Stacy Suskauer, M.D., discusses research presented at the AAPM&R 2022 Annual Assembly in Baltimore, Maryland titled “Equivalence of In-person and Telehealth Administration of the Physical and Neurological Examination of Subtle Signs Timed Motor Subscale in Youth Recovered from Concussion and Healthy Controls” . Dr. Suskauer is the Director of the Division of Pediatric Rehabilitation in the Department of Physical Medicine and Rehabilitation at Johns Hopkins Medicine.
I'm gonna tell you today about some work we did looking at the validity of telehealth administration of a measure called the physical and neurological examination for subtle signs or pan as this work was led by a research assistant in my group, Kayla Huntington's. The PMS is a motor observational task that helps us look at subtle motor functioning. And historically it's been used in Children with developmental disabilities like A. D. H. D. Or autism in my group. However we have found that the Panoz is very sensitive for detecting Children with a history of traumatic brain injury. Whether it is Children who had a concussion and recovered or Children with more severe brain injury and more than just that. The panis gives us clues to how the brain is functioning and how the child may perform more broadly. Now during the pandemic, everybody's in person research was shut down for everybody's safety. And so we pivoted to looking at what measures we could use via telehealth via zoom. And the Panoz has different parts. So some of it looks at repeated movements. For example how quickly can you tap your fingers? Well there are other parts that look at how somebody walks or their balance. Now those parts with walking were difficult to capture via zoom. However, we found that the repetitive and sequenced movements could be easily captured and so we began to collect data that way and once we were able to bring participants back into our research laboratory, we wanted to get an idea of how well for administered virtually and scored virtually virtually versus administered and scored in person um were the same or different to help us understand whether administering virtually was an ongoing option. And this is important because the pan? S needs training to complete and to score. And if virtual administration is feasible, it's a way to disseminate the pan? S more broadly while we work on training more people. And so what Kayla did was look at how well the scores aligned when somebody was administered the pianist person and then within a week, although typically during the same visit, we then had the child in a separate room from the administrator from Kayla who was doing the testing and tested them virtually. And what we found is that overall the panna scores lined up very closely, such that there was no significant difference when we break down the panas scores to a little bit more fine tune. We find that one of the scores which is not as relevant for Children with concussion, but maybe more important than other diagnoses that looks at the fluidity of movement may be harder to evaluate in this way that we're not clear if that was a repeated measures effect. So that Children, when doing this the second time in the same day have less of this dysrhythmia or if it's just harder to score by video because some of the lag that can be seen in telehealth. Um but overall what this shows us is that um administering via telehealth versus in person in general worked quite well. Uh And this gives us confidence in combining the data that we've collected in person and virtually, and also exploring how we might be able to use the pan s more broadly through telehealth.
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