Reliability of Automatic Computer Vision-Based Assessment of Orofacial Kinematics for Telehealth Applications.

Introduction: Telehealth/remote assessment using readily available 2D mobile cameras and deep learning-based analyses is rapidly becoming a viable option for detecting orofacial and speech impairments associated with neurological and neurodegenerative disease during telehealth practice. However, the psychometric properties (e.g., internal consistency and reliability) of kinematics obtained from these systems have not been established, which is a crucial next step before their clinical usability is established. Methods: Participants were assessed in lab using a 3 dimensional (3D)-capable camera and at home using a readily-available 2D camera in a tablet. Orofacial kinematics was estimated from videos using a deep facial landmark tracking model. Kinematic features quantified the clinically relevant constructs of velocity, range of motion, and lateralization. In lab, all participants performed the same oromotor task. At home, participants were split into two groups that each performed a variant of the in-lab task. We quantified within-assessment consistency (Cronbach's α), reliability (intraclass correlation coefficient [ICC]), and fitted linear mixed-effects models to at-home data to capture individual-/task-dependent longitudinal trajectories. Results: Both in lab and at home, Cronbach's α was typically high (>0.80) and ICCs were often good (>0.70). The linear mixed-effect models that best fit the longitudinal data were those that accounted for individual- or task-dependent effects. Discussion: Remotely gathered orofacial kinematics were as internally consistent and reliable as those gathered in a controlled laboratory setting using a high-performance 3D-capable camera and could additionally capture individual- or task-dependent changes over time. These results highlight the potential of remote assessment tools as digital biomarkers of disease status and progression and demonstrate their suitability for novel telehealth applications.

Telephone consultation for myasthenia gravis care during the COVID-19 pandemic: Assessment of a novel virtual myasthenia gravis index.

INTRODUCTION/AIMS: The aim of the study was to determine the association between the virtual Myasthenia Gravis Impairment Index (vMGII) with other patient-reported outcomes (PROs) of myasthenia gravis (MG) and its usefulness in telephone consultations with MG patients. METHODS: This was a retrospective case series in which vMGII score along with virtual Single Simple Question (vSSQ), virtual Patient-Acceptable Symptom State PASS (vPASS) response, and patient disease status based on Myathenia Gravis Foundation of America postintervention status were collected during telephone consultation along with the MGII, SSQ, and PASS responses during the preceding in-person clinic visits. RESULTS: In 214 patients, the mean difference of vMGII between the vPASS "Yes" and "No" groups was -14.2 ± 1.4 (95% confidence interval, -16.9 to -11.3; P < .001) with mean vMGII for vPASS "Yes" group being 6.4 ± 7.7 and vPASS "No" being 20.5 ± 11.5. A vMGII of 11.5 or higher predicted vPASS "yes" response with a sensitivity of 78.7% and specificity of 81.4%. A strong negative correlation was found between the vMGII and vSSQ (r = -.667; P < .001). The mean vMGII was 0.48 ± 1.42 for patients in remission, and 9.31 ± 10.93 for improved, 9.32 ± 8.79 for stable, and 22.58 ± 14.04 for worsened groups (P < .001). These associations were the same as those obtained during the preceding in-person clinic visit and the direction of change in MGII scores also indicated change in disease status. DISCUSSION: vMGII is an effective measure to assess an MG patient's disease status in telephone consultations and relates well with other PRO measures. The vMGII remains reliable for assessing MG disease status even with removal of the physical examination component.

Qualitative, Patient-Centered Assessment of Muscle Cramp Impact and Severity.

BACKGROUND: There is an urgent need for new therapeutic options to treat muscle cramps; however, no patient-reported measures exist that capture the entire cramp experience. We conducted a qualitative study to assess the experience of patients suffering muscle cramps, aiming to understand what factors determine the impact cramps have in patients' lives to guide the development of a patient-centered outcome measure of cramp severity and impact. METHODS: We enrolled patients with cramps due to several etiologies, including motor neuron disease, pregnancy-induced cramps, cirrhosis and hemodialysis, and idiopathic and exercise-induced cramps. Patients participated in semistructured interviews about their experiences with muscle cramps and their responses were recorded and transcribed. Data were analyzed with content analysis using data saturation to determine the sample size. We subsequently developed a conceptual framework of cramp severity and overall cramp impact. RESULTS: Ten patients were interviewed when data saturation was reached. The cramp experience was similar across disease and physiological states known to cause muscle cramps. The main themes that compose the overall cramp impact are cramp characteristics, sleep interference, daytime activities interference, and the effect on mental health. CONCLUSIONS: This framework will be used to develop a patient-reported outcome of cramp severity and impact.

Évaluer qualitativement l'impact et la gravité des crampes musculaires tout en étant axé sur les patients qui en souffrent. Contexte : Il existe un besoin urgent de mettre en œuvre de nouvelles options thérapeutiquespour le soulagementdes crampes musculaires. Cela dit, aucun patient qui en souffre ne semble avoir fait état d'optionstenant compte de la totalité de leurexpérience. À cet égard, nous avons effectué une étude qualitative afin justement de mieux cerner l'expérience de ces patients et de comprendreles facteurs qui déterminentl'impact que les crampes peuvent avoir dans leur vie. Nous voulons du coup orienter l'élaboration d'indicateursaxés sur les patients eux-mêmes, indicateurs visant à mesurer l'impact et la gravité de leurs crampes musculaires. Méthodes : Nous avons recruté des patients atteints de crampes musculaires en raison de plusieurs étiologies, par exemple des pathologies du motoneurone, des crampes liées à une grossesse, des cas de cirrhosenécessitant une hémodialyse, des crampes idiopathiquesou déclenchées par l'exercice, etc. Les patients recrutés ont participé à des entrevues semi-structurées portant sur leur expérience en lien avec des crampes musculaires, leurs réponses étant enregistrées et par la suite transcrites. En plus déterminer la taille de notre échantillon à l'aide de la saturation de données, nous avons ensuite analysé ces dernières au moyen de la méthode d'analyse de contenu. Enfin, nous avons élaboré un cadre conceptuel de la gravité des crampes musculaires et de leur impact général. Résultats : Une fois nos données saturées, dix patients ont été interviewés. Les expériences liées à leurs crampes se sont révélées comparables peu importe les maladies et les états physiologiques. Parmi les principaux aspects caractérisant l'impact général des crampes, mentionnons les suivants : les caractéristiques des crampes, les perturbations du sommeil qu'elles entraînent, leur interférence dans des activités de jour et leurs effets sur la santé mentale. Conclusions : Ce cadre de référence sera utilisé pour élaborer un outil mesurant la gravité et l'impact des crampes musculaires, et ce, en fonction de l'apport des patients eux-mêmes.

Quantitative sonographic assessment of myotonia.

INTRODUCTION: This study explores ultrasound imaging for qualitative and quantitative assessment of myotonia. METHODS: Sixteen patients with myotonia and 16 controls underwent sonographic evaluation of the thenar eminence muscles to assess the relaxation time after muscle percussion. RESULTS: The mean time for complete muscle relaxation in patients with myotonia was longer than that of controls. A cutoff of > 0.9 s for myotonia detection had a sensitivity of 88% and a specificity of 100%. The interrater reliability was moderate for qualitative assessment but was high for quantitative assessment. The relaxation time did not correlate with the number of trinucleotide repeats in patients with myotonic dystrophy. DISCUSSION: Sonographic evaluation for the presence of myotonia is feasible, sensitive, and specific but does not correlate with disease severity in myotonic dystrophy. Muscle Nerve 57: 146-149, 2018.

Cost-minimization analysis comparing intravenous immunoglobulin with plasma exchange in the management of patients with myasthenia gravis.

INTRODUCTION: Myasthenia gravis (MG) exacerbations may be treated with intravenous immunoglobulin (IVIg) or plasma exchange (PLEX), which have equivalent effectiveness. This cost-minimization analysis compared IVIg with PLEX for treatment of patients with MG exacerbation. METHODS: We combined the Ontario-based health cost data with clinical data from a randomized clinical trial. Analyses were undertaken from the perspective of a public healthcare insurer and from the perspective of a tertiary university hospital payer. RESULTS: PLEX was less costly than IVIg among patients with a body mass index (BMI) > 15.7 kg/m(2) , from the perspective of the public healthcare insurer (P < 0.0001). However, PLEX was more costly than IVIg from the perspective of the hospital payer when the costs of blood products were excluded (P < 0.0001). CONCLUSIONS: PLEX can be considered a short-term cost-minimizing therapy when compared with IVIg for treatment of MG exacerbation among patients with BMI >15.7 kg/m(2) , from the perspective of a public healthcare insurer. Muscle Nerve 53: 872-876, 2016.

Effectiveness of diagnostic strategies in suspected delayed cerebral ischemia: a decision analysis.

BACKGROUND AND PURPOSE: Delayed cerebral ischemia (DCI) is a serious complication after aneurysmal subarachnoid hemorrhage. If DCI is suspected clinically, imaging methods designed to detect angiographic vasospasm or regional hypoperfusion are often used before instituting therapy. Uncertainty in the strength of the relationship between imaged vasospasm or perfusion deficits and DCI-related outcomes raises the question of whether imaging to select patients for therapy improves outcomes in clinical DCI. METHODS: Decision analysis was performed using Markov models. Strategies were either to treat all patients immediately or to first undergo diagnostic testing by digital subtraction angiography or computed tomography angiography to assess for angiographic vasospasm, or computed tomography perfusion to assess for perfusion deficits. According to current practice guidelines, treatment consisted of induced hypertension. Outcomes were survival in terms of life-years and quality-adjusted life-years. RESULTS: When treatment was assumed to be ineffective in nonvasospasm patients, Treat All and digital subtraction angiography were equivalent strategies; when a moderate treatment effect was assumed in nonvasospasm patients, Treat All became the superior strategy. Treating all patients was also superior to selecting patients for treatment via computed tomography perfusion. One-way sensitivity analyses demonstrated that the models were robust; 2- and 3-way sensitivity analyses with variation of disease and treatment parameters reinforced dominance of the Treat All strategy. CONCLUSIONS: Imaging studies to test for the presence of angiographic vasospasm or perfusion deficits in patients with clinical DCI do not seem helpful in selecting which patients should undergo treatment and may not improve outcomes. Future directions include validating these results in prospective cohort studies.