Cerebral palsy is categorized into types and subtypes based on the extent and distribution of impairments such as spasticity and muscle tone abnormalities. The classification systems used to describe and organize cerebral palsy include:
- Muscle Tone Classification System
- Motor Disturbance Classification System
- Limb Involvement Classification System
- Severity of Cerebral Palsy
- Gross Motor Function Classification System (GMFCS)
- Manual Ability Classification System (MACS)
- Communication Function Classification System (CFCS)
Many of the classification systems for cerebral palsy overlap. Because these systems range from specific to general, encompass various areas of the body and explain different aspects of functional ability, they are often used together. For example, the motor function and limb involvement classification systems are commonly used together to create the classification of ‘spastic quadriplegic’ cerebral palsy. ‘Spastic’ relates to the motor function classification system and ‘quadriplegic’ relates to the limb involvement classification system.
1. Muscle Tone Classification System
In the muscle tone classification system, cerebral palsy is described based on how muscle tone is impaired. The two muscle tone classifications are as follows:
- Hypertonia: A physiological term used to describe abnormally high muscle tone. Individuals with hypertonia and hypertonic cerebral palsy have increased muscle tone, which creates muscular stiffness and rigidity. Spastic cerebral palsy is characterized by hypertonia.
- Hypotonia: A physiological term used to describe abnormally low muscle tone. Side effects of hypotonia include floppiness and weakness. Forms of non-spastic cerebral palsy (ataxic, dyskinetic and athetoid cerebral palsy) are characterized by hypotonia.
- Mixed cerebral palsy is characterized by both hypotonia and hypertonia,
2. Motor Disturbance Classification System
The motor disturbance classification system organizes cerebral palsy into four main types based on the location of the brain injury and the brain injury’s corresponding movement impairments. The four types include:
- Spastic cerebral palsy
- Ataxic cerebral palsy
- Dyskinetic/Athetoid cerebral palsy
- Mixed cerebral palsy
Other important terms to know relating to the Motor Disturbance Classification System include:
- Rigidity: Abnormal muscular stiffness.
- Tremor: An involuntary, shaking muscle movement that is often a sign of a neurological disorder. Coordination and movement in the hands, arms, head, face, voice and legs are most often affected.
3. Limb Involvement Classification System
This classification system categorizes cerebral palsy in terms of limb impairment. In the Limb Involvement Classification System, each type of cerebral palsy describes information about the number and location of affected limbs.
|Type of Cerebral Palsy
||# Limbs Affected
||Location of Affected Limbs
|Monoplegic cerebral palsy (monoplegia; monoparesis)
||Usually an arm, but can be any limb.
|Hemiplegic cerebral palsy
||Limbs affected on the same side of the body (ex: left arm and left leg).
|Double hemiplegic cerebral palsy
||Both arms and both legs affected; one side of the body is more involved.
|Diplegic cerebral palsy
||CP that affects symmetrical parts of the body (for example, both arms and/or both legs); most commonly impacts both legs.
|Paraplegic cerebral palsy
||Impairs the lower body, affecting both legs.
|Triplegic cerebral palsy
||Impacts three limbs; usually both arms and one leg.
|Quadriplegic cerebral palsy
||Involves all four limbs; commonly associated with spastic CP.
|Pentaplegic cerebral palsy
||Impacts both legs, both arms, and the head and neck.
4. Severity of Cerebral Palsy
Classifying cerebral palsy based on severity is the simplest way to describe the extent of an individual’s impairment.
- Mild Cerebral Palsy: Those with mild cerebral palsy may be independent and fully mobile depending on level of cognitive function. Some can complete daily tasks without or with very little assistance.
- Moderate Cerebral Palsy: Those with moderate cerebral palsy require assistance from assistive technology, adaptive equipment and other people to perform daily tasks.
- Severe Cerebral Palsy: Those with severe cerebral palsy require extensive help from assistive technology, adaptive equipment and other people in order to complete daily tasks.
5. Gross Motor Classification System (GMFCS)
The Gross Motor Function Classification System (GMFCS) is a system that is used to classify infants, children and adolescents with cerebral palsy into five groups based on the following categories:
- Extent of movement impairment: The GMFCS measures a child’s ability to perform gross motor functions independently. It takes into consideration limb control, movement transition, dependence on equipment and related factors.
- Age: The GMFCS measures individuals by age group including 0-2, 2-4, 4-6, 6-12 and 12-18.
- Performance in a variety of settings: The GMFCS measures a child’s functional ability in settings such as the home, school and community.
The GMFCS is measured in levels (GMFCS Level 1-5) with the highest level signifying the most severe forms of cerebral palsy. By classifying a child with cerebral palsy based on the GMFCS, parents, medical professionals and caregivers can determine appropriate therapy regimens, plan lifestyle adjustments and estimate rehabilitation potential. The GMFCS works in conjunction with other classification systems including the Manual Ability Classification System of cerebral palsy (MACS), the Motor Disturbance Classification System, severity, and the Communication Function Classification System of cerebral palsy (CFCS).
- GMFCS Level I
- Mobility: Children walk, climb, jump, run and move largely without limitations, but experience compromised speed, coordination and balance.
- Self-care: Independent.
- Adaptive Equipment: No adaptive equipment needed.
- GMFCS Level II
- Mobility: Children can walk with limitations and may require assistance balancing and moving on inclined or uneven surfaces. Many have difficulty running or jumping.
- Self-care: Independent.
- Adaptive Equipment: May require equipment to move on uneven or complicated surfaces.
- GMFCS Level III
- Mobility: Children can walk with hand-held adaptive equipment and may require a wheelchair for long distances and inclines.
- Self-care: Semi-dependent on adaptive equipment and personal assistance.
- Adaptive Equipment: Children often require handheld walking devices for level surfaces and manual wheelchairs for uneven or abnormal surfaces and long distance travel.
- GMFCS Level IV
- Mobility: Children are self-mobile only with significant limitations. Many use powered wheelchairs and require help with transfers.
- Self-care: Dependent on others and adaptive equipment.
- Adaptive Equipment: Powered wheelchairs and other assistive devices.
- GMFCS Level V
- Mobility: Children have physical limitations that impair voluntary movement and posture in all areas of motor function and are very dependent on assistive technology, adaptive equipment and people for mobility.
- Self-care: Very dependent on other people or assistive devices to stand, walk and move.
- Adaptive Equipment: Requires powered mobility, adaptive equipment and assistive technologies.
Source for this section: 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.
6. Manual Ability Classification System (MACS)
The Manual Ability Classification System (MACS) categorizes cerebral palsy based on an individual’s ability to manipulate objects with their hands, which is closely tied to an individual’s ability to complete tasks independently. The MACS works in conjunction with the Gross Motor Function Classification System (GMFCS) and the Communication Function Classification System (CFCS).
- MACS Level I: Children handle objects with ease.
- MACS Level II: Children largely handle objects successfully, but with compromised speed or ease.
- MACS Level III: Children experience difficulty handling objects and require help.
- MACS Level IV: Children always require help handling objects.
- MACS Level V: Children have no ability to perform manual activities.
7. Communication Function Classification System (CFCS)
The Communication Function Classification System (CFCS) categorizes individuals with cerebral palsy into five levels based on everyday communication performance. The CFCS works in conjunction with the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS).
- CFCS Level I: The person can effectively send and receive communicative information with unfamiliar and familiar partners.
- CFCS Level II: The person effectively, but slowly, sends and receives communication information with both unfamiliar and familiar partners. Communication ability may vary by environment.
- CFCS Level III: The person effectively sends and receives communication information with familiar partners, but not with unfamiliar partners.
- CFCS Level IV: The person inconsistently sends and receives communication information with familiar partners, and rarely can communicate with unfamiliar partners.
- CFCS Level V: The person rarely communicates effectively with familiar people and cannot communicate effectively with unfamiliar people