01.30.2025
By uscbknpt
Early Identification and Intervention for Infants Helps Babies with Cerebral Palsy Get Life-Changing Services

A USC-led program has made significant strides in early detection of infants with disabilities over the past two years.
IT CAN SOMETIMES BE HARD TO KNOW what’s normal in a baby — they are squishy, flexible and move in unusual ways. But better training and resources make a difference for babies born with cerebral palsy (CP), the most common physical disability in childhood, affecting approximately 1.6 to 4 per 1,000 children worldwide.
For the past three years, Stacey Dusing, a pediatric physical therapist who leads the USC Motor Development Lab, Christiana Butera, a research assistant professor and first author on a new paper detailing the work, and their colleagues have been hard at work on increasing awareness of the Early Identification and Intervention for Infants (Ei3).
The program, informally known as EI3 ,provides a network of patient care providers and caregivers a framework to identify and intervene as early as possible for infants with early signs of cerebral palsy (CP). A new paper, published in the Journal of Clinical Medicine, outlines the program’s success so far. Providers participated in various trainings offered by EI3: the Sykes Symposium on early detection and intervention (70), neurological exam (HINE) assessment training (211), GMA Basic or Advanced training (46), and an Early Detection Guidelines Implementation Conference (six facilities). HINE training provided by Dusing includes customized information for the implementation of early detection in CA, and participants report an increase in their ability to identify CP, knowledge of early detection, ability to implement early detection guidelines, and confidence in performing the HINE assessment.
In describing their process, the authors also say they hope the paper can serve as a template for other groups hoping to improve early detection in their local communities.
That’s important because detecting cerebral palsy early — at 3-6 months instead of 18 months — can lead to real benefits throughout someone’s life. Neuroplasticity (the brain’s ability to change in response to experience) is higher at younger ages, so interventions can be more effective, leading to better motor skills, cognitive development, and overall quality of life. Currently in California, the average age of CP diagnosis is around 2 and a half years of age, Dusing says, which is “really, really late.”
Some of the challenge comes from the fact that CP in young infants can present in many forms, but Dusing says the specificity of three tests in combination is more than 95 percent — so the likelihood of over- or under-diagnosing children is pretty low. And even if some do not have CP, they may still have mild motor delays and subtle issues that are helped by their therapy services.
In the first two years, the network focused on awareness building and capacity building for the early detection guidelines in Los Angeles. to the main goal is to reduce the average age of diagnosis of CP to less than 12 months allowing infants with CP to get CP specific evidence based interventions and access to state programs that require a diagnosis to receive services. Dusing notes that nationally, as well as in California, fewer than half the kids referred to therapy services ever actually receive them, because the system of referrals and providers is so complicated. “The goal with EI3 is that it allows kids to get into the system faster ideally with a single point of entry,” she says.
The program is already making inroads. They have been training providers to use the early detection assessment tools. In October 2024, the state agency California Children’s Services updated its guidelines (numbered letter link here) for the first time in 15 years, specifically identifying that tools included in the early detection guidelines, including the GMA and HINE, can be used to support CCS eligibility determination. “This update was really impactful, because it’ll change how kids are evaluated,” says Butera. “Combined with additional funding and collaborations these change will allow us to extend the EI3 network statewide as a resource for parents and providers.”
The EI3 network is highly interdisciplinary and reflects the ambitions of California to improve early detection. It includes representatives from every corner of the early detection space — including researchers, clinicians and therapists from the private sector as well as the state and county efforts. Two funding proposals have been awarded to expand the important work of Ei3 and we are collaborating in the California Perinatal Quality Care Collaborative (CPQCC) to streamline systems to improve early detection statewide.
—Katharine Gammon