Gross Motor Function Classification System
What is the Gross Motor Function Classification System?
GMFCS is a classification system that is based on self-initiated movement. This system looks at movements such as sitting, walking and use of mobility devices in 5 levels. These levels help provide families and clinicians with a description of a child’s current motor function and gives an idea of what equipment or mobility aids a child may need in the future, (such as crutches, walkers or wheelchairs). It was made to use on children with Cerebral Palsy.
What are the levels?
Below is a brief definition of each level:
- Level 1: Walks without limitations
- Level 2: Walks with limitations
- Level 3: Walks using a hand-held mobility device (crutches or walker)
- Level 4: Self mobility with limitations; may use powered mobility (in a wheelchair or scooter)
- Level 5: Transported in a manual wheelchair or uses power mobility with head support.
Before 2nd birthday
- Level 1: Infant moves in and out of sitting, crawls on hands and knees, pull to stand and take steps holding on to furniture. Infants walk between 18 months and 2 years of age without the need for any assistive mobility device.
- Level 2: floor sitting but uses hands for support. Crawls on hands and knees. May pull to stand and take steps holding onto furniture.
- Level 3: floor sitting with lower back supported. Creeps forward on stomach.
- Level 4: Infants have head control but trunk support is required for floor sitting. Infants can roll to back and may roll to stomach.
- Level 5: impairments limit voluntary control of movement. Need help with head and trunk control with sitting.
Between 2nd and 4th birthday
- Level 1: Move in and out of floor sitting and standing without help. Children able to walk.
- Level 2: Move in and out of floor sitting and standing without help. Able to pull to stand by a stable surface. Cruise holding onto furniture and walk with an assistive device.
- Level 3: Children creep on their stomach or crawl on hands and knees. Can pull to stand and cruise short distances. May walk short distances using a walker and adult supervision.
- Level 4: Children sit when placed and need hands for support. Need equipment for sitting and standing. Creeps on stomach or crawl for short distances.
- Level 5: Children need adaptive equipment for sitting and standing. No means of independent movement and some are using powered wheelchairs.
Between 4th and 6th birthday
- Level 1: Get in and out of sitting without hand support. Children walk indoors and outdoors and climb stairs. Starting to run and jump.
- Level 2: Able to sit in a chair. Able to move from floor to standing but require a surface to push off from. Able to walk short distances on stable ground. Able to climb stairs with help of a railing. No running or jumping.
- Level 3: Children can sit in a chair but may require some support. Walk with a hand-held mobility device. Climb stairs with assistance.
- Level 4: Children need trunk support when sitting. Use a walker for short distances. May achieve self mobility using a wheelchair.
- Level 5: All areas of motor function are limited. No means of independent movement.
Between 6th and 12th birthday
- Level 1: Children walk at home, school, outdoors, and in the community. Children are able to run and jump but balance is limited.
- Level 2: Children walk in most settings. Difficulty on uneven terrain. Can walk outdoors and in the community with assistance. Minimal ability to run and jump.
- Level 3: Children walk using a hand-held mobility device. Need a wheelchair when traveling long distances. May be able to walk up and down stairs using a railing.
- Level 4: Children require assistance with sitting and assistance with transfers. At home, children roll or crawl or walk short distances with assistance or use a wheelchair. For longer distances, kids use a manual wheelchair or power chair.
- Level 5: Children are transported in a manual wheelchair in all settings. Transfers require complete physical assistance.
Between 12th and 18th birthday
- Level 1: Able to walk at home, school, outdoors, and in the community. Able to run and jump. Balance is limited.
- Level 2: Able to walk in most settings. At school or work, they use hand-held mobility devices for safety. Outdoors and in the community, they use a wheelchair for long distances. Able to walk up and down stairs using a railing.
- Level 3: Youth walk using a hand-held mobility device. At school and in the community, they use a manual wheelchair or power chair. May walk up and down stairs using a railing.
- Level 4: Youth use wheeled mobility in most settings. Need 1 or 2 helpers for transfers. May use a power chair. May walk short distances indoors using a walker.
- Level 5: Youth are transported in a manual wheelchair in all settings. Youth are limited in their ability to maintain head and trunk postures and control arm and leg movements. Physical assistance from 1 or 2 persons or a mechanical lift is required for transfers.
This information is not specific to your child but provides general information. If you have any questions, please ask your healthcare team.
The CanChild website has full details on GMFCS-E&R and is published in several different languages.
Adapted from GMFCS - E & R © Robert Palisano, Peter Rosenbaum, Doreen Bartlett, Michael Livingston, 2007 CanChild Centre for Childhood Disability Research, McMaster University.
This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Family Resource Center library, or visit www.childrensmn.org/educationmaterials.
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