The global pandemic has permanently changed the state of practice for pre-DBS neuropsychological evaluations.

The evaluation and management of patients with movement disorders has evolved considerably due to the COVID-19 pandemic, including the assessment of candidates for deep brain stimulation (DBS) therapy. Members of the Neuropsychology Focus Group from the Parkinson Study Group Functional Neurosurgical Working Group met virtually to discuss current practices and solutions, build consensus, and to inform the DBS team and community regarding the complexities of performing DBS neuropsychological evaluations during COVID-19. It is our viewpoint that the practice of neuropsychology has adapted successfully to provide tele-neuropsychological pre-DBS evaluations during the global pandemic, thus permanently changing the landscape of neuropsychological services.

Technology meets tradition: a hybrid model for implementing digital tools in neuropsychology.

The COVID-19 pandemic has significantly impacted the provision of mental health care services and the ability to provide neuropsychological evaluations. The inability to conduct traditional evaluations has left neuropsychologists with the unprecedented task of determining how to modify existing paradigms while balancing the need to provide services and adhere to safety parameters. The COVID-19 literature suggests clinicians are modifying their evaluations based on the following models: (1) continuing to administer in-person evaluations; (2) discontinuing all evaluations due to issues related to standardization, test security, and patient-specific characteristics; (3) conducting virtual evaluations; and/or (4) adopting a hybrid model incorporating both traditional and technology-based modalities. Given the challenges with models 1-3, along with the modifications in telehealth guidelines and insurance reimbursement rates, neuropsychologists are more poised than ever to solidify the implementation of a hybrid model that lasts beyond COVID-19. We introduce the term Hybrid Neuropsychology, a model for the future of neuropsychological evaluations that includes three Action Items: (1) building a technology-based practice; (2) integrating data science; and (3) engaging with innovators in other fields. Hybrid Neuropsychology will enable clinicians to effectively modernize their practice, improve health care equity, and ensure neuropsychology secures its place in a technology-based world.

"You can't touch this": Delivery of inpatient neuropsychological assessment in the era of COVID-19 and beyond.

Objective: The COVID-19 pandemic is a global health crisis that has created sudden and unique challenges within the field of clinical neuropsychology. Adapting neuropsychology services using teleneuropsychology models (e.g. video or telephone assessments) may not always be a viable option for all providers and settings. Based on the existing teleneuropsychology literature, we propose a "contactless" evidence-based inpatient test battery to be used for in-person assessments amenable to physical distancing. Method: In addition to the proposed test battery, we suggest a decision-making workflow process to help readers determine the appropriateness of the proposed methods given their patients' needs. Considerations for special populations (i.e. seniors, patients with brain injury, psychiatric patients), feedback, limitations of the proposed physical distancing approach, and future directions are also discussed. Conclusions: Our aim is that the suggested teleneuropsychology-informed battery and model may inform safe and practical neuropsychological inpatient assessments during the COVID-19 pandemic and other situations requiring contact precautions for infection prevention and control.

Pediatric neuropsychological evaluation via telehealth: Novel models of care.

Objective: As the coronavirus pandemic extends across the globe, the impacts have been felt across domains of industry. Neuropsychology services are no exception. Methods for neuropsychological assessments, which typically require an in-person visit, must be modified in order to adhere to social distancing and isolation standards enacted in an effort to slow the pandemic. How can providers continue to meet the needs of patients referred for neuropsychology evaluations, while respecting federal and state guidelines for safety and ethical mandates? We offer a novel, tiered model of care, successfully implemented in response to mandated social distancing, in a large, pediatric neuropsychology program.Method: We describe the considerations and challenges to be addressed in transitioning a large neuropsychology department to a new model of care, including triaging referrals, developing -or rediscovering - types of services to meet the needs of a virtual patient population, and helping patients, parents, and providers to adjust to these new models.Conclusions: Lessons learned as a function of rapid changes in care models have implications for the field of neuropsychology as a whole as well as for future flexibility in meeting the needs of pediatric patients and their families.

Transitioning to telehealth neuropsychology service: Considerations across adult and pediatric care settings.

Objectives: In response to the 2020 COVID-19 pandemic, traditional, in-person neuropsychological assessment services paused in most settings. Neuropsychologists have sought to establish new guidelines and care models using telehealth neuropsychology (teleNP) services. The need to adapt to remote technology became the most difficult challenge to date for existing practice models. Results: Primary considerations for transitioning to teleNP include scope and limitations of the telehealth modality, informed consent for telehealth services, patient privacy and confidentiality, test security, and validity of telehealth assessments. Given timelines for fully re-opening clinical settings, access to traditional models of neuropsychological care remains unclear. These considerations will remain relevant even upon return to an in-office practice, as many assessment models will likely continue with teleNP to some extent. Specialists will need to consider the unique needs of their populations in ensuring quality care, as diagnostic differences and patient age will impact participation in teleNP. Conclusions: As the COVID-19 pandemic lingers, teleNP presents an opportunity as well as a challenge for neuropsychologists looking to provide patient care in the context of social distancing and stay-at-home restrictions. In this transformative time, the field of neuropsychology has opportunities to advance beyond traditional settings and focus on alternative delivery of patient care.

2020 COVID-19 American Academy of Clinical Neuropsychology (AACN) Student Affairs Committee survey of neuropsychology trainees.

Objective: To conduct an online survey in order to understand neuropsychology trainees' perspectives during the COVID-19 pandemic and identify pertinent concerns, training gaps, and recommendations.Method: A total of 874 neuropsychology trainees (81% female) completed the 69-item survey. Of the included trainees, 48% were doctoral students, 17% were interns, and 35% were postdoctoral residents (50% of resident respondents were in their first year).Results: The majority of neuropsychology trainees reported some impact of the pandemic on their professional and/or personal life. Overall, the impact did not differ by training level, geographic location, or demographic factors. Trainees' primary professional concerns included uncertainty about the impact of the pandemic on their professional future, loss of clinical hours, and desire for increased and ongoing communication from their leadership. A notable percentage of trainees reported increased personal mental health symptoms (i.e. anxiety/depression; 74%/54%), as well as a number of other personal stressors. Despite the transition to telehealth (mostly interviews/feedback sessions), few trainees have prior training or experience in providing neuropsychological services via phone or video platform. A limited proportion of trainees (approximately 10%) were still seeing patients face-to-face for neuropsychological evaluations during the COVID-19 pandemic as of 14 April 2020.Conclusions: The COVID-19 pandemic is impacting neuropsychological training and the well-being of trainees. This survey highlights the importance of communication with trainees during uncertain times. Based on the survey results, recommendations were developed to assist neuropsychology organizations in developing initiatives to support trainees during the current pandemic and in the future.

A survey of international clinical teleneuropsychology service provision prior to and in the context of COVID-19.

Objective: Despite expansion of telecommunication strategies across health services and data supporting feasibility of videoconference-based neuropsychological assessment, relatively little is known about teleneuropsychology (TeleNP) use in practice. The current COVID-19 pandemic provides an opportunity for greater use of TeleNP and understanding of neuropsychologists' experience with this unique assessment medium.Methods: During the course of a no-cost global webinar related to practical/ethical considerations of TeleNP practice, attendees were invited to engage in a 26-question survey about their TeleNP use and related COVID-19 concerns. TeleNP practices before the COVID-19 pandemic and early on during the global outbreak were queried among survey participants, along with examination of TeleNP intentions following COVID-19.Results: Multiple countries were represented across five continents, with two-thirds of respondents being from the United States. Approximately one-fourth of respondents reported using TeleNP for clinical interview, feedback, and intervention prior to the onset of the COVID-19 pandemic, and approximately one-tenth of individuals used TeleNP for testadministration. Increased use of TeleNP for clinical interview, feedback, and intervention was reported within the first few weeks of the global COVID-19 outbreak, though the use of TeleNP for testing remained relatively unchanged. Most respondents indicated an intention for future use of TeleNP.Conclusions: Our findings suggest the use of TeleNP is increasing, although use of remote TeleNP testing is still developing. Findings also illustrate increasing use of TeleNP in the context of the COVID-19 pandemic and encourage follow-up investigation in future studies to understand the changing practices and rates of TeleNP provision over time.

COVID-19 issues related to pediatric neuropsychology and inpatient rehabilitation - challenges to usual care and solutions during the pandemic.

Objective: To describe the challenges related to COVID-19 affecting pediatric neuropsychologists practicing in inpatient brain injury rehabilitation settings, and offer solutions focused on face-to-face care and telehealth.Methods: A group of pediatric neuropsychologists from 12 pediatric rehabilitation units in North America and 2 in South America have met regularly since COVID-19 stay-at-home orders were initiated in many parts of the world. This group discussed challenges to clinical care and collaboratively problem-solvedsolutions.Results: Three primary challenges to usual care were identified, these include difficulty providing 1) neurobehavioral and cognitive assessments; 2) psychoeducation for caregivers and rapport building; and 3) return to academic instruction and home. Solutions during the pandemic for the first two areas focus on the varying service provision models that include 1) face-to-face care with personal protective equipment (PPE) and social distancing and 2) provision of care via remote methods, with a focus on telehealth. During the pandemic,neuropsychologists generally combine components of both the face-to-face and remote care models. Solutions to the final challenge focus on issues specific to returning to academic instruction and home after an inpatient stay.Conclusions: By considering components of in-person and telehealth models of patient care during the pandemic, neuropsychologists successfully serve patients within the rehabilitation setting, as well as the patient's family who may be limited in their ability to be physically present due to childcare, illness, work-related demands, or hospital restrictions.

Initial changes in neuropsychologists clinical practice during the COVID-19 pandemic: A survey study.

Objective: In light of the COVID-19 pandemic, a majority of clinicians have had to quickly and dramatically alter their clinical practices. Two surveys were administered on 3/26/2020 and 3/30/2020, respectively, to document immediate changes and challenges in clinical practice.Method: Two surveys were administered between 3/26/2020 and 3/30/2020, via SurveyMonkey and Google Forms, asking clinicians questions pertaining to practice issues during the early stages of the COVID-19 pandemic. Quantitative responses from the second survey were stratified by clinical setting (Medical Hospital vs. Private Practice) prior to analysis. Qualitative, free-response items were coded by the authors to better understand immediate changes in practice and other concerns.Results: 266 neuropsychologists completed Survey 1 and 230 completed Survey 2. Results suggest that practices immediately moved towards remote service provision. A meaningful proportion of clinicians and their staff were immediately affected economically by the pandemic, with clinicians in private practice differentially affected. Furthermore, a small but significant minority of respondents faced ethical dilemmas related to service provision and expressed concerns with initial communication from their employment organizations. Respondents requested clear best-practice guidelines from neuropsychological practice organizations.Conclusions: It is clear that field of neuropsychology has drastically shifted clinical practices in response to COVID-19 and is likely to continue to evolve. While these responses were collected in the early stages of stay-at-home orders, policy changes continue to occur and it is paramount that practice organizations consider the initial challenges expressed by clinicians when formulating practice recommendations and evaluating the clinical utility of telehealth services.

Emory university telehealth neuropsychology development and implementation in response to the COVID-19 pandemic.

Objectives: Emory University has modified its clinical practices across specialties in response to the 2020 COVID-19 pandemic to provide service delivery while maintaining patient, staff, and faculty safety. This report shares current solutions and workarounds associated with telehealth neuropsychology (teleNP) while also recognizing teleNP opportunities.Results: We modified many measures from our traditional assessment protocols so they could be administered through Zoom. To maximize quality control, formal how-to coversheets and manuals were developed for both training and task administration (i.e. navigating Zoom assessment interfaces, practicing adapted test instructions, and troubleshooting).Conclusions: TeleNP has been successfully used to answer referral questions regarding deep brain stimulation (DBS) candidacy in Parkinson's disease patients and presence of mild neurocognitive impairment in patients with subjective memory decline. Our current protocols will continue to evolve with greater experience and are not considered to be a finished product. Nevertheless, development of robust teleNP protocols should expand availability of neuropsychology in both clinical and research applications while simultaneously decreasing assessment burden associated with traveling - sometimes long distances - for diagnostic neuropsychological evaluation.

Traces of culture: The feedback loop between behavior, brain, and disorder.

Culture is part of an extensive series of feedback loops, which involve multiple organismic levels including social contexts, cognitive mediations, neural processes, and behavior. Recent studies in neuroscience show that culturally contingent social processes shape some neural pathways. Studying the influence of cultural context on neural processes may yield new insights into psychiatric disorders. New methodologies in the neurosciences offer innovative ways to assess the impact of culture on mental health and illness. However, implementing these methodologies raises important theoretical and ethical concerns, which must be resolved to address patient individuality and the complexity of cultural diversity. This article discusses cultural context as a major influence on (and consequence of) human neural plasticity and advocates a culture-brain-behavior (CBB) interaction model for conceptualizing the relationship between culture, brain, and psychiatric disorders. Recommendations are made for integrating neuroscientific techniques into transcultural psychiatric research by taking a systems approach to evaluating disorders.

Steady at the helm: Neuropsychology into the next decade.

In this inaugural editorial, as the new editor of Neuropsychology, I would like to describe my vision and priorities for the journal. My vision is to build on Neuropsychology's strengths and successes to date while also anticipating the changes needed to remain one of the leading journals in the field of neuropsychology. The most critical element in a journal's success is its content. Neuropsychology is characterized by amazing breadth, spanning basic and clinical science across the life span. The journal is extremely relevant to society and public health, given the high incidence of neurological disease and brain injury, as well as the resulting human, economic, and societal costs associated with them. At the same time, neuropsychological research also can provide important insights into more positive aspects of human function, such as resilience, creativity, altruism, and friendship, and thereby help to understand and promote wellness. Thus, Neuropsychology will continue to provide an outlet for the most interesting and highest quality science in human brain-behavior relationships that seeks to increase our understanding of neuropsychological functions in both healthy and disordered states. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Evolution of clinical neuropsychology: Four challenges.

Quantitative and evidence-based approaches fail to capture "the whole person," neglect the important contributions of nonquantitative variables to understanding behavior, and have limitations when assessing individuals who fall outside traditional normative groups. The emphasis on quantitative and evidence-based practices is one challenge facing the profession. The lack of consensual definitions for various domains of interest is a second challenge, because it hinders research, poses communication challenges, and impedes the accumulation of knowledge about human behavior. A third challenge the profession faces is an overemphasis on the biological basis of behavior. Finally, the forth challenge is the impact of technology on practice. Since the 1970s, there has been a rapid advance in our ability to investigate the brain, resulting in a significant increase of information about brain functioning, making it difficult for clinicians to stay abreast of changes in the field. Advances in technology have resulted in "assessments" being completed by nonpsychologists. To place these and related challenges in context, a brief review of the history of assessment and efforts to investigate brain functioning will be presented. It is suggested that failure to meet these challenges will contribute to the demise of the profession. Suggestions for meeting these challenges are offered.

Why are neuropsychologists so reluctant to embrace modern assessment techniques?

OBJECTIVE: Computerized tests and use of the internet offer many opportunities for improvement of neuropsychological assessment over traditional paper-and-pencil tests. Nevertheless, many clinical neuropsychologists are conservative in their choice of tests when assessing patients; the majority still seems to prefer using well-established paper-and-pencil tests. METHOD: This deliberately one-sided opinion paper discusses several reasons that may explain the reluctance to embrace modern techniques. These reasons are of a psychometric, technical, theoretical, and strategic nature. CONCLUSIONS: A range of issues regarding each of these reasons need to be solved before digital assessment techniques can fulfill their promises. In the meantime, it seems wise to be cautious, and to be critical in adopting the digital assessment techniques.

Introduction to the special issue: Are modern neuropsychological assessment methods really "modern"? Reflections on the current neuropsychological test armamentarium.

OBJECTIVE: We introduce this special issue which focuses on how advances in neuroscience and technology can modernize and transform clinical neuropsychological assessment. METHOD: We included both invited and solicited papers to reflect on the strengths and weaknesses of currently used, standardized neuropsychological tests and to explore how we might incorporate new technologies and neuroscientific advances to modernize neuropsychological assessment methods. RESULTS: The papers are organized along the following themes: (1) A critique of the current clinical neuropsychological test armamentarium; (2) A description of new opportunities for collecting neurobehavioral data with technology; (3) Digital science, biomedical big data and the internet; (4) Integrating neuropsychological, neuroimaging, and neurophysiological assessments; (5) Modernization, globalization and culture. CONCLUSION: The process of modernizing methods of assessment in clinical neuropsychology is laborious and requires a coordinated, sustained effort among clinicians, researchers, and the test industry. While embracing technology is necessary, we must also be aware of unintended consequences as we navigate this exciting new territory.

National Institutes of Health initiatives for advancing scientific developments in clinical neuropsychology.

OBJECTIVE: The current review briefly addresses the history of neuropsychology as a context for discussion of developmental milestones that have advanced the profession, as well as areas where the progression has lagged. More recently in the digital/information age, utilization and incorporation of emerging technologies has been minimal, which has stagnated ongoing evolution of the practice of neuropsychology despite technology changing many aspects of daily living. These authors advocate for embracing National Institutes of Health (NIH) initiatives, or interchangeably referred to as transformative opportunities, for the behavioral and social sciences. These initiatives address the need for neuropsychologists to transition from fragmented and data-poor approaches to integrated and data-rich scientific approaches that ultimately improve translational applications. Specific to neuropsychology is the need for the adoption of novel means of brain-behavior characterizations. METHOD: Narrative review Conclusions: Clinical neuropsychology has reached a developmental plateau where it is ready to embrace the measurement science and technological advances which have been readily adopted by the human neurosciences. While there are ways in which neuropsychology is making inroads into these areas, a great deal of growth is needed to maintain relevance as a scientific discipline (see Figures 1, 2, and 3) consistent with NIH initiatives to advance scientific developments. Moreover, implications of such progress require discussion and modification of training, ethical, and legal mandates of the practice of neuropsychology.

Digital neuropsychology: Challenges and opportunities at the intersection of science and software.

OBJECTIVE: Digital devices are now broadly accessible and have the capacity to measure aspects of human behavior with high precision and accuracy, in a standardized manner. The purpose of this article is to characterize opportunities and barriers for modern digital neuropsychology, particularly those that are unique to digital assessment. METHODS: We provide a critical overview of the state-of-the-art in digital neuropsychology, focusing on personal digital devices. RESULTS: We identify three major barriers associated with digital neuropsychology, which affect both the interpretation of test scores and test norms: (1) variability in the perceptual, motor and cognitive demands of the same test across digital device classes (e.g. personal computer, tablet and smartphone); (2) hardware and software variability between devices within the same class that affect stimulus presentation and measurement and (3) rapid changes over time in hardware, software and device ownership, which can lead to rapid obsolescence of particular tests and test norms. We offer specific recommendations to address these barriers and outline new opportunities to understand and measure neuropsychological functioning over time and in everyday environments. CONCLUSIONS: Digital neuropsychology provides new approaches for measuring and monitoring neuropsychological functioning, informed by an understanding of the limitations and potential of digital technology.