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In the wake of the COVID-19 pandemic, headache Read More 

practices have transitioned where possible to

telemedicine. In this way, they can limit viral spread and 

protect patients, physicians and staff. However, not all

aspects of a physical face-to-face neurologic exam
readily translate to the virtual medium. To help TAGS:
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healthcare practitioners have successful headache Advanced Practice Providers
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visits through video conferencing, AHS hosted a AHSAZ
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Facebook Live with Jennifer Robblee, MD. During the Alprazolam
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stream, she discussed how to conduct a telemedicine Anti-CGRP
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neurologic examination. Behavioral Issues
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Robblee explains telemedicine Cbt
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techniques, gives advice on preparing patients for the Chop
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appointment and explains how to modify common Clarimar Borrero-Mejias
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neurological exam techniques to fit the necessary Cognitive Behavioral Therapy

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Preparing Patients for Their Telemedicine Visit Neuroimaging
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Dr. Robblee says that doctors should prepare their Neuromodulation
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patients for the examination in advance. This includes Otc
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listing any items that must be gathered before the Pediatric Headache
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appointment begins, such as a flashlight, ice cubes and Photophobia
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a thermometer. Dr. Robblee highly recommends that a Pregnancy
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family member be present during the appointment to Primary Care
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assist with some of the exam maneuvers. This is Rebecca Erwin Wells
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especially helpful if the patient has issues with mobility, Rebound Headache
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To follow best practices, she explains that practitioners Reyvow
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should remove any distractions in the video Seng

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background that might exacerbate symptoms in a Special Interest Section
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patient with a headache disorder, like sun glare. Stroke
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Additionally, physicians should maintain eye contact by Surprise
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looking directly at the camera. If you need to check a Telemedicine

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away so they know you are still attentive. Vestibular Migraine
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The Telemedicine Neurologic Exam

During the Facebook Live, Dr. Robblee walked viewers

through a physical exam, including collecting vital
signs like temperature, blood pressure and BMI. She
also demonstrated assessing mental status and cranial
nerves, and performing motor, sensory and
coordination exams. “The good news is that a majority
of our physical exam is a really reliable tool that we can
do through telemedicine,” she said.

For example, it’s still possible to comment on mental

status. Practitioners can do this by observing speech
rate, volume and articulation, and assessing the
patient’s thought process. If there’s reason to be
concerned about changes in cognition, practitioners
can walk patients through tests like the Montreal
Cognitive Assessment and the Mini-Mental State
Examination if they have a pen and paper and you are
able to print out the necessary images for them to see.
If your telemedicine software allows for screen sharing
and whiteboard use, that could be another option.

Limitations of Telemedicine

One limitation of telemedicine is that providers can’t

conduct a funduscopic exam, but Dr. Robblee pointed
to other ways to assess the patient’s vision. Providers
can ask the patient to cover one eye at a time and ask
them what they see, use a red object to assess red
desaturation or print out the NIH stroke scale cards to
test for visual field defects. Other tests in a cranial nerve
exam can be conducted by asking the patient to get
closer to the camera; assessing their pupils, tongue and
jaw movements. While the ability to conduct a motor
exam is limited, many maneuvers like pronator drift,
squats, and satellite sign can indirectly assess strength.
The sensory exam may require the patient have a
helper, but can provide at least a subjective report.
Coordination and gait can be assessed similarly to a
face to face visit in clinic.

While there are some limitations, providers should be

able to remotely conduct a neurologic exam. It’s
important to remember that you can comment on a lot
by walking the patient through simple tests for