International Cooperative Ataxia Rating Scale (ICARS)

walking capabilities

normal

0

almost normal, unable to walk with feet in tandem

1

abnormal but can walk without support

2

considerable staggering and difficulty at turns but walks without support

3

requires episodic support

4

requires one stick to walk

5

requires 2 sticks or stroller to walk

6

requires someone to support

7

unable to walk even if supported by someone (requires wheelchair)

8

gait speed

normal

0

slightly reduced

1

markedly reduced

2

extremely slow

3

unable to walk without support

4

standing capacity with eyes open

normal and can stand on one foot for 10 seconds

0

able to stand with feet together but cannot stand on 1 foot for 10 seconds

1

can stand with feet together but cannot stand with feet in tandem

2

cannot stand with feet together; able to stand in natural position without support, may show moderate sway

3

considerable sway when standing in natural position

4

unable to stand in natural position without strong support on one arm

5

unable to stand even with strong support

6

standing in natural position with eyes open

normal with <= 10 cm between medial malleoli

0

slightly increased distance between malleoli (11 to 25 cm)

1

clearly increased (26 to 35 cm)

2

severely increased (> 35 cm)

3

unable to stand in natural position

4

body sway with feet together, eyes open

normal

0

slight oscillation

1

moderate oscillations

2

severe oscillations (> 10 cm at the head)

3

immediately falls

4

body sway with feet together, eyes closed

normal

0

slight oscillation

1

moderate oscillations

2

severe oscillations (> 10 cm at the head)

3

immediately falls

4

quality of sitting position

normal

0

slight oscillations of trunk

1

moderate oscillations of trunk and legs

2

severe disequilibrium

3

impossible to sit

4

knee tibia test, left side

normal

0

lowering of heel in continuous axis

1

lowering of heel in axis but jerky

2

lowering with lateral movements

3

lowering with extreme lateral movements or testing impossible

4

knee tibia test, right side

normal

0

lowering of heel in continuous axis

1

lowering of heel in axis but jerky

2

lowering with lateral movements

3

lowering with extreme lateral movements or testing impossible

4

heel-to-knee test, left side

no trouble

0

action tremor stops as soon as the heel reaches the knee

1

action tremor stops within 10 seconds after the heel reaches the knee

2

tremor continues > 10 seconds

3

continuous tremor or testing impossible

4

heel-to-knee test, right side

no trouble

0

action tremor stops as soon as the heel reaches the knee

1

action tremor stops within 10 seconds after the heel reaches the knee

2

tremor continues > 10 seconds

3

continuous tremor or testing impossible

4

finger-to-nose test, decomposition and dysmetria on left side

no trouble

0

oscillating movement without decomposition

1

segmental movement in 2 phases and/or moderate dysmetria

2

segmental movement in 3+ phases and/or considerable dysmetria

3

dysmetria prevents the finger reaching the nose

4

finger-to-nose test, decomposition and dysmetria on right side

no trouble

0

oscillating movement without decomposition

1

segmental movement in 2 phases and/or moderate dysmetria

2

segmental movement in 3+ phases and/or considereable dysmetria

3

dysmetria prevents the finger reaching the nose

4

finger-to-nose test, intention tremor on left side

no trouble

0

simple swerve

1

moderate tremor with amplitude < 10 cm

2

tremor with amplitude 10 to 40 cm

3

severe tremor with amplitude > 40 cm

4

finger-to-nose test, intention tremor on right side

no trouble

0

simple swerve

1

moderate tremor with amplitude < 10 cm

2

tremor with amplitude 10 to 40 cm

3

severe tremor with amplitude > 40 cm

4

finger-to-finger test, left side

normal

0

mild instability

1

moderate oscillations with amplitude < 10 cm

2

considerable oscillations with amplitude 10 to 40 cm

3

jerky movements with amplitude > 40 cm

4

finger-to-finger test, right side

normal

0

mild instability

1

moderate oscillations with amplitude < 10 cm

2

considerable oscillations with amplitude 10 to 40 cm

3

jerky movements with amplitude > 40 cm

4

pronation-supination alternating movements, left side

normal

0

slightly irregular and slow

1

slow and irregular without sway of the elbow

2

slow and irregular with sway of the elbow

3

completely disorganized or impossible

4

pronation-supination alternating movements, right side

normal

0

slightly irregular and slow

1

slow and irregular without sway of the elbow

2

slow and irregular with sway of the elbow

3

completely disorganized or impossible

4

drawing Archimedes spiral

normal

0

slightly impaired

1

line completely out of pattern with recrossings and/or hypermetric swerves

2

major disturbance

3

completely disorganized or impossible

4

dysarthria, fluency of speech

normal

0

mildly abnormal

1

moderately abnormal

2

considerably slow and dysarthric speech

3

no speech

4

dysarthria, clarity of speech

normal

0

slight slurring

1

definite slurring but most words understandable

2

severe slurring and unable to understand most words

3

no speech

4

gaze-evoked nystagmus

normal

0

transient nystagmus

1

persistent and moderate

2

persistent and severe

3

ocular pursuit

normal

0

slightly saccadic

1

clearly saccadic

2

dysmetria of the saccade

none

0

bilateral over or undershoot of the saccade

1