A randomised controlled trial to evaluate the effect of modified constraint induced movement therapy or conventional occupational therapy following injection of botulinum toxin-A to improve bimanual performance in children with hemiplegic cerebral palsy.

INTERVENTION: Study Group ‐ Upper limb injections of Botulinum toxin‐A & modified Constraint Induced Movement Therapy using a neoprene mitt for 3 hours per day for 2 months. CONDITION: Hemiplegic Cerebral Palsy PRIMARY OUTCOME: Bimanual performance (Assisting Hand Assessment) SECONDARY OUTCOME: Canadian Occupational Performance Measure (COPM) & Goal Attainment Scaling (GAS). Caregiver Assistance Individual Goal Setting Pediatric Evaluation of Disability Index (PEDI) Frequency of Use ‐ Pediatric Motor Activity Log (PMAL). Quality of Movement ‐ Quality of Upper Extremity Skills Test (QUEST). Spasticity ‐ modified Tardieu scale Muscle tone ‐ modified Ashworth scale Passive Range of Movement ‐ Goniometry. INCLUSION CRITERIA: Diagnosis of spastic hemiplegic cerebral palsy; activie movement of the shoulder, elbow, wrist, digits and thumb; able to grasp a 1 inch cube from a table top and release it into a large container; ability to attend to tasks and follow simple one stage commands; moderate levels of muscle tone and spasticity; no fixed contracture in target group of muscles to be injected with Botulinum toxin‐A.