GMFCS E&R (Gross Motor Function Classification System – Extended and Revised)
The gross motor skills (e.g. sitting and walking) of children and young people with cerebral palsy can be categorised into 5 different levels using a tool called the Gross Motor Function Classification System (GMFCS).
GMFCS looks at movements such as sitting and walking. It is helpful because it provides families and clinicians with:
- a clear description of a child’s current motor function, and
- an idea of what equipment or mobility aids a child may need in the future, e.g. crutches, walking frames or wheelchairs.
Generally, a child or young person over the age of 5 years will not improve their GMFCS level so, if for example, a child is classified at a Level IV at the age of 6 then it is likely that they will need to use a mobility device throughout their life.
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 (may require assistance for long distances or uneven surfaces).
GMFCS Level IV
- Walking ability is severely limited even with assistive devices
- Uses wheelchairs most of the time and may propel their own power wheelchair
- May participate in standing transfers.
GMFCS Level V
- Has physical impairments that restrict voluntary control of movement and the ability to maintain head and neck position against gravity
- Is impaired in all areas of motor function
- Cannot sit or stand independently, even with adaptive equipment
- Cannot independently walk, though may be able to use powered mobility.
GMFCS descriptors copyright © Palisano et al. (1997) Dev Med Child Neurol 39:214-23 CanChild
Illustrations copyright © Kerr Graham, Bill Reid and Adrienne Harvey,
The Royal Children’s Hospital, Melbourne
- Palisano, R., Rosenbaum, P., Walter, S., Russell, D., Wood, E., & Galuppi, B. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine and Child Neurology, 39(4), 214-223. See abstract
- Rosenbaum, P. L., Walter, S. D., Hanna, S. E., Palisano, R. J., Russell, D. J., Raina, P., Galuppi, B. E. (2002). Prognosis for gross motor function in cerebral palsy: creation of motor development curves. Journal of the American Medical Association, 288(11), 1357-1363.
(Update: 18 Nov 2015)