T
Teleneuropsychology
Daniel Smith
Winship Cancer Institute, Emory University,
Atlanta, GA, USA
Description
Teleneuropsychology refers to the administration
of neuropsychological tests using remote contact
with the patient, typically through video-
teleconferencing (VTC) techniques. These VTC
techniques typically require one or more cameras
trained on the patient in one location, and on the
examiner in the other location. In addition, high
quality monitors, microphones, and fast internet
speeds are needed to maintain sufficient task
administration fidelity. Administration of the neu-
ropsychological tests typically follows the instru-
ment’s original standardized task instructions,
save for the changes in required equipment and
the manner of interaction between the patient and
examiner with the task stimuli. In one variation of
the remote assessment protocol, a hired proctor
may sit with the patient for support with stimuli,
while the clinician administers the tasks through
the monitor. In another variation, the materials are
maintained entirely by the examiner, who presents
them on the monitor being watched by the patient
(Cullum et al. 2014). Numerous widely used neu-
ropsychological instruments have been success-
fully administered in VTC format, including but
# Springer International Publishing AG 2017
J. Kreutzer et al. (eds.), Encyclopedia of Clinical Neuropsychology,
https://doi.org/10.1007/978-3-319-56782-2_9038-1
not limited to the Mini-Mental Status Exam, Hop-
kins Verbal Learning Test-Revised, letter and cat-
egory fluency, Boston Naming Test 15 item
version, digit span forward and backward, and
the clock-drawing test (Collum et al. 2014).
Background
The development of teleneuropsychology builds
upon recent trends in telemedicine, including the
substantial increase in the remote delivery of psy-
chological interventions using teleconferencing
methods (i.e., telepsychology). The purported
promise of remote neuropsychological assess-
ment is that it may address disparities in the geo-
graphic distributions of expert clinicians (Grosch
et al. 2011; Adjorlolo 2015), as well as provide
assessment opportunities to patients with rare con-
ditions who would otherwise need to travel great
distances (Ragbeer et al. 2015). There are how-
ever significant challenges associated with the
practice of teleneuropsychology and tele-
psychology that need to be addressed before
there is further clinical adoption.
To assist clinicians in navigating these chal-
lenges, Grosch and colleagues published initial
practice guidelines for the practice of tele-
neuropsychology (Grosch et al. 2011), which
were later closely mirrored by the American Psy-
chological Association’s (APA) guidelines
regarding the practice of telepsychology more
generally (APA 2013). Specifically, the practice
2 Teleneuropsychology
guidelines address problems with acquiring
informed consent remotely, methods for ensuring
privacy and confidentiality of services rendered
over the internet, defining and maintaining com-
petence in this new area, and addressing billing
and insurance related issues given jurisdictional
boundaries of practice. The guidelines further
emphasize the need to utilize appropriate assess-
ment measures but admit that few if any such
measures validated for remote administration
presently exist (Grosch et al. 2011; APA 2013).
Since the guidelines were published in 2011
and then in 2013, research exploring the delivery
of psychological interventions in telepsychology
has continued to expand rapidly. These studies
have generally revealed that face-to-face
(FF) and videoteleconferencing (VTC) methods
of intervention delivery are relatively comparable.
The literature on teleneuropsychology presently
consists of only a handful of studies, though the
limited work available does suggest promising
feasibility and reliability. The studies include a
small collection of instruments administered to a
narrow population of older adult patients with
diagnosed or suspected neurocognitive impair-
ment (Cullum et al. 2014; Galusha-Glasscock
et al. 2015) and to a juvenile population with
neuronal ceroid lipofuscinosis, a rare neurodegen-
erative disease (Ragbeer et al. 2015). Given the
limited work thus far, it is recognized that sub-
stantially more research is necessary to demon-
strate the feasibility of teleneuropsychology and
must include the validation of a greater number of
neuropsychological instruments and include addi-
tional patient populations (Galusha-Glasscock
et al. 2015).
References
Adjorlolo, S. (2015). Can teleneuropsychology help meet
the neuropsychological needs of western Africans? The
case of Ghana. Applied Neuropsychology-Adult, 22(5),
388–398. https://doi.org/10.1080/23279095.2014.
949718.
American Psychological Association. (2013). Guidelines
for the practice of telepsychology. The American Psy-
chologist, 68, 791–800.
Cullum, C. M., Hynan, L. S., Grosch, M., Parikh, M., &
Weiner, M. F. (2014). Teleneuropsychology: Evidence
for video teleconference-based neuropsychological
assessment. Journal of the International Neuropsycho-
logical Society, 20(10), 1028–1033. https://doi.org/10.
1017/S1355617714000873.
Galusha-Glasscock, J.M., Horton, D.K., Weiner, M.F.,
Cullum, C.M. (2015). Video teleconference adminis-
tration of the repeatable battery for the assessment of
neuropsychological status. Archives of Clinical Neuro-
psychology: The Official Journal of the National Acad-
emy of Neuropsychologists, acv058. https://doi.org/10.
1093/arclin/acv058.
Grosch, M. C., Gottlieb, M. C., & Cullum, C. M. (2011).
Initial practice recommendations for tele-
neuropsychology. The Clinical Neuropsychologist,
25(7), 1119–1133. https://doi.org/10.1080/13854046.
2011.609840.
Ragbeer, S.N., Augustine, E.F., Mink, J.W., Thatcher,
A.R., Vierhile, A.E., Adams, H.R. (2015). Remote
assessment of cognitive function in juvenile neuronal
ceroid lipofuscinosis (batten disease): A pilot study of
feasibility and reliability. Journal of Child Neurology,
1–7. https://doi.org/10.1177/0883073815600863.