Scale for the Assessment and Rating of Ataxia (SARA)

Original Editor - Ajay Upadhyay

Top Contributors - Kate Sampson

Objective

SARA is a clinical scale developed by Schmitz-Hübsch et al which assesses a range of different impairments in cerebellar ataxia. The scale is made up of 8 items related to gait, stance, sitting, speech, finger-chase test, nose-finger test, fast alternating movements and heel-shin test.[1] Schmitz-Hübsch et al developed the Scale for the Assessment and Rating of Ataxia (SARA) as an alternative to The International Cooperative Ataxia Rating Scale (ICARS). The daily use of ICARS scale in ataxic patients is difficult due to its many assessment items.[2] This new assessment tool has fewer assessment items than the ICARS and therefore has the advantage of easier daily assessment of ataxia. [3]

Intended Population

Currently, the following types of Ataxia have been investigated:

Method of Use

The SARA is a tool for assessing ataxia. It has eight categories with accumulative score ranging from 0 (no ataxia) to 40 (most severe ataxia). When completing the outcome measure each category is assessed and scored accordingly. Scores for the eight items range as follows:

  1. Gait (0-8 points),
  2. Stance (0-6 points),
  3. Sitting (0-4 points)
  4. Speech disturbance (0-6 points)
  5. Finger chase (0-4 points)
  6. Nose-finger test (0-4 points)
  7. Fast alternating hand movement (0-4 points)
  8. Heel-shin slide (0-4 points)

Once each of the 8 categories have been assessed, the total is calculated to determine the severity of ataxia.

For motor activities of the four extremities (items 5-8), assessments are performed bilaterally, and the mean values are used to obtain the total score.

SARA.png SARA Pg. 2..png [9]


Evidence

Spinocerebellar Ataxia

Concurrent validity - Subramony et al found the SARA scale had excellent concurrent validity with the Barthel Index or with Unified Huntington’s Disease Rating Scale [10]

Inter/Intra rater reliability - Schmitz-Hübsch et al found the SARA scale to have high inter/intra rater reliability[3]

Ataxia in non Spinocerebellar patients

Freidreichs Ataxia

Construct validity: - Saute et al found the SARA had excellent construct validity with International Cooperative Ataxia Rating Scale (ICARS) and with Friedreich’s Ataxia rating Scale [8]

Ataxic Stroke patients

Kim et al found that SARA corresponds well with gait assessments and functional impairments. The scale showed correlation with the Korean Modified Bartel Index and Berg Balance Scale [6]

References

  1. Weyer A, Abele M, Schmitz-Hubsch T, Schoch B, Frings M, Timmann D. Reliability And validity of the scale for the assessment and rating of ataxia: a study in 64 Ataxia patients. Movement Disorders 2007;22:1633–7
  2. Trouillas P, Takayanagi T, Hallett M, Currier RD, Subramony SH, Wessel K, Bryer A, Diener HC, Massaquoi S, Gomez CM, et al. The Ataxia Neuropharmacology Committee of the World Federation of Neurology. International Cooperative Ataxia Rating Scale for pharmacological assessment of the cerebellar syndrome. J Neurol Sci. 1997;145:205–211.
  3. 3.0 3.1 3.2 Schmitz-Hübsch T, du Montcel ST, Baliko L, Berciano J, Boesch S, Depondt C, Giunti P, Globas C, Infante J, Kang JS, et al. Scale for the assessment and rating of ataxia: development of a new clinical scale. Neurology. 2006;66:1717–1720.
  4. Schmitz-Hübsch T, Fimmers R, Rakowicz M, Rola R, Zdzienicka E, Fancellu R, Mariotti C, Linnemann C, Schöls L, Timmann D, Filla A. Responsiveness of different rating instruments in spinocerebellar ataxia patients. Neurology. 2010 23;74(8):678-84.
  5. Ataxia UK. Management of the Ataxias: towards best clinical practice. November 2009 http://www.ataxia.org.uk/Pages/News/Category/clinical-guidlines (accessed 23 Feb 2016)
  6. 6.0 6.1 Kim BR, Lim JH, Lee SA, Park S, Koh SE, Lee IS, Jung H, Lee J.Usefulness Of the Scale For the Assessment And Rating Of Ataxia (SARA) In ataxic stroke patients.Ann Rehabil Med 2011;35:772–80
  7. Bürk K, Mälzig U, Wolf S, Heck S, Dimitriadis K, Schmitz‐Hübsch T, Hering S, Lindig TM, Haug V, Timmann D, Degen I. Comparison of three clinical rating scales in Friedreich ataxia (FRDA). Movement Disorders 2009. 15;24(12):1779-84.
  8. 8.0 8.1 Saute JA, Donis KC, Serrano-Munuera C, Genis D, Ramirez LT, Mazzetti P, Pérez LV, Latorre P, Sequeiros J, Matilla-Dueñas A, Jardim LB. Ataxia rating scales—psychometric profiles, natural history and their application in clinical trials. The Cerebellum. 2012 Jun 1;11(2):488-504.
  9. Ataxia Study Group. Scale for the Assessment and Rating of Ataxia. http://www.ataxia-study-group.net/html/about/ataxiascales/sara/SARA.pdf (accessed 23 Feb 2016)
  10. Subramony SH. SARA—a new clinical scale for the assessment and rating of ataxia. Nature clinical practice Neurology. 2007 Mar 1;3(3):136-7.