ALS Communication Scale

communication-scale

Download the Functional Communication Scale for SLPs Here

ALS Functional Communication Scale (AFCS) and Measurement Tool

 

SCALE

Communication Competencies

 

 

Short Term Goals (examples)

Interventions 

(examples)

1.  Alerting/Emergency  (Clinic Visit Goal)

  1. Patient (and caregiver) can describe the method by which patient can alert others, not in patient’s immediate environment, to a need or emergency.

(Home Visit Goal)

  1. Patient is able to activate an alerting system 100% of the time to notify people in other rooms when he has a need or emergency.

 

Call chime

Switch adapted call chime

Emergency alerting system (adapted if needed)

 

2.  Communication Strategies

2.  Patient (and caregiver) demonstrate patient and partner strategies (via speech or SGD) that improve communication success, efficiency, speed and reduce fatigue.

 

 Energy conversation speech  strategies

Partner communication strategies

Voice amplifier

Rate enhancement strategies for AAC

  • ie. developing list of common phrases and methods to deliver them via listing, coding, storing message in buttons on grid, etc
  • use of core vocabulary

Modification of communication pages to compensate for reduced physical abilities

3.  Non-Voiced Communication 3. Patient demonstrates the ability to communicate novel messages via spelling or combining words using a low tech AAC method.

Writing

Pointing  on communication board

Typing

Typing with adaptive modifications

Message input with alternative access

 

4.  Speech Generation

 

 

 

4.  Patient demonstrates the ability to communicate a novel message via spelling or combining words with voice.

Via patients own speech or

Via  speech generating device

Via app on mobile device

5.  Communication with those at a Distance

 

 

 

5.  Patient describes a (adapted) method/s to communicate with partners at a distance.

 

Adapted phone

Skype or other,

State Telephone Access Program,

Text Messaging

Instant Messaging

Email

 

6.  Independence with Set-Up and Customization of AAC Systems

 

 

6.  Patient (and caregiver) demonstrate the operation, set up and customization of low or high tech augmentative communication equipment adequately to use the equipment independently in 5/5 trials.

 

Adjust mounting to appropriate heights and angles

Calibrate screens

Attach access devices and adjust settings

Adjust volume

Switch languages

Program simple message buttons

etc.

7.  Prepared for future changes

 

 

7.  Patient (and caregiver) describe a pro-active strategy designed to prepare for typical changes in speech and SGD access seen in patients with ALS.

 

Voice banking

Message banking

Storing message & customizing communication pages,

Beginning process for acquiring speech generating device

Learning about alternative access method

etc.

 

Score

The Score is the number of competencies a patient demonstrates out of the 7 ALS functional communication abilities.

 

G-Code severity modifiers are required for Medicare reporting

7/7( CH)

6/7 (CI)

5/7 (CJ)

4/7 (CK)

3/7 (CL)

2/7 (CM)

0-1/7 (CN)

 

 

 CLINICAL MEASUREMENT TOOL

G-Code G9174 G9175 G9176

Communication Abilities:

 

Current Status/

Baseline

Projected  Goal Status Discharge Status/ Able at End of Today’s Session

1.  Patient (and caregiver) can describe the method by which patient can alert others, not in patient’s immediate environment, to a need or emergency. (clinic goal)

1.  Patient is able to activate an alerting system 100% of the time to notify people in other rooms when he has a need or emergency.   (home visit goal)

+/- +/- +/-

2.  Patient (and caregiver) demonstrate patient and partner strategies (via speech or SGD) that improve communication success, efficiency, speed and reduce fatigue.

 

3.  Patient demonstrates the ability to communicate novel messages via spelling or combining words using a low tech AAC

 

4.  Patient demonstrates the ability to communicate a novel message via spelling or combining words with voice.

 

5.  Patient describes a (adapted) method/s to communicate with partners at a distance.

 

6.  Patient (and caregiver) demonstrate the operation, set up and customization of low or high tech augmentative communication equipment adequately to use the equipment independently in 5/5 trials.

 

7.  Patient (and caregiver) describe a pro-active strategy designed to prepare for typical changes in speech and SGD access seen in patients with ALS.

 

Score       (total “+” in each column)      # / 7  /7  /7  7/
Severity Modifier (CH, CI, CJ, CK, CL, CM, CN) X X X

 

Score                                          Noms Level                 Severity Modifier

7/7                                                         7                              CH                                          
6/7                                                         6                              CI
5/7                                                         5                              CJ           
4/7                                                         4                              CK
3/7                                                         3                              CL
2/7                                                         2                              CM
0-1/7                                                     1                              CN                                          

 

 

About the Scale and Tool

The ALS Functional Communication Scale and Measurement Tool were developed to provide a means for documenting the communication abilities as well as the change resulting from AAC interventions for patients with ALS at any point in progression.

The measurement tool can be used to document a patient’s abilities at baseline, their projected abilities, and their abilities following intervention for the following codes:

92506-Speech/Language/Communication Evaluation

92507- Speech/Language/Communication Treatment

92607- SGD Evaluation (first hour)

92608- SGD Evaluation (each additional half hour)

92609-SGD TX for use of SGD  including Programming+ Modification

 

Scale and Measurement Tool developed by Amy Roman, MS, CCC-SLP

HANDOUT FOR PATIENTS WITH ALS  (Downloadable PDF)

Here is a version of this scale designed  for patients and caregivers.  This can be used in support groups or provided to patients during or before therapy/clinic to alert them to the many aspects of communication we can help them maintain.  The checklist provides a column in which patients can jot down “My Challenges” with each of the competencies.