Manual Ability Classification System (MACS)

The ability of children from 4 – 18 years old with cerebral palsy to handle objects in everyday activities can be categorised into 5 levels using the Manual Ability Classification System (MACS).

Knowing a child’s MACS level can help parents, teachers and others to understand situations in which a child is independent and the extent to which they need support or adaptations.

MACS level is determined based on knowledge about the child’s actual performance in daily life. It is not done by conducting a specific assessment, but by asking someone who knows the child and how that child typically performs.

MACS levels

MACS Level I

Objects are handled easily and successfully.


Handles most objects but with some reduced quality and/or speed.


Handles objects with difficulty – the child will need help to prepare and/or modify activities.


Handles a limited selection of easily managed objects and always requires some help from others.

MACS Level V

The child is not able to handle objects or to complete even simple actions with their hands.

See MACS. Manual Ability Classification System website for more information