Conference Coverage
Performing Neurologic Exams Remotely
Researchers have found that the NIH Stroke Scale can be administered as reliably in a telehealth setting as in person, Dr. Gaines said. Shafqat et al found that four NIH Stroke Scale items had excellent agreement (ie, orientation, motor arm, motor leg, and neglect), and six items had good agreement (ie, language, dysarthria, sensation, visual fields, facial palsy, and gaze), whereas two items (ie, commands and ataxia) had poor agreement, when they compared remote and in-person assessments.
Certain examination elements require the assistance of a nurse or emergency department doctor who is with the patient, and a neurologist’s confidence in his or her ability to perform a neurologic examination via telehealth may depend on how much he or she is “willing to ask people to do,” Dr. Gaines said. “I will ask somebody to shine a light into the eyes so I can look at the pupils. I will have a person who is helping me in the ER setting do a Babinski sign and watch for the response. I have diagnosed a hereditary neuropathy with liability to pressure palsies via teleneurology.”
Emergency department doctors and nurses often know how to perform elements of neurologic examinations, even if they do not routinely use them. “We spend time training nurses at our sites to help us,” he said.
In addition, neurologists can assess gait, which typically is not tested in emergency rooms but can provide valuable information. A patient’s gait might help a neurologist identify cerebellar infarcts that otherwise would have been attributed to dizziness, for example.
Telemedicine presents “opportunities … to impact stroke care and hopefully other areas of neurology as well. It is not nearly as daunting as you might think to do these consults virtually,” Dr. Gaines said. “It is a great opportunity for us to put systems of care in place to deal with some of the inequities and problems with delivery that we have.”