Children with cerebral palsy can be graded according to the level of gross motor development, the limitation of motor function and the need for assistive devices to determine the GMFCS grade, which can play a role in prognosis of gross motor function.
For example, a child with cerebral palsy <2 years of age can achieve "sitting transitions, and can sit on the floor and play with hands. A child aged 18 months to 2 years can walk independently without any assistive device" is considered to be a level I child. At the age of 6 to 12 years, the child can basically "walk indoors and outdoors without any restrictions and climb stairs. The child can demonstrate gross motor skills such as running and jumping, but has reduced speed, balance, and coordination." The function of the GMFCS.
The following is a detailed description of the GMFCS
GMFCS Level I – Able to walk unrestricted; limited in accomplishing more advanced motor skills
<2 years: can shift in sitting position and can also sit on the floor and play with objects on both hands. Can crawl on hands and knees, pull objects to stand up and hold furniture for a few steps. 18 months to 2 years old can walk independently without any aids.
2 to 4 years: They can sit on the floor and play with objects on their hands. They can switch between sitting and standing positions on the floor without adult assistance, and walk as their preferred mode of mobility without the assistance of any walking aids.
4-6 years: Can sit on, off, or in a chair without the help of hands. Can get up from the floor or a chair without any object support, can walk indoors and outdoors, can climb stairs, and is developing the ability to run and jump.
6-12 years: Can walk indoors and outdoors without any restrictions and can climb stairs. Can demonstrate gross motor skills such as running and jumping, but speed, balance and coordination are diminished.
GMFCS Level II – Able to walk without the use of assistive devices; however, limited walking outdoors and in the community
<2 years: The child can sit on the floor but requires hand support to maintain balance; can crawl on the floor or crawl on hands and knees; may pull objects to stand up and walk a few steps holding onto furniture.
2 to 4 years old: Can sit on the floor, but may not be able to control balance when holding objects with both hands, and can sit and shift freely without adult help. Can pull objects to stand in a stable place. Can crawl alternately on hands and knees and can move slowly while holding onto furniture. The preferred method of movement is walking with a walker.
4 to 6 years: Can sit still in a chair while playing with objects with both hands and can stand up from the floor or chair, but often need a stable flat surface for their hands to pull or push on. They can walk indoors without the help of any walker, and can walk a short distance on a level surface outdoors, climbing stairs with a handrail, but cannot run or jump.
6-12 years old: can walk indoors and outdoors, can climb stairs with a handrail, but is limited in walking on uneven surfaces or slopes, and is limited in walking in crowds or narrow places, and can barely run and jump at most.
GMFCS Level III – Ambulation with assistive mobility devices; limited ambulation outdoors and in the community
<2 years: Needs to maintain a sitting position with lower back support. Also able to roll over and crawl with abdomen against the floor.
2 to 4 years of age: Can maintain a sitting position alone in a “W” position (sitting between flexed and internally rotated hips and knees) and may need to maintain other sitting positions with adult assistance. Belly crawling or crawling on hands and knees is the preferred method of self-mobility (but often without coordinated alternating movements of the legs), and can pull objects up to stand in a stable place and move short distances, and may walk short distances around the room with the help of a walker or an adult to help with direction and turning.
4-6 years old: can sit in a normal chair, but need pelvic or trunk support to free their hands, and need a stable surface for their hands to pull or push when sitting on and off the chair. They are able to walk on level ground with the help of a walker and can walk up stairs with the help of an adult. However, they cannot walk alone when traveling long distances or on uneven surfaces outdoors.
6-12 years old: They can walk indoors and outdoors on level ground with the help of a walker and may be able to climb stairs with the help of a handrail. Depending on the function of the upper limbs, some children can push their own wheelchairs when traveling longer distances or outdoors on uneven terrain, while others need to be transported.
GMFCS Level IV – Limited self-mobility; child needs to be transported or use powered mobility devices to walk outdoors and in the community
<2 years old: can control head, but trunk needs support when sitting on the floor, can roll from prone to supine, and may roll from supine to prone.
2 to 4 years old: Can sit in a chair, but needs to rely on a special chair to control the trunk, thus freeing the hands. Can sit in or out of a chair with the help of an adult or when there is a stable flat surface for them to push or pull with their hands. At most, they can walk a short distance with a walker under adult supervision, but it is difficult to turn around and maintain balance on an uneven surface. Cannot walk alone in public places. Can move on their own with the help of a powered wheelchair.
4-6 years old: Can sit in a chair, but needs a special chair to control the balance of the trunk and thus free the hands as much as possible, and can sit or leave the chair only with the help of an adult or with hands pulling or pushing a stable plane. They cannot walk on their own in public, but can move around on their own if they use a power wheelchair.
6-12 years old: The child may continue to maintain the motor skills acquired before the age of 6. Some children may become more wheelchair dependent at home, school and in public, and may be able to move around on their own with a power wheelchair.
GMFCS Level V – Severe limitations in self-mobility even with assistive technology
<2 years of age: Physical impairments limit the ability to control voluntary movement and to maintain a gravity-resistant position of the head and trunk in prone and sitting positions. They can only turn over with the help of an adult.
2 to 4 years of age: Physiological impairments limit control of voluntary movements and the ability to maintain a gravity-resistant posture of the body and head. All aspects of motor function are limited, and special equipment and assistive technology do not fully compensate for the functional limitations in the ability to sit and stand without the ability to move independently and require transfer. Some children are able to use further modified power wheelchairs for mobility.
4-6 years old: Physiological impairments limit their control of voluntary movement and their ability to maintain a gravity-resistant posture of the head and trunk, and all aspects of motor function are limited. Even with the use of special devices and assistive technology, they cannot fully compensate for the functional limitations in their ability to sit and stand, and are completely unable to move independently, and some children may be able to perform activities through the use of further modified power wheelchairs Some children may be able to move independently through the use of further modified power wheelchairs.
6-12 years old: Physiological impairments limit the control of voluntary movement and the ability to maintain a gravity-resistant posture of the head and trunk, and all aspects of motor function are limited. Some children may be able to move independently through the use of further modified power wheelchairs.