Gross Motor Function Classification System
The Gross Motor Function Classification System (GMFCS) is a 5 level classification system that describes the gross motor function of children and youth with cerebral palsy on the basis of self-initiated movement with particular emphasis on sitting, walking, and wheeled mobility.
Distinctions between levels are based on functional abilities, the need for walkers, crutches, wheelchairs, or canes / walking sticks, and to a much lesser extent, the actual quality of movement.
The original version was developed in 1997; as of 2007, the expanded and revised version (GMFCS - E&R) further includes an age band for youth 12 to 18 years. The original concept was developed collaboratively by Robert Palisano, Professor of Physiotherapy at Drexel University; Peter Rosenbaum, Professor of Developmental Paediatrics at McMaster's ; Stephen Walter, Professor of Biostatistics at McMaster's; Dianne Russell; Ellen Wood; and Barbara Galuppi.
GMFCS is now the standard in both North America and Western Europe for mobility assessment and ambulatory ability prediction for children with cerebral palsy. The examination is done using the Gross Motor Function Measure (GMFM), a set of 66 sitting (truncal control) and walking exercises that help the specialist classify the person into one of the system's five levels.
GMFCS Level I
• Can walk indoors and outdoors and climb stairs without using hands for support
• Can perform usual activities such as running and jumping
• Has decreased speed, balance and coordination
GMFCS Level II
• Has the ability to walk indoors and outdoors and climb stairs with a railing
• Has difficulty with uneven surfaces, inclines or in crowds
• Has only minimal ability to run or jump
GMFCS Level III
• Walks with assistive mobility devices indoors and outdoors on level surfaces
• May be able to climb stairs using a railing
• May propel a manual wheelchair and need assistance for long distances or uneven surfaces
GMFCS Level IV
• Walking ability severely limited even with assistive devices
• Uses wheelchairs most of the time and may propel own power wheelchair
• Standing transfers, with or without assistance
GMFCS Level V
• Has physical impairments that restrict voluntary control of movement
• Ability to maintain head and neck position against gravity restricted
• Impaired in all areas of motor function
• Cannot sit or stand independently, even with adaptive equipment
• Cannot independently walk but may be able to use powered mobility