Assessing hand function: what the MACS levels mean
Five levels describing how a child with cerebral palsy uses their hands in daily life, and why parents should know them.
MACS (Manual Ability Classification System) classifies hand function in children with cerebral palsy aged 4 to 18. It was developed by Ann-Christin Eliasson at the Karolinska Institute and describes not one hand but how the child uses both hands together in everyday activities.
Level I: handles objects easily and successfully; difficulty only with very small or heavy items. Level II: handles most objects but with reduced speed or quality; may avoid some activities. Level III: handles objects with difficulty; needs preparation or adaptation of the activity. Level IV: handles a limited selection of easy objects in adapted settings; needs continuous support. Level V: does not handle objects; ability for even simple actions is severely limited.
The MACS level complements GMFCS (gross motor) and helps set realistic goals: not 'make the hand work' but 'eat with a spoon independently'. Those are the goals we write down at the first consultation.
