Ann Rehabil Med.  2011 Dec;35(6):772-780. 10.5535/arm.2011.35.6.772.

Usefulness of the Scale for the Assessment and Rating of Ataxia (SARA) in Ataxic Stroke Patients

• Kim BR
• Lim JH
• Lee SA
• Park S
• Koh SE
• Lee IS
• Jung H
• Lee J

• KMID: 2266802
• DOI: http://doi.org/10.5535/arm.2011.35.6.772

Abstract

OBJECTIVE
To examine the usefulness of the Scale for the Assessment and Rating of Ataxia (SARA) in ataxic stroke patients. METHOD: This was a retrospective study of 54 patients following their first ataxic stroke. The data used in the analysis comprised ambulation status on admission and scores on the SARA, the Korean version of the Modified Barthel Index (K-MBI) and the Berg Balance Scale (BBS). The subjects were divided into four groups by gait status and into five groups by level of dependency in activities of daily living (ADLs) based on their K-MBI scores. Data were subjected to a ROC curve analysis to obtain cutoff values on the SARA for individual gait status and levels of activity dependency. The correlations between the SARA, K-MBI and BBS scores were also computed.
RESULTS
There was significant correlation between the SARA and the K-MBI scores (p<0.001), and this correlation (r=-0.792) was higher than that found between the BBS and the K-MBI scores (r=0.710). The SARA scores of upper extremity ataxia categories were significantly related to the K-MBI scores of upper extremity related function (p<0.001). The SARA scores were also significantly correlated negatively with ambulation status (p<0.001) and positively with ADL dependency (p<0.001). In the ROC analysis, patients with less than 5.5 points on the SARA had minimal dependency in ADL, while those with more than 23 points showed total dependency.
CONCLUSION
SARA corresponds well with gait status and ADL dependency in ataxic stroke patients and is considered to be a useful functional measure in that patient group.

Keyword

Ataxia; Stroke; Scale for the assessment and rating of ataxia

MeSH Terms

Activities of Daily Living
Ataxia
Dependency (Psychology)
Gait
Humans
Retrospective Studies
ROC Curve
Stroke
Upper Extremity
Walking

Figure

• 

  Fig. 1 SARA score according to gait status. Values are mean±SD. Correlation is significant at the 0.01 level (2-tailed).

• 

  Fig. 2 SARA score according to dependency level of ADL. Values are mean±SD. Correlation is significant at the 0.01 level (2-tailed).

• 

  Fig. 3 The cutoff values measured by ROC curve analysis for independent gait (A), independent Q-cane gait (B) and independent walker gait (C) in the SARA. Cutoff values: (A) independent gait, 8; (B) independent Q-cane gait, 11.5: (C) independent walker gait, 11.25

• 

  Fig. 4 The cutoff values measured by ROC curve analysis for mild dependent ADL (A), moderate dependent ADL (B), severe dependent ADL (C) and total dependent ADL (D) in the SARA. Cutoff values: (A) mild dependent ADL, 5.5; (B) moderate dependent ADL, 10; (C) severe dependent ADL, 14.25; (D) total dependent ADL, 23.

• 

  Fig. 5 (A) Correlation between SARA and K-MBI scores (r=-0.792, p<0.01). (B) Correlation between BBS and K-MBI scores (r=0.710, p<0.01).

• 

  Fig. 6 Correlation between SARA-UE and K-MBI-UE scores (r=-0.569, p<0.01).

Reference

1. Hwang SH. Stroke and ataxia. Korean J Stroke. 1999; 1:139–145.

2. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther. 2008; 88:559–566. PMID: 18292215.

3. 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. PMID: 9094050.

4. 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. PMID: 16769946.

5. Kim HS, Lee KW, Sung DH, Hwang JH, Kim TU. Posturographic characteristics of lesion site in stroke patients. J Korean Acad Rehabil Med. 2000; 24:363–369.

6. Jung HY, Park BK, Shin HS, Kang YK, Pyun SB, Paik NJ, Kim SH, Kim TH, Han TR. Development of the Korean Version of Modified Barthel Index (K-MBI): multicenter study for subjects with stroke. J Korean Acad Rehabil Med. 2007; 31:283–297.

7. Jung HY, Kim TH, Park JH. Relationship between Berg Balance Scale and functional independence measure in stroke patients. J Korean Acad Rehabil Med. 2005; 29:167–170.

8. Berg K, Wood-Dauphinee S, Williams JI, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can. 1989; 41:304–311.

9. Dettmann MA, Linder MT, Sepic SB. Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient. Am J Phys Med. 1987; 66:77–90. PMID: 3578493.

10. Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger C. Prediction of rehabilitation outcomes with disability measures. Arch Phys Med Rehabil. 1994; 75:133–143. PMID: 8311668.