Gross Motor Function Classification System for Cerebral Palsy

The Gross Motor Function Classification System (GMFCS) is a five-level classification system that focuses on the voluntary movements of children with cerebral palsy (CP), with specialized focus on walking and sitting. The higher the level in GMFCS, the more severe the CP is.  The GMFCS applies to all types of CP and all levels of severity. Once a child’s severity level is determined, it helps healthcare providers understand which form of treatment would work best according to each individual situation. It also serves as a guidelines for parents and caregivers to help them understand how their child’s movement abilities may progress over time. 

GMFCS Classification Levels

Keep in mind that all five levels are to be used as a guideline and may not directly affect each child at the same time in the same way. For instance, one child may fit the guidelines for Level II, yet is still unable to crawl, but will still be classified as a Level II because the majority of the other descriptions are there.

Level I

  •  Up to Two Years Old: Infants start to learn to sit on the floor and use both hands to play with and manipulate objects. Infants are also capable of crawling and pulling themselves up, and by 18 months, can walk.
  • Ages Two to Four: Children can successfully sit on the floor with no assistance. They may also begin to stand without adult assistance and walk. Walking is typically preferred over crawling.
  • Ages Four to Six: Children can sit in a chair and get up from a chair without assistance. They can also move to the floor from a chair without assistance, walk freely without assistance, and begin to run and jump/
  • Ages Six to 12: Children can run, walk, jump, and climb stairs without assistance; balance and coordination may be lacking still.

Level II

  • Up to Two Years Old: Infants may begin to sit on the floor but only with adult assistance or by relying on their hands for support. They may begin to crawl on hands and knees or “creep” on their belly.
  • Ages Two to Four: Children can sit on the floor but require assistance, especially if they’re using their hands to manipulate and grab objects. Reciprocal patterns are used when crawling on hands and knees, and children can walk either with assistive devices or by holding onto furniture or other sturdy objects.
  • Ages Four to Six: Children can now sit in a chair without assistance, but need assistance from standing to moving to the floor, such as a sturdy table or surface. Additionally, they can walk for short distances without support and can climb stairs as long as they are holding the rails for support. However, they cannot skip, run, or jump.
  • Ages Six to 12: Children can walk both indoors and outdoors with little to no assistance, but will need help with walking in crowds, in unfamiliar settings, and on inclined surfaces. They still need rails when climbing steps and only posses minimal abilities for gross motor skills, such as running, jumping, and skipping.

Level III

  • Up to Two Years Old: Infant can roll and creep in a forward position while on their stomachs, but will need assistance with sitting via lower back support.
  • Ages Two to Four: Children can sit on the floor unsupported, but typically in the “W” position: rotated hips and knees. They also can crawl on their hands and knees, usually without moving the legs. Crawling tends to be the preferred method of moving around.
  • Ages Four to Six: Children can sit upright on a chair but require trunk support if using their hands. Additionally, they can lift themselves from the chair with the assistance of sturdy furniture, such as a table, and can climb stairs with adult help. They can also walk while using a mobility device for assistance.
  • Ages Six to 12: With a mobility device for assistance, children walk both outdoors and indoors. They may able to climb stairs without adult assistance but with the use of handrails. If they are traveling long distances or walking on uneven or inclined distances, they’ll either need to be carried or use a wheelchair.

Level IV

  • Up to Two Years Old: Infants can roll from back to stomach and vice versa, but can only sit upwards with trunk assistance.
  • Ages Two to Four: When placed on the floor, children can sit up, but will need to use their hands and arms for support. In most instances, they’ll need adaptive equipment for both sitting and standing, but crawling an their hand and knees, stomach creeping, and/or rolling are the preferred methods of moving.
  • Ages Four to Six: Children can sit on a chair with trunk support and can move from the chair by holding onto a sturdy surface. They can walk short distances but adult supervision is highly recommended as they may have problems turning and keeping their balance.
  • Ages Six to 12: Children will maintain the same mobility from age six, but they may rely more on wheelchairs and walk-assisting devices, especially at school or in the community.

Level V

  • Up to Two Years Old: Voluntary control of movements are physically impaired and in turn, the infant cannot hold their head and trunk without support. They also need assistance in rolling over.
  • Ages Two to Four: All areas of motor function are still limited, rendering it difficult for the child to sit without assistance, to crawl, or achieve any type of independent mobility at all.
  • Ages Four to Six: Children can now sit on a chair but will need adaptive equipment to hold them in place. In addition, they will need to be transported, even for daily activities, as they still have no independent mobility.
  • Ages Six to 12: Some children may be able to achieve mobility on their own via an electronic wheelchair, but mobility will still be limited to the point where they cannot move on their own, including the inability to support their trunks and bodies. Additional expansive adaptation equipment is used in some instances.