[00:00:00] Eva Keatley, PhD: I was interviewing a young woman in preparation for a neuropsych testing that day. And we had kind of set up the appointment, letting her know what the expectations were and what the appointment would consist of. And during the interview I noticed she kept looking off screen. I realized her high needs child was right behind the screen. Um, and so she was trying to kind of parent and like manage their behavior during the appointment. She had so much going on in her life, she was just trying to fit in this testing and this interview in her day to day routine. And it was clearly not working. Right. We weren't able to continue the interview, let alone neuropsych testing that way. So we had to cancel the appointment. But this was an issue that happened over and over again, where we just had no control over the environment that patients were in. And very often life would kind of get in the way.
[00:00:58] Meghan Beier, PhD (2): Welcome to Find Empathy, a continuing education podcast for therapists, where we discuss the interaction between health and emotions. My name is Dr. Meghan Beier, a clinical psychologist who specializes in chronic illness and disability. Our current series is focused on using telepsychology to work with medical populations while the topics, stories, and case studies are relevant for every therapist who uses telepsychology with medical populations, the topics covered were created specifically to meet the criteria needed to satisfy PSYPACT requirements for psychologists and American Psychological Association, the Association of State and Provincial Psychology, and APA insurance trust telepsychology guidelines.
I hope you enjoy this episode.
Today we're talking with Dr. Eva Keatley. She is a clinical psychologist who specializes in rehabilitation psychology and neuropsychology. She's an assistant professor at Johns Hopkins university, where her clinical and research interests involve examining the relationships between brain, behavior, and health beliefs.
Clinically her work involves using neuropsychology assessment and psychological interventions to support cognitive recovery and emotional adjustment in the context of chronic illness and traumatic injury. Using a values based approach to neuropsychological assessment and treatment, her clinical work emphasizes patient-centered, collaborative strengths-based and compassion focused care.
Her research and interests are also related to improving clinical care of individuals with traumatic brain injury, persistent post concussion syndrome, and functional neurologic disorders.
Welcome Dr. Keatley. Thank you so much for spending time with us today.
[00:02:58] Eva Keatley, PhD: Thank you for having me, I'm looking forward to us.
[00:03:00] Meghan Beier, PhD (2): So today we're really gonna focus our conversation on neuropsychology and using telepsychology in the context of cognitive assessment. And we're really gonna focus on switching to telemedicine in the context of the pandemic and how that happened and, and what you did and what our department did in that context.
Um, so I'm gonna start with just a quick question. Keeping in mind, HIPAA, I'd love for you to share a story or a situation that you didn't expect when we were switching to telemedicine at the beginning of the pandemic.
[00:03:34] Eva Keatley, PhD: Sure. There's one that quickly comes to mind that I think is reflective of a lot of situations that happened during this switch. Which was when I was interviewing a young woman in preparation for a neuropsych testing that day. And we had kind of set up the appointments, letting her know what the expectations were and what, what the appointment would consist of. And during conversation, during the interview, I noticed she kept looking off screen.
And just seemed a little distracted and I wasn't so sure what to make of it. Um, but over the course of the interview, I realized her high needs child was right behind the screen. Um, and so she was trying to kind of parent and like manage their behavior during the appointment. So the, which was, you know, which was fine, we rolled with that.
And then I realized she kept, she kept leaving the screen for moments while still answering the questions. And it became clear that she was getting dressed. She was changing during the interview. And then, uh, shortly after she started walking to the car with the phone and the screen and got into the car and was getting ready to drive off, to go to work or to pick up someone from work, I think it was. And. She had so much going on in her life. Um, she was just trying to fit in this testing and this interview in her day to day routine. And, [00:05:00] uh, it was clearly not working, right. We weren't able to continue the interview, let alone, neuropsych testing that way. So we had to cancel the appointment and try to reschedule.
And it was hard for this patient to ever find the, sort of the time that she could take out of her life to do the, do the interview and the testing. But this, this was an issue that happened over and over again, where we just had no control over the environment that patients were in. And very often life would kind of get in the way.
[00:05:31] Meghan Beier, PhD (2): Yeah, I think that was true for me as well. I mean, there were numerous occasions where I would start turn the video camera on and there would be somebody who was actively driving or a passenger in a car. And in, in many ways it was nice that people were in their home environments because I often got to talk to family members who might not have made it to their appointment, but sometimes those family members would stay a little too involved during cognitive testing. Um, and as you said, there was a little less control over the environment than is ideal for cognitive testing.
[00:06:06] Eva Keatley, PhD: Yeah, definitely. Depending on the person's circumstances, sometimes it was just inevitable. Some people just didn't have a room where other people were not there, you know, they just couldn't get privacy.
[00:06:18] Meghan Beier, PhD (2): Yeah, absolutely. So when we were switching to telepsychology in the beginning of the pandemic, you were one of the people in, uh, the hospital who spent a lot of time reviewing the literature about what neuropsychological tests to choose and what should be part of our battery, what shouldn't be. And shared that with the rest of the team.
So when you were making those recommendations, what were some of the considerations you made before recommending a test for use in tele neuropsychology?
[00:06:49] Eva Keatley, PhD: Yeah. So at the time there wasn't that much out there. But what I did is that I put together an Excel sheet essentially. And some of the variables I was looking for, you know, I put together a list of tests that I thought would be, we might be able to use and what I was finding in the literature.
And I was trying to see if, um, A. Was there any empirical evidence for use of measures specific measures in the literature base for use in tele neuropsychology? And there were prior to the pandemic, several research labs and clinics that were using, measures. I will say typically this was in the context where a patient would come to a clinic, um, have their environment set up for them by an assistant of some sort. And then they, a neuropsychologist would remote in from another clinic. So it was less of a home based, um, environment, but. Still there was evidence that lots of neuropsych measures were valid for use over screen. Um, so we prioritized those.
And then we just looked at, you know, can these measures be administered over video? Can they be administered over phone? For example, anything that required physical stimuli, like block design is gonna immediately be ruled out. And then we also wanted to look at any computer based tests that might be accessible over the internet.
Uh, so for example, Many Brains, which is a, I know, you know, well is, um, a group out of Harvard that created a, a battery that you could administer online just by sending someone a link. Um, and so we, we looked into that as well.
[00:08:32] Meghan Beier, PhD (2): Okay, that's great. So you really went to the literature to look, um, were there any other particular resources outside of going to a PubMed search or a Google scholar search and looking up recommendations for tests? Um, are there any resources out there that other people who are looking for recommended tests might be able to find that information.
[00:08:52] Eva Keatley, PhD: The resource that I was using the most was the I O P C. This is the inter organizational practice committee that at the time was putting out, uh, lots of guidelines, lots of recommendations for measures and continues to keep that up to date. So I was going back to them frequently cause they were constantly sort of updating their, their recommendations for tele neuropsychology.
[00:09:16] Meghan Beier, PhD (2): That's great. And we'll link to them. So people can go to that website and find out more information. Uh, you know, one of the things that's important for people to consider is the platform that's used. And we had a couple of choices at Johns Hopkins. Um, Hopkins had their own platform. There's also others like zoom.
And we are not paid by zoom. We don't get any any funding by mentioning their name. Um, but it is a platform that we use. So it would be helpful to understand, you know, what virtual platform did we ultimately decide on and consider? Why was that platform chosen? What were some of the barriers to other platforms? Even what are some of the barriers to using the platform that we ultimately landed on?[00:10:00]
[00:10:00] Eva Keatley, PhD: Yeah, we landed. We landed on zoom in part, because we had sort of an encrypted business use from Johns Hopkins. But really in addition, there was just a lot more features and flexibility with zoom than any other platform available at the time. For example, I could easily share my screen for patients, which was essential to display visual stimuli that I needed for neuropsych testing. I could also edit the screen. So for example, on some recognition tasks, as patients were selecting a stimuli, I would circle it myself and then we would both see the one I was circling so they could correct me. If I had misunderstood. There was also the wait room feature.
So I could place patients in a wait room if I needed some privacy, for instance, to talk with another neuropsychologist. And then also the, the connection was just more stable than the other platforms that we had tried. And, and it was more, more patients were familiar with it, so they already had it downloaded.
But yeah, it was really, I think a lot of the, the flexibility continues to make it the easiest one to use for, for testing.
[00:11:06] Meghan Beier, PhD (2): And this is just a follow up question. Do you have any sense of, if that's still the best platform or if there's alternatives? And if you're not sure, that's okay.
[00:11:17] Eva Keatley, PhD: I'm not aware of any others.
And I think just the ubiquitousness of zoom makes it preferable for me, because at the beginning of the pandemic, I would spend a lot of time just helping patients download zoom, log into it, figure out how to use it. And now most people, or a lot of people have it downloaded. They've used it many times and that just makes the whole process a lot easier.
[00:11:42] Meghan Beier, PhD (2): It's familiar to people.
[00:11:44] Eva Keatley, PhD: Exactly.
[00:11:45] Meghan Beier, PhD (2): What were some of the ethical and copyright hurdles that we had to consider before implementing tele neuropsychology?
[00:11:52] Eva Keatley, PhD: With a copyright concerns, um, in order to display the visual stimuli, for example, with the B N T or with Rey Complex Figure Test, we had the option of just holding it up to the camera.
But there was often a lot of complications with that. It wouldn't come across very well. So ideally you would want to scan it into the computer and then put it up on your screen, then share that with the patient, but the act of scanning it and then saving it violated copyright. So there was a lot of concerns around, you know, if we would be violating copyright.
But fortunately, during the pandemic, a lot of companies came out and said they were easing their copyright rules and regulations, so that patients could be served, you know, through telemedicine. And I'm sure the copyright rules are just gonna be constantly in flux as time goes on and more and more in-person testing occurs.
But that was a really big help for us at the beginning of the pandemic.
[00:12:54] Meghan Beier, PhD (2): Oh, yeah, absolutely. And I think that those rules are constantly changing. And so, uh, again, I will update some of that information and put it in the course information, as well as, um, maybe add a little bit more to this podcast. Just so people are aware of at the time of a launch, what what's. What are the rules right now and how might they change over time?
I wanted to go back to something that you had mentioned earlier. So you had mentioned that one of the things that surprised you was that people, um, were maybe caring for children or they were in their car were maybe not in an environment that was conducive to neuropsychological testing.
How did you get people ready for the appointment? How did you consent them into the appointment or help them understand what the most ideal environment would be for this kind of visit?
[00:13:47] Eva Keatley, PhD: Through trial and error. And also with some support from I O P C guidelines, we came up with a sort of checklist to go through with patients at the beginning of appointments, just to ensure that we're all on the same page and the checklist.
Included things like screening the patient's identity, um, confirming their identity, making sure they understand that they need to be in a quiet environment. And if that wasn't available or possible on that day, we would have to reschedule.
We would also talk about consent. In the context of tele neuropsychological evaluations. In particular specific to neuropsychology, we would say that the, uh, the tests that we're using were not standardized for use over tele neuropsychology, and hence some of the impressions and interpretations that we can make might have some limitations.
And so we wanted make sure that they understood as well as we understood that we were practicing outside of what was the norm. And therefore we might, there might be some limitations to the conclusions we can come to and really wanted them to make an informed decision about whether they wanted to proceed with the tele neuropsych evaluation, because there's always [00:15:00] the option of waiting until in-person testing could be done. So that was, that was a good, a long conversation that we would have whether or not this was the right time to test at all.
And then some other aspects of the, the guidelines that we came up with or the, the checklist was asking them to get a piece of paper and pencil in front of them beforehand, getting a phone number to contact them at, because very often the, the video would cut out at some point and then making sure they understand how to, how to show stimuli through the camera, how to hold up the stimuli.
With those guidelines going through that process, we ended up mitigating a lot of the difficulties we had when we were first getting, getting used to the system.
[00:15:45] Meghan Beier, PhD (2): Oh yeah, absolutely. That's a great list. And I will make a checklist so people can follow that and see it online or online as well. You know, one of the things that I had to do too is, especially for things like, the Brief Visuospatial Memory Test–Revised™ or the Rey (Rey–Osterrieth Complex Figure (ROCF) test) or something like that, where there was a follow up drawing is really ask people to put that drawing in a place that they couldn't see it and destroy it after the appointment as well, so that they didn't have these drawings just sort of laying around to their house, which was very helpful because some people would just sort of draw it on the same piece of paper. And that was a little bit of a trial and error thing that I had to go through.
[00:16:26] Eva Keatley, PhD: Yeah. Yeah. And an issue for test security.
[00:16:29] Meghan Beier, PhD (2): Exactly.
[00:16:30] Eva Keatley, PhD: What I ended up doing is I would ask people to crumple it up in front of me and throw it to the side because when they just put it down in front of them, I had no way of seeing, you know, was it face up?
Was it face down? Could they actually see the stimuli? Um, would they actually destroy it after? That was definitely an issue with the test security with this platform.
[00:16:53] Meghan Beier, PhD (2): That's a great suggestion, the crumpling it up. I think I might adapt that now. if I ever do this again,
So other than what we've already talked about, what else do you think a provider needs to know and consider in terms of their equipment, in terms of test selection and preparation before they even consider using tele neuropsych testing?
[00:17:28] Eva Keatley, PhD: Yeah, I think there's two or three main things. One is just ensuring you have a stable, very strong connection. Um, which seems obvious at this point, but I will say, you know, in my apartment where I had my desk set up, it was just not a great connection. And I had to reorganize my whole apartment to make sure I was near my modem. Um, so that's definitely number one.
Number two. Is just to make sure you have your stimuli ready in a format that you are comfortable and familiar in presenting it. So for example, I put my battery in a PowerPoint presentation and that just made it easier for me. Cause I knew the exact order of where to show certain visual stimuli and it, it made it simpler for me than opening and closing a lot of different PDFs. Um, but whatever system you use is just like.
Whenever we learn a new test or we have to practice it, right. We have to practice it and familiarize ourself with it. It's the exact same thing with tele neuropsychology. You just have to practice it a few times before you, you go in and do an actual neuropsych assessment because there's just little nuances and glitches that happen. And once you figure it out, you can have a very smooth experience, but it takes, takes a couple times to, to get familiar.
[00:18:46] Meghan Beier, PhD (2): Yeah, that's a great point. I was thinking the same thing that I did a lot of practicing ahead of time before I actually started using it. And I believe with our trainees, uh, we have externs and post-doctoral fellows that they were encouraged to practice as well um, before we switched over. Do you have any sense of what was involved in terms of trainee preparation? If they're involved in testing?
[00:19:12] Eva Keatley, PhD: Kind of like what we, what we were saying, just practicing. I would have, you know, I was trained in the extern and I was also learning it myself at the same time.
So we would just practice on each other, um, go back and forth. And it's really just about, you know, pulling up those slides at the right time, making sure your timing's good. And it's just managing a lot of different things at once. And once you've gone through it a couple times, it feels at this point, I feel so familiar with it. It's second nature, but practicing with my trainees was very, very necessary.
[00:19:45] Meghan Beier, PhD (2): Wonderful. Okay. And you know, a lot of what I'm focusing on here is how to do telepsychology with medical populations. And we work with a lot of populations that have mobility challenges they may have hearing [00:20:00] or visual impairments.
Um, they may have all different kinds of disabilities that we have to kind of roll with. So how have you accommodated for patients who have disabilities, who have challenges that might impact their cognitive testing using telepsychology?
[00:20:15] Eva Keatley, PhD: I think the first question, um, especially working with people where it might make, it might add an extra challenge to tele neuropsychology is - can I get a valid test from this platform? Um, and really thinking what is the incremental value of testing on top of doing a very comprehensive interview, getting good collateral information, and then what are the risks and benefits also of, um, getting tests that might have some problems with validity. What are the stakes of the evaluation? So that, that I would just, you know, consider that because not everybody needs testing.
But I will say I did. I did test. So for example, I did have a, a patient who was blind and had pretty severe cognitive impairment. And I did a very brief battery, um, with this patient and I, I believe it was the MOCA-BLIND plus Digit Span plus maybe the HVLT-R, and some other measures that were, that were very brief. And it was in my mind, it was basically to confirm my suspicion that there were very severe impairments.
But I wasn't making very nuanced neuropsychological decisions with this. It was just to help confirm my hypotheses. So there are certainly accommodations that can be made. But I also think we have to be judicious about how far we're gonna go from standardized testing practice.
I will say when, when there is cognitive impairments, it can get in the way of just setting up the platform, uh, familiarity with just managing the tech issues that come up. And so bringing in a support person was always essential. So I would often, um, maybe call that support person ahead of time. They would set up the patient in front of the screen. Give them piece of paper and the pen and just help with that initial set up piece. That was always, um, very, very helpful.
[00:22:19] Meghan Beier, PhD (2): Those are all really good points. And I actually love that you brought up the point that not every person needs to be tested. And I often will talk to people, even if they were referred for cognitive testing, you know, what their end goal is because if their end goal is to get treatment, then sometimes.
I will talk about the benefits of testing. Right? Why would, why would this be helpful to you? Or what would this do for you? But if those benefits aren't really there, sometimes I would just refer them to cognitive rehab through speech pathology because they do their own testing, even though it's not as extensive and it's not, you know, as in depth and maybe it's not the right testing in every context, but I, I think that you're absolutely right, that we really need to consider whether or not every person needs cognitive testing, especially when you're dealing with the layers of telepsychology on top of it.
[00:23:12] Eva Keatley, PhD: Exactly. I think that was my biggest lesson from, you know, my year, year and a half of doing tele neuropsychology was how much the actual neuropsych test themselves are just one of many tools in my toolbox as a neuropsych trainee. There's a lot of other sources of information and like, you know, medical records, interview, collateral, informants, you know, behavioral observations that really inform and help me generate some hypotheses. So. I really, really learned to lean on that skillset, especially the clinical interview skillset during this period of time, which I think has really served me while moving forward.
[00:23:57] Meghan Beier, PhD (2): Absolutely. So in your mind, and through your experience here, uh, what are the patients that you think are, or are not appropriate for online cognitive evaluations?
[00:24:10] Eva Keatley, PhD: The easiest one to consider is just their access to internet connection. Um, not everybody has access to a stable internet connection. And that is a immediate rule out if they can't get access to a stable connection you cannot do this testing. Because there are certain moments where we've tried and it really is, you cannot get any valid data.
And under that, I would also put what devices you have access to. There are some, some people who only have a smartphone. And you cannot present visual stimuli, like the SDMT, which already has quite small, you know, figures on it on a smartphone and expect the patient to really be able to see that quickly.
And then I would also consider just their access to uninterrupted time and a [00:25:00] quiet environment. And many patients who were responsible for childcare during the pandemic, especially when, you know, kids weren't going to school and they just could not be without their children. They could do an interview to a certain extent, but they could not do neuropsych testing.
And then finally, considering to the earlier point, what are the, the risks and benefits of, or the, what are the stakes of a neuropsych assessment? You know, a lot of forensic neuropsychologists, I think were wary to do tele neuropsychology evaluations. Appropriately so, because the stakes of their conclusions are so high. And so deviating from standardization and how you interpret the results can be, can be risky.
So, yeah, I think, I think that's another important piece to consider what are, what. What is the testing for what are the stakes of the testing? And could you cause harm if you do a neuropsych evaluation that has some risks to validity, and then you have some mistakes in your interpretation, could you do harm to that patient?
[00:26:09] Meghan Beier, PhD (2): I'm gonna ask a follow up question that wasn't on my original list of questions to you, but if you decided, using your own clinical judgment, that maybe the stakes were too high for a patient who is in front of you. And you had that discussion with them. Number one, you know, how did people react? There might have been a range of reactions.
Um, and number two, kind of, how did you describe that to the patient so that they sort of understood. Because I think many times people don't understand all the nuances that you and I are talking about.
[00:26:41] Eva Keatley, PhD: I would say in the, in the context that I'm in, which is the rehabilitation department, the reactions of patients would usually be fine.
Um, because we could proceed with treatment with rehab, with other services quite easily without the neuropsych evaluation. So I could still keep them on for health and behavior and interventions, similar to what you said before, refer them to speech. It wouldn't halt or prevent their access to other services. I could imagine. In other context, like forensic evaluations, that would be a different story. So I never, I never actually experienced a negative response to deciding not to test.
So when describing the risks and benefits of testing and why I would recommend not testing to a patient. I would link it back to their goals, mostly of doing neuropsych valuation. And without going into psychometrics and validity, just explain to 'em that the evaluation that we would wanna do, if we had access to doing it in person might not be helpful for them in the context of telehealth.
We might not be able to, to come up with conclusions that are gonna really guide their treatment planning at this time. And to that first point, say that we can proceed with treatment at this time without doing the evaluation. And when you linked it back to their goal of really trying to get better and seeking some guidance and letting 'em know, we can proceed with services without the eval there was no, there was usually no resistance to it.
[00:28:15] Meghan Beier, PhD (2): Yeah, I've, I've similarly found the same thing. I think a lot of times when people are referred to me and I mostly work with multiple sclerosis, it's often in the context of they're struggling at work or at school, and they want assistance with that, right?
They, they want extra support. They want treatment in order to be more successful with their job, not to lose their job, not to be able, not have to have to drop out of school. And so often doing the testing was a bit of a barrier because they'd have to do the interview. They'd have to wait a couple of weeks to do the testing.
Then they'd have to wait to get the results. And often they wanted to just jump into getting something that would help them now. Not waiting another month or two to get the results of testing, to then tell them that they needed treatment. Right. So I, I think that linking them back to the goals is, is really helpful and important.
In other context, for me, I think, where it was maybe more helpful to think about how do we get valid cognitive testing was if people were applying for disability. Or if they needed testing to get accommodations at school. You know, some universities and schools require certain kinds of testing, obviously to, to be able to give those accommodations. So in those contexts, it's a different conversation.
I wanted to kind of go back again to a conversation that we started earlier, which was keeping materials confidential and protected. Now I know that we mentioned being able to talk to them about destroying or crumpling up the paper that's in front of them.
But are there other ways that you ensured that test materials were kept confidential and protected. And I'll think, you know, an example is, you know, I often would have the forms in my home office [00:30:00] that I was recording people's answers on. And so then what did I do with those forms to ensure that they weren't just like thrown in a home trashcan or something like that?
What were some things that you did that helped keep those test materials confidential and protected?
[00:30:14] Eva Keatley, PhD: Yeah. At the beginning, I had that same issue where I found myself with a lot of papers that I didn't know what to do with and what I, what I quickly turned to was just doing everything electronically. I would do it all in a word document.
I would type it out as they were going along. And then when they were showing me their, for example, with the BVMT-R and they had the trials where they copied the designs or, or wrote the designs for memory, they would hold it up to the camera and then I would take a screenshot of what they drew and then just paste it into my word document.
Hmm. So at the end of the evaluation, I had one word document with all of their responses written down. And then I could save that to our encrypted server where we can keep patient files. So that way I had nothing, I had no paperwork and then I just had documents for each patient that I could then store for the results. And I found that that. Made things a lot easier for me.
[00:31:15] Meghan Beier, PhD (2): Absolutely. Yeah. I think I, I started doing the same thing. Uh, although probably not as efficiently as you, I used an Excel file too. I eventually created so that it would, um, tally things up as we went along. But, uh, but then also kept notes separately.
So I think everybody kind of has to, again, like you said, practice this and figure out what the system is. That's gonna work best for them. .
[00:31:39] Eva Keatley, PhD: Yeah. I think someone else created a PDF file where they can sort of fill in the responses. Mm-hmm as well as agreed. A lot of people just sort of came up with creative ways that worked for them.
[00:31:49] Meghan Beier, PhD (2): Exactly. You know, um, we at Johns Hopkins work with many individuals who are either not English speaking or have low English literacy. And I think it's really important for us to keep that in context with this as well. So as a neuropsychologist, I think it's always important to take into consideration the needs of non-English speakers or those with limited English proficiency.
But in your mind, are there any unique considerations for this population when thinking about teleneuropsychology? Is it helpful? Is it not helpful? Do you refer out? You know, how do you handle those types of challenges?
[00:32:29] Eva Keatley, PhD: This is one area where I think. We actually found it very helpful to do tele neuropsychology because this has changed since, but at the time there were a lot of restrictions about doing practice across state borders were lifted during the pandemic. And so I, when there was someone who wasn't an English speaker who had limited English proficiency, you know, in the past, it might be very hard to find someone who speaks that language, but because I could basically do a nationwide search, I felt it was more a responsibility to find someone who spoke their language and can do it better.
Neuropsych evaluation in their language. So that was the default was to refer, put in the legwork to find someone and then refer them to that person. Um, so I never ended up doing any evals with an interpreter, which I think was ideal. But I imagine that in the, in the absence of being able to find someone who speaks that person's language, you could work with an interpreter and again, just the same way, bring them in as a, a third party into your zoom accounts and, and work with them that way, but I can't really speak to what that would be like.
[00:33:39] Meghan Beier, PhD (2): Okay, great. Yeah. So I think that there have been in many ways, barriers that have been brought down by being able to use telepsychology, but then also things that we really wanna keep in mind, uh, so that we're not going beyond our scope of practice.
Um, or also as you mentioned earlier, really, uh, using tests in a way that they weren't designed. Sure. All of this information has been really great. And I think there's lots of really important points here. Um, are there any other final thoughts that you think would be important for people to keep in mind if they're considering using teleneuropsychology?
[00:34:16] Eva Keatley, PhD: I think I'll just reiterate my, the earlier points about how testing is just one tool in the neuropsychologist toolbox. And there is a lot that we can do with record reviews, comprehensive interviews, getting collateral information that can really serve a patient. Well. And testing can certainly add and can be done over tele neuropsychology, but it's certainly not our only skill set.
So that was my biggest lesson was really using it as really using the testing as just one piece of my neuropsychological evaluation, rather than thinking about it as being the whole part of the evaluation. [00:35:00] So I think you can do a lot over tele neuropsychology, even if the number of tests that you use is quite small.
[00:35:06] Meghan Beier, PhD (2): Such a really great point. And I think that that's a really great place to end. Thank you so much, Dr. Keatley for all of your information.
[00:35:13] Eva Keatley, PhD: Thank you, Dr. Beier. It was wonderful. I really appreciate it.
[00:35:19] Meghan Beier, PhD (2): Thank you so much for listening and we look forward to you joining us in the next episode. Make sure you subscribe to be alerted when new episodes launch.
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