El Ensayo

|Amyotrophic Lateral Sclerosis Functional Rating Scale – Revised (ALSFRS-R) |
|Leo Montero Ferrer|
|24/12/1967|
|14/03/2007|

1. Date Performed: 11/ 07 / 2012 (mm/dd/yyyy)
2. Indicate administration method:
|[ X ] Self-administered |[ x ] Administered by professional in-person |[ ] Administered by professional via phone |

3. Responded by:
| [ X ]Participant/ Subject |[ ] Participant/ Subject via Caregiver |

QUESTIONS
|1. Speech|4. Handwriting |
|[ ] 4 – Normal Speech processes|[ ] 4 – Normal |
|[ ] 3 – Detectable speech with disturbances |[ ] 3– Slow or sloppy; all words are legible |
|[ X ] 2 – Intelligible with repeating |[ ] 2 – Not all words arelegible |
|[ ] 1 – Speech combined with nonvocal |[ ] 1 – Able to grip pen but unable to write...