Cerebral palsy is not a singular condition, but rather a group of disorders. Often, medical providers use the Gross Motor Function Classification System (GMFCS) to describe the severity of cerebral palsy and to help guide an individual’s treatment.
Five Levels of the Gross Motor Function Classification System
The GMFCS is broken down into five levels. The criteria for each level depend on a child’s age and motor function. We describe each level below.
Generally, children at a level one on the GMFCS have functional gross motor skills and can move independently. For each age level, this means:
- Birth-Age 2: Children typically meet their developmental milestones. They learn to sit independently, crawl, and walk by about 18 months of age.
- Ages 2-4: Children can sit on the floor, stand, and walk without assistance.
- Ages 4-6: Children can get in and out of chairs independently and move from sitting to standing independently. Children can climb stairs, run, and jump.
- Ages 6-12: Children can walk, run, and jump. Balance, speed, and coordination may be impacted.
Children who are at a level two can move independently in most situations but may need assistance in some cases, specifically:
- Birth-Age 2: A child can sit on the floor but may need to use hands for support. The child may crawl, pull up, and take a few steps while holding on to something, but does not walk independently.
- Ages 2-4: The child can sit independently but may lose balance when using hands to play with toys or do other things. The child can pull himself up to a standing position on something. Often, the child crawls or walks holding on to something rather than walking independently.
- Ages 4-6: The child can sit in a chair without help but may need help to move to a standing position. The child can walk independently on even surfaces. The child may need to hold a railing to walk on stairs, and cannot jump or run.
- Ages 6-12: The child can walk independently but may have trouble walking on uneven terrain, over long distances, or in other challenging situations. Adaptations are necessary for the child to participate in physical activities.
Children who are a level three on the GMFCS need assistance with movement and typically use adaptive equipment as follows:
- Birth-Age 2: The child can sit on the floor with support and may be able to roll over and crawl, but the child does not stand or walk independently.
- Ages 2-4: The child can sit on the floor but may need help getting into a sitting position. The child may crawl and may pull himself into a standing position by holding on to something, but may only take a few steps at a time while holding on to something.
- Ages 4-6: The child may need support to sit in a chair, walk, and use the stairs.
- Ages 6-12: The child needs adaptive equipment to sit and walk.
Children who are at a level four need significant assistance to move independently. Wheelchairs and other adaptive equipment are often necessary.
- Birth-2: The child develops the ability to hold up his head, but cannot sit without support. The child may roll over but does not crawl, stand, or walk independently.
- Ages 2-4: The child may be able to maintain a seated position if put in the position and uses his hands for support. The child may be able to crawl and roll over but requires assistance to stand or walk.
- Ages 4-6: The child needs adaptive seating and may be able to walk short distances with assistance.
- Ages 6-12: The child needs adaptive seating. The child may be able to roll or crawl at home but needs a walker or wheelchair outside of the home.
Children who are at a level five on the GMFCS usually cannot move independently. Restrictions include the following:
- Birth-Age 2: Children are unable to maintain head control and need help to roll over.
- Ages 2-4: Children may not be able to sit, stand, or move independently even with adaptive equipment.
- Ages 4-6: Children cannot move independently, and all movement is impaired.
- Ages 6-12: A wheelchair is required in all settings. Assistive technology is also required.
A child may move between levels of the Gross Motor Function Classification System throughout his or her life.
More Information to Help When Your Child Has Cerebral Palsy
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