Remote neuropsychology tests for children shown effective, study finds


Date:
September 24, 2020
Source:
UT Southwestern Medical Center
Summary:
Administering neuropsychology evaluations to children online in
the comfort of their own homes is feasible and delivers results
comparable to tests traditionally performed in a clinic, a new study
indicates. The finding could help expand access to specialists
and reduce barriers to care, particularly as the popularity of
telemedicine grows during the COVID-19 pandemic.



FULL STORY ========================================================================== Administering neuropsychology evaluations to children online in the
comfort of their own homes is feasible and delivers results comparable
to tests traditionally performed in a clinic, a new study led by UT Southwestern researchers and Children's Health indicates. The finding, published online this month in the Archives of Clinical Neuropsychology,
could help expand access to specialists and reduce barriers to care, particularly as the popularity of telemedicine grows during the COVID-19 pandemic.


========================================================================== Patients with a variety of neurological disorders require periodic neuropsychological evaluations to track their cognition, academic skills, memory, attention, and other variables. Typically, these tests are done
in clinics, often by specialists in these disorders.

However, explains Lana Harder, Ph.D., ABPP, associate professor of
psychiatry and neurology at UTSW, many patients travel hundreds of miles
to access specialists for their care -- a major expense and inconvenience
that can also cause fatigue and potentially influence the results. Harder
also leads the neuropsychology service and is the neuropsychology training director at Children's Health.

Research on adults has shown that these evaluations can be done
effectively, with the examiner and patient in different rooms. However,
those tests were conducted in controlled clinic or laboratory settings
rather than patients' homes, where distractions and technological glitches could confound results.

Plus, none of the earlier studies involved children, a population that
has its own unique challenges.

To evaluate whether teleneuropsychology evaluations could be effectively performed with children at home, Harder, along with Benjamin Greenberg,
M.D., professor of neurology and pediatrics at UTSW and co-director
with Harder of the Pediatric CONQUER Program at Children's, and
their colleagues recruited 58 patients primarily from the Pediatric Demyelinating Disease Program at Children's Medical Center Dallas. This
clinic treats patients with neurological autoimmune disorders that target myelin, an insulating layer on nerve cells that is critical to their
function. The disorders include transverse myelitis, multiple sclerosis,
acute disseminated encephalomyelitis, optic neuritis, and neuromyelitis
optica. The patients ranged in age from 6 to 20 and traveled up to 2,033
miles for visits to the clinic.

Each child received the same 90-minute neuropsychology battery twice --
once at home and once at the clinic -- spaced apart by about 16 days. Half
the group received the home test first; the other half got the clinic
test first.



==========================================================================
For the home test, children received a packet of testing materials prior
to their test date and, if they did not have a computer or tablet at
home, borrowed a tablet from the researchers' office in advance. For
both tests, parents or other caregivers left the room, allowing the
patient and researcher to interact one on one.

The home-based environment had unique challenges compared with the clinic, Greenberg explains: Any distraction, from a barking dog to a doorbell,
or technological glitches, such as a poor internet connection, could
invalidate the results. While distractions and technology problems
occurred intermittently during remote sessions, these were typically
fleeting and generally did not interfere with testing sessions.

When the researchers compared the results obtained from the home- and
clinic- based tests, no significant differences were found.

But it's not enough to show that the home-based testing is comparable to
the clinic, Harder notes -- patients and their caregivers must also be
willing and interested in remote testing to make it feasible. To that end,
the researchers gave each patient and their caregivers a survey to assess
their level of satisfaction with the videoconference-based test. The
vast majority (94 percent of caregivers and 90 percent of participants) responded that they were satisfied with home-based testing. If given a
choice between remote or in- person, most indicated no preference.

Teleneuropsychology testing still needs to be evaluated over a broader
age range and array of conditions and measures before it becomes a
staple in the field, Harder says. But having this as an option could
eventually help children avoid having to travel far distances to access specialists or avoid exposure from in-person visits -- a boon during
the era of COVID-19, she adds.

"This model could allow these young and often medically fragile children
to stay put but still receive the care that they need," Harder says.

Other researchers who contributed to this study include Joy Neumann,
Morgan McCreary, and C. Munro Cullum, all of UTSW; Ana Hernandez of
Children's Medical Center; and Cole Hague, of Boston Children's Hospital.

This work was supported by the National Multiple Sclerosis Society and
the Children's Trust.

Greenberg is a Distinguished Teaching Professor and a Cain Denius Scholar
in Mobility Disorders. Cullum holds the Pam Blumenthal Distinguished Professorship in Clinical Psychology.


========================================================================== Story Source: Materials provided by UT_Southwestern_Medical_Center. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Lana Harder, Ana Hernandez, Cole Hague, Joy Neumann, Morgan
McCreary, C
Munro Cullum, Benjamin Greenberg. Home-Based Pediatric
Teleneuropsychology: A validation study. Archives of Clinical
Neuropsychology, 2020; DOI: 10.1093/arclin/acaa070 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/09/200924101931.htm

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