Types of Cerebral Palsy: Severity Classifications 

Cerebral palsy (CP) is classified in three complementary ways: by movement type (what the muscles do), by body distribution (which limbs are affected), and by functional severity using standardised scales — GMFCS, MACS, and CFCS.

Understanding all three dimensions helps families, clinicians, and researchers describe any individual's CP comprehensively.

Learn about Movement Types and Body Parts Affected to see how movement and limb distribution combine with functional ability to give a complete picture.

By Severity

Functional classification systems describe what a person can do in everyday life. All three systems use a Level I–V scale: Level I indicates the most independent function; Level V the least.

GMFCS — Gross Motor Function

Describes how a person moves, sits, and walks in everyday activities. Based on usual performance, not best ability.

MACS — Manual Ability

Describes how children aged 4–18 use their hands when handling objects in daily activities.

CFCS — Communication Function

Describes everyday communication effectiveness with both familiar and unfamiliar partners.

GMFCS — Gross Motor Function Classification System

Based on a person's usual performance in daily life, not their best ability. Applies from infancy through adulthood.

LEVEL 1
Walks without limitations
Able to walk independently indoors and outdoors, navigate curbs and stairs without railings. Runs and jumps with some limitations in speed and coordination.

LEVEL 2
Walks with some limitations
Can walk in most settings but may use handheld mobility devices or a wheelchair for longer distances. Some difficulty on uneven terrain, stairs, or in crowds.

LEVEL 3
Walks using handheld mobility devices
Walks indoors with a handheld mobility device (walker, crutches, or canes). Uses a wheelchair for community travel and longer distances.

LEVEL 4
Limited self-mobility; may use powered wheelchair
Walking ability is severely limited even with assistive devices. Primarily uses a manual or powered wheelchair. May participate in standing transfers with assistance.

LEVEL 5
Transported in a manual wheelchair
Severe movement limitations in all areas of motor function. Unable to sit or stand independently. Cannot independently walk; may use a powered mobility device. Head and neck control against gravity is impaired.

MACS — Manual Ability Classification System

Classifies how children aged 4–18 years handle objects in everyday activities. Determined by asking someone who knows how the child typically performs, not by a formal assessment.

LEVEL 1
Handles objects easily and successfully
Objects are handled easily and successfully. At most, limitations in the ease of performing manual tasks requiring speed and accuracy.

LEVEL 2
Handles most objects with some reduced quality and/or speed
Handles most objects but with some reduced quality and/or speed of achievement. Alternative ways of performance might be used; certain activities may be avoided or achieved with some difficulty.

LEVEL 3
Handles objects with difficulty; needs help to prepare activities
Handles objects with difficulty and needs help to prepare and/or modify activities. Performance is slow and achieved with limited success regarding quality and quantity.

LEVEL 4
Handles a limited selection of easily managed objects
Handles a limited selection of easily managed objects in adapted situations and always requires some help from others to prepare and/or modify the activity.

LEVEL 5
Does not handle objects; cannot complete even simple actions with hands
Does not handle objects and has severely limited ability to perform even simple actions with the hands. Requires total assistance.

CFCS — Communication Function Classification System

Classifies everyday communication effectiveness with familiar and unfamiliar partners. All forms of communication are considered — speech, gesture, facial expression, and augmentative and alternative communication (AAC).

Communication (AAC) Levels

LEVEL 1
Effective sender and receiver with most people
Independently and effectively alternates between sending and receiving information with most people in most environments.

LEVEL 2
Effective but slower with most people
Independently alternates between sending and receiving information with most people in most environments, but conversations may occur more slowly than usual.

LEVEL 3
Effective with familiar partners; not with unfamiliar partners
Usually communicates effectively with familiar partners in most environments, but not reliably with unfamiliar people.

LEVEL 4
Inconsistent communication even with familiar partners
Communication is not always consistent, even with familiar partners.

LEVEL 5
Seldom effective even with familiar people
Rarely communicates effectively, even with familiar people. There are significant limitations in sending and receiving information.

Summary: All Three Dimensions Together

All three dimensions together give the full picture:
A complete description of an individual's CP should ideally include all three classification dimensions — for example, "spastic diplegia, GMFCS Level II, MACS Level II, CFCS Level I" tells us the movement type, body distribution, and functional severity across motor, manual, and communication domains. No single dimension alone captures the full complexity of the condition.

References & Sources
Australian Cerebral Palsy Register (ACPR) Group (2023). Australian Cerebral Palsy Register Report 2023. Sydney: Cerebral Palsy Alliance Research Foundation. · Cans C, Dolk H, Platt MJ, et al. (2007). Recommendations from the SCPE collaborative group for defining and classifying cerebral palsy. Dev Med Child Neurol 49(Suppl 1):9–24. · Cerebral Palsy Alliance Australia (2025). Types of cerebral palsy. cerebralpalsy.org.au/cerebral-palsy/types · Cerebral Palsy Alliance Australia (2025). Manual Ability Classification System (MACS). cerebralpalsy.org.au/cerebral-palsy/manual-ability-classification-system · Cerebral Palsy Alliance Australia (2025). Communication Function Classification System (CFCS). cerebralpalsy.org.au/cerebral-palsy/communication-function-classification-system · Palisano R, Rosenbaum P, Walter S, et al. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39:214–23. · Cerebral Palsy Guide (2026). Types of cerebral palsy. cerebralpalsyguide.com/cerebral-palsy/types