Why there are separate classification systems
Cerebral palsy affects people in very different ways. One person may walk well but find fine hand tasks hard, while another uses a wheelchair but communicates easily. So clinicians use several systems side by side, each describing one part of everyday function.
The Gross Motor Function Classification System (GMFCS) covers movement such as walking and sitting. MACS covers hand use. CFCS covers communication. All three use five levels and describe what the person usually does in daily life, not their best performance in a clinic.
MACS: the five levels of hand use
MACS is designed for children and young people aged 4 to 18. It looks at how they handle objects in everyday activities, such as eating, dressing, playing and schoolwork, and how much help or adaptation they need. A version called Mini MACS is used for children aged 1 to 4.
- Level I: handles objects easily and successfully
- Level II: handles most objects, but with somewhat reduced quality or speed
- Level III: handles objects with difficulty and needs help to prepare or change activities
- Level IV: handles a limited selection of easily managed objects in adapted situations
- Level V: does not handle objects and has severely limited ability to do even simple actions
CFCS: the five levels of communication
CFCS describes how effectively a person sends and receives messages in everyday life, using any method: speech, gestures, signs, eye gaze, pictures or a speech generating device. It looks at communication with familiar partners, such as family, and unfamiliar partners, such as a new teacher or a shop assistant.
- Level I: effective sender and receiver with both familiar and unfamiliar partners
- Level II: effective but slower paced with familiar or unfamiliar partners
- Level III: effective sender and receiver with familiar partners
- Level IV: inconsistent sender or receiver with familiar partners
- Level V: seldom an effective sender and receiver, even with familiar partners
How the NDIA uses MACS and CFCS
For cerebral palsy, the NDIA's preferred evidence of functional impact is the GMFCS, then MACS, then CFCS. Cerebral palsy at GMFCS level III, IV or V is on List A, so it usually meets the disability requirements once confirmed.
If your child is at GMFCS level I or II, MACS and CFCS levels can be important. They show the NDIA how cerebral palsy affects hand use and communication even when walking is less affected. They are also useful for planning therapy, equipment and communication supports, and for showing change at a plan reassessment.
Who assigns the levels
Occupational therapists most often assign the MACS level, and speech pathologists the CFCS level, although paediatricians, physiotherapists and rehabilitation teams may record them too. Parents are involved, because the levels are about what the child usually does at home and in the community.
Ask for the level, and for MACS the age of the child when it was assigned, to be written clearly in the report. For NDIS participants, assessments are usually paid from Capacity Building. Occupational therapy and speech pathology both have a 2026/27 price limit of $193.99 an hour in most of Australia.
Tips for families
- Describe what your child usually does, not what they manage on a good day
- Tell the clinician about help you give that others might not see, such as setting up food or finishing sentences
- Ask for all three levels, GMFCS, MACS and CFCS, to be in one report where possible
- Keep copies of reports for access requests, school planning and reassessments