Gross Motor Function Classification System

The Gross Motor Function Classification System (GMFCS) is used to classify cerebral palsy in children from birth to the age of 18. The GMFCS was first developed in 1997 by the CanChild Centre for Childhood Disability Research of McMaster University. Since then, the Gross Motor Function Classification System has evolved and expanded as researchers discover new information on cerebral palsy.

Classifying Cerebral Palsy

Prior to the GMFCS, other systems were already in place to identify the severity of cerebral palsy. To this day, different health care specialists use the classification system that exclusively benefits their medical agenda. The GMFCS was created in an attempt to establish one universal method for organizing and defining the severity of cerebral palsy cases. A universal classification system, such as the GMFCS, would also allow for greater consistency among cerebral palsy studies.

Types of cerebral palsy classification systems, include:

Severity Level

This method is much more generic than the GMFCS and other classification systems. It breaks cerebral palsy symptoms into mild, moderate, severe, and no CP. Severity level classification is only effective to quickly convey the child’s general cerebral palsy status, when accuracy is not important.

Topographical Distribution

Unlike the GMFCS, this system only identifies the affected body parts. It uses several base words to combine for more descriptive phrases that indicate specific body parts, number of limbs, and weakness or immobility. Topographical distribution classification stems from the use of the words “paresis,” meaning weakened, and “plegia” or “plegic,” meaning paralyzed. It is commonly used by orthopedic surgeons.

Motor Function

Also unlike the GMFCS, this method indicates the brain injuries or abnormalities that caused the cerebral palsy. By identifying the underlying neurological issues, the system is able to convey the control the child has over various areas of the body. Motor function classification is split into two main categories, including spastic cerebral palsy with increased muscle tone and non-spastic cerebral palsy with decreased or inconsistent muscle tone. It is commonly used by neurologists.

Gross Motor Function Classification System

The Gross Motor Function Classification System uses 5 levels to define the range of ability and impairment of each child. Separate age groups are associated with an expected set of activities. Children are evaluated on their performance of theGMFCS activitieswithin their current age group. The evaluation is then graded on the GMFCS scale of 1 to 5, with 5 being the most severe cases of cerebral palsy.
Cerebral palsy is a very individualized medical issue. The separation of age groups and correlating levels of severity in the GMFCS allow for the most comprehensive, long-term understanding of a child’s cerebral palsy. A parent and health care provider are able to track the child’s growth and development using the GMFCS. This is important because cerebral palsy evolves over time, as the brain matures and changes. The Gross Motor Function Classification System also allows for radiologists, neurologists, pediatricians, and orthopedic surgeons to use the same terms of cerebral palsy identification. In this way, the GMFCS leads to smaller risk of medical error and better tracking of cerebral palsy research.

GMFCS Levels

The 5 levels of the Gross Motor Function Classification System are:

Level I Walks Without Limitations

The child does not need to use assistive devices for mobility. The child may walk indoors or outdoors and climb stairs without railings. Gross motor skills, such as running or jumping, are demonstrated to a standard. The child has decreased agility, speed, balance, and coordination.

Level II Walks With Limitations

The child is able to walk indoors or outdoors. The child can climb stairs with railings. The child may display limited ability in outdoor activities. There is a clear mobile difficulty on inclines, uneven surfaces, or within crowds. The child demonstrates minimal ability with gross motor skills, including running and jumping.

Level III Walks Using a Hand-Held Mobility Device

The child is able to walk with assistive mobility devices such as crutches. The child may walk indoors or outdoors, provided that the surfaces are flat and relatively smooth. The child may be able to climb stairs with railings. The child demonstrates virtually no ability in gross motor skills such as running and jumping. A self-propelled, manual wheelchair may be used, with assistance during long distances or uneven ground.

Level IV Self-Mobility with Limitations; May Use Powered Mobility

The child displays a severely limited mobility, even with assistive devices. The child uses a wheelchair all of the time, or almost all of the time. The child demonstrates zero ability in gross motor skills. The child may be able to control a power wheelchair. Standing transfers may be possible.

Level V Transported in a Manual Wheelchair

The child displays zero self-mobility. There are marked physical impairments restricting voluntary movement. There is typically zero ability to maintain head and neck position against gravity. The child may not sit or stand independently or with adaptive devices. The child demonstrates zero ability in gross motor skills and is compromised in all areas of motor function. Use of powered wheelchair may be possible.



Barbara Galuppi, et al. “Correlates Of Decline In Gross Motor Capacity In Adolescents With Cerebral Palsy In Gross Motor Function Classification System Levels III To V: An Exploratory Study.” Developmental Medicine And Child Neurology 52.7 (2010): e155-e160. MEDLINE with Full Text.Web. 27 June 2012.
Day, Steven M., et al. “Prognosis For Ambulation In Cerebral Palsy: A Population-Based Study.” Pediatrics Nov. 2004: 1264+. Academic OneFile.Web. 27 June 2012.
“Gross Motor Skills.”Cerebral Palsy Alliance.United Cerebral Palsy, n.d. Web. 27 June 2012.