NeurEx: digitalized neurological examination offers a novel high‐resolution disability scale

Abstract

ObjectiveTo develop a sensitive neurological disability scale for broad utilization in clinical practice.MethodsWe employed advances of mobile computing to develop an iPad‐based App for convenient documentation of the neurological examination into a secure, cloud‐linked database. We included features present in four traditional neuroimmunological disability scales and codified their automatic computation. By combining spatial distribution of the neurological deficit with quantitative or semiquantitative rating of its severity we developed a new summary score (called NeurEx; ranging from 0 to 1349 with minimal measurable change of 0.25) and compared its performance with clinician‐ and App‐computed traditional clinical scales.ResultsIn the cross‐sectional comparison of 906 neurological examinations, the variance between App‐computed and clinician‐scored disability scales was comparable to the variance between rating of the identical neurological examination by multiple sclerosis (MS)‐trained clinicians. By eliminating rating ambiguity, App‐computed scales achieved greater accuracy in measuring disability progression over time (n = 191 patients studied over 880.6 patient‐years). The NeurEx score had no apparent ceiling effect and more than 200‐fold higher sensitivity for detecting a measurable yearly disability progression (i.e., median progression slope of 8.13 relative to minimum detectable change of 0.25) than Expanded Disability Status Scale (EDSS) with a median yearly progression slope of 0.071 that is lower than the minimal measurable change on EDSS of 0.5.InterpretationNeurEx can be used as a highly sensitive outcome measure in neuroimmunology. The App can be easily modified for use in other areas of neurology and it can bridge private practice practitioners to academic centers in multicenter research studies.

Smartphone Level Test Measures Disability in Several Neurological Domains for Patients With Multiple Sclerosis

“…Specific neurological systems, derived from the digitalized documentation of neurological examination [i.e., NeurEx App; (10)] performed by MS-trained clinicians, were examined against all Level Test features (Figure 3B, Supplementary Figure 2).…”

“…The observed strong correlations with cognitive scales SDMT and PASAT emphasize the importance of the reaction time for the successful completion of the Level Test. This interpretation is supported by low correlations between Level Test features and cognitive subdomains of NeurEx (10), which focuses on executive functions and memory rather than the reaction time, which is a strong component of SDMT and PASAT.…”

“…Percentages do not always sum to 100 due to rounding error. NeurEx (10) is obtained from an app-based documentation of the neurological exam. EDSS (1) denotes Expanded Disability Status Scale .a Descriptive statistics were calculated by excluding missing data .…”

“…NeurEx scores (10) were computed from an app that divides the standard neurological examination into 17 functions systems, each one displayed on a single iPad page, where a clinician conveniently documents his/her findings using touch gestures on human body diagrams that display features in real spatial distribution. NeurEx integrates this spatial information with fully quantitative (e.g., vibration sense) or semi-quantitative (i.e., mild, moderate, and severe) grading of observed neurological deficit to derive a final score for each subsystem.…”

Identifying and Quantifying Neurological Disability via Smartphone

“…MS-trained clinicians examined all MS patients at the time of their first (cross-sectional) smartphone apps testing and documented EDSS ( 3 ) into Neuroimmunological Diseases Section (NDS) research database and NIH electronic medical records. Additionally, the neurological examination in its entirety was documented electronically (via iPad or desktop) into NeurEx app developed by NDS ( 10 ) and linked to NDS database. NeurEx app automatically computes four disability scales used in neuroimmunology, including EDSS, and Kurtzke Functional Systems Scores (FSS).…”