ALS staging

Stage 1

early disease, mild focal weakness, asymmetrical distribution; symptoms of hand cramping and fasciculations.

Stage 2

moderate weakness in groups of muscles, some wasting (atrophy) of muscles; modified independence with assistive devices.

Stage 3

severe weakness of specific muscles, increasing fatigue; mild to moderate functional limitations, ambulatory.

Stage 4

severe weakness and wasting of LEs, mild weakness of UEs; moderate assistance and assistive devices required; wheelchair user.

Stage 5

progressive weakness with deterioration of mobility and endurance, increased fatigue, moderate to severe weakness of whole limbs and trunk; spasticity, hyperreflexia; loss of head control; maximal assist.

Stage 6

bedridden, dependent ADLs, FMS; progressive respiratory distress