Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R)
Speech
Normal
Detectable speech disturbance
Intelligible with repeating
Speech combined with non-vocal communications
Loss of useful speech
Salivation
Normal
Slight but definite excess of saliva in mouth; may have nighttime drooling
Moderately excessive saliva; may have minimal drooling
Marked excess of saliva with some drooling
Marked drooling; requires constant tissue or handkerchief
Swallowing
Normal eating habits
Early eating problems; occasional choking
Dietary consistency changes
Needs supplemental tube feedings
NPO; exclusively parenteral or enteral feeding
Handwriting
Normal
Slow or sloppy; all words are legible
Not all words are legible
Able to grip pen but unable to write
Unable to grip pen
Cutting food and handling utensils
Normal (patients with/without gastrostomy)
Somewhat slow and clumsy but no help needed (patients without gastrostomy
Can cut most foods, although clumsy and slow, some help needed (patients without gastrostomy)
Food must be cut by someone but can still feed slowly (patients without gastrostomy)
Needs to be fed (patients without gastrostomy)
Clumsy but able to perform all manipulations independently (patients with gastrostomy)
Some help needed with closures and fasteners (patients with gastrostomy)
Provides minimal assistance to caregiver (patients with gastrostomy)
Unable to perform any aspect of task (patients with gastrostomy)
Dressing and hygiene
Normal function
Independent and complete self-care with effort or decreased efficiency
Intermittent assistance or substitute methods
Needs attendant for self-care
Total dependence
Turning in bed and adjusting bed clothes
Normal
Somewhat slow and clumsy but no help needed
Can turn alone or adjust sheets but with great difficulty
Can initiate but not turn or adjust sheets alone
Helpless
Walking
Normal
Early ambulation difficulties
Walks with assistance
Non-ambulatory functional movement
No purposeful leg movement
Climbing stairs
Normal
Slow
Mild unsteadiness or fatigue
Needs assistance
Cannot do
Dyspnea (new)
None
Occurs when walking
Occurs with one or more of the following: eating, bathing, dressing
Occurs at rest, difficulty breathing when either sitting or lying
Significant difficulty, considering using mechanical respiratory support
Orthopnea (new)
None
Some difficulty sleeping at night due to shortness of breath, does not routinely use > 2 pillows
Needs extra pillows in order to sleep (> 2)
Can only sleep sitting up
Unable to sleep
Respiratory insufficiency (new)
None
Intermittent use of bilevel positive airway pressure
Continuous use of bilevel positive airway pressure during the night
Continuous use of bilevel positive airway pressure during the night and day
Invasive mechanical ventilation by intubation or tracheostomy
Please complete all sections.
Reference
J M Cedarbaum, N Stambler, E Malta et al. The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF ALS Study Group (Phase III). J Neurol Sci. 1999 Oct 31;169(1-2):13-21.
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