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Manual Ability Classification System (MACS)
Please visit this website for more information about the instrument: Manual Ability Classification System.
Supplemental – Highly Recommended: Cerebral Palsy (CP)
Short Description of Instrument
Construct measured: Upper extremity gross motor function.
Generic vs. disease specific: Disease specific.
Means of administration: Examiner administered.
Intended respondent: Administrator.
Background: The purpose of the Manual Abilities Classification System (MACS) is to describe how children with cerebral palsy (CP) use their upper extremities in daily acitivities.
Comments/Special Instructions
The classification is designed to reflect the child's typical manual performance, not the child's maximal capacity. It classifies what children do when using one or both of their hands for activities, rather than assessing and classifying each hand separately. The concept of MACS is "he children's ability to handle objects in daily life". This has been validated in children with CP aged 4–18 years.
Similar to the Gross Motor Function Classification System, the MACS is scored I to V with Level I being a chid who can handle objects easily but has difficulty with tasks requiring speed and accuracy. Level V is a child that requires total assistance for handling objects.
Administration Time: 5–15 minutes
Strengths/Weaknesses: It is quick to administer and reflects the childs usual skills, not their absolute best performance. It is not known if the classification level changes over time.
Psychometric Properties: The MACS has good validity and reliability for classification of a child with CP abilty to handle objects including children with bilateral, unilateral, ataxic, and dyskinetic CP. The intraclass correlation coefficient between therapists was 0.97 (95% confidence interval 0.96–0.98), and between parents and therapist was 0.96 (0.89–0.98), indicating excellent agreement.
Arner M, Eliasson AC, Nicklasson S, Sommerstein K, H?gglund G. Hand function in cerebral palsy. First report on 367 children in a population-based longitudinal health care programme. J Hand Surg. 2008;33(8):1337-1347.
Eliasson AC, Krumlinde-Sundholm L, RÖsblad B, Beckung E, Arner M, Öhrvall AM, Rosenbaum P. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006;48(7):549-554.
Manual Ability Classification System for Children with Cerebral Palsy 4 - 18 years [cited 2016 11 July]. Available from:
Additonal References:
Imms C, Carlin J, Eliasson AC. Stability of caregiver-reported manual ability and gross motor function classifications of cerebral palsy. Dev Med Child Neurol. 2010;52(2):153-159.
Öhrvall AM & Eliasson AC. Parents' and therapists' perceptions of the content of the Manual Ability Classification System, MACS. Scan J Occup Ther. 2010;17(3):209-216.
Öhrvall AM, Eliasson AC, Lowing K, Odman P, Krumlinde-Sundholm L. Self-care and mobility skills in children with cerebral palsy, related to their manual ability and gross motor function classifications. Dev Med Child Neurol. 2010;52(11):1048-1055.
Öhrvall AM, Krumlinde-Sundholm L, Eliasson AC. Exploration of the relationship between the Manual Ability Classification System and hand-function measures of capacity and performance. Disabil Rehabil. 2013;35(11):913-918.
Öhrvall AM, Krumlinde-Sundholm L, Eliasson AC. The stability of the Manual Ability Classification System over time. Dev Med Child Neurol. 2014;56(2):185-189.


Document last updated April 2020