectations, maintenance of legal and ethical standards, and development of specific administrative and clinical processes supporting the use of TeleNP.
Collapse
Affiliation(s)
- Andrea R Sherwood
- University of New Mexico Hospitals, Health Sciences Center, Albuquerque, USA
| | - Beatriz MacDonald
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, USA
| |
Collapse
|
25
|
Arias F, Safi DE, Miranda M, Carrión CI, Diaz Santos AL, Armendariz V, Jose IE, Vuong KD, Suarez P, Strutt AM. Teleneuropsychology for Monolingual and Bilingual Spanish-Speaking Adults in the Time of COVID-19: Rationale, Professional Considerations, and Resources. Arch Clin Neuropsychol 2020; 35:1249-1265. [PMID: 33150414 PMCID: PMC7665473 DOI: 10.1093/arclin/acaa100] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Neuropsychological assessments with monolingual Spanish and bilingual Spanish/English-speaking adults present unique challenges. Barriers include, but are not limited to, the paucity of test norms, uncertainty about the equivalence of translated neuropsychological tests, and limited proficiency in the provision of culturally competent services. Similar issues generalize to telephone- and video-based administration of neuropsychological tests or teleneuropsychology (TeleNP) with Hispanics/Latinos (as), and few studies have examined its feasibility and validity in this group. The sudden onset of the COVID-19 pandemic prompted neuropsychologists to identify alternative ways to provide equitable care. Clinicians providing TeleNP to this population during (and after) the pandemic must consider safety, professional factors, and systemic barriers to accessing and benefitting from virtual modalities. METHOD This clinical process manuscript describes how cross-cultural neuropsychologists across five U.S. academic institutions serving Hispanics/Latinos (as) developed TeleNP models of care during the pandemic. RESULTS Workflows, test batteries, and resources for TeleNP assessment with monolingual and bilingual Spanish-speaking patients are included. Factors guiding model development and informing decisions to incorporate virtual administration of neuropsychological tests into their practice are also discussed. CONCLUSIONS Provision of TeleNP is a promising modality. Additional research in this area is warranted with focus on cultural and contextual factors that support or limit the use of TeleNP with this community.
Collapse
Affiliation(s)
- Franchesca Arias
- Hinda & Arthur Marcus Institute for Aging Research, The Aging Brain Center, Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Cognitive Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Diomaris E Safi
- Department of Psychiatry and Behavioral Sciences, UCLA, Los Angeles, CA 90095, USA
- UCLA Hispanic Neuropsychiatric Center of Excellence, Los Angeles, CA 90095, USA
| | - Michelle Miranda
- Department of Cognitive Neurology, University of Utah, Salt Lake City, UT 84112, USA
| | - Carmen I Carrión
- Department of Neurology, Yale School of Medicine, New Haven, CT 06519, USA
| | | | | | - Irene E Jose
- Baylor College of Medicine Cerebro, Houston, TX 77030, USA
| | - Kevin D Vuong
- Baylor College of Medicine Cerebro, Houston, TX 77030, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Paola Suarez
- Department of Psychiatry and Behavioral Sciences, UCLA, Los Angeles, CA 90095, USA
- UCLA Hispanic Neuropsychiatric Center of Excellence, Los Angeles, CA 90095, USA
| | - Adriana M Strutt
- Baylor College of Medicine Cerebro, Houston, TX 77030, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
| | | |
Collapse
|
26
|
Bilder RM, Postal KS, Barisa M, Aase DM, Cullum CM, Gillaspy SR, Harder L, Kanter G, Lanca M, Lechuga DM, Morgan JM, Most R, Puente AE, Salinas CM, Woodhouse J. InterOrganizational practice committee recommendations/guidance for teleneuropsychology (TeleNP) in response to the COVID-19 pandemic. Clin Neuropsychol 2020; 34:1314-1334. [PMID: 32673163 PMCID: PMC7767580 DOI: 10.1080/13854046.2020.1767214] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 12/18/2022]
Abstract
Objective: The Inter Organizational Practice Committee (IOPC) convened a workgroup to provide rapid guidance about teleneuropsychology (TeleNP) in response to the COVID-19 pandemic.Method: A collaborative panel of experts from major professional organizations developed provisional guidance for neuropsychological practice during the pandemic. The stakeholders included the American Academy of Clinical Neuropsychology/American Board of Clinical Neuropsychology, the National Academy of Neuropsychology, Division 40 of the American Psychological Association, the American Board of Professional Neuropsychology, and the American Psychological Association Services, Inc. The group reviewed literature, collated federal, regional and state regulations and information from insurers, and surveyed practitioners to identify best practices.Results: Literature indicates that TeleNP may offer reliable and valid assessments, but clinicians need to consider limitations, develop new informed consent procedures, report modifications of standard procedures, and state limitations to diagnostic conclusions and recommendations. Specific limitations affect TeleNP assessments of older adults, younger children, individuals with limited access to technology, and individuals with other individual, cultural, and/or linguistic differences. TeleNP may be contraindicated or infeasible given specific patient characteristics, circumstances, and referral questions. Considerations for billing TeleNP services are offered with reservations that clinicians must verify procedures independently. Guidance about technical issues and "tips" for TeleNP procedures are provided.Conclusion: This document provides provisional guidance with links to resources and established guidelines for telepsychology. Specific recommendations extend these practices to TeleNP. These recommendations may be revised as circumstances evolve, with updates posted continuously at OPC.online.
Collapse
Affiliation(s)
- Robert M. Bilder
- Psychiatry & Biobehavioral Sciences and Psychology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Karen S. Postal
- Department of Psychiatry, Harvard Medical School, Andover, MA, USA
| | - Mark Barisa
- Performance Neuropsychology, University of North Texas, Denton, TX, USA
| | - Darrin M. Aase
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - C. Munro Cullum
- Psychology Division, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Lana Harder
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Margaret Lanca
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
| | - David M. Lechuga
- Neurobehavioral Clinic and Counseling Center, Lake Forest, IL, USA
| | | | | | | | | | | |
Collapse
|
27
|
Bilder RM, Postal KS, Barisa M, Aase DM, Cullum CM, Gillaspy SR, Harder L, Kanter G, Lanca M, Lechuga DM, Morgan JM, Most R, Puente AE, Salinas CM, Woodhouse J. Inter Organizational Practice Committee Recommendations/Guidance for Teleneuropsychology in Response to the COVID-19 Pandemic†. Arch Clin Neuropsychol 2020; 35:647-659. [PMID: 32666093 PMCID: PMC7454875 DOI: 10.1093/arclin/acaa046] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The Inter Organizational Practice Committee convened a workgroup to provide rapid guidance about teleneuropsychology (TeleNP) in response to the COVID-19 pandemic. METHOD A collaborative panel of experts from major professional organizations developed provisional guidance for neuropsychological practice during the pandemic. The stakeholders included the American Academy of Clinical Neuropsychology/American Board of Clinical Neuropsychology, the National Academy of Neuropsychology, Division 40 of the American Psychological Association, the American Board of Professional Neuropsychology, and the American Psychological Association Services, Inc. The group reviewed literature; collated federal, regional, and state regulations and information from insurers; and surveyed practitioners to identify best practices. RESULTS Literature indicates that TeleNP may offer reliable and valid assessments, but clinicians need to consider limitations, develop new informed consent procedures, report modifications of standard procedures, and state limitations to diagnostic conclusions and recommendations. Specific limitations affect TeleNP assessments of older adults, younger children, individuals with limited access to technology, and individuals with other individual, cultural, and/or linguistic differences. TeleNP may be contraindicated or infeasible given specific patient characteristics, circumstances, and referral questions. Considerations for billing TeleNP services are offered with reservations that clinicians must verify procedures independently. Guidance about technical issues and "tips" for TeleNP procedures are provided. CONCLUSION This document provides provisional guidance with links to resources and established guidelines for telepsychology. Specific recommendations extend these practices to TeleNP. These recommendations may be revised as circumstances evolve, with updates posted continuously at IOPC.online.
Collapse
Affiliation(s)
- Robert M Bilder
- Psychiatry & Biobehavioral Sciences and Psychology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Karen S Postal
- Department of Psychiatry, Harvard Medical School, Andover, MA, USA
| | - Mark Barisa
- Performance Neuropsychology, University of North Texas, Denton, TX, USA
| | - Darrin M Aase
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - C Munro Cullum
- Psychology Division, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Lana Harder
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Margaret Lanca
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
| | - David M Lechuga
- Neurobehavioral Clinic and Counseling Center, Lake Forest, IL, USA
| | | | | | | | | | | |
Collapse
|
28
|
Hammers DB, Stolwyk R, Harder L, Cullum CM. A survey of international clinical teleneuropsychology service provision prior to and in the context of COVID-19. Clin Neuropsychol 2020; 34:1267-1283. [PMID: 32844714 DOI: 10.1080/13854046.2020.1810323] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: Despite expansion of telecommunication strategies across health services and data supporting feasibility of videoconference-based neuropsychological assessment, relatively little is known about teleneuropsychology (TeleNP) use in practice. The current COVID-19 pandemic provides an opportunity for greater use of TeleNP and understanding of neuropsychologists' experience with this unique assessment medium.Methods: During the course of a no-cost global webinar related to practical/ethical considerations of TeleNP practice, attendees were invited to engage in a 26-question survey about their TeleNP use and related COVID-19 concerns. TeleNP practices before the COVID-19 pandemic and early on during the global outbreak were queried among survey participants, along with examination of TeleNP intentions following COVID-19.Results: Multiple countries were represented across five continents, with two-thirds of respondents being from the United States. Approximately one-fourth of respondents reported using TeleNP for clinical interview, feedback, and intervention prior to the onset of the COVID-19 pandemic, and approximately one-tenth of individuals used TeleNP for testadministration. Increased use of TeleNP for clinical interview, feedback, and intervention was reported within the first few weeks of the global COVID-19 outbreak, though the use of TeleNP for testing remained relatively unchanged. Most respondents indicated an intention for future use of TeleNP.Conclusions: Our findings suggest the use of TeleNP is increasing, although use of remote TeleNP testing is still developing. Findings also illustrate increasing use of TeleNP in the context of the COVID-19 pandemic and encourage follow-up investigation in future studies to understand the changing practices and rates of TeleNP provision over time.
Collapse
Affiliation(s)
- Dustin B Hammers
- Center for Alzheimer's Care, Imaging, and Research, Department of Neurology, University of Utah.,Center on Aging, University of Utah
| | - Renerus Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
| | - Lana Harder
- Children's Health, Children's Medical Center, Dallas, Texas.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
29
|
Galusha-Glasscock JM, Horton DK, Weiner MF, Cullum CM. Video Teleconference Administration of the Repeatable Battery for the Assessment of Neuropsychological Status. Arch Clin Neuropsychol 2015; 31:8-11. [PMID: 26446834 DOI: 10.1093/arclin/acv058] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 12/26/2022] Open
Abstract
Teleneuropsychology applications are growing, but a limited number of assessment tools have been studied in this context. The present investigation was designed to determine the feasibility and reliability of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) administration by comparing video teleconference (VTC) with face-to-face (FF) test conditions. Eighteen adult subjects over age 55 with and without cognitive impairment were administered Forms A and B of the RBANS in VTC and FF settings in counterbalanced fashion. Similar RBANS scores were obtained in both test conditions, with generally high correlations between administration methods. Results support the feasibility and reliability of remote administration of the RBANS via VTC.
Collapse
Affiliation(s)
| | - Daniel K Horton
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Myron F Weiner
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|