The gross motor function of children with cerebral palsy can be categorised into 5 different levels using a scale called the Gross Motor Function Classification System Expanded and Revised (GMFCS – E&R).

GMFCS considers movements like sitting, standing, walking and use of mobility devices. It is helpful in practice because it provides caretakers with:

• A clear idea about child’s current motor function, and
• What equipment or mobility device a child will need in the future, e.g. crutches, walkers or wheelchairs.

Generally, a child over the age of 5 years will not improve their GMFCS-E&R level so, if for example, a child is classified at a Level IV at the age of 6 then it is likely that the child will need to use a mobility device throughout their life.

More details about GMFCS-E&R can be obtained from CanChild website.

GMFCS-E&R can be applied to child under 2 years to the 18 years. GMFCS-E&R is translated in several different languages and a Family and Self Report Questionnaire is available in local languages.

Here is the brief description of various GMFCS level.

GMFCS Level I

Children at this level can walk at home, school, outdoors and in the community. They can climb stairs without the use of a railing. Children can run and jump, but speed, balance and coordination are limited.

GMFCS Level II

Children at this level walk without supporting device but hold onto a railing while climbing stairs. They may experience difficulty while walking long distances and balancing on uneven terrain, inclines, in crowded places or confined spaces.

Children may require physical assistance, while walking over long distances. Children can barely performs running and jumping.

GMFCS Level III

Children requires a hand-held mobility device in most settings. While climbing stairs they need to hold on to a railing. For long distance travel they need motorised wheelchairs.

GMFCS Level IV

Children at this level require physical assistance and assisted device in most settings. They may walk for short distances at home or in physiotherapy department. In the community children are transported in a wheelchair.

GMFCS Level V

Children at this level are non-ambulatory. They are transported in a manual wheelchair in all settings.