Cerebral palsy classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Classification

Topographical Distribution

Based on number of limbs involved cerebral palsy can be classified into 4 subtypes

Monoplegia

Based on the muscle tone

Based on the tone of involved muscle cerebral palsy can be divided into

• Hypertonic cerebral palsy
• Hypotonic cerebral palsy

Functional Classification of Cerebral Palsy

The Manual Ability Classification System (MACS) and the Gross Motor Function Classification System (GMFCS) are two most commonly employed systems for classification of cerebral palsy.

Manual Ability Classification System

The Manual Ability Classification System (MACS) classifies children with cerebral palsy into five levels. The levels are based on the children’s self-initiated ability to handle objects and their need for assistance or adaptation to perform manual activities in everyday life.

Does the child handle most kind of daily activities independently ( during play and leisure, eating and dressing)

Yes

No

Does the child handle even more difficult tasks with fair speed and accuracy and does not need alternative ways to perform

Does the child perform number of mannual tasks which commonly need to prepared or adapted and help is needed occasionally

Yes

No

Yes

No

Level 1 Handles objects easily and successfully

Level 2 Handles most objects with reduced quality and speed of acheivement

Level 3 Handles objects with difficulty but needs preparation

Can the child perform easy activites with frequent support

Yes

No

Level 4 Handles easy activites with limitations and support

Level 5 Cannot handle daily activites has severely limited abilities to perform even simple actions

Gross Motor Function Classification System

The Gross Motor Function Classification System (GMFCS) also classifies children with cerebral palsy into five levels. The levels are based on self-initiated movement abilities, in particular sitting and walking.

Level	Description
1	Can walk at home, school, outdoors and in the community without any support. Can climb stairs without the use of a railing. Can perform gross motor skills such as running and jumping, but speed, balance, and coordination are limited.
2	Can walk in most settings and climb stairs holding onto a railing. May experience difficulty walking long distances and balancing on uneven terrain, inclines, in crowded areas or confined spaces. Children may walk with physical assistance, a handheld mobility device or used wheeled mobility over long distances. Children have only minimal ability to perform gross motor skills such as running and jumping.
3	Children walk using a hand-held mobility device in most indoor settings. Children may climb stairs holding onto a railing with supervision or assistance. Children use wheeled mobility when traveling long distances and may self-propel for shorter distances.
4	Children use methods of mobility that require physical assistance or powered mobility in most settings. Children may walk for short distances at home with physical assistance or use powered mobility or a body support walker when positioned. At school, outdoors and in the community children are transported in a manual wheelchair or use powered mobility.
5	Children are transported in a manual wheelchair in all settings. Children are limited in their ability to maintain antigravity head and trunk postures and control leg and arm movements.