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Normal speech processes Detectable speech disturbance Intelligible with repeating Speech combined with nonvocal communication Loss of useful speech

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Normal Slight but definite excess of saliva in mouth, mat have nighttime drooling Moderately excessive saliva; may have some drooling Marked eccess of saliva with some drooling Marked drooling; requires constant tissue or handkerchief

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Normal eating habits Early eating problems - occasional choking Dietary consistency changes Needs supplemental tube feeding NPO (exclusively parenteral or enteral feeding)

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Normal Slow or sloppy: all words are legible Not all words are legible Able to grip pen but unable to write Unable to grip pen

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Normal Somewhat slow and clumsy, but no help needed Can cut most foods, although clumsy and slow; some help needed Food must be cut by someone, but can still feed slowly Needs to be fed

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Normal Clumsy but able to perform all manipulations independently Some help needed with closures and fasteners Provides minimal assistance to caregiver Unable to perform any aspect of task

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Normal Somewhat slow and clumsy, but no help needed Intermittent assistence or substitute methods Needs attendant for self-care Total dependence

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Normal Somewhat slow and clumsy, but no help needed Can turn alone or adjust sheets, but with great difficulty Can initiate, but not turn or adjust sheets alone Helpless

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Normal Early ambulation difficulties Walks with assistance Nonambulatory functional movement No purposeful leg movement

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Normal Slow Mild unsteadiness or fatigue Needs assistance Cannot do

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None Occurs when walking Occurs when one or more of the following: eating, bathing, dressing (ADL) Occurs at rest, difficulty breathing when either sitting or lying Significant difficulty, considering using mechanical respiratory support

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None Some difficulty sleeping at night due to shortness of breath, does not routinely use more than two pillows Needs extra pillows in order to sleep (more than two) Can only sleep sitting up Unable to sleep

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None Intermittent use of BiPAP Continuous use of BiPAP during the night Continuous use of BiPAP during the night and day Invasive mechanical ventilation by intubation or tracheostomy Calculate