📐 Severity & Classification

Gross Motor Function Classification System (GMFCS)

The GMFCS is the most widely used classification system for CP. It describes a person's ability to move on a scale of I to V:

• Level I — Walks without limitations. May have minor balance or coordination difficulties. Can run, jump, and participate in most physical activities.
• Level II — Walks with limitations. May have difficulty with uneven surfaces, slopes, stairs, or long distances. May use handrails on stairs.
• Level III — Walks with a hand-held mobility device (walker, crutches) indoors. May use a wheelchair for longer distances or outdoors.
• Level IV — Limited self-mobility. Uses a wheelchair in most settings. May be able to operate a powered wheelchair. Needs help with transfers.
• Level V — Transported in a wheelchair in all settings. Severely limited head and trunk control. Requires full physical assistance for all movement.

The GMFCS level typically remains stable over a person's lifetime, though function within each level can improve with therapy and support.

Manual Ability Classification System (MACS)

The MACS rates ability to handle objects in everyday activities:

• Level I — Handles objects easily and successfully
• Level II — Handles most objects but with reduced quality or speed
• Level III — Handles objects with difficulty; needs help to prepare or modify activities
• Level IV — Handles a limited selection of easily managed objects in adapted situations
• Level V — Does not handle objects; requires total assistance for even simple actions

Communication Function Classification System (CFCS)

The CFCS rates everyday communication performance:

• Level I — Effective sender and receiver with unfamiliar and familiar partners
• Level II — Effective but slower pace with unfamiliar or familiar partners
• Level III — Effective sender and receiver with familiar partners
• Level IV — Inconsistent sender and/or receiver with familiar partners
• Level V — Seldom effective sender and receiver, even with familiar partners

What Levels Mean in Practice

These classification systems are tools — not labels or limits. They help:

• Clinicians set realistic, meaningful therapy goals
• Families understand what to expect and plan ahead
• Researchers study outcomes across similar groups
• NDIS planners understand support needs

A GMFCS level does not define a person. People at every level lead rich, meaningful lives. The goal of classification is to ensure each person gets the right support — not to place limits on what they can achieve.