**3. Common signs and symptoms and clinical assessment**

On the physical examination of neurological ataxic patients, one of the main neurological symptoms and signs to be investigated when locating lesions in the nervous system with a complete neurological examination. Recognizing its importance becomes crucial, especially when it comes to changes in gait, changes in speech, and abnormal eye movements. Another ability to research related to ataxia refers to the inability to coordinate the position of the head, trunk, and limbs. Ataxia can also be a sensory dysfunction, and not just a motor one, which can only be identified when the patient moves. Remember that it can also be confused with motor impairment [18]. However, the main difference between ataxia and paresis is that ataxia affects coordination without affecting strength, while paresis affects only strength, and they are often confused with each other. However, the type of ataxia is characterized by a complete neurological examination (mental status, gait – postural reactions (mainly), assessment of cranial nerves, spinal reflexes, and pain perception), and the main causes of ataxia can be separated into vestibular, sensory ataxia, cerebellar, and antalgic [19].

Common signs and symptoms of ataxic patients include gait abnormalities, slurred speech, difficulty walking, abnormal eye movements, difficulty swallowing, increased fatigue, incoordination in fine motor movements such as handwriting, buttoning shirts, typing, tremors, vertigo, and cognition problems [20]. Clinicians should ask patients whether any of the signs and symptoms are present, the level of functional disability in activities of daily living, onset, and progression. At this point, the clinical assessment of ataxia can be performed by a set of ataxia rating scales [21].

There are several ataxia rating scales based on different ataxic populations, and four scales are highlighted following:


Ataxia evaluative scales have psychometric properties such as feasibility, acceptability, consistency, and reproducibility. They are usually used in different ataxic populations [21] in a way that determines similarities and differences in the aspects of ataxia addressed. For example, SARA mainly assesses ataxia and motor performance, while ICARS is concerned with assessing vision and ocular motricity disorders. Autonomic functions and bulbar dysfunctions are assessed in both UMSARS and FARS. The SARA scale proves to be an ideal scale for rapid assessment of ataxia or in clinical settings that require rapid screening. UMSARS or FARS are more appropriate for assessing the impact of ataxia on general health, monitoring the progression of ataxia, activity of daily living, and the individual's disability [26].
