The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability

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.

Development of The Viking Speech Scale to classify the speech of children with cerebral palsy

“…The scale incorporates the presence of a motor speech disorder and the severity of limitations in speech performance in everyday life. The process of developing the scale was similar to that of other classification scales (Eliasson et al, 2006) and took as its starting point the description of the speech of children with cerebral palsy with whom we worked who had different types of motor disorders and severities of dysarthria. Multidisciplinary experts (parents, speech and language therapists, occupational therapists, physiotherapists and paediatricians) were involved in developing the scale, and agreed on the description of speech at each level and the differentiation between levels, thereby ensuring face validity.…”

“…Unlike other classification systems (Beckung & Hagberg, 2002;Eliasson et al, 2006;Hidecker et al, 2011;Palisano et al, 1997), the Viking Speech Scale contains four levels. The scale's levels were determined by the need to create meaningful categories for epidemiological surveillance.…”

“…Extensive, clinical assessments are rarely practicable for surveillance purposes because of the time taken for completion and variation in personnel reporting data. Easy to use scales have been developed to describe the gross motor performance (Palisano et al, 1997) and manual performance (Beckung & Hagberg, 2002;Eliasson et al, 2006) of children with cerebral palsy and are now used across surveillance registers rather than detailed clinical assessments such as the Gross Motor Function Measure (Russell et al, 1993) or the ABILHAND-Kids (Arnould, Penta, Renders, & Thonnard, 2004). The use of common, consistent measures by registers has enabled the comparison of prevalence rates by severity of impairment across time and regions (Arneson et al, 2009;Platt et al, 2007;SCPE, 2002).…”

“…Following usual practice in SCPE surveillance, IQ was classified by paediatricians from clinical observations and medical notes using a three point scale: 41 (29.54%) children were classified as having an IQ of less than 50; 25 (18.0%) had IQ 50-69; 56 (40.3%) had IQ above 70 and the IQ of 17 (12.25%) was unknown. Gross motor function was classified using the Gross Motor Function Classification System (GMFCS) (Palisano et al, 1997), upper limb function was classified using the Manual Ability Classification System (MACS) (Eliasson et al, 2006) and the Bimanual Fine Motor Function scale (BFMF) (Beckung & Hagberg, 2002) (Table 1). Vision was classified using a three point scale: 67 (48.2%) had no visual impairment; 52 (37.4%) had impairment but not severe; 16 (11.5%) had severe impairment and the visual function of four (2.9%) children was unknown.…”

Higher Expression of Myosin Heavy Chain IIx in Wrist Flexors in Cerebral Palsy

“…Gross motor function (ambulation ability) was assessed according to the Gross Motor Function Classification System (GMFCS), where GMFCS I refers to independent ambulation without limitations and GMFCS V refers to when a child cannot drive an electric wheelchair by him/herself but has to be driven by someone else [17]. The Manual Ability Classification System (MACS) classifies the child's ability to handle objects in daily life, where a child in MACS I handles objects easily and successfully, while a child in MACS V does not handle objects and has severely limited ability to perform even limited actions [2]. The maximal passive extension of the wrist was measured with flexed fingers.…”