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GMFCS - Expanded and Revised (2007)

The Gross Motor Function Classification System (GMFCS) is a 5 level classification system that describes the gross motor function of children and youth with cerebral palsy on the basis of their self-initiated movement with particular emphasis on sitting, walking, and wheeled mobility. Distinctions between levels are based on functional abilities, the need for assistive technology, including hand-held mobility devices (walkers, crutches, or canes) or wheeled mobility, and to a much lesser extent, quality of movement.

The focus of the GMFCS is on determining which level best represents the child's or youth's present abilities and limitations in gross motor function. Emphasis is on usual performance in home, school, and community settings (i.e., what they do), rather than what they are known to be able to do at their best (capability). It is therefore important to classify current performance in gross motor function and not to include judgments about the quality of movement or prognosis for improvement.

Children who have motor problems similar to those classified in "Level I" can generally walk without restrictions but tend to be limited in some of the more advanced motor skills. Children whose motor function has been classified at "Level V" are generally very limited in their ability to move themselves around even with the use of assistive technology.

The GMFCS - E&R includes an age band for youth 12 to 18 years of age and emphasizes the concepts inherent in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). We encourage users to be aware of the impact that environmental and personal factors may have on what children and youth are observed or reported to do. The descriptions for the 6 to 12 year and 12 to18 year age bands reflect the potential impact of environment factors (e.g., distances in school and community) and personal factors (e.g., energy demands and social preferences) on methods of mobility.

Distribution and Translation of the GMFCS E&R

CanChild grants permission for printing of this document but does not allow the sale of the GMFCS-E&R, which should be made available with open access everywhere. In addition, the GMFCS-E&R has been translated by colleagues, and made available to all, in the following languages:

Arabic, CzechChinese (Simplified), Chinese (Traditional)Danish, Dutch, FrenchGerman, HebrewIcelandic, ItalianJapanese, Korean, NorwegianPersian, Portuguese (Brazil)Portuguese (Portugal), Romanian, Russian, Serbian, Spanish, SwedishThai, and Turkish 

Translations of measures and materials on the CanChild website are performed by individuals who are fluent in both English and their own language. CanChild requires a ‘back translation’ of the document by a different person than the original translator to ensure accuracy. The customs and culture of various regions may not be reflected accurately unless a validation study has been conducted.

Please refer to the CanChild Guidelines for Translation of the GMFCS for details about obtaining permission to translate the GMFCS E&R.

The recently developed GMFCS Family Report Questionnaire presents an option for parent involvement in classifying children's motor abilities and is available for four age groups of children: 2 to 4 years, 4 to 6 years, 6 to 12 years, and 12 to 18 years, and is also available in French/aussi disponible en français and other languages.

GMFCS E&R Descriptors and Illustrations are available for the 6 to 12 year and 12 to 18 year bands of the GMFCS E&R.

Find out the answers to Frequently Asked Questions about the GMFCS

The Motor Growth Curves and Percentiles for children with cerebral palsy describe development of children with cerebral palsy grouped by GMFCS level. These "growth curves" help doctors, therapists, and families understand how the gross motor abilities of children in each level change with age and how much independence children are likely to achieve.

For more information:

Palisano, R., Rosenbaum, P., Bartlett, D., Livingston, M. (2008). Content validity of the expanded and revised Gross Motor Function Classification System. Developmental Medicine & Child Neurology, 50 (10), 744-50.

Rosenbaum, P., Walter, S., Hanna, S., Palisano, R., Russell, D., Raina, P., Wood, E., Bartlett, D., & Galuppi, B. (2002). Prognosis for gross motor function in cerebral palsy: Creation of motor development curves. Journal of the American Medical Association, 288 (11), 1357-1363.

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 & Child Neurology, 39, 214-223.