The research design will be a randomized clinical trial. The study will recruit 36 children with spastic cerebral palsy and toe walking that fall within the ages of 5-17 years who have a defined balance deficit. The participants will be randomly assigned to one of two groups: group A (n=18), which will play the Bean Bag Tossing Game on Wedge, and group B (n=18), which will play the Bean Bag Tossing Game on a Balance Board. The intervention will be performed 3 times a week for 4 weeks 30 minutes a day. All participants will be assessed according to eligibility criteria. Guardians of participants who meet the eligibility criteria are requested to sign consent forms before they are entered into the study. The study involves two standardized assessment tools that measure the Gait and balance in children with Down syndrome: Berg Balance Scale and GALLOP Scale. The synopsis will present to the Research Ethical Committee of Riphah International University Lahore for ethical approval to conduct this study. Data will be analyzed by SPSS 27.0 version

Down syndrome is a genetic condition where people are born with an extra chromosome.

Normally people have 23 pairs of chromosomes i.e. 46 chromosomes. People born with Down syndrome have an extra pair of chromosome i.e. 47 chromosomes. Women who are 35 years or older are more likely to have a child born with Down syndrome. To address this problem, the study will examine the effects of "Bean Bag Tossing Game and Balance Board" on Balance and Gait in children with Down syndrome. Children with Down syndrome have low tone i.e. hypotonia and joint laxity due to which they have balance problems which may lead to gait impairments. Bean bag tossing activities involve throwing and catching so it may alter children's balance by increasing coordination, postural awareness, and dynamic stability. Bean bag on the head or other body parts trains children to be aware of their posture and body alignment, which improves balance control. Tossing and collecting bean bags while moving about requires children to dynamically change their balance, which improves their ability to maintain balance while moving.

The research design will be a randomized clinical trial. The study will recruit 36 children with spastic cerebral palsy and toe walking that fall within the ages of 5-17 years who have a defined balance deficit. The participants will be randomly assigned to one of two groups: group A (n=18), which will play the Bean Bag Tossing Game on Wedge, and group B (n=18), which will play the Bean Bag Tossing Game on a Balance Board. The intervention will be performed 3 times a week for 4 weeks 30 minutes a day. All participants will be assessed according to eligibility criteria. Guardians of participants who meet the eligibility criteria are requested to sign consent forms before they are entered into the study. The study involves two standardized assessment tools that measure the Gait and balance in children with Down syndrome: Berg Balance Scale and GALLOP Scale. The synopsis will present to the Research Ethical Committee of Riphah International University Lahore for ethical approval to conduct this study. Data will be analyzed by SPSS 27.0 version.

Inclusion Criteria:

• Ageof7-12years
• Abletorecognize the command given to them
• Understand the verbal command
• Standand walk independently without repeated falling
• Normalvisualization and Audible range

Exclusion Criteria:

• Children suffering from seizures
• Children with Multiple Sclerosis
• Children with Muscular Dystrophy
• Children with cardiac anomalies

Participants will get separate treatment protocol, and possible efforts will be put to mask both groups about the treatment