From the Guidelines
Ataxia is a neurological disorder characterized by impaired coordination of voluntary movements, resulting from dysfunction in the cerebellum or its connections, and its assessment involves a combination of clinical examinations and neuroimaging, with MRI being the preferred modality for initial assessment. Ataxia manifests as unsteady gait, poor balance, slurred speech, difficulty with fine motor tasks, and irregular eye movements. The clinical evaluation of ataxia includes several key components:
- The finger-to-nose test to evaluate coordination
- The heel-to-shin test to assess lower limb coordination
- Rapid alternating movements to test the ability to perform quick, repetitive actions
- Gait assessment, including walking normally, in tandem, and standing with feet together (Romberg test)
- Speech evaluation to identify scanning dysarthria Additional assessments include the Scale for the Assessment and Rating of Ataxia (SARA) or International Cooperative Ataxia Rating Scale (ICARS) for quantitative measurement, as noted in 1. Neuroimaging, particularly MRI, is crucial for identifying structural abnormalities in the cerebellum or brainstem, and guiding appropriate treatment and management strategies, as emphasized in 1. The choice of imaging modality depends on the clinical context, with MRI being preferred for its superior visualization of the posterior fossa and detection of subtle changes, as discussed in 1.
From the Research
Definition of Ataxia
- Ataxia refers to a group of neurological disorders characterized by a lack of coordination during voluntary movements 2, 3, 4, 5.
- It is a neurological sign characterized by the incoordination of voluntary movements, and is the most prominent manifestation of cerebellar disease 3.
- Ataxia can affect walking, vision, and speech, and is a heterogeneous disorder with various causes, including genetic, toxic, and metabolic factors 3, 4.
Assessment of Ataxia
- The assessment of ataxia involves evaluating the patient's coordination, balance, and movement 3, 6.
- One of the most commonly used tests to assess upper-limb coordination is the Archimedes spiral test 2.
- The Scale for the Assessment and Rating of Ataxia (SARA) is a reliable and valid clinical scale used to measure the severity of ataxia 6.
- SARA assesses various aspects of ataxia, including gait, stance, sitting, speech, and limb coordination, and has been shown to be highly reliable and valid 6.
- Other assessment methods, such as frequency analysis, can also be used to evaluate ataxia, particularly in patients with autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) 2.