Functional classifications for cerebral palsy: correlations between the gross motor function classification system (GMFCS), the manual ability classification system (MACS) and the communication function classification system (CFCS).
In kids with CP, severe motor level usually pairs with severe hand and communication levels—check all three scales before writing goals.
01Research in Context
What this study did
The team looked at three quick rating tools used for kids with cerebral palsy. The tools are GMFCS for gross motor, MACS for hand use, and CFCS for communication.
They asked whether the levels line up with each other and with IQ. Families from any income group were included.
What they found
Severe level in one tool usually meant severe levels in the other two. IQ scores moved in step with the tool levels.
Family income did not change the pattern. The links stayed strong across the whole age range.
How this fits with other research
Whittingham et al. (2010) first showed that GMFCS level predicts social delays in preschool. Eliana adds MACS and CFCS to give a wider picture.
Carter et al. (2011) saw that milder motor signs go with steeper cognitive growth. Eliana confirms this link with formal scales.
Asano et al. (2025) later tracked kids over time and found MACS level predicts fluid-intelligence growth. Eliana’s cross-sectional data set the stage for that longer view.
Why it matters
If you see a child classified as GMFCS V, expect equal limits in hand and communication skills. Use all three tools together to set goals that fit the whole child. No need to guess where extra support is needed—the levels already point you there.
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02At a glance
03Original abstract
This study aimed to investigate a possible correlation between the gross motor function classification system-expanded and revised (GMFCS-E&R), the manual abilities classification system (MACS) and the communication function classification system (CFCS) functional levels in children with cerebral palsy (CP) by CP subtype. It was also geared to verify whether there is a correlation between these classification systems and intellectual functioning (IF) and parental socio-economic status (SES). A total of 87 children (47 males and 40 females, age range 4-18 years, mean age 8.9±4.2) were included in the study. A strong correlation was found between the three classifications: Level V of the GMFCS-E&R corresponds to Level V of the MACS (rs=0.67, p=0.001); the same relationship was found for the CFCS and the MACS (rs=0.73, p<0.001) and for the GMFCS-E&R and the CFCS (rs=0.61, p=0.001). The correlations between the IQ and the global functional disability profile were strong or moderate (GMFCS and IQ: rs=0.66, p=0.001; MACS and IQ: rs=0.58, p=0.001; CFCS and MACS: rs=0.65, p=0.001). The Kruskal-Wallis test was used to determine if there were differences between the GMFCS-E&R, the CFCS and the MACS by CP type. CP types showed different scores for the IQ level (Chi-square=8.59, df=2, p=0.014), the GMFCS-E&R (Chi-square=36.46, df=2, p<0.001), the CFCS (Chi-square=12.87, df=2, p=0.002), and the MACS Level (Chi-square=13.96, df=2, p<0.001) but no significant differences emerged for the SES (Chi-square=1.19, df=2, p=0.554). This study shows how the three functional classifications (GMFCS-E&R, CFCS and MACS) complement each other to provide a better description of the functional profile of CP. The systematic evaluation of the IQ can provide useful information about a possible future outcome for every functional level. The SES does not appear to affect functional profiles.
Research in developmental disabilities, 2014 · doi:10.1016/j.ridd.2014.07.005