Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R)Loading...SpeechMarked drooling; requires constant tissue or handkerchief0Marked excess of saliva with some drooling+1Moderately excessive saliva; may have minimal drooling+2Detectable speech disturbance+3Normal+4SalivationMarked drooling; requires constant tissue or handkerchief0Marked excess saliva with some drooling+1Moderately excessive saliva; may have minimal drooling+2Slight but definite excess of saliva in mouth; may have nighttime drooling+3Normal+4SwallowingNothing by mouth; exclusively parenteral or enteral feeding0Needs supplemental tube feedings+1Dietary consistency changes+2Early eating problems; occasional choking+3Normal eating habits+4HandwritingUnable to grip pen0Able to grip pen but unable to write+1Not all words are legible+2Slow or sloppy; all words are legible+3Normal+4Patients with gastrostomy and > 50% daily nutrition intake via G-tubeNo0Yes0Cutting food and handling utensilsUnable to perform any aspect of task0Provides minimal assistance to caregiver+1Some help needed with closures and fasteners+2Clumsy but able to perform all manipulations independently+3Normal+4Dressing and hygieneTotal dependence0Needs attendant for self-care+1Intermittent assistance or substitute methods+2Independent and complete self-care with effort or decreased efficiency+3Normal function+4Turning in bed and adjusting bed clothesHelpless0Can initiate but not turn or adjust sheets alone+1Can turn alone or adjust sheets but with great difficulty+2Somewhat slow and clumsy but no help needed+3Normal+4WalkingNo purposeful leg movement0Nonambulatory functional movement+1Walks for assistance+2Early ambulation difficulties+3Normal+4Climbing stairsCannot do0Needs assistance+1Mild unsteadiness or fatigue+2Slow+3Normal+4DyspneaSignificant difficulty, considering using mechanical respiratory support0Occurs at rest, difficulty breathing when either sitting or lying+1Occurs with one or more of the following: eating, bathing, dressing+2Occur when walking+3None+4OrthopneaUnable to sleep0Can only sleep sitting up+1Needs extra pillows in order to sleep (> 2)+2Some difficulty sleeping at night due to SOB; do not routinely use > 2 pillows+3None+4Respiratory insufficiencyInvasive mechanical ventilation by intubation or tracheostomy0Continuous use of BiPAP during night and day+1Continuous of BiPAP during the night+2Intermittent use of BiPAP+3None+4