Recommendations for Virtual Administration of the <scp>PSP</scp> Rating Scale

Our article validating a subset of the Progressive Supranuclear Palsy Rating Scale (PSPRS) for video administration1 has prompted questions about how best to administer the individual test items given the constraints of that medium and of the disease. In response, we wish to provide several recommendations below as guidance (Table 1). We recommend following the guidance provided by the International Parkinson and Movement Disorder Society on optimizing the physical video setup.2 If sound quality is poor, consider switching to a telephone for audio to assess voice and speech (while muting your microphone and speaker on the virtual platform). We recommend that the caregiver angles their camera to show the patient's entire body during the motor assessments, which may require moving the camera away from the patient or onto the floor. Ask the caregiver: “Does the patient grab onto the arms of chairs, peoples' arms, clothing, or tablecloths, inappropriately? Do they have difficulty letting go?” 1 = Slight or equivocal; 2 = Definitely present but no effect on daily activities; 3 = mild interference with daily activities; 4 = severe interference, interferes with feeding and dressing. This should be performed under the supervision of a caregiver who is comfortable preventing falls. A gait belt may be helpful. Use a hallway or open area if available, put the camera on the floor, and then ask the caregiver to guard the patient without touching them as they walk to prevent falls. The caregiver, in order to remain free to prevent falls, should not hold the camera during gait testing. If the caregiver feels that the patient is at high risk of falling, or must use a walker to prevent falls, score the item as 3 (must use assistance all or almost all the time). Use a non-wheeled chair. The caregiver or a wall should be behind the chair to prevent tipping backwards as the patient sits down. If the patient cannot resist using the arms of the chair, provide an armless chair. In summary, we believe that the majority of PSPRS items can be safely and accurately performed via video visits with minimal adjustments. This is of particular importance for patients who cannot travel to the clinical site because of distance, advanced motor disability, lack of transportation, or infectious disease constraints. The Geraldine A. Dolce Fund for Progressive Supranuclear Palsy (PSP) at Massachusetts General Hospital. Data sharing is not applicable to this article as no new data were created or analyzed in this study. (1) Research project: A. Conception, B. Organization, C. Execution; (2) Statistical analysis: A. Design, B. Execution, C. Review and critique; (3) Manuscript: A. Writing of the First Draft, B. Review and Critique. A.M.W.: 1A, 1B, 1C, 3A L.I.G.: 1A, 1C, 3B A.E.L.: 1A, 1C, 3B T.X.: 1C, 3B M.D.: 1C, 3B A.E.: 1C, 3B M.C.T.: 1C, 3B S.H.F.: 1C, 3B S.A.P.: 1C, 3B N.R.M.: 1C, 3B R.B.S.: 1C, 3B F.R.P.: 1C, 3B. S.A.G.: 1C, 3B A.P.: 1A, 1B, 1C, 3B The authors have no relevant conflicts of interest. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

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