Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R)
Stratifies severity of amyotrophic lateral sclerosis (ALS), including respiratory function.
When to Use
Pearls/Pitfalls
Why Use
Normal
+4Detectable speech disturbance
+3Intelligible with repeating
+2Speech combined with nonvocal communications
+1Loss of useful speech
0Normal
+4Slight but definite excess of saliva in mouth; may have nighttime drooling
+3Moderately excessive saliva; may have minimal drooling
+2Marked excess of saliva with some drooling
+1Marked drooling; requires constant tissue or handkerchief
0Normal eating habits
+4Early eating problems; occasional choking
+3Dietary consistency changes
+2Needs supplemental tube feedings
+1Nothing by mouth; exclusively parenteral or enteral feeding
0Normal
+4Slow or sloppy; all words are legible
+3Not all words are legible
+2Able to grip pen but unable to write
+1Unable to grip pen
0No
Yes
Normal
+4Somewhat slow and clumsy but no help needed
+3Can cut most foods although clumsy and slow; some help needed
+2Food must be cut by someone but can still feed slowly
+1Needs to be fed
0Normal function
+4Independent and complete self-care with effort or decreased efficiency
+3Intermittent assistance or substitute methods
+2Needs attendant for self-care
+1Total dependence
0Normal
+4Somewhat slow and clumsy but no help needed
+3Can turn alone or adjust sheets but with great difficulty
+2Can initiate but not turn or adjust sheets alone
+1Helpless
0Normal
+4Early ambulation difficulties
+3Walks with assistance
+2Nonambulatory functional movement
+1No purposeful leg movement
0Normal
+4Slow
+3Mild unsteadiness or fatigue
+2Needs assistance
+1Cannot do
0None
+4Occurs when walking
+3Occurs with one or more of the following: eating, bathing, dressing
+2Occurs at rest, difficulty breathing when either sitting or lying
+1Significant difficulty, considering using mechanical respiratory support
0None
+4Some difficulty sleeping at night due to shortness of breath; does not routinely use >2 pillows
+3Needs extra pillows in order to sleep (>2)
+2Can only sleep sitting up
+1Unable to sleep
0None
+4Intermittent use of BiPAP
+3Continuous use of BiPAP during the night
+2Continuous use of BiPAP during the night and day
+1Invasive mechanical ventilation by intubation or tracheostomy
0Result:
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Evidence
Creator Insights
- Antony Winkel, MBBS, FRACP
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