The goal of this quasi-experimental study is to investigate and compare the effects of horizontal and vertical upper extremity performance on hand skills and trunk control in children with bilateral spastic cerebral palsy; could include any of the following: both gender, age ranged from 5 years to 8 years. The main question it aims to answer [is/are]:

There will be no significant difference effect between horizontal and vertical upper extremity performance on hand skills and trunk control in children with bilateral spastic cerebral palsy.

This study aims to investigate the effects of to investigate and compare the effects of horizontal and vertical upper extremity performance on hand skills and trunk control in children with bilateral spastic cerebral palsy. The research will evaluate fine motor proficiency, upper extremity function and trunk stability from sitting through a controlled and structured intervention program.

Participants will undergo designed Occupational Therapy program will be applied for 90 minutes, three days per week for successive three months for the both groups by the researcher The study adopts a quasi-experimental design, with thirty participants allocated into two groups of an equal number, twenty children for each group. Two group will be identified as group (A) and group (B).

Data will be analyzed using paired t-test will be used for within group comparison before and after the intervention, for each variable and independent t-test was used to compare the demographic data and the baseline characteristics of both groups for all measured variables, pre and post treatments, with a significance level set at p < 0.05.

Inclusion Criteria:

• Children with BSCP, their chronological age will be ranged from 5 years to 8 years.
• Their level of motor function will be I or II according to Gross Motor Function Classification System - Expanded and Revised.
• The degree of spasticity for these children will ranged from grade 1 to 1⁺ according to Modified Ashworth Scale.
• Their level of fine motor function will be I or II according to The Bimanual Fine Motor Function.
• All children's level of segmental trunk control will be level 7 (full trunk control) according to Segmental Assessment of Trunk Control.
• They will be able to follow instructions during evaluation and treatment.

Exclusion Criteria:

• Surgical interference in upper limbs and/or spine that may restrain the child performance during activities.
• Orthopedic problems or fixed deformities in the vertebral column and/or upper extremities.
• Uncontrolled seizures.
• Visual or hearing impairment.
• Receiving special medication affecting muscle and /or mental function.