Management Protocol: Hand affection in early age is managed by physiotherapy, training in fine motor activity, sensory modulation & brace. Most of the time persistent sensory problem interferes in getting good outcome. Botulinum toxin is required in severe spasticity. But when the deformity becomes fixed, then they need surgical intervention in the form of aponeurotic release of long musculo-tendinous unit. Tendon transfer is used to supplement function of weaker muscle. Common tendon transfer for pronation deformity is rerouting of pronater teres & transfer of Flexor Carpi Ulnaris to Extensor Carpi Radialis Brevis for weak wrist extensor & Flexor Carpi Ulnaris to Extensor digitorum Commines for finger extension. Functional deficit in the hands requires good therapeutic modality including CIMT, Mirror therapy, Fine motor activity and sensory modulation.