Practicing in a pandemic: A clinician's guide to remote neurological care

Neurologists around the country and the world are rapidly transitioning from traditional in-person visits to remote neurologic care because of the corona virus disease 2019 pandemic. Given calls and mandates for social distancing, most clinics have shuttered or are only conducting urgent and emergent visits. As a result, many neurologists are turning to teleneurology with real-time remote video-based visits with patients, to provide ongoing care. Although telemedicine utilization and comfort has grown for many acute and ambulatory neurologic conditions in the past decade, remote visits and workflows remain foreign to many patients and neurologists. Here, we provide a practical framework for clinicians to orient themselves to the remote neurologic assessment, offering suggestions for clinician and patient preparation prior to the visit; recommendations to manage common challenges with remote neurologic care; modifications to the neurologic exam for remote performance, including subspecialty-specific considerations for a variety of neurologic conditions; and a discussion of the key limitations of remote visits. These recommendations are intended to serve as a guide for immediate implementation as neurologists transition to remote care. These will be relevant not only for practice today, but also for the likely sustained expansion of teleneurology following the pandemic.