ALS Functional Rating Scale - Revised

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ALS Functional Rating Scale - Revised (ALSFRS-R) is a simple tool doctors use to measure how ALS affects daily life and how it changes over time. ALS is a progressive nerve disease that mostly affects adults; the typical age at diagnosis is about 54–67 years. After diagnosis, many people live about 2–4 years because the disease progresses quickly.

How ALSFRS-R works
- The scale has 12 questions. Each question is scored from 0 to 4: 0 means no function, 4 means normal function.
- The total score ranges from 0 to 48, with higher scores indicating better function.

Onset types and how the questions are grouped
- Bulbar onset (questions 1–3): functions like speech, swallowing, and saliva management.
- Limb onset (questions 4–9): movements of the arms and legs, such as handwriting, dressing, turning in bed, walking, and climbing stairs.
- Respiratory onset (questions 10–12): breathing and related activities.

ALS can start in different areas, which is why the questions are grouped by onset. Some people may show different patterns, so researchers and clinicians may look at scores by onset type.

What comes next after the basics
- There are extended versions: ALSFRS-EX adds more items to reduce floor effects, and ALSFRS-R-SE is a self-explanatory version for self-assessment that matches standard interview methods.
- Clinicians use ALSFRS-R scores over time to see how fast the disease is progressing. The rate of change, called the ALSFRS-R slope, helps with prognosis when used with other tests.
- Other measures that can improve prognosis accuracy include vital capacity (FVC%) and the Sickness Impact Profile (SIP).

Staging and research use
- The King’s system and Milano-Torino Staging (MiToS) use ALSFRS-R data to define stages of disease progression.
- The 12 questions provide a consistent way to rate function and track changes for care and research.