The Manual Ability Classification System (MACS) is a standardized tool used to classify how children with cerebral palsy (CP), aged 4 to 18 years, use their hands to handle objects in daily activities. It focuses on a child’s typical performance in everyday situations, rather than their maximum capability, and evaluates how well they use both hands together. The system includes a five-level classification system. The levels range from I (handles objects easily and successfully) to V (does not handle objects and has severely limited ability to perform even simple actions) [1].

The Mini-MACS is an adaptation of the original MACS, developed specifically for young children aged 1 to 4 years with cerebral palsy. It uses developmentally appropriate descriptions to classify how infants and toddlers use their hands to explore and manipulate objects during everyday tasks such as playing and feeding. Like MACS, it focuses on usual performance, not maximum ability, and helps guide early intervention planning by describing functional hand use across five levels.

Applications

• Informing clinical care, specifically physiotherapy and rehabilitation
• Tool for CP and other hand movement disorder clinical trials
• Clinical decision-making, treatment planning, outcome measurement, and communication among healthcare providers, researchers, and families

Advantages

• Available in many languages
• Developed collaboratively by therapists and doctors