2012 National Meeting

3016 — Potential of Low-Cost Web Cams for Remote Neurological Exam in Multiple Sclerosis

Finkelstein J, and Cha E, Baltimore VA Medical Center; Wallin M, Washington DC VA Medical Center;

Objectives:
Multiple Sclerosis (MS) is an inflammatory neurodegenerative disease that affects the brain and spinal cord. Patients suffer from a wide range of symptoms like muscle spasms, vision loss, problems with walking, and coordination. Due to the nature of MS progression, many patients are unable to or unwilling to travel to visit a doctor. In this study, we developed a telemedicine application to facilitate a remote doctor’s visit in patient’s home with a low cost secure video chat device. The goal of this study was to compare the remote neurological evaluation to a face-to-face visit in patients with MS.

Methods:
A cross-over design has been employed with total of 20 patients enrolled from Baltimore area. Each patient was assessed twice undergoing identical sets of neurological exams, one with a doctor in-person, and another via remote video-chat device with the doctor and the patient in a separate room. The assessments were performed by two clinicians that specialized in MS, alternating the role (in-person or remote) for every other patient. The remote device was developed to run on any computer with a low-cost webcam and a microphone, running via a secure connection. It was designed with simplicity in mind to minimize confusion and miscommunication. For the remote exam, a non-medical staff assisted the patient with positioning.

Results:
The outcomes of neurological assessments were recorded as Kurtzke’s Functional Systems (FSS) and Kurtzke Expanded Disability Scale (EDSS) scores. EDSS scores and each subcategory of FSS scores were compared for in-person and remote exams. According to the Fisher’s Exact Test, all scores showed p values (visual - p = 0.8; brainstem - p = 0.8; pyramidal - p = 0.1; cerebellar - p = 0.3; sensory - p = 0.5; bowel/bladder - p = 1.0; cerebral functions - p = 1.0) that were greater than 0.05 which means that the results from in-person and remote exams were not significantly different. When the raw EDSS scores were subtracted from the remote to in-person exam, 10 cases showed no difference, and other cases ranged from -1 to 2. In 90% of cases, providers reported that they obtained enough information interviewing the patient remotely; 100% of patients agreed that they felt comfortable with the equipment.

Implications:
Low-cost video cams may be effective means for remote neurological exam in MS patients.

Impacts:
The remote neurological exam conducted via a secure web cam application provides a novel way to bring patients and doctors together. This technology could be important in the management of Veterans separated from clinics by distance or disability.