The Cardiovascular
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Revised ALS Functional Rating Scale (ALSFRS-R)

Revised ALS Functional Rating Scale (ALSFRS-R)
Speech
Salivation
Swallowing
Handwriting
Cutting food and handling utensils
Use the gastrostomy sub-scale if a feeding tube is present; here the non-gastrostomy version is scored.
Dressing and hygiene
Turning in bed and adjusting bedclothes
Walking
Climbing stairs
Dyspnea
Orthopnea
Respiratory insufficiency
Result48 / 48

Higher scores indicate better preserved function. Serial totals and the rate of decline are commonly tracked over time.

Total function score
48 / 48

When to use

  • Measuring and following global physical function in amyotrophic lateral sclerosis in clinic and trials.

Formula

Sum of 12 items (bulbar, fine motor, gross motor, and respiratory), each scored 0 (no function) to 4 (normal). Range 0-48, higher being better.

Pearls and pitfalls

  • The revised scale adds three respiratory items (dyspnea, orthopnea, respiratory insufficiency) to the original 10-item scale.
  • Rate of decline in points per month is a widely used prognostic and trial endpoint.

References

  1. Cedarbaum JM, et al. J Neurol Sci. 1999;169(1-2):13-21.