Gross Motor Functions Classification System (GMFCS)

GMFCS in Clinical Practice and Research

It is used to assess the level of motor impairment in children with CP based on their functionality, need for assistive devices and mobility.

Assessment of the condition of patients with cerebral palsy (CP) and their functionality are necessary for the correct choice of treatment, evaluation of its results and the choice of strategies and means of adaptation. Many tools and classifications with proven validity and reliability have been developed to assess the level of development and capabilities of patients with cerebral palsy.

To provide a standardized assessment of the severity of motor impairment of patients with cerebral palsy, the staff of McMaster University in Canada in 1997 had developed the Gross Motor Functions Classification System. This classification system is used to objectively assess the level of motor impairment in children with cerebral palsy based on their functionality, need for assistive devices and mobility.

The Gross Motor Functions Classification System is a universally recognized world standard, its validity and reliability have been evaluated in many studies. The classification is translated into different languages. The scientific team of the Kozyavkin International Rehabilitation Clinic had translated this classification into Ukrainian.

In 2007, an expanded and refined version of the Gross Motor Functions Classification System was introduced, which is analogous to the previous one, but additionally includes a description of the functional capabilities of children aged 12-18. This is due to some decline in motor activity of children after 12 years of age, development of the contractures in the extremities, a period of intense growth, when the development of new functions is significantly slowed down, a possible “step back” in motor development.

Prognosis and Typical Functional Expectations by Level

According to this classification, all patients with cerebral palsy are divided according to their motor abilities into five levels. The division into levels is based on the child’s functional capabilities, the need for assistive devices and equipment, including mobility equipment (walkers, crutches, sticks, wheelchairs) and to a lesser extent on the quality of the child’s movements.

“Level I” corresponds to children who can walk without restrictions, but do not cope with more complex motor tasks – jumping and running. “Level V” corresponds to children with very limited ability to move independently, even with assistive equipment and poor control of the torso and head.

The classification can be applied quickly and easily, it focuses on determining the level that best suits the capabilities and limitations of the child’s motor functions at the time of the examination. Emphasis is placed on the typical behaviour of the child at home, at school and in society.

As the development of motor functions depends on age, for each level of classification a separate description is given for different age groups (up to 2 years, from 2 to 4 years, from 4 to 6 years, from 6 to 12 years, from 12 to 18 years).

In general, the patient classification process takes only a few minutes. Most indicators are clear, so one can quickly decide to what level to attribute the indicators of the overall motor function of the child. Sometimes (for example, at a certain age), the difference between the levels is blurred and requires careful consideration. To help determine the level of motor disorders in the child more accurately, the results of differences between adjacent levels in the classification are provided. Before working with the classification, it is necessary to read the instructions for users in detail.

The Gross Motor Functions Classification System can be used in clinical practice and research. By determining the level of classification, you can predict the child’s future prognosis and average capabilities.

Official Resources:

Detailed information on the GMFCS classification system is available on the website CanChild.

The Gross Motor Functions Classification System could be downloaded by the link.

About the author

Taras Voloshyn

Neurologist at the Kozyavkin International Rehabilitation Clinic since 2009. Conference participant, author of publications, specialized in the assessment and rehabilitation of patients with cerebral palsy.