# Agreement Between Tele- and Face-to-Face Assessment of Neuromotor Development in High-Risk Children
## 4 Discussion
[32] explored a telemedicine-based examination of the lower limbs and back for children aged 3 to 18 years as a foundation for structured telematics pediatric musculoskeletal examination. Also, they found this assessment to increase providers' confidence in telemedicine practice. Additionally, previous studies agree with our results about the validity of the telematic assessment on gross motor skills in minor infants with specific objectives and age ranges. Specifically, [PERSON] et al. [33; 34] and [PERSON] et al. [35] used the AIMS and the General Movement Assessment. These studies also include the collaboration of caregivers to capture the child's movement to be evaluated by a professional. The difference lies in the timing of the professional intervention because their assessments were asynchronous. The parents made a video of the child's movement following some instructions and then uploaded the video to be analyzed later. In our study, the assessment allowed us to guide parents through the assessment. The tools selected to evaluate motor development are designed to be used in early developmental stages. The AIMS is a well-validated scale previously used for telemonitoring [21; 27]. The NEM focuses on sequential stages of motor evolution. It emphasizes a developmental framework, tracing milestones like postural control, locomotion, and manipulation, particularly suited for identifying delays in motor milestones [28; 29]. Other scales, such as the Gross Motor Function Measure, focus on functional abilities rather than sequential milestones and are tailored toward children with cerebral palsy and other motor impairments [17]. The Bayley Scale of Infant Development assesses broader developmental domains (cognitive, language, motor) rather than focusing solely on motor evolution and can be used for a broader age range but requires more time and detailed observations [20]. Along the same line, some studies contribute to showing the potential for telemabilization services in the pediatric population as a feasible practice. In this sense, the studies of [PERSON] et al. [36], [PERSON] et al. [37], and [PERSON] et al. [38] support the reliability of synchronic tele-assessments of the gross motor function in pediatrics. [PERSON] et al. [36] aimed to investigate the feasibility and validity of the telematic use of the Movement Assessment Battery for Children--2 nd Edition. This study included five 11-year-old children who performed one face-to-face and one telerehabilitation-mediated assessment using an iPad application. During the telematic evaluations, a non-expert adult helped the therapist when needed just as we received help from the children's caregivers. [PERSON] et al. [37] included in their study mostly children with leukodystrophy to assess the reliability of the telematic Gross Motor Function Measure-88 compared to in-person assessments. They were also helped by the parents when needed with the telematic assessment. [PERSON] et al. [38] assessed the feasibility of the remote use of a short neurodevelopmental assessment tool, the Brief Developmental Assessment (BDA), via Zoom. This tool includes a domain for gross and fine motor skills. They assessed children younger than 5 years with congenital heart disease and concluded with the acceptability of the remote use of the BDA for the developmental screening of children with congenital heart disease. Our study has implications for clinical practice and the development of telematic assessments and telematic surveillance of infants at high risk of developmental delays or motor impairment. Early intervention is key to addressing developmental challengesduring critical periods of neuroplasticity when the nervous system exhibits more adaptability. Telerehabilitation allows healthcare professionals to implement targeted strategies to identify and address neuromotor delays at an early stage, preventing their progression.