COSMIN database

Upper limb function and deformity in cerebral palsy: a review of classification systems

McConnell, K., Johnston, L., and Kerr, C.
AIM: To review classification systems for the upper limb in children with cerebral palsy (CP), and evaluate their validity, reliability, and clinical utility to make recommendations for clinical practice and future research.

METHOD: We comprehensively searched electronic databases to identify upper limb classification tools and associated evidence of psychometric testing. Two independent reviewers assessed the quality of the psychometric studies, and rated the clinical utility of each system using previously published tools.

RESULTS: Eighteen classification systems were eligible for inclusion, with two primary functions: classification of function or deformity. Published evidence of psychometric testing was available for fewer than half of the identified systems. Reliability studies were frequently limited by sample size, rater blinding, representativeness, and the number of observers. The Manual Ability Classification System (MACS) demonstrated content validity and interrater reliability. The original and modified House functional, House thumb, swan-neck, and Zancolli systems had evidence of reliability; the modified House functional system also demonstrated criterion-related validity.

INTERPRETATION: This review supports the use of the MACS and modified House functional system to classify upper limb function in children with CP. Similarly, the House thumb and Zancolli systems are recommended to classify thumb, and hand and wrist deformity respectively.
Dev Med Child Neurol
1469-8749 (Electronic)
Publication year:
Biological and physiological variables:
Biological and physiological variables
Functional status:
Physical functioning
Children (0-18)
Congenital malformations, deformations and chromosomal abnormalities and related symptoms
Diseases of and symptoms related to the nervous system
PRO / non-PRO:
Non-patient Reported Outcome
Type of measurement instrument:
4 - Performance-based tests
6 - Clinical rating scales
7 - Observations
BFMF - Bimanual Fine Motor Function
Corry thumb abduction
Corry thumb extension
Forearm deformity classification
Green and Banks functional capacity test
Green and Banks functional rating
House Functional Classification System
House thumb classification
MACS - Manual Ability Classification System
Modified House Functional Classification
Modified house thumb classification
Modified Zancolli classification
Mowery classification
Sakellarides thumb classification
Swan-neck deformity
Swanson classification
Upper limb movement classification
Zancolli Classification