Neurological examination is possible using telemedicine

To compare the reliability of neurological examination performed by telemed icine and face to face, a junior doctor examined 23 patients face to face, these examinations being witnessed either by one or by two telemedicine obs ervers using a telemedicine video-link at 384 kbit/s. The gold standard was a face-to-face examination from a panel of six consultant neurologists. Po wer, deep tendon reflexes, plantar responses, coordination, sensation, eye movements, facial strength, tongue movements, sitting balance and gait were studied. Seventeen patients satisfied the inclusion criteria, and a total of 1084 matched pairs of observations were made. The reliability of the tel emedicine examination ranged from fair to moderate for deep tendon reflexes , coordination and eye movement, to near perfect for plantar responses. Ove rall, examination by telemedicine compared favourably with face-to-face exa mination. Telemedicine examination was more sensitive in detecting abnormal ities than face-to-face examination for all the neurological tests studied and more specific for all but one (plantar responses). The study showed tha t neurological examination using telemedicine is at least as good as face-t o-face examination performed by a junior doctor.