ALSFRS-R (Revised ALS Functional Rating Scale)

Paramters

Findings

Points

speech

normal

4

detectable speech disturbance

3

intelligible with repeating

2

speech combined with nonvocal communications

1

loss of useful speech

0

salivation

normal

4

slight but definite excess

3

moderate excess; minimal drooling

2

marked excess; some drooling

1

marked drooling

0

swallowing

normal

4

early problems; occasional choking

3

dietary consistency changes

2

needs supplemental tube feeding

1

NPO with parenteral or enteral feedings

0

handwriting

normal

4

slow or sloppy but legible

3

not all words are legible

2

able to grip pen but unable to write

1

unable to grip pen

0

cutting food and handling utensils

normal

4

slow and clumsy but no help needed

3

needs some help

2

provides minimal help to caregiver

1

unable to feed self

0

dressing and hygiene

normal

4

self care with effort or decreased efficiency

3

intermittent assistance or substitute methods

2

needs attendant

1

total dependence

0

turning in bed and adjusting bed clothes

normal

4

slow and clumsy

3

with great difficulty

2

needs assistance

1

helpless

0

walking

normal

4

some difficulties

3

walks with assistance

2

nonambulatory but with functional movement

1

no purposeful leg movements

0

climbing stairs

normal

4

slow

3

mild unsteadiness or fatigue

2

needs assistance

1

cannot do

0

dyspnea

none

4

while walking

3

with activities of daily living

2

at rest when either sitting or lying

1

significant with need for respiratory support

0

orthopnea

none

4

some difficulty sleeping at night; may use 2 pillows

3

needs 3 or more pillows to sleep

2

can only sleep sitting up

1

unable to sleep

0

respiratory insufficiency

none

4

intermittent use of BiPAP (bilevel positive airway pressure)

3

continuous use of BiPAP at night

2

continuous use of BiPAP day and night

1

invasive mechanical ventilation

0