ALS Functional Rating Scale

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ALS Functional Rating Scale

1. Speech

Normal speech processes

Detectable speech disturbance

Intelligble with repeating

Speech combined with nonvocal communication

Loss of useful speech

2. 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

3. Swallowing

Normal eating habits

Early eating problems-occasional choking

Dietary consistency changes

Needs supplemental tube feeding

NPO (exclusively parenteral or enteral feeding)

4. 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

5. Cutting food with gastrostomy

Normal

Somewhat slow and clumsy, but no help needed

Can cut most foods, although clumsy and slow; some help needed

Food must be cut by someone, but can still feed slowly

Needs to be fed

6. 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

7. Turning in bed

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

8. Walking

Normal

Early ambulation difficulties

Walks with assistance

Non-ambulatory functional movement only

No purposeful leg movement

9. Climbing stairs

Normal

Slow

Mild unsteadiness or fatigue

Needs assistance

Cannot do

10. Dyspnea

None

Occurs when walking

Occurs with one or more of the following: eating, bathing, dressing (ADL)

Occurs at rest, difficulty breathing when either sitting or lying

Significant difficulty, considering using mechanical respiratory support

11. Orthopnea

None

Some difficulty sleeping at night due to shortness of breath. Does not routinely use more than two pillows

Needs extra pillow in order to sleep (more than two)

Can only sleep sitting up

Unable to sleep

12. Respiratory insufficiency

None

Intermittent use of BiPAP

Continuous use of BiPAP

Continuous use of BiPAP during the night and day

Invasive mechanical ventilation by intubation or tracheostomy

13. How many years since onset of symptoms?

years

References:

1. Cedarbaum J. Archives of Neurology. 1996 Feb;53(2):141-7.
2. J. Neurol Sci. 1999 Oct 31;169(1-2):13-21.
3. ALS CARE Clinical Notes