Teleneurology and mobile technologies: the future of neurological care

Abstract

Neurological disorders are the leading cause of global disability. However, for most people around the world, current neurological care is poor. In low-income countries, most individuals lack access to proper neurological care, and in high-income countries, distance and disability limit access. With the global proliferation of smartphones, teleneurology - the use of technology to provide neurological care and education remotely - has the potential to improve and increase access to care for billions of people. Telestroke has already fulfilled this promise, but teleneurology applications for chronic conditions are still in their infancy. Similarly, few studies have explored the capabilities of mobile technologies such as smartphones and wearable sensors, which can guide care by providing objective, frequent, real-world assessments of patients. In low-income settings, teleneurology can increase the capacity of local care systems through professional development, diagnostic support and consultative services. In high-income settings, teleneurology is likely to promote the expansion and migration of neurological care away from institutions, incorporate systems of asynchronous communication (such as e-mail), integrate clinicians with diverse skill sets and reach new populations. Inertia, outdated policies and social barriers - especially the digital divide - will slow this progress at considerable cost. However, a future increasingly will be possible in which neurological care can be accessed by anyone, anywhere. Here, we examine the emerging evidence regarding the benefits of teleneurology for chronic conditions, its role and risks in low-income countries and the promise of mobile technologies to measure disease status and deliver care. We conclude by discussing the future trends, barriers and timing for the adoption of teleneurology.

Rapid implementation of virtual neurology in response to the COVID-19 pandemic

“…Subsequent to the widespread adoption of smart phones and tablets with broadband networking capabilities, there has been movement toward virtual health care provided to patients using their personal devices at home. 4,5,9 Our virtual urgent care system connects the provider directly to the patient using the patient's own mobile device or computer and network connection. 10 The swift deployment of teleneurology services at NYU neurology leveraged the preexisting robust technology platforms developed for the NYU virtual urgent care system.…”

“…No universal consensus yet exists that high-quality care for neurology patients can be achieved via virtual methods, but the evidence base is increasing. 5,6 For instance, virtual stroke care is now well established. [11][12][13] Recent reviews detailed the growing successes of teleneurology in caring for patients with neurologic disorders other than stroke.…”

“…4 By the use of electronic communications technologies, it has the potential to overcome geographical, physical, and biological barriers to health care access, and it is safe, timely, efficient, and convenient. [4][5][6] The adoption of telemedicine had been slowly progressing for the decades before the advent of COVID-19, with most telemedicine visits occurring for either primary or mental health care. 7,8 Before the advent of COVID-19, impediments to the practice of telemedicine were considerable, including technological, political, regulatory, reimbursement, clinical, and social barriers.…”

Reliable and automatic epilepsy classification with affordable, consumer-grade electroencephalography in rural sub-Saharan Africa

“…In conclusion, low cost brain recordings in combination with automatic time-series modeling may bring diagnostic capabilities to resource poor settings. As recently mentioned in a compelling review, the proliferation of Internet and smartphones in resource poor settings can increase health care access through so-called teleneurology [20]. Cooperation with local partners is essential for its success.…”

La gestión de la asistencia neurológica en tiempos de la pandemia de Covid-19

“…La situación de la pandemia ha motivado la necesidad de adaptar la atención neurológica al momento, como los programas de ictus y del código Ictus intra y extrahospitario a la accesibilidad del paciente, así como la protección del personal que lo atiende (24,25,26) y toma de decisiones sobre los pacientes con ictus que son asimismo covid +, a pesar de que existen programas tele-ictus, previamente a la pandemia. La respuesta a situaciones urgentes, el seguimiento de pacientes crónicos, pero con situaciones de cambio, o el mantenimiento de las terapéuticas a los pacientes, ha generado el uso de herramientas que hasta hoy se utilizaban en la excepcionalidad como el correo electrónico y otras herramientas electrónicas (27) , pero que tiene la limitación de la población a acceder que por razones de edad o de las propias enfermedades no utilizan estos métodos. La utilización de fotografías o de video captadas por el paciente o familiares para mostrar al neurólogo a distancia cambios clínicos como la exploración oculomotora, la marcha o el equilibrio han sido susceptibles de evaluar a través del video.…”