Inclusion Criteria:  Diagnosis of ALS as Clinically Possible, Clinically Probable, Laboratory-supported Probable and Clinically Definite ALS 18 years old to 100 years old, English-speaking ALS subjects, male and female  Exclusion Criteria:  Use of non-invasive ventilation more than 16 hours daily Non-English Speaker Psychosis or severe mental illness Use of high-dose sedating psychotropic medications determined to potentially interfere with task performance Infection Control issues and specific Pulmonary, Cardiac, Vascular contraindications as listed in the Standardization of Spirometry 2019 Update (Graham 2019)