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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] [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/).
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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
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Madero EN, Anderson J, Bott NT, Hall A, Newton D, Fuseya N, Harrison JE, Myers JR, Glenn JM. Environmental Distractions during Unsupervised Remote Digital Cognitive Assessment. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE 2021; 8:263-266. [PMID: 34101782 PMCID: PMC7964516 DOI: 10.14283/jpad.2021.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The current demand for cognitive assessment cannot be met with traditional in-person methods, warranting the need for remote unsupervised options. However, lack of visibility into testing conditions and effort levels limit the utility of existing remote options. This retrospective study analyzed the frequency of and factors associated with environmental distractions during a brief digital assessment taken at home by 1,442 adults aged 23–84. Automated scoring algorithms flagged low data capture. Frequency of environmental distractions were manually counted on a per-frame and per-trial basis. A total of 7.4% of test administrations included distractions. Distractions were more frequent in men (41:350) than women (65:1,092) and the average age of distracted participants (51.7) was lower than undistracted participants (57.8). These results underscore the challenges associated with unsupervised cognitive assessment. Data collection methods that enable review of testing conditions are needed to confirm quality, usability, and actionability.
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Affiliation(s)
- E N Madero
- Jennifer Rae Myers, 399 Bradford Street Ste. 101, Redwood City, CA 94063, USA, , Phone: 1 (301) 531-4179
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Zane KL, Thaler NS, Reilly SE, Mahoney JJ, Scarisbrick DM. Neuropsychologists' practice adjustments: The impact of COVID-19. Clin Neuropsychol 2020; 35:490-517. [PMID: 33371799 DOI: 10.1080/13854046.2020.1863473] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: The field of neuropsychology's response to the COVID-19 pandemic was characterized by a rapid change in clinical practice secondary to physical distancing policies and orders. The current study aimed to further characterize the change in neuropsychologists' professional practice, specifically related to teleneuropsychology (TNP) service provision, and also provide novel data regarding the impact of the pandemic on providers' emotional health. Method: This study surveyed 142 neuropsychologists between 3/30/2020 and 4/10/2020, who worked within a variety of settings (e.g., academic medical centers, general hospitals, Veterans Affairs medical centers, rehabilitation hospitals) across all four U.S. geographic regions. Mixed-model analyses of variance (ANOVAs) were conducted to assess for differences in neuropsychological practice (i.e., total number of patients and proportion of TNP seen per week) across time points (i.e., late February and early April) by practice setting and region. Descriptive statistics were conducted to describe respondents' perceptions of TNP, emotional responses to the pandemic, and perceptions of institutional/employers'/practices' responses. Results: Nearly all respondents (∼98%) reported making practice alterations, with ∼73% providing at least some TNP. Neuropsychologists across all settings and regions reported performing a higher proportion of TNP evaluations by April 2020. On average, respondents reported a medium amount of distress/anxiety related to COVID-19, which had a "somewhat small impact" on their ability to practice overall. Conclusions: The current study further elucidated neuropsychologists' provision of TNP services and offered initial data related to their emotional response to the pandemic. Future research is needed to examine the viability and sustainability of TNP practice.
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Affiliation(s)
| | - Nicholas S Thaler
- UCLA Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA
| | - Shannon E Reilly
- Department of Neurology, University of Virginia, Charlottesville, VA
| | - James J Mahoney
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV.,Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV
| | - David M Scarisbrick
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV.,Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV
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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] [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.
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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
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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: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [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.
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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
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56
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Caze T, Dorsman KA, Carlew AR, Diaz A, Bailey KC. Can You Hear Me Now? Telephone-Based Teleneuropsychology Improves Utilization Rates in Underserved Populations. Arch Clin Neuropsychol 2020; 35:1234-1239. [DOI: 10.1093/arclin/acaa098] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 01/18/2023] Open
Affiliation(s)
- Todd Caze
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Andrews Institute for Orthopaedics and Sports Medicine, Children’s Health, Plano, TX, USA
| | - Karen A Dorsman
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anne R Carlew
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aislinn Diaz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Psychiatry, Parkland Health & Hospital System, Dallas, TX, USA
| | - K Chase Bailey
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Psychiatry, Parkland Health & Hospital System, Dallas, TX, USA
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57
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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] [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.
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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
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Alonso-Lana S, Marquié M, Ruiz A, Boada M. Cognitive and Neuropsychiatric Manifestations of COVID-19 and Effects on Elderly Individuals With Dementia. Front Aging Neurosci 2020; 12:588872. [PMID: 33192483 PMCID: PMC7649130 DOI: 10.3389/fnagi.2020.588872] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide and has had unprecedented effects in healthcare systems, economies and society. COVID-19 clinical presentation primarily affects the respiratory system causing bilateral pneumonia, but it is increasingly being recognized as a systemic disease, with neurologic manifestations reported in patients with mild symptoms but, most frequently, in those in a severe condition. Elderly individuals are at high risk of developing severe forms of COVID-19 due to factors associated with aging and a higher prevalence of medical comorbidities and, therefore, they are more vulnerable to possible lasting neuropsychiatric and cognitive impairments. Several reports have described insomnia, depressed mood, anxiety, post-traumatic stress disorder and cognitive impairment in a proportion of patients after discharge from the hospital. The potential mechanisms underlying these symptoms are not fully understood but are probably multifactorial, involving direct neurotrophic effect of SARS-CoV-2, consequences of long intensive care unit stays, the use of mechanical ventilation and sedative drugs, brain hypoxia, systemic inflammation, secondary effects of medications used to treat COVID-19 and dysfunction of peripheral organs. Chronic diseases such as dementia are a particular concern not only because they are associated with higher rates of hospitalization and mortality but also because COVID-19 further exacerbates the vulnerability of those with cognitive impairment. In patients with dementia, COVID-19 frequently has an atypical presentation with mental status changes complicating the early identification of cases. COVID-19 has had a dramatical impact in long-term care facilities, where rates of infection and mortality have been very high. Community measures implemented to slow the spread of the virus have forced to social distancing and cancelation of cognitive stimulation programs, which may have contributed to generate loneliness, behavioral symptoms and worsening of cognition in patients with dementia. COVID-19 has impacted the functioning of Memory Clinics, research programs and clinical trials in the Alzheimer’s field, triggering the implementation of telemedicine. COVID-19 survivors should be periodically evaluated with comprehensive cognitive and neuropsychiatric assessments, and specific mental health and cognitive rehabilitation programs should be provided for those suffering long-term cognitive and psychiatric sequelae.
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Affiliation(s)
- Silvia Alonso-Lana
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Marta Marquié
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Agustín Ruiz
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
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59
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Loman M, Vogt E, Miller L, Landsman R, Duong P, Kasten J, DeFrancisco D, Koop J, Heffelfinger A. "How to" operate a pediatric neuropsychology practice during the COVID-19 pandemic: Real tips from one practice's experience. Child Neuropsychol 2020; 27:251-279. [PMID: 33059534 DOI: 10.1080/09297049.2020.1830962] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper aims to provide pediatric neuropsychologists with suggested processes and procedures to continue to provide neuropsychology services during the COVID-19 global pandemic. Our practice is located within an academic medical center/children's hospital, and setting-specific recommendations may not extend to all practices, though our hope is that others find guidance from our approach to providing pediatric neuropsychology evaluations when physical distancing is required. With consideration of ethics, equity, and assessment validity, we provide suggestions for a) modifying practices around seeing patients during COVID-19, b) tele-health for the pediatric neuropsychologist, c) safety standards and requirements, and d) working with special populations (e.g., Autism Spectrum Disorder, bilingual populations, immunocompromised patients, and acute inpatient assessment).
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Affiliation(s)
- Michelle Loman
- Department of Neurology, Medical College of Wisconsin/Children's Wisconsin , Milwaukee, WI, USA
| | - Elisabeth Vogt
- Department of Neurology, Medical College of Wisconsin/Children's Wisconsin , Milwaukee, WI, USA
| | - Lauren Miller
- Department of Neurology, Medical College of Wisconsin/Children's Wisconsin , Milwaukee, WI, USA
| | - Rachel Landsman
- Department of Neurology, Medical College of Wisconsin/Children's Wisconsin , Milwaukee, WI, USA
| | - Priscilla Duong
- Department of Neurology, Medical College of Wisconsin/Children's Wisconsin , Milwaukee, WI, USA
| | - Jessica Kasten
- Department of Neurology, Medical College of Wisconsin/Children's Wisconsin , Milwaukee, WI, USA
| | - Danielle DeFrancisco
- Department of Neurology, Medical College of Wisconsin/Children's Wisconsin , Milwaukee, WI, USA
| | - Jennifer Koop
- Department of Neurology, Medical College of Wisconsin/Children's Wisconsin , Milwaukee, WI, USA
| | - Amy Heffelfinger
- Department of Neurology, Medical College of Wisconsin/Children's Wisconsin , Milwaukee, WI, USA
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Tailby C, Collins AJ, Vaughan DN, Abbott DF, O'Shea M, Helmstaedter C, Jackson GD. Teleneuropsychology in the time of COVID-19: The experience of The Australian Epilepsy Project. Seizure 2020; 83:89-97. [PMID: 33120327 PMCID: PMC7561524 DOI: 10.1016/j.seizure.2020.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Traditional neuropsychological testing carries elevated COVID-19 risk for both examinee and examiner. Here we describe how the pilot study of the Australian Epilepsy Project (AEP) has transitioned to tele-neuropsychology (teleNP), enabling continued safe operations during the pandemic. METHODS The AEP includes adults (age 18-60) with a first unprovoked seizure, new diagnosis of epilepsy or drug resistant focal epilepsy. Shortly after launching the study, COVID-related restrictions necessitated adaptation to teleNP, including delivery of verbal tasks via videoconference; visual stimulus delivery via document camera; use of web-hosted, computerised assessment; substitution of oral versions for written tests; online delivery of questionnaires; and discontinuation of telehealth incompatible tasks. RESULTS To date, we have completed 24 teleNP assessments: 18 remotely (participant in own home) and six on-site (participant using equipment at research facility). Five face-to-face assessments were conducted prior to the transition to teleNP. Eight of 408 tests administered via teleNP (1.9 %) have been invalidated, for a variety of reasons (technical, procedural, environmental). Data confirm typical patterns of epilepsy-related deficits (p < .05) affecting processing speed, executive function, language and memory. Questionnaire responses indicate elevated rates of patients at high risk of mood (34 %) and anxiety disorder (38 %). CONCLUSION Research teleNP assessments reveal a typical pattern of impairments in epilepsy. A range of issues must be considered when introducing teleNP, such as technical and administrative set up, test selection and delivery, and cohort suitability. TeleNP enables large-scale neuropsychological research during periods of social distancing (and beyond), and offers an opportunity to expand the reach and breadth of neuropsychological services.
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Affiliation(s)
- Chris Tailby
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Australia.
| | - Alana J Collins
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - David N Vaughan
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; Department of Neurology, Austin Health, Heidelberg, Australia
| | - David F Abbott
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; The Florey Department of Neuroscience and Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Marie O'Shea
- Department of Clinical Neuropsychology, Austin Health, Heidelberg, Australia; School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | | | - Graeme D Jackson
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; Department of Neurology, Austin Health, Heidelberg, Australia; The Florey Department of Neuroscience and Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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61
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Postal KS, Bilder RM, Lanca M, Aase DM, Barisa M, Holland AA, Lacritz L, Lechuga DM, McPherson S, Morgan J, Salinas C. InterOrganizational practice committee guidance/recommendation for models of care during the novel coronavirus pandemic. Clin Neuropsychol 2020; 35:81-98. [PMID: 32996823 DOI: 10.1080/13854046.2020.1801847] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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 neuropsychological 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/).
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Affiliation(s)
- Karen S Postal
- Harvard Medical School, Department of Psychiatry, Camribdge, MA, USA
| | - Robert M Bilder
- University of California Los Angeles, David Geffen School of Medicine, Psychiatry & Biobehavioral Sciences and Psychology, Los Angeles, CA, USA
| | - Margaret Lanca
- Harvard Medical School, Dept. of Psychiatry, Cambridge Health Alliance, Boston, MA, USA
| | - Darrin M Aase
- The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Mark Barisa
- Performance Neuropsychology, Frisco, TX, USA.,University of North Texas, Denton, TX, USA
| | - Alice Ann Holland
- University of Texas Southwestern Medical School, Psychiatry, Dallas, TX, USA.,Children's Medical Center of Dallas, Dallas, TX, USA
| | - Laura Lacritz
- University of Texas Southwestern Medical School, Psychiatry, Dallas, TX, USA
| | - David M Lechuga
- Neurobehavioral Clinic and Counseling Center, Lake Forest, CA, USA
| | | | | | - Christine Salinas
- Neuropsychology Concierge, Indialantic, FL, USA.,University of Central Florida, College of Medicine, Orlando, FL, USA
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Hewitt KC, Rodgin S, Loring DW, Pritchard AE, Jacobson LA. Transitioning to telehealth neuropsychology service: Considerations across adult and pediatric care settings. Clin Neuropsychol 2020; 34:1335-1351. [DOI: 10.1080/13854046.2020.1811891] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Kelsey C. Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sandra Rodgin
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David W. Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Alison E. Pritchard
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lisa A. Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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63
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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] [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.
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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
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64
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Pritchard AE, Sweeney K, Salorio CF, Jacobson LA. Pediatric neuropsychological evaluation via telehealth: Novel models of care. Clin Neuropsychol 2020; 34:1367-1379. [PMID: 32787508 DOI: 10.1080/13854046.2020.1806359] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: As the coronavirus pandemic extends across the globe, the impacts have been felt across domains of industry. Neuropsychology services are no exception. Methods for neuropsychological assessments, which typically require an in-person visit, must be modified in order to adhere to social distancing and isolation standards enacted in an effort to slow the pandemic. How can providers continue to meet the needs of patients referred for neuropsychology evaluations, while respecting federal and state guidelines for safety and ethical mandates? We offer a novel, tiered model of care, successfully implemented in response to mandated social distancing, in a large, pediatric neuropsychology program.Method: We describe the considerations and challenges to be addressed in transitioning a large neuropsychology department to a new model of care, including triaging referrals, developing -or rediscovering - types of services to meet the needs of a virtual patient population, and helping patients, parents, and providers to adjust to these new models.Conclusions: Lessons learned as a function of rapid changes in care models have implications for the field of neuropsychology as a whole as well as for future flexibility in meeting the needs of pediatric patients and their families.
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Affiliation(s)
- Alison E Pritchard
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kristie Sweeney
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Cynthia F Salorio
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lisa A Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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