Changes in the relationship between upper limb ataxia and the Trail Making Test in multiple system atrophy patients before and after occupational therapy

Abstract

We have recently reported that intensive occupational therapy (OT) for multiple system atrophy of the cerebellar type (MSA-C) patients improves the upper extremity items of the Scale for the Assessment and Rating of Ataxia (SARA) and the Trail Making Test (TMT). Additionally, TMT may simultaneously measure upper extremity and attention function in patients with MSA-C. However, the relationship between improved upper extremity ataxia and improved attention function is unclear. Here, we aimed to analyze the changes in the correlation between SARA upper extremity items and TMT before and after intensive OT. The medical records of 12 inpatients with MSA-C with a mean age of 62 years were reviewed and included in this study. There was a positive, statistically significant Spearman’s rank correlation (P < 0.05; ρ [rs] > 0.3) between the SARA upper extremity items and TMT part B minus part A (TMT-D) before and after intensive OT. Among them, especially before OT, the correlation coefficient between hand pronation/pronation movements and TMT-D was the highest (rs = 0.87), and a strong correlation was found in the age-controlled rank partial correlation analysis (rs = 0.71). The results suggest that TMT-D can assess attentional/executive control abilities with hand and eye ataxia, including parkinsonism, even in patients with MSA-C. Our findings provide important information for evaluating the drive and for developing the eye-tracking version of TMT.