Gross Motor Function
Classification System

Not all cases and symptoms of cerebral palsy are the same. Each child diagnosed with this neurological condition will experience varying levels of impairment to their muscle control, communication abilities, and cognitive functioning.

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Some children with cerebral palsy will be able to walk and talk on their own with limited assistance. Others may need to rely on assistive devices and equipment such as wheelchairs, walking sticks, hearing aids, or augmentative communication devices.

The level of assistance a child needs will depend on the type and classification of cerebral palsy they are diagnosed with and the severity of their subsequent symptoms. Different tools like the Gross Motor Function Classification System (GMFCS) can help healthcare providers to properly assess and predict the level of assistance a child may need throughout their life.

These tools can help medical professionals and families prepare and plan for the child’s success by outlining the level of treatment they are expected to need to live a fulfilling life. Both parents and medical professionals can use the GMFCS as a benchmark to understand the type of treatment a child might need for their cerebral palsy symptoms and when to identify that they may need more help than they are currently receiving.

Over the past three decades, the nationally recognized team of birth injury attorneys at Miller Weisbrod Olesky have established a proven track record of delivering justice for children and families who have unfairly suffered from the consequences of birth injury negligence. Our firm is staffed with registered nurses and nurse attorneys to begin assisting your child with their treatment and therapy immediately.

We are prepared to meticulously investigate the circumstances of your case, gather crucial medical records, consult with top medical experts, and fight tirelessly to secure the compensation you deserve for your child’s injury, all at no upfront cost to you.

We represent families and their children in numerous service areas throughout the United States. You can contact us today to schedule your free legal consultation by calling our toll-free line at (888) 987-0005 or by filling out our online request form. We work on a contingency fee basis, meaning you won’t pay any legal fees unless we win your case. We only receive payment once you do.

The Gross Motor Function Classification System (GMFCS) was created originally in 1997 by a group of professors from Drexel University and McMaster University. It has been revised and expanded multiple times, most notably in 2007 when it was updated to include testing for children in the 12-18 age bracket.

“Gross motor function” refers to one’s ability to use large muscle groups together to perform movements like standing, walking, running, or bending over.

This is opposed to fine motor function, which involves engaging the smaller muscles for more precise movements like writing, playing an instrument, or brushing your teeth.

The current GMFCS can be used to assess children within five different age groups:

• Children ages 0 to 2 years
• Children ages 2 to 4 years
• Children ages 4 to 6 years
• Children ages 6 to 12 years
• Children ages 12 to 18 years (most recent addition)

For each age group, the expectations and criteria for classifying will of course be different. The questions typically align with the expected developmental milestones for the child’s age, with a focus on their physical performance in common settings like at home, at school, or within the community.

The GMFCS has five levels that increase in severity. A child who is classified as Level I is said to have functional gross motor skills with little to no assistance required to complete everyday tasks. A child who matches the description of a Level V on the GMFCS has limitations that impair nearly all motor function and will rely heavily on assistive devices and equipment.

The following levels and specifications for being classified in each level are as follows:

A level I child has functional gross motor skills with very few limitations. They are able to move around without requiring adaptive equipment. While they may still face challenges for some movements, any struggles they have with speed, coordination, or balance is very limited.

• Children ages 0 to 2 years: Can move in and out of sitting positions, can crawl, can pull themselves up, can walk without assistance (by age 2).
• Children ages 2 to 4 years: Can play with toys, can stand up and move with limited to no assistance.
• Children ages 4 to 6 years: Can get in and out of chairs, can walk indoors and outdoors, can climb stairs, able to run and jump in a somewhat limited capacity.
• Children ages 6 to 12 years: Can walk in all environments including inside, outdoors and in school, can run and jump at limited capacity, may participate in physical activities under supervised conditions.
• Children ages 12 to 18 years: Can walk in all environments including inside, outdoors and in school, can run and jump at limited capacity, may participate in physical activities under supervised conditions.

A child at level II on the GMFCS still has a fair amount of control over their motor function. They are usually able to walk independently, though they may need assistance at times when traversing over rough or uneven terrain.

• Children ages 0 to 2 years: Can sit on the floor, can crawl using their hands and knees, may be able to “toddle” (take short unsteady steps, usually while holding onto something).
• Children ages 2 to 4 years: Prefers crawling but can stand and walk with minimal struggle, moves holding onto furniture or handrails.
• Children ages 4 to 6 years: Can use hands to move objects, can climb stairs using a railing, may require some help with balance when moving.
• Children ages 6 to 12 years: Can walk in most settings, may require minimal assistance to walk outside or to participate in physical activities.
• Children ages 12 to 18 years: Can walk in most settings, may use hand-held devices in busier environments like work or school, may require minimal assistance to walk outside or to participate in physical activities.

At level III on the GMFCS, a child will likely require at least some use of assistive devices or equipment to walk. This usually comes in the form of hand-held equipment like crutches or walking sticks. They are typically able to move around without using wheelchairs, however they may need one for travelling long distances like at an airport or an amusement park.

• Children ages 0 to 2 years: Can sit upright on the floor with support, can roll and crawl.
• Children ages 2 to 4 years: Still crawls as primary mode of mobility, can walk short distances with hand-held mobility devices, requires assistance for turning and traversing uneven terrain.
• Children ages 4 to 6 years: Can move in and out of chairs using surfaces for support, can walk using hand-held devices, requires help from others for climbing stairs or travelling long distances.
• Children ages 6 to 12 years: Can walk using hand-held devices indoors for short distances, requires supervision for outdoor movement or to traverse stairs.
• Children ages 12 to 18 years: Can walk using hand-held devices indoors for short distances, requires assistance for transfers from wheelchair or when traversing stairs, will require adaptive equipment to participate in physical activities.

Children at a level IV on the GMFCS are only self-mobile with significant limitations. Most will use powered wheelchairs to get around and will require assistance.

• Children ages 0 to 2 years: Can move their head, can roll onto their stomach, requires assistance to sit upright or stand.
• Children ages 2 to 4 years: Can roll or crawl for self-mobility purposes only, can floor sit for short periods but falls over without support, requires assistance to move.
• Children ages 4 to 6 years: Requires adaptive seating such as a wheelchair, can use a walker with additional assistance to travel short distances, has potential to be self-mobile with a powered wheelchair.
• Children ages 6 to 12 years: Requires assistance to move around most areas, uses a wheelchair in social settings like school, may be able to use a walker or crawl when at home.
• Children ages 12 to 18 years: Requires one or two people to assist with transfers from wheelchair, capable of operating a powered wheelchair but will require assistance, unlikely to participate in physical activities.

Children who fall under level V on the GMFCS are the most dependent on assistive devices. They will have little to no control over their motor function and will likely require more than one devices for both movement and for communication.

• Children ages 0 to 2 years: Unable to control head or trunk movement, requires assistance to roll over or change positions.
• Children ages 2 to 4 years: All motor function is limited, unable to stand or move independently without assistance from caretakers or devices.
• Children ages 4 to 6 years: Cannot sit, stand, nor move independently, unable to maintain an upright position of the body without assistance.
• Children ages 6 to 12 years: Transported using a manual wheelchair, uses assistive technology in all aspects of movement including head alignment, standing, sitting, and travelling.
• Children ages 12 to 18 years: Uses a wheelchair in all settings, requires equipment to support head alignment, seating, and standing.

Using the Gross Motor Function Classification System can help healthcare providers to fully analyze the scope of a child’s impairments and identify their specific needs in relation to the severity of their cerebral palsy symptoms.

Treatment for cerebral palsy will typically consist of varying levels of physical therapy, occupational therapy, and speech therapy. When a child’s limitations are examined before these treatments begin, it can give specialists a stronger idea of where to start with treatment and what exercises to begin with.

Identifying a child’s strengths and restrictions with the GMFCS can also provide insight into how soon they may need assistive equipment like wheelchairs and communication devices. Children whose motor skill limitations fall into levels IV and V may be eligible for wheelchair assistance sooner than others with less severe types of cerebral palsy.

Using the GMFCS can also help healthcare providers to identify which children may need more intense treatment for their symptoms. Different medical procedures like hip muscle release surgery or a selective dorsal rhizotomy (SDR) have been proven to relieve issues with muscle tightness and spasticity.

It’s important to note that the Gross Motor Function Classification System was not created to track a child’s change or progress with their symptoms as they get older.

Instead, the GMFCS should be utilized to describe a child’s functional status, to facilitate communication between families and medical providers, to determine how regularly they should be monitored for potential complications, and to identify which equipment and intervention models will best suit their unique needs.

A child diagnosed with cerebral palsy will likely face several different physical challenges and disabilities throughout their life. The level of assistance they will require, however, is unique to their own personal symptoms and capabilities.

When birth injury negligence is to blame for causing these injuries, it counts as medical malpractice. Many different medical errors can contribute to a brain injury at birth that will lead to a cerebral palsy diagnosis later in life. These mistakes can include missing pregnancy complications, failing to properly monitor fetal heart rates, or needlessly delaying a C-section delivery past the point of safety.

If a family believes that a child’s current condition was either caused or worsened by preventable errors, legal support may be an option. A medical malpractice attorney specializing in birth injury can review the medical records and circumstances to assess whether a viable claim for medical malpractice exists.

Sometimes families are hesitant to reach out to a medical malpractice attorney or law firm. They may feel overwhelmed by their circumstances or are worried that a law firm will not be able to help them. But the only way to find out if you have a case is to talk to an attorney who understands how birth injuries can lead to developmental delays and other birth complications that require long-lasting medical support.

A statute of limitations (SOL) is a law that sets a time limit on how long an injured person has to file a lawsuit after an accident. It is essential to understand that statutes of limitations vary based on the type of case and the state where it is filed. For instance, the deadline for birth injury claims is typically different from other claims, such as injury to personal property, fraud, contract disputes, and collection of debts.

Generally, the clock starts ticking on the date the injury occurred. However, there are exceptions to this rule, and in some cases, the statute of limitations starts when a person discovers or reasonably should have discovered an injury. When dealing with government agencies, SOLs can become even more complex.

For example, if the party that injured you was:

• A federal employee
• Employed by a military hospital, Veterans Administration facility, or a federally funded medical entity

You may need to file a birth injury claim under the Federal Tort Claims Act (FTCA). In FTCA cases, claimants must go through certain administrative procedures before filing a lawsuit. In some states, if the negligent party was a local or state government hospital or the doctors and medical providers are employees of a governmental entity, the time period in which you must give "notice" may be shorter.

If your case is filed outside of the statute of limitations, it will typically be dismissed, and you will not be eligible to recover compensation for your injuries. Determining when a statute of limitations begins on your case can be tricky. If you're considering pursuing compensation for a birth injury, contacting an attorney as soon as possible is in your best interest.

It takes a detailed expert review of the facts and circumstances of your child's birth and the care they received in the years following to determine whether medical malpractice contributed to their cerebral palsy symptoms. Our firm wants to help you find those answers.

Our Process

At Miller Weisbrod Olesky, a team of committed birth injury attorneys, nurses and paraprofessionals uses our detailed medical negligence case review process to assess your potential birth injury case. We start by learning more about you and your child and the status of meeting/missing developmental milestones. We will also assess their level of care since receiving a cerebral palsy diagnosis and classification on the GMFCS scale.

Then we gather medical records to determine if at any point there was a misrepresentation of the child’s capabilities. We call in skilled medical experts who review your records and let us know if they think medical errors could have occurred.

If we feel medical negligence caused or contributed to your child’s condition, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors.

At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment once you do. The sooner you reach out to us, the sooner we can begin investigating your case and gathering the evidence needed to support your claim.

We work on a contingency fee basis, meaning you won't pay any legal fees unless we win your case. Contact us today to schedule your free legal consultation by calling our toll-free line at (888) 987-0005 or by filling out our online request form.