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Reoli R, Therrien A, Millar J, Hill N, Varghese R, Roemmich R, Whitall J, Bastian A, Keller J. The Scale for Assessment and Rating of Ataxia Is Reliable and Valid in the Telehealth Setting for Patients With Cerebellar Ataxia. Phys Ther 2024; 104:pzad166. [PMID: 38051602 PMCID: PMC10921830 DOI: 10.1093/ptj/pzad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/03/2023] [Accepted: 10/17/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE Health care has increasingly expanded into a hybrid in-person/telehealth model. Patients with a variety of health conditions, including cerebellar ataxia, have received virtual health evaluations; however, it remains unknown whether some outcome measures that clinicians utilize in the telehealth setting are reliable and valid. The goal of this project is to evaluate the psychometric properties of the Scale for Assessment and Rating of Ataxia (SARA) for patients with cerebellar ataxia in the telehealth setting. METHODS Nineteen individuals with cerebellar impairments were recruited on a voluntary basis. Participants completed 2 30-minute testing sessions during which a clinical examination and the SARA were performed. One session was performed in person, and the other session was assessed remotely. Outcome measure performance was video recorded in both environments and independently scored by 4 additional raters with varying levels of clinical experience (ranging from 6 months to 29 years). Concurrent validity was assessed with the Spearman rank order correlation coefficient (α < .05), comparing the virtual SARA scores to their gold standard in-person scores. Interrater reliability was evaluated with the intraclass correlation coefficient (ICC) (2,4) (α < .05). RESULTS Fourteen of the 19 participants completed both in-person and telehealth SARA evaluations. We found that the in-person SARA and the telehealth SARA have large concurrent validity (Spearman rho significant at the 2-tailed α of .01 = 0.90; n = 14). Additionally, raters of varying years of experience had excellent interrater reliability for both the in-person SARA (ICC [2,4] = 0.97; n = 19) and the telehealth SARA (ICC [2,4] = 0.98; n = 14). CONCLUSION Our results show that the telehealth SARA is comparable to the in-person SARA. Additionally, raters of varying years of clinical experience were found to have excellent interrater reliability scores for both remote and in-person SARA evaluations. IMPACT Our study shows that the SARA can be used in the telehealth setting for patients with ataxia.
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Affiliation(s)
- Rachel Reoli
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of Rehabilitation Sciences, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Amanda Therrien
- Moss Rehabilitation Research Institute, Thomas Jefferson University, Elkins Park, Pennsylvania, USA
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jennifer Millar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Nayo Hill
- Department of Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Rini Varghese
- Department of Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ryan Roemmich
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jill Whitall
- Department of Rehabilitation Sciences, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Amy Bastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Department of Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Keller
- Department of Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Reoli R, Cherry-Allen K, Therrien A, Keller J, Leech K, Whitt AL, Bastian A. Can the ARAT Be Used to Measure Arm Function in People With Cerebellar Ataxia? Phys Ther 2020; 101:6039314. [PMID: 33336704 PMCID: PMC7899061 DOI: 10.1093/ptj/pzaa203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/13/2020] [Accepted: 10/26/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE For people with ataxia, there are validated outcome measures to address body function and structure (BFS) impairments and participation; however, no outcome measure exists for upper extremity (UE) activity level in this population. The purpose of this study was to determine whether the action research arm test (ARAT), a measure of UE activity validated for other neurological conditions, might be a useful outcome measure for capturing UE activity limitations in ataxia. METHODS A total of 22 participants with ataxia were evaluated to assess construct validity of the ARAT; 19 of the participants were included in the interrater reliability assessment. Participants received a neurologic examination and completed a battery of outcome measures, including the ARAT. ARAT performance was video recorded and scored by 4 additional raters. RESULTS For construct validity, Spearman rho showed a significant moderate relationship between the ARAT and BSF outcome measures. A small, nonsignificant relationship was noted for the ARAT and the participation measure. For interrater reliability, Spearman rho showed a large, significant relationship among all raters for the ARAT (range = .87-.94). High reliability was demonstrated using the intraclass correlation coefficient ([2,1] = .97). CONCLUSION The ARAT is moderately correlated with ataxia BFS outcome measures, but not with participation scores. The ARAT is a measure of UE activity, which is different from BFS and participation outcome measures. The ARAT was identified to have strong interrater reliability among raters with varying amounts of experience administering the ARAT. Thus, for the ataxic population, the ARAT may be useful for assessing UE activity limitations. IMPACT Ataxia can negatively affect reaching tasks; therefore, it is important to assess UE activity level in people with ataxia. Until this study, no outcome measure had been identified for this purpose. LAY SUMMARY People with ataxia may have difficulty with daily tasks that require reaching. The ARAT is an outcome measure that clinicians can use to assess UE activity limitations to help design a treatment program.
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Affiliation(s)
| | - Kendra Cherry-Allen
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Amanda Therrien
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Jennifer Keller
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Kristan Leech
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, USA
| | | | - Amy Bastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA,Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Abeysekara LL, Tran H, Pathirana PN, Horne M, Power L, Szmulewicz D. Multi-domain Data Capture and Cloud Buffered Multimodal Evaluation Platform for Clinical Assessment of Cerebellar Ataxia. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5640-5643. [PMID: 33019256 DOI: 10.1109/embc44109.2020.9176341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebellar Ataxia is a neurological disorder without an approved treatment. Patients will have impaired and uncoordinated motor functionality making them unable to complete their day-to-day activities. Ataxia clinics are established around the world to facilitate research and rehabilitate patients. However, the patients are generally evaluated by human - observation. Therefore, machine learning based data analysis is popular on motion captured via sensors. There are many neurological tests designed to analyse the motor impairments in different domains (such as upper limb, lower limb, gait, balance and speech). Clinicians follow scoring protocols to record the severity of patients for each domain test. This paper delivers a clinical assessment platform combining 12 neurological tests in 5 domains. It captures motion (from BioKin sensors), haptic and audio data (from the tablet or laptop screen). A data analysis system is hosted in a remote server which evaluates data to produce a severity score via different models built for each neurological test. The assessment platform clients and server communicate via a cloud buffer system. The scores input by the clinicians and predicted by the machine learning models are logged in the cloud database. This enables clinicians and doctors to view and compare the history of patient diagnosis. The server system is structured for automated score model upgrades via prompted approval. Thus, the most viable scoring model could be accommodated for each test based on longitudinal studies.
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Ataxia in Childhood: Epidemiological, Clinical and Neuroradiologic Features, and the Risk of Recurrence. IRANIAN JOURNAL OF CHILD NEUROLOGY 2017; 11:1-6. [PMID: 28883869 PMCID: PMC5582352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/23/2016] [Accepted: 09/06/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study was conducted on the demographic data, clinical characteristics, electroencephalography, neuroradiological findings, and their impact on the recurrence of ataxia. MATERIALS & METHODS A 3-yr retrospective review of 49 children with ataxia in Mofid Children Hospital, Tehran, Iran was conducted from Apr 2013 to Apr 2016. The demographic, clinical and paraclinical data were recorded in pre-prepared questionnaires. The patients were also classified in two groups of with or without recurrence and the results were compared. The diagnostic etiologies in our patients were classified as brain tumor, drug ingestion, encephalitis, post infectious immune-mediated disorders, pseudoataxia, trauma, congenital malformations of the central nervous system and hereditary ataxias. RESULTS Forty-nine children with ataxia were enrolled. The mean age of the patients with a recurrence of ataxia was more than those without a recurrence. Neurodevelopmental delay in patients with recurrence was more frequent than those without a recurrence. Abnormal findings in the neuroimaging were seen more in the patients with recurrence than those without recurrence. The most common cause of ataxia in patients with recurrence was hereditary ataxia and in patients without recurrence was a viral post infectious disorder. CONCLUSION After a mean follow-up period of 16.36 months (range: 2-37 months), 9 cases (18.4%) showed recurrence. Older age, abnormal neuroimaging, and neurodevelopmental delay should be considered as the risk factors of recurrence of ataxia in children.
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Subramony SH. Degenerative Ataxias: challenges in clinical research. Ann Clin Transl Neurol 2016; 4:53-60. [PMID: 28078315 PMCID: PMC5221462 DOI: 10.1002/acn3.374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 01/05/2023] Open
Abstract
The degenerative ataxias are a very heterogeneous group of disorders that include numerous genetic diseases as well as apparently “sporadic” entities. There has been an explosion of discoveries related to genetic defects and related pathomechanisms that has brought us to the threshold of meaningful therapies in some but not all of these diseases. There also continues to be lack of knowledge of the causation of disease in a sizeable proportion of these patients. The overall rarity of ataxias as a whole and certainly of the individual genetic entities together with slow and variable progression and variable prognosis in juxtaposition with a rapid development of possible therapies in the horizon such as gene replacement and gene knock‐down strategies places the ataxias in a unique position distinct from other similar neurodegenerative diseases. The pace of laboratory research seems not matched by the pace of clinical research and clinical trial readiness. This review summarizes the author's views on the various challenges in translational research in ataxias and hopes to stimulate further thought and discussions on how to bring real help to these patients.
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Affiliation(s)
- Sub H Subramony
- Department of Neurology University of Florida College of Medicine and McKnight Brain Institute Gainesville Florida
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