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The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of
Ann-Christin Eliasson1, Lena Krumlinde-Sundholm, Birgit Rösblad
1Neuropaediatric Research Unit, Astrid Lindgren Children's Hospital, Stockholm, Sweden. ann-christin.eliasson@kbh.ki.se
Insights
The Manual Ability Classification System (MACS) effectively classifies hand use in children with cerebral palsy (CP). This system demonstrates strong validity and reliability for assessing daily manual activities.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) significantly impacts manual ability in children.
- Standardized tools are needed to assess functional hand use in daily activities for children with CP.
Purpose of the Study:
- To introduce and validate the Manual Ability Classification System (MACS).
- To provide a reliable classification of manual performance in children with CP.
Main Methods:
- Developed a five-level classification system (MACS) for hand use in children with CP.
- Validated MACS through expert consensus, literature review, and analysis of children across functional spectrums.
- Assessed reliability through inter-therapist and parent-therapist agreement in 168 children with CP aged 4-18 years.
Main Results:
- MACS demonstrated good validity and reliability.
- High intraclass correlation coefficients (0.97 between therapists, 0.96 between parents and therapists) indicated excellent agreement.
- The system accurately reflects typical manual performance in daily activities.
Conclusions:
- The Manual Ability Classification System (MACS) is a valid and reliable tool for classifying manual ability in children with cerebral palsy.
- MACS can aid in understanding and addressing the functional hand use challenges faced by children with CP.
Abstract:
The Manual Ability Classification System (MACS) has been developed to classify how children with cerebral palsy (CP) use their hands when handling objects in daily activities. The classification is designed to reflect the child's typical manual performance, not the child's maximal capacity. It classifies the collaborative use of both hands together. Validation was based on the experience within an expert group, a review of the literature, and thorough analysis of children across a spectrum of function. Discussions continued until consensus was reached, first about the constructs, then about the content of the five levels. Parents and therapists were interviewed about the content and the description of levels. Reliability was tested between pairs of therapists for 168 children (70 females, 98 males; with hemiplegia [n=52], diplegia [n=70], tetraplegia [n=19], ataxia [n=6], dyskinesia [n=19], and unspecified CP [n=2]) between 4 and 18 years and between 25 parents and their children's therapists. The results demonstrated that MACS has good validity and reliability. The intraclass correlation coefficient between therapists was 0.97 (95% confidence interval 0.96-0.98), and between parents and therapist was 0.96 (0.89-0.98), indicating excellent agreement.
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