What is MACS?
The Manual Ability Classification System (MACS) is a five-level classification system that describes how children and youth with cerebral palsy (CP) use their hands to handle objects during everyday activities.
MACS focuses on a child’s usual performance in daily life rather than their maximum capability. It reflects how children typically manage objects at home, at school, and in the community during activities such as dressing, eating, writing, playing, and when participating in leisure time.
Manual ability is influenced by many factors, including motor skills, sensation, cognition, vision, posture, motivation, and the environment. MACS does not evaluate these underlying factors individually. Instead, it provides a practical description of how effectively children use one or both hands to perform meaningful everyday tasks. For example, some things that the MACS will assess includes the quality of movement and the level of assistance required.
Global use and translations
Since its development in 2002, MACS has been adopted worldwide and translated into more than 25 languages. Official translations are available in languages including French, Spanish, German, Greek, Japanese, Korean, Serbian, Turkish, and Traditional Chinese, helping ensure consistent use of MACS across clinical practice, research, and education internationally.
Why should you use MACS?
Hand use plays a central role in children’s participation. The ability to handle objects affects success in school activities, play, and social participation. MACS was developed to provide a standardized, reliable, and meaningful way to classify manual ability.
Inspired by the Gross Motor Function Classification System (GMFCS), MACS offers a framework that focuses specifically on hand function. Gross motor function and manual ability do not always develop in the same way, making a separate classification system essential.
How do you use MACS?
MACS is a classification system, not a test. Determining a child’s MACS level should be based on their typical performance in everyday situations rather than direct assessment of their best abilities.
The most accurate classification is obtained by consulting people who know the child well, such as:
- Parents and caregivers
- Teachers and educational assistants
- Therapists
- The child or youth themselves, when appropriate
Questions should focus on how the child usually handles objects during meaningful daily activities, including:
- Play and leisure
- Eating
- Dressing
- School tasks
- Community participation
When assigning a MACS level, consider the child’s performance relative to what is typical for their age. Expectations for object handling and independence naturally change from early childhood through adolescence.
Who is MACS for?
MACS is intended for children and youth with CP between 4 and 18 years of age.
Because children’s abilities and daily activities change with age, the interpretation of each level should always take developmental expectations into account.
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What is Mini-MACS?
Mini-MACS is an adaptation of the Manual Ability Classification System (MACS). It is designed for children with CP aged 1 to 4 years. Mini-MACS provides an early, practical description of how very young children use their hands in everyday situations. It retains the same five-level classification structure as MACS, however, the descriptions are modified to be more appropriate for young children.
Why should you use Mini-MACS?
Families and clinicians need meaningful ways to describe a child’s functional abilities. Mini-MACS provides a clear and standardized way to describe manual ability for young children. This classification can support communication between families and healthcare professionals, guide goal setting, and intervention planning.
How do you use Mini-MACS?
The Mini-MACS is used in the same manner as the MACS, with the context of a child aged 1-4 years old.
The most accurate classification is obtained by consulting people who know the child well, such as:
- Parents and caregivers
- Childcare providers
- Therapists
Classification should be based on the child’s typical performance during activities such as:
- Playing with toys
- Eating and self-feeding
- Drawing and early learning activities
- Participating in routines at home, childcare, or preschool
Who is Mini-MACS for?
Mini-MACS is intended for children with CP or early signs of CP between 1 and 4 years of age. Mini-MACS is particularly valuable during the early years, when a formal diagnosis of CP may still be evolving but there is a need to understand and describe the child’s functional abilities.