1. Swallowing
– 4 Normal
– 3 Early eating problems—occasional choking
– 2 Dietary consistency changes
– 1 Frequent choking
– 0 Needs tube feeding
2. Handwriting (with dominant hand prior to IBM onset)
– 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
3. Cutting food and handling utensils
– 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
4. Fine motor tasks (opening doors, using keys, picking up small objects)
– 4 Independent
– 3 Slow or clumsy in completing task
– 2 Independent but requires modified techniques or
assistive devices
– 1 Frequently requires assistance from caregiver
– 0 Unable
5. Dressing
– 4 Normal
– 3 Independent but with increased effort or decreased efficiency
– 2 Independent but requires assistive devices or modified techniques (Velcro snaps, shirts without buttons, etc)
– 1 Requires assistance from caregiver for some clothing items
– 0 total dependence
6. Hygiene (bathing and toileting)
– 4 Normal
– 3 Independent but with increased effort or decreased activity
– 2 Independent but requires use of assistive devices (shower chair, raised toilet seat, etc)
– 1 Requires occasional assistance from caregiver
– 0 Completely dependent
7. Turning in bed and adjusting covers
– 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 Unable or requires total assistance
8. Sit to stand
– 4 Independent (without use of arms)
– 3 Performs with substitute motions (leaning forward, rocking) but without use of arms
– 2 Requires use of arms
– 1 requires assistance from a device or person
– 0 Unable to stand
9. Walking
– 4 Normal
– 3 Slow or mild unsteadiness
– 2 Intermittent use of an assistive device (ankle–foot orthosis, cane, walker)
– 1 Dependent on assistive device
– 0 Wheelchair dependent
10. Climbing stairs
– 4 Normal
– 3 Slow with hesitation or increased effort; uses hand rail intermittently
– 2 Dependent on hand rail
– 1 Dependent on hand rail and additional support (cane or person)
– 0 Cannot climb stairs
This 10 point functional rating scale was developed by modifying
the ALS functional rating scale. The highest score possible is 40, and the higher the score the better the person is functioning. Find out more about this rating scale.
