Established care
Early detection and early intervention
General Movements Assessment, HINE, early MRI, infant-led therapy
The single highest-value thing in this whole field, and the one least often discussed in clinics selling treatment. Cerebral palsy can be identified in the first months of life, and that is when therapy does the most.
Either a medicines regulator has licensed it for this use, or clinical practice guidelines recommend it on the strength of controlled trials. This is the standard everything else on the scale is measured against — and for most children, the treatments at this level are the ones that will actually change their day.
Where it stands, condition by condition
The same therapy can be well supported for one problem and completely untested for another. This is the single most common place families are misled.
| Condition | Evidence | What that means here |
|---|---|---|
| Cerebral palsy — detection before 5 months | Established care | International clinical practice guidance supports combining the General Movements Assessment, a structured neurological examination and MRI to identify or strongly suspect cerebral palsy in early infancy. |
| Cerebral palsy — intervention after early detection | Established care | Guideline-backed. The recommended approach is infant-led, task-specific practice with the family, started as soon as risk is identified rather than waiting for a confirmed diagnosis. |
| Preterm and high-risk infants generally | Established care | Structured developmental follow-up is standard care in most health systems, and is how most early diagnoses are made. |
What it is
Three tools used together: watching the baby's spontaneous movements (the General Movements Assessment), a structured infant neurological examination, and brain imaging. In combination they identify cerebral palsy, or very high risk of it, far earlier than waiting to see whether a child walks.
Early intervention is then not a different therapy — it is the ordinary therapy, started earlier. It is delivered mostly by the family in daily routines, coached by a therapist, with the baby doing the movement rather than being moved.
“Wait and see” was standard practice for decades and is no longer defensible where these tools are available.
How it is meant to work
The infant brain is at its most adaptable in the first year. Motor pathways are being selected and pruned on the basis of what the baby actually does, so practice during this window shapes the wiring that is kept.
Waiting until 18–24 months for a confident diagnosis spends that window. It also leaves the family without support during the period they most need it.
The second reason to detect early has nothing to do with the brain: parents given a name and a plan early do better than parents left with months of unexplained worry.
What has actually been tested
- The accuracy of combined early assessment is the best-established part. Used together, these tools identify infants who will have cerebral palsy with a precision that single examinations do not reach.
- Early, task-specific, family-delivered intervention is recommended in international guidance for infants at high risk, in preference to passive handling-based approaches.
- Evidence for specific early programmes is still developing — the strong recommendation is for early and active, not for one branded protocol over another.
- What has not been shown is that any early programme prevents cerebral palsy. The goal is better function, participation and family coping, not a different diagnosis.
What we still do not know
- How much of the long-term difference is attributable to the therapy itself rather than to earlier support, equipment and family understanding.
- The optimal intensity in infancy — more is not automatically better, and exhausted parents are a real cost.
- How well the detection tools perform outside specialist centres with trained assessors.
Risks and costs
- Early labelling causes anxiety, and a small number of infants identified as high risk will not go on to have cerebral palsy. Good services explain this openly rather than avoiding the conversation.
- Intensity can tip into pressure. A programme that leaves no room for the family to simply be a family is not a good programme.
- The realistic harm in most countries is the opposite one: delay. Months lost to “let's review in six months” cannot be recovered.
Questions to ask before you agree
A centre that is doing good work will welcome these questions and answer them in writing.
- Has my baby had a General Movements Assessment and a structured neurological examination, and by whom?
- If cerebral palsy is suspected, what are we starting now, rather than after a confirmed diagnosis?
- What should I be doing in daily routines, and can you show me rather than describe it?
- Who reviews progress, how often, and what would change the plan?
More in this section
Goal-directed, task-specific training
Not a brand of therapy but the principle underneath the ones that work: the child practises the actual task they are trying to learn, with enough repetition to matter.
Established careConstraint-induced therapy and bimanual training
For a child who uses one hand much more than the other, these are among the best-evidenced interventions in paediatric neurology — and both work, for different things.
Established carePhysiotherapy and strength training
Well supported when it is built around function and genuinely loaded — much weaker when it is passive stretching and generic exercise.
Established careOccupational therapy
The discipline that works on what the child actually does all day — dressing, eating, writing, playing, getting through a school morning.
Established careSpeech, language and communication
For a child who cannot speak clearly, giving them a way to communicate is among the most consequential interventions available — and the fear that it will stop them talking is unfounded.
Established careSpasticity and tone management
Medical and surgical treatment of tone, which works best when it is tied to a functional goal rather than to a number on a tone scale.
In clinical trialsTechnology-assisted rehabilitation
Useful mainly as a way of delivering more practice, not as a treatment in its own right — and that distinction decides whether it is worth the money.
In clinical trialsNamed physiotherapy approaches
Families are usually asked to choose between brands. The evidence says the brand matters far less than whether the session is active, goal-directed and repeated often enough.
In clinical trialsSensory therapies
Two things are sold under one word. Manualised Ayres Sensory Integration has been tested in trials; the sensory add-ons sold around it mostly have not.
Established careVision and cerebral visual impairment
The most commonly missed problem in children with brain injury. A child who cannot interpret what they see is often described as inattentive, uncooperative or more delayed than they are.