Neurological examination is possible using telemedicine

Abstract

To compare the reliability of neurological examination performed by telemedicine and face to face, a junior doctor examined 23 patients face to face, these examinations being witnessed either by one or by two telemedicine observers using a telemedicine video-link at 384 kbit/s. The gold standard was a face-to-face examination from a panel of six consultant neurologists. Power, deep tendon reflexes, plantar responses, coordination, sensation, eye movements, facial strength, tongue movements, sitting balance and gait were studied. Seventeen patients satisfied the inclusion criteria, and a total of 1,084 matched pairs of observations were made. The reliability of the telemedicine examination ranged from fair to moderate for deep tendon reflexes, coordination and eye movement, to near perfect for plantar responses. Overall, examination by telemedicine compared favourably with face-to-face examination. Telemedicine examination was more sensitive in detecting abnormalities than face-to-face examination for all the neurological tests studied and more specific for all but one (plantar responses). The study showed that neurological examination using telemedicine is at least as good as face-to-face examination performed by a junior doctor.

Telemedicine in General Neurology: Interrater Reliability of Clinical Neurological Examination Via Audio-Visual Telemedicine

“…To our knowledge, there is only one study examining the interrater reliability of general neurological examination via telemedicine compared to bedside performance. Interrater agreement in this study was reported to be fair to moderate [12] and was performed in a laboratory setting. To test the value of telemedicine in acute neurological care, we sought to investigate interrater reliability of neurological examination via telemedicine in real acute cases in its natural setting, which is the emergency room of an acute care hospital.…”

“…One prior study by Craig et al [12] has already investigated the same topic, although they studied normal subjects in a laboratory setting that is not directly comparable to the situation in the emergency room. In our study, patients were seen within the first minutes to hours after admission.…”

Telemedicine in Emergency Evaluation of Acute Stroke

“…In a prior article, it was concluded that neurological examination is possible through an audiovisual link and is as good as face-to-face examination of a junior doctor. 19 In our study, remote examination in the emergency room was equal to bedside testing by an expert with the same level of experience. Accordingly, teleconsultation over an audiovisual link may be a clear improvement to smaller hospitals.…”

A Review of the Evidence for the Use of Telemedicine Within Stroke Systems of Care

“…One small study focusing on the feasibility and reliability of the neurological 30 In 17 patients with a variety of neurological diseases, a standard face-to-face examination by neurological experts was compared with an HQ-VTC examination over a 384 -kilobits per second ISDN system performed by house officers and scored by senior neurological trainees at a distance. It is not stated if the distant examiners could direct the bedside examination or ask for individual tests to be repeated.…”