Gross Motor Function Classification System

The Gross Motor Function Classification System (GMFCS) is a clinical system that uses five distinct levels to classify the gross motor function of children and youth with cerebral palsy.¹ It was developed to strengthen communication between families and clinicians when discussing functional gross motor abilities, goals, and clinical management.² It was also developed for use in clinical practice and has been shown to have good reliability, validity, and stability. As a validated tool with high reliability, it is the international standard for assessing functional mobility in the pediatric cerebral palsy population.³

The GMFCS focuses on the current daily function of skills such as sitting, transfers, and mobility. It utilizes five age ranges: <2 years, 2-4 years, 4-6 years, 6-12 years, and 12-18 years. The 12-18 age band reflects the impact of the World Health Organization’s International Classification of Function, Disability, and Health (ICF) framework, highlighting the concepts of environmental and personal factors that may affect the child’s abilities. The focus is on current performance (what the child actually does), not the individual’s capability (what they can do in a clinic) or best performance.²

GMFCS Levels: An Overview

• Level I:

  Children at this level generally walk without limitations. They may have limited balance, coordination, and speed for advanced gross motor skills.

• Level II:

  Children at this level generally walk with limitations and may use hand-held mobility devices (like a gait trainer) or wheeled mobility over long distances.

• Level III:

  Children at this level generally walk using a hand-held mobility device and may use manual wheelchairs or powered mobility for long distances, outdoors, or at school.

• Level IV:

  Children at this level use wheeled mobility devices in most settings. They may complete some self-mobility with the use of a body support walker (such as a Pacer) at home or for short distances.

• Level V:

  Children at this level are transported in a manual wheelchair. They have limited ability to control arm and leg movements and require extensive postural support.

The full descriptions of the criteria for each level should be used to determine the most appropriate GMFCS level for a child. Distinctions between each level are also provided in the tool, making it easier to discern which level is appropriate. The full tool is available here.

GMFCS Family Report Questionnaire

The GMFCS Family Report Questionnaire was developed to allow parents to provide critical input into the classification of their child’s motor abilities. It is available for children from 2-4 years of age, 4-6 years of age, 6-12 years of age, and 12-18 years of age.¹

GMFCS Illustrations

Descriptors and illustrations of the five GMFCS levels have been developed for the 6-12 year age band and the 12-18 year age band. These illustrations can easily be found online and are helpful to share with family members and colleagues to visualize the child’s current functional status.

Clinical Significance and Equipment Selection

The GMFCS allows for the consistent classification of motor function in children with cerebral palsy throughout childhood and adolescence. This provides clinicians with a reliable framework for discussing function with parents and families. Understanding a child’s daily performance within the context of environmental and personal factors can help clinicians and families determine the most appropriate selection of adaptive equipment. Adaptive equipment that supports functional sitting, transfers, and mobility skills can allow each child to achieve meaningful participation in their daily activities at home, at school, and in the community.

References:

1. CanChild. GMFCS – E & R. Available at: https://canchild.ca/resources/42-gmfcs-e-r/ Accessed March 7, 2026.
2. Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised Gross motor Function Classification System. Dev Med Child Neurol. 2008; 50(10), 744-750. https://doi.org/10.1111/j.1469-8749.2008.03089.x
3. Piscitelli D, Ferrarello F, Ugolini A, Verola S, Pellicciari L. Measurement properties of the Gross Motor Function Classification System, Gross Motor Function Classification System-Expanded & Revised, Manual Ability Classification System, and Communication Function Classification System in cerebral palsy: a systematic review with meta-analysis. Dev Med Child Neurol. 2021; 63(11), 1251-1261. https://doi.org/10.1111/dmcn.14910