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1.
J Neurol Sci ; 435: 120201, 2022 04 15.
Article in English | MEDLINE | ID: covidwho-1703833

ABSTRACT

The field of neurology has experienced a dramatic push towards providing care via telemedicine approaches, triggered by the COVID-19 pandemic. The remote monitoring of movement disorders, including tremor, provides a set of challenges compared to gold-standard in-clinic assessments, but also opens opportunities to assess patients' symptoms in a setting where it most matters, such as patients' homes, and during their daily life activities. A successful remote interaction with patients experiencing tremor is dependent on a seamless teleneurology interaction allowing for a high-quality medical history and physical examination. In addition to the clinical evaluation, tremor may be characterized and quantified remotely using transducer-based methods, which may be applying devices containing sensors to objectively and precisely capture tremor movements. This review aims to provide (Zheng et al., 2017 [1]) a practice-oriented overview of telemedicine basics, when it comes to the assessment of tremor, Powers et al. (2021) [2] an update of the most notable techniques and devices, and (Mari, 2021 [3]) an outlook into future opportunities and challenges, as well as and next steps towards seamless remote care of patient with tremor. In conclusion, teleneurology, propelled by the COVID-19 pandemic, has evolved into to a widely established method of physician-patient interaction, aided by technological advancement of remote assessment tools of tremor. However, as the technological, regulatory and reimbursement environment is increasingly adapting to serve the needs of telemedicine, the methods presented for remote measurement of tremor using devices are still largely experimental and largely limited to the research setting. This article is part of the Special Issue "Tremor" edited by Daniel D. Truong, Mark Hallett, and Aasef Shaikh.


Subject(s)
COVID-19 , Movement Disorders , Telemedicine , Humans , Pandemics , Tremor/diagnosis
2.
Parkinsonism Relat Disord ; 93: 97-102, 2021 12.
Article in English | MEDLINE | ID: covidwho-1536977

ABSTRACT

Inequalities in mental healthcare and lack of social support during the COVID-19 pandemic have lowered quality of life and increased overall burden of disease in people with Parkinson's (PWP). Although the pandemic has brought attention to these inequalities, they are long standing and will persist unless addressed. Lack of awareness of mental health issues is a major barrier and even when recognized disparities based on race, gender, and socioeconomic factors limit access to already scarce resources. Stigma regarding mental illness is highly prevalent and is a major barrier even when adequate care exists. Limited access to mental healthcare during the pandemic and in general increases the burden on caregivers and families. Historically, initiatives to improve mental healthcare for PWP focused on interventions designed for specialty and academic centers generally located in large metropolitan areas, which has created unintended geographic disparities in access. In order to address these issues this point of view suggests a community-based wellness model to extend the reach of mental healthcare resources for PWP.


Subject(s)
Healthcare Disparities/trends , Mental Disorders/therapy , Mental Health/trends , Parkinson Disease/therapy , Social Support/trends , Health Resources/trends , Humans , Mental Disorders/epidemiology , Mental Disorders/psychology , Parkinson Disease/epidemiology , Parkinson Disease/psychology , Social Support/psychology
3.
Parkinsonism Relat Disord ; 92: 41-45, 2021 11.
Article in English | MEDLINE | ID: covidwho-1472127

ABSTRACT

BACKGROUND: The initial COVID-19 pandemic shutdown led to the canceling of elective surgeries throughout most of the USA and Canada. OBJECTIVE: This survey was carried out on behalf of the Parkinson Study Group (PSG) to understand the impact of the shutdown on deep brain stimulation (DBS) practices in North America. METHODS: A survey was distributed through RedCap® to the members of the PSG Functional Neurosurgical Working Group. Only one member from each site was asked to respond to the survey. Responses were collected from May 15 to June 6, 2020. RESULTS: Twenty-three sites participated; 19 (83%) sites were from the USA and 4 (17%) from Canada. Twenty-one sites were academic medical centers. COVID-19 associated DBS restrictions were in place from 4 to 16 weeks. One-third of sites halted preoperative evaluations, while two-thirds of the sites offered limited preoperative evaluations. Institutional policy was the main contributor for the reported practice changes, with 87% of the sites additionally reporting patient-driven surgical delays secondary to pandemic concerns. Pre-post DBS associated management changes affected preoperative assessments 96%; electrode placement 87%; new implantable pulse generator (IPG) placement 83%; IPG replacement 65%; immediate postoperative DBS programming 74%; and routine DBS programming 91%. CONCLUSION: The COVID-19 pandemic related shutdown resulted in DBS practice changes in almost all North American sites who responded to this large survey. Information learned could inform development of future contingency plans to reduce patient delays in care under similar circumstances.


Subject(s)
COVID-19/prevention & control , Deep Brain Stimulation/statistics & numerical data , Implantable Neurostimulators/statistics & numerical data , Movement Disorders/therapy , Parkinson Disease/therapy , Postoperative Care/statistics & numerical data , Preoperative Care/statistics & numerical data , Quarantine/statistics & numerical data , Telemedicine/statistics & numerical data , Academic Medical Centers , Canada , Health Care Surveys , Humans , Neurologists/statistics & numerical data , Neurosurgeons/statistics & numerical data , United States
4.
J Alzheimers Dis ; 83(4): 1563-1601, 2021.
Article in English | MEDLINE | ID: covidwho-1468319

ABSTRACT

Neurological disorders significantly impact the world's economy due to their often chronic and life-threatening nature afflicting individuals which, in turn, creates a global disease burden. The Group of Twenty (G20) member nations, which represent the largest economies globally, should come together to formulate a plan on how to overcome this burden. The Neuroscience-20 (N20) initiative of the Society for Brain Mapping and Therapeutics (SBMT) is at the vanguard of this global collaboration to comprehensively raise awareness about brain, spine, and mental disorders worldwide. This paper aims to provide a comprehensive review of the various brain initiatives worldwide and highlight the need for cooperation and recommend ways to bring down costs associated with the discovery and treatment of neurological disorders. Our systematic search revealed that the cost of neurological and psychiatric disorders to the world economy by 2030 is roughly $16T. The cost to the economy of the United States is $1.5T annually and growing given the impact of COVID-19. We also discovered there is a shortfall of effective collaboration between nations and a lack of resources in developing countries. Current statistical analyses on the cost of neurological disorders to the world economy strongly suggest that there is a great need for investment in neurotechnology and innovation or fast-tracking therapeutics and diagnostics to curb these costs. During the current COVID-19 pandemic, SBMT, through this paper, intends to showcase the importance of worldwide collaborations to reduce the population's economic and health burden, specifically regarding neurological/brain, spine, and mental disorders.


Subject(s)
Global Burden of Disease , International Cooperation , Mental Disorders , Nervous System Diseases , COVID-19/epidemiology , Global Burden of Disease/organization & administration , Global Burden of Disease/trends , Global Health/economics , Global Health/trends , Humans , Mental Disorders/economics , Mental Disorders/epidemiology , Mental Disorders/therapy , Nervous System Diseases/economics , Nervous System Diseases/epidemiology , Nervous System Diseases/therapy , Neurosciences/methods , Neurosciences/trends , SARS-CoV-2
5.
Parkinsonism Relat Disord ; 89: 199-205, 2021 08.
Article in English | MEDLINE | ID: covidwho-1300965

ABSTRACT

The use of telemedicine in the management of chronic neurological conditions including movement disorders has expanded over time. In addition to enabling remote access to specialized care, telemedicine has also been shown to reduce caregiver burden and to improve patient satisfaction. With the COVID-19 pandemic, implementation of telehealth for patients with movement disorders, particularly those with more severe mobility issues, has increased rapidly. Although telemedicine care has been shown to be effective for patients with various movement disorders, its utilization for patients with device aided therapies such as deep brain stimulation (DBS) is limited due to challenges related to adjusting these devices remotely and to the lack of consensus recommendations for using telemedicine in this patient population. Thus, guidelines for telemedicine and DBS will assist clinicians on the appropriate implementation of telemedicine to provide care to DBS patients. Optimizing the use of telemedicine for DBS will expand this type of therapy to remote locations with limited access to programming expertise, and also reduce the need for patient travel. Telemedicine is particularly important during the ongoing pandemic due to infection risk and limited access to clinic visits. In this article we review the currently available and emerging strategies for telemedicine and remote care for DBS. We then outline common principles and recommendations for telemedicine care in patients with DBS, review patient selection and best practices. Finally, we briefly discuss the current state of reimbursement for DBS telemedicine visits.


Subject(s)
Deep Brain Stimulation/trends , Telemedicine/trends , COVID-19 , Deep Brain Stimulation/standards , Humans , Pandemics , Remote Consultation , Telemedicine/standards
6.
Parkinsonism Relat Disord ; 86: 97-100, 2021 05.
Article in English | MEDLINE | ID: covidwho-1174447

ABSTRACT

INTRODUCTION: Traditionally, medical care and research in Parkinson's disease (PD) have been conducted with in-person encounters. The recent COVID-19 pandemic has profoundly impacted the delivery of in-person clinical care and clinical research. We conducted an online survey of active clinician members of the Parkinson Study Group (PSG) to evaluate the adoption of various non-face-to-face methods in clinical practice and research in PD during the COVID-19 pandemic. METHODS: We conducted a survey using the open-access online SurveyMonkey tool (http://www.surveymonkey.com). The survey had 27 items and was designed to elucidate clinical/research care before and during the COVID-19 pandemic. The survey was sent to 414 active PSG members with weekly reminders and it remained accessible for 30 days from May 2020. RESULTS: We received 142 responses, of which 133 (93.7%) provided demographic data. The clinical use of virtual visits via synchronous video conferencing increased from 39.5% pre-COVID-19 to 94.6% during the COVID-19 pandemic. Lack of access for patients (68.2%) and patient resistance (51.4%) were the top barriers for its use. Approximately 70% respondents stated that 75-100% of their research activities were suspended during the COVID-19 pandemic. Many sites had to fill out protocol deviations (38.2%), protocol exceptions (25.5%) or change their research profile due to layoffs (16.8%). The overall use of video conferencing increased from 30.3% to 64.1%. CONCLUSION: The current results suggest a need for flexibility in conducting office visits and clinical trials in PD patients. Technology has the potential to enhance patient care and convenience, when in-person visits can be challenging.


Subject(s)
COVID-19 , Pandemics , Parkinson Disease/therapy , Telemedicine/trends , Adult , Clinical Protocols , Clinical Trials as Topic , Female , Humans , Male , Middle Aged , Office Visits , Patient Satisfaction , Research , Surveys and Questionnaires , User-Computer Interface , Videoconferencing/trends
7.
Mov Disord ; 35(10): 1701-1711, 2020 10.
Article in English | MEDLINE | ID: covidwho-726315

ABSTRACT

BACKGROUND: The COVID-19 pandemic restricted usual healthcare management for movement-disorders patients, with a consequent upsurge in telemedicine to bridge the gap. OBJECTIVE: To assess global telemedicine usage in the context of the pandemic. METHODS: The Movement Disorder Society (MDS) Telemedicine Study Group surveyed telemedicine experts from 40 countries across all continents in March-April 2020. Four domains of telemedicine were assessed: legal regulations, reimbursement, clinical use, and barriers; comparing emerging responses to the pandemic versus the baseline scenario. RESULTS: All forms of telemedicine for movement disorders increased globally, irrespective of country income categorization, as an immediate response to the pandemic. This was aided by widespread availability of technology and updated government regulations. However, privacy concerns, lack of reimbursement, limited access, and lack of telemedicine training were barriers highlighted worldwide. CONCLUSIONS: Questions remain about the longevity and extent of changes in regulations and reimbursement regarding telemedicine in the aftermath of the pandemic. © 2020 International Parkinson and Movement Disorder Society.


Subject(s)
Coronavirus Infections/economics , Movement Disorders/drug therapy , Pandemics/economics , Pneumonia, Viral/economics , Reimbursement Mechanisms , Telemedicine , Betacoronavirus/pathogenicity , COVID-19 , Female , Humans , Male , SARS-CoV-2 , Surveys and Questionnaires , Telemedicine/economics
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