Manual Ability Classification System (MACS) for Cerebral Palsy

The Manual Ability Classification System (MACS) is a method of classifying how well children with cerebral palsy can use their hands to manipulate objects in the course of day-to-day activities. The classification is determined based on observations from a person who knows the child well. It takes into account how children use their hands in tandem rather than separately.

MACS provides a more fine distinction than other categorizations of mild, moderate, and severe impairment of hand function. The aim of this classification was to create a metric similar to the Gross Motor Function Classification System (GMFCS), but specifically for hand movement.

Developing a scale for hand function is important for two reasons. The first of these is the complex nature of hand function. Hand function is influenced by considerations such as sensorimotor components, cognition, postural control, visual acuity, and motivation. The MACS scale does not try to quantify these underlying factors, but merely to assess how well they work together as a whole. Secondly, hand use is critical for a child’s independence in daily life, at school, and during recreation.

The MACS levels

The MACS scale is divided into five levels (2):

  1. Handles objects easily and successfully; limitations in hand movements only apparent in speed and accuracy.
  2. Handles objects, but with somewhat reduced quality and/or speed of achievement; certain activities are difficult, but more can be done independently.
  3. Handles objects with difficulty; needs help to prepare and/or modify activities; slow and inaccurate performance of activities when trying them independently.
  4. Handles a limited selection of easily-managed objects in adapted situations; completes parts of activities with limitations, requires support and assistance.
  5. Does not handle objects and has severely limited ability to perform even simple actions; needs assistance for all activities.

The developers of the Manual Ability Classification System have developed numerous MACS resources, including an informational leaflet and a simple flowchart for classification. More information about the system can be found on the MACS website.

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Related resources


  1. Manual Ability Classification System for children with cerebral palsy 4-18 years. (n.d.). Retrieved July 19, 2019, from
  2. MACS Manual Ability Classification System for Children with Cerebral Palsy 4-18 Years[Pamphlet]. (2010). Http://