In determining prognosis for the ALS patient, examination by a neurologist within three months of assessment is advised. All patients must meet criteria #1, rapid progression of ALS, as well as either 2A, critically impaired ventilatory capacity, 2B, critical nutritional impairment, or 2C, life-threatening complications.

1. Rapid progression of ALS. Most of disability should have developed in past 12 months.

_____ progression from independent ambulation to wheelchair or bed-bound
_____ progression from normal to barely intelligible or unintelligible speech
_____ progression from normal to blenderized diet
_____ progression from independence in all or most ADLs to requiring assistance in all ADLs

Patients with slow progression may survive for longer periods,
although clinical judgment may still indicate they may be within six months of death.

2. At least one of the following must also apply:

A. Critically Impaired Ventilatory Capacity

____ vital capacity (VC) less than 30% of predicted
____ significant dyspnea at rest
____ supplemental oxygen required at rest
____ intubation or tracheostomy and mechanical ventilation considered
(Note: patients receiving ventilation assistance may survive longer than six months unless there is a life-threatening co-morbid condition)

B. Critical Nutritional Impairment

____ artificial feeding not elected or discontinued
____ oral intake insufficient
____ continued weight loss
____ dehydration or hypovolemia

C. Life-threatening Complications

____ recurrent aspiration pneumonia
____ decubitus ulcers, multiple, stage 3-4, particularly if infected
____ upper urinary tract infection, e.g. pyelonephritis
____ sepsis
____ fever recurrent after antibiotics