15-White Dots APP-Coo-Test: a reliable touch-screen application for assessing upper limb movement impairment in patients with cerebellar ataxias

  • Giuseppe ArcuriaEmail author
  • Christian Marcotulli
  • Claudio Galasso
  • Francesco Pierelli
  • Carlo Casali
Original Communication



The use of objective measurements is essential to assess disease progression and to evaluate the effectiveness of rehabilitation protocols and clinical treatments.


The purpose of this study was to develop a touch-screen application, that we named 15-White Dots APP-Coo-Test (15-WDACT), able to carry out quantitative and objective measurements of the rapid and coordinated upper limb movements, typically impaired in patients with cerebellar ataxias (CA).


A total of 87 CA patients and 170 healthy subjects participated in this study. The subject was asked to touch with their index finger a white dot, appearing consecutively and randomly on the screen at different positions, for a total of 15 dots per session. The score is the execution time of a single session.


15-WDACT measurements have highly correlated with the scores obtained with the Scale for the Assessment and Rating of Ataxia (SARA), with the Composite Cerebellar Functional Severity (CCFS) and with the measurements obtained using two validated evaluating systems, i.e., the Nine Hole Pegboard test (9HPT) and the Click Test. We also observed high internal consistency and an excellent intra-rater and test–retest reliability. We found a small Standard Error of Measurement (SEM) and an excellent Minimal Detectable Change (MDC), indicating that even small variations in the 15-WDACT measurements are to be associated with real changes in performance.


We have concluded that 15-WDACT is an easy, fast and reliable tool to assess the severity of the upper limb ataxia in patients with CA.


Cerebellar ataxia Neurodegenerative diseases Upper limb movement impairment Quantitative assessment Touch-screen application SARA 


Compliance with ethical standards

Conflicts of interest

The manuscript has been approved by all the authors. The authors declare that they have no financial kind of relationships that might lead to a conflict of interest.

Ethical approval

This study was conducted in the Department of Medical and Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, at “Marco Pasquali” Institute—ICOT (Latina), from October 2016 to September 2018. All patients who participated to the study were informed of the use of measurements for research purposes and gave their written informed consent. All the procedures performed were in accordance with the ethical standards of the institutional and national research committee. The regulations of our institution concerning intellectual property has been respected. The ethical standards, laid down in 1964 Declaration of Helsinki and its later amendments, were respected.

Supplementary material

415_2019_9299_MOESM1_ESM.pdf (193 kb)
Supplementary material 1 How to select the APP-Coo-Test format (a) and how to download the PDF report (b) (PDF 194 kb)
415_2019_9299_MOESM2_ESM.pdf (107 kb)
Supplementary material 2 Four different examples of reports generated by the APP-Coo-Test. a refers to a healthy subject, while b, c and d refer to three patients with different ataxia levels as reported by a SARA score of 10, 20 and 30, respectively (PDF 107 kb)
415_2019_9299_MOESM3_ESM.pdf (307 kb)
Supplementary material 3 Some phases of the 15-WDACT: The patient selects the 15-WDACT on the screen (a), then presses the start button (b); the countdown that prepares the patient to perform the test starts (c, d, e); the first dot appears on the screen and the test begins (f); the patient types with their index finger on the 15 white dots that will appear on the screen sequentially in random positions (gi, lv); after reaching all the 15th white dots the test stops and the execution time appears on the screen (z) (PDF 307 kb)
415_2019_9299_MOESM4_ESM.mpg (1.3 mb)
Supplementary material 4 (MPG 1368 kb)
415_2019_9299_MOESM5_ESM.pdf (34 kb)
Supplementary material 5 (PDF 33 kb)
415_2019_9299_MOESM6_ESM.pdf (75 kb)
Supplementary material 6 (PDF 75 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medical and Surgical Sciences and Biotechnologies (DSBMC)Polo Pontino-University of Rome “Sapienza”LatinaItaly

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