In 2002, Beckung and Hagberg introduced the Bimanual Fine Motor Function (BFMF) classification system. However, the initial version struggled to clearly distinguish between its five defined levels. Despite this, the BFMF system aimed to align with the Gross Motor Function Classification System (GMFCS) levels. Since its introduction, the BFMF system has been widely utilized in the Surveillance of Cerebral Palsy in Europe (SCPE) registry and various epidemiological studies

Beckung and Hagberg developed the Bimanual Fine Motor Function (BFMF) classification system in 2002. Although the initial version had limitations in clearly differentiating between its five levels, it aimed to align with the Gross Motor Function Classification System (GMFCS). Since then, the BFMF system has been widely used in the Surveillance of Cerebral Palsy in Europe (SCPE) registry and various epidemiological studies. The BFMF is a five-level ordinal scale, ranging from Level I (best performance) to Level V (most limited function), designed to assess the ability of children with cerebral palsy to use both hands together to handle objects. Evaluation is based on observation of bimanual performance and parental reports of usual performance. This study consists of two parts: a pilot study for physiotherapists, with defined inclusion and exclusion criteria, and a main study involving cerebral palsy patients, using a finalized Urdu version of the questionnaire to collect data.

Inclusion Criteria:

• Age: 8-15 years
• Gender: Both male and female patients
• Type of CP: Diplegic, athetoid, ataxic, and spastic forms
• Gross Motor Function Classification System (GMFCS) level: 2 or 3

Exclusion Criteria:

• - Orthopedic conditions such as fractures or rickets
• Systemic disorders, including inflammatory diseases and autoimmune conditions
• Psychological and behavioral issues.

the study focuses on school-aged children with various types of Cerebral Palsy, with moderate to severe gross motor impairments, as classified by the GMFCS system. The study does not include children who have musculoskeletal problems, chronic health conditions, or mental health concerns that may impact their ability to participate or affect the study's outcomes.