SPEECH 

4. Normal speech processes 

3. Detectable speech disturbance 

2. intelligible with repearing 

1. speech combined with non-vocal 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
 

SWALLOWING 

4. Normal eating habits 

3. early eating problems, occasional choking 

2. dietary consistency changes 

1. needs supplemental tube feedings 

0. NPO (exclusively parental or enteral feedings)
 

HANDWRITING 

4. Normal 

3. slow or sloppy, all workds legible 

2. not all words legible 

1. able to grip pen, unable to write 

0. unable to grip pen
 

CUTTING FOOD AND HANDLING UTENSILS
(patients without gastrostomy) 

4. Normal 

3. somewhat slow and clumsy, needs no help 

2. can cut most foods, slow of clumsy, some help needed 

1. foods cut by someone else, can still feed slowly 

0. needs to be fed
 

CUTTING FOOD AND HANDLING UTENSILS
(patients with gastrostomy) 

4. Normal 

3. clumsy, able to perform all manipulations 

2. some help needed with clsures and fasteners 

1. provides minimal assistance to caregiver 

0. unable to perform any aspect of task 

DRESSING AND HYGEINE 

4. Normal 

3. independent self care with effort of decreased effieicency 

2. intermittent assitance or substitute methods 

1. needs attendant for self care 

0. total dependence
 

TURNING IN BED AND ADJUSTING BEDCLOTHES 

4. Normal 

3. somewhat slow or clumbsy, needs no help 

2. can turn alone or adjust sheets with great difficulty 

1. can initiate, cannot turn or adjust sheets 

0. helpless
 

WALKING 

4. Normal 

3. early ambulation difficulties 

2. walks with assistance 

1. non-ambulatory 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
 

DYSPENA 

4. None 

3. occurs when walking 

2. occurs with one more more:eating, bathing, dressing 

1. occurs at rest, either sitting or lying 

0. significant difficulty, considering mechanical support
 

ORTHOPNEA  

4. None 

3. some difficulty sleeeping, d/t shortness of breath, does not routinely use >2 pillows 

2. needs extra pillows to sleep (>2) 

1. can only sleep sitting up 

0. unable to sleep
 

RESPIRATORY INSUFFICIENCY 

4. None 

3. intermittent use of BiPAP 

2. continuous use of BiPAP at night 

1. continuous use of BiPAP day and night 

0. invasive mechanincal ventilation by intubation/trach