In reference to hemiplegic forms of CP, five classes of hand are described in order of increasing severity: integrated, semi-functional, synergic, prisoner, and excluded. For each hand class, kinesiological characteristics, functional use starting from reaching and anticipation, influence of spasticity, perceptive aspects including need for visual supplementation, and finally secondary deformities are described. The role of thumb and forearm supination is particularly investigated. Rationale for therapeutic intervention includes timing related to the possibility to modify the use of the affected hand and organization of compensatory solutions, including subsidiary grasps, functional reeducation from both a motor and sensorial point of view, aimed also at inhibiting (CIMT) or facilitating intervention of unaffected hand, use of drugs, especially botulinum toxin, orthoses and finally functional orthopedic surgery. Particular attention is paid to operating space in which affected hand is used alone or in support of unaffected one (assistive modality), to characteristics of objects used in physiotherapy, possibly proposed in a game mode, to strategies of grasping, transport and release. Finally, the most frequent manipulation modalities found in CP bilateral forms, diplegias, and tetraplegias are presented.