Classification of manual abilities in children with cerebral palsy under 5 years of age: how reliable is the Manual Ability Classification System?

Clin Rehabil. 2009 Feb;23(2):164-70. doi: 10.1177/0269215508098892. Epub 2009 Jan 7.


Objective: To assess the interobserver reliability of the Manual Ability Classification System (MACS) in young children (age 1-5 years) with cerebral palsy.

Design: Interobserver reliability study.

Setting: A cross-sectional study of a hospital-based population of children with cerebral palsy.

Subjects: Thirty children, 18 boys and 12 girls between 1 and 5 years of age (mean age 2.5 years +/- 14.2 SD, Gross Motor Function Classification System level I-IV).

Measures: the children were classified by means of the MACS by two independent observers. Interobserver reliability was analysed using Cohen's kappa.

Results: Overall interobserver reliability of the MACS for children aged 1-5 years was moderate, with a linear weighted kappa (kappa) of 0.62 (95% confidence interval (CI) 0.49-0.76). According to the generally accepted categories of agreement, reliability was moderate for children under 2 years of age (kappa = 0.55), and good for children between 2 and 5 years of age (kappa = 0.67).

Conclusion: Classification of manual ability of young children with cerebral palsy is possible between 2 and 5 years of age. For children younger than 2 years old, it should be done with caution. Further development of the MACS for children under 5 years of age is recommended with an emphasis on age-appropriate descriptions of manual abilities.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Cerebral Palsy / classification*
  • Cerebral Palsy / epidemiology
  • Cerebral Palsy / rehabilitation*
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Hand
  • Humans
  • Infant
  • Male
  • Motor Skills / classification*
  • Observer Variation
  • Reproducibility of Results