1- Speech |
|
7- Turning in bed |
|
Normal speech processes |
4 |
Normal |
4 |
Detectable speech disturbance |
3 |
Somewhat slow and clumsy, but no help needed |
3 |
Intelligible with repeating |
2 |
Can turn alone or adjust sheets, but with great difficulty |
2 |
Speech combined with nonvocal communication |
1 |
Can initiate, but not turn or adjust sheets alone |
1 |
Loss of useful speech |
0 |
Helpless |
0 |
2- Salivation |
|
8- Walking |
|
Normal |
4 |
Normal |
4 |
Slight but definite excess of saliva in mouth; may have nighttime drooling |
3 |
Early ambulation difficulties |
3 |
Moderately excessive saliva; may have minimal drooling |
2 |
Walks with assistance |
2 |
Marked excess of saliva with some drooling |
1 |
Non-ambulatory functional movement only |
1 |
Marked drooling requires constant tissue or handkerchief |
0 |
No purposeful leg movement |
0 |
3- Swallowing |
|
9- Climbing stairs |
|
Normal |
4 |
Normal |
4 |
Early eating problems, occasional choking |
3 |
Slow |
3 |
Dietary consistency changes |
2 |
Mild unsteadiness or fatigue |
2 |
Needs supplemental tube feeding |
1 |
Needs assistance |
1 |
Exclusively parenteral or enteral feeding |
0 |
Cannot do |
0 |
4- Handwriting |
|
10- Dyspnea |
|
Normal |
4 |
None |
4 |
Slow or sloppy; all words are legible |
3 |
Occurs when walking |
3 |
Not all words are legible |
2 |
Occurs with one or more of the following: eating, bathing, dressing |
2 |
Able to grip pen but unable to write |
1 |
Occurs at rest, difficulty in breathing when either sitting or lying |
1 |
Unable to grip pen |
0 |
Significant difficulty, considering using mechanical respiratory support |
0 |
5A- Cutting food without gastrostomy |
|
11- Orthopnea |
|
Normal |
4 |
None |
4 |
Somewhat slow and clumsy, but no help needed |
3 |
Some difficulty in sleeping at night due to shortness of breath. Does not routinely use more than two pillows |
3 |
Can cut most foods, although clumsy and slow; some help needed |
2 |
Needs extra pillow in order to sleep (more than 2) |
2 |
Food must be cut by someone but can still feed slowly |
1 |
Can only sleep sitting up |
1 |
Needs to be fed |
0 |
Unable to sleep |
0 |
5B- Cutting food with gastrostomy |
|
12- Respiratory insufficiency |
|
Normal |
4 |
None |
4 |
Clumsy but able to perform all manipulations independently |
3 |
Intermittent use of BiPAP |
3 |
Some help needed with closures and fasteners |
2 |
Continuous use of BiPAP during the night |
2 |
Provides minimal assistance to caregiver |
1 |
Continuous use of BiPAP during the night and day |
1 |
Unable to perform any aspect of task |
0 |
Invasive mechanical ventilation by intubation or tracheostomy |
0 |
6- Dressing and hygiene |
|
Total Score |
…/48 |
Normal |
4 |
|
|
Independent and complete self-care with effort or decreased efficiency |
3 |
|
|
Intermittent assistance or substitute methods |
2 |
|
|
Needs attendant for self-care |
1 |
|
|
Total dependence |
0 |
|
|