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Updated: Jul 18, 2026
Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy
Published on: January 11, 2016
Reliability of the manual ability classification system for children with cerebral palsy
Christopher Morris1, Jennifer J Kurinczuk, Raymond Fitzpatrick
1National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
Insights
Family and professional assessments of manual ability in children with cerebral palsy (CP) using the Manual Ability Classification System (MACS) show good reliability. This supports MACS as a valid tool for communication regarding upper limb function in children with CP.
Area of Science:
- Rehabilitation Medicine
- Pediatric Neurology
- Occupational Therapy
Background:
- Cerebral palsy (CP) significantly impacts manual ability in children.
- The Manual Ability Classification System (MACS) is used to classify upper limb function.
- Reliability of MACS assessments by families and healthcare professionals is crucial for consistent care.
Purpose of the Study:
- To determine the reliability of family and professional MACS assessments in children with CP in the UK.
- To evaluate agreement between family and professional classifications of manual ability.
Main Methods:
- Postal surveys were distributed to families and nominated health professionals (physiotherapists, pediatricians, occupational therapists) of children with CP.
- Manual ability was classified using the Manual Ability Classification System (MACS).
- Agreement was assessed using percentage agreement, Cohen's kappa (chance-corrected agreement), and intraclass correlation coefficient (ICC) for reliability.
Main Results:
- High response rates were achieved from families (71%) and professionals (85-93%).
- Perfect agreement between families and professionals exceeded 50%.
- Chance-corrected agreement (kappa) ranged from 0.3 to 0.5, and reliability (ICC) ranged from 0.7 to 0.9, indicating good to excellent reliability.
Conclusions:
- The Manual Ability Classification System (MACS) demonstrates valid and reliable classification of manual ability in children with CP.
- Agreement and reliability between families and professionals are comparable to those between different professional groups.
- MACS is a valuable tool for consistent communication about manual ability in children with CP, though environmental variations may affect precise level agreement.
Abstract:
The aim of this study was to determine the reliability of family and professional assessment of manual ability using the Manual Ability Classification System (MACS) for children with cerebral palsy (CP) in the UK. Families who were taking part in a study measuring the activities and participation of children with CP were invited to classify their child's manual ability using the MACS. Postal surveys were conducted with the families and health professionals nominated by the families. Perfect agreement was assessed as a percentage; chance-corrected agreement was measured using Cohen's kappa (kappa), and reliability was determined using the intraclass correlation coefficient (ICC). Families of 91/128 (71%) children responded to the survey (53 males, 38 females; mean age 9y 11mo [SD 1y 11mo], range 6-12y) out of whom 88 indicated a single MACS level. Seventy-two children (82%) were classified with spastic CP, 12 (14%) with dyskinesia, two (2%) with ataxia, and two (2%) were not classified. There were 21, 27, 11, 10, and 19 children who were classified by their families in Gross Motor Function Classification System Levels I to V respectively; 14, 30, 18, 13, and 13 children classified by their families in MACS levels I to V. The survey of health professionals generated 60/71 (85%) responses from physiotherapists, 55/58 (93%) responses from paediatricians, and 21/24 (88%) responses from occupational therapists. There was perfect agreement between families and professionals for more than 50% of children; the indices of chance-corrected agreement ranged from kappa=0.3 to 0.5, and the reliability coefficients ranged from ICC 0.7 to 0.9. Indices of agreement and reliability between families and professionals were equivalent to those between different professionals. The MACS, therefore, offers a valid and reliable method for communicating about the manual ability of children with CP. Families and professionals may not always agree precisely on a MACS level, particularly if children's performance of manual tasks varies in different environments.
