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

Published online by Cambridge University Press:  19 June 2006

Ann-Christin Eliasson
Affiliation:
Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden.
Lena Krumlinde-Sundholm
Affiliation:
Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden.
Birgit Rösblad
Affiliation:
Department of Community Medicine and Rehabilitation, University of Umeå, Umeå, Sweden.
Eva Beckung
Affiliation:
Queen Silvia Children's Hospital, Göteborg, Sweden.
Marianne Arner
Affiliation:
Hand Unit, Department of Orthopaedics, Lund University Hospital, Lund, Sweden.
Ann-Marie Öhrvall
Affiliation:
Department of Habilitation, Stockholm County Council, Stockholm, Sweden.
Peter Rosenbaum
Affiliation:
CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.
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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.

Type
Original Articles
Copyright
2006 Mac Keith Press

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