Short Parallel Assessments and Online Delivery

How Covid-19 ushered in the first empirical evidence for administering assessments of neuropsychological status online

“Can you hear me?... Can you hear me now?”

All of us are familiar with the sounds of remote calling, particularly after two years of learning to cope professionally within a pandemic world. From the early days of lockdown in March 2020, clinicians, psychologists and anyone else delivering critical outpatient appointments and assessments had to try to find a way to adapt to a new virtual reality – and adapt quickly, and with little guidance or evidence to support them.

For patients with neuropsychological needs – including acquired brain injury and suspected or diagnosed dementia or Alzheimer’s – visiting a memory clinic or hospital even on a normal day (never mind in the midst of a global pandemic) can be confusing, chaotic and sometimes scary. Add to that the very real issues associated with Covid-19 in terms of shielding vulnerable patients, difficulties with face masks, and generally having been isolated for two years – and suddenly remote assessment has become not just desired, but especially critical for some of our most vulnerable population.

In an exciting technological advance, an assessment for neuropsychological status has been developed specifically to be administered remotely, via an online videoconference platform. The Short Parallel Assessments of Neuropsychological Status – Extended (SPANS-X), a test battery for accurate cognitive measurement, expands upon the important work of its earlier edition in various ways – and includes essential empirical evidence from a validity/equivalency study, which compared demographically matched samples performances administering remote SPANS-X against traditional in-person administration.

Now, patients with neuropsychological needs can be assessed from home or clinic – and health care workers can be assured of the results.

How does this work?

As the ‘original’, in-person, face-to-face (FTF) SPANS administration required few paper materials and used mostly just a stimulus book and the administrator’s voice, it was possible to convert SPANS-X to online remote (REM) administration. As a result, the SPANS-X administrator should not find it difficult to shift between FTF and REM administration, as the situation requires.

The basis of REM administration is that you can administer SPANS-X to anyone in the world who has the suitable technology and aptitude, by simply ‘sharing screen’ while on an online videoconference platform with the examinee.

A validation study that examined equivalency between FTF and REM administrations can be found in the SPANS-X manual, which in summary found them suitably equivalent.

What technology do I require? And my patient?

Digital materials, including recordings to support a listening task (helping to avoid any confounding bias that may occur with delays in technology) are included with every SPANS-X kit. These will be made available online to download and use.

Familiarity with your computer is essential, and it must be capable of taking screenshots, have a built-in or external webcam and mic, and have access to a videoconferencing platform with ‘share screen’ capability. You should be fluent and adept at switching screen share on and off and use an audio headset for noise clarity and to reassure the examinees of their privacy.

Similarly, the examinee will require aptitude and/or assistance (from you or from someone with them). They will need access to a computer with webcam/videoconference capability and have a reliable internet connection.

What else can SPANS-X do?

The SPANS-X now boasts:

  • a norm for every age from 18 to 90 years, calculated using an innovative nonlinear regression process, for precise and accurate interpretation
  • equivalent alternate versions for reliable retest while minimising practice effects
  • ‘functional’ everyday skills for real-world application
  • simpler administration and new streamlined scoring for quick and accurate results
  • expanded interpretation guidance – including specific guidance for using the measure in different situations (such as assessing mental capacity, testing those with intellectual disability or with yes/no only responding, etc.)
  • new validation studies and updated reliability studies

For more on the SPANS-X, please contact us or attend our upcoming webinar with author Gerald H. Burgess.