# ALSFRS-R ALSFRS-R Status: LIVE Price: $0.005 USDC `GET /api/calc/alsfrs_r` HTML: https://magentlab.com/docs/alsfrs-r Markdown: https://magentlab.com/docs/alsfrs-r.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum twelve caller-assigned Cedarbaum 1999 ALSFRS-R items (each integer 0-4, including three respiratory) and return the published 0-48 total. Does not apply later total-score severity bands or percent of maximum. ## When to use When an agent already has Cedarbaum 1999 integers 0-4 for the twelve ALSFRS-R items and needs the published total. magent does not examine the patient, diagnose ALS, score original 10-item ALSFRS, score Karnofsky or ECOG, or apply later percent-of-max or staging cutoffs. ## When not to use - Not a medical device and not an ALS diagnosis or treatment order. - Each of the twelve items is a caller-assigned integer 0-4. magent does not examine the patient. - This is Cedarbaum 1999 ALSFRS-R only (twelve items including dyspnea, orthopnea, and respiratory_insufficiency; max 48). magent does not score original 10-item ALSFRS, Karnofsky, or ECOG. - cutting_food is one 0-4 slot. Patients without gastrostomy and patients with gastrostomy share that slot; the caller assigns 0-4 from whichever Cedarbaum 1999 Table 1 column applies. magent does not branch on gastrostomy. - Cedarbaum 1999 published no total-score severity bands. This tool returns score and max_score only. It does not apply later percent-of-max, mild/moderate/severe, or staging website or review cutoffs. ## Formula ``` ALSFRS-R = speech + salivation + swallowing + handwriting + cutting_food + dressing_hygiene + turning_in_bed + walking + climbing_stairs + dyspnea + orthopnea + respiratory_insufficiency; each caller-assigned 0-4; Cedarbaum 1999 twelve items including three respiratory; cutting_food is one 0-4 slot for with or without gastrostomy; max 48; no total-score severity bands ``` ## Citation [The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF Study Group (Phase III)](https://doi.org/10.1016/s0022-510x(99)00210-5) Cedarbaum JM, Stambler N, Malta E, Fuller C, Hilt D, Thurmond B, Nakanishi A J Neurol Sci. 1999;169(1-2):13-21 DOI: [10.1016/s0022-510x(99)00210-5](https://doi.org/10.1016/s0022-510x(99)00210-5) ## Worked example ### All items 0 Given: `climbing_stairs=0, cutting_food=0, dressing_hygiene=0, dyspnea=0, handwriting=0, orthopnea=0, respiratory_insufficiency=0, salivation=0, speech=0, swallowing=0, turning_in_bed=0, walking=0` 1. speech, salivation, swallowing, handwriting, cutting_food, dressing_hygiene, turning_in_bed, walking, climbing_stairs, dyspnea, orthopnea, and respiratory_insufficiency are 0 as assigned by the caller 2. Score = 0 (max 48). Cedarbaum 1999 published no total-score severity band. ### All items 4 Given: `climbing_stairs=4, cutting_food=4, dressing_hygiene=4, dyspnea=4, handwriting=4, orthopnea=4, respiratory_insufficiency=4, salivation=4, speech=4, swallowing=4, turning_in_bed=4, walking=4` 1. each of the twelve Cedarbaum 1999 ALSFRS-R items is 4 as assigned by the caller 2. Score = 48 (max 48). No total-score severity band. ## Also searched as - ALSFRS-R - Revised ALS Functional Rating Scale - Cedarbaum 1999 ALSFRS-R - ALSFRS-R score - 12-item ALSFRS-R - amyotrophic lateral sclerosis functional rating - ALSFRS revised respiratory - revised ALSFRS ## Parameters - `speech` (integer, required): Caller-assigned Cedarbaum 1999 speech (integer 0-4): 4 normal speech processes; 3 detectable speech disturbance; 2 intelligible with repeating; 1 speech combined with nonvocal communication; 0 loss of useful speech. magent does not examine the patient. - `salivation` (integer, required): Caller-assigned Cedarbaum 1999 salivation (integer 0-4): 4 normal; 3 slight but definite excess of saliva in mouth, may have nighttime drooling; 2 moderately excessive saliva, may have minimal drooling; 1 marked excess of saliva with some drooling; 0 marked drooling, requires constant tissue or handkerchief. magent does not examine the patient. - `swallowing` (integer, required): Caller-assigned Cedarbaum 1999 swallowing (integer 0-4): 4 normal eating habits; 3 early eating problems, occasional choking; 2 dietary consistency changes; 1 needs supplemental tube feeding; 0 NPO (exclusively parenteral or enteral feeding). magent does not examine the patient. - `handwriting` (integer, required): Caller-assigned Cedarbaum 1999 handwriting (integer 0-4): 4 normal; 3 slow or sloppy, all words are legible; 2 not all words are legible; 1 able to grip pen but unable to write; 0 unable to grip pen. magent does not examine the patient. - `cutting_food` (integer, required): Caller-assigned Cedarbaum 1999 cutting food and handling utensils (integer 0-4). Patients without gastrostomy and patients with gastrostomy share this single 0-4 slot; the caller assigns 0-4 from whichever Table 1 column applies. Without gastrostomy: 4 normal; 3 somewhat slow and clumsy, but no help needed; 2 can cut most foods, although slow and clumsy, some help needed; 1 food must be cut by someone, but can still feed slowly; 0 needs to be fed. With gastrostomy: 4 normal; 3 clumsy but able to perform all manipulations independently; 2 some help needed with closures and fasteners; 1 provides minimal assistance to caregiver; 0 unable to perform any aspect of task. magent does not examine the patient. - `dressing_hygiene` (integer, required): Caller-assigned Cedarbaum 1999 dressing and hygiene (integer 0-4): 4 normal function; 3 independent and complete self-care with effort or decreased efficiency; 2 intermittent assistance or substitute methods; 1 needs attendant for self-care; 0 total dependence. magent does not examine the patient. - `turning_in_bed` (integer, required): Caller-assigned Cedarbaum 1999 turning in bed and adjusting bed clothes (integer 0-4): 4 normal; 3 somewhat slow and clumsy, but no help needed; 2 can turn alone or adjust sheets, but with great difficulty; 1 can initiate, but not turn or adjust sheets alone; 0 helpless. magent does not examine the patient. - `walking` (integer, required): Caller-assigned Cedarbaum 1999 walking (integer 0-4): 4 normal; 3 early ambulation difficulties; 2 walks with assistance; 1 nonambulatory functional movement only; 0 no purposeful leg movement. magent does not examine the patient. - `climbing_stairs` (integer, required): Caller-assigned Cedarbaum 1999 climbing stairs (integer 0-4): 4 normal; 3 slow; 2 mild unsteadiness or fatigue; 1 needs assistance; 0 cannot do. magent does not examine the patient. - `dyspnea` (integer, required): Caller-assigned Cedarbaum 1999 dyspnea (integer 0-4): 4 none; 3 occurs when walking; 2 occurs with one or more of eating, bathing, dressing (ADL); 1 occurs at rest, difficulty breathing when either sitting or lying; 0 significant difficulty, considering using mechanical respiratory support. magent does not examine the patient. - `orthopnea` (integer, required): Caller-assigned Cedarbaum 1999 orthopnea (integer 0-4): 4 none; 3 some difficulty sleeping at night due to shortness of breath, does not routinely use more than two pillows; 2 needs extra pillows in order to sleep (more than two); 1 can only sleep sitting up; 0 unable to sleep. magent does not examine the patient. - `respiratory_insufficiency` (integer, required): Caller-assigned Cedarbaum 1999 respiratory insufficiency (integer 0-4): 4 none; 3 intermittent use of NIPPV; 2 continuous use of NIPPV during the night; 1 continuous use of NIPPV during the night and day; 0 invasive mechanical ventilation by intubation or tracheostomy. magent does not examine the patient. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/alsfrs_r` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "climbing_stairs": "0", "cutting_food": "0", "dressing_hygiene": "0", "dyspnea": "0", "handwriting": "0", "orthopnea": "0", "respiratory_insufficiency": "0", "salivation": "0", "speech": "0", "swallowing": "0", "turning_in_bed": "0", "walking": "0" }, { "climbing_stairs": "0", "cutting_food": "0", "dressing_hygiene": "0", "dyspnea": "0", "handwriting": "0", "orthopnea": "0", "respiratory_insufficiency": "0", "salivation": "0", "speech": "0", "swallowing": "0", "turning_in_bed": "0", "walking": "0" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/alsfrs-r Example 200: ```json { "count": 2, "path": "/api/calc/alsfrs_r", "items": [ { "components": [ { "value": 0, "factor": "speech", "points": 0, "present": true }, { "value": 0, "factor": "salivation", "points": 0, "present": true }, { "value": 0, "factor": "swallowing", "points": 0, "present": true }, { "value": 0, "factor": "handwriting", "points": 0, "present": true }, { "value": 0, "factor": "cutting_food", "points": 0, "present": true }, { "value": 0, "factor": "dressing_hygiene", "points": 0, "present": true }, { "value": 0, "factor": "turning_in_bed", "points": 0, "present": true }, { "value": 0, "factor": "walking", "points": 0, "present": true }, { "value": 0, "factor": "climbing_stairs", "points": 0, "present": true }, { "value": 0, "factor": "dyspnea", "points": 0, "present": true }, { "value": 0, "factor": "orthopnea", "points": 0, "present": true }, { "value": 0, "factor": "respiratory_insufficiency", "points": 0, "present": true } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Cedarbaum JM, Stambler N, Malta E, Fuller C, Hilt D, Thurmond B, Nakanishi A", "doi": "10.1016/s0022-510x(99)00210-5", "id": "cedarbaum-1999", "pmid": "10540002", "source": "J Neurol Sci. 1999;169(1-2):13-21", "title": "The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF Study Group (Phase III)" }, "formula": "alsfrs_r", "formula_expression": "ALSFRS-R = speech + salivation + swallowing + handwriting + cutting_food + dressing_hygiene + turning_in_bed + walking + climbing_stairs + dyspnea + orthopnea + respiratory_insufficiency; each caller-assigned 0-4; Cedarbaum 1999 twelve items including three respiratory; cutting_food is one 0-4 slot for with or without gastrostomy; max 48; no total-score severity bands", "max_score": 48, "score": 0 }, { "components": [ { "value": 0, "factor": "speech", "points": 0, "present": true }, { "value": 0, "factor": "salivation", "points": 0, "present": true }, { "value": 0, "factor": "swallowing", "points": 0, "present": true }, { "value": 0, "factor": "handwriting", "points": 0, "present": true }, { "value": 0, "factor": "cutting_food", "points": 0, "present": true }, { "value": 0, "factor": "dressing_hygiene", "points": 0, "present": true }, { "value": 0, "factor": "turning_in_bed", "points": 0, "present": true }, { "value": 0, "factor": "walking", "points": 0, "present": true }, { "value": 0, "factor": "climbing_stairs", "points": 0, "present": true }, { "value": 0, "factor": "dyspnea", "points": 0, "present": true }, { "value": 0, "factor": "orthopnea", "points": 0, "present": true }, { "value": 0, "factor": "respiratory_insufficiency", "points": 0, "present": true } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Cedarbaum JM, Stambler N, Malta E, Fuller C, Hilt D, Thurmond B, Nakanishi A", "doi": "10.1016/s0022-510x(99)00210-5", "id": "cedarbaum-1999", "pmid": "10540002", "source": "J Neurol Sci. 1999;169(1-2):13-21", "title": "The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF Study Group (Phase III)" }, "formula": "alsfrs_r", "formula_expression": "ALSFRS-R = speech + salivation + swallowing + handwriting + cutting_food + dressing_hygiene + turning_in_bed + walking + climbing_stairs + dyspnea + orthopnea + respiratory_insufficiency; each caller-assigned 0-4; Cedarbaum 1999 twelve items including three respiratory; cutting_food is one 0-4 slot for with or without gastrostomy; max 48; no total-score severity bands", "max_score": 48, "score": 0 } ] } ``` ## Response fields - `formula` (string): alsfrs_r - `formula_expression` (string): Exact expression used - `score` (integer): Cedarbaum 1999 ALSFRS-R sum of twelve caller-assigned 0-4 items (total 0-48) - `max_score` (integer): Always 48 - `components` (array): Per-item caller-assigned points - `citation` (object): Cedarbaum J Neurol Sci 1999 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": 0, "factor": "speech", "points": 0, "present": true }, { "value": 0, "factor": "salivation", "points": 0, "present": true }, { "value": 0, "factor": "swallowing", "points": 0, "present": true }, { "value": 0, "factor": "handwriting", "points": 0, "present": true }, { "value": 0, "factor": "cutting_food", "points": 0, "present": true }, { "value": 0, "factor": "dressing_hygiene", "points": 0, "present": true }, { "value": 0, "factor": "turning_in_bed", "points": 0, "present": true }, { "value": 0, "factor": "walking", "points": 0, "present": true }, { "value": 0, "factor": "climbing_stairs", "points": 0, "present": true }, { "value": 0, "factor": "dyspnea", "points": 0, "present": true }, { "value": 0, "factor": "orthopnea", "points": 0, "present": true }, { "value": 0, "factor": "respiratory_insufficiency", "points": 0, "present": true } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Cedarbaum JM, Stambler N, Malta E, Fuller C, Hilt D, Thurmond B, Nakanishi A", "doi": "10.1016/s0022-510x(99)00210-5", "id": "cedarbaum-1999", "pmid": "10540002", "source": "J Neurol Sci. 1999;169(1-2):13-21", "title": "The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF Study Group (Phase III)" }, "formula": "alsfrs_r", "formula_expression": "ALSFRS-R = speech + salivation + swallowing + handwriting + cutting_food + dressing_hygiene + turning_in_bed + walking + climbing_stairs + dyspnea + orthopnea + respiratory_insufficiency; each caller-assigned 0-4; Cedarbaum 1999 twelve items including three respiratory; cutting_food is one 0-4 slot for with or without gastrostomy; max 48; no total-score severity bands", "max_score": 48, "score": 0 } ``` ## Errors - HTTP 400 `invalid_alsfrs`: ALSFRS-R needs the twelve Cedarbaum 1999 items each as an integer 0-4. Returned before settlement; you are not charged. - HTTP 400 `invalid_alsfrs_item`: each ALSFRS-R item must be an integer from 0 to 4 (Cedarbaum 1999). Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [Karnofsky](https://magentlab.com/docs/karnofsky) — Return the Karnofsky 1949 Performance Status 10-100 from a caller-assigned integer, with a stable label. - [Barthel Index](https://magentlab.com/docs/barthel) — Sum ten caller-assigned Mahoney 1965 Barthel Index item points and return the published 0-100 total. ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.