Essential Tips for Videotaping a Movement Disorders Patient Encounter

The field of movement disorders relies more heavily on visual observation of phenomenology for diagnosis than most other fields of medicine, including other areas of neurology. The videotaped patient encounter has been used by movement disorder specialists as a learning tool since the field was founded, and in recent years it has become common practice to see videotaped patient encounters added to scientific articles. Some clinical trials incorporate “blinded” reviewers of videotapes to assess efficacy of the drug or surgical procedure being studied. The International Parkinson and Movement Disorder Society holds a “Video Challenge” session at its annual Congress, reflecting the importance of this method as a learning tool and a way of sharing knowledge. The digitization of visual media and ubiquity of smartphones and tablets have greatly simplified the process of videotaping patient encounters, as well as storing and sharing videos. In recent years, video recording using cell phone cameras is becoming more common, particularly among younger physicians. A video recording of a patient encounter adds invaluable information that goes beyond the traditional history and physical examination provided by the written medical record. Similar to the written record, the video record of a patient may aid in the diagnosis, monitoring of disease progression, or may be used for research or educational purposes.1 A videotaped patient encounter also enables the treating provider to consult with colleagues on challenging (difficult) cases, allowing the patient to be “examined” long distance by specialists. As the world population ages and the prevalence of Parkinson's disease (PD) is expected to rise in the coming years,2 the need for movement disorder specialists will increase. This increased demand may be difficult to meet through local providers alone, and may promote the implementation of remote patient encounters (telemedicine), with the provider based in a movement disorder specialty center. Teleneurology provides neurological expertise to rural areas with limited availability of neurologists and improves care for patients with difficulty traveling owing to neurological disease. Given that the use of teleneurology is expected to increase even more in the coming years,3, 4 the need for standardized, high-quality, comprehensive videotapes of patients with movement disorders will rise. In our experience, the quality of videos varies widely among clinicians. If obtained without attention to technique, the video can obscure important clinical findings and can even lead to diagnostic errors. However, following a few simple guidelines can maximize the quality of videos. As far as we know, there is only one publication in the literature proposing guidelines for producing a high-quality videotape patient encounter.5 However, it was geared toward a nursing audience, rather than movement disorders specialists, and written before the advent of digital technology. This is rather surprising given how common a diagnostic and pedagogical tool videotaping is for movement disorder specialists. The following guidelines were devised based on our collective experience from a large movement disorders academic center. They are intended primarily for movement disorder specialists, but many recommendations can be shared with other physicians wishing to consult regarding challenging cases, and even with patients who might be instructed to take videos of themselves at home to document phenomenology not observed in the office or to provide long-distance follow-up status. For medicolegal purposes, before videotaping a patient exam, written informed consent must be obtained from the patient.6 The physician should keep this consent together with all other medical documents. We find it preferable to videotape the signed consent form so that it is located directly with the patient's examination on the same video. Written informed consent is also important for facilitating sharing of the videotape with other providers, if needed. All relevant documents should be videotaped, such as the Montreal Cognitive Assessment, handwriting, and Archimedes spiral drawing, given that these tests frequently add valuable information regarding the diagnosis. Ideally, the videotape should be systematic and follow a consistent pattern. Though every physician will have his own style of examining the patient, we have found it works best to first videotape the patient while sitting, and then proceed in the examination in a rostral-caudal sequence, comparing the two sides after each exam maneuver. This is followed by having the patient arise from a sitting to a standing position (initially without pushing off, if the patient is able, and then pushing off with his or her hands if the patient fails to arise initially). The patient is then asked to walk for at least 5 meters in each direction in an unimpeded corridor with at least two turns to assess gait and turning. Walking is best observed by videotaping the patient walking away from and toward the camera, such that both arms and legs are visible at all times, rather than in a plane 90 degrees from the camera, from which one cannot observe the two sides of the patient's body at the same time. Postural reflexes are assessed with the pull test, which is often abnormal in classical parkinsonism, but may also be helpful in distinguishing between other movement disorders. For example, patients with Huntington's disease, dopa-responsive dystonia, and MSA frequently have positive pull tests, in contrast to patients with other forms of chorea, dystonia, and cerebellar ataxia, which do not affect postural stability. During the pull test or gait assessment, posture may be recorded as well. After these standing procedures, it is useful to observe the patient in the act of sitting down. This concludes the standard videotape. If clinically indicated, additional videotaping can be done to demonstrate the effect of postures or positions (e.g., lying supine) or specific tasks such as writing, talking, singing, biting, chewing, swallowing, drinking, holding objects, pouring water into a cup, running, tandem walking, walking backward, or standing on one leg. In almost all circumstances, the videotape can be performed with the patient fully clothed. In specific cases, it may be necessary to remove specific items of clothing obstructing anatomical locations of interest, as in, for example, foot dystonia or spinal myoclonus. The videotape is not uniform for all patients, although the general guidelines do apply to all cases. Different symptoms require focusing on specific tasks. While videotaping a patient, the camera should be placed directly in front of the patient (rather than off to one side) in order to observe for asymmetries between the two sides of the body. Any objects impairing the camera's view should be removed and care should be taken to avoid videotaping bystanders or family and friends accompanying the patient. The room should be well lit and be large enough to include the patient's entire body within the camera screen. Avoid backlighting by not aiming the camera toward windows or lamps. The background noise (air conditioners and fans) should be minimized in order not to miss relevant clinical signs, such as slurred speech or voice tremor. The photographer should alternately zoom in on the area of interest being examined and zoom out to show the whole body during motor activation. This can sometimes enhance involuntary movements in other parts of the body,7, 8 or cause the disappearance of movements by distraction as occasionally observed in patients with psychogenic movement disorders.9 The patient should sit with arms and legs uncrossed (hands in lap). The camera battery should be fully charged before beginning to videotape in order to maintain continuity of the exam. We recommend videotaping the patient at the first clinic visit in order to have a baseline audiovisual record with which to compare future clinical evaluations. Preferably, the camera operator is not simultaneously examining the patient given that some features of the exam may not be videotaped by the examiner. In the remainder of this article, we offer specific recommendations for videotaping an examination tailored to several common movement disorders. Videotaping the neurological examination is a valuable diagnostic, educational, and research tool and is especially important in the field of movement disorders, which relies heavily on critical observation of phenomenology. Many videotapes suffer from poor attention to technical issues, which can detract from the quality of the video both by obscuring as well as failing to highlight important clinical information. We hope that the tips for producing an effective video that we have outlined above will serve as a useful guide for clinicians, students, and educators and enhance the effectiveness of the videotaped patient encounter for diverse purposes. (1) Research Project: A. Conception, B. Organization, C. Execution; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript Preparation: A. Writing of the First Draft, B. Review and Critique. D.R.: 1A, 1B, 1C, 3A, 3B S.F.: 1B, 1C, 3B M.K.: 1A, 1B, 1C, 3A, 3B The authors thank David Payne for assistance with video editing. Funding Sources and Conflicts of Interest: The authors report no sources of funding and no conflicts of interest. Financial Disclosures for previous 12 months: The authors declare that there are no disclosures to report. Videos accompanying this article are available in the supporting information here. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.