ALSFRS-R score
1. Speech
Detectable speech disturbance.
Intelligible with repeating.
Speech combined with nonvocal communication.
2. Salivation
Slight but definite excess of saliva in mouth; may have nighttime drooling.
Moderately excessive saliva; may have minimal drooling.
Marked excess of saliva with some drooling.
Marked drooling; requires constant tissue or handkerchief.
3. Swallowing
Early eating problems-occasional choking.
Dietary consistency changes.
Needs supplemental tube feeding.
NPO (exclusively parenteral or enteral feeding).
4. Handwriting
Slow or sloppy; all words are legible.
Not all words are legible.
Able to grip pen but unable to write.
5a. Eating - For patients without gastrostomy
Somewhat slow and clumsy, but no help needed.
Can cut most foods, although clumsy and slow; some help needed.
Food must be cut by someone, but can still feed slowly.
5b. Eating - For patients with gastrostomy
Clumsy but able to perform all manipulations independently.
Some help needed with closures and fasteners.
Provides minimal assistance to caregiver.
Unable to perform any aspect of task.
6. Dressing and hygiene
Independent and complete self-care with effort or decreased efficiency.
Intermittent assistance or substitute methods.
Needs attendant for self-care.
7. Turning in bed
Somewhat slow and clumsy, but no help needed.
Can turn alone or adjust sheets, but with great difficulty.
Can initiate, but not turn or adjust sheets alone.
8. Walking
Early ambulation difficulties.
Non-ambulatory functional movement only.
No purposeful leg movement.
9. Climbing stairs
Mild unsteadiness or fatigue.
10. Dyspnea
Occurs with one or more of the following: eating, bathing, dressing (ADL).
Occurs at rest, difficulty breathing when either sitting or lying.
Significant difficulty, considering using mechanical respiratory support.
11. Orthopnea
Some difficulty sleeping at night due to shortness of breath. Does not routinely use more than two pillows.
Needs extra pillow in order to sleep (more than two).
Can only sleep sitting up.
12. Respiratory insufficiency
Intermittent use of BiPAP.
Continuous use of BiPAP during the night and day.
Invasive mechanical ventilation by intubation or tracheostomy.