Early Detection and LEAP‑CP: Shifting Cerebral Palsy Care into the First Year

At the recent EACD and IAACD 2025 Congress, the message was loud and clear: early detection and early intervention are no longer optional, they are essential.

In session after session, researchers, clinicians, and community leaders pushed for screening before one year and for therapy that begins in the home.

Here’s why that matters, and what’s working in real-world low-resource settings.

Predicting CP Early with HINE and General Movements

The Hammersmith Infant Neurological Examination (HINE) and General Movements Assessment (GMA) can flag cerebral palsy risk within the first few months of life.

GMA evaluates spontaneous movement in infants, and the absence of "fidgety movements" around 12–16 weeks is a strong predictor.

HINE, used between 12 and 40 weeks, offers a simple neurological assessment linked to future function.

In this trial in West Bengal, India, researchers used both HINE and GMA to identify infants at high risk of CP. These babies then received an intervention called LEAP‑CP, showing strong outcomes in mobility, cognition, and maternal wellbeing by 18 months.

What LEAP‑CP Actually Does

LEAP‑CP (Learning through Everyday Activities with Parents) is a home-based, peer-delivered intervention for infants at risk of CP.

It focuses on play-based motor goals, cognitive learning, visual engagement, and carer mental health.

Around 15–30 home visits are delivered by trained community peers, not specialists.

Sessions are designed to work around daily routines and use items already in the home.

The LEAP-CP India study found statistically significant improvements in Peabody Motor scores (PDMS-2), cognitive goal achievement, and reduced stress for mothers. This model makes therapy accessible, frequent, and meaningful.

First Nations Adaptation: LEAP‑CP in Australia

In Australia, the LEAP‑CP Indigenous project adapted the program for Aboriginal and Torres Strait Islander communities, who face up to 50% higher CP rates and severe gaps in service access.

Cultural advisors shaped content and delivery to respect language, values, and beliefs.

First Nations Health Workers were trained to conduct screening (HINE, GMA) and deliver LEAP-CP over 30 visits.

The model prioritised trust, flexibility, and family partnership.

This culturally responsive delivery increased access to early rehab for babies who might otherwise miss the neuroplasticity window.

What We Heard at the Congress

At EACD–IAACD, many presenters backed early motor assessments:

HINE, GMA, and the Gross Motor Function Classification System (GMFCS) were widely used in real-world trials.

Gross Motor Function Measure (GMFM) was the tool of choice for tracking functional gains over time.

Researchers pushed for early detection and therapy before 12 months, especially in underserved areas.

The goal? To act during peak neuroplasticity and give infants the best start possible.

What You Can Do Now

1. Train frontline staff in early screening using HINE and GMA.

2. Adapt LEAP‑CP or similar models to your cultural or geographic setting.

3. Work with peer trainers or community workers, not just health professionals.

4. Track outcomes using tools like GMFM, PDMS-2, and parent reports.

5. Start before diagnosis. Do not wait until two years.

Why This Matters

Too often, children with CP are diagnosed late, missing a crucial window for intervention. LEAP‑CP, HINE, and GMA together offer a pathway for early action, even in rural, Indigenous, or low-resource communities.

These models are proven, accessible, and ready to be used, not just researched.

Could you bring LEAP‑CP or early screening into your own setting? The evidence is there. The tools are ready. The time to act is early.

Let’s not wait to move. Let’s move early, where it matters most.

Rehabilitation is now essential care. What does that mean for disability support?

In May 2024, the World Health Assembly passed a resolution that puts rehabilitation services into the heart of public healthcare. It is the first time rehab has been officially recognised as essential, not optional.

What actually changed

Many governments have treated rehab like a specialist service, only for hospitals or high income areas.

Now they are being asked to include it in primary care.

That includes:

• occupational therapy, physiotherapy, speech support

• psychological care and counselling

• mobility and assistive devices

• basic rehab services that reach schools, clinics, and homes

What this solves

In most countries, more than half of the people who need rehab never get it.

That means:

• children not walking to school

• adults unable to return to work

• carers burning out with no support

• rehab equipment arriving late, broken, or never

The longer rehab is delayed, the more costly it becomes. Families pay. Governments pay. People lose time and independence.

What this means for everyday work

This resolution makes room for:

• new jobs in occupational therapy and physio

• better funding for community programs

• local production and supply of assistive tech

• rehab support written into health insurance and public services

It also means frontline workers can now point to a global agreement when advocating for services.

What to do now

This matters if you are a therapist, a parent, a carer or a teacher.

Use this resolution to:

• start a training program

• ask for rehab services at your local clinic

• build partnerships between rehab workers and other health teams

• show decision makers what real access looks like

Why it matters

Rehab is not a luxury. It is what gets people out of bed, back to school, back to work. It is what helps people live life on their own terms.

If we say we believe in inclusion, then rehab needs to be part of the plan.

This resolution gives you the backup to push forward.

So ask yourself:

What does essential rehab look like where you live? What would it take to make that happen?

It starts small. One clinic. One worker. One community.

Now we have policy on our side. Let’s build from there.

Sacks of Rice and Other Sensory Miracles: Rethinking Sensory Processing in Low-Resource Settings in India

If you’ve ever sat in a room with a child who can’t sit still, who’s chewing on the collar of their t-shirt like it’s a three-course meal, or who bursts into tears at the sound of a flushing toilet, then you’ve already met sensory processing in the raw. No clinics. No fancy swings. Just you, a child, and the full orchestra of the senses playing wildly out of tune.

Years ago, I spent just two weeks in the misty hills of Mussoorie. That’s where I met Ravi, a boy who would sprint barefoot through narrow paths, his arms wide open, always seeking hugs, not just out of affection, but out of a deep need for pressure. He was unknowingly chasing proprioceptive input, the kind that helps us know where our body is in space. It was instinctual, not clinical.

I never got to see Ravi again after those two weeks. But I’ve never forgotten him, or his mother. She came from a poor family, was raising him alone after her husband left, and had been quietly ostracised by many in her community. Some whispered about her son’s behaviour. Others pulled their children away when Ravi ran up to greet them with those strong, unexpected hugs.

But his mother was extraordinary. After learning a bit about sensory processing difficulties through a visiting educator, she started noticing what helped. She created small adaptations: folding quilts in layers, placing weighted sacks near him during study time, and teaching him to carry water pots to get the deep pressure his body craved.

It helped. It wasn’t a golden bullet. But it gave him another way to manage, so he wasn’t always chasing hugs from people who weren’t ready for it. It gave his mother dignity, and it gave Ravi more connection with his world.

The Sensory Landscape: What We’re Dealing With

For those new to the term, Sensory Processing is how our brains interpret and respond to the information coming in from our environment. For some kids (and adults), this process gets scrambled, exaggerated, or dulled. The result? Meltdowns, withdrawal, hyperactivity, confusion, and often, misdiagnosis.

In high-income countries, therapists have entire rooms dedicated to sensory integration—swings that spin, ball pits, weighted blankets, vibrating cushions. But what happens when your therapy room is a verandah, a corridor, or a plastic mat under a tree?

You adapt. You get creative. You listen deeply.

Sensory Is Never Just About Sensory

Here’s something we forget too easily: sensory is never the goal.

You don’t just do sensory activities for the sake of doing them. It’s always about function, about helping someone brush their teeth without gagging, sit through a lesson, participate in prayer time, eat a meal with the family, or simply sleep through the night.

A clinic might offer powerful sensory input, swings, squeezes, vibrations, but it’s a moment. Useful, yes. Therapeutic, even. But that 45-minute session doesn’t last 24 hours. Clinics are best thought of like gyms. Gyms are great places to build strength, learn technique, and get support, but we don’t live in gyms. Real life happens elsewhere.

So, the sensory activities we design, whether in a clinic or under a mango tree, must always translate into daily routines. That’s where growth happens. That’s where skills stick.

If a child learns to self-regulate using a body sock in the clinic, can they do the same by rolling in a heavy quilt at home? If a student calms by swinging in therapy, can they replicate that with a hammock or even rhythmic sweeping in their courtyard? These are the questions that matter.

Creative Solutions Born from Scarcity

Take rice, for example.

A mother in the hills noticed her son calmed instantly when he sat on her lap while she sorted lentils. She began tying rice into old saree scraps and tucking them into a pillowcase. It became a weighted lap pad of sorts. When the child needed to focus, she’d place it over his legs without a word. No label. No explanation. Just a natural adaptation.

In a nearby school, teachers hung an old dhoti between two wooden posts to make a hammock. The children took turns gently rocking in it a brilliant way to support their vestibular system and calm their bodies after noisy, busy days.

And for tactile play? A steel thali filled with grains, dried flowers, or mustard seeds became a sensory bin. Hidden beads or pebbles made the hunt fun and focused. No purchases. Just play.

But again, none of this happens in isolation. These sensory tools supported real goals, better concentration, easier mornings, calmer transitions. Not just input for input’s sake.

The Importance of Context

In many places, the term "sensory processing" doesn’t translate easily, linguistically or culturally. Teachers might describe a child as disobedient or hyper. Parents might say their child is "naughty" or "not listening." The trick is to start where people already are. Every culture understands comfort. Every parent has seen their child overwhelmed. We don’t need technical jargon to begin the conversation.

We’d often begin by asking adults what they did when they felt overwhelmed. Drink chai? Lie down in a quiet corner? Walk barefoot on cold stone? That’s sensory regulation. Everyone does it. Some kids just need more help finding the right match for their nervous system.

What Works (Even Without a Budget)

Heavy work: Carrying water pots, kneading dough, sweeping courtyards. These offer strong proprioceptive input and are woven into daily life.

Oral input: Chewing roasted chana, sucking thick lassi through a straw, or singing bhajans aloud can regulate the oral sensory system.

Visual and auditory filtering: Dupattas, curtains, or homemade tents provide a visual break. Cotton in the ears or a quiet box of soft items can soften noise.

Smell and routine: Cloves, tulsi, or eucalyptus oils used in the home can act as calming anchors. The familiar smell of incense or herbal tea becomes a sensory signal for rest or transition.

Don’t Wait for Perfect

One of the biggest barriers in low-resource contexts is the belief that you need special equipment or a formal diagnosis to start sensory supports. You don’t. You need observation, curiosity, and a willingness to adapt.

Start by noticing:

What helps the child calm down?

When are they most dysregulated?

What activities do they naturally gravitate toward?

From there, experiment. And involve the child. Ask them what helps. Let them lead when they can. Children, especially those with disabilities, are often the best co-therapists you’ll ever meet.

Let’s Talk Legacy

These solutions weren’t parachuted in. They were created alongside families and teachers, rooted in rhythm and tradition. The goal was never to mimic Western clinics but to embed sensory understanding into everyday life.

A sensory-informed approach isn’t a therapy session. It’s the way we serve meals, set routines, welcome children into classrooms, and respond when emotions boil over.

It’s about working toward the real goals: eating with dignity, playing with joy, sleeping through the night, engaging in learning, living in community.

Final Thoughts from the Mountain Paths

I remember Ravi that afternoon, dragging an old quilt that had been stitched and restitched until it became a soft, heavy nest. He wrapped himself in it, spun in circles on the stone floor, and then lay down, still and smiling.

Sensory support isn’t a luxury. It’s a need. And in the hills of Mussoorie, with nothing but resourcefulness and heart, they found a way to meet that need, with rice, rhythm, and a focus on real, everyday function.