Advantages of digital neurological assessment

Advantages

Digital approaches to neuropsychological assessment have many recognized advantages:-

• In terms of accessibility, richness of measurement, standardization and cost.

• Digital technology also offers a level of precise stimulus control and behaviour
measurement that is difficult or impossible to achieve with traditional paper-and-pencil-
based neuropsychological assessment. Such precision allows measures to be adapted
from experimental psychology and cognitive neuroscience, including those that require
parametric stimulus control and precise quantification of reactions times and changes in
reaction times that occur over seconds or minutes (De Leeuw, 2015; Germine et
al., 2012; Reimers & Stewart, 2015).
• Personal digital devices and wearable’s are also equipped with increasingly
sophisticated audio-visual and sensor technology (Onnela & Rauch, 2016), permitting
the collection of primary and secondary data about behaviour that can supplement
traditional neuropsychological assessment (Giannouli, Bock, & Zijlstra, 2018; Min et
al., 2014) and,
• In some cases, may provide data that obviate the need for more burdensome assessments
and provide greater ecological validity (Insel, 2017).
• With decreasing costs and broader adoption of digital devices in the population,
worldwide, the idea that data from such devices will be integrated into clinical
assessment is almost inevitable.

Digital neuropsychology to refer to the neuropsychological assessment of cognition and

behaviour using digital tools, simultaneously, a shift towards developing and incorporating more
sophisticated models of behaviour that emphasize the sorts of moment-to-moment data that can
be easily captured with digital devices (e.g. variability in reaction time within a test; Hultsch &
MacDonald, 2004) as well as accounting for the potential confounds that come with digital
assessment (e.g. differences in input latency, described below; Koudritzky et al., 2017).
 Technology & mental healthcare, support

Why technology?

• Digital technology can allow for real time data collection and result in immediate clinical
interventions based on that data (Morris and Aguilera, 2012).
• These technologies offer hope to fill gaps in improving clinical interventions in social
work and related professions.

Areas of evaluation with consideration to newer technologies in psychological assessment-

• Feasibility, efficacy, and effectiveness research

• Technology for disorders such as schizophrenia, HIV, depression, anxiety, autism,

suicide, and trauma

• More interventions for cognitive issues, illness management, behaviour, and health
communication

• Fewer interventions for a personal computer and more interventions for mobile devices
(apps pertaining to self-management and care)

• More engaging ways to deliver therapies or skill development (for example, interactive
formats or game-like approaches)

• Real-time (users exchanging information with peers or professionals as needed)(easier

accessibility of health care services- help centres as the expense of a call)

• Active and passive mobile assessment/monitoring

Contributions

Because of their ubiquitous nature, smartphones and wearable sensors have the potential to
collect a warehouse full of physiological, social, emotional, and behavioural data in real time
with limited burden on the client. Data of this nature is important in informing decisions about
treatment options, as well as in monitoring response over time. Physical activity, social
connection, cognitive function, and symptom burden are important targets for most therapeutic
interventions, and changes in these functions are indicators of treatment success or failure.
Current technologies can capture many different kinds of behaviour, and with the right analytical
tools, it is possible to identify behavioural profiles or phenotypes that predict illness trajectories
and differential responsive to treatment over time. As an example, the global positioning system
(GPS) and accelerometer technologies in smartphones can be used to calculate physical and
spatial activity, which are known to be good measures of disability associated with depression
and anxiety

Online interventions

Web-based interventions have the most evidence of efficacy when compared with other
technologies.

The Internet boom of the early 2000s brought with it development of health interventions online
due to the low cost, increase in convenience and stigma reduction (Griffiths et al, 2006).

Online interventions began as passive websites with information that people would read and
complete much like a self-help book and have evolved into more interactive sites that are
customized to individuals.

Online interventions have addressed a wide range of problems including depression

(Christensen, Griffiths and Korten, 2002), smoking (Muñoz et al., 2006), obesity (Williamson et
al., 2006; Gold et al., 2007), diabetes (Glasgow, Boles, Mckay, Feil and Barrera Jr, 2003), and
alcohol consumption (Murray et al., 2007) among others.

Disadvantage - Primarily, web-based interventions suffer from high rates of attrition -- many
people who start are not likely to complete the interventions. In an open intervention as many as
85% of participants fail to come back for a second “session” of treatment (Eysenbach, 2005).

Ecological momentary assessment and why technology is more advantageous

(EMA) holds promise as a method for capturing more accurate accounts of a client's emotions,
functioning, and activity.4-6 Examples of EMA commonly used are daily diary methods, signal-
dependent reporting, and event-dependent reporting. Daily diaries require the client to report on
events and mood at the end of the day and are thus still subject to some recollection bias.

Personal mobile technology, such as smartphones and wearable sensors, has the potential to
capture a more accurate picture of a client's symptoms in real time, with far less burden and
greater adherence than traditional EMA methods. Momentary assessment through technology
gives clinicians an opportunity to look at how one's symptoms and disability vary over time, and
could give us insights into how these symptoms vary between different social contexts (work
versus home)

Self- report

Likert-style mood ratings conducted over text messaging or as survey apps are as reliable at
measuring mood over time as weekly paper-and-pencil self-report measures.

Apps that track self-reported symptoms are often customizable. A common example of this is the
T2 Mood Tracker, which provides an array of surveys and symptoms that clients can elect to
monitor, as well as customize how often and when to send prompts and reminders to track the
selected symptoms. The use of customizable symptom tracking enhances client engagement in
treatment and daily monitoring by giving real-time feedback about how the client is improving
over time.

Performance data

Performance data consists of asking clients to engage in a task delivered over an app and
collecting data on how they perform on that task. In mental health, the most common
performance-based assessment apps are those that deliver cognitive assessments over a game-
like platform. Tests commonly used to measure attention, concentration, and working memory
are redesigned to mimic video games. As the clients use the game, data is collected on the
number of errors, reaction time, and other task-based measures of performance.

Given the recent research on the association between poor executive and attentional function and
poor response to certain antidepressants, these tools could be useful in the selection of treatment
options for given disorders.

Sensor data

Physical activity and physical location. Wearable sensors can also detect physiological data,
such as blood pressure, galvanic skin response, heart rate, and respiration, and some sensors
claim to collect electroencephalogram (EEG) measures.

A recent study demonstrated that data on changes in daily physical activity collected with
smartphone GPS and accelerometer technology were predictive of mood states before clients
reported changes in mood.

Data of this nature could serve as an early alert to clinicians and result in expedient delivery of
an intervention before a client experiences a relapse.
Social media data

Social data collected from smartphones include a combination of incoming and outgoing call and
text frequency, length of texts and calls, and number of people contacted, as well as the content of
public messages sent via social media (eg, Twitter). These data can serve as a proxy for social
connectivity. Given the tendency of smartphone owners to use these devices for Internet searches,
keywords entered into a search could also serve as indicators of psychopathology.

One study demonstrated that Twitter posts can predict suicidal ideation and onset of depression.
Internet-search behaviour has also been found to be predictive of suicidal ideation. Even the type
of apps downloaded could serve as a marker for psychopathology.
REFERENCES

https://www.tandfonline.com/doi/full/10.31887/DCNS.2016.18.2/parean

https://escholarship.org/content/qt0nj447nk/qt0nj447nk.pdf?t=nxyciy&v=lg

https://sso.apa.org/apasso/idm/success-
logout?ERIGHTS_TARGET=https%3A%2F%2Fpsycnet.apa.org%2F

https://www.nimh.nih.gov/health/topics/technology-and-the-future-of-mental-health-
treatment#part_2444

https://www.tandfonline.com/doi/abs/10.1080/13854046.2018.1535662?casa_token=vTZBbFTjK
XEAAAAA%3AUV8FwGd78LZ_Cc9QMt7qg9bOwOWENIuiEbWLAtEeb5Vh0QVNRAW5zc
FW1N6OVls8wCPruO_tFJJP1Q&journalCode=ntcn20

https://www.pewresearch.org/internet/2018/04/17/the-future-of-well-being-in-a-tech-saturated-
world/

https://www.researchgate.net/publication/329353139_Happiness_and_Technology_Special_Cons
ideration_of_Digital_Technology_and_Internet