Remote evaluation of stereotypy in hypokinetic catatonia with the Timed Stereotypies Rating Scale

Abdelwahab Elshourbagy; Neeraj Kadubandi; Arifa Tasmiya; Adam Epstein; Landon Smith; Miriam van des Emde; Hazem Rezq; Jacqueline Barnett; James Brasic

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Remote evaluation of stereotypy in hypokinetic catatonia with the Timed Stereotypies Rating Scale

Abdelwahab Elshourbagy

^{*

1},

Neeraj Kadubandi

²,

Arifa Tasmiya

³,

Adam Epstein

⁴,

Landon Smith

³,

Miriam van des Emde

⁵,

Hazem Rezq

⁶,

Jacqueline Barnett

⁷,

James Brasic

^{8, 9, 10}

¹ Faculty of Applied Health Sciences / Clinical Laboratory Sciences, Misr University for Science and Technology, Cairo 12568, Egypt
² Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland 21218, USA
³ Boston University, Boston, Massachusetts 02215, USA
⁴ Touro University School of Medicine, New York 10010, USA
⁵ Department of Radiology, University of Michigan, Ann Arbor Michigan 48109, USA
⁶ Faculty of Medicine, Al-Azhar University, Cairo 11651, Egypt
⁷ Center for Cognition and Communication, New York 10016, USA
⁸ Department of Psychiatry, New York City Health and Hospitals/Bellevue, New York 10016, USA
⁹ Department of Psychiatry, New York University Grossman School of Medicine, New York 10016, USA
¹⁰ Russell H. Morgan Department of Radiology and Radiological Science, Division of Nuclear Medicine and Molecular Imaging, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA

Academic Editor: Woon‑Man Kung

Published: 04 March 2026 by MDPI in The 5th International Electronic Conference on Brain Sciences & 1st International Electronic Conference on Neurosciences session Behavioral Neuroscience

Abstract:

Background:

Stereotyped behaviors are a hallmark of neurodevelopmental disorders, but are often difficult to quantify in real-time, especially in remote clinical settings. These repetitive, non-goal-directed movements can provide critical diagnostic information, yet no dedicated tool currently exists for structured assessment via telehealth. In response, we utilized the Timed Stereotypies Rating Scale (TSRS) [Brašić JR. Treatment of movement disorders in autism spectrum disorders. In: Hollander E (Editor). Autism Spectrum Disorders. Volume 24 of the Medical Psychiatry Series. ISBN 0-8247-0715-X, Marcel Dekker, Inc., New York. 2003;273-346] to identify and rate these behaviors in a patient with hypokinetic catatonia.

Objectives:

As part of an ongoing project [Kadubandi, et al. Development of a rating instrument to identify catatonia by virtual viewing of motor assessments. Zenodo, V3, 2025. https://doi.org/10.5281/zenodo.16061703], we tested the feasibility of applying the TSRS during remote clinical assessments using video recordings shared via teleconferencing platforms.

Methods:

Archived video recordings of a male displaying markedly reduced movements were shown to trained clinical raters during online meetings. The session host shared the screen to present each video. Raters independently used the TSRS to assess the presence, frequency, and severity of stereotyped motor behaviors. After individual ratings, consensus scores were discussed and documented for each video segment.

Results:

Fifteen valid observations were included in the analysis utilizing R. The internal consistency of the TSRS was high, demonstrated by a Cronbach’s alpha of 0.838 across 7 items. Inter-rater reliability was also strong. The Intraclass Correlation Coefficient (ICC) for average measures was 0.804 (95% CI: 0.611–0.923, p < 0.001), indicating excellent agreement among raters when averaging scores. The ICC for single measures was 0.370 (95% CI: 0.183–0.631, p < 0.001), suggesting fair reliability for individual raters.

Conclusions:

Preliminary application of the TSRS in remote settings shows promise as a structured method for evaluating catatonic behaviors virtually.

Keywords: Movement Disorders; Neurocognitive Disorders; Cronbach’s Alpha; Intraclass Correlation Coefficient (ICC); Reliability; Virtual Assessment