When Gabriel Pardo MD, gives talks about the use of telemedicine in multiple sclerosis (MS), he likes
to show images from The Jetsons. This classic 1960s TV show somehow forecasted the invention of flat-screen TVs, smart watches, and even telemedicine. Telemedicine can serve as an effective alternative to in-person healthcare visits, Dr. Pardo told NARCOMS Now. “With the COVID-19 pandemic, telemedicine quickly went from an optional or even futuristic concept to an everyday necessity.” 

Dr. Pardo is Director of the Oklahoma Medical Research Foundation Multiple Sclerosis Center of Excellence in Oklahoma City. He believes that telemedicine services like virtual check- ups have advantages over traditional medical office visits by removing distance barriers
and providing easier access to care. “Many of our patients with MS have found the shift to telemedicine to be preferable in some ways,” he said. Eliminating the need to travel can take the pressure off of an upcoming appointment, not only for people who live a long distance from the MS care facility, but also for those with mobility limitations, fatigue, or other symptoms. “Even a person who lives in an urban area with MS care centers nearby may still need to obtain a ride or navigate public transportation,” Dr. Pardo said. “This is not always easy if one is using a walker or other assistive device.”

 

Navigating the Virtual Exam 

A neurologic examination may seem a strictly in-person process, but a health professional can perform a modified exam using a computer connection with video and sound. The healthcare provider may ask a person 

with MS to look at an object on the screen or in the room, or to move close to the screen and perform certain movements with the eyes, tongue, or jaw. Walking, gait, strength, and coordination can also be assessed remotely, although not as well as through
an in-person visit. “It can be helpful to have a family member or friend present during the appointment, to assist with some of the exam maneuvers,” Dr. Pardo suggested. This is especially helpful if the person with MS has issues with mobility, dizziness, or balance. 

Some parts of the complex neurologic exam cannot be performed virtually, Dr. Pardo noted. This includes a fundoscopic exam, which
looks at the retina of the eye, and a vestibular examination that studies eye movements and the inner ear. “Subtle changes in a person’s condition can be extremely meaningful and
can represent MS disease activity. This in turn may require changes or adjustments in the treatment,” Dr. Pardo said. “Although we can perform a modified version of the examination that is acceptable, it does not fully replace what we can do when evaluating a patient in person.” People who have been receiving their MS care mainly via telemedicine during the COVID-19 pandemic may want to discuss arrangements for an in-person visit, if the local facilities offer it and the benefits outweigh the risks. 

Tele-Rehabilitation

Like the neurologic exam, services such
as physical therapy (PT) are normally very hands-on. However, “tele-rehabilitation” is effective for people with MS. Dr. Pardo and his colleagues at the University of Oklahoma performed a study in 2018 evaluating an 8-week PT program attended by 30 people with MS. The participants were divided into 3 groups: Group 1 performed an unsupervised home-based exercise program for 5 days each week; Group 2 received at-home PT services that were supervised via audio/visual telecommunication (tele-rehabilitation) in real time, 2 times per week; and Group 3 had in-person PT at a medical facility 2 times per week. At the end of the study period, the researchers found no significant differences between the tele-rehabilitation group and the in-person rehabilitation group for many measures of MS function. They concluded that tele-rehabilitation is a feasible method to perform PT in persons with MS and is comparable to conventional in-person PT, as measured by patient-reported outcomes and objective measures of gait and balance. 

 

“We have moved forward a decade in the use of telemedicine in this country and it’s going to become - and will remain - an increasingly important part of medical practice going forward.” 

- Todd Askew, Senior Vice President of Advocacy, American Medical Association 

 

Patient Education 

In addition to tele-health visits and remote support for exercise or rehabilitation services, education for persons with MS can be enhanced online through an expanding array of webinars, podcasts, online articles, and apps. 

Apps for the smartphone or tablet can
help a person with MS track symptoms or communicate health information to health care providers. Some apps can be used to monitor real-time status of a person’s MS, by allowing users to perform tests such as 6-minute walk or cognitive and visual scales. Dr. Pardo suggests that patients be cautious about MS apps and discuss them with their healthcare provider, to ensure that the app provides the expected service, as well as secure the privacy of sensitive healthcare information. These apps are designed to provide general information, but cannot be a substitute for individual care. Dr. Pardo added that “We also want to be careful in case an app or other online source conveys false reassurance—that is, makes a person think a new symptom or oncoming relapse is not a concern,” Dr. Pardo added. “A healthcare professional should be consulted to help decide if appropriate treatment is needed.” 

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Telemedicine—The New Normal? 

Although we all look forward to an end or easing of the COVID-19 pandemic, many experts feel that telemedicine is here to stay. Now that certain restrictions have been
eased and payment systems have been put in place, healthcare groups are pushing to keep telemedicine moving forward. The technology is not always the best substitute for in-person care, Dr. Pardo said, but the good parts of 

it can be kept and improved upon to offer a balance that can benefit people with MS.