Table 1

Functional domains and stages

ALSFRS domainItemScoreFunctional score*
Movement (walking/self-care)†8
4 Normal0
3 Early ambulation difficulties
2 Walks with assistance
1 Non-ambulatory functional movement only1
OR0 No purposeful leg movement
Dressing and hygiene
4 Normal function0
3 Independent and complete self-care with effort or decreased efficiency
2 Intermittent assistance or substitute methods
1 Needs attendant for self-care1
0 Total dependence
4 Normal eating habits0
3 Early eating problems; occasional choking
2 Dietary consistency changes
1 Needs supplemental tube feeding1
0 NPO (exclusively parenteral or enteral feeding)
4 Normal speech processes0
3 Detectable speech with disturbances
2 Intelligible with repeating
1 Speech combined with non-vocal communication1
AND0 Loss of useful speech
4 Normal0
3 Slow or sloppy; all words are legible
2 Not all words are legible
1 Able to grip pen but unable to write1
0 Unable to grip pen
4 None0
3 Occurs when walking
2 Occurs with one or more of: eating, bathing, dressing
1 Occurs at rest, difficulty breathing when either sitting or lying1
OR0 Significant difficulty, considering using mechanical respiratory support
Respiratory insufficiency
4 None0
3 Intermittent use of NIPPV
2 Continuous use of NIPPV during the night1
1 Continuous use of NIPPV during the night and day
0 Invasive mechanical ventilation by intubation or tracheostomy
ALS-MITOSStageFunctional domains lost
11 domain
22 domains
33 domains
44 domains
  • *Staging determined by the sum of functional score of 1 for each domain.

  • †Where two items were used, scoring was based on either or both item scores as indicated.

  • ALFSRS, Amyotrophic Lateral Sclerosis Functional Rating Scale; ALS-MITOS, Amyotrophic Lateral Sclerosis Milano-Torino Staging; NIPPV, nasal intermittent positive pressure ventilation; NPO, nothing by mouth.