Appendix.
ALSFRS-R Scale
| Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) | |||
|---|---|---|---|
| The evaluated finding | Score | The evaluated finding | Score |
| 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 | ||