Validity and reliability of the International Cooperative Ataxia Rating Scale (ICARS) and the Scale for the Assessment and Rating of Ataxia (SARA) in multiple sclerosis patients with ataxia

Salcı, Yeliz; Fil, Ayla; Keklicek, Hilal; Çetin, Barış; Armutlu, Kadriye; Dolgun, Anıl; Tuncer, Aslı; Karabudak, Rana

doi:10.1016/j.msard.2017.09.032

Cited by 40 publications

(32 citation statements)

References 22 publications

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“…Various clinical balance and ataxia scales have been tested in MS cohorts and measured for potential correlation with EDSS or ability to predict falls, but results have been inconsistent and have not been applied to early MS cohorts with low overall disability. 32,33 As noted, our data demonstrate that balance impairment notably contributes to ambulatory dysfunction early in MS. These results align with previous work demonstrating that persons with MS exhibit several abnormalities of balance control (e.g., decreased ability to maintain position, slow movement toward limits of stability, and delayed responses to postural displacements), which all contribute to gait dysfunction and increased fall risk.…”

Section: Discussionsupporting

confidence: 73%

Detection of subtle gait disturbance and future fall risk in early multiple sclerosis

et al. 2020

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ObjectiveTo test the hypothesis that higher-challenge gait and balance tasks are more sensitive than traditional metrics to subtle patient-reported gait dysfunction and future fall risk in early multiple sclerosis (MS).MethodsPersons with early MS (n = 185; ≤5 years diagnosed) reported gait function (MS Walking Scale) and underwent traditional disability metrics (Expanded Disability Status Scale [EDSS], Timed 25 Foot Walk). Patients and healthy controls (n = 50) completed clinically feasible challenge tasks of gait endurance (2-Minute Walk Test), standing balance (NIH Toolbox), and dynamic balance (balance boards; tandem walk on 2 ten-foot boards of different widths, 4.5 and 1.5 in). MRI assessed global and regional brain volumes, total T2 lesion volume (T2LV), infratentorial T2LVs and counts, and cervical cord lesion counts. Falls, near falls, and fall-related injuries were assessed after 1 year. We examined links between all tasks and patient-reported gait, MRI markers, and fall data.ResultsPatients performed worse on higher challenge balance, but not gait, tasks compared with healthy controls. Worse patient-reported gait disturbance was associated with worse performance on all tasks, but only dynamic balance was sensitive to mild patient-reported gait difficulty. Balance tasks were more correlated with MRI metrics than were walking tasks or EDSS score. Thirty percent of patients reported either a fall or near fall after 1 year, with poor dynamic balance as the only task independently predicting falls.ConclusionsBalance plays a leading role in gait dysfunction early in MS. Clinically feasible higher-challenge balance tasks were most sensitive to patient-reported gait, MRI disease markers, and risk of future falls, highlighting potential to advance functional outcomes in clinical practice and trials.

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Section: Discussionsupporting

confidence: 73%

Detection of subtle gait disturbance and future fall risk in early multiple sclerosis

et al. 2020

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“…The ICARS is a clinical test that detects ataxia in five domains: posture, gait, kinetic, speech, and oculomotor function [ 39 , 40 ]. The ICARS has been reported as a reliable measure of ataxia in persons MS [ 41 ]. The score range is [0,100] with 0 representing no detectable impairment and 100 representing the highest level of impairment.…”

Section: Methodsmentioning

confidence: 99%

Targeted ballet program mitigates ataxia and improves balance in females with mild-to-moderate multiple sclerosis

et al. 2018

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BackgroundMultiple sclerosis (MS) is a disease of the central nervous system that causes ataxia and deficits in balance. Exercise-based therapies have been identified as integral to the recovery of motor function in MS, but few studies have investigated non-traditional movement interventions. We examined a targeted ballet program (TBP) designed to mitigate ataxia and improve balance in females with mild-to-moderate relapsing-remitting MS.Methods and findingsTwelve females with mild-to-moderate disability due to MS were assessed for study eligibility for the study. Ten participants met the inclusion criteria. Two were lost to unrelated health complications. Eight participants completed the TBP. The TBP met twice a week for 60 minutes for 16 weeks. Assessments included (a) the International Cooperative Ataxia Rating Scale (ICARS), (b) the Mini-Balance Evaluations Systems Test (Mini-BESTest), (c) smoothness of movement during a five-meter walk, and (d) balance in a step to stand task before and after the TBP. There were no TBP-related adverse events. Single-tailed paired samples t-tests and Wilcoxon tests were conducted. Improvements were observed in ICARS (p = 7.11E-05), Mini-BESTest (p = 0.001), smoothness of movement in the left (p = 0.027) and right (p = 0.028) sides of the body, and balance in a step-to-stand task in the back (p = 0.025) direction. Results yielded 42% and 58% improvements in the mean Mini-BESTest and ICARS scores, respectively.ConclusionsThis study adds to current research by providing support for a TBP intervention targeting ataxia and balance in MS. The TBP was well tolerated, improved balance, and mitigated ataxia. Clinical improvements were larger than those of previous studies on physical rehabilitation in MS with similar outcome measures.Trial registrationISRCTN ISRCTN67916624.

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“…47 In SCA, ICARS correlated with Barthel index (r = −0.70) and disease duration. 37 Other data also suggest validity in MSA, 40 MS with ataxic symptoms, 42 and FXTAS. 48 ICARS was also related to brain atrophy as measured by neuroimaging techniques.…”

Section: International Cooperative Ataxia Rating Scalementioning

confidence: 96%

Assessment of Ataxia Rating Scales and Cerebellar Functional Tests: Critique and Recommendations

Pérez-Lloret

Warrenburg

Rossi³

et al. 2020

Movement Disorders

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A BS TRACT: Background: We assessed the clinimetric properties of ataxia rating scales and functional tests, and made recommendations regarding their use. Methods: A systematic literature search was conducted to identify the instruments used to rate ataxia symptoms. The identified rating scales and functional ability tests were reviewed and ranked by the panel as "recommended," "suggested," or "listed" for the assessment of patients with discrete cerebellar disorders, using previously established criteria. Results: We reviewed 14 instruments (9 rating scales and 5 functional tests).

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Validity and reliability of the International Cooperative Ataxia Rating Scale (ICARS) and the Scale for the Assessment and Rating of Ataxia (SARA) in multiple sclerosis patients with ataxia

Cited by 40 publications

References 22 publications

Detection of subtle gait disturbance and future fall risk in early multiple sclerosis

Detection of subtle gait disturbance and future fall risk in early multiple sclerosis

Targeted ballet program mitigates ataxia and improves balance in females with mild-to-moderate multiple sclerosis

Assessment of Ataxia Rating Scales and Cerebellar Functional Tests: Critique and Recommendations

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