The Manual Ability Classification System (MACS) is a medical classification system used to describe how children aged from 4 to 18 years old with

cerebral palsy Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, spasticity, stiff muscles, Paresis, weak muscles, and tremors. There may b ...

use their hands with objects during

activities of daily living Activities of daily living (ADLs) is a term used in healthcare to refer to an individual's daily self-care activities. Health professionals often use a person's ability or inability to perform ADLs as a measure of their Performance status, functi ...

, with a focus on the use of both hands together. Like the

Gross Motor Function Classification System The Gross Motor Function Classification System or GMFCS is a 5 level clinical classification system that describes the gross motor function of people with cerebral palsy on the basis of self-initiated movement abilities. Particular emphasis in cr ...

(GMFCS), there are five levels - level I being the least impaired, only finding difficulty in tasks needing speed and accuracy, and level V being the most impaired, not being able to handle objects and having severely limited abilities for even simple actions.

Medical use

It is mostly used as a way of describing a sample population and as an

independent variable A variable is considered dependent if it depends on (or is hypothesized to depend on) an independent variable. Dependent variables are studied under the supposition or demand that they depend, by some law or rule (e.g., by a mathematical function ...

. Occasionally it is used as a

dependent variable A variable is considered dependent if it depends on (or is hypothesized to depend on) an independent variable. Dependent variables are studied under the supposition or demand that they depend, by some law or rule (e.g., by a mathematical functio ...

. MACS levels are stable over time and so they can be used as part of a

prognosis Prognosis ( Greek: πρόγνωσις "fore-knowing, foreseeing"; : prognoses) is a medical term for predicting the likelihood or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) ...

for individuals. Although MACS was not designed for adults, it has been used with a good measure of reliability in young adult populations ranging in ages from 18-24. Although it has a good level of reliability when used for children between 2 and 5 years of age, there is less evidence for using it with children younger than 2. Unlike the GMFCS, there are no age bands for the MACS. Assessment is typically done by asking questions of the parent or therapist of the child to see where the child fits. MACS has had some studies demonstrating good to excellent

inter-rater reliability In statistics, inter-rater reliability (also called by various similar names, such as inter-rater agreement, inter-rater concordance, inter-observer reliability, inter-coder reliability, and so on) is the degree of agreement among independent obse ...

. As of 2015, the MACS is used worldwide except in Africa. It is not recommended to use the MACS to detect change.

Development

The widespread adoption of the GMFCS inspired the development of the MACS.

Alternatives

Alternative classification systems used for children with CP include: ABILHAND, AHA, CHEQ, CPQOL, House, MUUL, PedsQLCP, and SHUEE.

Mini-MACS

A version of the test for children under the age of four years old, the Mini-MACS, was developed in 2016. It has similar tiers to the MACS, with descriptions that are more relevant for the toddler age group, and has good inter-rater reliability.

References

External links