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Kiefer M, Simione M, Eichler F, Townsend EL. Development of an Infantile GM2 Clinical Rating Scale: Remote Assessment of Clinically Meaningful Health-Related Function. J Child Neurol 2024; 39:161-170. [PMID: 38659405 PMCID: PMC11168865 DOI: 10.1177/08830738241246703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
GM2 gangliosidoses (GM2) are a group of rare lysosomal storage disorders in which accumulation of GM2 gangliosides results in progressive central nervous system damage. The infantile GM2 phenotype is characterized by delays in milestones by 6 months of age, followed by rapid loss of motor, cognitive, and visual function. Advancements in early diagnosis and pharmacotherapies provide promise for improved outcomes. However, the lack of feasible and clinically meaningful clinical outcome assessments for GM2 poses a challenge to characterizing GM2 natural history and selecting clinical trial endpoints. The purpose of this study was to develop a remotely administered infantile GM2 rating scale to measure health-related function in children with infantile GM2. A 2-phase mixed methods design was employed. In phase 1 of the study, 8 families of children with Infantile GM2 completed a natural history survey and a 1:1 semistructured interview to provide caregiver perspectives on the impacts of GM2 on health-related function. In phase 2 of the study, 8 expert clinicians provided feedback via surveys and participated in videoconference-hosted focus groups to refine scale administration and scoring procedures. These methods guided the development of 16 scale items to assess function in 5 health-related function domains: vision, hand and arm use, communication, gross motor, and feeding. This study used caregiver perspectives and expert clinician feedback to develop a remotely administered clinical outcome assessment of clinically meaningful health-related function in children with infantile GM2. Future studies will further evaluate the feasibility, reliability, and validity of the Infantile GM2 Clinical Rating Scale.
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Affiliation(s)
- Michael Kiefer
- Department of Physical Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
- PhD in Rehabilitation Sciences Program, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - Meg Simione
- Division of General Academic Pediatrics, Mass General Hospital for Children, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Florian Eichler
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elise L. Townsend
- PhD in Rehabilitation Sciences Program, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
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Brima T, Freedman EG, Prinsloo KD, Augustine EF, Adams HR, Wang KH, Mink JW, Shaw LH, Mantel EP, Foxe JJ. Assessing the integrity of auditory sensory memory processing in CLN3 disease (Juvenile Neuronal Ceroid Lipofuscinosis (Batten disease)): an auditory evoked potential study of the duration-evoked mismatch negativity (MMN). J Neurodev Disord 2024; 16:3. [PMID: 38183037 PMCID: PMC10770910 DOI: 10.1186/s11689-023-09515-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND We interrogated auditory sensory memory capabilities in individuals with CLN3 disease (juvenile neuronal ceroid lipofuscinosis), specifically for the feature of "duration" processing. Given decrements in auditory processing abilities associated with later-stage CLN3 disease, we hypothesized that the duration-evoked mismatch negativity (MMN) of the event related potential (ERP) would be a marker of progressively atypical cortical processing in this population, with potential applicability as a brain-based biomarker in clinical trials. METHODS We employed three stimulation rates (fast: 450 ms, medium: 900 ms, slow: 1800 ms), allowing for assessment of the sustainability of the auditory sensory memory trace. The robustness of MMN directly relates to the rate at which the regularly occurring stimulus stream is presented. As presentation rate slows, robustness of the sensory memory trace diminishes. By manipulating presentation rate, the strength of the sensory memory trace is parametrically varied, providing greater sensitivity to detect auditory cortical dysfunction. A secondary hypothesis was that duration-evoked MMN abnormalities in CLN3 disease would be more severe at slower presentation rates, resulting from greater demand on the sensory memory system. RESULTS Data from individuals with CLN3 disease (N = 21; range 6-28 years of age) showed robust MMN responses (i.e., intact auditory sensory memory processes) at the medium stimulation rate. However, at the fastest rate, MMN was significantly reduced, and at the slowest rate, MMN was not detectable in CLN3 disease relative to neurotypical controls (N = 41; ages 6-26 years). CONCLUSIONS Results reveal emerging insufficiencies in this critical auditory perceptual system in individuals with CLN3 disease.
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Affiliation(s)
- Tufikameni Brima
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Department of Neuroscience and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | - Edward G Freedman
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Department of Neuroscience and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kevin D Prinsloo
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Department of Neuroscience and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Erika F Augustine
- University of Rochester Batten Center (URBC), Department of Neurology and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Heather R Adams
- University of Rochester Batten Center (URBC), Department of Neurology and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kuan Hong Wang
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Department of Neuroscience and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Jonathan W Mink
- University of Rochester Batten Center (URBC), Department of Neurology and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Luke H Shaw
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Department of Neuroscience and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Emma P Mantel
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Department of Neuroscience and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - John J Foxe
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Department of Neuroscience and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
- University of Rochester Batten Center (URBC), Department of Neurology and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
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Viñas-Guasch N, Chia PSQ, Yap MLM, Wu CY, Chen SHA. Cognitive pediatric tele-assessment: a scoping review. Front Psychol 2023; 14:1288021. [PMID: 38162979 PMCID: PMC10754967 DOI: 10.3389/fpsyg.2023.1288021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Cognitive tele-assessment (CTA) adoption has increased considerably recently, in parallel with the maturation of the digital technologies that enable it, and the push to move assessment to the online format during the COVID-19 pandemic in 2019. This mode of assessment stems from remote assessment applications that originated in general tele-medicine, where it was typically used for patient screening as part of an intervention. The development of remote tele-medicine was later adapted for CTA in adult populations in tele-neuropsychiatry and tele-psychology and is increasingly applied in experimental research in cognitive science research with adult and pediatric populations, and for remote academic assessment. Compared to in-person assessment, CTA offers advantages such as decreasing time and logistic costs and facilitating the assessment of remote or special needs populations. However, given the novelty of CTA, its technical, methodological, and ethical issues remain poorly understood, especially in cases where methods for assessment of adults are used in pediatric populations. In the current paper, we provide a scoping review on the evolution of remote tele-assessment from the years 2000 to 2021, to identify its main themes, methodologies, and applications, and then focus on the issues of assessment in pediatric populations. Finally, we present recommendations on how to address the challenges previously mentioned.
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Affiliation(s)
- Nestor Viñas-Guasch
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Phoebe Si Qi Chia
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Michelle Li-Mei Yap
- Centre for Research in Child Development, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Chiao-Yi Wu
- Centre for Research in Child Development, National Institute of Education, Nanyang Technological University, Singapore, Singapore
- Centre for Research and Development in Learning (CRADLE), Nanyang Technological University, Singapore, Singapore
| | - S. H. Annabel Chen
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
- Centre for Research and Development in Learning (CRADLE), Nanyang Technological University, Singapore, Singapore
- Lee Kong Chian School of Medicine (LKCMedicine), Nanyang Technological University, Singapore, Singapore
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Brima T, Freedman EG, Prinsloo KD, Augustine EF, Adams HR, Wang KH, Mink JW, Shaw LH, Mantel EP, Foxe JJ. Assessing the integrity of auditory sensory memory processing in CLN 3 disease (Juvenile Neuronal Ceroid Lipofuscinosis (Batten disease)): An auditory evoked potential study of the duration-evoked mismatch negativity (MMN). RESEARCH SQUARE 2023:rs.3.rs-3203894. [PMID: 37645970 PMCID: PMC10462191 DOI: 10.21203/rs.3.rs-3203894/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background We interrogated auditory sensory memory capabilities in individuals with CLN3 disease (juvenile neuronal ceroid lipofuscinosis), specifically for the feature of "duration" processing, a critical cue in speech perception. Given decrements in speech and language skills associated with later-stage CLN3 disease, we hypothesized that the duration-evoked mismatch negativity (MMN) of the event related potential (ERP) would be a marker of progressively atypical cortical processing in this population, with potential applicability as a brain-based biomarker in clinical trials. Methods We employed three stimulation rates (fast: 450 ms, medium: 900 ms, slow: 1800 ms), allowing for assessment of the sustainability of the auditory sensory memory trace. The robustness of MMN directly relates to the rate at which the regularly occurring stimulus stream is presented. As presentation rate slows, robustness of the sensory memory trace diminishes. By manipulating presentation rate, the strength of the sensory memory trace is parametrically varied, providing greater sensitivity to detect auditory cortical dysfunction. A secondary hypothesis was that duration-evoked MMN abnormalities in CLN3 disease would be more severe at slower presentation rates, resulting from greater demand on the sensory memory system. Results Data from individuals with CLN3 disease (N=21; range 6-28 years of age) showed robust MMN responses (i.e., intact auditory sensory memory processes) at the medium stimulation rate. However, at the fastest rate, MMN was significantly reduced, and at the slowest rate, MMN was not detectable in CLN3 disease relative to neurotypical controls (N=41; ages 6-26 years). Conclusions Results reveal emerging insufficiencies in this critical auditory perceptual system in individuals with CLN3 disease.
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Affiliation(s)
- Tufikameni Brima
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Department of Neuroscience and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Edward G. Freedman
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Department of Neuroscience and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kevin D. Prinsloo
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Department of Neuroscience and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Erika F. Augustine
- University of Rochester Batten Center (URBC), Department of Neurology and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Heather R. Adams
- University of Rochester Batten Center (URBC), Department of Neurology and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kuan Hong Wang
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Department of Neuroscience and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Jonathan W. Mink
- University of Rochester Batten Center (URBC), Department of Neurology and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Luke H. Shaw
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Department of Neuroscience and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Emma P. Mantel
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Department of Neuroscience and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - John J. Foxe
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Department of Neuroscience and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- University of Rochester Batten Center (URBC), Department of Neurology and The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Walker EJ, Kirkham FJ, Stotesbury H, Dimitriou D, Hood AM. Tele-neuropsychological Assessment of Children and Young People: A Systematic Review. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2023; 9:1-14. [PMID: 37359106 PMCID: PMC10231293 DOI: 10.1007/s40817-023-00144-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 06/28/2023]
Abstract
The coronavirus pandemic identified a clinical need for pediatric tele-neuropsychology (TeleNP) assessment. However, due to limited research, clinicians have had little information to develop, adapt, or select reliable pediatric assessments for TeleNP. This preliminary systematic review aimed to examine the feasibility of pediatric TeleNP assessment alongside (1) patient/family acceptability, (2) reliability, and (3) the quality of the literature. Between May 2021 and November 2022, manual searches of PubMed, PsycINFO, and Google Scholar were conducted using terms related to "pediatric" and "tele-neuropsychology." After extracting relevant papers with samples aged 0-22 years, predefined exclusion criteria were applied. Quality assessment was completed using the AXIS appraisal tool (91% rater-agreement). Twenty-one studies were included in the review, with reported qualitative and quantitative data on the feasibility, reliability, and acceptability extracted. Across included studies, TeleNP was completed via telephone/video conference with participants either at home, in a local setting accompanied by an assistant, or in a different room but in the same building as the assessor. Pediatric TeleNP was generally reported to be feasible (e.g., minimal behavioral differences) and acceptable (e.g., positive feedback). Nineteen studies conducted some statistical analyses to assess reliability. Most observed no significant difference between in-person and TeleNP for most cognitive domains (i.e., IQ), with a minority finding variable reliability for some tests (e.g., attention, speech, visuo-spatial). Limited reporting of sex-assigned birth, racialized identity, and ethnicity reduced the quality and generalizability of the literature. To aid clinical interpretations, studies should assess underexamined cognitive domains (e.g., processing speed) with larger, more inclusive samples. Supplementary Information The online version contains supplementary material available at 10.1007/s40817-023-00144-6.
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Affiliation(s)
- Elise J. Walker
- Developmental Neurosciences Unit and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, England
| | - Fenella J. Kirkham
- Developmental Neurosciences Unit and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, England
- Clinical and Experimental Sciences, University of Southampton, Southampton, England
| | - Hanne Stotesbury
- Developmental Neurosciences Unit and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, England
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, Department of Psychology and Human Development, UCL Institute of Education, London, England
| | - Anna M. Hood
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Coupland 1 Building, Manchester, M15 6FH Manchester, England
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Equivalency of In-Person Versus Remote Assessment: WISC-V and KTEA-3 Performance in Clinically Referred Children and Adolescents. J Int Neuropsychol Soc 2022; 28:835-844. [PMID: 34569463 PMCID: PMC9026666 DOI: 10.1017/s1355617721001053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Teletesting has the potential to reduce numerous barriers to patient care which have only become exacerbated during the COVID-19 pandemic. Although telehealth is commonly utilized throughout medicine and mental health practices, teletesting has remained limited within cognitive and academic evaluations. This may be largely due to concern for the validity of test administration via remote assessment. This cross-sectional study examined the equivalency of cognitive [Wechsler Intelligence Scales for Children - Fifth Edition (WISC-V)] and academic [Kaufman Test of Educational Achievement - Third Edition (KTEA-3)] subtests administered via either teletesting or traditional in-person testing within clinically referred youth. METHOD Chart review using a retrospective, cross-sectional design included a total of 893 children and adolescents, ranging from 4 to 17 years (Mean age = 10.2 years, SD = 2.9 years) who were administered at least one subtest from the aforementioned cognitive or academic assessments. Of these, 285 received teletesting, with the remaining (n = 608) receiving in-person assessment. A total of seven subtests (five from the WISC-V and two from the KTEA-3) were examined. A series of inverse probability of exposure weighted (IPEW) linear regression models examined differences between groups for each of the seven subtests after adjustment for numerous demographic, diagnostic, and parent-reported symptom variables. RESULTS Only two significant differences were found, such that WISC-V Visual Puzzles (p < .01) and KTEA-3 Math Concepts (p = .03) scores were slightly higher in the teletesting versus in-person groups. However, these differences were quite small in magnitude (WISC-V Visual Puzzles, d = .33, KTEA-3 Math Concepts, d = .18). CONCLUSIONS Findings indicate equivalency across methods of service delivery without clinically meaningful differences in scores among referred pediatric patients.
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Executive Functions and Rapid Automatized Naming: A New Tele-Rehabilitation Approach in Children with Language and Learning Disorders. CHILDREN 2022; 9:children9060822. [PMID: 35740759 PMCID: PMC9222183 DOI: 10.3390/children9060822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/13/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022]
Abstract
Executive function deficits are documented in many neurodevelopmental disorders and may contribute to clinical complexity or rehabilitation resilience. The present research was primarily aimed at presenting and evaluating the feasibility and effectiveness of a telerehabilitation program used during the pandemic period. MemoRAN (Anastasis), a computerised cognitive training to improve executive control during visual-verbal integration tasks was used in a sample of 42 children (5–11 years old) with specific learning or language disorders. The MemoRAN training was based on exercises of inhibition, cognitive flexibility and updating in working memory for three months, with a frequency of approximately three sessions per week. Afterwards, a comparison between a subgroup of children using Memo-RAN and an active control group, using a tele-rehabilitation program directed on reading was conducted. Effect size analysis in pre-post measurements suggests an average effect of MemoRAN in measurements that require control processes, such as accuracy in dictation, reading, inhibition and working memory testing. Comparison with the active control group and the clinical utility implications of these types of treatment will be discussed.
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Ruffini C, Tarchi C, Morini M, Giuliano G, Pecini C. Tele-assessment of cognitive functions in children: a systematic review. Child Neuropsychol 2021; 28:709-745. [PMID: 34856882 DOI: 10.1080/09297049.2021.2005011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cognitive Tele-Assessment approach (CTA) has been widely used in adults for clinical, research, and screening purposes. In the last decades, it has been considered a useful tool for evaluating child development in both clinical and educational settings and new instruments for CTA in children have been developed. In comparison to In Person Assessment (IPA), CTA can have several advantages, such as increasing accessibility, cutting waiting lists, reducing time and travel costs, and assisting with infection control by minimizing face-to-face contact in times of pandemic. Nevertheless, several issues related to the feasibility and reliability of using CTA to evaluate cognitive development are still open. The present systematic review has a twofold aim: 1. to describe the cognitive functions that are most frequently measured by CTA in children, the procedures used, and the characteristics of the samples investigated; 2. to investigate the agreement between CTA and IPA scores in children.In the present systematic review, 23 studies using CTA in children, with typical or atypical development, have been selected and analyzed. Results support the similarities in performance scores between IPA and CTA and good compliance by children and their families in participating in CTA. Nonetheless, most studies suggest that several methodological precautions must be taken to manage technical and procedural characteristics that may represent challenges for CTA of children. Suggestions for a correct use of CTA, factors affecting the validity of the results and directions for future research are discussed.
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Affiliation(s)
- Costanza Ruffini
- Department of Education, Languages, Intercultures, Literatures and Psychology (FORLIPSI), University of Florence, Firenze, Italy
| | - Christian Tarchi
- Department of Education, Languages, Intercultures, Literatures and Psychology (FORLIPSI), University of Florence, Firenze, Italy
| | - Monica Morini
- Department of Education, Languages, Intercultures, Literatures and Psychology (FORLIPSI), University of Florence, Firenze, Italy
| | - Gabriella Giuliano
- Department of Education, Languages, Intercultures, Literatures and Psychology (FORLIPSI), University of Florence, Firenze, Italy
| | - Chiara Pecini
- Department of Education, Languages, Intercultures, Literatures and Psychology (FORLIPSI), University of Florence, Firenze, Italy
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Worhach J, Boduch M, Zhang B, Maski K. Remote Assessment of Cognition in Kids and Adolescents with Daytime Sleepiness: A pilot study of feasibility and reliability. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33791741 PMCID: PMC8010773 DOI: 10.1101/2021.03.24.21254190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In this pilot study, we assessed the reliability of cognitive testing for kids and adolescents ages 8–19 years of age with narcolepsy or subjective daytime sleepiness compared to healthy controls. Forty-six participants took part in the study (n=18 with narcolepsy type 1, n=6 with subjective daytime sleepiness, and n= 22 healthy controls recruited from the community). Participants completed verbal (vocabulary testing) and non-verbal intelligence quotient (IQ) tasks (block design, matrix reasoning) from the Weschler Abbreviated Scale of Intelligence- Second Edition (WASI-II) in-person or remotely in their home through a HIPAA compliant telehealth web platform with conditions counterbalanced. We found that vocabulary T-scores showed good reliability with intraclass correlation coefficient (ICC) of 0.76 (95% CI: 0.64, 0.85) between remote and in-person testing conditions. Matrix Reasoning T-scores showed moderate reliability (ICC 0.69, 95% CI: 0.68, 0.90) and Block Design T-scores was poor between testing conditions. Bland-Altman plots showed outliers on vocabulary and matrix reasoning tasks performed better on remote assessments. Overall, the results of this pilot study support the feasibility and reliability of verbal and non-verbal IQ scores collected by telehealth. Use of telehealth to collect verbal and non-verbal IQ scores may offer a means to acquire cognitive data for pediatric sleep research through the COVID-19 pandemic and beyond.
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Worhach J, Boduch M, Zhang B, Maski K. Remote Assessment of Pediatric Patients with Daytime Sleepiness and Healthy Controls: A Pilot Study of Feasibility and Reliability. Child Neurol Open 2021; 8:2329048X211048064. [PMID: 34660839 PMCID: PMC8512221 DOI: 10.1177/2329048x211048064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022] Open
Abstract
We assessed the reliability of cognitive testing for children and adolescents ages 8 to 19 years of age with narcolepsy or subjective daytime sleepiness compared to healthy controls. Forty-six participants took part in the study (n = 18 narcolepsy type 1, n = 6 subjective daytime sleepiness, and n = 22 healthy controls). Participants completed verbal (vocabulary testing) and non-verbal intelligence quotient (IQ) tasks (block design, matrix reasoning) from the Wechsler Abbreviated Scale of Intelligence- Second Edition (WASI-II) in-person or remotely through a HIPAA compliant telehealth platform with conditions counterbalanced. We found that vocabulary T-scores showed good reliability with intraclass correlation coefficient (ICC) of 0.76 (95% CI: 0.64, 0.85) between remote and in-person testing conditions. Matrix Reasoning T-scores showed moderate reliability (ICC 0.69, 95% CI: 0.68, 0.90) and Block Design T-scores was poor between testing conditions. Overall, the results of this pilot study support the feasibility and reliability of verbal and non-verbal IQ scores collected by telehealth.
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Affiliation(s)
| | | | - Bo Zhang
- Boston Children’s Hospital, Boston, MA, USA
- Boston Children’s Hospital, Institutional Centers for Clinical and Translational Research,
Boston, MA, USA
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Scherr JF, Albright C, de los Reyes E. Utilizing telehealth to create a clinical model of care for patients with Batten disease and other rare diseases. THERAPEUTIC ADVANCES IN RARE DISEASE 2021; 2:26330040211038564. [PMID: 37181116 PMCID: PMC10032454 DOI: 10.1177/26330040211038564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/22/2021] [Indexed: 05/16/2023]
Abstract
The COVID-19 pandemic transformed the delivery of healthcare across the world. Telehealth has emerged as the primary method for providing healthcare early in the pandemic. Patient and healthcare provider views of the effectiveness of telehealth services are encouraging and support the long-term use of telehealth services in clinical practice. Telehealth may provide a strategy that has far-reaching benefits for diverse patient populations, such as patients with Batten disease and other rare diseases, who face additional barriers to accessing subspecialty healthcare services. The aims of this paper, through the experience of a single Batten Disease Center of Excellence, are to (1) review the benefits and barriers involved in the delivery of telehealth services to patients with rare diseases; (2) discuss components of a model for clinical care that utilizes telehealth services for patients with Batten disease; (3) discuss limitations and future directions of using telehealth in patients with rare diseases. Healthcare systems should consider building clinical models that utilize telehealth services to provide multidisciplinary services to patients with rare diseases. There are numerous benefits in using telehealth that can enhance and expand service delivery between the patient and clinician. Telehealth services can also improve provider-to-provider communication and collaboration when providing clinical care to individuals with rare diseases. Although there are many benefits to utilizing telehealth services in provision of care to patients with rare diseases, it is important to consider factors that may limit or add additional barriers prior to implementing telehealth services. There is a need for future collaborative research to examine and compare the effectiveness and outcomes of telehealth services with standard of care services that are provided in-person. Future research should also examine how to reduce the challenges and barriers associated with the implementation of telehealth services. Plain language summary What is telehealth? Telehealth is defined by the US Department of Health Resources and Services Administrations1 as the "use of electronic information and telecommunication technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration. Technologies include video conference, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communication." What was the aim of this review? This review was conducted to guide a clinical model using telehealth services for patients with Batten disease and other rare diseases based on the experiences of a single Batten Disease Center of Excellence. Why is this important? Individuals with rare diseases may face multiple barriers to accessing clinical services. Local doctors and treatment providers, such as speech therapists, occupational therapists, physical therapists, and psychologists, may not have knowledge of rare diseases or how to manage symptoms and disease progression, or how to guide treatment services. Other barriers may also include:• Lack of local resources;• Increased caregiver stress;• Difficulty obtaining a correct diagnosis.There are numerous benefits to using telehealth services for both patients with rare diseases, such as:• Convenience;• Cost savings;• Improved access to care;• Ability to see multiple providers that can help with symptom monitoring, assessment, and treatment services. Where do we go from here? It is important to consider limitations when creating a model for clinical care for patients with rare diseases. Some limitations to think about are:• Clinician and organization familiarity with telehealth;• Reimbursement and coverage from insurance companies for telehealth;• Security and privacy of patient information;• Training of telehealth providers;• Logistical factors, including use of equipment, internet/connectivity, and technical troubleshooting.Future directions should involve collaborative research that studies the effectiveness, feasibility, and perceptions of families of rare diseases and providers that use telehealth for clinical healthcare services. Research should also further study and consider ways to improve barriers and challenges associated with implementing telehealth systems into existing healthcare systems.
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Affiliation(s)
- Jessica F. Scherr
- Nationwide Children’s Hospital, Child
Development Center, Columbus, OH 43205, USA
| | - Charles Albright
- Nationwide Children’s Hospital, Child
Development Center, Columbus, OH, USA
| | - Emily de los Reyes
- Nationwide Children’s Hospital, Department of
Neurology, Columbus, OH, USA, The Ohio State University Department of
Pediatrics and Neurology, Columbus, OH, USA
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12
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Stifel SWF, Feinberg DK, Zhang Y, Chan MK, Wagle R. Assessment During the COVID-19 Pandemic: Ethical, Legal, and Safety Considerations Moving Forward. SCHOOL PSYCHOLOGY REVIEW 2020. [DOI: 10.1080/2372966x.2020.1844549] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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13
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Peterson RK, Ludwig NN, Jashar DT. A case series illustrating the implementation of a novel tele-neuropsychology service model during COVID-19 for children with complex medical and neurodevelopmental conditions: A companion to Pritchard et al., 2020. Clin Neuropsychol 2020; 35:99-114. [PMID: 32757708 DOI: 10.1080/13854046.2020.1799075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: Despite a movement toward tele-based clinical services in other healthcare domains, implementation of these services within neuropsychology, particularly with pediatric populations, is limited. With the onset of social distancing due to COVID-19, the field of pediatric neuropsychology is encouraged to consider the utility of non-traditional, tele-neuropsychological assessments. In order to accommodate ongoing service needs for medically and neurodevelopmentally complex children, a novel three-tiered telehealth service model of care was developed and implemented in a large pediatric outpatient neuro/psychological clinic within an academic medical center.Method: In this article, we provide case examples that illustrate the clinical implementation of this three-tiered telehealth service model of care for serving children during this uncertain time.Conclusion: The primary aim of this article is to provide examples outlining how clinical service decisions were made in the application of this three-tiered model for children with complex medical and neurodevelopmental histories. This article is intended to serve as a guide for other pediatric neuropsychology providers considering tele-neuropsychological services for complex pediatric patients during social distancing.
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Affiliation(s)
- Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Natasha N Ludwig
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dasal Tenzin Jashar
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
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14
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Hodge MA, Sutherland R, Jeng K, Bale G, Batta P, Cambridge A, Detheridge J, Drevensek S, Edwards L, Everett M, Ganesalingam K, Geier P, Kass C, Mathieson S, McCabe M, Micallef K, Molomby K, Ong N, Pfeiffer S, Pope S, Tait F, Williamsz M, Young-Dwarte L, Silove N. Agreement between telehealth and face-to-face assessment of intellectual ability in children with specific learning disorder. J Telemed Telecare 2018; 25:431-437. [DOI: 10.1177/1357633x18776095] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction Access to cognitive assessments for children living remotely is limited. Telehealth represents a potential cost- and time-effective solution. A pilot study was conducted to determine the feasibility of telehealth to assess cognitive function in children with learning difficulties. Methods Thirty-three children (median age = 9 years 11 months), recruited from the New South Wales (NSW) Centre for Effective Reading, underwent assessment of intellectual ability. Comparisons were made between the intellectual ability index scores obtained by a psychologist sitting face-to-face with the children and another psychologist via telehealth using a web-based platform, Coviu. Results The telehealth administration method yielded comparable results to the face-to-face method. Correlation analyses showed high associations between the testing methodologies on the intellectual ability indices (correlation coefficient range = 0.981–0.997). Discussion Findings indicate that telehealth may be an alternative to face-to-face cognitive assessment. Future work in a broader range of cognitive tests and wider range of clinical populations is warranted.
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Affiliation(s)
| | | | - Kelly Jeng
- The Children’s Hospital at Westmead, Australia
| | - Gillian Bale
- New South Wales (NSW) Department of Education, Australia
| | - Paige Batta
- New South Wales (NSW) Department of Education, Australia
| | - Aine Cambridge
- New South Wales (NSW) Department of Education, Australia
| | | | | | - Lynda Edwards
- New South Wales (NSW) Department of Education, Australia
| | | | | | - Philippa Geier
- New South Wales (NSW) Department of Education, Australia
| | - Carol Kass
- New South Wales (NSW) Department of Education, Australia
| | | | - Michael McCabe
- New South Wales (NSW) Department of Education, Australia
| | - Kay Micallef
- New South Wales (NSW) Department of Education, Australia
| | - Kirsty Molomby
- New South Wales (NSW) Department of Education, Australia
| | - Natalie Ong
- The Children’s Hospital at Westmead, Australia
| | | | - Sylvia Pope
- New South Wales (NSW) Department of Education, Australia
| | - Francine Tait
- New South Wales (NSW) Department of Education, Australia
| | | | | | - Natalie Silove
- The Children’s Hospital at Westmead, Australia
- CSIRO Data 61, Australia
- The University of Sydney
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Abstract
PURPOSE OF REVIEW Advances in technology have expanded telemedicine opportunities covering medical practice, research, and education. This is of particular importance in movement disorders (MDs), where the combination of disease progression, mobility limitations, and the sparse distribution of MD specialists increase the difficulty to access. In this review, we discuss the prospects, challenges, and strategies for telemedicine in MDs. RECENT FINDINGS Telemedicine for MDs has been mainly evaluated in Parkinson's disease (PD) and compared to in-office care is cost-effective with similar clinical care, despite the barriers to engagement. However, particular groups including pediatric patients, rare MDs, and the use of telemedicine in underserved areas need further research. Interdisciplinary telemedicine and tele-education for MDs are feasible, provide similar care, and reduce travel costs and travel time compared to in-person visits. These benefits have been mainly demonstrated for PD but serve as a model for further validation in other movement disorders.
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Abstract
Neurological disorders are the leading cause of global disability. However, for most people around the world, current neurological care is poor. In low-income countries, most individuals lack access to proper neurological care, and in high-income countries, distance and disability limit access. With the global proliferation of smartphones, teleneurology - the use of technology to provide neurological care and education remotely - has the potential to improve and increase access to care for billions of people. Telestroke has already fulfilled this promise, but teleneurology applications for chronic conditions are still in their infancy. Similarly, few studies have explored the capabilities of mobile technologies such as smartphones and wearable sensors, which can guide care by providing objective, frequent, real-world assessments of patients. In low-income settings, teleneurology can increase the capacity of local care systems through professional development, diagnostic support and consultative services. In high-income settings, teleneurology is likely to promote the expansion and migration of neurological care away from institutions, incorporate systems of asynchronous communication (such as e-mail), integrate clinicians with diverse skill sets and reach new populations. Inertia, outdated policies and social barriers - especially the digital divide - will slow this progress at considerable cost. However, a future increasingly will be possible in which neurological care can be accessed by anyone, anywhere. Here, we examine the emerging evidence regarding the benefits of teleneurology for chronic conditions, its role and risks in low-income countries and the promise of mobile technologies to measure disease status and deliver care. We conclude by discussing the future trends, barriers and timing for the adoption of teleneurology.
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Shapiro E, Bernstein J, Adams HR, Barbier AJ, Buracchio T, Como P, Delaney KA, Eichler F, Goldsmith JC, Hogan M, Kovacs S, Mink JW, Odenkirchen J, Parisi MA, Skrinar A, Waisbren SE, Mulberg AE. Neurocognitive clinical outcome assessments for inborn errors of metabolism and other rare conditions. Mol Genet Metab 2016; 118:65-9. [PMID: 27132782 PMCID: PMC4895194 DOI: 10.1016/j.ymgme.2016.04.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 01/03/2023]
Abstract
Well-defined and reliable clinical outcome assessments are essential for determining whether a drug provides clinically meaningful treatment benefit for patients. In 2015, FDA convened a workshop, "Assessing Neurocognitive Outcomes in Inborn Errors of Metabolism." Topics covered included special challenges of clinical studies of inborn errors of metabolism (IEMs) and other rare diseases; complexities of identifying treatment effects in the context of the dynamic processes of child development and disease progression; and the importance of natural history studies. Clinicians, parents/caregivers, and participants from industry, academia, and government discussed factors to consider when developing measures to assess treatment outcomes, as well as tools and methods that may contribute to standardizing measures. Many issues examined are relevant to the broader field of rare diseases in addition to specifics of IEMs.
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Affiliation(s)
- Elsa Shapiro
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Shapiro & Delaney, LLC, Mendota Heights, MN, USA.
| | - Jessica Bernstein
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA.
| | - Heather R Adams
- Department of Neurology, Division of Child Neurology, University of Rochester Medical Center, Rochester, NY, USA.
| | | | - Teresa Buracchio
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA.
| | - Peter Como
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA.
| | - Kathleen A Delaney
- Shapiro & Delaney, LLC, Mendota Heights, MN, USA; Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Florian Eichler
- Department of Neurology, Center for Rare Neurological Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jonathan C Goldsmith
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA.
| | - Melissa Hogan
- Saving Case & Friends, Inc., Thompson's Station, TN, USA.
| | - Sarrit Kovacs
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA.
| | - Jonathan W Mink
- Department of Neurology, Division of Child Neurology, University of Rochester Medical Center, Rochester, NY, USA.
| | - Joanne Odenkirchen
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
| | - Melissa A Parisi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
| | - Alison Skrinar
- Clinical Outcomes Research and Evaluation, Ultragenyx Pharmaceutical Inc., Novato, CA, USA.
| | - Susan E Waisbren
- Metabolism Program, Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Andrew E Mulberg
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA.
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