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ALS Severity Score of Hillel

The ALSSS is a scale developed by Hillel et al to evaluate patients with ALS. It assesses four areas: speech, swallowing, lower extremity function, and upper extremity dressing. Scores are combined to determine a bulbar and spinal score, with lower scores indicating more impairment. The scale has high reliability between examiners and strongly correlates with objective speech measures. It can provide a rapid assessment of disease status and progression to aid treatment planning.

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2K views3 pages

ALS Severity Score of Hillel

The ALSSS is a scale developed by Hillel et al to evaluate patients with ALS. It assesses four areas: speech, swallowing, lower extremity function, and upper extremity dressing. Scores are combined to determine a bulbar and spinal score, with lower scores indicating more impairment. The scale has high reliability between examiners and strongly correlates with objective speech measures. It can provide a rapid assessment of disease status and progression to aid treatment planning.

Uploaded by

Slvtierra Azu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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The ALS Severity Score of Hillel et al (ALSSS)

Overview: Hillel et al developed the ALS Severity Scale (ALSSS) to evaluate patients with amyotrophic
lateral sclerosis. The score when combined with measurement of vital capacity can provide a rapid and
accurate assessment of the patient's disease status. Since the disease is progressive the scale can help
identify the next problem areas and so can aid in treatment planning. The authors are from the University of
Washington in Seattle.
Measures:
(1) speech
(2) swallowing
(3) lower extremity and walking
(4) upper extremity dressing and hygiene
Speech

Ability (see Table I page 143)

normal speech processes

normal

10

nominal abnormalities

perceived speech changes

obvious speech abnormalities

repeats message on occasion

frequent repeating required

speech plus nonverbal


communication

limits speech to one word response

vocalizes for emotional expression

nonvocal

tracheostomy

detectable speech disturbances

intelligible with repeating

speech combined with nonverbal


communication

loss of useful speech

Points

where:
Determining the score when a tracheostomy is present is not stated so I used 1 point.
Swallowing

Ability (see Table II page 144)

normal eating habits

normal swallowing

10

nominal abnormality

minor swallowing problems

early eating problems

Points

dietary consistency changes

needs tube feeding

no oral feeding

prolonged time or smaller bite size

soft diet

liquefied diet

supplemental tube feedings

tube feeding with occasional oral


nutrition

secretions managed with aspirator


and/or medications

aspiration of secretions

Lower Extremity and Walking

Ability (see Table III page 145)

normal

normal ambulation

10

fatigue suspected

difficulty with uneven terrain

observed changes in gait

walks with mechanical device

walks with mechanical device and


assitant

able to support weight

purposeful leg movements

minimal movement

paralysis

early ambulation difficulties

walks with assistance

functional movement only

no purposeful leg movements

Points

Upper Extremity Dressing and


Hygiene

Ability (see Table IV page 146)

normal function

normal

10

suspected fatigue

slow self

effortful self-care performance

independence and complete self-care

Points

intermittent assistance

needs attendant for self-care

total dependence

mostly independent

partial independence

attendant assists patient

patient assists attendant

minimal movement

paralysis

bulbar score =
= (speech subscore) + (swallowing subscore)
spinal score =
= (lower extremity subscore) + (upper extremity subscore)
Interpretation:
minimum total score: 4
maximum total score: 40
The lower the score the more impairment is present.
Performance:
The average estimated reliability coefficient between examiners: 0.95
The correlation between the speech rating and objective speech measures: > 0.80
References:
Hillel AD Miller RM et al. Amyotrophic Lateral Sclerosis Severity Scale. Neuroepidemiology. 1989; 8: 142150

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