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Table 1 The items of the pilot scale

From: Validity and reliability of a pilot scale for assessment of multiple system atrophy symptoms

1. Gait (from SARA 1)
 Patient is asked (1) to walk at a safe distance parallel to a wall including a half-turn (turn around to face the opposite direction of gait) and (2) to walk in tandem (heel-to-toe) without support.
  0. Normal, no difficulties in walking, turning, or walking in tandem (up to one misstep allowed)
  1. Slight difficulties, only visible when walking 10 consecutive steps in tandem
  2. Clearly abnormal, tandem walking >10 steps not possible
  3. Considerable staggering, difficulties in half-turn, but without support
  4. Marked staggering, intermittent support of the wall required
  5. Severe staggering, permanent support of one stick or light support by one arm required
  6. Walking >10 m only with strong support (two special sticks or stroller or accompanying person)
  7. Walking <10 m only with strong support (two special sticks or stroller or accompanying person)
  8. Unable to walk, even if supported
2. Transfers (from BBS 5)
 Arrange chairs(s) for a pivot transfer. Ask patient to transfer one way toward a seat with armrests and one way toward a seat without armrests. Two chairs (one with and one without armrests) or a bed and a chair may be used.
  0. Able to transfer safely with minor use of hands
  1. Able to transfer safely definite need of hands
  2. Able to transfer with verbal cueing and/or supervision
  3. Needs one person to assist
  4. Needs two people to assist or supervise to be safe
3. Finger tapping (from UMSARS Part II–8)
 Patient taps thumb with index finger in rapid succession with widest amplitude possible, with each hand for at least 15 to 20 s. Rate the worst affected limb. Note that impaired performance on this task can be caused by bradykinesia and/or cerebellar incoordination. Rate functional performance regardless of underlying motor disorder.
  0. Normal.
  1. Mildly impaired.
  2. Moderately impaired.
  3. Severely impaired.
  4. Can barely perform the task.
4. Handwriting (from UMSARS Part I–3)
  0. Normal
  1. Mildly impaired (all words are legible).
  2. Moderately impaired (up to half of the words are illegible).
  3. Markedly impaired (the majority of words are illegible).
  4. Unable to write
5. Standing unsupported with feet together (from BBS 7)
 Place your feet together and stand without holding
  0. Able to place feet together independently and stand 1 min safely
  1. Able to place feet together independently and stand for 1 min with supervision
  2. Able to place feet together independently but unable to hold for 30 s
  3. Needs help to attain position but able to stand 15 s feet together
  4. Needs help to attain position and unable to hold for 15 s
6. Turning to look behind over left and right shoulders while standing (from BBS 10)
 Turn to look directly behind you over toward left shoulder. Repeat to the right. Examiner may pick an object to look at directly behind the subject to encourage a better twist turn.
  0. Looks behind from both sides and weight shifts well
  1. Looks behind one side only other side shows less weight shift
  2. Turns sideways only but maintains balance
  3. Needs supervision when turning
  4. Needs assist to keep from losing balance or falling
7. Turning 360° (from BBS 11)
 Turn completely around in a full circle. Pause. Then turn a full circle in the other direction.
  0. Able to turn 360° safely in 4 s or less
  1. Able to turn 360° safely one side only in 4 s or less
  2. Able to turn 360° safely but slowly
  3. Needs close supervision or verbal cueing
  4. Needs assistance while turning
8. Body sway (from UMSARS Part II–13)
  0. Normal.
  1. Slight body sway and/or retropulsion with unaided recovery.
  2. Moderate body sway and/or deficient postural response; might fall if not caught by examiner.
  3. Severe body sway. Very unstable. Tends to lose balance spontaneously.
  4. Unable to stand without assistance.
  1. UMSARS Unified Multiple System Atrophy Rating Scale, SARA Scale for the Assessment and Rating of Ataxia, BBS Berg Balance Scale