The Amyotrophic Lateral Sclerosis Functional Rating Scale

Original Editor - Ajay Upadhyay

Top Contributors - Ajay Upadhyay and Amrita Patro  

The Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS)


Its an instrument for assessing the activities of daily living of patients with Amyotrophic Lateral Sclerosis. Its also used to record disease progression in patients with ALS against other functional scales, quantitative isometric muscle testing, and global assessment scales.

Intended Population

All the patients with amyotrophic lateral sclerosis.

Method of Use

It consist of 10 items of functional rating scale which includes activities of daily living, speech, salivation, and swallowing. Each item is scored from 0 to 4. 4 is given if person is normal, and 0 for poor performance

  1. Following items are included in the assessment scale-
  2. 1. Speech
  3. 2. Salivation
  4. 3. Swallowing
  5. 4. Handwriting
  6. 5. Cutting food and handling utensils (with or without gastrostomy)
  7. 6. Dressing and hygiene
  8. 7. Turning in bed and adjusting bed clothes
  9. 8. Walking
  10. 9. Climbing stairs
  11. 10. Breathing


minimum score: 0
maximum score: 40
The higher the score the more function is retained.


Test-retest Reliability

It showstest-retest reliability (ICC = 0.95) and is consistent.

Interrater/Intrarater Reliability
Kaufmann et al, 2007
• Excellent interrater reliability when administered by a primary rater; (ICC = 0.93)
• Excellent interrater reliability when administered by a back-up rater, n = 9 (ICC = 0.93)
• Excellent intrarater reliability, n = 41 (ICC = 0.95)
• Excellent reliability when test is administered on telephone, n = 27 (ICC = 0.97)


Criterion Validity

Brooks, B., Sanjak, M., et al. (1996). "The amyotrophic lateral sclerosis functional rating scale-Assessment of activities of daily living in patients with amyotrophic lateral sclerosis." Archives of Neurology 53(2): 141-147.

The sensitivity of ALSFRS scores to change in 53 patients’ statuses over time was assessed in this two phased trial. The ALSFRS scores declined together in motor and pulmonary function indicating its sensitivity to change.