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Digital outcome measures show promise, demonstrating sensitivity to disease severity changes in ataxia and strong correlations with clinical scales. The objective of this study was to develop a smartphone application for SPAX (SPAX-app) to obtain valid digital outcome measures for use in clinical trials. The app contains four tasks assessing gait, standing balance (stance), and finger and hand movements. We carried out a validation study in 22 SPAX patients and 10 controls. Subjects performed the tasks three times during one visit. In parallel, we performed Ambulatory Parkinson\u2019s Disease Monitoring (APDM) sensor recordings, Q-motor upper limb assessment, and the Scale for the Assessment and Rating of Ataxia (SARA). Significant correlations were found between the SPAX-app and APDM or Q-motor for step time (<jats:italic>r<\/jats:italic>\u2009=\u20090.91), all measures of stance (<jats:italic>r<\/jats:italic>\u2009=\u20090.51\u20130.87) and duration of hand alternation (<jats:italic>r<\/jats:italic>\u2009=\u20090.64). No significant correlations were found for variability measures (e.g. standard deviation of step time). All tasks of the SPAX-app, except for stance, can discriminate SPAX from controls and show moderate to high test-retest reliability (ICC 0.67\u20130.97). Significant correlations were found between SARA and step time (<jats:italic>r<\/jats:italic>\u2009=\u20090.70), inter-onset interval in finger tapping (<jats:italic>r<\/jats:italic>\u2009=\u20090.57), and duration of hand alternation (<jats:italic>r<\/jats:italic>\u2009=\u20090.65). The stance task did not show significant correlations with SARA. With the SPAX-app, we present a set of digital outcome measures for potential use in clinical trials. Longitudinal studies are needed to evaluate whether these measures can track disease progression.<\/jats:p>","DOI":"10.1007\/s12311-025-01820-3","type":"journal-article","created":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T07:25:36Z","timestamp":1742801136000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Smartphone Application for Spastic Ataxias: Cross-Sectional Validation of a Newly Developed Smartphone App for Remote Monitoring in Spastic Ataxias"],"prefix":"10.1007","volume":"24","author":[{"given":"Ilse H. 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This study was approved by the medical ethical committee of Arnhem-Nijmegen (CMO-2020-6245). All participants provided written informed consent before enrollment.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"Ilse H.J. Willemse was supported by ZonMw (The Netherlands Organisation for Health Research and Development; grant number 463002002). Jorik H. Nonnekes has received research support from ZonMW, Parkinson Foundation, Michael J Fox Foundation and Gossweiler Foundation. Bart P.C. van de Warrenburg has received research support from ZonMw, Dutch Scientific Organization, Hersenstichting, Radboudumc, and the Christina Foundation, and has received consultancy fees from Biogen, Biohaven Pharmaceuticals, Servier, and Vico Therapeutics. Matthis Synofzik has received consultancy honoraria from Ionis, UCB, Prevail, Orphazyme, Biogen, Servier, Reata, GenOrph, AviadoBio, Biohaven, Zevra, Lilly, and Solaxa, all unrelated to the present manuscript. Rebecca Sch\u00fcle received sponsoring and honoraria by Abbvie, Bial, Everpharma and Stada, all unrelated to the manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Financial Disclosures for the Previous 12 Months"}},{"value":"SM and CT own a share in the spin-off company of the University of Bologna, mHealth Technologies s.r.l. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}],"article-number":"71"}}