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Objective: To compare the effectiveness of Task-Oriented Arm Strength training in children with Cerebral Palsy (TOAST-CP), using Progressive Resistance Exercise principles with manual skill learning in improving the performance of manual daily activities in children with spastic Cerebral Palsy.

Methods/Design: This multicenter randomized controlled trial investigates the effectiveness of TOAST-CP in children with spastic Cerebral Palsy, involving 50 participants aged 8-18 years. Participants are recruited from rehabilitation centers. Eligible participants are randomly allocated to either TOAST-CP or usual care related to manual skill learning.

Intervention: The participants of the intervention group performed a TOAST-CP program, based on individual goals and guided by a progressive resistance exercise algorithm. The control group receives the usual care related to the manual skill learning program. TOAST-CP consists of an individual-based 30-minute session, three times a week over 16 weeks. A specific exercise program is developed.

Outcome: Outcome is measured at baseline at eight weeks, 16 weeks (end of training), three, and six months after training.

As a primary outcome, the Assisting Hand Assessment is used. Secondary outcomes are task-oriented strength measures and muscle strength measures of the upper limb. The Observation and Scoring of Arm Hand Skills  (performance and amount of use of both hands), the ABILHAND (-Kids), and the Jebsen Taylor Hand Function test (speed of hand use) are measured.  The most important needs and goals for the child and his/her parents are scored by Canadian Occupational Performance Measure and Goal Attainment Scaling.