Cerebral Palsy

Manual Ability Classification System

Around the age of four it is possible to work out how adeptly a child is able to handle smaller more fiddly objects like pencils, buttons or zips. The Manual Ability Classification System (MACS) is conducting using information provided by someone (such as a parent), who knows how the child typically performs each day. MACS is based on the use of both hands, rather than being an assessment of each hand separately.  


Level 1 - Handles objects easily and successfully. At most, limitations in the ease of performing manual tasks requiring speed and accuracy. However, any limitations in manual abilities do not restrict independence in daily activities.

Level 2 - Handles most objects but with somewhat reduced quality and/or speed of achievement. Certain activities may be avoided or be achieve with some difficulty; alternative ways of performance might be used but manual abilities do not usually restrict independence in daily activities.

Level 3 - Handles objects with difficulty; needs help to prepare and/or modify activities. The performance is slow and achieved with limited success regarding quality and quantity. Activities are performed independently if they have been set up or adapted.

Level 4 - Handles a limited selection of easily managed objects in adapted situations. Performs parts of activities with effort and with limited success. Requires continuous support and assistance and/or adapted equipment, for even partial achievement of the activity.

Level 5 - Does not handle objects and has severely limited ability to perform even simple actions. Requires total assistance.

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