ALS Functional Rating Scale

Attach6AScoring ALSFRS final.docx

National Amyotrophic Lateral Sclerosis (ALS) Registry

ALS Functional Rating Scale

OMB: 0923-0041

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Attachment 6A. ALS Functional Rating Scale – Revised (ALSFRS): Scoring Sheet

Self-Administered ALS Functional Rating Scale-Revised

Patient Name: ___________________________ Date: ________________________

Scoring Sheet (for use by the health


1. SPEECH

No change value = 4

Noticeable speech disturbance value = 3

Asked often to repeat words or phrases value = 2

Alternative communication methods value = 1

Unable to communicate verbally value = 0

Q1. Score =

care provider)


7. TURNING IN BED AND ADJUSTING BEDCLOTHES

No change value = 4

Slower or more clumsy, without

assistance value = 3

Can turn alone or adjust bed clothes value = 2

Can initiate but requires assistance value = 1

Helpless in bed value = 0

Q7. Score =


2. SALIVATION

No change value = 4

Slight excess saliva, nighttime drooling value = 3

Moderately excessive saliva, minimal

drooling value = 2

Marked excess of saliva, some drooling value = 1

Marked drooling, requires constant tissue value = 0

Q2. Score =

8. WALKING

No change value = 4

Change in walking, no assistance

or devices value = 3

Requires assistance to walk value = 2

Can move legs or stand up, unable to

walk from room to room value = 1

Cannot walk or move legs value = 0

Q8. Score =


3. SWALLOWING

No change value = 4

Occasional choking episodes value = 3

Modified the consistency of foods value = 2

Supplemental tube feedings value = 1

NPO (do not eat anything by mouth) value = 0

Q3. Score =


9. CLIMBING STAIRS

No change value = 4

Slower value = 3

Unsteady and/or more fatigued value = 2

Requires assistance value = 1

Cannot climb stairs value = 0

Q9. Score =

4. HANDWRITING

No change value = 4

Slow or sloppy, all words legible value = 3

Not all words legible value = 2

Able to hold pen, unable to write value = 1

Unable to hold pen value = 0

Q4. Score =

10. DYSPNEA

No change value = 4

Occurs only with walking value = 3

Occurs with minimal exertion value = 2

Occurs at rest, either sitting or lying value = 1

Significant shortness of breath

considering mechanical support value = 0

Q10. Score =


5a. CUTTING FOOD AND HANDLING UTENSILS

(patients without gastrostomy)

No change value = 4

Somewhat slow and clumsy, needs no help value = 3

Sometimes needs help value = 2

Foods cut by someone else value = 1

Needs to be fed value = 0

Q5a. Score =

11. ORTHOPNEA

No change value = 4

Occasional shortness of breath, does

not routinely use more than two pillows value = 3

Require more than 2 pillows to sleep value = 2

Can only sleep sitting up value = 1

Require the use of respiratory

support (BiPAP®) to sleep value = 0

Q11. Score =


5b. CUTTING FOOD AND HANDLING UTENSILS

(patients with gastrostomy)

Uses PEG without assistance or difficulty value = 4

Somewhat slow and clumsy, needs no help value = 3

Requires assistance with closures and

fasteners value = 2

Provides minimal assistance to caregiver value = 1

Unable to perform any manipulations value = 0

Q5b. Score =


12. RESPIRATORY INSUFFICIENCY

No respiratory support value = 4

Intermittent use of BiPAP® value = 3

Continuous use of BiPAP® at night value = 2

Continuous use of BiPAP day and night value = 1

Invasive mechanical ventilation value = 0

Q12. Score =

6. DRESSING AND HYGIENE

No change value = 4

Performs without assistance with increased

effort or decreased efficiency value = 3

Intermittent assistance or different

methods value = 2

Requires daily assistance value = 1

Completely dependent value = 0

Q6. Score =

Total Score __= / 48




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