Early intervention in cerebral palsy 1.0-3.0: From passive approaches to precision, context-responsive care

Cerebral palsy (CP) is the most common lifelong physical disability, with substantial global health and socioeconomic burden. Advances in early diagnosis now enable identification in infancy, enabling a critical window for intervention during periods of heightened neuroplasticity. This narrative review synthesises the evolution of early intervention from historical passive, late, and low-dose approaches to contemporary models emphasising early, child-active, task-specific, and contextually embedded care. Early randomised trials demonstrated benefits of active interventions compared with passive care. In contrast, more recent large pragmatic trials show attenuated overall between-group differences, with effects emerging primarily in subgroups defined by age, severity, and context. Evidence certainty is low to moderate, with the most consistent improvements observed in upper limb function in unilateral CP. Collectively, findings indicate that early intervention is effective, but not uniformly so, and that outcomes depend on the interaction between the individual, intervention, and environment. Early diagnostic and intervention pathways also provide earlier certainty regarding neurodevelopmental trajectory and enable timely identification of infants with treatable genetic conditions. The field is transitioning toward a precision medicine early intervention model focused on optimising who, when, how much, and where to intervene, reflecting a shift toward a precision early intervention model.