Research in Pediatric Tele-Neuropsychology
Dr. Lana Harder discusses research being done on pediatric neuropsychology, the tele-neuropsychology program at Children’s Health, and how it will positively impact the patient population.
Featured Speaker:
Nationally, Dr. Harder was elected to the Board of Directors of the American Board of Clinical Neuropsychology (ABCN) and the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) and serves on the Board of Directors and Medical and Scientific Council of the Seigel Rare Neuroimmune Association.
Dr. Harder earned her doctorate from the University of Texas at Austin and completed her pre-doctoral internship at the Kennedy Krieger Institute and Johns Hopkins School of Medicine. She completed post-doctoral fellowship at Texas Children’s Hospital and Baylor College of Medicine. Dr. Harder has served as a Pediatric Neuropsychologist at Children’s Health since 2008. She was a founding member and is the current Co-Director of the Children’s Pediatric Demyelinating Diseases Clinic.
Her research interests include pediatric tele-neuropsychological assessment, brain imaging correlates of neuropsychological functioning in transverse myelitis and multiple sclerosis, and longitudinal cognitive and psychosocial outcomes for pediatric multiple sclerosis, transverse myelitis, acute disseminated encephalomyelitis, and neuromyelitis optica. Dr. Harder also participates in a multi-site longitudinal investigation on the impact of pediatric cancer and its treatment on early development in infants and toddlers.
Lana Harder, PhD, ABPP
Dr. Harder leads the Neuropsychology Service and Neuropsychology training program at Children’s Health in Dallas, Texas. She holds dual faculty appointments as Associate Professor of Psychiatry and Neurology and Neurotherapeutics at UT Southwestern. Dr. Harder is board certified in Clinical Neuropsychology and is a board-certified Subspecialist in Pediatric Neuropsychology.Nationally, Dr. Harder was elected to the Board of Directors of the American Board of Clinical Neuropsychology (ABCN) and the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) and serves on the Board of Directors and Medical and Scientific Council of the Seigel Rare Neuroimmune Association.
Dr. Harder earned her doctorate from the University of Texas at Austin and completed her pre-doctoral internship at the Kennedy Krieger Institute and Johns Hopkins School of Medicine. She completed post-doctoral fellowship at Texas Children’s Hospital and Baylor College of Medicine. Dr. Harder has served as a Pediatric Neuropsychologist at Children’s Health since 2008. She was a founding member and is the current Co-Director of the Children’s Pediatric Demyelinating Diseases Clinic.
Her research interests include pediatric tele-neuropsychological assessment, brain imaging correlates of neuropsychological functioning in transverse myelitis and multiple sclerosis, and longitudinal cognitive and psychosocial outcomes for pediatric multiple sclerosis, transverse myelitis, acute disseminated encephalomyelitis, and neuromyelitis optica. Dr. Harder also participates in a multi-site longitudinal investigation on the impact of pediatric cancer and its treatment on early development in infants and toddlers.
Transcription:
Research in Pediatric Tele-Neuropsychology
Prakash Chandran: You are listening to Pediatric Insights, Advances and Innovations with Children's Health. On today's episode we'll be talking about research in pediatric teleneuropsychology with our expert Lana Harder, PhD, ABPP, a Pediatric Neuropsychologist at Children's Health and Associate Professor of Psychiatry and Neurology and Neurotherapeutics at UT Southwestern. This episode was recorded on April 16th of 2020 in the midst of the COVID-19 pandemic. This is Pediatric Insights, Advances and Innovations with Children's Health. I Prakash Chandran, so Lana, for those who may not know, can you first explain neuropsychology and then explain teleneuropsychology?
Dr. Harder: Absolutely. Neuro-psychology is the study of the brain as it relates to things like our behavior, cognition and mood. So at children's we focus on evaluation of children and adolescents with neurologically relevant medical problems like head injury, brain tumor, and other conditions that impact brain function. So our evaluations involved standardized tests that we administer in a one-on-one fashion. So imagine paper, pencil question, answer tests that evaluate everything from IQ to language, attention, memory, and so forth. And so as part of that, we also conduct clinical interviews, consultations and provide recommendations for treatment. Teleneuropsychology is just an extension of that service using video conference technology. So think about tests administered over a video conference platform like FaceTime or Zoom.
Host: I see. And I'm going to ask just a more basic question here. Who would come to see a neuropsychologist?
Dr. Harder: Great question. Children who are affected by some medical condition that impacts the brain. So this could be a patient who has had a head injury or has undergone treatment for cancer. We see a whole variety of kids with brain-based medical problems. And so our clinicians help to provide these evaluations to determine the consequences of those medical problems and create treatment plans to address any specific challenges the patient may be facing.
Host: And can you maybe give us an example of one of your sessions and how it might work?
Dr. Harder: Sure. So we typically meet with our patients and sit with them at a table from across the table, to do these activities. So we might give them a memory test to see how well they can remember. And then everything we do, we score it and compare them to other kids their age in a certain domain of function. So we take that information to design recommendations for their treatment.
Host: Okay. That makes sense. I've heard you've done some research in pediatric teleneuropsychology. Can you tell us a little bit about it?
Dr. Harder: Sure. My research examined the administration of those tests. I just talked about that over video conference. It had never been studied before in pediatric neuropsychology. Our design involved participants completing these two different sessions using the same battery of tests. So once we administered the battery of person and once remotely from the participant's home using that teleneuropsychology model, our study compared the results for each of those two conditions. And what we found was there were no differences when we looked at results across, the in person versus the video based testing.
Host: Wow. That's pretty interesting. I've always heard that there is a nuance that is lost when you're not in person, but it sounds like for the purposes of these studies, that isn't the case. Right?
Dr. Harder: Right. So in terms of the results that we found from the testing, certainly there's a lot of promise here for using this technology to complete our evaluations. At the same time, there are always, you know, pluses and minuses to everything. So there are certainly things that, that we lose when we go to the virtual setting. But I would say we also gain some things as well.
Host: Yeah. So maybe let's unpack some of those gains.
Dr. Harder: Sure. I think, thinking of our patients and families and their experience. We're creating a service that is very convenient to them. We are meeting them in the comfort of their own home so you don't have to travel. Many of our patients have medical problems that make it difficult to travel great distances to see us. So we've made it convenient and we think there's a cost savings for patients and families who aren't having to take off work or miss school. So I think those are some benefits to teleneuropsychology.
Host: Right. And you know, as of today, you know, we're still in the middle of this COVID-19 crisis. So I'm curious to learn a little bit about how your research here is informing clinical practice in the midst of all of this.
Dr. Harder: Yes. Well, it's really been overwhelming actually over the last few weeks, we've received a number of requests for education on this topic. Since Children's is the place where we conducted the very first study and only known study of pediatric teleneuropsychology. And also the first study using a home based model. Our adult colleagues have done research in teleneuropsychology but always in a clinical setting. So we are the very first home-based study as well. And just to give you an example, I recently participated in a webinar for international Neuro-psychological Society with over 3000 participants tuning in live from around the world. So there's a lot of discussion about this topic right now for the obvious reasons.
Host: Yeah, absolutely. So you mentioned Children's Health does have that teleneuropsychology, you know, maybe talk a little bit about how it specifically works, when you are at a distance doing this teleneuropsychology?
Dr. Harder: Sure. So at Children's we have been working to roll out a virtual option for awhile in relation to this research study. So with the help of our entire team as well as really all of Children's, we've been working to set up a virtual service as quickly as possible. We initiated this process about three weeks ago, and then I'm pleased to say we've already successfully completed multiple remote sessions using the Children's virtual platform and sometimes the phone. So we did rely on the phone at first before we were all set up to use the platform. And what that looks like is our neuropsychologists, we have 11 neuropsychologists at Children's. We're all connecting with our patients and families whose appointments were canceled as a result of the need for social distancing. So we've been able to make contact with them remotely to make sure that we're meeting their needs and that we're completing as much of the evaluation process as possible if the clinician and the patient family choose to do so.
Host: And you know, we touched on this briefly, but I'm curious to hear your thoughts around how teleneuropsychology will impact the future of clinical services at Children's.
Dr. Harder: Sure. As I mentioned, we've been working now for a bit on establishing a virtual care option for reasons that we've talked about to create convenience, especially now it's more important than ever to have a virtual option to maintain our social distance and keep everyone safe. So of course the COVID-19 crisis has really accelerated our efforts in this area. We are so appreciative to Children's and to all of our colleagues for working so quickly to make this a reality. I do believe that we'll come out of this with many tools that will be relevant and useful for patient and family care going forward. So I strongly believe this experience, that quick adapting that we've all done in this moment is going to make us better on the other side of this.
Host: Absolutely. I believe that as well. And you know, just as we wrap up here, is there anything else that you'd like other providers to know about teleneuropsychology?
Dr. Harder: Sure. I think anytime we try something new, we want feedback and I think we're doing that all the time. We're asking for feedback so we can be better. One thing that we did in our study was asked our parents and patients, what was it like, how was it for you to do this testing over video and what was that like in comparison to the kind of traditional in-person service? And I just want to say that the overall satisfaction rating showed in 90% or higher favorable responses for using this virtual care model. So we were really encouraged to see that and feel like we're going in the right direction by establishing a virtual care model.
Host: Absolutely. I mean there's no replacement for coming to patients where they are and especially as you mentioned before, if there's no difference in the effectiveness between in-person versus something remotely like FaceTime or zoom, then you know, why not offer that as a service. So that sounds wonderful. Any final thoughts before we close?
Dr. Harder: The last thing I'll say is our work is undergoing peer review now to hopefully be published in a journal in the very near future. We want to disseminate this information as quickly as possible that we are undergoing that process and we know that all research should be replicated. We should evaluate this model in other populations and we're very hopeful and excited that this moment that we're in will actually yield more research in this area so we can feel even more confident as we move forward providing the service.
Host: Alright, Lana, I really appreciate your time today. That's Lana Harder, a Pediatric Neuropsychologist at Children's Health and associate professor of psychiatry and neurology and neurotherapeutics at UT Southwestern. Thank you for listening to Pediatric Insights, Advances and Innovations with Children's Health. For more information, visit childrens.com. Thank you so much and we'll talk next time.
Research in Pediatric Tele-Neuropsychology
Prakash Chandran: You are listening to Pediatric Insights, Advances and Innovations with Children's Health. On today's episode we'll be talking about research in pediatric teleneuropsychology with our expert Lana Harder, PhD, ABPP, a Pediatric Neuropsychologist at Children's Health and Associate Professor of Psychiatry and Neurology and Neurotherapeutics at UT Southwestern. This episode was recorded on April 16th of 2020 in the midst of the COVID-19 pandemic. This is Pediatric Insights, Advances and Innovations with Children's Health. I Prakash Chandran, so Lana, for those who may not know, can you first explain neuropsychology and then explain teleneuropsychology?
Dr. Harder: Absolutely. Neuro-psychology is the study of the brain as it relates to things like our behavior, cognition and mood. So at children's we focus on evaluation of children and adolescents with neurologically relevant medical problems like head injury, brain tumor, and other conditions that impact brain function. So our evaluations involved standardized tests that we administer in a one-on-one fashion. So imagine paper, pencil question, answer tests that evaluate everything from IQ to language, attention, memory, and so forth. And so as part of that, we also conduct clinical interviews, consultations and provide recommendations for treatment. Teleneuropsychology is just an extension of that service using video conference technology. So think about tests administered over a video conference platform like FaceTime or Zoom.
Host: I see. And I'm going to ask just a more basic question here. Who would come to see a neuropsychologist?
Dr. Harder: Great question. Children who are affected by some medical condition that impacts the brain. So this could be a patient who has had a head injury or has undergone treatment for cancer. We see a whole variety of kids with brain-based medical problems. And so our clinicians help to provide these evaluations to determine the consequences of those medical problems and create treatment plans to address any specific challenges the patient may be facing.
Host: And can you maybe give us an example of one of your sessions and how it might work?
Dr. Harder: Sure. So we typically meet with our patients and sit with them at a table from across the table, to do these activities. So we might give them a memory test to see how well they can remember. And then everything we do, we score it and compare them to other kids their age in a certain domain of function. So we take that information to design recommendations for their treatment.
Host: Okay. That makes sense. I've heard you've done some research in pediatric teleneuropsychology. Can you tell us a little bit about it?
Dr. Harder: Sure. My research examined the administration of those tests. I just talked about that over video conference. It had never been studied before in pediatric neuropsychology. Our design involved participants completing these two different sessions using the same battery of tests. So once we administered the battery of person and once remotely from the participant's home using that teleneuropsychology model, our study compared the results for each of those two conditions. And what we found was there were no differences when we looked at results across, the in person versus the video based testing.
Host: Wow. That's pretty interesting. I've always heard that there is a nuance that is lost when you're not in person, but it sounds like for the purposes of these studies, that isn't the case. Right?
Dr. Harder: Right. So in terms of the results that we found from the testing, certainly there's a lot of promise here for using this technology to complete our evaluations. At the same time, there are always, you know, pluses and minuses to everything. So there are certainly things that, that we lose when we go to the virtual setting. But I would say we also gain some things as well.
Host: Yeah. So maybe let's unpack some of those gains.
Dr. Harder: Sure. I think, thinking of our patients and families and their experience. We're creating a service that is very convenient to them. We are meeting them in the comfort of their own home so you don't have to travel. Many of our patients have medical problems that make it difficult to travel great distances to see us. So we've made it convenient and we think there's a cost savings for patients and families who aren't having to take off work or miss school. So I think those are some benefits to teleneuropsychology.
Host: Right. And you know, as of today, you know, we're still in the middle of this COVID-19 crisis. So I'm curious to learn a little bit about how your research here is informing clinical practice in the midst of all of this.
Dr. Harder: Yes. Well, it's really been overwhelming actually over the last few weeks, we've received a number of requests for education on this topic. Since Children's is the place where we conducted the very first study and only known study of pediatric teleneuropsychology. And also the first study using a home based model. Our adult colleagues have done research in teleneuropsychology but always in a clinical setting. So we are the very first home-based study as well. And just to give you an example, I recently participated in a webinar for international Neuro-psychological Society with over 3000 participants tuning in live from around the world. So there's a lot of discussion about this topic right now for the obvious reasons.
Host: Yeah, absolutely. So you mentioned Children's Health does have that teleneuropsychology, you know, maybe talk a little bit about how it specifically works, when you are at a distance doing this teleneuropsychology?
Dr. Harder: Sure. So at Children's we have been working to roll out a virtual option for awhile in relation to this research study. So with the help of our entire team as well as really all of Children's, we've been working to set up a virtual service as quickly as possible. We initiated this process about three weeks ago, and then I'm pleased to say we've already successfully completed multiple remote sessions using the Children's virtual platform and sometimes the phone. So we did rely on the phone at first before we were all set up to use the platform. And what that looks like is our neuropsychologists, we have 11 neuropsychologists at Children's. We're all connecting with our patients and families whose appointments were canceled as a result of the need for social distancing. So we've been able to make contact with them remotely to make sure that we're meeting their needs and that we're completing as much of the evaluation process as possible if the clinician and the patient family choose to do so.
Host: And you know, we touched on this briefly, but I'm curious to hear your thoughts around how teleneuropsychology will impact the future of clinical services at Children's.
Dr. Harder: Sure. As I mentioned, we've been working now for a bit on establishing a virtual care option for reasons that we've talked about to create convenience, especially now it's more important than ever to have a virtual option to maintain our social distance and keep everyone safe. So of course the COVID-19 crisis has really accelerated our efforts in this area. We are so appreciative to Children's and to all of our colleagues for working so quickly to make this a reality. I do believe that we'll come out of this with many tools that will be relevant and useful for patient and family care going forward. So I strongly believe this experience, that quick adapting that we've all done in this moment is going to make us better on the other side of this.
Host: Absolutely. I believe that as well. And you know, just as we wrap up here, is there anything else that you'd like other providers to know about teleneuropsychology?
Dr. Harder: Sure. I think anytime we try something new, we want feedback and I think we're doing that all the time. We're asking for feedback so we can be better. One thing that we did in our study was asked our parents and patients, what was it like, how was it for you to do this testing over video and what was that like in comparison to the kind of traditional in-person service? And I just want to say that the overall satisfaction rating showed in 90% or higher favorable responses for using this virtual care model. So we were really encouraged to see that and feel like we're going in the right direction by establishing a virtual care model.
Host: Absolutely. I mean there's no replacement for coming to patients where they are and especially as you mentioned before, if there's no difference in the effectiveness between in-person versus something remotely like FaceTime or zoom, then you know, why not offer that as a service. So that sounds wonderful. Any final thoughts before we close?
Dr. Harder: The last thing I'll say is our work is undergoing peer review now to hopefully be published in a journal in the very near future. We want to disseminate this information as quickly as possible that we are undergoing that process and we know that all research should be replicated. We should evaluate this model in other populations and we're very hopeful and excited that this moment that we're in will actually yield more research in this area so we can feel even more confident as we move forward providing the service.
Host: Alright, Lana, I really appreciate your time today. That's Lana Harder, a Pediatric Neuropsychologist at Children's Health and associate professor of psychiatry and neurology and neurotherapeutics at UT Southwestern. Thank you for listening to Pediatric Insights, Advances and Innovations with Children's Health. For more information, visit childrens.com. Thank you so much and we'll talk next time.