Amyotrophic Lateral Sclerosis (ALS) Score

Items (34):

(1) functional group (22 items)

(2) physical examination (11 items)

(3) emotional (1 item)

 

Functional group:

(1) hold up head

(2) chew food

(3) swallow

(4) speak

(5) turn in bed

(6) sit up

(7) empty bowel and bladder

(8) breathing

(9) cough

(10) write name

(11) use buttons or zippers

(12) feed self

(13) grip to lift self

(14) lift book or tray

(15) lift fork or pencil

(16) change arm position

(17) climb 1 flight of stairs

(18) walk 1 block

(19) walk across the room

(20) walk with assistance

(21) stand up

(22) change leg position

 

Ability	Points
normal	3
impaired	2
trace (severely impaired)	1
unable to perform	0

 

Physical examination:

(1) stretch reflexes in arms

(2) stretch reflexes in legs

(3) jaw jerk

(4) plantar response on right

(5) plantar response on left

(6) muscle fasciculations

(7) muscle wasting in face and tongue

(8) muscle wasting in arms and shoulders

(9) muscle wasting in legs and hips

(10) fatigability

(11) leg rigidity

 

Physical Parameter	Finding	Points
stretch reflexes in arms	normal	3
	hyper-reflexia	2
	hypo-reflexia	2
	absent	1
	clonic	0
stretch reflexes in legs	normal	3
	hyper-reflexia	2
	hypo-reflexia	2
	absent	1
	clonic	0
jaw jerk	absent	3
	present	2
	hyper	1
	clonic	0
plantar response on right	flexor	3
	mute	2
	equivocal	1
	extensor	0
plantar response on left	flexor	3
	mute	2
	equivocal	1
	extensor	0
fasciculations	none	3
	slight	2
	moderate	1
	severe	0
muscle wasting in face and tongue	none	3
	slight	2
	moderate	1
	severe	0
muscle wasting in arms and shoulders	none	3
	slight	2
	moderate	1
	severe	0
muscle wasting in legs and hips	none	3
	slight	2
	moderate	1
	severe	0
fatigability	none	2
	mild	2
	moderate	0
	severe	0
leg rigidity	none	2
	mild	2
	moderate	0
	severe	0

 

Emotional:

(1) emotional lability

 

Emotional Parameter	Finding	Points
lability	normal	3
	slight	2
	moderate	1
	severe	0

 

total ALS score =

= SUM(points for all 34 items)

 

Interpretation:

• minimum score: 0

• maximum score: 100

• The higher the score, the better the functional ability.

 

Limitations (Andres et al. mine):

• It is a subjective scale that is affected by inter-rater variability.

• The intervals between grades are uneven.

• Each item is weighted equally regardless of the overall distribution score on that item.

• Items with different significance for impairment are mixed together. Walking has 3 items with different significance for impairment.

• Improvement in some items could mask deterioration in others.