Evaluation of Repetitive Transcranial Magnetic Stimulation as an Adjunct to Modified Constraint Induced Movement Therapy in Improving Upper Limb Function in Children With Hemiparetic Cerebral Palsy Aged 5 - 18 Years

Inclusion Criteria: * • Age 5 - 18 years * Hemiparetic Cerebral Palsy (perinatal brain injury) * Intelligence Quotient \>70 (Binet Kamat Test/Malin's Intelligence Scale for Children) * Modified Ashworth scoring 1-3 for affected limb * Can sit independently or with support (GMFCS stage : 1-4 and Manual Ability Classification System stage: 1-3) * Preserved vision and hearing (with or without correction) Exclusion Criteria: * • Uncontrolled epilepsy as defined by seizure frequency \>1/month for preceding 3 months * Severe concurrent illness or disease not associated with CP or unstable medical conditions like pneumonia * Genetic or syndromic associations * Children diagnosed with Autistic Spectrum Disorders * Modified Ashworth Scale Score more than 3 at shoulder/elbow/wrist * Contractures of affected limb * Severe movement disorder like dystonia, choreo-athetosis or ballismus interfering with purposeful limb movement * Any congenital brain malformation detected on conventional MRI brain * Recent surgery/cast/splint in affected limb * Botulinum toxin/phenol block in affected limb in past 6 months or planned to receive in study period * Those receiving tone modifying agents within two weeks before enrolment (Tizanidine, baclofen, benzodiazepines, dantrolene) * mCIMT received in last 6 months * Any contraindications for TMS - implanted electronic device and non-removable metallic objects near coil e.g. Pacemaker, cochlear implant