Children with cerebral palsy may be classified as Diplegic, Hemiplegic, Quadriplegic, Dyskinetic, Ataxic or a mixture of these depending on the presentation of their symptoms.
This classification system is useful for determining overarching areas of deficit, but can leave much to be desired when identifying a kiddos level of functional capacity or severity of disability.
While these traditional markers continue to be the primary method of classification used in the medical field, there is an additional system that can provide a more robust picture of the kiddo as a whole.
The Gross Motor Function Classification System (GMFCS) uses 5 levels to classify a child’s individual motor abilities through an analysis of functional mobility or more simply, how they get from place to place.
5 Levels of Cerebral Palsy
Level 1 includes children who have no restraints when walking. They can ambulate freely without instability. Typically children in this level do not wear any assistive devices.
Level 2 includes children who can walk without assistance but may have some difficulty at times. Typically these kiddos cannot jump or balance on one foot, may fall frequently and/or need to hold onto railings when walking up stairs or over curbs.
Level 3 includes children who need to use an assistive device to walk upright. These kiddos can walk in certain environments for reduced distances by self directing the use of devices such as revere walkers or forearm crutches. For longer distances children in level 3 will used wheeled mobility and can often self propel their chair.
Level 4 includes children who require external assistance in order to get around. They may use a wheelchair or a walker with significant help and support to compensate for lack of speed and/or stability. The child on the right is using a device called a Gait trainer, which provides trunk support for those who are unable to fully support themselves using a typical walker..
Level 5 includes children who require the assistance of a guardian for all movements. These kiddos often cannot support their head and trunk while seated and may utilize wheelchair positioning devices such as head rests and lateral supports.
Sometimes, the distinctions between different levels can be unclear. Kiddos can have varying abilities, depending on the day. The best way to determine which level is the best fit is to think of how the child gets around most of the time, not just their best performance. Also, although GMFCS levels may seem to focus on lower body function, understand that many of these assistive devices require the use of arms and hands as well.
Seek the advice of your medical or therapy team if you are not sure what GMFCS level applies to your child or if a treatment plan is recommended to maximize their day-to-day function.
- Siena Conde, OTR/LSiena is an occupational therapist and rehabilitation technology and clinical application specialist based out of San Francisco, CA. Siena works for Rally Health as a Clinical Content Manager.