• assessment
• bimanual
• rehabilitation

A severe hand impairment is a strong predictor of restricted participation and decreased quality of life in children with Cerebral Palsy (CP). Despite wide literature about unilateral CP, knowledge of upper limb (UL) function and effective treatment strategies are limited for children with bilateral spastic forms. However, approximately 60-70 % of these children showed UL dysfunction, that could be characterized by varying degrees of motor impairment in both sides of the body, with asymmetric or symmetric involvement, motor planning deficits and/or coordination problems. A literature review was firstly conducted on studies enrolling children with bilateral spastic CP and in which the results of a treatment, focused on upper limb functional improvement and/or on spasticity reduction, were investigated. A wide heterogeneity of rehabilitative strategies emerged, without specificity of treatment application based on upper limb function or on children’s clinical characteristics. Treatment based on top-down approaches showed stronger evidence on ICF body function but above all on activity and participation domain. However, poor evidence on UL dysfunction management is also due to the lack of guidelines on the outcome measures that should be used. Based on this concept, in order to characterize different ULs functional patterns, a multiaxial evaluation tool box based on ICF framework was created and applied on a sample of 18 children with bilateral spastic CP. We found that chosen outcome measures were able to discriminate children with different manual ability (MACS level), but were not influenced by age. However, results showed that different levels of unilateral and bilateral UL motor impairment correlated with different bimanual performance patterns. In particular we found a significantly better bilateral Uls function and an overall greater bimanual performance in children with symmetric bimanual pattern, compared to children with an asymmetric one. Our preliminary results, despite the small study sample, may offer a significant contribution on the UL functional characterization, that could be useful to guide individualized intervention in children with bilateral spastic CP.