Objective: To deliver palliative care via telemedicine in a video format to veterans at risk with movement disorders in need of palliative care in the age of COVID-19. We present the first proposed model for virtual health and palliative care for movement disorders in the Veteran population.

Background: Veterans are at risk for isolation when they have movement disorders that limit mobility and increase risk of infection due to advancing age. Palliative care can start at diagnosis of a progressive neurodegenerative disease^1,2. We present a Department of Defense and Veterans Affairs (VA) 5 million dollars initiative to provide telemedicine to veterans at risk.

Method: The VA had set up mobile cameras and computers at their neurology clinics to evaluate patients with movement disorders to be evaluated by a nurse practitioner on site and relayed live via video to the movement disorder neurologist at Walter Reed National Military Medical Centre (WRNMMC). This was done for veterans who could not travel to WRNMMC and during the initial phase of the COVID-19 epidemic March 2019 to March 2021.

Results: 10 Veterans were screened which included, 2- Lewy body dementia, 5-Parkinsons disease dementia, 1-Multi System Atrophy,1- Dystonia and1-Dopa Responsive dystonia.  All veterans were diagnosed and treated via telemedicine and follow up was done in 3 month intervals. There was no infection with COVID-19 and all has maintained mobility and access to rehabilitative services through specific referrals targeting specific symptoms. Therapy such as Big and Loud was also done virtually as an initial assessment. No veteran was hospitalized for falls or psychotic episodes or dystonic crisis through real time telemedicine management.

Conclusion: Telemedicine can be a potent tool in palliative medicine to reduce morbidity and mortality associate with progressive movement disorders. Virtual visits provide a warm contact for families in isolation and support needed during the COVID-19 epidemic^3,4. Virtual Health can be successful in palliative care of movement disorders with careful collaboration with nurse practitioners, who can provide a virtual exam in remote locations and real time care through collaboration with neurologists specialized in movement disorders. This can be a proof of concept model for health care delivery to Veterans in remote locations.

References: 1. Sokol LL, Kluger BM. Palliative Care for Persons Living With Parkinson Disease. JAMA. 2020 Oct 20;324(15):1579. doi: 10.1001/jama.2020.18333. PMID: 33079156. 2. Tuck KK, Tarolli CG. Palliative care and advance care planning in Parkinson disease. Neurology. 2019 May 28;92(22):1039-1040. doi: 10.1212/WNL.0000000000007555. Epub 2019 Apr 26. PMID: 31028128. 3. Wang SSY, Teo WZW, Teo WZY, Chai YW. Virtual Reality as a Bridge in Palliative Care during COVID-19. J Palliat Med. 2020 Jun;23(6):756. doi: 10.1089/jpm.2020.0212. Epub 2020 Apr 22. PMID: 32324080. 4. Dhahri AA, De Thabrew AU, Ladva N, Pardoe H. The Benefits and Risks of the Provision of a Hospital-Wide High-Definition Video Conferencing Virtual Visiting Service for Patients and Their Relatives. Cureus. 2021 Feb 19;13(2):e13435. doi: 10.7759/cureus.13435. PMID: 33633917; PMCID: PMC7899281.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/palliative-care-evaluation-for-movement-disorders-during-covid-19-using-tele-neurology-to-provide-real-time-care-for-an-at-risk-veterans-population/