Table 1.

Functional status scale (FSS) adapted for resource-poor settings (scale 6–29).

FSS domain	Normal (Score = 1)	Mild dysfunction (score = 2)	Moderate dysfunction (score = 3)	Severe dysfunction (score = 4)	Very severe dysfunction (score = 5)
Mental status	Normal sleep/wake; appropriate responsiveness	Sleepy but arousable to noise, touch, movement, and/or periods of social non-responsiveness and/or insomniaa	Lethargic and/or irritable	Minimal arousal to stimuli	Unresponsive, coma, and/or vegetative state
Sensory functioning	Intact hearing, vision, response to touch	Suspected hearing or vision loss	Not reactive to auditory stimuli OR to visual stimuli	Not reactive to auditory stimuli AND to visual stimuli	Abnormal responses to pain or touch
Communication	Appropriate vocalizations, interactive facial expressiveness, or gestures	Diminished vocalization, facial expression, and/or social responsiveness	Absence of attention-getting behavior	No demonstration of discomfort	Absence of communication
Motor functioning	Coordinated movements, normal muscle control, awareness of action	1 limb functionally impaired	>2 limbs functionally impaired	Poor head control	Diffuse spasticity, paralysis, or posturing
Feeding	All food taken by mouth with age-appropriate help	Cannot eat by mouth without frequent coughing or sputteringb	Needs more help with feeding than other children his or her age (ex. pureed foods for any child over 12 months of age)c	Receives formula through a feeding tubed	–
Respiratory statuse	Room air and no artificial support or aids	Requires frequent suctioning of the nose or mouth and/or requires supplemental oxygen	Frequently has difficulty in breathing WITHOUT color change	Frequently has difficulty in breathing WITH color change	Frequently stops breathing and someone has to stimulate him or her to remind him or her to breath

^aAddition of insomnia to mild dysfunction in the mental status domain.

^bAdapted feeding mild dysfunction to focus on signs of aspiration rather than requirement for assistance with feeding.

^cModerate feeding dysfunction no longer includes need for tube feeding.

^dSevere dysfunction adapted to include children requiring tube feeds and parenteral nutrition removed from the definition.

^eRespiratory domain scores adapted to remove use of devices such as tracheostomy, positive pressure, or mechanical ventilation originally defined as moderate, severe, and very severe dysfunction, respectively.