ALSFRS-R (ALS Functional Rating Scale, Revised)
The ALS Functional Rating Scale - Revised (Cedarbaum and colleagues 1999): twelve functions rated 0 to 4 for a total of 0 to 48.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Does the patient have a gastrostomy?
- No
- Speech
- 3
- Salivation
- 4
- Swallowing
- 3
- Handwriting
- 4
- Cutting food and handling utensils
- 4
- Dressing and hygiene
- 4
- Turning in bed and adjusting bed clothes
- 4
- Walking
- 2
- Climbing stairs
- 2
The other 3 values
- Dyspnea
- 3
- Orthopnea
- 4
- Respiratory insufficiency
- 4
Result: ALSFRS-R 41 of 48.
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Direction
- Higher is better. 48 is normal function and 0 is complete loss, the opposite of most scored instruments here.
- What changed
- The revision replaced the original single breathing item with three, taking the scale from 10 items and a maximum of 40 to 12 items and 48.
- Cutting food
- Two alternative scales, chosen by whether the patient has a gastrostomy. Exactly one is scored; both would give a maximum of 52.
- Respiratory
- Dyspnea, orthopnea, and respiratory insufficiency, reported as a subscore out of 12. These are reported symptoms and support, not a vital capacity.
- Scope
- Measures function. Not a diagnosis, not a prognosis for an individual, and not a substitute for respiratory testing. Trials use the rate of change, not a single total.
What you enter
- Does the patient have a gastrostomy?
- Speech
- Salivation
- Swallowing
- Handwriting
- Dressing and hygiene
- Turning in bed and adjusting bed clothes
- Walking
- Climbing stairs
- Dyspnea
The other 4 fields
- Does the patient have a gastrostomy? This SELECTS which of the two alternative cutting-food scales is scored. Supply only that one.
- Speech [4 - Normal speech processes; 3 - Detectable speech disturbance; 2 - Intelligible with repeating; 1 - Speech combined with nonvocal communication; 0 - Loss of useful speech]
- Salivation [4 - Normal; 3 - Slight but definite excess of saliva in mouth; may have nighttime drooling; 2 - Moderately excessive saliva; may have minimal drooling; 1 - Marked excess of saliva with some drooling; 0 - Marked drooling; requires constant tissue or handkerchief]
- Swallowing [4 - Normal eating habits; 3 - Early eating problems, occasional choking; 2 - Dietary consistency changes; 1 - Needs supplemental tube feeding; 0 - Nothing by mouth, exclusively parenteral or enteral feeding]
- Handwriting [4 - Normal; 3 - Slow or sloppy; all words are legible; 2 - Not all words are legible; 1 - Able to grip pen but unable to write; 0 - Unable to grip pen]
- Dressing and hygiene [4 - Normal function; 3 - Independent and complete self-care with effort or decreased efficiency; 2 - Intermittent assistance or substitute methods; 1 - Needs attendant for self-care; 0 - Total dependence]
- Turning in bed and adjusting bed clothes [4 - Normal; 3 - Somewhat slow and clumsy, but no help needed; 2 - Can turn alone or adjust sheets, but with great difficulty; 1 - Can initiate, but not turn or adjust sheets alone; 0 - Helpless]
- Walking [4 - Normal; 3 - Early ambulation difficulties; 2 - Walks with assistance; 1 - Nonambulatory functional movement only; 0 - No purposeful leg movement]
- Climbing stairs [4 - Normal; 3 - Slow; 2 - Mild unsteadiness or fatigue; 1 - Needs assistance; 0 - Cannot do]
- Dyspnea [4 - None; 3 - Occurs when walking; 2 - Occurs with one or more of the following: eating, bathing, dressing; 1 - Occurs at rest, difficulty breathing when either sitting or lying; 0 - Significant difficulty, considering using mechanical respiratory support]
- Orthopnea [4 - None; 3 - Some difficulty sleeping at night due to shortness of breath. Does not routinely use more than two pillows; 2 - Needs extra pillows in order to sleep (more than two); 1 - Can only sleep sitting up; 0 - Unable to sleep]
- Respiratory insufficiency [4 - None; 3 - Intermittent use of BiPAP; 2 - Continuous use of BiPAP during the night; 1 - Continuous use of BiPAP during the night and day; 0 - Invasive mechanical ventilation by intubation or tracheostomy]
- Cutting food and handling utensils (patients WITHOUT a gastrostomy). Score this ONLY if hasGastrostomy is no; the other alternative scale is not scored [4 - Normal; 3 - Somewhat slow and clumsy, but no help needed; 2 - Can cut most foods, although clumsy and slow; some help needed; 1 - Food must be cut by someone, but can still feed slowly; 0 - Needs to be fed]
- Cutting food and handling utensils (alternate scale, patients WITH a gastrostomy). Score this ONLY if hasGastrostomy is yes; the other alternative scale is not scored [4 - Normal; 3 - Clumsy but able to perform all manipulations independently; 2 - Some help needed with closures and fasteners; 1 - Provides minimal assistance to caregiver; 0 - Unable to perform any aspect of task]
How this is calculated
Cedarbaum JM, Stambler N, Malta E, et al. The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF ALS Study Group (Phase III). J Neurol Sci. 1999;169(1-2):13-21. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.