Level I: Handles objects easily and successfully. At most, limited in the ease of performing manual tasks requiring speed and accuracy. However, any limitations in manual abilities do not restrict independence in daily activities.

Level II: Handles most objects but with somewhat reduced quality or speed of achievement, or both. May avoid or achieve with some difficulty certain activities; might use alternative ways of performance, but manual abilities do not usually restrict independence in daily activities.

Level III: Handles objects with difficulty; needs help to prepare or modify activities, or both. The performance is slow and achieved with limited success regarding quality and quantity. Performs activities independently if they have been set up or adapted.

Level IV: Handles a limited selection of easily managed objects in adapted situations. Performs parts of activities with effort and with limited success. Requires continuous support and assistance or adapted equipment, or both, for even partial achievement of the activity.

Level V: Does not handle objects and has severely limited ability to perform even simple actions. Requires total assistance.

Distinctions between Levels I and II: Children in Level I may have limitations in handling very small, heavy, or fragile objects, which demand detailed fine motor control or efficient coordination between hands. Limitations may also involve performance in new and unfamiliar situations. Children in Level II perform almost the same activities as children in Level I, but the quality of performance is decreased or the performance is slower. Functional differences between hands can limit effectiveness of performance. Children in Level II commonly try to simplify handling of objects, for example, by using a surface for support instead of handling objects with both hands.

Distinctions between Levels II and III: Children in Level II handle most objects, although slowly or with reduced quality of performance. Children in Level III commonly need help to prepare the activity or require that adjustments be made to the environment, or both, since their ability to reach or handle objects is limited. They cannot perform certain activities and their degree of independence is related to the supportiveness of the environmental context.

Distinctions between Levels III and IV: Children in Level III can perform select activities if the situation is pre‐arranged and if they receive supervision and plenty of time. Children in Level IV need continuous help during the activity and can at best participate meaningfully in only parts of an activity.

Distinctions between Levels IV and V: Children in Level IV perform part of an activity with continuous help. Children in Level V might at best participate with a simple movement in special situations, for example, by pushing a button.